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.

A Conversation Between Me and My Dad

Me: Hi Dad, guess what? I bought a new car. (I've been driving and old 1986 minivan for years...love it, but it's time has come...well, did come years ago)

Dad: Hell, you never listened to your father's advice. Why in the hell would you buy a new car? (sort of joking I think)

Me: The same vehicles, but 3 years older, are only $3000.000 less and have no warranty, it made way more sense to buy new, plus I have never owned a new car. I just wanted a new car.

Dad: What else are you up to?

Me: (really excited)..oh, I applied for and got the volunteer position to teach 3 half day printmaking workshops to teens in the summer.

Dad: What kind of teens are they.

Me: Teens coming to the Art Clubhouse. Teen with mental illnesses.

Dad: Oh, you mean not real teens?

Me: (in my head...WTF?) (Out loud)They are REAL teens, what is that supposed to mean? They just have illnesses too.

Dad: Why the hell aren't you getting a real job, one that pays? Why the hell would you volunteer when you could be working for money.

Me: Well, I'm only volunteering to teach 3 hours a week and it's in a rehabilitative and supportive environment. I am trying to get better.

Dad: Well if you can volunteer to work you can get a real job.

Me: (wishing I'd never called, and wondering WHY I always contact him with the delusion that someday he will actually be proud of how hard I try, and wondering where I could get a job that allowed me to work just 3 hours a week and where I could feed myself and pay the rent) Dad, I am still not well. I cannot work right now. I am slowly trying to get better so I can work.

Dad: What you need is a real job. You have been doing that volunteer stuff for a long time now.

Me: (thinking yes...I've been managing a few hours a week for the last 1.5 years, but just recently began to feel safe doing that or even well enough to do that....and besides that, what I do in my volunteer work now is far more "real", much more meaningful and important than anything I have done work wise in my past). I am not ready to work yet Dad. I'm trying to get well and volunteering in this supportive environment is a safe way for me to work towards that.

Dad: Hrmfft. (Translation: you are so lame)

Me: (Hanging up from a call I initiated and entered feeling excited and proud of myself; and hanging up from the call feeling dejected, rejected, diminished, ashamed)

...bye Dad. I love you.

Dad: yup, bye. (click)

My Depression is Returning

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

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

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

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

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

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

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

Oh God, please do not let my depression return .

Managing my Depression Getting Through the Toughest Days

In a previous post I welcomed my 5000th visitor to ask me a question, or suggest a topic for a post. Deepblue being my 5000th visitor posed the question/s:

"I guess the question I'd have to ask is: what has been the most helpful thing you have done to help manage your depression? or, how do you get through your
toughest days? I guess you can answer either of those".

I am not sure how long Deepblue has been following my blog, or what s/he knows about my situation. I have had Major Depressive Episodes (MDE) since I was 17 or 18. I always managed to pull out of them either on my own, or with a small amount of counselling, until I was 31 or 32 (I'm now 42). At that time I sought long term counselling (2 years/once a week), and then I was referred to an outpatient Cognitive Behavioural Training (CBT) group and then a group therapy program, both of which did not help me at all. I had tried CBT in therapy when my MDE's were mild to moderate, but this time my depression was become far worse than ever before. For about a year my MDE went into remission on it's own (with some residual symptoms...not sleeping, irritable, fatigue).

In the summer of 2001 I became despondent and requested more help from my family Dr. She referred me to the Mood Disorders Clinic and on October 3, 2001 I met my pdoc. He invited me to become his patient. I knew as soon as I began talking with him, that were a perfect match. I agreed and began seeing him for therapy and a search for medications. He and I have worked for 6.5 years to try to help me manage my symptoms and my depression. It has been a brutal and tough journey. No medications worked for me; and I tried almost everything you can think of (more than 35 different medications in total, either alone or in combination with other medications) Part of the problem was that not only do I have MDD, I also have anxiety and OCD problems. I think this makes my depression harder to treat.

Back to your first question: " What has been the most helpful thing you have done to help manage your depression?

Until the last month or two, I would not even say I was managing my depression. I was literally trying to "Survive my Depression". There have been a few things:

1) The first most helpful thing I did was find a pdoc that I could receive both therapy and medication advice from. A pdoc who was supportive, authentic, available, hopeful, intelligent, and who I connected with on a personal level. There were weeks and weeks where all that kept me going were thoughts that "I have an appointment in three days. I can survive until then".

In some of my worst moments I would visualize myself laying on the floor in Dr. X's office (no I have never really laid on his floor). The thought of just being near his calming presence helped me calm down.

I never have told Dr. X. this, but one day he left a message on my voicemail at work asking me to call him. I never erased that message until the day I left work. Whenever I was so stressed out I wanted to kill myself in the staff washroom, instead, I would go to my phone, pull up the phone message, listen to his voice, maybe repeat it a few time and something about his voice magically helped me survive...I know it's weird...but it helped

2. Medication that worked is the second thing.

Years of therapy and support helped me survive and try to get going and begin to "live with my depression", but as soon as I found a medication that helped, I was suddenly able to make a huge transition. Suddenly my anxiety dissipated, I lost most of (not all) my fear of people. I wanted to leave the house (vs.having to force myself out of the house), I wanted to see people, I wanted to experience new things. I felt hope. I saw the possibilities. I became more motivated. I began sleeping better. My mood lifted.

I would not say the medication was a miracle, because I had been working so hard on setting up a foundation to begin with, but suddenly, along with medications that worked, my foundation became like rich soil feeding growing plants and I was finally able to grow and blossom very quickly.

