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I know there are people who are depressed who are depressed around everyone; people who are melancholic, or outwardly irritable. I am generally not one of those people. When around others I usually can either fake it and be sociable and pleasant, or my mood actually does lift for the time
I am interacting.

I suppose many would see this as a gift...the ability to pretend, or actually become "normal", i.e. my pleasant self, when I need to. It may seem something like a superhero's ability to become an ordinary human when walking amongst the general public.

There are costs to this way of being. When I am severely depressed the energy it takes to be what I think others need me to be is exhausting. I often leave a social function feeling so much fatigue I want to throw up. The second I walk out the door intense depression sets back in, and I feel exhausted; even more so than my general day to day exhaustion.

The other difficulty I encounter, and this one I find so frustrating I want to scream, is that people don't believe I am sick, or depressed. If I reach out, or open up and bring up how depressed I am, I often (more often than not, hear so many stories about how friends, relatives, family members of the person I am talking with suffer from a depression much worse than mine.

Sometimes I just let the comments go, because it is not a contest...if they think that is the case who am I to argue. So often though I feel like my pain is being dismissed as mild, or not worth worrying about, or even worse, that I am being told I am not depressed at all.

This happened last night. I managed to open up to someone about my mood disorder and they immediately told me their sister had a depression "...much worse than {mine}". The sister had had a breakdown, ended up in care and during one episode became catatonic and had to be hospitalized.

That sounds like a very severe depression to me. It is very sad. How though is it worse than mine...years and years of cycling, no medications that consistently help, or if medications help side effects that impact my life, isolation from most of the people I know, loss of my job, paranoia, fear suicidal ideation loss of pleasure, fatigue, inability to motivate myself...and an increasing sense that I want to die all the time?

Last night every time I would express what my struggle was like this person would interrupt half way through to explain how I wasn't that depressed. Eventually I just became quiet and listened. I felt really dismissed and vulnerable for opening up myself only to be told others are far more depressed, and that I really had not experienced a "real" depression, not like other people have.

I am sure some others are far more depressed, though I do not understand how a person would manage to stay on this earth much more depressed than I feel sometimes. It is a brutally difficult battle at this severity.

I am sitting here right now, just trying to hang on. I feel so isolated and scared. I cancelled a volunteer luncheon I was supposed to go to because I am so depressed I feel physically ill. I know I will be in trouble for cancelling, because I have missed so many meetings recently, but I just don't have it in me to be fake, or for my mood to increase to please others, only to make me more intensely depressed and tired later.

I know it is weird that I care that others see how depressed I am. It is not that I want others to see how depressed I am, or to say yes you are severely depressed, or even to empathize or sympathize. I just want others to know I am not slacking, or lazy, or using the system, or getting disability for something that isn't that difficult to manage. I want others to know I am struggling against an illness just as severe and real as any physical illness. I want others to know I am trying as hard as I can, but my enemy is vengeful and strong. Maybe too, I am reaching out for help.

I'm Tired

I sat in front of Dr. X today, so sad and lost and empty. I felt like I was going to crumble into a pile of nothingness. I told him I have had thoughts of suicide. I want so badly to be able to speak this truth out loud to someone without fear of hurting them, or their rejecting me for my intensity of pain and depth of failure to become "well".

I try hard to believe this person is Dr. X. He's trained to deal with this stuff. Something inside me make me hold back the details with him too. I am scared my thoughts/plans/ideas/visions will hurt him, in the way just having the thoughts seems to hurt others.

While we are talking he says something using the word "dialectics" and alarm bells go off in my head. I think he is referring to helping someone with Borderline Personality Disorder. One of the treatments for which is DBT...and I immediately think he is mistaking my having these thoughts for borderline behaviour. I feel scared; completely misunderstood and misread.

I can't speak the entire truth to anyone.

The thoughts are intense, powerful and detailed. I suspect they will disappear only when they have been successful. I want the detailed plans and visions out of my head. I want the thoughts to disappear.

