"How Are You"? "I'm Okay."

I haven't really written for a long while. and for days now I have been wanting to write about this...and then in my last post I saw the last commenter comment about a similar dynamic when people ask how you are. So I am going to let it out...

It makes me crazy'(er) that I can never be me with anyone. When my sisters or stepmom, or dad call they sometimes ask how am. Sometimes they avoid the topic altogether. My usual response is either, "I'm okay", or "I'm not feeling so great". If I say the latter the topic changes so fast to something else that it is obvious the question was just a polite conversation opener.

My sisters and family are good, loving people...It must be the chronicity of my illness, the awful person it makes me become, and the neediness of myself that has them pull away from me so much.

A couple times I have tried to express how I need help because x, y, z is happening; i.e. I have been honest about how depressed I feel. The topic changes, or the person tries to get off the phone as fast as possible...and the stops calling or e-mailing completely to protect themselves.

What I most often want to write when they ask how I am , and I am unwell, is: " I am feeling really scared and depressed. I cannot stop thinking about suicide. The noise in my head, telling me to kill myself, telling why it is the best thing, planning how to do it, etc., won't stop. I feel like nobody loves "me".

They love the "me" who laughs and is funny and upbeat...that is part of me, but often that part of me comes out when I am trying to help others feel okay around me, or if I am trying to not act as crazy as I feel. When I want to be cared for, or loved, I try really hard to suppress, or minimize all the things about me that others either cannot handle, or understand, or will take as proof that for their well-being, they should get me out of their lives...NOW.

I understand why this happens. It would be hard to have a sister/daughter like me. I understand, but it hurts me so much that my family doesn't try to help me, or somehow let me know I can call them if I need help. I feel so intensely alone.

Even with my pdoc I am afraid if I tell him what I really feel he will think I am overstating, or that I am crazier than I am. I often leave his office thinking God I must drive him crazy. I try to be/say/express less suicidal thoughts/ideas/plans than I really have, or am, or really feel. I tell him I have the thoughts, but I don't think I have been able to express their relentlessness inside my brain; the way, over, and over and over, and over, the thoughts speed through my head, telling me to:

"...wrap a rope around my neck, wrap a rope around my neck, do it, do it, do it, do it do it...shoot yourself, kill yourself, hire someone to kill you, no one loves you, you are alone, completely alone, lonely, this depression just keeps getting worse, and the worse it gets the more people move away from you..."

"...your family doesn't want you anymore, they only want you when you are okay, they don't want to hear about how you need help, they want you to just go away. So my brain says to me, over and over, "...do it, do it, do it, hang yourself, wrap a rope around your neck, etc., etc." All the while, that Violent Femmes Song, "Why Can't I Get Just One Kiss?" is playing rapidly. obssessively, over and over inside my brain...like I can't get away from the song, or the thoughts.

I can't tell anyone these things. I even don't want to write them here, because all I want is to get them out of my head. I am venting; trying to help myself find some relief.

So I answer, "fine, been feeling a bit down, but that's okay"...WTF!!! "...that's okay"?."...a bit down"???? This will never end...end it.

Homeless

I am very worried and anxious.

My husband came back in the house and told me to get out with the dog by the time he came back to the house. So as of now we are "homeless". While Skookum and I have no home anymore we did check into the best hotel in the city. They allow dogs...even have a hotel dog you can take for a walk...very cute.

Yesterday I began the process of trying to find a place to rent. Thank god I have a great friend , E, who has been helping me. She is amazingly supportive. I hope I can return the favour someday (hopefully not for these circumstances though)...no one should have to ever go through this.

I called both my sisters to let them know where I was. Both of them are extremely angry at me, with my one sister saying: "What did you expect" and "You could have thought of me and the kids. We really love (my husband). I feel very distraught and alone; so scared that I keep disappearing into my bubble. It isn't helped by the fact that the two people in the world that I need to help me think I'm a bitch.

It is hard to explain to anyone why I cannot remain married to my spouse. He is a good man in so many ways. He just is not good for me. I need someone who lets me in; someone who is caring towards me in a nurturing way, someone who allows me to be the creative, loving, accepting, caring, singing, painting, teaching being I am meant to be.

Two of my readers, Shock and Jcat, two incredibly supportive people towards me, have given me good advice in my previous post...to seek counselling, and tell Dr. X. I did tell Dr. X yesterday. He was so caring and supportive. There is a huge part of me that feels so ashamed of what I have done. I asked him if I had destroyed his perception of me, (because I feel I want so badly to be, and be seen as, a good person). What I have done to my husband is shameful. Dr X said no, but he had the saddest look on his face. I don't know if he felt sad that I would think that, or if he felt sad about what I had done. I think probably the former. I have a hard time believing anyone cares for me as much as he seems to. I don't feel I deserve so much compassion and lovingkindness. I always feel I am such a bad person. I guess what I have done pretty much reinforces that.

I called my husband yesterday and asked if he wanted to try counselling. He said, "no, counselling is out of the question because I have destroyed his trust in me, and that is the only thing that matters. He said he would never be able to forgive me, or trust me again. He also told me that his friends had been asking him for years why he stayed with me. He said he always loved me and believed in me. He told them I was a good person. He said ALL his friends had been trying to talk him into leaving me for years,

This really hurts me, as I felt they did not like me, but went into my relationships with them, believing I was just sick and paranoid...that despite my fears I was an outcast, they did like me as my husband told me over and over again.

To know I spent 18 years visiting with, and developing "friendships" with people who really abhorred me all this time is really distressing. It feels like abandonment. It feels like all my relationships except the ones with my personal friends have been completely false. It hurts me very very deeply.

anyways...I managed to get my own phone yesterday and called a few places, but no one accepted pets. So I will try again today. Please send positive energy my way. I really, really need it,

Fears of Abandonment?

Last night I had a dream:

...I dreamed that a friend of mine decided to stop taking her medications (in the dream MAOI's and Ativan). She phoned me and told me to watch for them in the water flue beside my house. Every morning, first thing in the morning I would go to the flue and there I would find her 4 perfectly preserved pills sitting on the edge of the water. I felt suicidal, so I began hoarding these pills.

One day when I went to pick up the pills there was a note beside them. It had been torn in two, along the bottom. I pieced it together. It was written by my friend and read: "Dr X will be seeing only 9 patients a week. He will no longer take new patients and will stop seeing the patients he has until he sees only 9 original patients"

I was desperately sad, and severely depressed. I needed help. I wanted to kill myself. I was planning on taking the hoarded medication, not because I thought he was leaving me, but because I was depressed. The only hope I felt was in my therapy sessions with Dr. X.

I had an appointment the next day. I got to his office and found a man in his office. Dr X walked in and didn't say anything to me. Inside I was getting angry, because clearly he knew he was going to dump me as a patient and he wouldn't get rid of the other man in the room. Someone knocked on the door and two women came in. Dr. X began reading the paper, the 3 others began talking amongst themselves. I tried to talk, but no one was listening and I felt uncomfortable bringing up Dr. X's impending departure and my impending suicide.

I was becoming both distraught and absolutely furious for the way I was being treated in my appointment (i.e. ignored, other people in the room, no respect for my privacy, Dr. X obliviously reading the paper). I could not bring up my suicidal thoughts, or my hoarding medication, because I was afraid he would think I was being manipulative and trying to make him not leave me. No matter how much I knew this was not true, I could not stop believing this is how the information would be perceived.

