Catch Up

I have been in the hospital so haven't been able to keep up with my postings or responses. I apologize. I am still "technically" in the hospital, but am out on a pass right now. It feels so good to be at home!!!

This post is going to be a smattering of things I have been doing, information about treatments for depression I have been receiving and results I have experiencing from those treatments. Here goes...

1) ECT (electroconvulsive therapy)...I remember, years ago when I was in university, the student newspaper published an whole issue that was radically anti-electroconvulsive therapy (ECT). Am I ever glad I never listened to all the negative hype and (with trusted support and help) decided for myself whether I would try ECT as a treatment.

I have been receiving unilateral ECT treatments approximately 3X/week for 3 weeks. The X-mas holidays made it a bit mixed up. For the past couple weeks I have had ECT treatments once a week. I said in the previous post my increase in mood has been nothing short of miraculous. I was so severely depressed a couple weeks ago, and throughout most of the past 17 plus years( ...actually I had MDE's even before that, but the worst ones and this past 10 year plus treatment resistant MDE, have occurred in the past two decades).

Yesterday and the day before my mood was so intensely high I felt like I was in heaven. My self had come back!!! I was bubbly, effusive, effervescent, talkative, extremely outgoing, energetic, so happy I cannot even describe it. I felt like I was glowing, beautiful, and I felt extremely sexy and sexual. This is how I feel when I feel well. I think the intensity feels so strong because feeling good for me has been so hard to achieve, and suddenly all my bad feelings and thoughts were gone.

Unfortunately, my mood began to crash last night, but nowhere near as low/bad as it was before. It definitely is low though...which is upsetting, as I have seen this kind of cycling mood before, where I become my high self for a few days, only to crash and burn a few days later.

I am hoping this crash is temporary, and caused by my not sleeping the other night. I slept last night, and hopefully will sleep again tonight, and maybe that will help lift my mood again.

2) I don't even want to write this, but I will...I wonder if I have been hypomanic the past couple days. I really did not think so, until my boyfriend and I started discussing my behaviour and he told me I was being really pushy about sex. Until he said that I just felt like me and my "true" high sex drive had returned.

I know I have a much higher libido than many women...even when severely depressed, if sex is initiated by someone else I almost always am happy to participate...though I have difficulty initiating when depressed). I was feeling extremely sexual last night, and I can see how my boyfriend might have felt a bit overwhelmed by my advances, as he was not feeling very well.

He told me that sometimes when I am "high" I get really demanding and pushy. I have received this feedback from other people before, that sometimes I am so "ramped up" and "on", and when I am I sometimes demand the same level of energy and competence from others. I have seen this in myself too. I can tone it down, but unless I constantly pay attention to my behaviour I tend to slip right back into high energy mode.

Problem is...I think this behaviour is my personality...not my mood. Many members in my family have this same personality...super on all the time, constantly busy and always doing many things at the same time. My Dad is like this, as are both my sisters. I am a bit more outgoing, talkative, and effusive than them, but my paternal grandmother was EXACTLY like me, right down to being easily annoyed by anyone who couldn't keep up with her.

I am not saying that I am proud of my negative behaviour, but unfortunately I think my pushiness is tied to my "high" personality. In my defense...unlike my Grandma...who could really hurt others feelings with her insensitivity, I am really sensitive myself and knowing how easy it is to feel hurt by someone else, I try really, really hard to not hurt others, or effect them in a negative way. While sometimes I do make mistakes, or forget to hold back; I work hard to be as thoughtful, and aware of how by behaviour affects others as I possibly can.

There is more to write, but I need a break...I will continue to write again soon. Take care everyone.

P.S. Thank you so much to all the friends, readers, and health care professionals who have helped me throughout my depression. Of course, an especially big thank you goes out to Dr. K. (my psychiatrist). I would not be here without him. He is one of the most caring, knowledgeable and consistently supportive doctors and people I have ever had the pleasure to work with. Thank you so much for never giving up on me.

Kafkaesque Bureaucratic Nightmare

My life already feels like a bad dream. Today, trying to get the care I need, in the manner I need it made me feel like I must be a character in a Kafka novel.

My province's (BC) Mental Healthcare system's rigid and top down dictatorial, rule bound, and unsympathetic, inflexible bureaucracy seems to forget that people with mental illnesses require "patient's needs focused care" (rather than bureaucracy-needs focused care), just like patients with physical illnesses. Right now I am frustrated, angry, even more depressed. I had an appointment with Dr. X. today, because I want a referral to receive ECT as an outpatient. He contacted the ECT coordinator at the hospital, and they said I had to have someone with me for 24 hours after each treatment. Period.

It didn't matter that last time I had ECT I was fine and able to care for myself a few hours after the procedure. My only option if no one was available 24hrs/day, three days a week, was to go in as an inpatient.

I felt really annoyed and angry about this, thought it was ridiculous and one of those irritatingly bureaucratic rules where people forget that patients have varying needs, and flexibility would go a long way towards helping patients get there needs met. Patients getting their needs met is what a hospital is supposed to be about...isn't it? The next thing that happened showed me just how unpatient focused BC's Mental Health system can be. I have no idea how people who are even more ill than me get the help they need.

So...Dr. X. and I discussed my going in as an inpatient. I asked him what he would recommend for me, knowing how I am feeling, and he thought going in as an inpatient would be the best thing. Despite really not wanting to be an psychiatric inpatient...for lots of reasons: loss of autonomy, stigma, scrutiny, potentially getting a misdiagnosis in my file, because a new doctor sees something in the 20 minutes they see me, that my careful, diligent, and intelligent psychiatrist has not seen in my nine years of treatment, loss of freedom, being away from my dog, having to share a room with someone I don't know, phobia of getting bedbugs or lice from a public bed, etc. The reasons are many and and varied, and each of them really impacts my fear and lack of trust that I will be treated fairly. I am afraid I will be harmed, rather than helped by an inpatient stay.

...despite all that, I agreed to go into the hospital.

This is where the real Kafkaesque bureaucracy begins...
I asked Dr. X. to refer me to the hospital next door to where his office is. This is where I went before for ECT. My experience had been okay, and some of it had been really positive. I trusted that going there would be okay.

What follows is none of DR. X's doing...I could tell he wished he could send m,e to the Mood Disorders ward I went to before. I appreciate all he has done to help me and can see he tried to help me, but the system has too many blocks, rules, and idiotic systems in place to allow him to refer me to the University Hospital...

Dr. X told me he cannot refer to the mood disorders ward at the University anymore. All referrals for inpatient ECT had to be done at VG Hospital's emergency department. I listened carefully, thinking he could send a referral to the emergency department and then maybe they phoned me when a bed became available.

They wouldn't make a severely depressed people, (who had a diagnosis, and whose personal psychiatrist was recommending inpatient ECT), sit in the emergency room all day or all night, go through a slew of questions and questionnaires by nurses, psychologists, social workers, residents and doctors: They wouldn't make me sit in an emergency room when I was feeling this unwell and knew what I needed to do to help myself...would they?

They would. In order to be an inpatient I have to go to the emergency room, sit there patiently and politely for potentially hours, and even then I may not be given ECT.

This enrages me. I do not believe that a chronically physically ill person, who had a specialist who had seen them for years, and who now wanted to refer her for some kind of surgery, or other "in hospital" care or program, would be told to send their patient to emergency, where they would be interviewed poked and prodded by numerous hospital staff, and if and when a hospital bed became available, then MAYBE they would be admitted for the specialist's requested plan of action.

