Kafkaesque Bureaucratic Nightmare

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Homeless

I am very worried and anxious.

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

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

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

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

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

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

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

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

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

Thank You

Dear Dr. X,

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

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

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

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

Thanks,
...aqua

I May Feel Depressed but...

I may have been feeling extremely depressed today, but this evening I feel really good about what I accomplished despite, and in spite of feeling so bad I want to give up.

Recently I have been volunteering some of my time to help others with mental illnesses learn about, and apply for a disability savings plan and tax credit that has become available to people with mental illnesses in Canada as of last year. I applied for it myself and found it to be so difficult to both understand the process, the eligibility, the criteria to qualify, the steps needed to open an account and to apply for an investment and to finally apply for the government portion of the savings plan.

Luckily I used to be a banker so I managed to get through it because I had a pretty good idea about how the banking system works and how investments work. When I finished doing it for myself I thought others not as well groomed in the mysterious ways of the finance industry, others trying to apply for themselves, or their family members might have an incredibly hard time doing so.

With that in mind I have volunteered my knowledge and set up an information session to help people make sense of, and get started on the process of applying for and opening an account. Tonight I offered to speak at a local mental health team's "Family Support Group" meeting. I was there to help people who had family members who may be eligible for this government program learn how to help their family members.

When I first got there a woman asked me what organization I was with. I said, "the organization of me", (I thought that was pretty funny!!) and explained I was doing this to help myself recover and gain confidence again. She was dumbfounded that someone would do this. I stayed and spoke and helped them with questions and information for about 1.5 hrs. About mid way she said to me, "but you are not like others with mental illnesses, you can do all these things. How are people who are really sick going to do this? (Ugh!)

I looked at her and told her I put a great face on. I could come do these sessions, and then when I left the building I struggled to want to be alive. I told her I was one of those people with an invisible mental illness. Ill inside, and well, to most, on the outside. Many of us are like this. She was a bit annoyed with me...but I felt it had to be said. Not everyone with a severe mental illness is recognizable as that. In fact I bet most of us are invisible to the world. Anyways...

At the end the only man in the group looked at me and said he wanted to say something to me.

He told me my talk was so helpful, and that I was an inspiration for all people with mental illnesses and to all their families. He said I could be an advocate for people I was so good at it. He went on and on...of course I couldn't hold back the tears. I felt really good about contributing to the community and helping others advocate for themselves and others. It felt really nice to have someone express that what I was doing was valuable.

On the way home I stopped at an expensive grocery store and spent my money frivolously on premade organic meals; a reward to myself for what I had accomplished. As I walked out to go to my car a man had his cap out asking for money. I glanced the other way, feeling guilty for doing so. As I looked away I found myself staring at his old, frail and grizzled black lab just sitting on the pavement in the cold waiting for his owner to take him to the next corner.

Something about the lab woke me out of my stupour. What I couldn't feel for the man as I passed him, I felt for his dog. As I felt for his dog I began to feel for the man. I put my grocery bags down and walked back to the man and gave him $20.00 and smiled and told him to buy himself and his dog some food. The man looked twice at the money I gave him and then looked up at me in disbelief. Thank you so much he said. I felt good about reaching out to someone who I could tell really needed an act of kindness at that very moment.

The Nightmare, Henri Fuseli 1741-1825

I actually slept last night. Thank god. I increased my Tegretol to 800mgs, took 125mgs of Trazadone and had a couple big martinis. I fell asleep within an hour of going to bed (12:30) and stayed asleep until close to 5am. I still feel wired for sound today, but I am very happy I slept.

I can't explain why sleeping is important to me when, although I wasn't sleeping, I had tons of energy. I guess there is some relief in knowing I got some sleep and in not spending all night trying to force and coax myself into sleep.

This whole experience is making me wonder how much I may need a mood stabilizer. I was trying to go off Tegretol because I thought maybe it was keeping my mood down; not allowing my antidepressant (Prozac) to lift my mood as much as I wanted. I also felt like maybe it was causing my fatigue.

Now, given my insomnia and hyperactive mood after I decreased Tegretol from 1000mg to 200mgs, I am rethinking whether it is wise to go off Tegretol. I guess I am afraid now that the Prozac is maybe lifting me too high on its own. Its not a good high either. There is so much energy behind my increase in mood that while I am "activated", or energized, I am also agitated and anxious. So much so that I do not think I can manage it much longer.