I started yelling very loudly at him..."Are you leaving your practice? Am I one of the 12 patients? Why are you ignoring me? Can't you see I am having trouble? Can't you see I am not well yet?

He looked at me and said he had found money in his child's account. $45,800.00 (maybe $43,800.00??unsure). He had figured out that financially he did not have to work like he did anymore.

I asked him if I was going to be able to see him. He ignored every question I had, and everything I said except he told me I was being unreasonable for wanting the others out of the room. That if they stayed in the room maybe I would get better.
I raced out of the room, climbed out an open window and took all the pills I had hoarded.

Disdain

I had two dreams the other day about Dr. X. rejecting me. The theme in both was the same, but I can only remember the details of one:

In the dream I have met a man and am enjoying his company. Soon I discover Dr. X is his good friend. After a few days the man dumps me while we are in some kind of theatre or concert venue. Dr. X is sitting beside this man when the man breaks up with me. As I am getting up to leave Dr. X gives me an intensely hurtful look of disgust and disdain; a look that betrays his hatred of me and his loathing for me.

The look sends me many messages, all awful. His look tells me I am not good enough. I am stupid. I am laughable. I sense there is a huge line drawn between him and people like me. I am not worth anything. I am worthless. I do not belong anywhere near "people like him". (successful, knowledgeable, intellectual people)

I woke up on the verge of tears.

I feel that way quite often. Like I am less of a human being than others. That I am bad and disdainful. That others are so much better than me. I sense a divide between people who are well, intelligent and successful, and myself, like I have failed at what is expected of me; that I have not met the standards for valuable people.

In my appointment Dr. X asked me if I recognized that this isn't the case..no I don't. I suspect it is the case but people only talk about it behind my back. That people I know laugh at me, think I am a bad person, think I am completely messed up, think things like if they weren't friends with my husband I would not be worth seeing.

I know some people feel like this, feel the divide between me and them. I see it when they talk with me. I felt it in my choir on Wednesday. Like I was trying too hard to fit in. At one point the two sisters next to me, who I thought liked me, started talking in sign language a few times when I made mistakes. I am certain they were making fun of me. That made me feel intensely self conscious, sad and lonely.

I feel like I will never be normal, never fit in, always be "outside the circle"; that circle where the people who matter , or people who count, exist.

Thank You

Dear Dr. X,

Thank you. I felt completely understood and immensely cared for in my session today. I really needed to experience belonging and connection. You really helped me feel less alone than I was /am feeling.

At one point when I was telling you about something intensely personal and highly embarrassing for me to admit out loud I saw your face change to sudden sadness....not about what I was talking about, but at my expression of fear that you might judge me, or feel I was a bad person for things I have done.

At that moment I knew you would never be judgemental of anything I have done, or might do; that I need not fear speaking any of my truths, past or present. The encouragement you gave me was incredible.

When I felt like an outsider you helped me recognize that often it is the outsiders who are talented and interesting beings. You encouraged me to embrace my "outsiderness" rather than try to fit in. You helped me become aware that often my being an outsider is a gift, a talent, it is (ironically) what draws others to me. That was a great lesson. You are a great mentor for me.

Thanks,
...aqua

The Value of a Powerful Therapeutic Alliance

I am falling deeper and deeper into depression; again. I feel so helpless as I feel myself falling farther and farther down. I went to my appointment with Dr. X yesterday, and all the way there I kept thinking: "I have had enough, I cannot take this anymore. I am quiting everything: medication, therapy, and if that doesn't work, life.

I sit down in my chair, across from Dr. X. and I feel an intense shame come across me. It is as though I feel not worthy to be in his company, to take up so much of his time, to have him see me for so long. I feel that same shame right now. How can I get so much help, and such good help, and still remain unwell?

I sit facing Dr. X. and I feel certain I must be exhausting to him. I must frustrate him so much. I cannot imagine how he manages to meet with me week after week, after week. How, after seeing me crash, seeing me unable to manage simple tasks, seeing me fail over and over again, how can he not be intensely frustrated, or in my mind even worse; how can he not have given up hope for my ever becoming well?

I manage to ask him if I frustrate him. He explains frustration is not the right word; sadness, a sadness that you would feel for a friend, or family member who remains chronically sick, that is closer to how he feels.

I feel touched by his saying that. No one except my Mom, when she was alive, has ever said that to me before. No one says they are saddened by my struggle to become well. My family mostly tries to make me believe that everyone has depressed days, shifting moods, anxiety, etc. That depression is normal. This makes me feel completely misunderstood. I am certain this state of mind is not "normal". They assure me I am strong and need to step out of this hole I am stuck in. Either that or they say "get a job", as thought that will fix me.

Even my Mom used to say I needed to accept my illness, get a job and I would become better. My husband says I am sick because I focus too much on my depression, am in therapy, and take antidepressants.

People without this illness have no concept of what it is like to struggle, and then often to even lose the ability to struggle. Life is hellish, empty, frightening, worthless, hopeless. I wake up everyday hoping today is the day, but most often I realize and know it will never end. It has been part of me for too long.

Sometimes I wake and think: " Today is the day this MDE will end". I have glimpses of joy, moments of laughter throughout the day, but after the moment ends it feels as thought the moment is mocking me; laughing at me, not with me, showing me a moment in time that will only ever be that: a moment, a split second of freedom, an infinitesimally small break in the darkness.

I sat in my appointment yesterday, ashamed of who I have become, wanting so badly for Dr. X. to know who I have the potential to be. In the moments we talk I believe he may know my real self. He may understand I am a better person than the one I have become. Actually he sounds like he accepts both of me: the sad one and the bright and joyful one. In fact, it appears he sees us as neither one or the other. It seems he sees the real me through the sadness. During the time I sit in that chair, across from Dr. X, I feel that the sad and joyful me are seen as one and the same.

I am not two people. It is not fake for me to be joyful for a few hours and barely able to move the rest of the day. Dr. X even says it is not a facade when I laugh gleefully at my puppy running and jumping for a Frisbee, and moments later feel sad. My sadness, and fatigue, and amotivation, my wanting to sleep all day are all symptoms. We will continue to work to address these. He seems confident that wellness is a possibility, that I will not be stuck in this hell forever, that we can, at the very least, help me lengthen and intensify the good moments.

I feel myself laugh when I think of my dog. He is bringing so much joy, and at least some fresh air and exercise into my life. He drags me out of bed, deserves a walk and play time. I am fully responsible for his care. Which at times seems overwhelming, but also is a responsibility that protects me and gives me energy.

Dr. X and I begin to talk about how we, as Dr. and patient, interact. He begins asking me questions I do not know how to answer. He asks me how my interaction with him differs from my interaction with a friend. I try to express how a friendship is a two way relationship and we have a one way relationship. I feel distanced from him by that separation; the him and me.. The game we play has rules and strict boundaries. The playing field looks different to each of us. We are playing entirely different games and I do not completely understand the rules. I only know there are strict boundaries that I need to guard.

I feel intensely uncomfortable asking him questions. I feel like it is not my place to question. That is how I was brought up. Call people Dr. Sir, or Cst.,Cpl, Sgt, Staff, or Inspector. They ask the questions. You answer them. I try to ask him questions like he seems to want, but I feel awkward and nosy. He insists I keep asking. I'm thinking it is a type of behavioural therapy. He wants me to see and believe he is a person like any other, that he cares about me, that I can ask him anything.

