Showing posts with label Listen to people you trust. Show all posts
Showing posts with label Listen to people you trust. Show all posts

Tuesday, November 24, 2009

What Does a Depressed Person Look Like

The entire time I have been off work I have been sure that my insurance company is spying on me. This fear has caused me so much stress and grief. Dr. X. has really tried to encourage me to keep trying to play, smile, do things that I enjoy doing, despite both my depression and my concerns about the insurance company seeing me enjoying myself.

He says, act like they are watching you and do it anyways. I have tried really hard to do just that, but my worries about the insurance company misconstruing my joy in the moment, with wellness, and my ability to return to work, keeps me feeling terrified about doing things. It seems I may be worrying for a reason.

Over on Shrink Rap there is a post that will scare the hell out of anyone who is depressed and on disability. It tells the story of how a woman placed photos of herself on facebook showing her having fun and vacationing. Her insurer removed her from disability benefits for her depression partially based on how happy she appeared in her pictures.

The article made my me outraged, but it was the 668 comments after the article that made my blood bubble and boil. I could not believe how little so many people understand about what it is to live with and try to survive, and recover, from major/clinical depression.

I organized the comments by "agree", and the fourth most common agreed upon comment was:
  • 525 people agreed: "...it is clear this woman is a scam artist".

Not far down the page were more unbelievable "agree" comments...

  • 262 people agreed, "...I hate to be cruel but from the facts presented, I'm leaning towards support of the insurance company's side. If she's ok to take trips, have parties, and go bar-hopping, how is she not ok to report to work every day? "
  • 212 people agreed..."Oops, looks like you got caught to me !!! Back to work we go....like the rest of the depressed workforce of today"
  • 143 people agreed..."This woman sounds like a real go-getter"

How is it "clear this woman is a scam artist"? She posted pictures of a smiling self, enjoying the company of friends and a vacation on the beach. Do depressed people never go out with family or friends? Does major depression always preclude smiles, laughter and enjoyable moments on vacations?

I know for me, smiles come easily sometimes, and must be forced or faked other times. Even if I am severely depressed, I often find myself in situations where my mood suddenly lifts for a short period of time (when I teach art is an example). I have been so depressed I felt suicidal, unable to get out of bed, and was sure I was unable to get to my class...and then I walk through the door, see a student and my persona suddenly switches into high gear, and no one in the world would ever guess I was depressed. The problem is, afterwards, I almost always need to nap because I exhaust myself.

Does my ability to lift my mood mean I am not really depressed? I have wondered about this a lot. I cannot reconcile my depressed self with its thoughts of suicide, plans for suicide, hopelessness, and intensely low mood, with the persona that seems to be bubbly, personable and for some moments maybe even "happy".

I know that others have a difficult time believing I am depressed sometimes because I often am able to hide my sadness, or even become "unsad" for short periods of time. This has caused me a great deal of stress, because people are constantly underestimate, and often dismissing, how sad I am, and how much my depression impacts and continues to destroy my life, and my desire to live.

Another commenter writes, "If she's ok to take trips, have parties, and go bar-hopping, how is she not ok to report to work every day?" Can a person, who is truly depressed go on a vacation and enjoy any of it?

For me my depression often stops me from doing things, going places, being with people, but I still push myself to participate in these activities. Sometimes I even enjoy the activities I do. Can you believe I am depressed and actually enjoy some things? I do sometimes go away on a vacation.

Most of the time I still feel as depressed as I would be back at home, often the stress of being away from home is too much, but sometimes, the vacation provides me with moments of relief, and a break from myself. Do moments of relief mean wellness? Does it mean I can work?

Whether I am able, or not able, to work is complicated. When this depressive episode began I was severely depressed and somehow still managed to work at a job that required a great deal of energy and effort. My fear of losing my job pushed me to keep working well past the time I should have kept working. I struggled for two years to maintain my work, but near the end I shut down completely and would sit and listen to people at work explain things or discuss things...yet I could not understand what was going on anymore.

I know for me stress really triggers me and increases my depression. Currently I do some volunteer work, but only a few hours a week. I know I am not able to manage more than a few hours right now. Even with just those few hours it takes me a long time to recuperate.

I feel so scared I will not be given the time I need to get well, that I will be told I need to go back to work before I feel well enough to manage working. I question myself everyday about how it is that I am able to participate in life; write in my blog, volunteer, take singing lessons, see friends, yet am unable to manage working. I guess the simplest explanation is that the singing lesson is an hour long and then I can go home and sleep. My volunteering is a few hours a week, then I can go home and be alone, and sleep. My blog is just all the thoughts already in my head, being typed onto the page. It is cathartic for me to write...and then I can sleep. My friends know I am depressed, so I can just be most of the time.

I don't think that my sleeping after every little increment of work, at a job, would be very acceptable to any company. There is a term called "Presenteeism" that is replacing "Absenteeism" as what a company is not looking for. A person who shows up for work, yet is not well enough to fully participate in work costs companies a lot of money in lost revenue and work accomplished. The "Presentee shows up, does very little, and gets paid. It does not help the company to have a worker who is unable to fully participate in work.

Anyways I ramble...but I want to show that people who are severely depressed can sometimes lift themselves enough to do things others might perceive to be impossible to someone who is unaware what depression is really like. This just points to the resilience of the people pushing themselves to help themselves move towards wellness.

Sunday, November 15, 2009

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.

Thursday, February 26, 2009

Let Others Carry the Hope For You

Foreword: I titled this photo "Grief and Shame", not because of how I was, or how I felt in my appointment today. I felt no grief and no shame because Dr. X was sincere and caring about the feedback he provided me, and how he provided it. In fact I felt intensely valued and cared for, in part because he told me the truth about how what I did affected him. No, I titled the picture "Grief and Shame" because it is how I so often felt as a child when my dad made tried to correct me by making fun of me: Grief because I wanted him to love me so much and he didn't, and shame that I was never what he expected me to be. I was never good enough.