My sister calls and asks how I am. Usually, I can feign a, "fine". When she calls I am so depressed I have no energy to outright lie..so I say; "I am so depressed right now, I can't take this anymore". She is silent on the other end of the phone. The silence feels cold and it draws a clear line: "do not tell me anymore!" I was about to say, "I want to die", but instead say, "I'm okay".

Then the niceties begin...both of us knowing what I did not say. An invitation to visit her place is forthcoming, but I have no energy to cook, or eat, or stay out of bed, let alone drive for 5 hours. What I really want is her come to me, like my Mom might have. The empty space, between small talk, on the phone only proves to heighten my sense of loneliness and despair.

Dr.X asked me to find reasons to live. I thought of three:

• My dog...he needs me.
• My sisters would be hurt if I died
• I don't want to hurt Dr. X

But, I could provide for my dog to be taken care of, I could write notes to my family and Dr. X assuring them I know they tried so hard to help me. letting them know I love them, but I can't manage anymore. On some level I am certain it would be a relief for my sisters to see my pain end.

That is what I want. I want this pain to end.

At What Point is There No Hope Left?

I volunteered to teach a class today. I was dreading teaching the whole time beforehand, even as I drove to the studio. While I was teaching I felt some relief; I was too distracted by the complexities of the lesson to think about how much I wanted to die. The second I touched the door to leave I was exhausted and fell once again into myself and all the hell that brings with it.

When I look objectively at what I have tried to do to to help myself make the depression go away it frightens me. It scares me that I have tried so much, and so many things, and still nothing is consistently helping my depression dissipate. My mood still continues to cycle, I still feel angry and frustrated and depressed, anxious and panicky, and can't sleep, or sleep too much, eat too much, avoid everything, have difficulty leaving the house, doing things, cleaning, cooking, laundry, dishes, sex, lose interest in everything, lose hope...All this never goes away for any length of time. When it does it feels like temptation threatening to drown me as soon as I begin enjoying myself. I feel like Satan sits and waits for a good mood to begin inside me...and then BLAMO! he whacks me upside the head just to show me I am still lost to hell. Paradise; a life of enjoyment and happiness, is lost.

It gets to the point where I begin to ask: Is it worth it? Am I worth it? There is a lot of money, medication, time and effort, both on my part, and the part of others, going into helping me become well. If, as I suspect, I will always cycle in and out of depression: What is the point of all this trying? From a utilitarian perspective it makes no sense at all to keep me here.

Why take medications? Why continue in therapy? Why continue living? If life is going to be as hard as it has been these last 7.5 years and the two years, with a two month reprieve before that...and the too numerous to remember episodes of depression before that, if life is going to be this hard a struggle forever...why keep trying? At some point don't you just give up and say it will never get better. Live with it, accept it, give in, or die. Dr. X said let him carry my hope, but at what point is that futile? At what point to we both concede to having been beaten by this illness? If you review all I have tried you will think the same thing:

1. 19: Journals filled with writing

2. 304: Number of blog entries

3. 425: Psychotherapy sessions with Dr. X. (give or take a few)

4. 21250: Minutes of therapy with Dr X

5. 14.75: years in my life lost to depression (conservative estimate)

6. 6.2: Number of years spent unemployed because of my depression

7. 104: Number of days on top of the 6.2 years lost employment because I could only manage working 4 days/week

8. 29: Number of years underemployed because of my depression

9. More than 8640: Number of pills bought to try to treat my depression if prescriptions were all one pill per day (many weren't/aren't)

10. 288: Number of bottles of pills purchased

11. Hundreds: of Visits to the pharmacy

12. 33: Number of psychotropic medications tried**

13. 9: Number of different vitamin/supplements tried

14. 8: Number of ECT sessions received

15. 177: Approximate number of months I have spent depressed in my lifetime

16. 5384: Approximate number of days spent depressed

17. 40: Number of years spent anxious and wanting to hide

18. 36: Number of years I remember having difficulty sleeping

19. 6: Number of therapists I have seen

20. 3: Number of psychiatrists I have seen

21. 2: Number of psychiatrists/ therapists I connected with

22. 1. Number of Psychiatrists, Doctors, Health Care Workers I trust.