All I keep thinking is he must think I am a complete loser. I bet doctors make fun of people like me. Sit in their offices and laugh about how bizarre people like me are. Over coffee, having conversations that begin with: "You would not believe the patient I had today...". I feel scared people do not like me, make fun of me, are secretly talking about me behind my back.

At the same time I feel so disrespectful of Dr. X. for even thinking he might be like this. How rude. How unthoughtful am I to think this man, a man who has always been there for me, who is consistently caring and goes out of his way to help me, how can I even think he would be like that? I feel like I have hurt his feelings for even suggesting this might be possible.

I cannot, however stop worrying that he will give up on me, or that he is exhausted by me, or simply cannot take it anymore. It is always what happens. I wear people out. They leave me. I even used to ask my Mom, every time I spoke with her, if she loved me. As though her actions never screamed those words loud and clear. They always did, but something inside me felt I was unlovable.

My husband and I have been together 16 years and everyday I think he wants to leave. Everyday I ask him: 'Do you love me"? and everyday he answers yes, but I cannot believe anyone would love me, or care deeply and honestly for me. Not really.

This is what I need to work on in therapy. I need to learn to believe I am likable and worthy of people caring about me, and for me. This is where a powerful therapeutic alliance is intensely important. If I can work through my conflicting feelings about Dr. X., maybe I can reflect the behaviours and beliefs I learn onto the rest of the relationships in my life. Even if I am scared, what I do know, is that Dr. X is the safest person with whom I can to practice and relearn better personal and social skills.

It's Not Always Perfect: Sometimes That's Why it Helps

I recognize that there are many many people in therapy who are really struggling, either with their therapist and/or with their continuing, and maybe worsening mental illness, in spite of therapy and medication. I was looking back at my recent posts and I can see that my therapeutic alliance with Dr. X. might seem perfect, or completely seamless to people who have only fairly recently been reading my posts. I want my readers to understand that I have struggled with difficulties in therapy too. It has take a long time for me to feel as safe as I do with Dr. X

It is true, I am, and have been since I began seeing Dr. X, extremely confident that he is the right Pdoc/therapist for me. This is not to say I have never had difficulties with him in therapy. There have been many times in the past where I have entered, departed from, or have been in sessions, where I feel incredibly scared, or abandoned, hurt and once, even punished. Therapy is often an extraordinarily difficult process to participate in.

I entered therapy because I was extremely and increasingly depressed. That depression; its causes, it continuation, and its increasingly worsening hold on my life, brought tons of baggage into the therapy room. That room had two people in it: myself and Dr. X. Any room full of that many difficult behavioural and thought patterns carries the potential for lots of conflict. For me, I do not believe that good therapy is free of conflict.

What I do believe is that in good therapy, when conflict happens, both the patient and therapist feel safe addressing the issues that cause or contribute to feelings of conflict. I am not suggesting it is easy, or that I always feel safe addressing issues as they happen.

Often, within the session, I am feeling angry, or hurt, or rejected, or simply feel I made an idiot of myself. At the time I am simply unable to garner the courage to speak up, or address how I am feeling about something I feel is happening within the session.

Sometimes, I am able to address my fears during the session. I remember one time I was late for my appointment. I am never late. I waited in the waiting room, and 5 , 6, 7, 8, 9 and 10 minutes went by and Dr. X never came to get me. At about the 5 minute mark I began thinking he was punishing me, by the time 10 minutes had gone by I was sure he was teaching me a lesson.

Finally I got the courage to go up to the receptionist and ask if she could get him. He came out, and immediately I knew my mind had been getting the worst of me. However, it was important for me to say something, both because I was angry and hurt for 10 minutes, and also so we could make a plan if I am late again. Addressing the anger and hurt in a calm and safe environment, with a therapist who listened and understood became a learning opportunity and a therapeutic alliance building exercise.

Some of my readers may not have been reading my blog for very long. To ensure everyone that I have conflicts with my therapist too, and that the relationship blips happen within even the strongest of therapeutic alliances; I thought I would share some links to previous posts that express some of the difficulties I have had within my patient/therapist relationship.

The key when reading each of them is that every single time there was a conflict I forced myself to talk with Dr. X. about it. Sometimes it took a few sessions before I felt safe to bring it up. Sometimes I could not even say the words, so I printed up my blog post and let him read it, and sometimes I addressed my feelings in the moment.

The important thing is I never let conflicts go unaddressed. Why would I? The conflicts I have with Dr. X. are always reflections of feelings and conflicts I have outside the therapeutic hour. Addressing fear, shame, anger, depression and anxiety about something that happened between myself and Dr. X helps me work out those feelings when I later have them with someone else.

The following are links to posts, and short excerpts from those posts, to give you an idea of what the post is about. I am hoping others in therapy might see that conflict in therapy can sometimes be used to gather great insight into yourself, others and your behavioural patterns in other relationships.

That said, I do not believe all conflict within therapy is good. My experience has been that trust and mutual respect between therapist and patient needs to be strong, and in place, in order for the conflicts to be healthy learning experiences.

I learned more from the following therapeutic moments than any other moments I have had:

1) "Opening Up Too Much"

"I just got back from my therapy session. I have mixed feelings about how it went and how much I opened myself up to Dr. X..."

2) "Do I Tell My Pdoc the Truth?"

"...The truth I am afraid to tell is how deceptive I have been in regards to my dog's prescriptions. I have been amassing very large amounts of two types of heart medications and a very large, and definitely lethal dosage, of Phenobarbital My dog does need these meds, but I have been getting the pharmacist to give me all his refills at once under the guise that I do not want to pay the dispensing fee for monthly doses.That is not the truth. I want to use the medicine to commit suicide..."

3) "Is it a Love Hurt Thing?"

"...Today I went and saw my pdoc again and he says he thinks I should go off all medication for a while and really work on my relationship with my husband and other non-medication things (like exercise, eating well etc.) ...

...I lost it...I feel so ashamed of how I reacted...

...I felt like my pdoc was taking my husband's side and my family's side..."

4) "You Won't Die From Not Sleeping!" (About being 'taken off' benzodiazepines when I did not feel ready...this post actually led to a really good discussion and a lot of support from my pdoc this past week...as I try to come off them again. This time I feel safer and more confident I will get help if I need it)

"...All I want is to sleep, but I asked my pdoc what to do and he said he did not want to take all this energy away from me. I was hoping he would give me something to help me sleep...Why can't I ask more directly?

"...He said he did not want to sedate me when I finally was feeling more energetic. He wants me to look at it and use it in a positive way, because I have been so depressed for such a long time with no break in my mood. He said, he doesn't want me to feel like he is not supporting me, or dismissing how difficult not sleeping is, by saying that, but he wants me to really try to use this time to push forward..."

5) "Preparing For my Therapy Session Tomorrow"

"...I don't know why, but I feel it is not my place to ask Dr. X. to reveal some of these things...so maybe I can do it on paper..."

(About things I was unable to talk about or open up about in therapy)

6) "A Fine Line"

"...I just need help and I'm not one to take myself to the hospital, or call my pdoc...so I cry, and I cry and all I want is a way out."