I have to say, the bloom has fallen off my plant a bit lately, but I still feel like I am strongly supported by the medications. I think in the beginning, when the medications first helped my mind was so blown that I actually could feel okay, that I ran with it above any of my expectations. Now I feel more like I have a long way to go to get well, but the medicine will help me get there.

3. Build and Create a life that has meaning and purpose. I have always been angst ridden about my life. Except for the time I was in my third and fourth years of university, and doing EXACTLY what I thought mattered, and exactly what supported my feeling that I was doing something meaningful and purposeful, I have always had a sense that I am wasting my life; that I will die and my life will have been meaningless.

I am really interested in existential psychology, because it speaks to this exact thing. So Dr. X. and I have worked really hard to help me slowly build a life full of meaning and purpose. It began slowly, but initially I thought, maybe if I give back to the world somehow I would feel better about my existence. So I began volunteering to walk dogs at the local SPCA. It was a start. I felt that no matter how depressed I was being around a dog would help me, and it was a flexible, drop in when you can situation, so days I couldn't leave the house, or even my bed, I didn't have to.

I realized I needed something more meaningful than walking dogs, so the next year I volunteered for our city's Shakespeare festival. This time I had to commit to one shift a week. That scared the hell out of me. It meant even if I was sick I had to go. It came with many therapeutic moments. I worked with people who either did not have a mental illness, or were not "out" about it. I struggled. My medication and medication changes made it difficult for me to think straight sometimes. I felt really self conscious. I was terrified. I did it anyways, and I got through the first season. The second season was less difficult, except I became so severely depressed part way through the season that I left, thinking I was going in for ECT. Even though I had to leave it helped build my confidence to try something even more challenging.

I began volunteering at the Art Clubhouse for people with severe and persistent mental illnesses. I took classes there, and eventually I began volunteering to apprentice classes with an O.T. and now I am volunteering to teach classes there. This all during the period before my medications worked.

It was hell, but I also loved it. It was hard to manage my responsibilities when I was so sick, but the structure really helped me leave the house, get out of bed, relearn to communicate with people, learn to lessen my social anxiety by exposing myself to more and more social situations: meetings, classes, and teaching. A structure to depend on, and one that was meaningful, and purposeful to me, helped me live with my severe depression.

4. Writing in this blog

For lots of reasons. First I have met some really interesting and caring people in the blog community. I feel like I able to be so open and honest here. It feels purposeful to me. I really hope that people who come here and are struggling with mental illness see what I write and realize they are not alone. I never want to provide false hope, because so many times I have written about feeling completely hopeless, but I know for me there is something about knowing I belong to a shared human experience that lessens my load. I hope that is what I help people with; providing a sense that we are not alone in this world, or in this battle.

The last question you ask is: "how do you get through your toughest days?"

I wrote a post a while ago titled: "Coping Strategies for Treatment Resistant Depression (TRD)"

probably provides my most comprehensive answer to this question. Honestly, some days I just cling to my life; curl up in a ball and just get through the obsessive suicidal thoughts, plans and urges. Those thoughts always pass eventually, and they always come back too, but I try really hard to just get through each tough moment as it comes and try to not think it will always be this way. Ant then there is always the thought...."three more days until I see Dr. X." I can last three days. I can manage knowing I have his support.

Deepblue is my 5000th visitor

Deepblue asked "How do I know if I'm the 5000th visitor?

You are, by the way. (is that your question? or do you want to ask another question, or suggest a topic for me to write about?...I'm open to another question...

Deepblue I know you are my 5000th visitor because you left a post on my blog at 10:53 and my 5000th visitor viewed my blog at that time (the "sitemeter" icon on the sidebar of my blog is free and it gives me simple statistics about how people find my blog (i.e. what they used in google that made my blog show up, times of visits, #'s of visits to my site per day etc.) It is really great because I can see what interests people and think about that when I write. I think you can click on the icon and it will give you a summary of what it tracks.

It says it tracks location, but it must track the city and then maybe your internet provider's address, because I looked up myself and it is nowhere near where I live. When I first saw "sitemeter" on someone's site I was worried about what kind of information it had about me...but having downloaded it to my site and viewing my own information that it tracks I feel pretty confident that my privacy is still protected.

I want everyone to know that I respect your privacy and only use the sitemeter to make my blog more interesting.

P.S. my visits are not tracked as part of the volume of visitors. You can set it to either include you, or not. Idid not include myself as it would skew the #'s.

5000 visitor? Ask me a question.

It is June 7th/08 10:33 PST and the next visitor is my 5000th visitor. If you are that person...ask me a question and I will provide a post about it.

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.

Prozac and Bruxism or Tardive Dyskinesia, or both?

I am exhausted right now. It is the "witching hour", that wicked two hours everyday where someone sprinkles a magic potion over me and I fall into a deep sleep, like sleeping beauty. Hey, Where's my prince?

I get so tired everyday at this time that I feel sick, literally. The tiredness isn't "sleepy" tired, it's fatigued, "burnout" tired. So I will lay down and even though I'm not sleepy tired, will fall asleep for a few hours. I am trying hard to be okay with this. To accept that outside these few hours my mood is definitely better; so what if the trade of is a few hours extra of tiredness. At least I do not feel like this all day, like I do when I am depressed.

I am also having "mouth movement problems". At first my pdoc said it was bruxism, then three or four weeks ago he seemed to be really concerned about how my mouth was moving and took me off the Dexedrine as he said it was making the movement worse.