Supplements/Vitamins I have tried/++Supplements/Vitamins I am currently taking:

1. St. John's Wort


2. Valerian


3. Salmon Oil (took 6 grams/day)


4. L-Tryptophan 2grams/day


5. Iron supplement twice daily++


6. B100 Complex (B1 100mg) ++


7. B12


8. Folic acid 1.0 mg


9. 100mgs of each B vitamins++


10. Multivitamin++

SSRI's

1. Prozac 60 mgs
2. Paxil
3. Celexa
4. Effexor
5. Luvox
6. Zoloft

Novel Anti-depressants:
7. Wellbutrin.
8. Remeron
9. Moclobemide

Tricyclic Antidepressants:
10. Nortriptyline
11. Amtrytiline (took for trauma symptoms...for 5 days after a traumatic incident)
12. Desiprimine

Anticonvulsants/Mood Stabilizers:
13. Lamotrigine 200mg
14. Lithium
15. Epival
16. Gabapentin
17. Lithium (800-1200mg)
18. Carbamazepine (800-1000mg)

Benzodiazepines:
19. Clonazepam
20. Diazepam
21. Lorazepam
22. Temazepam

Beta blocker:
23. Propranolol

Other:
24. Low dose Doxepine
25. Clonidine

Atypical Antipsychotics:
26. Seroquel
27. Risperdal
28. Olanzapine

Hypnotics/Sleep Medication

29. Trazadone (25/50mg/100mg/200mg/300mg)
30. Zopiclone (7.5mg/15mg)

Stimulants:

31. Ritalin
32. Dexedrine (tablets and spansules 5-20mgs)
33. Modafinil

Note: Also tried numerous combinations of above medications

Am I doing something wrong? Am I making things not work? If so What? and Why? Does this happen to other people? Am I the only one who never gets better? Why? I used to want so badly to live a beautiful life. Now I have no desire to live.

Ask Me a Question Part II

First Dr. X was my 9997th visitor. So close to the 10,000th. Wouldn't it have been mystical if he were the 10,000th visitor...yet there he sits three visits away. I wonder what he would ask if he could ask me any one question? Hmmmm?

I want to write, and I'm stuck for a topic, and my 10,000th visitor: Mr/Ms " Minneapolis, Minnesota. [who] started their visit at 12:09:56 pacific time (3:09:56 their time)and got to my blog by Googling "My Therapy Sessions" Did not or has not (yet) asked a question...the offer is still open...ask away.

So I thought I'd try to answer the 3 questions that were asked:

1) On Friday, October 17, 2008 11:08:00 AM Lola Snow from "Marine Snow" asked...

"If you woke up tomorrow and your life was perfect, what would have to change?"

Well...if it was perfect? Nothing! ...Sorry Lola I couldn't resist.

I will assume your question is an existential one, as in "what would I have to change to make my life perfect"? Is that what you are asking?

If so, that is a question to which I have been searching for the answers to for years. Today I said I was going to be honest in my answers. This will be hard, because I know I control some of the things that keep me down, but sometimes it is easier to live with the life you have, than make the changes you need to make.

a) I would have a job that I loved. One that required creativity and caring for others. A job that was stable and I was not alway afraid of losing, that did not change all the time, but that had change within it...i.e. one that required me to to think on my feet, utilized lots of different skills, was interesting in its variety and challenged me intellectually. I would work four days a week.

b) My husband would actively participate in marriage counselling with me. We would both work on completely overhauling how we communicate with each other. I would want to have sex again (I have completely lost my desire) and we would enjoy it at least a few times a week. On top of that I could actually manage to orgasm again. So, both my desire, and my ability to have enjoyable sex, would return. If my husband did not participate in counselling and work to help us change the way we communicate with each other I would divorce him.

c) I would not live in my old, falling down rented place. I would own my own home somewhere in Vancouver or east Richmond....just a small place with a yard. Nothing extravagant. All I want is a small home of my own that is not a a condominium. Unfortunately in this city, that dream is impossibly expensive. Maybe one day I can buy a lane home, or a carriage house. I need my own quiet space. I need a space I know is my own, where no one else (except my husband...who of course has gone to marriage counselling with me) has any power over my living situation.

