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.

Anxiety and Obsessions

The past few weeks I would say overall my mood has been better, although it's lability is still showing. I always am feeling bad in the morning and then better midday, and then I get exhausted around 4-5pm, have a long nap...or just laying down from exhaustion (1-3 hours) and feel a bit revived.

The problem is my anxiety is getting worse, and worse, and worse. I am not sleeping as well and I have a weird sensation inside me that I can only describe as an obsession. I have increased my valium, but it is not helping.

Do you remember when you were young (a teenager) and you fell inexplicably and madly in love with someone and you could not stop thinking about that person. Do you remember the feelings that seemed like a mixture of intense energy inside you that was off the charts, anxiety, a sense that you were helpless in terms of your obsession, feelings that were out of your control, strange and made no sense. Am I making any sense?

I am having problems with those types of feelings right now. Not really directed at a person, rather directed at a fear I have hurt someone, or exposed someone, or been selfish and caused someone else to worry, or feel bad. I feel sick that I might have said things I did not mean to say, or opened up and this person may have misunderstood what I actually meant to say (vs. their understanding what I said)

I feel that same sick feeling I did when I was young and cheated on someone, or did some foolish thing without thinking of the consequences of my actions. The feelings of regret I felt after the fallout of an intense upswing in mood, and my inability to set boundaries for myself had me doing things that destroyed a relationship.

This post may not make any sense, but I needed to get out all these guilty feelings...because they are eating me up inside. I suspect some of my increase in anxiety this week is driven by these obsessive feelings of guilt and betrayal; feeling that I have been disloyal. Not all of the anxiety is related to this though, as those feelings have been clearly increasing over the past 4-5 weeks. I sort of see it is possible the anxiety is feeding the obsessive worrying and guilty feelings; making me worry excessively about things.

My Depression is Returning

Even as I was answering the question, "How do I manage my depression"? I could feel my mood slipping. In my session last week I was frustrated that my creativity seems to have disappeared. The ability to paint, which seemed so innate, and was pouring out of me, is gone.

After talking with Dr. X about this, and him being supportive and suggesting it hadn't disappeared I came home and tried to paint. Leaving my appointments and trying to do what I tell my pdoc I cannot do is a common occurrence with me. Something about telling him I can't do something challenges myself to try.

So I tried, and nothing worked. I tried again the next day, and the outcome was pure frustration. I tried again the next day and I became angry and annoyed that something that seemed so easy a few weeks ago was so complicated and irritating now. I tried playing my guitar twice yesterday too, but again it ended in me feeling annoyed and angry that I could not get such a simple lesson. I had my blues lesson today and for the first hour I was awkward. My fingers and brain wouldn't connect. Simple rhythms would come and then suddenly disappear. My brain feels like a sieve; a sieve that only pours out things I want to learn, or things I want to do, things I want to retain, but instead on that holds in all the garbage I want to rid myself of; a clogged up and broken sieve.

My mood is slipping, and I'm scared the depression is sinking back into me. I am obsessing about my mouth movements (this is how the thoughts go...and they are rapid and circular and seem like they will never stop):

"Oh God I have Tardive Dyskinesia, but what if I go to the neurologist and he doesn't see the movements, so many of the movements are inside my mouth, my tongue is pushing in a weird way inside my mouth, my lips are pursing, and it feels like my lips are really tight together, my teeth are tapping, and grinding and clenching, but the only external notification of this is a tiny movement by my temples which is covered by my hair, My cheeks and lips are making strange movements every once in a while, my eyebrows are going up every so often, my toes are wiggling annoyingly but maybe I am just so conscious that I have a problem that I am making it happen, I feel it, but what if I'm just making it happen by thinking about it so much, what if the neurologist thinks I'm faking it, what if he doesn't believe me, what if he doesn't see what I'm seeing and feeling, what if he says nothing is going on, but I know something is going on, and I'm scared it will get worse, but what if no one see it, or believes me, what if it really isn't there and I'm imagining it (not consciously, but subconsciously), I have had so many times when I have felt physically ill, or like something is wrong and it often turns out to be nothing, what if I'm just a hypochondriac, but what if it's real, and what if it is permanent, and what if it gets worse, Oh God, I have TD....etc., etc."