(About my inability to tell Dr. K how suicidal I feel, or to reach out)

7) "Prepare to be Cut Off"

"I went into my session today feeling really good, despite not having slept more than a couple hours last night and not much the past week or so.

...Then I do not know what happened, but all sorts of negative thoughts started to creep into my session..."

8) "Truthtelling in Therapy" (I sometimes print off things that are really difficult to say and hand them, or read them to Dr. X)

"I feel so ashamed and guilty about how I behave. While I believe absolute honesty in therapy is extremely important to, (and maybe the cornerstone of), successful therapy, I still hold back and find it hard to explain the bad things I do to myself..."

9 ) "Judge and Jury" (about my projecting my Dad onto Dr. X and its affect on the therapeutic relationship)

"... I felt so stressed out and scared in my therapy session today. I have been severely depressed (even more so than usual)and have been feeling really paranoid about being abandoned...both physically and emotionally, by Dr. X, by my family, by my friends, basically by everyone..."

10) And Then the Door Slams Shut"

"...Ahhhhhhhhhh! I want to scream. Four days ago I was going on and on about trust and how I am feeling safer and closer to my pdoc and now I am totally obsessing about how I think my pdoc is not being straight up with me..."
how I was able to talk to Dr. X about my feeling dumped

11) "Blind-Sided"

"...I do not think he is being honest with me. I think he saw an out and took it as quickly as he could. I feel totally let down...and angry that when I am so severely depressed, (but finally had the courage to ask for him to change his schedule to meet a need of mine), I got shot down in flames..."

12) "Freed Up" (about my addressing how I felt "Blind-Sided")

"...I am so proud of myself today. I was brave in my session today and brought up how I left the session in shock...wondering how, when I was brave enough to ask for a change to accommodate my needs, I left feeling like I had been dumped like a hot potato..."

You know that song by REM..."Everybody Hurts" It is really important to speak up and try to understand and work things out if you feel hurt happening in therapy. I swear speaking up with Dr X. has led to some of the biggest therapeutic epiphanies I have ever had.

Confession

The Confession (Dicksee 1896)

I am not Catholic, but was brought up Anglican; which is close enough. The two churches' teachings are pretty similar except where it comes to divorce and birth control (and of course we have no Pope, the Queen is head of our church).

While I no longer practice my childhood religion I somehow feel deeply tied to the church and its rituals. It is very strange, because I do not even believe in God, but there is a peacefulness about walking into a church that is only rivalled when I step into Dr. X's office.

The other area the Anglican Church differs from the Catholic is the practice of confession. I have often wondered how freeing a regular, completely anonymous confession, the penance given afterwards, and the simple act of being told you are forgiven must be deeply satisfying and soul refreshing.

I suppose therapy is supposed to be like that, but there are always secrets and fears of what will happen if you open yourself up completely and 100% honestly to your therapist or psychiatrist. Fears about how the other will react, how their reaction will affect your relationship, how, even if there is no outward reaction, a seed of discontent, distrust, or even anger will be planted. The fear that some of those seeds will grow into plants, and the plants will give rise to more plants that negatively impact the therapeutic relationship.

I try extremely hard to allow myself to open up fully to Dr. X. in therapy. The day I met him I sensed immediately he was a person I could talk to. Which was strange as I had so many "man" issues I never really felt safe around men. I think I was extremely open with him during my first interview. Some people entice me to be open, but I am also a fairly open and participative person. A little too much so sometimes. By the time I met Dr. X. I had been in and out of therapy so many times that I understood I needed to let go of my fear of being judged and get everything out of my head in order to receive the help I needed.

There are things though, that I cannot seem to get out, cannot seem to say, to Dr. X, or on my blog, or to anyone. Probably important things, but shame, guilt and fear holds me back. I feel ashamed about things I do, or feel, and the words to explain these will simply not come out, no matter how hard I try to get them out. I think over and over that I should talk about these things, but it is as though I am physically mute, unable to speak about certain things I do or feel.

Often this fear of embarrassment, or abandonment, or punishment holds me back for months, or sometimes years, before I can finally tell him what I want to tell him. Every time I have done that he has reacted in an accepting and positive way. So why do I still find it hard to talk about some things?

I remember reading about this psychotherapeutic phenomenon in Irvin Yalom's, "Existential Psychotherapy". (A book that feels like it was written for me). He gave an example of a patient being terrified to talk about something, Eventually the patient managed to write it down on a piece of paper. When The Dr. read the note it said something like "I pick my nose". Hardly earth shattering, or shameful, yet to the patient, based both on his inability to say what he did, and the lengths to which he avoided saying what he did, it was both of these and more.

I believe my "secrets" are held private for a variety of reasons. One problem is some things I do or feel or sense seem so bizarre that I do not even understand why I do, feel or sense them. It is like someone completely different from the real me is rallying my thoughts and obsessively dragging me into doing things. I worry they will only be proof that I am a bad or extremely weird person. They are not even really earth shattering things, nothing illegal, but I am so afraid if I talk I will be rejected, or seen in a completely different light, no longer cared for, or thought to be crazier than I already am. I know I am being a bit cryptic, but I am trying to prepare myself to get things out of me and this is one small step towards really opening up completely.

Therapy is not like confession. It is not anonymous. The confessor knows their "confessee". The relationship is intensely important to the confessor. There is always a sense of potential instability or loss; a "contrived"genuineness (e.g. What therapist is going to say..."That is the absolute, most bizarre thing I have ever heard?...even if it was?); and an unsureness of the strength of the relationship, in part because while the therapist may love their job and like their patients, therapy is, after all, a financial transaction on the part of the therapist. The therapists are never (I don't think), or can never be as invested in therapy as the patient. The therapist has many patients, but the patient only one therapist.

For the patient there is more at risk in therapy than in confession. We, the patient and the therapist, are mere humans. Thetherapist can say everything is okay; that my thoughts and actions are normal, or symptomatic of my illness, but they may not really believe that to be the case. God, if he exists, is capable of forgiving anything. Pdocs and therapists are mere mortals. People whose feelings get hurt, who reflexively react to some information, who have fears and and joys and belief systems that may or may not conflict with their patients ideas. For me it is sometimes hardest to explain things to people who are most important to me.

Honesty in Therapy

Recently quite a few people have found my blog by googling "Honesty in therapy", or "How can I be honest with my therapist?", or variations of that theme. Today I will share some of my experiences with Dr. X and hopefully they will show you that being honest in therapy takes a huge amount of courage on the part of the patient, but also that the therapist or psychiatrist has to show they are worthy of that honesty in order to facilitate your being truly open with them.

I cannot think of a single instance where Dr. X. was judgemental about things I told him. I can think of many instances where I felt he ", "should be" or "would be" judging me. I can also think of many times where I can see now that I was "paranoid" he would judge me. In retrospect though, his refusal to label or judge my behaviour has allowed me to be honest in therapy.

Sometimes it has taken me a great deal of time to get to the point where I am able to share information. I weigh the odds of the information hurting me, or affecting Dr. X's relationship with me, or my relationship with him. I often spend weeks, sometimes much longer, worrying about opening up about something. Everytime I finally have opened up and been honest it has taken a huge weight off my shoulders.