d) I would swim everyday for at least 30 minutes (my perfect home would have a narrow 25" lap pool in the back yard)

e) I would WANT to live. I would not be plagued by depressive thoughts, or thoughts of suicide. I would no longer have all those thoughts of stabbing myself, or hanging myself, or shooting myself in the head, going through my brain over and over and over. I would give up the stash of medications I have hoarded for when I decide to kill myself.

f) I would not have any depression or anxiety symptoms. I would not have anxiety attacks, or panic attacks. I would not have any mood cycling. My mood would be level most of the time and my depression and anxiety would have disappeared. I would feel good like I did a couple years before this depressive episode and like I did in my last two years of university.

g) I would not stress out around others. I would look forward to going out to see others. It would be easy to go out with others. I'd stop feeling like I was in a bubble, or outside the circle at large social functions, or in stores and other places with lots of people.

h) I would not need a couple drinks every night. I would be able to drink socially like I did before; when I go out, never at home alone.

i) It would feel good and I would have the energy to do my housework. It would be enjoyable to cook dinner etc. It would feel good having a neat and tidy home.

j) I would enjoy gardening again.

k) My sisters and nieces would live closer to me.

l) My puppy would grow up to be well trained, behave like a saint, and be just as cute and cuddly as he is now.

m) I would have less things. No more clutter, or sentimental nic nacs. I would have a warm, yet calming zen like home...without all the accouterments of life I have gathered or been given over the years.

n) My Mom would be alive

o) I would make enough money to not worry about my bills or the things I need. If I made lots of money I would give away the amount I did not need to set up an art therapy foundation to help others with mental illnesses

p) I would spend at least 1 hour everyday creating art.

q) I would have an art studio in my house, where I could leave half done things up, and things I needed to create art were easily accessible at all times.

r) I would feel loved, cared for and wanted by those around me.

s) I would participate and join organizations that helped me feel a strong sense of community both culturally and spiritually with other people.

t) I would volunteer at least once a week

u) I would have season tickets to the Vancouver Symphony (and a companion who I didn't have to drag there to go with me each time)with me.

v) I would eat lots of veggies and take my vitamins. I might even become vegetarian again.

w) All my fatigue would disappear and I would sleep 8 hrs straight every night. I would have the energy I had during periods when I was not depressed.

and finally...
x) I would see Dr X once in a while because I enjoy his company, not because I need to see him. When I met with him we would have joyous discussions about all aspects of a good life, art, literature, intellectual ideas, friends, etc.


2) On Friday, October 17, 2008 11:11:00 AM deepblue from "Out of the Blue" asked:

"how do you afford/pay for your therapy?"

This is easy. I don't. In Canada we have nationalized health care. All doctors visits are covered by my province's medical insurance. I see my Psychiatrist for therapy, so the therapy is covered.

Having said that, before I met him I paid for therapy on my own for two years, once a week as psychologists are not covered. I really shored up how many times I went out for lunch and coffee etc. to save the $100.00 a week it cost. Also, on top of that I worked for a large corporation who allowed 6 free visits a year to a therapist...not great, but it helped. The only problem was I had to see psychologists covered by their plan, and I did not do well with any of them.

3) On Friday, October 17, 2008 11:55:00 AM Hannah from "Becoming Hannah" asked:

"Why you?"

I will answer this with a few different "voices":

a) The voice of reason: Depression, bipolar disorder and anxiety runs in my family. My maternal grandmother took antidepressants for years. My Mom was depressed for at least 10 years I can remember. My cousin has Bipolar Disorder and while undiagnosed, I am certain her Dad, my maternal uncle had bipolar disorder. It explains his bizarre, unpredictable and impulsive behaviour and his poor judgement.

My Dad has had a panic attack and I recently found out my paternal Grandma frequently had anxiety attacks. She also had an intensely hyperthymic temperament, the same way I feel better than most people when well.

My paternal Grandparents were alcoholics. I am pretty certain my Dad is too. Irritability, anger and a propensity towards emotional abuse and violence run in my paternal side as well. I was a worrisome child, and prone to insomnia, anxiety and dark thoughts from a very young age. It appears obvious I have a strong biological/genetic disposition to mental illness and alcoholism.