This is what was going through my head all day yesterday, and it is back again today. The thoughts are obsessive, and relentless. On top of this the 4-8 bars of repetitive music is starting to come back into my head; the same beat/section of a song, over and over and over.

I'm not sleeping well again. I am irritable. I am feeling much more anxious. I do not want to see people. I have avoided the art clubhouse. I feel depressed again.

Oh God, please do not let my depression return .

Prozac and Tardive Dyskinesia

I am intensely worried. Remember I was telling you about my teeth clicking and the relentless snippets of music running through my head? Well my problems in this area are getting worse, not better, despite taking clonidine to try to help the teeth clicking problem.

My teeth "clicking has turned into a "chewing" like motion. This triggered a worry in me that I may be exhibiting symptoms of Tardive Dyskinesia. Yesterday I went to Pubmed and WebMD and searched to see if it was possible to get TD from Prozac. It appears that both patients and Drs have experienced Prozac leading to this side effect.

I began researching more and found I am having numerous symptoms. Obviously, I am not a pdoc, so I cannot say I have or do not have TD symptoms, because, while I can read what they are, I do not have the knowledge to determine I the physical changes I am experiencing are TD...but I feel I am exhibiting enough of what I have read to be really scared.


Here are the psychological and physical changes I have experienced since starting Prozac:

1. My mood has lifted. It's not great, but it is way better than what it was. Sometimes I even feel good. This is a huge shift for me.
2. My mouth is moving in a "chewing" motion, or a "grinding" motion. At times my teeth are tapping to the music in my head. (more about the music later). My jaw feel clenched while this is going on. It is semi-unconscious". Meaning I can stop it for a while if I really focus on stopping it, but as soon as I stop focusing on stopping it the movements begin again. I thought it was happening constantly, but it seems there are times when it stops, starts on its own. I'm not sure if it stops when I'm sleeping. I think so, because when I wake up my immediate thought is..."thank god it's stopped, but then it begins again. If I take Valium at night, it slows down, or stops altogether.
3. My toes are moving up and down, sometimes my feet "squirm" (move up and down, twist upwards) along with the tapping. This is not continuous...not sure what triggers it...maybe anxiety. They are doing it right now. This type of tapping has happened before in my therapy sessions when I get really stressed out. However, it is happening much more often since I began Prozac.
4. My fingers tap...this is similar to the toes, and often happens at the same time as the toes. It appears to be doing it to the music in my head, and is very, very fast...sometimes outside music is playing, but it is not in rhythm with that.
5. This one is weird...I am periodically making a weird, unconscious sound sometimes. It is hard to describe...the best I can describe it is air passing through my voice box, making almost a moaning sound. This is embarrassing as it comes when I'm not expecting a sound. I feel embarrassed that others might hear it.
6. I have obsessive snippets of anywhere from 2-6 bars of music playing over and over rapidly in my head. These are not aural hallucinations. They are thoughts of the music...like when you get a song stuck in your head. Early on it was 4-5 bars of a portion of the same Schumann piano piece playing maniacally through my head...for days. Now I seem to be picking up music from what I am listening to, or advertising jingles, but it is NEVER the whole piece of music, but an annoyingly tiny portion of it over and over and over and over...(you get the picture).
7. I am having increasingly anxious and obsessive thoughts. By "obsessive" I mean I am not bringing them into my head. They are appearing like a constant negative feedback loop, rapidly firing bad thoughts at me. The strange thing is, while they, along with the music and my teeth/mouth problems are making me exceedingly anxious, I am not feeling the sadness, sorrow, or depression that usually accompanies them.