I will take 800mgs Tegretol again tonight and see if I can sleep with 100mgs Trazadone. Maybe if I get sleep for a few nights I will calm down. My brother-in-law and his wife are coming to visit next week. I have avoided them for a couple years now. Always opting out visiting them when my husband goes East to visit. I just get too stressed out trying to put on a face for everyone. It is exhausting.

My husband insists I spend time with them when they visit. I really do not want to be this high when I see them next week. They are really nice, but I'm sure they already think I am crazy. The last thing I need is to be speed talking, interrupting, agitated, irritable and anxious around them.

Unfortunately, we have to visit them away from our house. Travelling and staying away from my own bed is another stressor that contributes to my not sleeping well, and usually to a drop in mood. I am trying to go with the flow, but am really not looking forward to being away from home.

What Do You Do: Are You Valuable?

A few days ago I went to the optometrist. A task I have been trying to get myself to do for more than a year now. Fortuitously, or not, my dog tried to eat my husband's glasses and I ended up at a glasses repair shop that had optometrists on site, so I booked an appointment and, because I have an intense sense of responsibility, despite not wanting to go when the time came to show up, I went and saw the optometrist anyways.

That is not the point of this post. Part of the point is WHY I do not want to see any health professionals outside my pdoc. It is because after the greetings, the first question out of their mouths is always, "are you healthy?"

My head always swirls with this question...my first thought always being, "I am desperately unhealthy if you include mental health as part of health. Then, "do they need to know about that?" Then, "well it would be lying to say I was healthy, should I lie?" Then, "but I don't want anyone to know I am WEAK" (argh... i.e. all that fear of discrimination, sense that I am doing this (my depression) to myself. It's my fault. If I wanted to change I would. I am such a loser for being like this." Then finally, "if I tell anyone they will think all these things about me too."

So I falter, and do not know how to answer the question. The Optometrist picks up on this and pushes from another direction, "Are you on any medications?" I feel so stressed out now, because as soon as I tell him my medications he will know I am a complete loser. I become hot, and I can feel my face become red. Embarrassment sets in. I list my medications, "Prozac, Tegretol, Valium, and Dexedrine". It is obvious to him now, that my hidden secret is out: I am mentally unstable. I feel little in the room; an "unperson".

Why? I do not feel this about anyone else with a mental illness. Just me. I don't get how I can be an advocate in so many ways for people with mental illnesses, yet feel as though I am less because of mine. I know that a huge part of it is that I feel devalued. I feel because I am not working I am incurring a huge debt to society. I am less worthy than others. I am, in fact, less than what people expect a person to be. These thoughts are drilled into my head. I can try to get rid of them. I can try to move beyond them by writing like I did in my last post, but they are always nagging me. They never go away.

Last night I thought about this picture. It is me, as a child, feeding the pigeons. I am certain that people found me valuable then. I am 100% sure that a little girl feeding the pigeons, a little girl doing what brought her joy, was a beautiful sight to others. I am sure no one was watching me and thinking, "That little girl should stop all this fun and enjoyment and get onto something more serious in her life". I am sure others would have seen me as valuable despite my not working.

What is it about children that makes the inherently valuable in a way that adults are not? Why would we never ask a child, "WHAT do you do?" Rather we might ask them, "What do you LIKE to do?

Why are adults so readily judged by the question, "what do you do? Why do we judge ourselves that way? Why am I obsessed with getting a job? Why can't I get that a job may follow a period of doing things I love to do, things that create meaning and purpose in my life. Why can't I get that a job is just one important aspect of life. Why can't I learn, or believe that a job CAN be simply a means to an end? Why can't I manage to give less power to the idea that a job is the what creates meaning and purpose for me?

Part of it is societal norms. Almost the first question out of a person's mouth when they first meet you is "What do you do?": As though with that information they will know everything they need to know about you.

When I was a banker I dreaded this question, because saying "I am a banker" elicits all kinds of stereotypes about who I am, and I was not those stereotypes, or if I was those stereotypes were the parts of me that I hated the most. The entire time I was a banker it was as though I was being the opposite of how I saw myself. The opposite of who I wanted to be, who I imagined I would grow into. I dread the question even more now that I am off work.

