It is Gone.

I have lost my joy and all that is left is extreme fatigue, depression, apathy, grinding, tapping, clenching teeth and a desire to sleep all day long.

I just got back from a visit to my youngest sister's. I should have felt joyful and intense love, because I know I feel that about her and my nieces, but I felt nothing.

I found myself disappearing into my bubble...my description of when I dissociate. I feel like I am all of a sudden covered in a bubble that shuts out all the sounds and any kind of sensory perceptions. I stay in the bubble and then it suddenly disappears and I am back from wherever I was and the sounds and sights flood back into my head.

I had a few panic attacks this weekend at my sister's...almost fainting a couple times, getting that clammy I am disappearing and going to pass out feeling. I was so spacey most of the weekend that I was tripping and falling all the time. In fact, in one of my dissociative experiences I fell down my sister's stairs and really, really hurt myself. I landed on my behind and both my arms. I thought I broke my arm and was afraid to get up, because it felt almost exactly like when I broke my elbows...throbbing agonizing pain.

I finally managed to get up, but a few hours later I notice my arms were both covered in massive bruises. I have a monster sized bruise on my backside that is so black and huge it is frightening.
The next day I woke up and I was having a hard time using my right arm. It's okay now though, but it looks like someone beat me up.

I am so clutzy; always have been. I have broken so many bones and hurt myself accidentally so many times that it really does shock people how often I fall, break bones, get in accidents etc. I think it is because I disappear and the real world keeps on going.

I find it hard to visit my little sister, because she lives in the same town my mom lived in. God I miss my Mom. It feels like I have a huge empty hole in my heart where she used to sit. I seem to miss her even more this year than the first year after she passed away. My sister said the same thing. My Mom's Birthday is coming up soon, so that seems to trigger so much grief in me. To be honest, I still think I am in denial about her dying. It feels like I am just stuck in some horrible nightmare that I can't wake up out of. I wish it had been me and not her. She had so much to give the world; so much love, so much compassion, so much more to live for. I really do wish we could have switched places. I would give anything for that.

Medications, side effects and doubt I will ever find what I need

This post finds me frustrated beyond belief. Not only have my combination of medications seemed to have stopped working, they are causing me distress over and above their not working.

I started taking Tegretol (800mgs) about 6 months ago. I thought it helped somewhat with the lability of my mood. (Although in my appointments my pdoc used to ask me why I was telling him I was feeling better when I clearly was not???). I really felt a tiny helpful change.

So to augment that tiny lift we added Prozac, starting at 10mgs and now I'm taking 30mgs. Almost immediately (within two weeks) my mood lifted, but it also came with intensely annoying 4-8 bars of the same music playing over an over in my head and my teeth began tapping like mad.

So I tried Valium to calm that down and it seemed to help a bit, especially at night. The Valium also helped with my intense anxiety and alcohol cravings, so we added Valium to my nightly regime. The music has disappeared, as did my need for alcohol. Unfortunately as time went on the Prozac seemed to not work very well (from my perspective..if at all). Also, either it, or my returning depression began causing intense fatigue. I felt so tired I could not do anything. All SSRI's I had tried before did this same thing to me.

So we added Dexedrine to my mix to help with some energy and motivation. The day after i began it I got my old self back, and for 3 glorious weeks I felt like me again: motivated, action oriented, delighted to be alive, enthralled with everything I saw, social anxiety disappeared, I became my old self assured, bubbly and outgoing self.

Unfortunately the Dexedrine came with two price tags: It increased my teeth tapping problem tenfold. The teeth tapping became tapping, grinding, clenching, strange mouth movements like my lips kept pursing together. All this damaged my teeth and I had to get a guard to wear during the day, but it kept getting worse. The second problem with Dexedrine is that it quickly wore off. At first I started with regular release the next week I switched to a 10mg spansule (extended release) in the a.m., then the next week I added a 10mg spansule at noon, but by the end of that second week by 4pm the Dexedrine seemed to wear of and I became so exhausted I felt sick. By 4 or 5 that I had to nap until 7/7:30.