Last week he said they were not as bad as the previous week, but the night before I saw him I took extra Valium and two muscle relaxants because I had such a sore next from my teeth clenching and grinding. I got a bit mad at him, because I felt he was brushing off my concerns about Prozac and tardive dyskinesia. However, he told me he was aware Prozac has been seen to cause TD and he was concerned too.

Anyways, He suggested I see a neurologist to rule TD out. I told him I would like to see if it subsides over time first. In the mean time I want to come off Valium, because I think it is masking the movements. So I began cutting back slowly and already the movements are getting worse and I am not sleeping well. Argh!

I definately have Prozac induced bruxism; and I am increasingly certain I have TD as well. I have videotaped myself while I am involved in an activity (playing guitar, working on the computer) and the weird mouth movements are definitely there. Every once in a while my mouth makes really strange movements. This is freaking me out, I do not want to look strange to other people. What do I do if it is TD? When my current medication mix is the first thing to ever help me?

My Soul Wants to Trust

Me: You must have noticed I have trouble trusting?

Dr. X.: No, I haven't really noticed that.

Me: You have to be kidding. I waffle back and forth between totally and completely trusting you and then thinking you are being disingenuous. It is not you though. You have shown you are completely trustworthy. It is me. I don't trust people.

Dr. X. : I have not seen that.

These are moments that make me go huh?

How can I think this, feel this, KNOW I am like this and no one sees that in me. I told him he would see what I meant if he read my blog, because while I believe he is an incredible doctor and I believe he is knowledgeable and I believe we have the best therapeutic alliance I could ever hope for, I often still feel scared. I sometimes feel suspicious or paranoid or afraid of him and our work together.

Dr. X., "You mean like you are afraid it is too good to be true?" [Our therapeutic alliance, his caring about me, his compassion and trustworthiness etc.]

Exactly! Exactly!

Everything I believe in, everyone I trust hurts me or dies, or disappears. I am afraid that if I believe and trust in him I will be hurt the same way the other important men in my life hurt me. It is like I think he is my Dad; someone I always try to seek approval from, try to make care about me and every time I let my guard down and think I can trust him, I can let him in....every time he dismisses me, or does, or says something that hurts me or that reminds me I am nothing. Every time I try I get sent back to square one. The unpredictability destroys my trust (though you would think by now I would just stop trying...but to me that is not an option)

Maybe it is not that I don't trust, but that I trust too much. A friend at the Art clubhouse and I were talking and he said it was funny how you would think so much depression and mental illness would make me jaded, but I'm not.

Me (To Dr. X.): I know you think I am jaded, because you see me when I am so sad all the time, but really I am not jaded. When I feel well I feel like the world is this perfectly beautiful place. I don't know if it is just me, but I am astounded by all the details in life and in everything on this earth. It almost feels like I have achieved some godly state of being when I feel well...I am ensconced in this world that simply is total beauty and it feels breathtaking to stand amongst such sublime surroundings.

Dr. X.: I do not think you are jaded. I think sometimes when you are really depressed you sometimes struggle against being jaded.

I was glad he said that, because I think, in spite of the hell I go through, when I am on the other side I want so hard to believe. To believe in love, to believe in caring and kindness, to believe I am likable, to believe I will be loved, I am loved and cared for. I want so hard to believe that I do make a difference to some people; that it matters what I do, that one day my purpose will become apparent, or even better I will choose my purpose. I want my life to matter.

Two Wolves

Last Sunday I went with two friends to a local Community Centre to participate in something called "The Remarkable Women's Poster Project". We each brought a photo of someone we considered to be a remarkable woman and made a poster of that woman. These poster's will be on display at the Community Centre to celebrate National Woman's Month in October. I did one of my Mom.

If you can believe it my best friend did one of me. It was so beautiful. With my permission she "outed" me as a person with a mental illness. Her caption below my photo read: "My Name. Still living. Yeah!" I felt honoured that she chose me as a remarkable woman. Thanks "H".

At the Community Centre there was a poster pinned to the wall with a fable written on it. I do not really subscribe to the pejorative nature of the descriptions of evil in the poster. I am not even certain I believe in "good" or "evil".

I also recognize that Major Depression is the instigator of many of the "evil" symptoms below, but I also think that despite being severely depressed I can push a tiny bit to rid myself of ego and it's soul impairing accoutrements.

Given my propensity to dream about wolves and to cross paths with coyotes the poster captured my eye. This is what it said:

"Two Wolves:

One evening an old Cherokee told his grandson about a battle that goes on inside people. He said, "My son, the battle is between two 'wolves' inside us all.

One is Evil.
It is anger, envy, jealousy, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority and ego.

The other is Good.
It is joy, peace, love, hope, serenity, kindness, benevolence, empathy, generosity, truth, compassion and faith.

The grandson thought about it for a minute and then asked his grandfather,"Which wolf wins?"

The old Cherokee replied, "The one you feed". "

I am so afraid my improved mood and my new found capacity to participate in life will be taken from me; that my mood will disappear into anguish, like it always does. I am trying so hard to feed the "good" wolf, but am terrified that the "evil" wolf gently slips back into my mind unnoticed. I am trying hard to remain vigilant and push forward while I feel well. The thought of returning to the place from whence I came terrifies me.

Am I Overdoing Things?

I had a really great session today. It was so full of hope and heard many expressions come out of my mouth about my feeling like I am indeed moving forward; increasing my resiliency.