My therapy lesson today:

"Let others carry the hope for you, let me carry it for you." Dr. X said this to me today, while I was crying and feeling like all my hope had disappeared. What an incredibly kind and loving thing to say to a patient.

Dr. X did a lot of trying to lift my spirits today. When I was complaining of not being able to remember my songs, he had me try, and when I got a few words he said..."You ARE remembering". When I was crying about my anxiety and ineptness in my choir practice last night he told me to be anxious, have performance anxiety and sing anyways, if you make a mistake be embarrassed and consider that [having sung and been embarrassed and lived through it] therapeutic. When I was stressing out about what is happening in my Art class, he told me I was talented and a good leader.

At first I brushed the kind words off with a, "you're just saying that because it's your job". He told me it annoyed him that I brushed his comments of like that, that I did not feel he was sincere. I immediately recognized what he meant.
I laughed, not because it was funny that he felt annoyed, but because I instantaneously felt that moment of "Touche", (he was right). I knew immediately what he meant by his feedback, I knew I had annoyed him, and exactly how I had done so. It was rude for me to dismiss his comments to me, as though he were lying to me.

I apologized, and he smiled and said, "that's okay I can take it"...and then asked that I please not ruminate on my mistake all day. Which I said I wouldn't, but of course, unfortunately (or fortunately) I will.

I say "fortunately" because rumination is sometimes good for me; especially if it helps me learn a lesson, and/or learn something about my reactions and interactions with others.

I recognize a couple things about my dismissive reaction to Dr. X's support and caring words. First, dismissiveness is a character trait I loathe. It reminds me immediately of my dad, or my husband when they are at there worst. I recognize I have that awful trait within me too. I often dismiss other people's kind words about me. Not good. I am going to work on that.

Second, I believe I dismissed Dr. X. because I could not actually believe someone really felt something good about me, or cared about me that much. I recognize now that is an automatic reaction I have to praise. The root of this reaction may be the hypervigilence I have felt, and continue to feel when I am in the company of my dad. I am never sure if what he is saying is true, or if it is meant to tease, bully and embarrass me; to draw me in and make me feel good, only to later find it was/is a backhanded compliment; one meant to humiliate me.

Due to my dad's unpredictable mood and reactions to me I was constantly on the lookout for a double meaning in what he was saying, or the "real" intent behind his praise. When he paid me a compliment I never knew if it was real or not. It rarely was real. It usually was another means to make me feel I was the bad person, or the loser he thought I was.

Third, because of my previous experiences with my dad, and very similar experiences with other men (I have never very good at picking men who are genuine, or who care much about me), my immediate response to a man's positive feedback is to either discount it, or to dismiss it outright.

It may be a case of 'you get what you expect' (I.E., if I always dismiss men's compliments, then I become annoying to them and they no longer care about me). It would be hard to care about someone who technically is calling you a liar all the time.

I wonder if I dismissed Dr. X because I find it hard to believe someone (especially a man), cares for me? Maybe the disbelief is about myself? Or maybe I dismiss his kindness to further isolate myself; maybe I push him away right now because I feel like I don't want to be here, and if I can only believe no one cares about me, I could go.

Whatever the reason, it was really rude and impolite of me to discount, dismiss and to think Dr. X's was being disingenuous when he complimented and reached out to me. I apologize for that, but I won't "ruminate" on my mistake. I will learn from it. I have learned from it.

Sunday, February 22, 2009

It is so Difficult Most of the Time

Two incredible bloggers, Lola, from "Marine Snow" , and Hannah, from "Becoming Hannah" posted a comment on my post titled, "Benevolent Structure".

Hannah's blog reflects upon her struggles with Borderline Personality Disorder, and Lola writes about her challenges living with an eating disorder; both work through the blackness of depression on a regular basis. I feel so much in common with both these bloggers. There comments reverberated a common difficulty I am sure many people with mental illnesses encounter: Motivation difficulties.

Hannah writes that with the people around to encourage her to create she creates. Home alone, with all the tools, materials etc. to create she has a difficult time getting going. In her words: "I need someone to nudge me along otherwise I scrabble back under the duvet and curse myself.".

Lola's comment is different, but I think is a similar problem. She writes that the more she stays in bed, the more she wants to, and does, stay in bed. She writes, "If I don't get up with a purpose on a Saturday then i spend all weekend in bed moping, sort of like this weekend. Trouble is I am so exhausted by a Friday, that the only thing which gets me through is the thought of a lie in on the Saturday!!!"

I relate so much to both comments it is frightening. I have pretty much stayed in bed since Friday at 4:30, only getting up to walk the dog, blog and go to a Flamenco show I had committed to seeing on Saturday Night. Like Hannah, I need a pull, a tug, a commitment to get going...that's okay, many people who are well need that too.

Like Lola's experiences...the more I slept, the more I NEEDED to sleep. In fact right now I want so badly to crawl back into bed. I have already given up trying to paint this morning (I managed for about 15 minutes and simply couldn't do it)

To top it all off last night at the Flamenco show I had huge problems with "disappearing" and "disconnecting" at the Flamenco show last night. I found myself unable to talk, or feel like I belonged during the wine and cheese reception afterwards, and during the show I kept dissociating.

However...had I not gone to the show I would have missed two of the most incredible Flamenco dances I have ever seen. Both were by the same dancer and I have NEVER seen so much passion in flamenco before. It is always passionate, sensual and outright sexual, but this dancer had the ability to drag me out of my dissociative state, to hold my interest.

I felt her dancing inside my body, in the way your body reacts to a sexual come on, or enticement. It was amazingly erotic. The only way I got out last night was by making a commitment to a friend to go. I would have missed two stunning dances, and would not have known of this dancer had I not known. I discovered she dances at different venues around the city...now I have something I enjoyed that I can experience again.