So now I am left with two options: Stop the Dexedrine for a while and hope that my teeth/moth movement problems are reduced and when I go back to the Dexedrine in a while it will help again, or stop the Prozac (as the initial cause of the teeth problems). Neither seems like a very good solution to me.

Here I am with a combo of medications that seems to help somewhat to (periodically) quite a bit, but the side effects are such that periodically I will need to stop and the restart them. All I see is that my mood is going to be okay, bad, okay, bad, okay, bad forever. God I hate this illness. I hate the medications and I hate that nothing seems to consistently help me. Will I ever find a combination that really works?

Letter to My Sad Self From My Happy Self

Above is the card I choose for myself. It is from a series of cards Marcia Lippmann made from photographs she took of Buddha statues around the world. She also does a series of photographs of angel statues that are stunning. I choose this because despite how little and inconsequential I feel sometimes, like the flowers in this picture, I am a gift to someone, or some being...(I hope).

In my last post I wrote how, on the advice of Dr. X., in order to help myself when depressed, I wrote a letter to my sad self on a day where I was feeling really well. I have perused it so many times when I am unwell and it is definately a worthwhile exercise.

Inside the card and envelope I placed photos of my nieces, a ticket stub from when I went to hear the Dalai Lama speak, $60.00 (I said $50 before, but guess inflation hit me last time I dipped into it) so I could get out of the house and buy something I wanted, or pay for a massage or buy a book, or anything that helped me feel good. When I looked at it just now I realized I also placed a book of stamps in there...to mail a card to someone else. I always love handwriting and mailing cards the old fashioned way...it makes me feel good. I also folded up a whole newspaper page full of cryptic puzzles I like to do, and finally, included stickers my nieces gave me with their names and pictures on them.

If you want to write your own letter and tuck things into it the ideas are endless. Basically, place anything in with the letter that will make you smile, feel love, help you become distracted when you most need to be. What those things are is up to you...good luck.

Below is my letter to myself. If you click on the image of the letter below it will become bigger:

How Mood Stabilizers Feel and I want to Die

I thought I'd write a post to those of you who get to my blog by googling the above two topics. They seem to be common and maybe I can help you. Remember the following is based on my experiences only. I am a patient, not a Dr. and everyone experience these things differently. Please call your psychiatrist, or doctor if you are in distress. If you cannot get a hold of them and are feeling suicidal please call your crisis line and/or take yourself to the hospital. No one should have to cope with these things alone.

1) I Want to Die: (Please read this first)

I have felt this way this way too many times to count. You can find many posts on this blogsite where I have said this very thing. What has kept me here through 6.5 years of hellish severe treatment resistant major depression and twenty years of having major depressive episodes?

I'd say four things: My family, my psychiatrist, medication and some kind of resiliency inside me that clings to life even in my darkest moments.

Every time I think of suicide I am left with the thought about how, while it will be a release for me, it will forever impact those who love me. I have tried so many times to think of how I could die without impacting others, but after losing my Mom two years ago I know that is not possible.
Even if I did not have my family, I have a psychiatrist who does therapy with me once and for a long while twice, a week. He is intensely supportive, consistent, caring and available. I can speak to him about anything and every thing and trust he will help me. I tell him about my obsessive suicidal thoughts when I have them. Sometimes this is enough to relieve me of them if only for a while. I find sharing the thoughts and knowing he gets it to be helpful for me.

Some medications have helped me too...Epival, Valium (to reduce my anxiety, which sometimes leads to anxious, violent and agitated suicidal ideation).

Finally there is something inside me that never gives up, even in my darkest moments. Sometimes I just need to cling to the couch, or my pillow until I get through the thoughts and come out the other side alive.

My psychiatrist made a suggestion that has really helped. He told me to write a letter to my sad self on a day when I was feeling really good. So I bought a beautiful card and one day when I was feeling really well I wrote a point form note to my sad self about all the things that are good about me and my life. In the envelope I enclosed pictures of my family members and $50.

When I felt like suicide I open and read the note and look at the pictures. The $50 was an incentive to get myself out of the house and go buy something that made me feel good (a massage, or a new top, or a plant for the garden etc.) This really helps me.

I am not saying suicide is not your choice, because I believe ultimately we should all be free to make that choice. I am saying, it may be your choice right now, but you may not make that choice a few hours, days or weeks from now. If you commit suicide you will not be able to change your mind.