I'm not sure if others have this experience in therapy, but I often do despite KNOWING my pdoc is perfect for me and is always caring and thoughtful. I subconsciously re-enact life experience situations in my relationship with him. Yesterday when I was describing Dr, Bennington-Davis' speech I felt this intense feeling that Dr. X. was scrutinizing me/re-traumatizing me; as I became aware of the dynamic it felt like my Dad and how he acts/acted towards me when I found something interesting, or wanted him to find what I was saying valuable. I feel bad because I brought that up with Dr. X; although I expressed that I know it is not him, it is my reaction to him, I still feel bad for feeling that way.

I wasn't very nice of me to tell Dr, X. I was feeling some kind of minor re-traumatization. I didn't mean it that way. Part of what was going on was his proximity to me. He was sitting closer than normal to me and I felt he was too close to me. I found that uncomfortable.

Also, I am almost afraid to say I feel better to him for fear of rejection or loss of support. Maybe that was what it was. I don't know. Whatever it was it was nothing about anything he was doing it was me perceiving in a weird way.

On another note: My husband and I just got in a fight about how much I am doing at the art clubhouse and how I am unable to do anything else, including cook for myself, or him, eat properly, go to the store to buy food, clean the house and my intense fatigue at 4:00/4:30 that causes me to sleep for 2-2.5 hrs.

He says I am doing all the work at the studio because I am seeking approval and that all it will take is one person making a nasty comment to me and my whole world will come crashing down. He is concerned that I am burning out now, and will burnout even more if I volunteer more (I want to apply to teach a teen/young adult group as I though thought it would be good experience).

I see some sense in what he is saying, but I also hear Dr X's voice, "use this energy to push ahead" from last summer when I was a bit too high after coming off Valium. I feel like this is similar in that I need to use the energy I have between morning and 4pm to do things that make me feel good.

Unfortunately, like my husband I do see my health re: bad food, not cooking , not eating etc. is at risk, as is my messy house and undone chores. I feel like I have this very limited energy supply and to waste any of it on something I don't want to do, or don't find intensely pleasing seems like a waste of precious good mood and energy.

I am having a very difficult time finding balance in my life at this time. Dr. X. said the crash at 4pm could be a symptom of Atypical depression, and he has also read literature about MAOI's causing a similar experience. It makes no sense to me that the Prozac is causing this phenomena as it has such a long half-life. Whatever is going on I know I need to do more at home, but I really want to become resilient enough to get back to work. Right now that seems like a more important priority.

M.I.A.

Literally! I have been so active...I have been missing IN action. My mood seems to have lifted to the point that on Sunday I would say it was the first day in 6.5 years that I felt "Well" most of the day...not too high, not to low, no anxiety, cheerful, bubbly and vivacious even around strangers, confident in my self image; basically my well self.

I say almost well because the last few days have been like that too, but at about 4pm everyday I am so burnt out I feel sick and have to sleep for 2-2.5 hours. Then after about 1/2 an hour awake I feel a bit refreshed again, but evenings I feel really low key and fatigued.

I have had such an interesting week. I went to a mental health conference on Thursday that was one of the most interesting conference I have ever been to. There were three key speakers:

• Dr. Steve Onken (a social worker from Hawaii)
• Dr. Maggie Bennington-Davis is a psychiatrist and medical director of Cascadia Behavioral Healthcare, Portland, Oregon (USA)
• Amy Long (both a person with a mental illness and a psychiatric nurse)

I won't try to encapsulate their ideas, but I would like to share a few key things I am going to change, either in my beliefs, or my actions as a result of the conference. I made them into "I will" statements. Here I go:

(based on Steve's talk):

1. As I become the ancestor, I will be remembered for my voice, not my silence. This is based on an old Hawaiian saying ("As we become the ancestors, we will be remembered for our voice, not our silence). As of this moment I am "outing" myself as a person with a mental illness. I will not be afraid. My voice is powerful and I am going to use it.

2. I will speak up an challenge any "microagressions" I see in the Mental Health Care community. Microaggressions were described as subtle and not so subtle ways, through words, or social structures and concepts, that mental health staff distance themselves from the shared humanity of people with mental illnesses. An example would be "staff only" signs on washrooms (like we don't want clean washrooms too).

(based on Maggie's talk):

Her talk about how the brain changes in response to trauma and later "re-traumatization" was fascinating. I will try to capture the essence of her talk...please remember I may get some of the details wrong as I am no neuroscientist oir psychiatrist, but this is what I think I "heard":

She spoke of three areas of the brain that "manage" experiences. The amygdala, which is like a primitive responder to sensory information. It chooses, without benefit of rational thought, whether to Fight, Flight, or Freeze (FFF). Most regular daily sensory encounters go through the amygdala and then into the hippocampus, which acts as a filing system, and then your prefrontal cortex gets the information and decides what to do with the information.

When we encounter a traumatic experience, or traumatic sensory input, we skip the hippocampus/prefrontal cortex experience and go directly into FFF mode("Hypervigilance, Action, not thought, Cognitive diminishment, increased aggression, loss of impulse control, speechless terror") Bloom 2001.

The next time we encounter something similar, or the same traumatic sensory input, we become "re-traumatized". Over time it might happen than seemingly subtle "re-traumatization, can cause huge FFF responses( "traumatic Re-enactment, Chronic aggression, Dissociation, Chronic hyperarousal which interferes with cognitive clarity {and} loss of (or failure to develop)affect modulation" Bloom 2001.

Part of the problem seems to be that the more we are re-traumatized, the more our hippocampus and prefrontal lobes diminish in size, so not only are we on myper alert mode because our amygdala is working overtime, we are slowly losing the capacity to add reason to our reaction in these situations.