I do not know how, in the 21st Century, so much discrimination, and inadequate and downright awful treatment, of people with mental illnesses is allowed. I am telling you...if ECT helps me I am going to make it my business to fight for changes to increase the accessibility, availability, and flexibility of treatments and resources available to people needing help for mental illnesses.

I will patiently accept my situation right now, and go through all the hoops and rigamarole to get the help I need, because I don't want to labelled as a difficult patient, or a borderline. I need help so I will work within the system for now, however,...

The system has pissed off the wrong person. I am going to make it my business to see that in the future mental health patients are treated with the respect, the patient focused resources, and the dignity every human being deserves. I do not mean I will blame the doctors, or nurses, or even individual administrators. I might blame the governments insufficient funding and support for mental health services:>0

I mean I will volunteer my time to work towards seeing positive structures, regulations and individualized, patient focused support systems and care are available to ALL people with mental illnesses. My first plan of action will be to find a way to ensure that no person wanting ECT is made to wait in the emergency room, when a referral from a regularily seen psychiatrist should make it easy enough to call the patient when a bed is available.

Anti-Psychiatry, Anti-medication; Thinking Critically about "Antidotes"

I suppose my post today is about thinking critically about any medical treatment you choose, or do not choose. It is about deciding for yourself, maybe with or without someones help, what you are willing to try to achieve your mental health goals. Please do not decide not to follow your psychiatrists treatment plan simply because someone told you someone, somewhere, but they can't remember who or where, had a bad reaction to a particular treatment. Some people have bad reactions to aspirin, it doesn't mean everyone should stop taking, or never take aspirin.

I've noticed more than average antimedication, antitreatment, antipsychiatry comments on my posts lately. Generall,y my first reaction when I read these comments is to become annoyed and brush off the comments as antipsychiatry propaganda or unbalanced, undereducated opinion, or opinions not informed by facts.

I am aware that some of my reaction is a reflection of my own irritation that the treatments I try aren't working. Some of my reaction though is worry that someone, who may really need help for their mental illness, may read the comment and without thinking critically about the other side of the information, might decide they are too afraid to seek treatment, or try a particular treatment.

Today I began thinking that the people/person writing the comments may have had some very bad/awful experiences of there own in psychiatric treatments,; either with the treatments themselves, or the medications. I suppose if I were not completely confident that I was being treated in the best manner possible I might feel that way too. I hope, if people have had bad experiences with their treatment for mental illness, that they find the power inside themselves to find a therapist or psychiatrist that they feel they can trust. I know for me, when nothing seems to help, just having a psychiatrist I connect with on a very deep level helps me keep trying to get better.

I am sorry to see people are having/or have had such negative experiences with their doctors, or medications, or other aspects of psychiatric treatment. It is ironic that although I do not seem to get better, I feel absolutely no anger, or annoyance or fear that I am not receiving the best care possible. You would think after so many failed treatments I might be anti-medication, or anti-ECT, or anti-therapy. I am not. In fact I feel that being treated with so many things has helped me learn about all the treatments available to people. It has also taught me I am very blessed to have Dr. X as my therapist/psychiatrist: very, very blessed.

I read somewhere (Maybe in a book called "Bipolar Disorder: A guide For Patient's and Families", by Francis Mark Mondimore, M.D....great book by the way IMO) that people used to die from being manic. Given there were no mood stabilizer to slow them down they would sometimes just collapse from exhaustion. Given how little was available to help people with mental illnesses even 30 or 40 years ago, I find it remarkable how much has been, and is being developed to help people now.

Some of the comments lately (and in the past) focus on how dangerous the side effects of a particular medication or treatment can be. Part of my difficulty with some of these comments is that they often relay unbalanced, inaccurate, or highly subjective "knowledge". For example, one commenter wrote:

"Antipsychotics are very dangerous drugs and can even cause Parkinson's disease and Tardive Dyskinesia...Many psyche drugs can cause permanent damage to the brain and nervous system...ECT causes memory loss - BRAIN DAMAGE....It has been my experience that most people are depressed for a valid reason...It sometimes goes all the way back to childhood. For someone who is considering incurring brain damage to rid themselves of a problem, I would ask this: What unpleasant truth are you willing to damage yourself in order to hide?" (from, ECT Media Portrayals of Depression comment)

(Note: I am using this particular comment as an example because it covers a range of concerns similar to many of the comments other people, who suggest psychiatry/psychiatric treatments don't work, are dangerous etc., often make,)

My understanding of some of the above treatments considers some of what this commenter has suggested. Yes, I believe use of antipsychotics should be carefully considered, because there is a potential for side effects such as Tardive Dyskinesia, and other unwelcome/dangerous side effects. As a patient I need to decide if my illness warrants taking the chance with the side effects of the medications I try. I have decided that for me, the pain of my continued depression, is far worse than my fear of a side effect that I may, "potentially", (not "necessarily"), experience.

As for "ECT caus[ing] memory loss- brain damage": I understand that memory loss is a fear, and sometimes. or for some, a side effect of ECT. I have had ECT though, and while I did experience some memory loss around the time I was receiving the treatments, I don't believe I permanently lost any memory. I could be mistaken, given that even when I was experiencing short term memory loss while being treated with ECT, it was not me who was noticing it. It was my family members. I couldn't remember, what I couldn't remember(...ha, ha.) Regardless, my choice to try ECT was informed and in fact it was my idea to try it. People underestimate how severe depression can be, and how hard it can be to treat sometimes. My depression was severe enough, and treatment resistant enough for me to decide that even if I had memory loss from ECT, it was worth trying a treatment that was shown to be highly effective in treating depression. I was willing to lose a few memories for the hope of feeling better mentally.

Last, but not least, this commenter, and others with similar concerns, has suggested my depression continues because of some "hidden", or unresolved "truth" from childhood. The truth is I had parents who were at times imperfect...imagine! Like everyone mine childhood was not perfect. Maybe at times my childhood experiences were devastatingly awful, but at times, in fact I'd say most times I had it pretty good. My parents loved me and tried to be good parents. I do have difficulty accepting and understanding some of my experiences in childhood, but I have worked hard in therapy to learn to manage, understand and for the most part accept and forgive some of the bad things. While sometimes I wonder if I have some deep dark hidden secret in my brain somewhere...locked away so deep that I cannot remember...I feel pretty confident that is not the case.

I work hard in therapy with Dr. X and I worked hard in therapy with every therapist I saw. I am open and able to articulate my feelings and work through my experiences. While my depression often makes me ashamed of things, when I am in therapy I work hard to ensure any shame about any memories or experiences is challenged and dealt with. It is not likely that my brain has hidden something from me, some deep dark secret that I cannot face. I feel pretty confident I could face any truth in therapy, especially with Dr. X. because I know he accepts me anyway I am.

For me there is no deep dark past that is keeping me depressed. My depression is keeping me depressed That's it, and I will do all I can, use any and all weapons available to me in the psychiatric arsenal to fight that depression. Of course I will learn about any of the medicines and treatments before I agree to try them. For me though, rejecting theses treatments outright because I am afraid of what I don't know, or because I hear bad things about them, or because I hear/read about other's bad experiences, is not my way of doing things. I try to check out all sides of the story, learn as much as I can, read balanced information, look for scientific information and then make a decision based on as much fact, and as little conjecture as possible.

I know no science is perfect. Mistakes are made. Drug and treatment side effects can be devastating ands sometimes permanent. Companies selling things like medication, treatments, help etc. sometimes lie and cheat. Pharmaceutical companies' studies are sometimes falsified or sometimes only positive drug trial outcomes are published. There are good and bad therapists/psychiatrists, and people in general, out there. It is not easy knowing what will or will not help or harm you.