Please, if you are thinking of suicide, or planning to commit suicide, seek help. Call your doctor, call a friend, call the crisis line or go to emergency at the hospital.

2) How does a mood stabilizer feel?

I believe Aristotle was the first to say "Knowledge is power" (although Sir Francis Bacon also said it, but much later)...sometimes though, it is difficult to discern the difference between "knowledge" and "information".

They are two completely different things. There is tons of "information" about mood stabilizers out there. You could read forever about all the scary side effects...but remember:

You may NEVER experience those side effects!!

The drug companies are supposed to list all the major side effects that people have experienced (information), but until you try a particular medication you will have no idea whether you will have even a single side effect (knowledge). The information about possible side effects for the mood stabilizer I take, (Tegretol/Carbamazepine), would be enough to frighten even the most brave (or desperate) patient...I have had ZERO side effects from it.

Remember different people have different reactions to these medications. I have no idea why, but things I can't manage at even minute doses I have friends who are on HUGE doses who are feeling much, much better. Here is my experiences:

Lithium: I was so scared to try Lithium. I thought it would mean I was really insane (I am...ha, ha), or much sicker than I thought I was. I felt stigmatized by even the suggestion that I try it. I avoided trying it for 4 years. Then I tried it out of desperation.

At 1200mgs...Surprise, surprise...I felt almost instantaneously better and I had hardly any side effects, and no significant side effects. I had to pee more. That was the side effect. Unfortunately, it did not seem to work after I became sick with a really bad 4-week long cold/flu. I seem to remember my lithium levels going too high two weeks into being sick, causing extreme fatigue, which may have contributed to my being sick for so long. I lowered to 900mgs didn't help and then up to 1050mgs and I felt fatigued again and it didn't help my mood. I really wanted Lithium to work, because I felt comfortable with having so few side effects. Lowered to

Divalproex Sodium (brand names: Epival, Depakote): (tried 900-1200mgs) Epival quickly slowed down and lowered my intense feelings of rage and helped lower my anxiety. My mood still cycled, but the intense BAD energy dissipated and my thoughts of suicide slowed down. Unfortunately it came with side effects I could not manage. In the beginning my hair began falling out in clumps (I took 200micrograms Selenium a day with Zinc and this slowed down and eventually stopped). The big problem I had was trouble with my memory and attention. I would walk into a room and forget why I went there. I did memory tests with my pdoc and it was clear I was having difficulties. Still I remained on it until I got through and intensely bad period in my depression. It really helped the agitated energy inside me and was worth the side effects.

Lamotrigine 200mg: Tried twice. Once after 8 sessions ECT(2004). The ECT time my mood seemed to lift for a while. I seemed to become almost hypomanic like when I took it after ECT (could have been the ECT?). I had balance problems both times, but two weeks after ECT I was extremely high and running all over the place on the ice at a curling event. I fell a broke both elbows. Three weeks later I fell fell again off a curb into traffic, then fell a couple more times. Dr. X suspected it was causing balance problems, Tried 200mg again Jan/Feb 2007 with Lithium...nothing.

Gabapentin...might as well have taken sugar pills.

Carbamazepine (Tegretol): Since August/07 I have been taking this at doses of 600-900mgs/day in the p.m. I have ABSOLUTELY no side effects. I believe it slowly is helping my moods cycle less often, though I still cycle and I have been severely depressed on it until the past few weeks I really think it has slowed the lability of my moods...I cry less even when depressed, I can function a bit better even when depressed. I am taking it now with Prozac, Valium and Dexedrine, and I think it is helping me sleep better than before (Although I still go through long periods of insomnia like right now).

I haven't discussed my experience with antipsychotics as mood stabilizers. I know many people who take high doses of these and swear they help them. I could barely function on even low doses. I guess this supports the idea that we are all so unique in what does and does not help us and how we react to different medications.

I guess what I would like to get across in this post is that there is so much misinformation about mood stabilizers out there. If you read an article saying they will impact you negatively, you can easily find another that states the opposite. I have learned to both trust my psychiatrist to guide me through my medication trials, but never blindly. I still research what he suggests and we make the decision together about what I will try.