Sleep is a narcotic. It pulls you in and holds you hostage. The more sleep I get the more I want to sleep. Depression is like a drug too. The more you succumb to its power, the more you stop doing things because you don't have the motivation, or the energy, or the will, the more power depression gains on you. It is so difficult. It is not easy. It requires external help to both create and participate in a benevolent schedule of activities.

  1. For me that external help is a little caring "pressure" from Dr. X...a few questions about what I am doing next week, a soft commitment to do them, and a desire to please him, is in part what keeps me mostly on track.
  2. Commitments with friends to visit, to do activities, and sometimes a gentle competition between us to do the things we want to do, helps me too.
  3. Commitments to others (like volunteering to teach art) keeps me getting out of bed, even if I don't want to.
  4. A commitment and love for my dog gets me outside at least a few times a day, rain or shine

...and you get the picture. This benevolent structure only happens if I have a caring structure in place to get me moving, to get me out of bed, to make me want to be actively participating in my life. ...and no it isn't easy. It sucks sometimes and it is always hard work. I do however believe in the long run it will pay off for me.

Benevolent Structure

Over at Dr. Shock's Blog he has posted a blog about depression and art. With the post he has posted two paintings Klaas Koopmans painted of his fellow patients when Koopmans was in the hospital. They are beautiful.

Here are a couple drawings I did while in the hospital. My roommate, who I adored, had amaranthus on here beside table...it was stunning, so I drew it. Then I drew the part of my hospital room that I found myself staring vacantly at while I was there.

When I went into the hospital for ECT in 2004 I brought my drawing board, paper and pencils with me. Drawing helped me break away from the fear I felt about receiving ECT, but it was also a really positive way to pass the time during a very dark period of my life.

(note...an aside): ECT and my hospital stay was a positive experience for me. I read up about it and felt confident, and feel confident, that it is a safe and often effective treatment for major depression. There was however, some kind of primal fear about being put to sleep and trusting and allowing a stranger to do something physical to your brain. My fears were unfounded as the only negative side effect I was left with is crumby spelling (I used to have impeccable spelling...now it is really bad...though this could be medication induced and/or caused by my decline in reading since being depressed. It did however, seem directly associated with ECT..There is always spell check, so not really a big deal.
It is taking me a really long time to learn one of the most important lessons I can learn:

Plan to participate in positive activities in my life, even when, and especially when, I am depressed .

It is extremely difficult given how, when depressed, I have so much fatigue and a desire to do nothing but sleep. In the end though planned activities like volunteering, painting, drawing, and singing work to help me in a few ways:

1. The planned activities create a "benevolent structure" (Dr. X's term) This benevolent structure creates an external "pull" towards my continuing to do things to help myself, even when my mood drops.
2. The plan replicates some form of structure, which emulates a sort of "work". I really need structure to get out of bed. I do more if I have a set plan to do things.

3. While it may not seem like doing things is helping, maybe while doing things I feel overwhelmed, overbooked or just plain tired, but...I know doing things keeps me at least more on track than if I avoid everything and sleep.

4. Scheduling and doing planned activities "forces me" to actually do something. I don't mean really forces, I mean creates a sense of responsibility to myself and others that acts as a motivation for my doing, rather than only thinking about doing. The latter only creates guilt.

5. "I don't want to, or I'm too tired to, (go, paint, participate, see anyone etc.) usually means "I am too depressed to"...if I am thinking these thoughts it is extremely important for me to challenge them.

Monday, February 16, 2009

Lessons Learned in Therapy

What have I learned in therapy? Here are some of the lessons I have learned, or am working on learning, in therapy. Some I have managed to learn by practising and failing, practicing and failing...over and over again, until suddenly the lesson becomes ingrained and followed. Some of them have taken medication to allow me to get to the place where I am able to abide by the lessons. I truly believe that medication has tipped the scales in my favour, but I also know that without therapy I would not have gained what I have gained over the past few years...
  1. There are people who are trustworthy.
  2. There are kind men.
  3. Doing things...activities that feed my love for living is integral for my feeling better.
  4. Guilt is a difficult feeling to dispense of. It is not helpful to me. In fact it harms me. (I am still struggling with this one.)
  5. Lessons learned in therapy must be practised, not just thought about.
  6. Hiding at home is not conducive to improved mental health. It takes the stimulation of others, the stimulation of challenges for me to slowly learn I am both a good and knowledgeable person.
  7. That while a medication may work for some people, it may even have been shown to work for many people, I am an individual and it may not work for me. I require a personalized medication plan. Medication probably requires small changes here and there depending on my cycles.
  8. That having a trustworthy, trusting, knowledgeable, and caring psychiatrist who never gives up on me makes all the difference in the world. I have learned I can lean on Dr. X and he will not give up on me. Knowing I have an advocate and a mentor has allowed me to keep trying and not give up.
  9. Even if it takes 7 years to find the right medication/s, it is possible to find a combo that works to quell my symptoms. Again it may require "tweeking" here and there if symptoms change or become worse. It is not simply a matter of finding the right medication. It is an ongoing challenge.
  10. The more I struggle against my depression and anxiety, the more depressed and anxious I become. This does not mean I need to give up. It means I have to accept my symptoms, yet continue to calmly try to find a way, or ways, to help myself.
  11. That teaching others in a similar situation as me has helped me understand and learn more about myself.
  12. That volunteering gives me a sense of purpose.
  13. That others might actually like me.
  14. That I am not a horrible person...I am an individual, with individual desires and needs. My needs and desires are not weird, they are part of a spectrum of human behaviour.
  15. Even if you think you like being alone, it is important to have friends.
  16. I have an artist inside me.
  17. I should always sing.
  18. Feeling guilty about not being able to work is not helpful, because working to get better, and all the energy that takes is working.
  19. My sexuality is a blessing.
  20. I am a passionate person when I feel better.
  21. "Better" is on a continuum...For me I may not always be on an upward trajectory towards well, but the more I keep working on this difficulty, the more I accept there will be setbacks, the more I recognize that setbacks are a normal state or part of increasing my resiliency, the more I am able to recognize the little steps, the big and small activities I need to do to get back on track if I slip up.
  22. I need to work towards a life I choose, not one that falls into my lap. It is difficult, but rewarding work.
  23. That creativity helps my soul heal, as does helping others.
  24. My blog is work. It is therapeutic for me, and perhaps to others. It has helped me to create and build a supportive community for myself.
  25. That treatment resistant depression is common. That does not mean the depression will never be treatable. It means it may take a lot of support and a longer period of time to find the treatment that works for the person with treatment resistant depression and/or anxiety.
  26. Despite being, knowing, believing I am being spied upon...Do things, Write in my blog. know I am being watched and do it anyways. It is hard to be so open if you think you are being watched, but it is important to know my gaining resiliency, my getting better requires I do all I need to get better, even if I feel afraid.