Those who read my blog on a regular basis might notice that I use my blog to prepare myself to open up, to tell the truth, to Dr. X. A few times I have been intensely suicidal, lethal medications in my hand, and instead of choosing to take the medications I have written about how hard it is to express that kind of suicidality to Dr. X. Often it is because I am afraid of how he will react, or that he will take away my freedom. He never has, and the talking about it always de-escalates my suicidal feelings and reassures me I can trust him. (Note: I now trust that if Dr. X. did place me in the hospital against my will, he would be doing it for my own well being. I recognize that there may be times where I, or others, are not able to make those decisions for ourselves)

Sometimes if I absolutely cannot get the words out, if I simply cannot open up or tell Dr. X. the truth, I will print off what I wrote in my blog, or I type out the feelings and print them out. In my appointment I then hand the written version to him to read. As he reads the note I sometimes feel so ashamed of who I am and how I act, but I also recognize that he cannot help me if I do not let him know exactly what is going on.

At these times he usually reads the note and then is very silent, waiting for me to speak. Always these moments have been catalysts for more open conversation, and every single time they have promoted and reinforced a deeper sense of trust between myself and Dr. X.

I remember one time I waited 2 or 3 years to tell him about something I had done years prior. In retrospect, especially after telling him, I held so much guilt and fear inside me for such an unextrordinary piece of behaviour.

When I was in second year university I had a fairly short, but extremely severe Major Depressive Episodes(MDE). I would sit in my classes and all I could do is cry. I could not get the energy to shower for days at a time. Everyday I would go sit by the beach trying to get myself to kill myself by getting in the water and just swimming out to sea until I could swim no more.

In a couple of my classes nothing made any sense to me. It was as though I was sitting there, but the professors were talking some other language. I was having a particularily difficult time understanding lessons in one of my philosophy classes.

So, in desperation, believing there was a magical solution to my problem, I decided to look up the professor. I found out he lived near me. Believing it to be the magical answer to my not understanding his class, once or twice a day I would walk past his house. I believed that each time I walked past his house, all his knowledge would somehow magically transfer to me.

When I became well again, when my MDE ended, I felt so much shame about what I saw as a kind of "stalking" behaviour. I could not believe I would have done something so bizarre. I was afraid I was dangerous, and that if I told Dr. X. what I had done he would think I was too weird to be trusted. I was afraid he would be afraid of me. So I never told him or anyone I had done that.

A couple years into therapy I began to feel safer with Dr. X. and I forced that story out of my mouth and into one of our sessions. After listening carefully Dr. X. said (paraphrase), "What a beautiful story you have told me. It is wonderful that you were able to have such a magical belief in the way the world worked; beautiful that you were able to suspend reality and have such faith in a mystical type of transference of knowledge".

I was overwhelmed with relief and finally was able to talk to him about my fears that I had been stalking the professor, or that I might be capable of stalking another human being. I never wanted to SEE the professor, it was the act of passing his house that was so important. We talked about how I have OCD symptoms and and vivid imagination. He told me I was not stalking the professor, rather I was suspending reality and looking for a unique way to help myself in the class.

I recognize now that I may have been having some kind of psychotic delusion during that depression, but Dr. X never used those words. He gently helped me see the magical nature of my thoughts without judging me, or making my experience a bad one. It was simply a different experience than most people might have. He assured me he knew I was not dangerous, or a stalker, that I was a human being trying to understand her world.

Being honest with him then, and his positive reaction to what I saw as a frightening and terrible flaw in myself, set the stage for my feeling more and more free to express myself and be honest in therapy. Honesty in therapy takes guts and determination on the part of the patient. It also takes consistent compassion and kindness on the part of the therapist or psychiatrist with whom patients entrust their information. The therapeutic alliance that is created between an open, willing and brave patient and a welcoming, compassionate and consistent therapist is what facilitates honesty to take place in both directions. I feel blessed I have such a therapist.

Disclosure

(**Note: I misunderstood Dr. Shock when I wrote this blog post. He agreed with Dr. X's type of disclosure. Misunderstood or not, his thoughts were the catalyst for my writing about this topic and it felt good to get it all out of my head. Thanks Dr. Shock).

You may have picked up from my blog that I am not only in therapy, but I am also intensely interested in the therapeutic process: The patient/therapist relationship, how that alliance affects therapy and how powerful a catalyst for change and growth a relationship with a trusted therapist can be.

This post is inspired by my curiousity about that process. Recently Dr. Shock has written a series of posts about the Dr./Patient Relationship. They are all very interesting. I find myself both agreeing and disagreeing with one aspect of the Dr/Patient relationship he believes in. He disagrees with a Dr's self-disclosure (in particular when speaking of a psychotherapeutic relationship).

I for the most part agree with him. I think it is important for me as a patient to be able to project my difficult relationship communication problems onto Dr. X. When Dr. X "becomes" my Dad, like in my recent post "Letting Go of the Past", I am able to reflect afterwards and learn from the experience. It is during those moments when I learn the most.

I have had therapists who spent much of my session comparing their problems to mine, telling me everything about themselves. These have never been helpful therapeutic relationships to me. They begin to feel like they turn into therapy for the therapist instead. Dr. X. is not like that. He is very good at limiting self disclosure to almost nothing. While I have an intense desire to know him better, I appreciate that he reveals little to me, he is whoever I need him to be at any given time.

Recently however, he did disclose to me that he has been unwell, and that it appears he has MS. Dr. Shock finds this disclosure uncalled for (**Here is where I misunderstood Dr. Shock' position about Dr. K's disclosure...he actually agreed with Dr. X disclosing his illness ...read his comments and the posts on his site).

Here is where I disagree with Dr. Shock and the following disclosure about my past will explain why. (If you happen to read this Dr. Shock I would be really interested to know how you would manage a situation like this after reading some of why I think this self disclosure was imperative for my well being.)

I have had numerous situations that have intensified my fears of abandonment. The following were probably a few of the things probably the straw that broke this camel's back:

My Dad left my Mom when I was almost 17 years old. I came home from school one day and my Mom as gone. I had no idea why, or where she went. she just disappeared. It was traumatic.

A week later she returned home and suddenly my Dad disappeared. Although I discovered he had moved into his own apartment, again, there was no explanation as to why he left. I was distraught, confused and felt intensely abandoned both times. As the weeks wore on I began to fall into my first depression, but I had no time to help myself, because my Mom was disappearing too, only in a different way.

She began to drink, stopped eating, wouldn't get out of bed all day, began leaving us at night to go drink, lost weight to the point she began to appear anorexic, became so angry she was hard to be around (she is was usually the most calm and compassionate, loving person I have ever encountered). In a word she became severely depressed as a result of my Dad leaving. She desperately needed a job as she had no money of her own.

My Dad had always taken care of us financially. She could not get work, or manage to renew her licensing requirements to become an RN again because she was too sick. When asked my parents if we could see a counsellor, they both responded "it was none of my business. It was between them"

All I knew for years was that my Dad left. I had absolutely no idea why, or why he never came home. He was just gone. I made up all kinds of things in my head..." I was a difficult child, he didn't like me, he couldn't handle my sisters and I, he had just decided one day that he did not want to be with his family, etc." I felt intensely abandoned, sad, lonely, let down, ashamed that I had been such a bad person that I made him leave us. I had destroyed our family.