She was not talking about PTSD, but of other kinds of trauma. My personal trauma that I kept thinking of as she talked was about the way my Dad could be when I was growing up, and sometimes even now. He was extremely dismissive of anything I ever did. I wanted so badly for him to like me and to be proud of me, but he always pushed me away. He also had the capacity to become enraged out of the blue. He became extraordinarily intimidating and scary to a little girl (he was a policeman and he KNEW exactly how to scare the crap out of people to make them do what he wanted), he also sometimes became violent towards me in these rages.

To this day, any experience I have with anyone in a position of power or authority is coloured by my childhood experience. It takes very little to make me cry or cower, or feel abandoned or dismissed or rejected.

This is what I was conceptualizing as "re-traumatizations: A man coming towards me quickly and me fleeing in terror, A boss saying something negative about me and me being flooded with memories and tears, just like my Dad is standing over me berating me, A person stabbing their finger in the air and I am back as a little girl with my dad stabbing my chest with his finger, pushing me backwards, scaring the hell out of me.

Maggie suggested when these re-traumatizations occur that we try to use "cognitive wedges" to eventually retrain the brain's capacity to be "re-traumatized". Eventually if we are able to do this enough, the hipocammpus and prefrontal areas of the brain will begin to grow again. Those areas will become more in control of what used to be FFF reactions to external "re-trauma"

3. I will practice using cognitive wedges whenever I encounter a situation that feels like it is a re-traumatizing situation. A cognitive wedge requires that when the re-traumatization sequence begins we IMMEDIATELY start doing some task, any task, that requires you to use the cognitive areas of your brain. Examples she gave me was go into the washroom and try brushing your teeth with your wrong hand, or try reading some difficult passage, or write with your wrong hand...anything that takes the brain away from the amygdala reaction and to a prefrontal reaction.

4. I will be careful that as an instructor I do not do anything that may re- traumatize someone. In order to not re-traumatize myself if/when I make a mistake I will forgive myself and ensure the the mistake leads to a change for the next time a similar situation happens.

(Based on Amy Longs Talk):

5. I will remember that if I am alive, I am coping. I never got this before. I remember Dr. Shock replied " I am glad to see you are coping!) to one of my posts I wrote when I was really feeling close to the edge. I didn't understand what he meant. I do now. Thanks.

6. I will never ever use the word "recovery". I will instead say I am "developing my resiliency". Whenever I here the word "recovery to do with mental health I feel like I am failing, because I never seem to recover. If I do feel better I always seem to crash shortly thereafter. I feel like I am not doing what everyone else does when I fail to recover. I think developing my resiliency, so I am able to fight the depression better each time it shows its grotesque self to me is a better description of how I am working towards feeling better over time. I may never recover from this battle, but I can always add more solid layers of resiliency to my suit of armour

Anyways...it was all very stimulating and interesting. I learned a great deal at this conference. The really cool thing was that after each speaker they had a panel of three people (different people for each panel member) responding to the speakers speech. Each panel included a mental health care professional, a person with a mental illness, and a family member of a person with a mental illness. I learned as much from them as I did from the speakers. Whoever organized the event did a great job.

...aqua

Selling My Art Work

God...you are not going to believe this (and I don't have time to tell the whole story)...I have had an incredibly fascinating 2 days. Yesterday I attended a Mental Health Conference and then today I along with other Studio members and staff, I met with the 3 key speakers from the conference.

One of the speakers, an American psychiatrist (who spoke about how the brain physically changes when introduced to trauma and how to untrain the brain when trauma is reintroduced) (soooo interesting), wanted to buy one of my paintings...the "Unravelled" painting. I didn't sell it, because I can't part with it yet, but she gave me her card in case I change my mind...I feel really honoured that she wants to buy it. This makes me feel like I am headed in the right direction and towards the right destination.

I have a guest this weekend, but will tell you more about the conference in a few days. It was so interesting and I had so many epiphanies during it that I would like to share.

Happy Victoria Day Long Weekend for all you People of the Commonwealth Nations,
...aqua

A Switched Flipped Yesterday and...

A switched flipped yesterday and my mood lifted. Well, in fact, I will retract that statement.

"I flipped a switch and my mood lifted"

I take responsibility for lifting my mood...and Dr. X. if you are reading this sit down:
I joined a guitar class and seriously played my guitar for the first time in years!

And guess what...it made me feel so good. The experience was mostly extremely pleasurable. And then...we played again this morning! And guess what else...though I woke up today exhausted, the music and the inspiration of other's music, and the safe camaraderie in the drop in session this a.m. was again soul enhancing.

Dr. X. will understand how hard this was for me. Years ago, when I was in my early twenties, I hung out with a large group of people. Before and during part of second year University I was dating one of them. Music was my life.

From the time I was young I played ukulele(no lie), the guitar and drums. I listened to all the music I could get my hands on. In my late teens and early twenties I went to see live bands every week, all the time. This was when the grunge movement beginning and was getting big on the Westcoast and I was enthralled by the energy of the music.

A couple girlfriends and I started a band. We had a practice space and practised all the time. It was so fun to sing and make music. Then I started university.

I became overwhelmed by the academics, partly because I was having to work to support myself, partly because I was trying to keep up with my friends outside university and partly because I hadn't been in school for a while and really was not prepared for how much pressure there was. I slipped into an extremely severe depression. As I became depressed my boyfriend cheated on me (on purpose) knowing I would dump him. He told me I was too depressed to be around.