On top of that environmental factors made things more difficult for me. Our family moved almost every two years when my Dad was transferred with his job. So I was constantly in the mode of trying to please people, or trying to make new friends. As a coping strategy I tended to sever ties with those I left and form instant attachments to people in our new town. I always felt like an outsider.

My father was often away during my younger years as he was a police dog handler and was often called out for weeks at a time to search for people. He was emotionally abusive, distant and at times, a physically abusive father.

My parents divorce and how it proceeded in secret, how my Dad secretly remarried, how my Mom remained depressed for most of her life after my Dad left. This all affected me. I lost many friends to death in high school and was in a car accident where my best friend had a permanent head injury. That affected me.

With all that behind me it seems I was left unprepared and less resilient for all the regular sad and bad things that happen in everyone's lives. My depression and anxiety are not my fault. They are caused by a mix of environmental, genetic and biological factors.

b) The depressed voice: It is my fault I became this way. I had everything; a good job, a good family, (maybe my Dad was a bit harsh), but all in all my family cared for me. I just don't try hard enough. If I tried harder I would get better. I am too dependant on Dr. X. Maybe if I hated him I would get better so I would want to leave. Maybe I chooses to be this way? Maybe I stay this way because I get something out of it. Look I don't have to work, I can do whatever I want all day etc...but that's not true, because I am to depressed to do what I want and I want to work.

Well maybe I am being punished. Maybe I did bad things when I was young and I am paying penance for being a bad person. Maybe I deserve to feel this bad because I am a bad person. I think bad things about people. I hurt people. I don't deserve to be happy.

c) My Husband's voice: It's the medication and the help. If you hadn't tried medication you wouldn't be so sick. If Dr. X just refused to see you, you would get better. You will never get better while you have someone to help you (huh?). The day he cuts you off seeing him and off medication is the day you will start to feel better.

d) My Existential Voice: You continue to be depressed and anxious because you have intense death anxiety. Life is short, limited, it ends. You are not well because you are not living the life you want to live, you are not using what little time you have on this earth wisely. When you discover what it is you want and pursue that dream the depression will subside.

e) Dr. X's Voice (my interpretation): You have an illness that is caused by genetic, biological and environmental factors. Medication can help, but it will not be the only thing you need. You need to work hard to become well. To do all the things you can to feel better. I think he believes, like I do, that there is a strong existential angst component to my depression as well. He knows that finding and creating meaning in my life, and creating a purposeful life for myself are essential to my becoming well. They are not all I need, but they are a huge part of it.

Lola, Deepblue and Hannah:

Thanks for the questions. they really gave me both a lot to write about, but also a huge amount to think about and work on in therapy. Thanks.
...Aqua

How I Left Work

Sara, over at "My Sad Alter Ego", posed a couple questions to me in the comment section of my last post.

She asked:
"...do you have a post on here about when/how you decided you needed to stop working? How do you get to that point, and more importantly, how do you know when you do? I always am wondering this. "

I do have some information willy-nilly throughout my postings, but nothing in one post. I will try to provide my experiences about trying to leave work in this one post.

First, some background about me. It is important to know who I am, because it plays into the difficulty I had leaving work. I am a worker. My entire life I identified myself as a worker. I AM what I do. Even when I worked at a fast food restaurant in high school, or was a chambermaid when I first left home. I always work exceedingly hard and take pride in what I do. Even when I hate my job/s I always give 160% plus. So leaving work was an incredibly tough decision, and remains a difficult and guilt ridden decision for me. That being the case, it was imperative that I leave work. I would have killed myself if I had not.

Second, I joined the organization I worked for out of university, because I had acquired a huge debt load going to university. I am terrified of ending up homeless, or having absolutely no money. This has much to do with my parents divorce and the subsequent difficulties my Mom had finding a job and affording to live the first few years after my Dad left. I would say I have phobia of being jobless, homeless and penniless. Because of these "phobias, I took a job that had nothing to do with what I was educated in. I cried almost everyday on my way to work for the first few years. I knew I had "made a deal with the devil" to pay my bills.