I felt abandoned by my Dad, but even though my Mom was physically still around, she was gone. She was inconsolable. She was one of those women who married for life. Divorce and remarriage were not options. It was so sad to watch such a beautiful, strong, and loving Mom become nobody without her husband. Without Dad she disappeared into severe depression for at least 10 years and remained moderately to mildly depressed until the year she passed away.

Two years after my Dad left I could not handle the feelings I felt for losing both parents, for not understanding why it had all happened, so I left home to get away from those feelings. I ran.

Four and a half years and three cities later I phoned my Dad and a man answered the phone. Suddenly, it became absolutely clear why my Dad had left my Mom. He was gay. For the first time in years I felt an intense sense of relief and understanding. I finally understood why no one would talk about it. It was the typical shame issue too many people feel about being gay.

Unfortunately, that was not true. My Dad had remarried, and now had a whole new family, a new wife and two sons, without telling any of us. He had left my Mom for a woman he had been dating for a couple years while still living with us. I can't even express the shock, and feelings of betrayal I felt, and to this day feel. My father marries without telling us, allowed us to suffer feelings of abandonment and fear we were the cause of him leaving, when all he could easily have explained what was going on. Maybe not when he first left, but at the very least before he married.

The woman he married was an absolute bitch. I rarely say that abut anyone, but she was the equivalent, and perhaps worse than, the epitome of the evil stepmother. She would draw you in, get you to reveal your souls deepest feelings and then use those to bait my Dad, and to make him angry at us. My little sister used to have to go stay with my Dad very couple weekends. She could hear my Dad's wife yelling at him about how he had to get rid of her. How she did not want my sister there, ever.

She destroyed any hope that my sisters and I could ever have a relationship with my Dad. My Dad has never once mentioned why he left Mom, or even the fact that he did. He never once stood up for us in front of his wife, or any other time tha we know of. Any attempts over the years to talk with him about his leaving and how it affected us ended in our being immediately silenced. This (among other things) left all his children with no ability to have any kind of trusting relationship with him.

What does this have to do with Dr. X's disclosure? Everything. Given I so often, so easily, and so strongly project my father onto him any sudden disappearance on his part, without my understanding why, would cause me to relive those feelings of abandonment, disingenuity, and deceitfulness all over again. Any trust I had in him would be gone, and I am not sure it could ever be regained, especially if I found out he knew, and had known for some time, that he might have to stop work for a while, or "disappear' for a while.

I am working so hard in therapy to learn that I can trust others, that people are genuine, that not everyone will leave me or outright lie to me, or lie to me by leaving out information. It has taken years for me to trust Dr. X. and to begin to feel safe.

On top of my Dad's deceit, and my intense sense of abandonment surrounding the way it all happened, I recently lost my Mom. She had been the only person in my life outside of therapy who really, really supported and understood me and my depression. She became ill with pancreatic cancer and died within 2.5 months of her diagnosis.

I am still having an intensely difficult time dealing with, not just her loss, but the swiftness of her death and the traumatic act of watching her die: watching her try to cling to her children, seeing her try so hard not to abandon us. The intensity of her will to survive, even after she fell into the final throes of death, gasping for air for hours, trying to communicate, when her ability to talk was gone, watching her not wanting to abandon this world and all she loved in it was so traumatic I don't think I will ever recover from the unwilling and unexpected abandonment of someone I loved so much.

Dr. X. needed to tell me he was ill to preserve the integrity and trust in our therapeutic relationship. He needed to show me he valued me enough to be honest and forthright about his potentially needing to cancel, or rearrange appointments. I needed to feel I was important enough for him to be open with me about WHY he was unable to see me; that it wasn't because he didn't want to see me, or because I was a difficult patient, or because he wanted to get rid of me. I needed to know I was not being abandoned and that I would be taken care of in his absence. Dr. X.'s decision to disclose his illness and the potential it had for him possibly needing to take time off work periodically was only decision he could have made given my background and the issues I have been dealing with.

Death Anxiety

Aqua, "Destination Unknown" (linocut 1/5) 2007

Me: (Among a list of other things) "I have been sleeping a lot. I'm not sure if it's because I am tired or I just can't face doing things. I feel like I just don't want to do anything, or I have too much to get done and it's overwhelming. I can't face all the things I have to do, so all I want to do is sleep."

Dr. X: "Tell me your list of things you want to accomplish."

Me: (Completely misinterpreting "why" he is asking this question, because all I am worried about is losing him) "Why? Is this so if I need to be seen by someone else they will have a list of all the things I need to work on? So, they will know what I need to address in therapy?"

Dr. X: (Looking really perplexed, but trying hard to hide that) "No, you just said you were sleeping a lot to avoid things, or because you were avoiding getting things done. I was wondering what those things were."

Me: "Oh! Getting a job!"

Dr. X.: "You have a job. (referring to my volunteer work)"

Me: "I mean a job where I get paid; where I stop being a drain on the social services system; where I can take care of myself; where I don't rely on anyone else. All I ever heard from my Dad when I was growing up was how awful "those" people were (Hippies, the unemployed, anyone who wasn't working and paying there own way, anyone who needed help from anyone else). I have internalized my Dad. On top of that all I'm hearing from him and my one sister right now is do more and you will feel better, or (from my Dad) Why don't you get a job? A "real" job. Get it together."

Dr. X. "You are working at a real job. The system sets it up so you cannot win one way or the other. Maybe the Art Clubhouse should pay you a higher wage, so it would be seen more as work and more valuable by you and by others, where it could help support you. The big thing here though is your internalization of your Dad's criticism."

Me: (Feeling cared for and supported by Dr. X, but dejected; like I will never be a valuable human being). "I know. I am doing things that are important to me. If I worked for $10/hr doing something I felt was meaningless or purposeless I know I'd be even more depressed. I just never thought I would end up like this. I always thought I would move up the ladder in life (always moving forward, getting better jobs, getting ahead). I never expected to be on disability, to not be working, or to be unwell. I always thought I would do something with my life."

Dr. X: Silent (His specialty: a safe, reflective silence...like he is when he waits for me to figure out for myself that I am not thinking clearly)

Me: "I guess it is like the print I made for you last year..."Destination Unknown". (Thinking to myself how making that print for Dr. X may have been eerily full of the bizarre sense of magical foresight I seem to have sometimes. I made it to represent my struggle and how it is taking me in directions I never expected; and often didn't want, to go, but he clearly sits on that same bus with me now...that I never expected).

I was driven to make that print for him. I felt I had to give it to him. I messed it up so many times and did it over and over until it came out right. An intense dream created the metaphor of a bus taking me in an unexpected direction; I added the Raven; a trickster figure. He is devising, overseeing and fully intending whatever outcome occurs.

None of us knows which way our lives are headed. None of us can foresee the outcome. We are all on that bus whose destination is unknown. That scares the hell out of me.

Fear of Loss

I have written about this two or three times over the past few weeks, but each time I have removed the posts or portions of the posts that refer to my pdoc disclosing he is unwell. Each time I wrote about it, afterwards I felt I was being unfaithful, traitorous, untrustworthy, or unsupportive of him. I felt afraid that my apprehension and fear about him being unwell was both unhelpful to him, and proof that I am selfish in my fear.

I need to write about it though because I am terrified and extremely worried for both of us and it is really affecting me.