I believe all we can do is try to find a psychiatrist/therapist whose education, knowledge and experience we trust, take the responsibility to look into treatments offered to us and try to understand the pros and cons, and decide for ourselves what we are willing to try to help ourselves become healthier. For some, they will decide no treatment is the best treatment for them, for others they will willingly try anything their psychiatrist suggests. For me, I will try any treatment that my psychiatrist thinks might help, if I feel is more likely to help me than harm me and I can see that the potential for benefits outweighs the potential for unacceptable side effects. We (my pdoc and I) may not always make the right choices, but they are well thought out choices and the choices I am willing to live with.

"It is the Relationship That Heals"

If this is your psychiatrist or therapist run...

I am always struck by how much support I get in my comments and how many thoughtful people comment. This was going to be a response to the comments in my last post, but it has turned into its own post instead...

I love to hear from people who comment on a regular basis. I feel like over the years I have developed relationships/friendships with many of these people. I also feel really good when I hear from those who rarely or never write. It feels like the beginning of a mutual support system. I am glad my writing reaches out to people. I hope it continues to do so. Your comments often inspire posts...like this one, so comment away.

I write this blog, not just for myself, but also for others trying to work through and battle the same or similar issues and demons. People sometimes comment about how open I am. My original intent for my blog was to try really hard to make this as close to therapy as possible. I wanted to push myself to be open and as completely honest as I thought I needed to be for therapy to work for me.

I also planned to use it to prepare for my therapy sessions, to debrief after my sessions, and to push myself to become brave enough to talk about deeply personal, and often scary thoughts I have. In writing I hoped I am able to show others that therapy is a rewarding, and helpful process, even if it is sometimes really, really hard to fully participate in.

I was hoping that if others could be "insiders" in another person's therapy sessions, if they could see my process, my difficulties, my struggles, my successes, my cycling, my wingbat thoughts and ideas, my creativity, my attempts to get better, and even my failures: I was hoping others might take a chance with their therapist; try hard to open up in therapy, to go to therapy if they never have, to address there darkest secrets, to address any patient/therapist disconnects in therapy, and to find the therapist or psychiatrist that truly fits their needs.

Before I met Dr. X. I had already been to therapy numerous other times each with varying degrees of success, and sadly often failure. With most of the therapists I saw there was either a complete disconnect between myself and them, or if it worked I was in need of a longer course of therapy, and I believe medication which no therapist ever mentioned was available.

I now believe I needed to somehow muster up enough energy to be more of an advocate for myself...Though I know, when severely depressed that may not be possible. If I were to have a second chance to be start at 19 again, if I needed to see a new psychiatrist/therapist, I would approach it as a customer trying to find the best "product"/"service"/treatment for me.

I would be more assertive, have greater expectations, ask more questions and not settle for the first person who comes along. I would have looked for someone like Dr. X from the start. Of course, that is easier said than done.

Below are some of the things I would look for in a psychiatrist/therapist if I had to look again:

When meeting a new psychiatrist or therapist, make a list of the types of behaviours that are important to you in someone you are seeking help from.

Be open to new ideas and approaches.

Ask them questions.

Listen to how they answer your questions. Are they welcoming? Do they sound put off by your questions? Are they caring?, or pushy?, or short?

Do they have time for you?

Are they just medication oriented?

or Do they provide therapy? (I find it really helpful to have a psychiatrist who does both).

Do they LISTEN?

What are there credentials?

What kind of experience do they have treating people like you?

What type of therapy do they practice? I find the less dogmatic about a particular therapy style the better....Use whatever works!

How flexible are they?

Do you feel comfortable around them?

The last sentence...Do you feel comfortable around them? ...is tricky, because many many times, probably during each of my sessions, there is some degree of feeling uncomfortable around Dr. X. Even 8 years into therapy I feel guilty, or ashamed, or afraid, or even angry at him periodically. The test of being comfortable lays in whether I can talk about my uncomfortableness...even if it takes a few sessions.

If I feel he has said or done something I am uncomfortable with, and I can safely work through and see this as an opportunity to discover something about myself and others...then it is indeed a powerful and psychically "comfortable" relationship.

The question I try to ask myself when this happens is whether these feelings are coming from me and my mood or experiences, or whether the psychiatrist or therapist is doing or saying something, that promotes my feeling ashamed, afraid, intimidated etc

I "understand" (in my rational mind) Dr X. is NEVER judgemental, or angry, or pushy, or authoritative, or any other way that might increase or promote my feeling bad in therapy. That does not mean I do not ever feel these things. Who I am, what I have experienced etc. impact my reactions towards all my relationships' experiences and interactions

Some Psychiatrists/Therapists (like some people of every persuasion or occupation) are pushy, or arrogant, or sure whatever they say is right, and the patient knows nothing about helping themselves. They tell the patient to just do whatever they tell them to do etc. This is the kind of therapy/doctor, that I always found did not work for me. For me a good therapist and/or psychiatrist forms a partnership with their patient, values their patients ideas and lets the patient know they are valued

Some of my readers have expressed difficulties, or difficult relationships with, with their psychiatrists and/or therapists. I believe it is important to delving into into why I might feel that way. What kinds of behaviours, exchanges, actions, thoughts are taking place both in and out of therapy that are leading to your feeling a disconnect?

In his book, "Love's Executioner" and in his novels and psychotherapy textbooks, Psychiatrist Irvin Yalom writes and expands upon the idea that, "it is the relationship [between patient & psychiatrist or therapist] that heals". My experiences in therapy with Dr. X have reinforced and proven this to be the case for me.

I try to remember therapy is sometimes difficult. During some phases it can see impossible a lot of the time. As people with depression, or other mental illnesses, (really as people even with no mental illness)... as people period, we may have difficulties with some relationships in the first place; maybe that is even why we are in therapy.

If I find something happening in my sessions that disturbs or perturbs me I always ask myself is the difficulty in therapy the therapist, or have I not opened up and taken the chances I need to take in therapy.

• Is it my issue clouding the session,
• Are my symptoms such that they are affecting my judgement (not always easy to know)
• or is the therapist doing something hurtful that negatively impacts my ability to open up?
• Is my therapist a good therapist?
• Did they just make a mistake,
• or is their attitude always this way?
• Is it my approach to therapy?
• or is it the therapists approach that is making it not work?

The most important thing I can do as a patient is talk to my psychiatrist or therapist if I am feeling uncomfortable, or hurt, or diminished or disconnected in any way. I may not have the courage to bring it up while it is happening, or even during the next session, but if something about my therapy is festering inside me...I always bring it up.

Everytime I have brought difficulties up he is completely open to discussing what went on. He apologizes if a mistake was made on his part, or we discuss my reaction if we discover my perception might be coloured by other things. He accepts and encourages my feedback no matter what. This is part of what makes our relationship so important and the bond so strong.

I guess what I am trying to say here is that the first therapist you see, even the fifth and sixth therapist you see, may not be right for you . Don't give up because your therapy does not seem to be working for you.

Therapy, and good relationships in therapy, is/are hard work. If the relationship between you and your psychiatrist or therapist does not seem to have a positive impact on you maybe try approaching your therapy a different way, or try a different kind of therapy, tell your therapist how you feel. If it still is not working perhaps trying a different therapist or psychiatrist would be the positive change you need.