Friday, October 31, 2008

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.

Sunday, September 28, 2008

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.

Thursday, September 18, 2008

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.

Saturday, August 23, 2008

Rethinking Wednesday's Session

I am not sure what was up with me Wednesday. I entered my session feeling despondent and down about not being able to hang onto the feelings I had a few days prior about being ABLE to change my life, being EXHORTED by my dream to change my life, feeling SURE the switch had finally flipped and I was magically better.

I recognize today, there is no "switch"...it is more like a light dimmer that I need to turn up very slowly to bring more light into my life. The switch is what I don't want or need. It represents the endless cycling mood states I need to get out of.

I was rereading some of my posts, and I recognize that I do have a lot of cycling to my moods. I also understand what Dr. X. meant on Wednesday when he said he worries my higher moods, in conjunction with less sleep, might be unsustainable. I see it, but I wish they were sustainable. Problem is the higher I go, the more likely I am to crash afterwards.

I also see that when my mood is high, it is generally not a bad thing...I don't go off and buy houses, or gamble my life savings away, or cheat on my husband, or do anything that is potentially harmful to me or anyone else.

In fact, that state is a state of freedom for me; freedom from social anxiety, depression, anger, freedom from all the symptoms that haunt me when I am depressed. I also do not lose my insight into my mood state. I can tell when my mood is high. My high mood is really high, but not pathological in any way.

I don't know what it is, but I am often afraid people are lying to me, or hiding things from, or keeping things from me, or spying on me, or have some secret agenda that they don't want me to know about. I think my concerns about my "real" diagnosis being withheld from me fall into that category.

Dr. X. has told me there is a "bipolarity" to my depression. We have also talked about the tendencies in my family, especially on my paternal side, towards hyperthymic temperaments; how my well might be higher than many people's well. It really does describe me perfectly.

I think I was being weird when I got all concerned about having bipolar disorder and not being told about it. Part of my worry stems from the fact that my cousin has Bipolar Disorder, and though undiagnosed, my Uncle had all the symptoms of it as well.

So I worry I am headed that way. The only way I can see it sometimes becomes a problem is for others in my way when I am really hyper. I know I sometimes overwhelm others. Also, I do worry that my high mood will become so high I won't be able to control myself. I think that worry stems from some of the wild, and stupid things I did when I was younger when I was high.

When high I absolutely could not say no to anything...which frightens me now. What if I go high and cheat on my husband, or cannot control my sexuality, or take off with some stranger. I did do those things when high before. I worry I am capable of that again.

Why does it really matter to me one way or the other. If my treatments are helping me, if the mood stabilizers have slowed the cycling (or at least made it less drastic), if I have a really great therapeutic alliance with Dr. X. who really cares what my diagnosis is. Plus, why would Dr. X. not tell me the truth? In my experience he has always been forthright, open and honest about everything during my treatment.

I think part of the difficulty is that I see things in black and white. Grey areas are difficult for me to understand, to conceptualize. I am the product of a very black and white upbringing. My home was very top down authoritarian. My Dad being a policemen lived by very strict rules/laws. I like to think I am open minded and able to understand life is not so simplistic, but some of my belief systems are so hard wired in me it is difficult to change, grow, and understand concepts that sit outside of strictly laid out guidelines and rules.

It is really funny though:

...what I love most about my therapy with Dr. X, and Dr. X. himself, is his refusal to see things from a dogmatic perspective. I love that he challenges the status quo. He feels like the perfect role model for me; the person who is best able to challenge my strict adherence to rules, the person most capable of helping me learn to both see, and accept that life, like a beautiful drawing, is full of many, many shades of grey.

Sunday, June 29, 2008

Getting Rid of Those Labels

Over at the Shrink Rap Blog Dinah has written a very interesting post called "True Emotions".In the post she describes a patient:

"...the patient was floridly manic. I don't remember the details, what I do remember was that she was running on empty, high as a kite, going 99 revolutions per minute, you name the cliche. There was a reason why she was on an inpatient unit and not being seen by an out patient doc. She wasn't getting better and, as is often the case with people suffering from mania, she had no insight that she was ill, she was feeling good-- really good-- and oh so energetic, and even louder than that, and so what's the problem here?

...I'm trying to reason with her, and finally, she screams at me in a way that stays clear long after her name and the details of her life have oozed from my memory, "You're problem is you're not Italian! You don't understand TRUE EMOTION!!" She had a point."

The post is really important for me and probably for other people who are receiving psychiatric treatment. When I read Dinah's post I felt so understood, like I do with my pdoc, but not like I do around other health professionals, or my family, especially my husband. I do it myself too: Dissect every tiny mood change like I'm going to go crazy either too high, or too low. It's hard to get better when I'm constantly worried about "how I AM".

When I read Dinah's post it reminded me of a situation I was part of a number of years ago. I commented the following below Dinah's blog, and I should remember this anytime I worry I might become manic...

" What a great post. Two other pdocs have given me the label "bipolar", but the one I see every week says I have MDD and a hyperthymic temperament. This I believe, but I can't help but worry every time my mood skyrockets. I am so scared I am going to go manic.