Third, As I stayed with the company, because of my work ethic and my creativity I began to work my way up the corporate ladder and started to move into corporate teaching. The money became better and better, the challenges more exciting and I found my real love was teaching. The problem was I did not fit into a bureaucratic organization. The structure and bureaucracy were overwhelming and soul sucking.

The problem was, by the time I recognized this I was making so much money that for the first time in my life I felt fairly recognized financially. I am definitely not a material person. It was not material goods I was seeking. It was "financial safety"
Also, I had experienced several depressive episodes, and began having anxiety attacks partly due to, and I would suggest increasingly due to, some of the organizational behaviour I was experiencing within the company. My self esteem was getting worse and worse and the "financial security" I felt I was experiencing was not true.

The problem was in the corporation I worked for there was no such thing as financial, or job, security. I believe, and I still believe, that the organization had a "plot" at it's core. The plot was to make every employee believe they were expendable so each employee would work harder. You may think this sounds like paranoia, but the company would restructure jobs and positions and departments, and lay off people so often, yet pretty much keep everything the same and then hire new people after all the kerfuffle, that it really seemed like they were trying to bully people into working harder.

Bullying terrifies me and I spent almost the whole time I worked there afraid I would lose my job, and for good reason. The organization restructured and cancelled positions I worked in on a regular basis and then made me "apply" for the new...almost identical job. The underlying message was always that I may not be the successful applicant. I stayed though because of my financial phobias, but also because in the last 6 or 7 years the jobs I took were so interesting at least 1/2 of the time.

So... After several MDE's that lasted months, to up to two years, with some stretched of good times in between, in 2001 I became more depressed than I had ever been. For the first time in my life, despite seeing several therapists and my family doctor finally trying to prescribe anti-depressants, I was finally referred to a pdoc, because nothing was helping me. That was in 2001.
I spent once a week going to therapy with him. We tried several medications while I was working. I became more and more despondent. It was increasingly hard to work while trying to find medication/s to help me. I had been having a lot of suicidal ideation the entire time, but by 2002 and early 2003 the ideation was turning into clear plans, and was getting worse and worse and more violent. Dr. X and I discussed my leaving work over and over, but he never pushed, because he knew work, even though it was stressful and much of it was not "me". There was a huge part that helped me thrive.

In early 2002, through to 2003 my job position was restructured, and I was forced to apply for the newly developed positions each time. I managed, despite increasing depression, because in the building I worked in there were approximately 400 people I knew very well, having trained most of them. I had a really tight group of people I worked with, my boss was amazingly supportive, I was allowed to lower my work week to four days which seemed to let some pressure off as I could sleep/wind down for 3 days on the weekend.

In late 2003 I applied for and received a new (read old) job. It was highly stressful and included travelling and working with upper management, executives and the V.P. I was told to move to a building where I knew know one except my boss. Suddenly I was extremely isolated and so stressed out I began planning my suicide. I planned to hang myself in the handicap washroom (because I could lock the door). Everyday I would go to the bookstore near my work and look for books on how to commit suicide. I would surf the net at work trying to find ways to commit suicide. I walked into my coffee shop before work one day and the band Nirvana was playing on the t.v. screen. I was sure Kurt Cobain was telling me to commit suicide. After many weeks of this increasingly suicidal ideation I managed to tell Dr. X what was happening.

In that appointment he said: "what do you need to leave work? What forms need to be filled out? I will fill them out right now and we can fax them." I declined. Work was so busy and I cared so much for my boss. I could see she was overwhelmed and I could not leave her in a lurch.

That week I almost (purposely) stepped out in front of an oncoming bus. The only thing that stopped me was my compassion for how the driver would feel. The thoughts and plans of hanging myself became unbearable and obsessive. On top of that, I suddenly stopped comprehending anything at work. It was as though my work was written in some other language. I also became increasingly afraid to interact with people at work. Literally, so afraid, to the point of that I became increasingly paranoid that everyone was out to hurt me, or make me feel stupid, embarrass me, or that they were ridiculing and talking about me behind my back. I sat there almost all day, crying, distraught and unable to do anything.