Being an active participant in my therapy, asking questions, working together with my doctor, and having a therapeutic relationship with my psychiatrist where I both trust my doctor's knowledge and his support is the way I make decisions about what medications I will take to try to help myself. I hope everyone has the opportunity for this type of an experience.

I Am Cycling Downwards...Again

These past three or four weeks I really thought my pdoc and I had hit upon the magic mixture for my depression. For the first time in years I felt like myself for a few weeks. This week that all began to disintegrate once again.

I went to my pdoc appointment today and I felt like I just didn't want to talk. I feel frustrated, annoyed, irritable about the loss of my creativity, high mood, and recently rediscovered feelings of self esteem. All week I have become increasingly fatigued; feeling so tired by 4-4:30 pm that I feel sick I am so tired.

I have been crawling into bed at 4:30 or 5 and sleeping until 7 or 7:30. When I get up I feel less tired, but my mood is still low. The I have not been able to sleep during the night. I am awake, asleep, awake, asleep, awake, asleep...all night long.

Dr. X. suggested I try napping for only 1/2 hour around 4:30 and then get up and go for a brisk walk around the farm. I told him I would try, but today I set my alarm and when it was time to get up I shut it off...I just couldn't get out of bed. I felt like I was made of unmoveable stone.

He also explained to me that I need to try eating small amounts of food throughout the day. In the last 3 weeks I have eaten very little, because when I am well it is like I forget to eat...the rest of life becomes to exciting. I've lost 6-7 pounds, which to me is a good thing, but Dr. X. says nutrients provided in regular eating of food can affect mood.

I did not have the energy, or the motivation before to cook dinner...I have really not been eating well for quite a while, and then when I felt good I didn't want to waste my time cooking. I would say I was eating okay though. I had a bowl of granola/muslix at about 10:30a.m. and then around 7:30pm I made myself a yogurt, blueberry, mango, banana and blueberry juice smoothie. At least I'm getting some fruit. Sometimes I'd eat a couple eggs too.

Anyways, the other thing I am going to try to do (on Dr. X's advice) is actually two things: keep painting even if my creativity seems to have disappeared. He says to keep doing the things that make me feel good when well, even if they are hard to do, or I don't feel like it. Secondly, give myself permission to slow down and ride out the low cycle. He expressed that he knows these are both easier said than done. I appreciate that he gets that.

All in all my mood is lower, but no where near as low as it sometimes goes, so I'm hoping I can get a hold on it before it really crashes. I hate the unpredictability of my mood.

Therapy and Boundaries

This is to address a couple comments on my last post. It also addresses things I have thought about, wondered about in therapy, things that made me stopped doing things I really enjoyed doing, because I beacame afraid I may be perceived as crossing boundaries.

In my previous post "Co-Blogging Re-visited and a Therapeutic Epiphany", both Dr. Shock and Jcat encouraged me to to continue towards trying a co-blog with my pdoc, in spite of some reservations about this being a means of avoiding the person to person communication issues I have, or a way of overstepping the therapeutic boundaries.

I agree with Dr. Shock when he says not to generalize another therapy's belief onto my relationship and therapy with my pdoc. That was a powerful comment and really made me think. I believe my pdoc and I have a really good and mutually respectful therapeutic alliance. I am not one to try to cross boundaries. In fact my crossing boundaries might signify a breakthrough in my therapy, because I am always so conscientious about doing the "right" thing, about not ever making a mistake, or taking a chance.

I, like Jcat, find it easier to express myself clearly in writing. Like her I have wondered about, and was careful to not cross anything I felt was a boundary.

I used periodically send cards to my pdoc , just to say thanks. I never saw this as stepping over a line, or "acting out". I saw it as, and meant it to be, a symbol of kindness, caring, and to let him know that even though my mood never seemed to get better, I valued his seeing me. Of course one could look for a subtext here: I was fearing abandonment because I felt I was an incredible burden on Dr X. because I was so unwell and not making any progress. I sent the cards to let him know I wanted to continue trying, that I found him helpful and that I really wanted to keep seeing him. That is all true, but the cards were more like a thank you for his consistently being there when I needed someone.