Choose to Reach Out For Help: That is Truly a Choice

Today's post is a philosophical look at suicide and life. I believe, in most instances, choosing the latter over the former even when in your bleakest, blackest moments is both the moral imperative and the choice people would make if they were feeling well. This is my opinion, but I believe there are good reasons to hold this belief. I hope the reader sees those too.

I am a great proponent of personal choice. I do not believe the State has any business interrupting a person's choice to do whatever it is they wish with their body and their life. As long as you are making your choice of your own freewill, and your choice is not harming another human being, or any sentient being, you should be able to do what you want in any given situation.

Your choosing to commit suicide may seem like it should be your choice. It is after all your body, and your life. In some instances, I believe it truly should be your choice. However, in many, probably most, instances suicide both is not a fully informed choice, nor is it one of those choices in life that harm no one else.

Even a Libertarian, those avid endorsers of freewill and choice, might agree. I suggest this because based on my initial criteria: "You have the right to choose any action as long as it is a choice based on freewill", and, "As long as it harms no other sentient being". Suicide as a valid, moral choice is limited by both.

Is suicide a choice based on freewill? I argue most times it is not. I say this in a moment of clarity, in a moment where suicidal thoughts are not floating through my mind enticing and often imploring me to end my life. Many times over the years (even a few days ago) I would have argued the opposite. When my brain is thinking clearly I can see living is important for so many reasons.

When I feel well, or even if I have brief remissions from my symptoms, I recognize my capacity to "choose" suicide is severely limited by my depression and its symptoms. It is not me who chooses to end my life. It is my illness.

I never plan or decide to commit suicide, or have suicidal ideation, or start pulling out all my hoarded meds, or plan to hang myself when I am thinking clearly. I do these things, think these thoughts, when my illness takes hold of my brain, when it renders me helpless and makes my life seem worthless and hopeless. When I believe suicide is a choice; when I believe I should be allowed to decide to die, I cannot truly choose because reason has left my mind and fear, sadness and desperation have taken over.

The scary thing is the thoughts and plans seem perfectly reasonable, and of my own freewill, at the time. It is only afterwards that I understand my capacity to choose has been impaired by my depression and my cycling mood. I cannot tell the difference between reason and false reason while in the midst of my suicidal sufferings. This is where I have learned to listen to my friends and my psychiatrist, Dr. X. I understand my brain is not "well". I need medication and therapy and extra support. I have learned that when my mind is moving, or stuck in this direction, I need external support and help. When depressed, mentally unwell, or thinking about and planning suicide I need to trust and accept an other's support and opinion.

What about the criteria of not harming another sentient being? The choice to commit suicide, actually the action of committing suicide, cannot fulfill this criteria either.

A very close friend's father committed suicide when my friend was 9 years old. He is 43 right now and he thinks of his father's suicide, is saddened by it, every single day of his life. His father's suicide led to a chain of events that may have been avoided had his father sought treatment and support rather than hang himself.

I won't go into details, but every single person in my friends family, and his family's life has been devastated by a choice his father made while his father was severely depressed. The sad thing is his Dad should have known he was not thinking clearly. His dad was a psychiatrist.

Even professionals who treat others with depression, or any mental illness, may lack the capacity to reason, to clearly choose, when it comes to their own suicidal thoughts, urges and actions. The thing is there are always people hurt and affected when a person commits suicide.

I know in my darkest moments I have sat down and written letters to my family, believing I could explain why I needed to go, and how they would eventually understand that my "choice" was best for us all. I have been so sick that I didn't care if I affected others; times where I kept thinking over and over again I just cannot take it anymore.

When I become less depressed I see how much my suicide would impact those I love. Even if I have no one, which in my depressive episodes has sometimes seemed the case, maybe my death would impact others I am not yet aware of, others who need me, or want me to live.

When depressed, or mentally ill the brain sometimes attempts to, and sadly too often succeeds at, telling us suicide is a choice; that it is the right choice, that it will not harm others. This is an illusion. The choice is not free, nor is it true others will be left unscathed.

Please, please, please...before you make a decision that is not really based on freewill and unbiased choice, a choice all too informed by depression, or an untreated/or undertreated mental illness; before you make a decision that will devastate the people you leave behind (and it will) please seek help.

There are family doctors, therapists, social workers, nurses and psychiatrist who really care about people struggling like we do. I know because I have a psychiatrist who makes my worst days survivable and sometimes even worthwhile because I am able to learn something about myself and others.

Please seek help. Every human being deserves to want to live, to have the option to live, and to build there sad or difficult life into a life that is worthy of their beautiful selves.

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.

Be Embarrassed and Do It Anyways

Today, I woke up depressed, flat, apathetic, a feeling of dissociation throughout my mind...detached, disconnected. Alone.

I met with my friend "Z" and went for a late breakfast and then she took me grocery shopping... a task that I dread and fear when I feel like this.

As we sat having breakfast I felt so cared for and understood by her. I was going on about some "bad girl" stuff and she told me I was like a train...impossible to stop. She meant it as a compliment...like, even when depressed, I have a powerful joie de vivre and head straight into everything I do at full blast straight ahead.

I really like that imagery of a train plowing where it is destined to go, or wherever it desires to go. It made me feel like my old wild self. It made me feel valued for who I am. It also made me recognize I am strong and powerful and there is no stopping me once I get going. Getting going is the hard part.

I have had an awful cold/sore throat for a few weeks now. I cancelled my singing class last week because I didn't think I could sing. When I walked into Dr. X's office and told him I cancelled he suggested I reconsider. He did so for a couple of reasons. He said I could still learn things other than the singing aspect of singing...things like timing or style. He also he wanted me to challenge my fears about making mistakes.

I was afraid to go to my singing lesson because I had completely blown a solo in choir the night before. I was so embarrassed...mortified might be a better word, and I felt sick about my mistakes. He told me that feeling the embarrassment and doing it anyways was a great form of behavioural therapy. This was a great opportunity.

This morning when I woke up depressed and still sick I kept trying to tell myself I shouldn't go to choir practice tonight. I tried to nap and couldn't and as I realized why I couldn't. I clued into the fact that it was not because I felt sick, rather I was ruminating about the mistakes I had made last week. I was AFRAID to go.

I realized this is exactly when Dr. X. explained to me I need to go (which I did). Go, and even make the same mistakes (which I did) and survive the embarrassment (which I also did...though I feel sick about it again)...at least I went and tried.

On my way home, despite my embarrassment and some difficulties feeling like I was "outside the circle" or detached from the group, I felt really good about all I did and accomplished today. I felt good that I recognized a pattern and challenged it head-on. I didn't back out of or cancel because I was depressed. Because I was powerful and challenged myself my mood lifted and I sang to my favourite songs all the way home.

Something is Wrong With This Picture

When I was talking at the family support group last night and I came to the part about the psychiatrist needing to fill out a portion of the tax credit form one of the family members participating in the meeting said: "How is my son's psychiatrist going to fill this section out. They barely know him. They have hardly met with him".