Then I had a dream. I wrote about it in the post "Transformational Dreams" People who have followed my blog know that I take some of my dreams very seriously. Some of the most important revelations in my life have come out of dreams. This was one that told me to leave work.

The dog in the dream, the one I first kicked and then later saved from drowning had the exact strawberry blond colour hair as me. I was the dog I was kicking and watching drown. I had to be the person who saved myself. At first I heard the messages in the dream. Then a few weeks later I listened to, and acted on the messages.

The next appointment I had with Dr. X asked me if I thought the whole gigantic corporations was going to collapse if I left? Suddenly, I saw the absurdity in my fear of leaving the organization. There would always be someone to step in and do my job. Dr. X told me I needed to tell my boss exactly the types of thoughts I was having. It would be hard to say, and harder for her to hear, but she needed to understand how sick I was.

Three weeks prior I had made an attempt to tell my boss I needed to leave work due to my illness. She felt I simply had to much work on my shoulders and volunteered to hire a previous, trusted coworker to help me. I thought that might be a viable solution, so we tried it. It did not help. My thoughts of suicide did not dissipate. I was too sick to keep working.

The next three weeks I slept all weekend, every 3 day weekend. The second I got home I went to bed. My body was shutting itself down.

So I wrote in my journal: : "I will tell [my boss] I have to leave work tomorrow" (Monday). I wrote exactly what I was going to say over and over and over. I got to work and thought I was going to throw up. I couldn't do it. I tried to push myself again the next day. Couldn't do it. The next day I was determined. I walked in the door straight up to my boss. I told her I needed to talk with her privately. I sat down and then I told her I was going to commit suicide if I did not leave work. I told her about all my thoughts and that my pdoc was insisting I leave work.

She seemed really mad at me, and I was devastated. She wouldn't talk with me all day. She was one of my favourite co-workers and I had so much respect for her. I was devastated.

The next day at lunch I sat down beside her and apologized for having to leave. I told her I cared so much for her and the work, but I needed to protect myself. I said I was very sad she was mad at me. She began to cry. She said she was not mad, she was afraid she would never see me again. We both cried. I promised her she would see me again. I left two days later thinking I was just taking a few weeks off. However, I remained, and remain, to ill to return to my workplace.

On top of everything else I had so much external which made it an easier transition (albeit still year and a half decision). My pdoc was and has remained, unconditionally supportive. My Mom, when she was alive, and my sister's were very supportive and pushing for me to take care of me. Also, my workplace also has a Long Term Disability program, and I qualified for my country's disability program. Knowing my financial situation was going to remain stable until I was able to work again helped me take the leap and leave to take care of myself.It was the most difficult decision I ever had to make. It was life changing. I have spent many, many hours thinking I did the wrong thing. I know however, that I would not have survived had I stayed a week longer. I was too sick.

That was in early 2003. Five and a half years later I still struggle with wanting to work, but slowly I am learning to believe I am building a life that is better for me. I would never have discovered my love for art, or that I could draw, let alone that I was a good drawing instructor. I would never have learned that I loved to paint. Had I not made the decision to leave work I know I would either be dead, or even more severely depressed than I have been (I cannot imagine what that would look like?).

The pressures and responsibilities of work were incompatible with working towards becoming more emotionally resilient. It took a long time for me to get beyond the loss of my work, I still have moments where I feel guilty about having to leave, but I know now, in my heart, it was the only decision I could have made. The dream I had a couple weeks ago: "The Wolf Returns" reinforced, I am hoping for good, that I made the right decision. The recent dream told me my old life is over. It has ended. It is time to look forward. The black wolf in the dream ended my old life. My new white puppy is the beginning of my new, improved, and desired life.

Until leaving work I have never, ever had the opportunity to learn what I loved to do, to actually decide what it is I want to do. Leaving work woke me up to a difficult and terrifying existential search; an existential journey that has challenged my inner being to the question "Who am I". I am not sure about that answer yet, but I know the answer is important to my well being. My leaving work allowed me the opportunity to move closer towards the discovery of who I am and who I am meant to be. These have been questions I have struggled with since I was a small girl. These are the most important questions in my life and I know the answers will be the biggest catalysts towards wellness I will ever achieve.