I live on a flower farm, and I used to sometimes bring flowers to my appts for Dr. K. I stopped doing it because I felt really self -conscious that maybe that was crossing a boundary. Flowers seemed too personal, even though there were thousands of them growing all around me, and I found joy in giving them away. It is a shame I felt wierd about bringing some to Dr. X, because the act of choosing the flowers, arranging the bouquet, and the joy of giving a beautiful gift heartfelt gift to him. actually inspired me, the giver.

When I was saying Ms. Fuller gave me food for thought, it was that she reminded me of some of the things I used to do, and stopped doing, because of my fear of crossing boundaries. There is obviously something there, because I rarely bring flowers in, or send cards anymore, because I feel uncomfortable for some reason, though I'm not sure why.

I was also thinking she has a point about how it is really important for me to learn to speak what I seem so easily to write. Despite that I feel I really have been able to speak up many times, because I write.

I think writing directly to my pdoc, about my experience in therapy, as long as we have an agreement that his portion takes place within the therapeutic hour, will only enhance my already great experience in therapy with Dr.X. I will remain conscientious of the boundaries between us; they are as important to me as they are to him. I am looking forward to trying a private co-blog with my pdoc.

Co-Blogging Re-visited and a Therapeutic Epiphany

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

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

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

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

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

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

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

"For the purists, a letter from a patient between sessions is an instance of acting out and they would not read it but rather place it on the table and wait for the patient to talk about it. And it is acting out, because it is an extra-therapeutic contact, a kind of effort to gain more time and attention from the therapist outside of the boundaries of their time together, and it is writing rather than putting the feelings into words and speaking them in the session. But that it is acting out does not mean it is useless, meaningless or bad; what it does is signal the presence of unresolved feelings or or need." [I find this interesting, because I have in the past sent Dr. X. cards, and it makes me think of why I do that]
"The actual words of the letter may indeed impart thoughts or ideas not expressed in session but it is what drives the desire to write them rather than say them that is probably of greater importance. And dealing with the fear/resistance to expressing those feelings and thoughts directly is a big part of what depth psychotherapy is about." [(my bold)...I have wondered about this in the past...this reinforces that wonder...?]
So back to the idea of co-blogging --
I have to wonder if, like writing a letter or sharing a journal, this isn't at base a way to sidestep the heart of the matter -- that it takes time and effort to work through our defenses and resistances and to do so in the presence of another human being". (Cheryl Fuller, Jung At Heart")

Ms. Fuller really got me thinking about why I want to write, as opposed to talk. I have mentioned some things in my previous posts: My difficulty thinking clearly as I am often intensely emotional in my sessions...it is like my brain shuts down, I find it easier to express myself clearly when I write, Sometimes the medications that I take make it difficult for me to find the right words to describe what I am feeling...in writing I can think for the correct phrase or word, and most important, Usually I am writing in my blog to clarify to myself what happened during my session and how I could use what happened to make my next session better, more open, more honest...a sort of practice session for my next session.

Ms. Fuller is right in many ways though. There are some things I probably should be able to express in my sessions that I am unable to. For example if there is conflict in my session (honestly, by conflict I mean me misunderstanding something) I have a really hard time addressing that in the moment. When I have it has been really helpful. Usually I write about it and try to figure out how to address it the next session.

Also, if I am feeling intensely suicidal, I am afraid to address this in my session for fear I will not be able to make my own decision about what to do about it. I am afraid my freedom to choose will be taken away. So often I do not say anything, until the next session when the intensity of the feelings have dissipated.

Anyways, "Jung at Heart" gave me things to think about and I found her comments very interesting. I will address some of these ideas in my next therapy session.

The Blog as Therapy

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

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

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

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

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

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

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


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

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

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

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

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

Pros:

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

Cons:

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

Idea # 2: Start a new Co-blog

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

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

Pros:

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

Cons:

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

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

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

Pros:

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

Cons:

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

"Unravelled"

This is my latest painting. I finished it 5 minutes ago. It is titled, "Unravelled". As always it is full of symbolism.