This did two things. It set me into an even more severe depression and it made me lose contact with all my friends. All my friends were mutual friends with him. So along with the relationship ending, all , but one of my friendships ended, our band ended and I stopped going to listen to bands. I also put down my guitar. It was too painful a reminder of so much loss. I became even more depressed and sought help, which helped with the depression, but never helped me pick up my guitar and play again. I literally didn't play it again for years.

Dr. X has tried to get me to play, because he knows music creates a sense of joy in me. I made a couple weak attempts to try, but it just brought back too many sad feelings.

In the impromptu lessons yesterday (that we planned at the Art Clubhouse on Monday) I almost cried numerous times when I was playing. I have so many feelings of loss and abandonment tied up in my guitar. I was terrified I would be so bad and I would embarrass myself. I did embarrass myself, because almost twenty years away from an instrument does not a good guitar player make, but I survived the embarrassment. Dr. X. has tried to help me so many times to allow myself to be embarrassed and live through it. He has advised me to take a behavioural approach to my embarrasment. The more I let myself get through those moments, hopefully the more I will learn to feel less embarrassed.

While I played my guitar in the lesson I almost cried from fear, shame, and embarrassment, but I kept trying and I received so much encouragement. A group of us are planning to meet for lessons and jam session every week.

I am so glad I took that step to force myself to try to play again, despite all my fears and all the bad memories attached to that guitar. It felt like yesterday and today were an attempt to create good memories with the guitar. That is a huge step in the right direction. I can tell it helped me, because my mood lifted during the first guitar session continued to lift today despite being exhausted this morning. After I started playing the guitar at the studio it was like I woke up. I began to joyfully make up lyrics and sing out loud and strong along to the blues riffs we are learning. I love music.

Invisible

I feel like a slug: a sick slug, a slug more sluggish than a slug. I could barely drag myself out of bed today. Maybe I am sick on top of being depressed, I don't feel physically or mentally well, but I suspect the illness is hypochondriacal and brought on by how depressed I feel.

Yesterday I had intense urges to end it all. I have the means as I have hoarded all my leftover meds and still have all my dogs phenobarbital and heart medication. Despite those intense feelings I managed to stop myself from acting. It is not good for me to be alone when I feel like that. I came so close to taking all those pills and just ending it all.

What stopped me? My family. The thought of my husband having to find me dead was too much responsibility for me to place on his shoulders, so I lay down on the bed and clung to the covers and waited for him to come home. He didn't notice I was unwell, like he never notices I need help. It is like I am invisible to him. That really hurts me.

I feel like that a lot; like I am invisible. It is Mother's day and I really miss my Mom. I never felt invisible with her. Even on Mother's Day she would send me a "Happy Aunty's Day" card. She was so thoughtful that way. Without my Mom, without a job, without kids, without the energy to maintain my household even to minimal standards, without the energy to return calls and e-mails, to meet with friends and keep friendships going, without the energy to be a good wife...I have made myself invisible in this world.

I SHOULD Have Stayed in Bed...

I had my pdoc appt this morning. I should have stayed in bed. I sat there wondering if I should continue therapy, continue medications, continue any of this. I sat there feeling overexposed and under protected, listened to, but unable to say what I feel...partially because I feel nothing and partially because I feel like I'm just biding time until I die.

I see no real change in my perceptions taking place. A friend told me about an exercise she was doing, whereby you think of all the things you do now and then repeat the exercise with all the things you would do if you knew you only had had 2 years to live, or what if you had only two weeks, or even less...2 days. When she explained the exercise to me it sounded so much like the type of existential exercise I find so very powerful.

I sat down and tried to put down on paper how my life would change if I had a pre-determined, set time to live. The first thing I thought of was I would call my sisters and express to them how much I love them, the same with my nieces. However, I already do this on a very regular basis, so nothing would really change there. My next thought was that I would feel intense relief knowing life would soon be over. I decided, for me, nothing would change.

I would continue to wait to die, just like always. Dr. X. said maybe we are all waiting to die, but in between we can do things in our life to make the waiting less difficult. I know what he was trying to say...we all die, but we all can impact the time in between, even if in small ways.

I'm sitting there looking at him thinking..."what the hell do you know about waiting to die? You have an interesting job, that you are good at and well compensated for. You have kids to live for and love, you have the energy to ride your bike and to play the piano and to enjoy living."

I know that sounds harsh...but I just felt an intense disconnect between my situation and his. His is the situation I worked so hard to get into and failed so miserably at. I may not have been able to be a Dr., but I had the skills and knowledge to do something with my life that mattered, something I loved: then my lifelong anxiety kept increasing and it and my depression just took me down. Maybe I should be grateful that now I am only "waiting" and not "willing, or making plans on how to make myself die.

That is what I feel Prozac has done for me; changed my wanting to kill myself into, wanting to die. Something I have felt for so many years I have a hard time remembering any extended period where I did not feel like I wanted to die. Is it worth it?

I've been listening to some of my old cds and my whole headspace sort of reminds me of that Smiths song "That Joke Isn't Funny Anymore" :

"Park the car at the side of the road
You should know
Time's tide will smother you
And I will too
When you laugh about people who feel so
Very lonely
Their only desire is to die
Well, I'm afraid
It doesn't make me smile
I wish I could laugh
But that joke isn't funny anymore
It's too close to home
And it's too near the bone
It's too close to home
And it's too near the bone
More than you'll ever know ...

...[refrain]

...It was dark as I drove the point home
And on cold leather seats
Well, it suddenly struck me
I just might die with a smile on my
Face after all

Knowing when I was going to die would be like putting a smile on my face. Life seems to be the big joke I'm not finding funny anymore. Well, really, I haven't found the joke funny for a long time.