Even before someone tried to label me my friends would make fun of the hyper energy I have when I am well; my million ideas, my rapid speech, how loud I get (very loud...because I get so excited with all the ideas), how excited I get, how wild I get.

I almost bought into the labels until I went to my Great Uncle's funeral and met my Grandma's side of the family...every single one of them was like that...So "On" it was absolutely amazing. It was like being in a room with twenty people just like the well me.

We weren't Italian, and certainly, statistically, we cannot all have been manic at the same time: we just are a family of people whose personalities are exuberant, jovial, high, full of ideas, like to do a million projects at once, can fly from one idea to another and understand the connections between all these ideas with ease. Maybe everyone else was just "slow?"

The experience of being surrounded by so many people just like me was breathtaking and eye opening. I recently had the pleasure of meeting three more members from that side of the family; people I had never met before.

At a family wedding this little old lady came up to me and said, you must be "B's" daughter. I just had to meet you (she's talking really loud, and is exuberant, and excited, and very, very talkative). We have to stick together us "Family name".

No one is like us, listen to the din, the room, listen to how loud everyone is, they are excited and energized. We've always been this way. You stay here I have to grab "M" and "R" They are going to fall over when they meet you. They are just like us...and with that this 85-90 year old lady ran off to look for my new found relatives.

They all showed up, along with my uncle, my cousin, and my second cousin. The din was unimaginable. Everyone talking really loud, everyone butting into everyone else's conversations. Ideas flowing like rain pours in a monsoon, and all of us are keeping up with all the conversations. Never a pause to catch our thoughts or to let someone else speak.

Then suddenly we all went silent, looked at each other and burst out laughing. We are all just like Grandma was...it is too bizarre: Loud talkers, so excited about the world and all the things in it, a bit pushy, speaking a mile a minute, and no patience for people on the outside who don't get what is going on.

Almost the entire side of my paternal Grandma's clan have hyperthymic temperaments. When "on" we are more than on, when happy, we are beyond happy. I think that is why I have such a hard time with my depression...because when I am well I feel like I am completely in control of my life, I absolutely love being alive and I think this world is the most amazing place in which to exist. To lose that to depression is beyond devastating.

Saturday, June 14, 2008

Benzodiazepines and Me

In my appointment this week Dr. X. and I spent a lot of time talking about me and Diazepam (Valium). I take a small dose of Valium everyday, along with 600mg Tegretol and 30 mgs Prozac.

This mixture seems to have been the first to do anything towards helping my mood disorder's symptoms. I have taken some form of benzodiazepines (Lorazepam, Clonazepam, Temazepam and finally Diazepam) both short and long term off and on ever since I began seeing Dr. X. 6.5 years ago.

The short acting ones (especially Lorazepam) are a nightmare for me, because I get what seems to be withdrawal effects each day as they wear off and become really irritable, anxious and angry. Diazepam (Valium) has been different. It has helped me immensely.

My Major Depressive Disorder( MDD) is also accompanied by constant and debilitating anxiety attacks and sometimes panic attacks, insomnia, non-stop worrying, and some OCD symptoms; checking/rechecking, contamination fears and obsessive worries and thoughts.

This time I began taking Valium to ease my mouth movement symptoms and obsessive thoughts and music in my head (I am worried it is Tardive Dyskinesia, my pdoc suggested it is bruxism, but recently began wondering about TD too). The Valium seemed to stop the obsessive thoughts, allowed me to be comfortable in my volunteer role teaching art, helped me sleep, basically calmed me down enough so I can live a more relaxed life and not have constant anxiety symptoms. It also helped slow the mouth movements down a bit; although they are still pretty bad.

I read other's comments about benzodiazepines. The Shrink Rap psychiatrists, whose opinions I am interested in, and respect, seem very opposed to using them), also, I belong to an online support group and many people psychiatrists seem opposed to providing benzodiazepines for long term usage. I get the sense that these psychiatrists see long term need for benzodiazepines as a slippery slope to addiction and drug seeking behaviour.

So, in keeping with not wanting to be addicted, and not wanting to be a drug seeker, also, because I was afraid the Valium was masking my possible TD mouth movements, three weeks ago I decided I should try to get off Valium.

I informed Dr. X that this was what I wanted to do. He supported the idea, but told me to go off it very, very slowly; 10% or less a week. He said this would help me avoid some of the withdrawal side effects.

So I began. Within a week my good mood began slipping. I became more and more stressed, more and more depressed. By the time I went into this week's pdoc appointment I was slipping back into a deep depression. I had began craving alcohol again (and drinking again to relieve my stress and anxiety; something that I had stopped almost immediately upon beginning Valium again (a common pattern for me). I began isolating, not wanting to leave the house, unable to sit and be creative without being completely stressed out about how bad I was at what I was trying to do...the list goes on.

I asked Dr. X. about long term benzodiazepine usage. I asked him why he so readily provided them to me when so many pdocs and people seem opposed to the idea of anyone using these medications for long periods of time. I told him I had wanted to stop taking Valium because I did not want to be addicted, or dependent and because I hear so much negative press about people on these medications.

He told me that many psychiatrists would say there is a population of people where the risks of dependency and addiction have to be weighed against those people's debilitating symptoms. He said for me taking a small amount of Valium seemed to relieve me so much of so many symptoms of my anxiety. It appeared to him that my continuing to take Valium was the right choice for me (He said it better and much more coherently than that).

I expressed my feelings that some of my memory and word finding problems, and perhaps some of my balance problems were associated with taking a benzodiazepine. He told me that is possible and perhaps likely. Unfortunately the alternative for me is irritability, inability to sleep, extreme anxiety and the return of depressive symptoms. I decided I would go back on the Valium dose I was on. He seemed to think that was a good idea.