She is me, but she isn't. She is dreamlike and is about to defy gravity. Before she hits the sea and rocks below, before she reaches the depths of madness and death, she will lift out of the fall. The shroud she has been wrapped in is becoming unravelled and as the fabric unravels, as she unravels her shroud is becoming wing like.

I was thinking of Icarus and his inevitable fall when he tried to reach the sun with wax wings. However another symbol developed as I began to paint, that of an angel protecting me and saving me from Icarus's impending death on the rocks below.

I have within me the foolishness to strive for the sun, wrought by my intense upswings in mood, and the sadness to send me crashing to earth. While painting this I was believing that somewhere there is a middle ground; a place where though I may soar, or I may fall, it is a safe place.

Dr. X and I have spoken about that place in the past. I think I am now ready to explore and accept the idea that safety is not what I used to think it was. The idea that I need to embrace my new, intensely personal, and unexpected way of being. That may be the only thing I have control over in terms of embracing and saving myself.

This is Fascinating

I've posted 2 posts today. My therapy focused post is below this one.

I came across this video and I found it so fascinating I wanted to share it with you. In many ways Ms. Bolte Taylor's experience reminded me of when I read and wrote about Aldous Huxley's book, "The Doors of Perception", in my other blog, Aqua's Quest.

In so many ways her experience of the right hemisphere of her brain slowly taking over, reminds me of when I feel at my highest, when I am almost hypomanic. Life becomes intensely fascinating, colours intensify, I feel completely at one with the universe. Other parts of her description sound like exactly how I feel when I dissociate, or when I experience depersonalization...that feeling like you have completely disconnected from the outside world. Like you are outside your body looking in. It is a very interesting video.

Here's the website's description and the link:

"Neuroanatomist Jill Bolte Taylor had an opportunity few brain scientists would wish for: One morning, she realized she was having a massive stroke. As it happened -- as she felt her brain functions slip away one by one, speech, movement, understanding -- she studied and remembered every moment. This is a powerful story about how our brains define us and connect us to the world and to one another." (TED talks)

http://www.ted.com/index.php/talks/view/id/229

Self Esteem, Guilt and the Definition of Work

My appointment felt difficult in the beginning, but I really felt cared for and understood as it progressed. The past few days I have felt my mood slipping, along with my energy. I have really been fighting against both, but have had to nap for at least a couple hours in the late afternoon, early evening the past few days.

I got my period yesterday, which makes some of the slip make sense, because the two to three days before I menstruate I always feel absolutely exhausted...like I can hardly move. I get confused and really clumsy; tripping, bumping into thing and especially dropping things. Yesterday I poured myself a glass of water and promptly let it slip out of my hand. Water went everywhere. Immediately afterwards I realized I was getting my period. So maybe my dip in mood, my increased irritability and my fatigue can be explained by that. I hope so.

Today I talked to Dr. X about my paintings and the dynamics of shame, fear of judgement and embarrassment I felt around showing them to him. I also expressed how I felt like a little girl seeking approval when I showed him. I wanted him to be as excited as me, then afterwards I just felt like that was so childish and lame. He said everyone wants approval from others. I asked him: "Do you?", thinking he doesn't strike me as someone who feels the need for approval. His answer, "Yes I do" came so quick and was so sincerely spoken I really believe him.

Funny, I always think of him as a rebel, or a maverick. He seems to challenge the status quo and seems so much like I WANT to be; good at what he does AND confident in his approach, even if he is unsure of the outcome. He strikes me as a person who, while not dogmatic about which approach is right to achieve a specific outcome, is very confident in his approach towards his job. So confident that he is not afraid to say I do not know. To be like that you need self esteem and the freedom inside yourself to let your ego go and know your self, your core values and the beliefs about yourself, will remain intact even when you are being challenged by others. I do not feel that.

I feel that any challenge to my ability to achieve an outcome, or about the way I approach a task, or about the outcome of the task, is a defacement of my self. In the face of negative feedback I do not have the self esteem to stand up and say I am right, my work is valuable, my approach will work, and to follow through on my convictions.

One example of this is my approach to trying to get back to "work". My definition of work is so narrow and defined by my past, by my peers, by my insurance company, I would suggest by society in general: Work is a job you do in return for a regular paycheck.