• An example of the above I have been having suicidal thoughts, over and over and over, yet my mood feels okay. The thoughts are about how I could o/d on all my hoarded medications and my dogs heart medications. Usually I cry, or feel sad while having these thoughts. Now I feel anxious because the thoughts won't stop, but nothing in me feels sad about them. In fact, they seem pretty reasonable.
• Another example is my having negative thoughts about myself. Bad thoughts over and over about how I'm crazy, I am becoming increasingly bizarre, I'm a bad person, I will never get well, there is something deeply disturbing about the person I have become, & (suspicious thoughts) my pdoc is not telling me everything, he is keeping something from me, he's not telling me the truth about my diagnosis etc. Again, the thoughts are causing severe anxiety, my heart rate is up to 78-80 while I'm having them (it's usually 60) and they are coming at me at a rapid rate, but I don't feel depressed, or sad, just really angry, irritable and really anxious.

My pdoc has told me he believes the teeth "tapping" is a Prozac induced "tic". The music he says is an OCD symptom (I have many of those anyways). I called him yesterday because when I went to Pubmed and Webmd, and began looking at TD symptoms, to me, the untrained "experiencee", it seemed I had a few of them. I recognize the difference between my untrained understanding of a description of an illness (TD) and the trained understanding/knowledge of a psychiatrist. I really KNOW nothing about TD and how it presents, and I should trust my pdoc does, but I still cannot help being frightened by what I am experiencing.

I phoned my pdoc yesterday to ask if I can stop taking Prozac. When I called I was anxious to the point of feeling distraught. I explained my fears. He said: "I have never expressed or thought of your Prozac side effects as TD". I asked him if he thought my fears were unreasonable, explaining the Prozac makes me feel better, but I am afraid I will have a permanent physical problem(TD). He said no I was not being unreasonable, especially if the symptoms were getting worse and not subsiding at all.

Some part of me wanted him to categorically claim that my symptoms were definately not TD and to keep taking the Prozac until I saw him again next week. I think when I phoned I was looking for reassurance that it was safe to keep taking it, that my fears were unfounded, not support to quit taking it. I really don't WANT to stop taking it as at least, for the first time in years, my mood has lifted. What if I never find something else that helps?

I must frustrate the hell out of my pdoc

Remembered snippets of my conversation in my session today...may not be entirely accurate, but I'm trying to clearly recall

Me: I feel tormented. All I can think about is suicide. I'm not sleeping and I am tired all the time. I get up at 9-9:30 and then am back in bed at noon. I want to die.

Dr. X.: are your thoughts conscious thoughts?

Me: No they feel intrusive, like they won't go away, like they are pushing me.

Dr. X.: What is the nature of your thoughts?

Me: I keep thinking over and over if I could overdose on the meds I have at home. I keep looking up on the Internet how to die, how much of each medication I need to ensure death (I have quite a bit). The last thing I want is to survive and be physically and mentally ill/hurt. I keep thinking I could take all my pills and drown myself as I become unconscious...just to be sure.

Dr. X: There is always a hospital stay. (he has mentioned this every week for at least the past 6 weeks)

Me: ...but I have committed to so many things and I have so many things I need to do. I cannot go into the hospital.

Dr. X.: You do not have to do the things you committed to. It would be best for you to take care of yourself first. The hospital seemed to help you last time.

Me: ...You don't know me (him...with a look of surprise? or maybe a bit stunned or hurt that I said that)...when I commit it is almost impossible to not do the thing.

Me: ...My sister and brother-in-law are coming on the 11th for 4 days and my sister and her family are coming on the 12th for a day and night. My house is a disaster, disgusting, messy, dirty. I have to clean it, but I can barely move.

Dr.X.: You do not have to clean your house for your visiting relatives

Me: I DO have to clean my house. It's disgusting. Besides people will judge me for those sorts of things.

Dr. X.: People will judge you for all sorts of things, maybe it is important to let things go and allow the judgement and maybe allow your embarrassment to happen. (to learn I can't be embarrassed to death)

We made a list of all my commitments and went through each one and he tried to get me to see the world wouldn't end if I "uncommitted" to any of them.

We talked about the value of a hospital stay, but I know I cannot escape what I have said I will do. Maybe that is my way of pushing myself into the future? My way of ensuring I remain...I feel obligated? Who knows. All I know is I think I can hang on for a couple months and I am not committing to anything beyond that. Maybe then I can let myself get the help I need.

Anyways...it ended with him encouraging me to bring my old meds into our next session so he could dispose of them and I would no longer have them tormenting me with a means to an end.