I know I build up a tolerance for Valium. It seems to stop working after a period of time. At that point I need a small increase in my dosage. I also know I have really bad withdrawal effects every time I go off it, which I need to do every once in a while for a period of time to offset the tolerance. However, I also know I am far more functioning and able to enjoy life when I take Valium.

I really worry that one day something might happen to Dr. X. and I will need to get a new pdoc, and they will not understand this dynamic the way Dr. X. does. They will think I am drug seeking if I ask for Valium, or think I am an addict, when in reality I wonder if there are some of us for whom benzodiazepines are a much needed supplement to the other medications we take.

What is the difference between a medication that is needed to maintain balance in a person's life, and a medication that the person is addicted to. I do not really understand where I fit in or to which category I belong. Dr. X says I am not an addict, nor am I drug seeking when I ask for Valium. I have to trust and believe he is right.

Friday, June 06, 2008

I Just Want The Old Me Back

I have been so frustrated, despite my recent mood lift. You would think I would be happy that my mood has been consistently better for much of each day, but that is not the case.

As my mood remains better, my expectations of myself increase. I feel I should be able to do what I did when I was well; things like work, and read, and remember things, and not have difficulty doing simple tasks. I feel I should be fully functioning, now that I have felt better for a while, but that is not the case either.

I still cannot read. I used to be one to have 5-6 books on the go at any given time. I could leave a book for months and pick up where I left off, remembering the plot, characters and themes from what I had read previously. This seemed like a simple, everyday thing to me.

Now I pick up a book, read a chapter, and sometimes, even while reading that chapter get confused, because I cannot remember who is who, or what is going on. I often read and re-read the same paragraph or pages over again because I get lost and cannot figure out where I got off track.

If I read a chapter and put the book down for a couple days and then pick it up again I cannot remember what happened in the previous chapter/chapters, so I become disheartened and feel stupid and lose the desire to keep trying the book.

It is not just reading. I watch a movie, and a week later I cannot remember the most of the plot line. I remember I liked it, or hated it, but cannot remember what it was about. I have been taking blues guitar lessons. Years ago I played the guitar and all through grade school and high school I was a percussionist. I understand (or thought I did) rhythms. The first guitar lesson I got home to practice and I could not remember the simple blues shuffle pattern. I went to the next class and we practiced all class and then came home and again I could not remember the simple pattern. The third lesson I recorded it. True to form I came home and could not remember the pattern, but this time I had a reminder to help me.

I feel so stupid, when before I felt like I was very intelligent. It is like I have lost big chunks of memory, or ability to store memories, or ability to learn new things. I always thought when my mood lifted these would all come back to me.

Dr. X. and I discussed this today. He said part of the difficulties may be made worse by the way I am placing negative labels on what is happening. The more negatively I see myself, the more I live up to my own expectations (those are my words, not his...he was much more eloquent). For example, by calling these things "simple", and then seeing myself unable to do them, I become frustrated that I cannot do "simple" things.

He said the rehabilitation process can take a while and, like someone being rehabilitated to walk again, it can be very frustrating to not just be able to walk like you did before. I guess I thought when my mood was better I would magically become my old self; the self that never really had to try very hard to succeed at anything I tried.

Sunday, April 13, 2008

Co-Blogging Re-visited and a Therapeutic Epiphany

I had such an incredible therapy session on Friday. I feel like I am really making huge steps forward recently. What was so great about my session?

First, I felt so unbelievably supported during the session, something that I often feel, but, when I am severely depressed, I have a difficult time maintaining the feeling when I leave Dr. X's office. Suspicion begins sneaking into me that the support isn't 100% genuine, or real, or I heard wrong, or it is based on some kind of sneaky way to get me to change. Of course, none of that has to do with anything my pdoc does. It is some strange component of my depressed mood.

In my last session I felt able to ask really direct questions about how supportive Dr. X was of my understanding of my treatment plan. I asked him all the questions that fill my mind with guilt and despair about my understanding of what it means to work and to be well enough to work.

He so clearly supported all aspects of my understanding of our recovery plan, that I feel so much more at ease about my being on the right path now. I feel like I AM working, I AM doing what is not only best for me, but what is best for the people I volunteer to help, and for society in general. I feel like what I am doing now is the ethical thing to do.

Wow! The session was a huge relief for me. It probably helps that I feel less depressed right now and am able to absorb the lesson.

About a co-blog...I discussed it with Dr. X. He seemed to think it was an interesting idea. I sensed some trepidation on his part, but he said we could try it. One thing he mentioned was that he would not be able to read the blog throughout the week, which I had already addressed in my proposal. I also believe boundaries need to be really clear between the two of us. I told him to think about it until next session and we can discuss it again. I have been busy trying to test how private and secure a co-blog can be. It seems like you can make them so only the two of us can view and write in it. I am still checking that out.

I do have a few more concerns about a co-blog than I did before. The worry was brought on by a post I read on a blog called Jung at Heart". In her post titled, "Therapeutic Space Revisited" , Jungian Therapist Cheryl Fuller comments about the idea of writing in therapy as opposed to face to face communication. Here is an excerpt from that post:

"For the purists, a letter from a patient between sessions is an instance of acting out and they would not read it but rather place it on the table and wait for the patient to talk about it. And it is acting out, because it is an extra-therapeutic contact, a kind of effort to gain more time and attention from the therapist outside of the boundaries of their time together, and it is writing rather than putting the feelings into words and speaking them in the session. But that it is acting out does not mean it is useless, meaningless or bad; what it does is signal the presence of unresolved feelings or or need." [I find this interesting, because I have in the past sent Dr. X. cards, and it makes me think of why I do that]
"The actual words of the letter may indeed impart thoughts or ideas not expressed in session but it is what drives the desire to write them rather than say them that is probably of greater importance. And dealing with the fear/resistance to expressing those feelings and thoughts directly is a big part of what depth psychotherapy is about." [(my bold)...I have wondered about this in the past...this reinforces that wonder...?]
So back to the idea of co-blogging --
I have to wonder if, like writing a letter or sharing a journal, this isn't at base a way to sidestep the heart of the matter -- that it takes time and effort to work through our defenses and resistances and to do so in the presence of another human being". (Cheryl Fuller, Jung At Heart")
Ms. Fuller really got me thinking about why I want to write, as opposed to talk. I have mentioned some things in my previous posts: My difficulty thinking clearly as I am often intensely emotional in my sessions...it is like my brain shuts down, I find it easier to express myself clearly when I write, Sometimes the medications that I take make it difficult for me to find the right words to describe what I am feeling...in writing I can think for the correct phrase or word, and most important, Usually I am writing in my blog to clarify to myself what happened during my session and how I could use what happened to make my next session better, more open, more honest...a sort of practice session for my next session.
Ms. Fuller is right in many ways though. There are some things I probably should be able to express in my sessions that I am unable to. For example if there is conflict in my session (honestly, by conflict I mean me misunderstanding something) I have a really hard time addressing that in the moment. When I have it has been really helpful. Usually I write about it and try to figure out how to address it the next session.
Also, if I am feeling intensely suicidal, I am afraid to address this in my session for fear I will not be able to make my own decision about what to do about it. I am afraid my freedom to choose will be taken away. So often I do not say anything, until the next session when the intensity of the feelings have dissipated.
Anyways, "Jung at Heart" gave me things to think about and I found her comments very interesting. I will address some of these ideas in my next therapy session.

Wednesday, April 09, 2008

The Blog as Therapy

This post was inspired by a comment made by Dr Shock on my recent post titled: "Letting People In" .

I found his comment very thought provoking. He said: "...what is interesting is how can a blog help besides "getting it of your chest", what are the therapeutic factors. Another important topic is how can a therapist use the blog for the therapy. Especially when doing a more psychodynamic psychotherapy. For cognitive therapy [CBT] with housework it is relatively easy, you can monitor the progress but with more psychodynamic therapy based on psychoanalytic principles such as transference and counter transference and defense mechanisms it is difficult to use the blog together with the therapeutic sessions."

I was intrigued for a few reasons. I agree that a blog, shared with a therapist, for CBT, would be fairly straight forward. In a CBT situation the blog could be used as a documentation and reference for the activities, goals the patient is accomplishing.

I am not 100% sure I understand what Dr. Shock was referring to when he said " but with more psychodynamic therapy based on psychoanalytic principles such as transference and counter transference and defense mechanisms it is difficult to use the blog together with the therapeutic sessions", but if I understand his comment correctly, I think I believe the opposite . I believe a blog is an incredible way for the patient to clearly layout their defense mechanisms and for the Psychiatrist to have a much more in depth and detailed view of his/her patient's transference. If the blog is two way; one written by both the patient and the pdoc, I could see tremendous value for the therapist to also recognize their countertransference more clearly.

I am very interested, and in fact believe I have been utilizing my blog, more and more to enhance my therapy experience. Second to that my hope is that those who read my blog will see how I struggle and work through different difficulties in therapy; how I depend upon a safe therapeutic experience, a consistent and trustworthy psychiatrist, to both ensure, and allow me to be completely open and honest in therapy. I believe that is the cornerstone of good therapy. If I am not safe to say anything and everything, then I cannot work through the things I have the most difficulty with.

Here are some of my ideas/experiences/hopes for using my blog as therapy:

My experience thus far:
My blog has always been a means by which I both prepare for my therapy sessions and debrief myself AFTER my therapy sessions. This debrief allows me to absorb what I have learned in therapy; to retain the lesson.


My thoughts about my therapy sessions are often much more intense after I leave the session. In the 50 minute session I am so focused on interacting that I find it difficult to clearly reflect on the dynamics happening between Dr. X. and I, or around a specific subject. I often feel so emotional I cannot think straight. While in a highly emotional state I become reactive instead of reflective. To me, what happens between Dr. X. and I; the feelings while we discuss something, my reactions to him etc. are like a microcosm of my feelings and reactions to people in the outside world. Our interactions replicate difficulties in my life. This is super important for me to recognize and work through. My blog assists me with this.

Ideas to enhance my experience and my therapy via a blog:

I have some ideas about how to use a blog to enhance my therapy sessions even further, with each idea I have pros an cons I need to consider:

Idea #1: Keep my current blog and use it IN therapy sessions.

I was thinking of asking Dr. X. if we could together spend the first 10 minutes of my sessions reviewing my weekly blog postings. The next 40 minutes could be spent reviewing what was read/discussed:

Pros:

  • I wouldn't forget to tell Dr. X things like I do now
  • He would have a really clear record of what I'm thinking/feeling
  • I often find it easier to write about a topic, rather than bring it up in therapy. I often use my blog as practice to get brave enough to open up and tell the truth, or explain how I really feel.
  • My feelings, thoughts, experiences etc. are clearly laid out,
  • I could list any medications side effects (I always forget to tell him things),
  • I could clearly list any interpersonal difficulties, successes etc.
  • I could make a simple list of discussion topics,
  • If he wanted, he would have access to the information later( he takes notes, but if he missed something he thinks might be important, the information is there).
  • I could express in clear details what I wanted to achieve in my session (I often get side tracked)
  • I believe he would see transference, projection issues etc. even more clearly than he may already...because sometimes I am more shy or embarrassed to say things in person.

Cons:

  • Privacy (from my employer, my insurance company etc.)
  • Ethics on his part in terms of what he keeps in his files about me
  • Boundaries would have to be really clear with me. I.e. I would not expect him to read my blog on his own time. It would be part of our therapy sessions

Idea # 2: Start a new Co-blog

This idea was inspired by an Irvin Yalom story about how, after each therapy session, he and a patient wrote a brief synopsis about each of their experiences, learnings, understandings etc. in that session. They then shared what they wrote at the beginning of the next session. It was intriguing how each picked different components of the session as meaningful. It seemed like a really interesting way for a patient to learn to fully understand their behaviours and experiences from a third part perspective.