I am very concerned for Dr. X. He told me he has Multiple Sclerosis (MS). He needed to disclose this too me, because MS can be unpredictable and there may be (and lately have been) times when he needs to be away from work. I need to know why. I need to know it is not me when he calls and says he cannot meet for our appointments.

When faced with this kind of information my first reaction is to inform myself about what the information means. MS is a disease that attacks the central nervous system. It breaks down the myelin that acts as a protective coating for the central nervous system. It causes lesions in the white matter of the brain (an effect of the breakdown in patches of myelin). From what I have read MS can be a very difficult illness to manage.

Some people may have very few symptoms for long periods of time and then become ill for periods of time. Some people have minimal symptoms and some have very difficult symptoms to manage. It seems the disease's symptoms are very individuated to each person.

Symptoms can include (but may not include, or may minimally include): Vision, balance and short term memory problems, bladder an bowel problems, incoordination and muscle stiffness and sometimes paralysis and severe fatigue.

From what I understand there are four subtypes of MS:

Relapsing & Remitting MS; a type of MS where the person has times of relapse into the illness and then the symptoms remit for periods of time,
Benign MS: (unsure), but I think this is where the person with MS has minimal symptoms and years after they have been diagnosed they are still functioning very well
Progressive MS, which includes two sub-types:
Primary - Progressive MS- People with this form of MS have symptoms that continually worsen, with no relapses.
Secondary Progressive MS - This version starts out as a relapse and remitting pattern and eventually becomes unremitting with a continual gradual worsening of the conditions symptoms

That is the "education" aspect of my fear, then comes the sense of intense and deep sadness for my pdoc. He is so young (younger than me). Has a family, is so active and seemed so healthy. He is generally a "blank page" to me. He rarely talks about himself or anything personal. However, from meeting with him and talking with him I know a bit of what he is like.

He is extremely intellectual, well read, and I see an intense desire for him to learn and understand everything he comes across. I worry that MS will affect his ability to enjoy intellectual undertakings, like reading and remembering, in the way my depression and maybe also, the medications I take, have pretty much destroyed my ability to read, remember, follow any book that is more difficult than a newspaper.

Short term memory problems can really be a huge barrier to being able to follow plot lines, or in the case of academic articles, scientific information. Not being able to read has caused an intense sense of loss in me. I hope Dr. X's MS does not affect him in this way. I also know he plays the piano, and is very physically active. I pray he is able to continue these pursuits. I am really worried for him.

Now comes the really selfish part. I am really worried for me too. A huge part of me wishes I could magically become better so I did not need his support. I want so badly to be better for him, so he had one less thing to worry about. I understand how a chronic illness can impact your life. I recognize that at some point he may have to use what energy and good days he has to take care of himself and his family. Even though I completely understand how his need to make himself and his health and well being need to be the most important thing in his life, I am terrified he will leave work. I am so scared I will never see him again. I feel afraid losing him will be a loss in the way losing my Mom was a loss.

I have never met anyone like him. I know that without him I would never have survived these past 6.5 years. I recognize I am stronger now, but I am certain there is no person on earth I could connect with, open up too, and be as honest and open as I am with him.

He gets me, like I know no other pdoc ever would or could. He understands my lifelong search for meaning and purpose. He always gives me the sense that I am a normal human being, with intense, yet not strange or unordinary struggles, without my feeling dismissed or misunderstood. He understands how important my dreams and their symbolism are to me and my life, how much value I place on my struggle to create, expand and relay my search for meaning to others and how important my working towards a purposeful life is to my well being. He gets me.

I am so afraid I will have to start from scratch with someone else; that I simply will not connect to a new person, that I will need to spend this long learning to trust someone else, Most of all I am so scared I will lose my connection to someone who is as important to me as someone in my family. Even if he needs to leave work to take care of himself. I am terrified of the sense of loss I would feel if I could never see him again.

Loss

I am at my sister's. She lives about 250 km from me, in the town my Mom used to live in before she died. I used to come to this town all the time, but since Mom died it is almost impossible for me to come here. It feels empty and I feel alone and sad, even when surrounded by the family I love.

Yesterday I drove to the house my Mom used to live in. I haven't been there since she passed away. I pulled over at the side of the road across from her house and sobbed. I am crying right now. The loss of my Mom and how it has affected me is impossible to relay. I loved her more than anything in the world and three years after her death I am still having a really difficult time accepting I will never see her again.

I have been at my sister's for a few days now. I love my sister and her kids so much, but I feel more alone with them, than I do when I am alone at home. We rarely talk about Mom, and I feel like my presence is a reminder to her of our loss, and her presence is a reminder to me of that loss. I just want to go home, but I have to go to a family wedding today.

I am dreading it, in the same way I dreaded that party two weeks ago. I already feel dissociative and I'm not even there yet. I am exhausted and afraid of all the people I will have to be someone else for. All I want to do is go back to bed.

Recurring Nightmare

My latest painting. I have no title yet. It represents a nightmare I have over and over again, where I am being chased through the woods and some kind of post apocolyptic landscape full of broken down buildings and homes, tons of rubble and cement everywhere.

I run, and I run all the while screaming help me, help me! My husband and Dad stand off at the side and watch. No one tries to help me.

Finally, in desperation I climb up onto a big peice of cement to try to save myself, but I fall. The wolf is snarling and on top of me. He is foaming at the mouth and he is about to bite my head or neck and I always wake up at this point absolutely terrified.

When I wake I can't tell if it was a dream, or real. Usually I have to go to the bathroom upon waking, but I am too scared to get out of bed. It usually takes me a couple minutes or more before I calm down, realize it is a dream and am able to climb out of bed.

Stream of Consciousness

Jazz over at "In Pieces" has a great blog where she provides us with a writing prompt each day. Today I was stuck for something to say and her prompt sounds like an interesting exercise:

"Writing Prompt: Set aside twenty minutes or so and do a brain dump. Just write whatever is on your mind no matter how mundane or boring. Even if you have nothing to say, write that. The trick is to just keep your hand moving the pen across the page for twenty minutes. When you have finished, sit in silence for a few moments and ask yourself how you feel. Do you feel more collected? Less scattered? Consider whether or not a morning brain-dump might be a helpful thing to add to your arsenal of wellness tools."

Here goes:

I am really worried about Dr. X. His office called to say he was away sick this week. He is never away, for any reason. He hasn't seemed well the past couple weeks, in fact the past couple months he's seemed a bit distracted. Now I am really worried. Worried he is sick like my Mom was sick. What if he were. I couldn't bear to lose him. How would I deal with that? I know my mind is taking me down that negative road, and for all I know he could just have the flu, but it seems like he has been worried about something lately. I even brought up my attachment to him, and how much he means to me in our sessions a couple times, because I felt something was wrong.

My mood is dropping again. Part of it is that worry about Dr. X and his well being, and part of it is the letter from my insurance company. I now feel like I am being watched (once again). At the bottom of the request for detailed minitue (sp?) of my day and any work or volunteer work I do they are making me sign the form saying I understand all my statements will be investigated and that they will contact the people I volunteer for etc. They don't get it. The more they put the fear of being spied on into me, the more I believe i am being watched, and the more I am afraid to do anything that might indicate to the non-psychiatrist eye that I am well and ready to return to work.