Then, after my pdoc appointment, in case I needed another reason for staying in bed, I was the lucky recipient of a $196.00 speeding ticket; all because my road rage kicked in when the twit in the LEFT (passing lane in Canada) lane was dawdling at 40kms/hr in both the passing lane and a lane that was 50 km zone, and crossing the centre line between the two lanes.

I decided the person was going to cause an accident and I needed to get out of the way, so I saw a break in traffic on the right side, slid in and hit the accelerator to pass the idiot's car quickly. I guess a little too quickly, because as soon as my overdrive kicked in an "insane" policeman stepped out right in front of me on the highway...he's lucky I was paying attention as he was pretty close to me when he stepped out...anyways, to make a long story short it ended in him giving me a ticket with a huge fine and me saying "thank you"...can you believe that???

Who's the insane one? Oh yeah that would be ME!!!!...I bet he walked away laughing at me saying thank you for his ticket writing skills...Oy! I should have stayed in bed.

Fatigue and Isolation and Anxiety

All I want to do is hide out and crawl into bed. I feel so tired I feel literally sick. The tiredness is not "sleepy" tired, but rather, "exhausted" tired, like I cannot move and have no energy reserves to do anything. I pushed myself to paint on Monday for an hour or two, but it took every ounce of willpower to do that, Yesterday I went to the Art Clubhouse for a meeting, again only by exerting my will over my desire to hide out at home.

It is strange, I do not want to see, or contact anyone; I am not picking up the phone, or returning calls and I hide behind call display and feel dread at the thought of having to call people back. On the other hand if I push myself out of the house to go to the studio, it is like I get energy from other people. The problem is when the contact is finished I feel even more exhausted than before. It is as though I vicariously absorb all the energy from people around me, but when I touch the door to leave it is really apparent that I have pushed myself to hard to be up and energetic FOR other people. After the interaction I feel even more sickly fatigued.

Today I am forced out of the house as I have committed to volunteer at the studio this afternoon. I know in my role I am expected to be welcoming, available and helpful. All I really want is to stay home, or go there and hide out in my own little world.

Tomorrow is the beginning of the next set of drawing classes I volunteer to teach at the studio. I feel dread about tomorrow. I am really afraid I will not be what people need me to be. I think part of that is because I have no formal art training. I feel like a fraud; someone who got this amazing volunteer position, but really is not qualified to teach what I teach. I am always afraid someone in my class will call me on that and then everyone will make fun of me and than I will die of embarrassment from the ridicule.

Happy Birthday Mom. I Miss You.

(The stained glass window my Mom gave me before she died. She gave each of my sisters and I one and told us to go to it if we ever needed to talk with her.)

It is my Mom's birthday today. She would have been 68; a young and vibrant 68. I miss her so much it is unbearable some days. Myself and my two sisters all agree that it would be impossible to have had a better Mom. I cannot fathom why someone like her would be taken away from us like she was. Happy Birthday Mom. I love you more than you can even imagine.

Here is an excerpt from the eulogy I wrote for her:

"...Along with her great life of adventure, mom managed to bring up three daughters. It is impossible to explain the love that existed between Mom and her three girls. She was the most incredible and inspiring, caring and compassionate, patient and loving mom anyone could hope for. All of us adored her and will continue to do so. There was not a time when she wouldn't help us if we needed it.

She was always there to lend a hand, listen to us, offer us sage advice, and give us hugs, kisses and show us love whenever we needed it. In return the 3 of us learned to how to love. Well versed in caring for another we returned her love to her. When her 4 grandchildren were born the love in our family expanded even more. Mom adored her Granddaughters [S,J,A,and J]. Sadly her grandson [H] passed away at birth, but Mom took care of him both in her prayers and by bringing him to all our family functions. She so strongly believed it was important that he be a part of our family that she sewed him a beautiful bag, placed his ashes in it and ensured he was with us on all our family's special occasions.

As a testament to her love for her children and grandchildren she has literally hundreds, maybe thousands, of pictures showing the experiences she had with us and the little girls. Her children
and grandchildren returned those experiences with love, affection and adventures of their own. When we asked the granddaughters[2,4,4 and 6 at the time] what they loved about grandma they responded gleefully:

• she was very nice to us,
• she took us to movies (and left 10 minutes in if we got scared, or bored),
• she always let us buy a toy,
• we had sleepovers in the camper,
• she told us stories,
• she made us feel happy and gave us lots of hugs, kisses and
  snuggles.
• She took us for walks with Bert
• and last, but not least..."she made us feel special"

That was Mom's legacy. Her ability to make everyone she met feel special.

People told us this time and time again. She always saw the good in people. If we are to learn anything from Mom's life it is to understand that we all have the capacity for goodness within us. That treating people well, no matter what the circumstances are increases the likelihood of that
person treating someone else well. She believed in practising and showing kindness, compassion and caring, thoughtfulness, patience and love towards others, even when, and especially when, it was difficult to do. Mom showed us that love begets love. That was her lesson to all of us.

Let us carry what we have learned from Mom into the future and let her lesson of love live forever. We love you Mom"

4000th visitor "My Psychiatrist Won't Give Me Counselling..."

Just a today I had my 4000th visitor to this site. Thanks for visiting everyone. I am always so interested to hear from others and to discover other people searching for some of the answers to the questions I ask. I feel less alone knowing other people exist and are trying to work through their lives while struggling with mental illness. I also appreciate those visitors who may not be mentally ill, but support and search for help for those of us with these illnesses.