I thought maybe Dr. X. and I could set-up a private blog; with the two of us as co-bloggers. Maybe we could shorten our sessions to 30 minutes and then each of us would be responsible for utilizing 20 minutes sometime during the week for each of us to blog about the experience. At the beginning of each session we would debrief what was blogged by each of us.

Pros:

  • I often leave my sessions and think, what was Dr. X. trying to tell me,
  • What did I miss?,
  • I'm not quite sure I understood what we talked about.
  • Maybe Dr. X. experiences that too.
  • It would be a great way to remember and/or clarify lessons, ideas, sharings, understanding, misunderstanding etc. etc.

Cons:

  • Privacy...I checked out to see if you can set these blogs to a private setting. It appears you can, but I need to find out if private blogs are "googleable", if they are really safe to be 100% open about EVERYTHING, like in therapy.
  • Unsure how the Canadian medical system would view and reimburse Dr. X. for this type of therapy. I would not do this if he couldn't be reimbursed the same as he is now. (I have heard of a new system being introduce in Canada whereby Drs can communicate online with patients on a patient pay per contact basis)
  • A co-blog would be really cool and groundbreaking for others to view therapy sessions in progress...I can imagine it as a really interesting teaching tool for psychiatrists and therapists in training, and for patients in therapy themselves, but privacy in therapy is really a huge part of why I (and I assume many others) are able to discuss certain things.

Idea # 3: Co- Blog as a means of identifying transference/countertransference/defense mechanisms etc.

I think the co-blog would provide the perfect opportunity to address some of these psychodynamic issues.

Pros:

  • You would have to really trust your therapist/pdoc, as there would be no deniability about what was said...it is written down for each of you to see.
  • I see tons of defense mechanisms on my part when I both write and read my blog. My current blog has been a wealth of information for myself, and, if I remember to bring it up, for my pdoc while we discuss these in therapy.
  • Conscious and unconscious thoughts, of both patients and Drs/therapist may become more evident when they are seen on the page.
  • Dreams are there to review and analyze more clearly (I am a great believer in my dreams telling me things, so this is important to me).
  • Feelings could be clearly written about, there for posterity and further discussion and clearer understanding
  • What you write would open doors to both the therapists and the patient's perspectives. What Irvin Yalom discovered was that what he thought was intensely important to his patient was often not the case at all. Often what mattered to the patient, what inspired the patient was some aspect of Dr/patient the relationship that came out in therapy; a gesture of kindness, or respect; a moment where the patient felt really understood.
  • Identifying these could really have the potential to add value to therapy and really move the patient's therapy forward.
  • Alternately, it could also really help therapists identify what really makes a difference to their patients.

Cons:

  • Privacy...again...for this type of therapy to help it has to be very clear that what is said remains between Dr. and patient.
  • If there was not an intense sense of trust between the patient and therapist difficulties might arise in what was written (although with the trust I have with Dr. X., even though I am afraid sometimes, I think I would feel safe and secure in this type of therapy)

Saturday, February 16, 2008

Resistance is Futile

I would like to say that I follow my pdoc's advice all the time, but I do not. I think he is brilliant, trustworthy, knowledgeable about medications, and a gifted therapist; so why do I resist what he suggests so much?

Here is a classic example. The appointment I had three weeks ago, before he went on holidays, I was feeling depressed still, even after increasing my antidepressant (Prozac). About 5 weeks prior to that, for a few weeks Prozac seemed to help. Then it just stopped working. So about 2 weeks before said visit we increased the dosage...and nothing occurred except an increase in teeth tapping and annoyingly repetitive snippets of music in my head.

I asked if I could stop taking Tegretol. I was thinking maybe it was interferring with the ability of the Prozac to increase my mood. Made sense to me. If it stabilizes mood, it must take both the highs and the lows away. Really it seems to have MAYBE stabilized my moods fast cycles a tiny bit. I don't break out in tears over every tiny little thing, but my longer cycles are still there, however I only go severely low and never get high at all anymore.

When I say high, I do not mean manic or even hypomanic. I mean my regular, hyperthymic temperment never seems to show itself anymore. I am mostly moderately depressed to severely depressed, spending almost all my time in the latter type of mood.

Dr. X. looked at me sheepishly; giving me that look that means "are you completely out of your mind???" Well I'm sure he was not thinking that exactly, but that is the meaning of the look. As he flashed it to me I imagined all the people who sit in his office arguing it's the mood stabilizer that is the problem...honest! Ha, ha.

I explained how I thought maybe it was keeping my mood from lifting. I also expressed my desire to be on as few medications as possible. Given I am on four at the moment I thought simplifying the mix might be better for me. He suggested I stay on the Tegretol. So I followed what he said and he went away for three weeks.

Then this week, after I explained how poorly I had been doing, he suggested I begin to go off the Tegretol. My reaction: "WHAT? It's the only thing that I am taking that I think even works at all. At least with it I do not feel as labile. I manage to get through my Art clubhouse volunteering without breaking down everytime I step through the door".

I am insane...

Was it not me who previously had asked to do the very same thing he just suggested I do? Why do I do that? Why do I resist him so much?

I am so stubborn. That has been both a blessing and a curse. It has kept me alive and trying despite so many medication failures. The problem is I do not know when to resist and when not to. I resist all the time.

Could be a father issue. Dr. X. being a man in authority could be a reminder of my extremely authoritarian father. Dr. X. is about as opposite a man you could get from my father...he is nurturing vs. terrifying, caring vs. demanding, empathetic vs. ridiculing, kind vs, bullying...the list could go on forever, but you get the point. He's more like my Mom was than anyone else. That is the highest statement of regard I can give anyone. So not sure why I resist.

Anyways...I am going to start decreasing my Tegretol. What is the point of seeing a great Pdoc if I do not listen to his advice? Yeesh.