I am one of those people who is able to put a face on when I have to, so the studio I volunteer at, and even when i was working, my workmates and bosses, never had any idea I was sick. I can hide behind a type of false boisterousness for short periods of time, but the price I pay is exhaustion and an intense need to be alone. I believe I am working really hard at getting well, but I know I am no where near well. I need more "safe" time more time to slowly build my stamina. 5-6 hours a week volunteering in a supportive environment, where I can call in sick anytime I need to, where I have complete backup, in no way resembles a fast paced and highly stressful workplace where I am in fear of losing my job all the time.

Last week I wanted to commit suicide so badly. It isn't even that I feel as bad as I did before. I just feel like I will never get WELL...the capitals are intentional and represent the well that is me when I feel empowered, completely not depressed, powerful and excited about life, social and extremely outgoing.

All I want now, even though I feel better than I did, is to hide away at home, not answer the door, keep the curtains closed (so no one can watch me).. I have the means and opportunity to commit suicide. Last week I didn't because all my nieces have birthdays in these two/three weeks. I do not in any way want my death associated with such joyous occasions. I just want to go, and i feel like the time is getting closer and closer.

I wish my family could understand that my going would be a blessing. My pain would end. I do not know if they understand how painful it is to feel depressed all the time. Even I did not "get" what depression really could become until these last 6-7 years. Before I was depressed, but nothing I went through came even close to the length and intensity of this major depressive episode.

I have to teach today. I feel stressed out and angry that i have made that commitment. All I want to do is crawl into bed and stay there. Hide form the world, hide from myself, avoid life...this in itself is a "little death". Maybe if I do this long enough I will disappear.

20 minutes is harder than I thought. I don't know if any of you get what I mean when I see death as an intense relief. I think anyone who has not been depressed has a difficult time getting it. Even my pdoc. I think he gets it on an intellectual level, but I think he believes the desire to die will end with the relief of symptoms. I don't think that is true for me, because for me...I KNOW the symptoms will return, They never go away for ever, and every time they return they are worse. What kind of existence is that. I wish we were allowed to be put to sleep. My biggest fear is surviving suicide. I am so afraid I will miscalculate my plan and end up both severely depressed and lose my brain, or be completely physically trapped in a body that won't work. I would choose euthanasia if it were available.

I still have one more minute. I guess there is an upside to my depression. I met my pdoc and he has enhanced the life I have. I also met lots of people online who have also enhanced my life. I am grateful for that. Thanks for listening.
(20 minutes are up)

I feel exhausted. This might not be a good idea for me when depressed. It was why I stopped writing in my journals...I became too negative and focused on my depression. When well I can see how it might help me get ideas out on paper. Thanks Jazz for the idea.

Is it a Love Hurt Thing?

1. My husband hates pharmaceuticals, especially psychiatric medications and especially if my pdoc augments or mixes medications to try to help me. He says the meds have kept me chronically depressed. We get in HUGE fights over my being on meds/trying different meds.

2. I understand/believe I have an illness. I believe, and my pdoc has told me he believes, my illness is biological and/or genetic.

3. Two days ago my husband came to my therapy session with my pdoc. He sounded much more rational and understanding about medications when talking to my pdoc than he is when he talks to, or yells at, me.

4. Today I went and saw my pdoc again and he says he thinks I should go off all medication for a while and really work on my relationship with my husband and other non-medication things (like exercise, eating well etc.)

5. I lost it...I feel so ashamed of how I reacted:

• At first I thought he was concerned about me using medications he prescribes to commit suicide. I said something really stupid like, "I can commit suicide without the medications. I don't need them for that"...partly because a couple weeks ago he was asking me about whether I was hoarding meds again. He caught me off guard and I felt really embarrassed that I had been saving any leftover meds. I have not been hoarding meds that I am supposed to take...When I left his office I was worried he might have been left with the impression that I have been noncompliant with my meds. Not so. I (almost) always take my meds the way he prescribes them. The ONLY times I have not is with benzodiazepines and sleeping medications...I sometimes have increased them, or reduced them on my own, either because, I feel like I can't calm down, or sleep on the dose he prescribes, or alternately , I start to feel addicted, and want off them "NOW".
• Then I felt like it was too much of a coincidence that he makes this decision right after he met with my husband and myself.
• I really do not think my marriage is fixable. I do not even know if I want to be married anymore given how my husband has treated me while I have been struggling so hard. The last few days I believe I have come to terms with the failure of our marriage. So why do I want to risk my well being for something I do not even know I if I want to preserve?
• I feel like my life is finite and I want to get well as fast as I can. I do not want to waste six months not trying to find medication/s that might help only to find that time off meds was a waste of precious time.
  

6. My pdoc says no medications will be able to help me if I am constantly having battles with my husband at home about the medications.

7. I felt like my pdoc was taking my husband's side and my family's side.

8. I already feel let down by the therapist at the clubhouse I go to. The feedback she gave me has increased my paranoia and suspicion about all the therapists and the members there and what they think of me. I feel like a couple members may have complained about me...(they are nice to my face, but talk negatively about other people)...so I extrapolate that to... "They talk bad about me". Plus, I feel like all the therapists must have been involved for the head therapist to say something...especially given the day prior to being talked to it was another therapist who talked to me when I was upset. I feel like I am an outcast.

9. Now I feel like my pdoc is on someone else's side. Except, I am pretty sure, based on my past experience with him, he is on my side...but I'm feeling really confused by this reversal of our previous discussions.

10. I feel like my husband and family are underestimating how depressed I've been, how much it impacts my life and the consequences and potential consequences of my being severely depressed for this long (six years...almost the whole time) Their "Get out and do more things" comments make me feel like they have no idea what it is like to be INCAPACITATED by depression for this long.

11. Now I wonder what my pdoc is thinking? I thought he understood how desperate I am to get well and how important it is that I get well as quickly as possible. I am really upset by this sudden turn in his treatment plan. For months we have discussed treatment plans in terms of medication and maybe my going to the hospital and maybe ECT. He has never pushed medications, but has always talked in terms of our eventually finding a medication, or medications, that would help me . I know I need to do more than take medication. I need to work hard to get my life back, but I cannot manage to do those things when I am this depressed. I need something to help lift my mood enough so I can manage to become motivated to begin living again.

12. I have never, ever read "stop medications" as a strategy to treat Chronic Major Depression, or Treatment Resistant Depression. It feels like he is giving up on me.

13. My husband says he is looking into his future and does not think he wants the rest of his life, what life he has left, to be impacted by my depressed and unstable mood. We have talked several times in the last 4 days about my moving out.

14. I love my husband and I feel so sad I have impacted his life in such a negative way. It was me who initially suggested I move out both because I know my not getting well in a timely manner is hard on my husband's wellness. He is depressed now because of it. Also, I feel I will not get well with us constantly fighting over my medications.

15. I asked my pdoc to let us first try increasing my Carbamazepine to 800mg for 3 weeks to see if that will help my mood. It has not helped thus far, however, I have also had no bad side effects and that's good. My pdoc agreed to try, but he did not sound very hopeful.

16. I feel so confused, sad, angry, and abandoned by my husband, my family, my pdoc, the art clubhouse I go to, my friends (all of them have given up on me), even my dog, because he is really sick again and I know he will pass away soon.

17. Over the past couple days, it's hard to explain, but I have a cloak over all those emotions. I feel nothing, despondent, like I have no emotions anymore...nothing left to feel. Everything is so bad in my life right now that I see no hope anymore.