I had a few thoughts in that moment:

1. Something is wrong with this picture. Given how ill it sounded like her son was it does not seem right that the psychiatrists have not met much with him. He isn't even at the point where he has the insight that he has a mental illness. When I mentioned I was in therapy with my pdoc, and that it was a very important (I think the MOST important), aspect of my treatment...the lady looked incredulously at me and could not believe my pdoc participated in therapy with me.
2. I felt guilty. Guilty that her son was so ill and needed help and here I was 7.5 years into therapy, once, and for extended periods twice, a week. I am taking up important resources that others need too. Maybe I need to leave therapy so others can receive the help and support they need to get better.
3. I really think therapy needs to be a part of the healing process. People need human support, they need professional psychiatric support, not just medication. What if this had been me? No medications seemed to help until recently...and I am not even sure about them helping now, as I am still taking them and I feel extremely depressed again. I am sure I would not be here if my pdoc simply prescribed me medication and sent me on my way. My way would not have been merry and I would have given up.
4. I am so extremely lucky that I am cared for by Dr. X. When I first met him I thought it was the norm in psychiatry to treat patients with both therapy and medication. I recognised fairly quickly that Dr X. and his psychiatric style and approaches to treatment were/are far above the norm. I recognised, and still do recognize, meeting him, and having his unflagging support is the biggest blessing I have ever received in my life.

Here is My Truth

My appointment today was at first a bit stressful, but mostly it was uplifting. I am blessed to be a patient of Dr. X. I have known that from the first day I met him. I connect with him in a way that I cannot seem to with anyone else. I am learning, slowly, that connections like this are important to me and I need to search out other people I feel this way about.

I once again felt worried I had destroyed my therapeutic alliance with him, by "outing" my crush on him. A big part of why I am afraid it was the wrong thing to do is that it seems that everyone I say I love you to, or anyone I really really like and say so, always disappears in my life. It is so hard for me to get to the stage where I can actually speak my truth about someone. By the time I do it is too late, or the words magically destroy the bond.

Dr. X told me he was glad I told him, and that it was always important that I speak my truth with him. He also said we have a very strong alliance. I felt he was speaking truthfully, and that it was okay for me to feel whatever I did, and to talk about it openly, safely.

Part of the reason I feel drawn to him is the way he is: introspective, interesting, interested, thoughtful, never angry, calm, compassionate, always supportive, always available.

I have never met any man, my entire life who is these things. It's strange, but I was always drawn to the "bad boys". The men who always wanted to use me, or who wanted only one thing (I wanted that to)...but I also wanted more...and could never figure out why I always received less than I needed.

I watched as all my friends met men, who cared for them, and fell in love with them. By the time I was 27 I had slept with too many men to count, always enjoyed the experiences, but was always left wanting more than sex. I don't know what it is about me, but it seems I am not a lovable person. On top of that I am not sure I have ever loved. I guess that explains not receiving romantic love...you need to feel it to receive it.

This is my truth:

• The first man in my life, my dad, was the pattern from which all my relationships with men were cut. It was the relationship I learned to emulate. Unfortunately I have some of my dad in me. I get angry, and irritated, I am a bit overwhelming sometimes. I don't listen enough. I talk too much.
• My father was controlling, punishing, physically abusive and even worse a dismissive bully who believed the only correct views were his own. He scared me to death. He used intimidation; mental and physical abuse to keep me in line. I am still terrified by him. Almost every time I see him he does something that elicits tears in me. I know I am responsible for the tears, but I cannot make them stop. I cry on the way to his house. I don't want to go, but feel an intense sense of duty to be a good daughter. I humour him when with him to protect myself, but it always backfires. I never mange to stand up for myself.
• I left home the week after high school and moved to a different province. Less than a week after I moved far away from home I was date raped by the first boy I dated in my new town. I don't know what I was thinking, but I went back to his place after going to a club with him. We started kissing and then he began to take my clothes off. I tried to stop him, but he kept saying it was okay, we didn't have to do anything. When I was laying on the bed with him, partially clad, feeling cared for and enjoying the intimacy, feeling attractive and attracted to this man, he began trying to have sex with me. I said no numerous times, but he pushed me down and forced himself into me. As soon as it was over he told me to leave. I got dressed. Left, and cried all the way home. I felt dirty and used. I showered and cleaned myself up. Then I went to the payphone to beg my Mom to let me come home. She kept telling me I was just homesick and I had to stick it out longer and I'd get over it. I was so ashamed that I had let myself be in the position to have sex, that I had led the person on, that inside I had kind of wanted to make out, that I had not fought harder to get out of there. After that night I let men do whatever they wanted with me. If it got rough, something about that turned me on. It was like my being "taken" triggered a need to be taken. I think I lost my ability to love that night.

The truth is, the only man, in my real life (vs. people online), that has ever treated me respectfully is Dr. X. Even with other doctors, or professionals I have always felt either condescended to or dismissed. I can see that maybe my first male role model made it impossible for me to trust men, so all men get painted with the same black brushstrokes. Dr. X is consistently respectful. I need that.

My truth is that I have a lot of pain inside about how my relationships/nonrelationships with men have gone. I don't feel love, because I don't trust anyone. I always expect them to hurt me. I get what I expect.

I don't mean I get what I expect in a "The Secret" kind of way. I don't believe simply expecting others to be honest, fair, truthful and loving will make it so. That is magical thinking. I know that.

I mean I get what I expect, because I act and react to the people I would like to love me, in a way that creates a wall between us, in a way that projects fear and self consciousness. In a way that doesn't come across as genuine, or authentic.

When I am my authentic self I am full of intense passion and a desire to love. I sing loud, and laugh louder. I am overjoyed with being here on earth. I want to experience more, to witness more, to learn more. When I am my authentic self I draw people to me. Unfortunately my authentic self always eventually disappears for days, or weeks, sometimes months, and over the past 10 years into 2 and then 10 years of depression...which leads me to recede, to make myself small, to lose touch with all my talents and skills.

In therapy I think I have finally realized my truth. My truth is that I will always be besot by depressed periods. This is true. I will always have some sort of cycling appear here and there. This is true. What isn't true is that there is no hope, no way out. I have the power, both within me, and by reaching out to others, like my pdoc, to MANAGE to live with the depression.

If I have a structure to at least part of my day everyday, if I have other people or my cats and dog that I am responsible to, if I take my medication regularly, if I keep a regular sleep schedule, if I sit in front of my S.A.D. lamp every morning, if I keep in contact with people who care about me, if I continue to see Dr. X. for support...and maybe especially because I like seeing him, if I create art, if I sing everyday...even if I am sad...actually ESPECIALLY is I am sad, I can manage my life. I can make my life, even if it is a sad one, a life worth living.

It seems ironic, but without my struggles with depression, especially the intense despondency, hopelessness and despair I have felt this last depressive episode, I don't think I would ever have discovered my love for creating art. I may not have rediscovered my intense love for music and singing, I would never have began volunteering. I am not saying depression is a gift...I hate that misplaced platitude. I am saying that without my depression I would never have questioned what I wanted, or who I am. I would have continued on my weary way to a hellish existence. I would never have looked at my life from an existential perspective and asked myself if I loved the life I was living. I did not, but I am beginning to create the life I want. It is remarkable what I am learning about myself. It is remarkable that I am slowly learning it is okay to feel joy.

Long Term or Short Term Therapy

I woke up today embarrassed and stressed that I opened up so much in therapy yesterday. Still I stand by my decision to do so. It was important for me to share my feelings for many reasons. One of the big reasons is I have a sort of "magical thinking" that if I tell someone I care for them they will disappear, or the relationship will end. For this reason I avoid telling many people I care about how much I care for them. Yesterday was my brave attempt to believe that speaking my truth will not affect my relationship with Dr. X. Today I feel the fallout and fear of that decision, but I think sometimes I need to challenge these beliefs, despite feeling the terror of impending loss...

