Monday, December 22, 2008

What Keeps Me "In Line"

At my last pdoc appointment I (sort of) jokingly told Dr. X that "fear", or fear of punishment ALWAYS works as a motivator for me. It was not a joke. It is true. I always comply when I am afraid: afraid of loss, afraid of judgement, afraid of abandonment, afraid of rejection...all these fears "motivate" me, or as the title says, keep me in line.

I would guess "to keep a person in line" is probably a reference to a army or police type of structure. A structure that has inspection lines, marching lines or serious punishments for breaches of its people getting out of line.

The past few days I have been speaking so much of my own will and my own power to stop my medications and to make the changes I need to make, successfully this time. I was going on about how I can get of the Valium. I am strong enough to do that. It isn't so.

I recognize that my motivation to stop was my perception that Dr. X was disappointed in me. He told me my increasing my Valium dosage was a worrisome pattern. I heard what he was saying loud and clear. I do not want to be a patient who does not comply with the medication regime set out by my pdoc. I want to do what is right. I do not want to be rejected, or to disappoint. Those things compel me to change.

Dr. X has really tried hard to help me use non-punitive means of motivating myself, but fear always works. Wanting to please also is a strong motivator for me. At least as strong as my fear motivation.

Last appointment I told Dr. X I may run out of Valium. He gave me a sheepish look, and I saw that. He wrote me a prescription because we had not decided on my going off Valium until I was off Tegretol and I had increased the dose and was unsure I would have enough until tomorrow. I put the prescription in my wallet and decided only to fill it if I had to.

I managed to stop Valium as of yesterday, but last night and today I was beginning to have withdrawal effects: couldn't sleep, increased intense energy verging on agitation, increased irritability and anxiety, spaciness, and an intense "need" to take something to calm myself.

All day my brain tried to talk me into filling that prescription. All day some part of me managed to fight back. I want so badly to bring that prescription to Dr. X tomorrow morning and rip it up as a statement to myself that I am stronger than the urges I feel to take benzodiazepines. I am literally terrified of entering a long stretch of time away from Dr. X without a prescription for Valium.

However, I know, if I fill that prescription my chances of quitting are very low, because as the days free of Valium go on, something ignominious in my head will tell me I need it more and more. My brain will try every excuse to just "take a little". At that point the whole cycle will begin again and I will have to begin to quit all over again.

I never saw any of this coming. I never knew I had a drinking problem, until the problem became part of my depression. I never thought I ever would have any kind of addiction or tolerence problems to either alcohol, or medications. I feel I was always so cognisant of the pitfalls of these things.

I can make excuses, like I only really started drinking when my depression and anxiety became unbearable and nothing helped me. Drinking and benzodiazepines helped me survive the loss of my Mom. The excuses are real. For the most part they are true. That doesn't make the problems I am having now stopping both alcohol and Valium any less real.

I want to get better, but I cannot see anyway out of a depression that has anxiety as a key feature. I need something to lift me, but also something to lower me (to lessen my anxiety). The two seem like opposite goals and benzodiazepines always seem to help me for periods of time. I feel like I will never find a combination of medications that do not conflict with one another: Medications that allow me to have a lift in mood, energy AND remain calm, have a stable mood and have my memory and wordfinding back. Is that too much to ask?


Border Life said...

I recall once, when I was but a wee lass starting out and working very, very hard, that the V.P. of Engineering said to me... something to the effect of... that I was really motivated by recognition and wanted accolades. I tilted my head and looked at him. What a gap we had. I was floored. All I wanted to do, or rather, all I desperately wanted to NOT do was fail. Or displease. Or be ashamed.

I hear you.

That anxiety "kept me in line" and "motivated" me.

I think the issue is that there is the nice, normal adaptive motivation, and then there is this unbearable, all consuming anxiety.

I understand your terror of getting off of Valium. I'm not sure of the problems you face with alcohol and valium in your life, other than alcohol can contribute to depression. It sounds as if you would like more energy as well, which may be difficult when on Valium.

I think you hit the nail on the head-- anxiety, and the loss of your Mom were unbearable, and nothing else that you had tried or found helped.

I was thinking about addiction, and was trying to find an open letter from a former Heroin addict who has now been on Methadone long-term. She says she does not plan to go off Methadone, ever. While looking for this letter, I came across the following:

"We also know that patients with chronic pain who need opiates to function (sometimes over extended periods) have few if any problems leaving opiates after their pain is resolved by other means. This may be because the patient in pain is simply seeking relief of pain and not the rush sought by the addict." From National Institute on Drug Abuse, for Updated: November 21, 2007

Chronic pain.

What other means are at our disposal that resolves this pain?

Loss is painful. Anxiety is difficult- shame is painful, abandonment and rejection are painful.

I don't think it's just a question of "developing better coping and relaxation strategies" or " accepting" or "turning the mind" or doing all the exercise/light therapy/Omega 3/eating/sleeping schedule kind of things that will make a life worth living and let us be off of medications.

So with that, I think my point is... be gentle with yourself on this one...

Anonymous said...

Fear of failure and fear of being unproductive motivate me. But not in a good way. I set very high standards for myself, ones that are basically impossible to achieve. Somewhat like you say - "I will stop taking all meds tomorrow" or "I will eat 1000 calories each day" or "I will be a great wife and mother every minute of every day". Then I am constantly anxious because I am not meeting my expectations. Then I'm a loser because I'm not meeting my expectations. I want to get out of this cycle, but I don't see a way out.