I thought I'd address the question Visitor 4000 googled to get to my blog because I found it especially poignant given how much support I receive from my psychiatrist. It saddens me that people are being left to fend for themselves when they think they need more support.

Visitor # 4000 googled: "my psychiatris[t] wont give me counselling i need more than 20 sessions".

In my experience I have seen so many people whose psychiatrists offer no therapy, but are simply there to provide medication and biological treatment advice. In some cases, where a person takes an antidepressant, it works wonders and the person is off and returning back to a normal life, I think this might be a good approach.

My question is...and this is a big one...Does this EVER happen? I have met so many people in the last 10 years or so with depression and honestly, I cannot think of a single one whose illness was that easily treated.

I don't believe depression is simply a biological illness. There are so many factors involved in why someone becomes depressed and why one person gets better while another struggles. 15 years ago I would have told you all I needed was 5 or six therapy sessions when I was depressed and I got my life back and became well...but DID I BECOME WELL?

Would I have been in a better situation now if my depression had been taken more seriously when I was having short Major Depressive Episodes. I addressed this before in my post "Early Medical Intervention for Major Depression" . There are no easy answers, but I really believe I needed the support of a psychiatrist, and especially a psychiatrist who works longterm with his or her patients in therapy as well. Twenty therapy visits would not be enough for me, even before this episode.

Why do I believe this??

1. I believe Major Depression is complex and has complex triggers...environmental stressors, the person's family history, the individual's history, the individual's coping mechanisms. whether abuse has been involved, whether there are other psychiatric problems like anxiety disorders, or OCD problems, or alcohol or drug abuse problems, whether genetics is a factor, how much, or how little support the depressed person has, whether or not medication, or medications work....the list goes on. No one can convince me that all these things can be addressed in 20 sessions or less.
2. What if medications don't work, or work for a while and then stop, or are not optimal and as such are leaving the depressed person at risk of another depressive episode, or more problems in their life due to the side effects, or ineffectiveness of the medication. Long term support is crucial.
3. By long term support I mean a psychiatrist you have the opportunity to learn to trust. A psychiatrist who is there for you when it's black and dark and life is not worth living, a supportive psychiatrist who listens and cares and believes they can help you, a psychiatrist who does not falter when mistakes happen, or when the patient gives up hope, or even when the patient feels distrustful of the psychiatrist in spite of the doctor's consistency. My experiences in life have left me scared and scarred and afraid and distrusting of other people. No medication takes those fears away without a combination of therapy. Certainly, 20 therapy sessions cannot eradicate a lifetime of lessons in anxiety, fear, intimidation, helplessness, hopelessness and sadness.
4. I know the reason I have survived the last few years is because my psychiatrist offers therapy. Without his continuing support, without there being an understanding that I can see him until I am well, and even after I feel well, I would not have the courage to keep trying.

Dear 4000th visitor...there are psychiatrists who offer therapy. If that
is what you want, or think you need, please listen to yourself and look for a different doctor. You have one life and it is so important to get the care you need to make your life manageable, and, hopefully one day, delightful. I wish you all the luck in the world.

In My Bubble

This past week I went to see my sister and my nieces, all of whom I love so much, but I could feel nothing. I spent a great deal of my time there struggling against my self disappearing into a frustratingly detached state. I call it being "in my bubble". I think it is what is referred to as dissociation or maybe depersonalization. As I slip back into depression I find myself spending more and more time either sleeping or, even worse, in my bubble.

Usually this type of feeling is brought on by extreme stress, typically intense social anxiety, or fears that I will embarrass myself or look stupid, or fears I will be rejected. I talked with Dr. X about how I have been feeling in my bubble this past week. I don't really understand what we were talking about in our appointment this morning.

I think he was explaining to me that when I get in that state it would be better for me to just "be" in that state, rather than both be in the state and berate myself for being there.

When I got home I thought of a funny story my sister told me this weekend. It seems when she was in her early 20's she smoked some extreme pot with a friend and some people she didn't know that well. She said she was so high that inside her head she kept repeating "Just say something!,Just say something!, Just say something!", over and over, but nothing would come out of her mouth until suddenly, in a really loud voice she said, "SAY SOMETHING"!

....I laughed so hard when she told me that story, but her description of her inner turmoil while stoned sounds so much like my inner dialogue when I begin to go into my bubble, and when I come out of it. I begin to feel aware of myself slipping away. I suddenly am detached from everything. I can't see, hear, touch, smell anything. I'm gone.

Then just as suddenly I come out of it. I feel so scared and afraid I must look completely bizarre, or that people will have noticed me "gone", but no one has ever said anything. Given other's reactions to my behaviour I can only surmise too much time does has not passed while I was stuck in my bubble.

I have other experiences like this that are so distressing. Not sure why, but it seems to happen in large stores, especially grocery stores. I feel like I've left my body and am hovering above myself. I feel myself getting all clammy, like I'm going to faint, I begin to panic and then I'm gone. This sometimes happens when I am in a stressful group situation, for example with people I do not know that well, or even with people I know well when I am feeling severely depressed and anxious. It is as though I am "outside the circle": a detached third party viewing myself and others from outside myself.

In both types of situations I feel "stuck in the sensation" of not being there. I want to be in the moment, but feel completely disconnected from it. I begin slipping away and there is nothing I can do to stop it from happening. It is an awful feeling; almost as though I am a ghost of a person and existence is surreal, or experienced through a veil or from a distance.

I don't really understand what Dr. X was trying to get me to do, or understand. Was he saying to just let go and give in to slipping away. Let go, don't struggle and accept these sensations as part of who I am? How do I do that?