On another note:
In my post yesterday, cbtish said...
"Yes, good therapists recognize the feelings on both sides in a therapeutic relationship.But it has to be said that few good therapists now believe therapy lasting many years, or involving the kind of feelings you describe, is likely to have a positive outcome.So it frightens me, too, that you feel you depend on him so much.The thing is, support, kindness and compassion do not actually promote change — instead, they maintain the status quo. Therapy is meant to be about healing. Things actually happen. Tomorrow is different from yesterday."

I would like to discuss my feelings about the benefits for me, of long term, versus short term therapy.

First thank you cbtish for taking the time to comment. I always enjoy hearing other people's opinions. On some level I agree with cbtish. I think for some people, some of the time, short term Cognitive Behavioural Therapy (CBT) may be the most effective treatment. However, I think we need to be careful that our dogmatic beliefs about a particular therapy do not mean we blanket all people with the same kind of therapy, especially if there are times when it is clear that a particular type of treatment may not be what the patient needs in that moment.

I think for me, during the early years of my illness (17-25) when I had had only a few Major Depressive Episodes CBT worked well for me. By the time I was 25 I had been depressed several times at 25 I saw a Counsellor for 6 sessions of CBT and I remained well for approximately two years. It really helped me. The difference is that at that point my illness was less severe and I was able to do the activities I needed to do to help myself become well again.

However, there were a few things every therapist, counsellor, psychologist and the pdoc I saw before Dr. X missed, or misinformed me about, or neglected to inform me about:

1. That there are medications that can help people. Not a single counsellor/therapist discussed this with me. I discovered this on my own after reading a book about depression. Personally, I think it is negligent to encounter a patient like me, who has had numerous MDE's, and understand that for the most part each seems to last longer and become more severe, yet not inform the patient that medications help some people.


2. Until Dr. X every Counsellor/Therapist I saw was very rigid in the type of therapy they practiced. One believed in CBT, one believed in Eye Movement Desensitization and Reprocessing. (EMDR), another was Jungian, another Psychodynamic etc. I do not believe for me that a particular therapy is necessarily the best approach. My mood disorder is such that my mood cycles between complete inability to even get out bed sometimes, to highly agitated and anxious, to feeling disconnected from everything, to how I feel right now: extremely motivated, content and relaxed. When I am fatigued and extremely depressed short term CBT, or even the ideas of challenging negative thinking does not help me. I do not have the ability to do the actions I need to do to challenge my negative thinking or to change my behaviour. During these times I need supportive therapy. Therapy that helps me understand it is not my fault I am unable to change, or get better. I need help understanding that guilt about how I am is unproductive. I need to know I am cared for no matter how I feel.


3. I need different approaches in therapy depending on how my mood is, and what kind of cycle I am in. When anxious I need someone to help me relax, and learn relaxation techniques. I often also need medications to calm me down. When I am high I need someone who is familiar with CBT and can help me set goals and activate my life, because during these times I have the energy and power to change, when I am agitated and depressed I need to have a therapist who is not rattled by my intense suicidal thoughts, someone I know will listen and not judge me, someone who allows me to speak my truth, When I am severely depressed I need someone who understands and helps me learn to participate in activities outside my house; someone who knows I am struggling, but believes I can do things anyways. Sometimes, I just need someone I feel connected to; someone who I believe accepts and cares for me no matter what.


4. My depression has been treatment resistant believe it is unconscionable to treat a patient for 12-16 sessions, see they were not well still, and end therapy despite the patient remaoning ill. Basically this is what would have happened to me, and happened to me, numerous times. The therapists would treat me, I seemed a bit better, or even much better, but I continuously slipped back into depression. I did not need short term therapy. I needed (and need) long term support to change huge areas of my life, to learn how to make healthier decisions and choices, to learn what kinds of activities drive me forward and which hold me back. My lifestyle has had to change dramatically for me to survive and thrive with and in spite of having this illness. Dramatically changing ones life cannot be done in short term therapy. Personally, for me, I often see that small changes take a very long time. In long term therapy I am able to practice my changes and polish them. I am able to find who I truly am, who I want to be, and how I want to live my life. Before seeing Dr. X I was lead to almost every decision by fear; fear of ending up homeless, jobless, loveless. I am not certain I made any decisions based on what I wanted and enjoyed doing. Long term therapy has allowed me to work through my fear and work towards what stimulates me. I feel I am working towards having a life based on Joy.

I guess what I am saying is there is a time and a place for short term therapy, but to be dogmatic about either short term, or long term therapy is to miss an opportunity to really help a patient change the outline, or structure of their life to one that supports ongoing wellness and resiliency. Patients like me may need ongoing support indefinitely. If I discontinue therapy, it will not be with an eye towards never going back. If I need help again I will return. For me long term therapy, and different types of therapy within my sessions has been extraordinarily effective and helpful . I really believe it is the relationship between the patient and therapist that leads to lasting positive change.

Relationships, trust, and the ability to be truthful and open about all aspects of my life in order that I have the opportunity to address those aspects, can take a long time. The relationship between myself and Dr. X. is strong and I feel safe to make the changes I need to make. I am grateful I have a therapist who understands the psyche may take time to adapt, change, and grow. For me, long term therapy has led to a great deal of positive change; not just surface change, but change that is becoming embedded in my character. This is a great thing.

Fear and Desire

First, before anyone reads this I want everyone to recognize that while I periodically have feelings of love/lust and always care for Dr. X; I believe these are reflections of the difficulties I have with romance, connection and lust in my "real" (i.e. outside therapy) life.

This topic is very difficult for me to write about, but I also believe it is very important to dissect and address the feelings I experience.

While I respect and care deeply for Dr. X as a person and psychiatrist; I feel he is an extraordinary human being...I do not REALLY love Dr. X. I don't really even know him. (It feels kind of sad to say that)

I see him an hour a week and we talk about me. He has strict boundaries and I definitely respect those boundaries. In fact, I am probably more cautious of the boundaries than most Drs, because Dr. X is extremely valuable as a psychiatrist to me. I have no trouble recognizing I am transferring love onto him, rather than feeling love for him. I believe this is a common occurrence in therapy. I also believe gaining insight into my feelings, and why I have those feelings, for my therapist can help me.

The reason I brought the love/lust/caring thing with Dr. X. is not because I wanted him to know how I feel about him...I think he could have guessed that. I am not very transparent. The reason I brought the topic up is I believe it reflects and shows me difficulties and patterns and relationships in my life that need changing. I believe in acknowledging my feelings I have the opportunity to open up at a deeper level than I have ever been able to in therapy. I also believe this needs to happen before I can set about making changes to the relationships I am having trouble with. I think the love I feel for Dr. X. is a reflection of the love and connection I am missing in my "real" life (vs. life in therapy).

I thought it might be helpful to brainstorm some of the real life connections/disconnections that lead me to desire the love of my pdoc. By writing them here I will have a list of things to discuss and work on in therapy.

I came upon a very powerful statement about transference the other day. I have turned it into a question for myself:

What are the feelings the patient has towards the therapist? Examine the feelings the patient has and how they relate to unconscious motivations, desires and fears.
Conscious/Unconscious Motivations that Lead to My Feelings:

• I feel listened to. How could I not feel attracted to someone who listens carefully to what I say; someone who listens not only to what is being said, but also wants to uncover what is not being said. In my real life love relationship I feel unheard, undervalued, and ignored.


• I feel safe. I feel I can say pretty much anything with Dr. X. He never gets mad at me, never yells at me, never challenges my opinion in an angry way. My spouse always seems angry at me.