I have always fancied answering the question, "What do you do?" in another way: "I draw, and paint. I like to dance and listen to music. I love watching quirky crime drama's. I have a pretty good voice and I love to sing. I like the idea of tradition, but believe we need to envelope new ideas to. I write a blog. I absolutely love to read and learn. I volunteer at a mental health arts facility. I love to hang out with my sisters. I love my nieces and my sisters. I enjoy going out for breakfast with a friend, or going for long walks on the beach or in the woods. I love to garden, canoe and go camping. The problem is, for a long time, I have had trouble consistently doing and enjoying any of the things I "enjoy".

Of course, I love my sisters and nieces, but leaving home to visit them is frightening and exhausting. I am always afraid I won't be able to manage being away from home. I no longer garden, or hike, or camp, or canoe...I cannot muster the energy. I cannot seem to read. Yesterday I tried to read a book that I started a month ago. I knew I had read some of it before, but could not remember where I had read to so I began again. I remembered parts of chapter one and then nothing until I came to Chapter 6 (page 63)...I had read all the way to there before and remembered nothing except that I had read a part of chapter one. How is that possible? Anyways, my point being I don't even truly enjoy all the things I enjoy anymore.

I just don't get why, after years, and years, and years of therapy I can't accept my predicament; accept the life I have fallen into; accept that I am a different person and somehow learn that I am still as valuable as I was when I was that little girl feeding the birds.

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.

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.

Inertia and Shame

I often notice myself avoiding eye contact with Dr. X. Almost every appointment I begin by explaining how I am feeling and what has taken place the past week. During this time I always look away, staring at the corner of the door, or the books on his shelf; looking anywhere else but at the person I am talking with. During this time I almost always feel ashamed of myself. Ashamed for not getting better, ashamed of the way I act, ashamed for not doing the things I know I need to do to get better; like exercise, eat better, and spend more time with other people.

Usually about half way through my session I begin to feel less anxious and my gaze moves towards Dr. X's face. Yesterday this never happened. I spent almost my whole appointment staring at the bookshelf. I recognize this is a problem. My avoidance of eye contact is a reflection of my fears of being rejected by Dr. X., my low self esteem, and how much guilt and shame I carry inside me.

The last two sessions I have noticed that my chair has been positioned so it is directly facing Dr. X. If I sat in the chair as it was I would have a hard time avoiding Dr. X. Both times I have repositioned my chair so it faces away from Dr. X. I never thought he might have positioned the chair facing him on purpose until last night. Now that I think about it I think he intentionally positioned the chair so, when I sat down, I would have no choice, but to face him.

I have thought about this before. Part of why I move the chair is because I feel like I am too close to him (proximity wise) when facing him. I need more space. This feeling happened when I first began seeing him in another office. I began thinking he was moving closer and closer to me to test the veracity of my claim that I felt uncomfortable when others got to close to me. Now that I know him I do not think he was doing that. I believe he simply became more comfortable with me over time. I do however think he repositioned my chair the last few weeks. The chair was too sharply angled towards him.

This post is not to fault him for that, but to help myself participate in his scheme. I think it is unhealthy for me to avoid eye contact with him. I believe my doing this only serves to reinforce the feelings of shame and guilt I have about my increased inertia. My feeling this shame and guilt is like my buying into the scorn others heap on me about my not trying hard enough, not doing what I need to do to get better. This shame about who I am when severely depressed ignores such depressive symptoms as the severe inertia and amotivation that encompasses me when I am depressed and even the fact that the shame itself is a symptom.

I am going to address this in my next session. I have a difficult time challenging my avoidance of eye contact when I am in the moment. It is only afterwards that I regret missing the opportunity to address it. I will ask Dr. X. to help me take a behavioural approach to this problem, to help me redirect my gaze towards him when I speak; especially when I speak of things I feel bad about.

I believe if I can look at him while I tell him the things I feel ashamed about it may help dissipate those feelings of shame and guilt. I also believe by looking at him while talking I am asserting my self esteem and acknowledging that it is my illness, and not some lack of character on my part, that keeps me from becoming well. I am hoping a behavioural approach to this situation will reduce the amount of self-stigmatization I feel about having treatment resistant depressive symptoms.