Sara, I hope you are able to take care of you better than I was able to take care of me. Your health is more important than any job in the world. Without your health you have nothing. That much I know.

One of Those Therapy Sessions...

I just got back from one of those therapy sessions that left me feeling cared for, honoured and understood. I went in exhausted...from all that puppy love, but also from a personal situation that has gone in a tough direction.

It doesn't matter what the situation is only that I was able to talk really openly about what I was feeling, and how I was trying to manage the hurt. I asked Dr. X to be really open and honest with me about my communication style. I wanted to hear if I'm doing something wrong.

Often I will ask things like that and I will get positive reinforcement and then I just chalk that positive reinforcement up to his being my pdoc, my therapist, my coach, etc.. I often think he is saying nice things just to help build my self-esteem.

It did not feel like that today. I asked him if he was just saying what he said and, (like always when I ask that question), he said he would tell me the truth and be honest. Usually I am suspicious about this being the case. I never felt that today. I felt like he was a friend willing to tell me both my positive traits, but also my faults, or where I could improve. It felt good to trust.

I now believe he will always be honest. Something about the session today made me BELIEVE that, not just hear it. I like that. I want a straight up relationship. I cannot heal if I fear I am being lied to, either explicitly, or by omission. I cannot change my behaviours if I fear I am being placated, rather than honoured with the truth; even if the truth is difficult to hear.

I need to know myself. Sometimes it takes an other's eyes and ears to help me see that self. I need to understanding clearly, who I am, and how my being the way I am impacts others. I want to improve my communication skills so my social anxiety will lessen. I want to move through this life in in a loving and caring manner, but I also need to learn to say no when I have to in order to care for myself.

Anyways, today was a great session. I feel blessed to be able to continue seeing Dr. X. I hope in my life I can find a job where I am both gifted at what I do and enjoy what I do. From my experiences with Dr. X. I believe he is blessed with those two things. I know that finding a meaningful job, one that I am good at and where I feel can make a difference to someone else, would bring me to that state of being too. I am praying for that day to come. That will be the day I am well.

Honesty in Therapy

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Disclosure

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

"Outing" Myself

I was wondering what other people do in terms of having a mental illness and how much or how little information they reveal about themselves to other people.

In particular "The Silent Voices in My Mind" made a comment on my "Fatigue and Depression" post about how her kids do not understand how, sometimes, it takes too much energy to talk on the phone.

First SV I want you to know you are not alone. I rarely answer the phone for the exact same reason, and calling people who have left messages for me is one of the most difficult things for me to do. I think I almost have a phobia of the phone.

I explained to my nieces this weekend that I have a mental illness. One of my sisters has told her kids, and I have mentioned it in passing to the other two before, but this weekend they all saw that I was taking pills morning, afternoon and night and they outright asked me what I was doing. (gotta love the curious and unafraid to ask anything aspect of kids)

So I sat down and I told them:

Me: "Auntie Aqua takes medicine because she has a mental illness".

Them: "What's that?"

Me: (unsure exactly how to explain it). "It means I have an illness in my brain that makes me feel really sad all the time. The illness makes me really tired and afraid to do or try things most people would not be afraid of. It makes me think sad thoughts."

Them: "WHAT???"

Me: "Well, are you ever sad sometimes? Or are you ever really scared of things?"

Them: "Yes."

Me: "When you feel like that is it because something makes you sad, like when someone hurts your feelings, or when you can't do something you want to do. Or, when you feel scared is it because something scared you?

Them: "Yes"

Me: "What happens when the thing that scared you or made you sad goes away?"

Them: "We are happy, or not scared anymore"

Me: "Well, your Auntie feels sad and scared most of the time, for no reason. I take medicine to help me feel less afraid, to help me sleep and to help me feel happy like you"

Them: "That doesn't make any sense"

Me: "My mental illness, a sickness inside my brain, makes me sad and scared. Something inside my brain makes me feel that way. I don't know why, it just does"

Them: "Ohh"....and then they all run off to play.