• I feel cared for. by Dr. X. He is always thoughtful, kind and compassionate. In my real life love relationship I feel the target of a huge amount of anger and frustration. I feel like my husband goes out of his way to avoid me. Much of the time I feel lonely when with him.

Conscious/Unconscious Desires that Propel My Feelings:

• I desire the love of a kind man. Dr. X is like this, always. I recognize it is his job to be this way, but I have NEVER encountered a man like this...ever. It would be hard not to have feelings for someone who, every time you see them, is kind, and thoughtful.
  I used to enjoy casual encounters. On some level I miss the excitement and newness of casual sex. I get bored in my sex life. Dr. X is a powerful "taboo". This excites me. It is the IDEA of a prohibited encounter that excites me.


• I desire a man/woman who wants to spend time with me and who shows me that. I feel wanted (as in I don't feel rejected) in therapy. I often feel rejected by my husband in many areas of our relationship. He calls me greedy for wanting too much sex, or ignores me when we are together, or is angry at me all the time.


• Dr. X seems to enjoy many of the cultural things I do (music, art, intellectual pursuits etc). My husband could care less. It is a chore to get him to participate in cultural events. I feel like we have little in common. I would love a partner who liked to do some of the same things as me.


• Dr. X never seems uncomfortable with my sexuality. Rather he normalizes the desires I have that may seem out of bounds to some. My husband is good like this too. He is really open minded...but he gets jealous. I like to flirt sometimes. It feels like harmless fun to me because I never have the intention to take my flirtation to the next level. I am just flirting as a form of fantasy. I get angry when my husband wants me to stop being a sexual being with anyone but him. I don't mean my having sex with others...though I miss that...I mean innuendo and flirtation, just for the fun of it


• I love a man who is an authority figure. Dr. X is this to me...though we have tried and tried to help me lose that feeling. Part of my sexual psyche craves someone in control, someone who knows what to do, someone who has power over me, someone who "forces" me to do things I do not want to do., etc. I have created a fantasy world where people in my life, other than my husband are doing this for me. I recognize both that Dr. X is not like this with me. He really has tried and tried to help me feel like an equal, but something about how close I feel to him makes me want him to be. This is a weird pattern of behaviour in that, on some level, it reflects my feelings towards my father. He was intensely controlling and my feelings of having an authority figure "force" me to do something, or tell me what to do are holdovers from both my childhood and from how my dad still treats me. I suppose, given my father's authoritative behaviour I always have had a difficult time making decisions for myself. I have an ingrained need to be given the answer, the activity, the way of being. This has slipped over into my sexual fantasy life.

Conscious/Unconscious Fears that Lead to My Feelings:

• I am afraid I am unlovable and cannot love. I feel like I have never been loved by a partner. Likewise, I have never felt "love" for any partner. I care about them, lust after them, am obsessed with them, excited by them etc., but I don't think I have ever truly loved or felt loved. I am not sure why. I think I am so scared I will be rejected that I neglect to allow myself to feel and show love.


• I am afraid my marriage is a sham. I fear I have spent from 27 to 43 (16 years) trying to hold together, repair and survive a marriage that was not meant to be. I am terrified that my husband stays with me just because he doesn't want to hurt me. I am scared we both stay together because the other choice is too difficult to decide and take action towards.


• I am afraid I have become old, depressed and unattractive. On some level, my desire for an "other" reflects my fear I will never be interesting, or desired by anyone else.


• I fear dying and not having experienced true love. Or having missed out on opportunities to exchange an intense and everlasting bond with someone else.

Subjectivity and Objectivity of Symptoms

I explained the types of side effects I was having today, with special concern about my mouth movements and memory. O asked Dr X to watch my mouth and give me some feedback. Dr X. asked me if I wanted to do a memory test. I did. I love things like that...curious minds want to KNOW.

The first test he did was a test for attention. It was made up of all 26 letters of the alphabet and corresponding #'s (A1, B2C3 etc.). The letters and numbers were dispersed willy nilly on the page. The task was to start with A, draw a line to 1, then a line to B, then a line to 2, c then 3 and so on until you finished.

Subjectively I felt really self conscious. I felt like I was going agonizingly slow. I was praying he would let me stop, because I felt stupid. I seemed unable to find letters, then I would scour and scour the page again for the corresponding # and I just felt like I couldn't find any of them. I felt very frustrated. However Dr. X said I seemed really engaged and I was within the norm for attention.

He said he also watched my mouth as I did it and my mouth was not moving outside the norm. That should feel good, knowing he saw nothing, but subjectively I still feel like my lips are pursing tighter and tighter throughout the day, and my tongue is moving like mad. I do feel a bit relieved that others aren't seeing the movements.

Then he gave me a list of 10 words to write down and try to remember. After that, to distract me a bit he asked me to say as many words as I could that started with the letter "F". I thought of a reasonable # of words. He said I was within the norm.

Then he asked me to tell him the ten words I was to have remembered. I could think of only two. I think after prompting and hints I got 1 more...but I really could not visualize the words. It was like they were gone. Which is the problem I have been having with memory...word finding difficulties, remembering things I have just thought of or learned and recalling memories.

These "tests" for different cognitive difficulties makes me wonder how much the subjective experience of depression jives with a psychiatrists objective experience of a person who has depression. I remember a few years ago believing that it was impossible to be more depressed than I was, but Dr. X told me there are people whose depression is more severe. He said this in a caring context, but I was still confused.

To me my depression, when bad, is barely survivable. I can see how maybe people who attempt, or commit suicide, must have a depression that has a darker and deeper hold on them, but it still is difficult to imagine feeling more depressed than some of the times I have experienced over the past 7 years.

Perhaps the mind protects the body and your person, by telling us that this is the worst it could ever be. If this is the worst and we make it through alive, then we know we can make it through this depression. It makes me wonder if my subjective experience of my depression is accurate, or if objectively I am not as depressed as I feel. That is a difficult thing to really understand given I sense I am what I feel, and I don't feel good.

Graciously Accepting Compliments

Yesterday near the end of my session Dr. X looked at me and explained he wanted to say something to me, but he wanted me to accept the compliment, and not reject it, or become self effacing about it. He really wanted me to try hard to accept and embrace what he was about to say. At this point I became extremely self-conscious and worried about what he was about to say.

At this moment, as I write, I am going to practice accepting praise at face value AND being proud of myself:

He began to express how much he like my blog. Not just that he went on in detail about what he like about it. I don't even remember what it was he said about it, because I was listening and it all seemed surreal. It seemed unlikely that someone like him, someone so important to me, someone so intelligent and well read would see so much value in what I write. I wish I could remember what he said, because after he said it I was flabbergasted. Yet, at the same time could not help but doubt the sincerity of such profoundly kind and elaborate praise.

I tried REALLY hard to just ACCEPT what he was saying, but I couldn't help let slip, "Are you serious? Do you really mean that?". He looked at me with a slight look of consternation that told me I had slipped up and done exactly what I had promised not to do. I was supposed to accept what he said, be proud of myself, and if I wanted to, say thank you.

I still find it hard to believe that he meant what he said, despite deep in my heart recognizing that he is not one to lie, or make things up. I wanted so badly for him to enjoy my writing, and it feels so important to me that he be interested in what I have to say, that it feels impossible that he would actually feel that way.

I was thinking yesterday why I would have such a reaction to praise about something I do, and something that means so much to me. I love writing in my blog. I find it intensely cathartic and challenging to write about the issues I do.

All I can think is that maybe I was projecting my Dad onto him. I try to please my father, to make him proud of me, yet no matter what I do I feel I never please him, or live up to what he wants, or expects, me to be. I am always a disappointment. My being depressed, and off work makes me disappoint him even more. I am trying hard to let that go, but I find the dynamic clings to me.

I think, because my blog is so important to me, I believe it became a contender for incurring disappointment in someone who matters to me. That is why I took in the compliment with a huge amount of doubt about its sincerity. My immediate thought was that the compliment was a gesture to placate me, to retrain me, to make me feel better during a therapy session where I was feeling so badly about myself.

My Dad called last night and asked me how my dog training was going. I told him about our first trip to the off-leash dog park, and how the despite all my hard work training my puppy to learn the words, "Come", "Sit", Heel" etc., the second my puppy saw another dog he was off like a flash and I may as well been a stranger. He tugged madly on the leash when I did manage to leash him, even though on the farm he happily walks with a loose leash at my side.

My Dad sounded so indignant. What the hell are you doing letting him off the leash? What did I tell you? That is when you need to use the long lead. He needs to be on a leash." Those words don't look too bad as I write them, but it was the tone in which they were delivered that said..."You are a fucking idiot, you never get anything right, I don't know why I even bother"

It is no wonder I get so angry with myself. I have internalized my father's dismay in who I have become, and who I was my whole life. I swear at myself; internally scream at myself, to, " just fucking get it together. Fucking change you idiot. You are such a loser. You don't get anything right. You just aren't doing the right things. You aren't trying hard enough. If you were you be better and back at work. You are disgusting."

Dr. X. explained that it is very difficult to get rid of those negative voices in my head, but I can bring more positive voices in to counter the negativity.

During the phone call I should have been thinking:

...Dad is just trying to help me. He does not realize that criticism from him cuts me to the bone. As a policeman, he spent his whole life barking commands and ordering people around. He does not understand how deliver a message softly. That's not his fault. He is a product of his life, just like me.

I need to not take his help as rejection. I need to accept what he is saying at face value. He is only trying to help me be a better dog owner, and he has the knowledge to do that.

Wow, I have worked really hard to teach my puppy manners and commands. He is however, still a puppy, and he has just recently been off the farm and into other environments. He becomes over stimulated and distracted by all the new things. I made a mistake. I have never had my own puppy before so I did not know better. I should have had him on a long lead. I know that now and will be better prepared the next time we go out. Dad was only trying to help me.

I feel like I will never learn these lessons. It is so painful to make the same mistakes over and over again. I would like to graciously accept Dr. X's compliments and believe he meant what he said. I feel flattered and very pleased with myself for all the effort I put into writing the things I do in my blog. Dr. X. you helped me feel even better about something I love to do. Thank you.

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.

Processes in Therapy That Help Me

The process of therapy is always fascinating and somehow mystical and magical to me. I went in to my session today feeling really low, guilty, withdrawn, angry at myself for allowing the depression to sink into me again, and for doing things that I know in my logical mind affect my mood. I also still felt very tired. Within about half an hour I felt like a huge load had been lifted off my shoulders. I felt completely different at the end of my appointment than I did at the beginning. Sometimes I feel that all I need is to sit in a room with my pdoc and life becomes less difficult. There are however, obective actions/activities/discussions that take place during my therapy that are of this world, practical and very helpful to me.

As I left I began thinking about what happened in my session that facilitated such an immediate and obvious change for me. I thought of a few things, many of which happen on a regular basis in my appointments, because Dr. X is very consistently non-judgemental about any information he requests, or I provide.

Here's a list of things that helped me this session:

1) Dr. X. has the calmest demeanor of anyone I know. This is where the magic comes in. Just being in the room with him calms me and puts me at ease. Even if I have a preconceived notion that I have done something "wrong" and I have been worrying about it; the minute I sit down and we begin to talk my shame, or fear begins to dissipate.

2) I say "wrong" because it is only me thinking that (or at least vocalizing that:) Dr. X. alerts me to my self-talk, and, without being annoying, quietly helps me see that using pejorative terms when describing things I do makes me feel worse.

Note: I say "without being annoying", because I would get really irritated if it was a constant barrage of CBT lingo and techniques being tossed at me...I see some merit in Aaron Beck's Cognitive Behavioural Theories, but I find his books and his "CBT is the holy grail of therapy" attitudes really annoying. When a person is severely depressed the theories require energy and a "stick-to-it-iveness that are impossible to garner, let alone maintain.

3) Dr. X. asks me the questions I'd rather not talk about. This point may sound strange, but I need him to ask me about some things because I feel shame around them, and they are impacting me, and I need help. For example my drinking. He asked me today about my drinking and immediately I feel sheepish and sensitive.

I feel that way, because I know my slope is getting slipperier. I have gone from 1oz to 2 oz. to 3oz. of vodka/day in a fairly short period. It is not tough for me to see I need to get a hold of it NOW, before 3 become 4 and 5 and so on. I have insight. The problem is, for some reason if it becomes a "don't ask, don't tell" situation I will keep increasing my alcohol intake. I need Dr. X. to ask me. There is something about him asking me that makes me feel a sense of responsibility to rein in my alcohol consumption.

Again, this is some kind of magical/mystical aspect of therapy. He never, ever says anything that makes me feel bad about my alcohol usage. In fact, he is extraordinarily tactful, thoughtful and caring when asking, even when I have been regularly drinking larger amounts of alcohol. He understands that I do it to "help" myself, but he also, gently helps me see that the effect I am seeking (freedom, release, relaxation etc.), might actually end up being the opposite...fatigue and and its companion insomnia.

4) At the end of my session he told me he has been reading my blog, and that he liked it. I immediately played down the value of my blog...even though inside I really do like it too. I like writing. I enjoy the connections I have made with other fellow bloggers. I enjoy the challenge of coming up with something I think others might be interested in etc. I felt really happy that he has been reading my blog. However, I never said any of that. I negated the value of my blog.

We talked about my tendency to put myself down when someone compliments me. The talk was helpful and I sensed he really did enjoy reading what I write. That both made me feel good and made me able to tell you (the readers) that someone I care about enjoys reading what I write(...there!!... that is an exercise in being proud of myself and sharing that pride).

5) We discussed, and decided together, to make some medication changes to try and address my fatigue. I love that he respects and allows room for decision making based on what he thinks might help, but also based on my wishes and what I think might help too. I feel like we are a team and that he is working with me. Trying to make some medication changes made me feel more hopeful than when I went in. So our joint decisions were to:

• Cut my alcohol in half...and savour the 1/2 that I drink
• Cut my Valium down from 15mgs to 10 mgs this week...I'm the one who wants to go off it this fast...I really have a hard time with slow.

Dr. X also interjected here that if I cannot do manage to lower the dose of Valium, to not be afraid to tell him. He said he would help me and the amount I am taking is small, so he is not concerned about that. Most important he reinforced that I not be afraid to ask for the Valium if I feel I really need it. This really made my plan to lower my dose seem safer. When he said that I felt comforted knowing he wasn't going to just cut me off and not help me.

• Increase Tegretol from 800 to 1000 mgs (might help me decrease alcohol/Valium and still manage to sleep
• Increase my Prozac from 40mgs to 60mgs (because I am wondering if the fatigue is a depression symptom, vs. caused by the medicine. (my idea)

Anyways...I felt much better by the time I was ready to leave my appointment, because I felt very valued, listened to and cared for in my appointment. Unfortunately I feel myself fading right now, so I'm going to have a nap, but maybe I will set my alarm for 3 and try to wake up and paint for an hour or so before dinner.