Dr. X. seems to define what I am doing now to help myself as work: my volunteering, my painting, my artwork, my taking art classes, my helping others at the Art clubhouse, these things he calls work that is no less valuable than my definition. In fact I sense he believes, for me, it is MORE valuable than my own marred, achieving other's expectations filled, and guilt driven definition.

He said some people leave work on disability from a workplace that subjectively is unhealthy. These people will leave and find it helps them because, maybe for the first time in their lives, they begin to live a life that is meaningful and healthy. From what he said I think I fit into that category, but the glitch is I feel guilty about being reimbursed by my insurance for leaving a subjectively unhealthy job to now be doing things that are really healthy for me and getting paid by the very organization that was unhealthy for me?

It is all so very confusing

Letting People In

Here is my latest painting.

I haven't quite decided what to call it, but I am leaning towards "A Green Burial". It is a cross-section of a river and the land beside and underneath it. Your perspective would be that of a person standing in the middle of the river; somehow seeing both below and above the surface of the river; like a plate of glass was stopping the water and the land and you were viewing it as though it were a display in a museum.

I'm not quite done the picture as I want to change a couple things, but I thought I'd share anyways, because it is mostly complete. It is a bit deeper than it looks as I cut some of the bottom off because my name was on it, but that blue running along the bottom is an underground stream and there is probably another 1.5 inches along the bottom. The painting is approximately 24 inches by 36 inches.

That is not really what I wanted to write about today, but sharing this painting with you runs along the same themes of today's post: Those themes being allowing others in, letting people know me, challenging my feelings of inadequacy and my fears of embarrassing myself, and taking chances in order to meet and get to know new people.

First I want to welcome "E" here if she visits my site. I do not generally share my blog site with people I know in the real world (vs. the cyber world), but today I took a chance and gave her this blog's address. I haven't seen her in a long time and it was good to talk with her today. We both share a love of art and writing, and from my brief conversations with her it seems we both struggle with some of the same issues. Anyways, other than my friend "H", and of course on Friday, Dr. X. I have kept this part of my life very private.

I am hoping that sharing myself with others, letting people in, letting people see the real me, will do a few things:

1. It will help me learn to take chances with people. Learn to open up and share, despite being afraid I will be a burden on others, or I will scare others, or frighten, or repel others


2. It will be practice sharing myself with others even if I am unsure how others will react to me. This is like taking a behavioural approach to my intense fears of embarrassing myself.

Up to now this blog was fairly safe from that because of two things: I do not REALLY know the people reading my blog (although I have supportive online acquaintances and friends...and I thank each of you for your support)...so I think if I did become extremely embarrassed about something I said, or did, there is a sense that I have some distance, or I am not as invested in how someone I have never met reacts to me. Also, While I can walk away from my blog if I become devastatingly shy, or embarrassed, or ashamed, I will still see the people who I know personally and have shared the site with.

I guess what I am trying to say is I am practicing being the real me, in the real world...all the good, bad, mad, sad, up, down me there is. I'm taking chances and hoping it will build and strengthen my relationships with the people I know, in spite of being really fearful that I am leaving myself too open and vulnerable.

So, "E" if you came to visit today, welcome. I hope I do not scare you away with my openness. I also hope we can meet for tea or coffee one day soon. I really enjoyed talking with you today.

Opening Up Too Much

I just got back from my therapy session. I have mixed feelings about how it went and how much I opened myself up to Dr. X.

All day yesterday and last night I was so excited about the paintings I had done, so last night I really wanted to share my joy with Dr. X. This morning I awoke with a feeling of shame, or impending doom about my art and sharing it with my pdoc. I wrapped the paintings up and put them in my truck anyways, so I at least had the option to decide once I got to his office.

I've been trying to figure out why I felt ashamed, or feared embarrassment, or was afraid of (hidden) criticism, or had a sense of doom around sharing my pictures, when yesterday I was so really excited and happy to share them with everyone at the studio.

I think one reason is that what he thinks about me matters more to me than what others think about me. This is a strange dynamic. I think partly it has to do with him being a man. Maybe also as a man I project my father onto him. My father would be the only other person from whom I would fear criticism, or a negative reaction.

Dr. X. is probably the exact opposite of my father in terms of personality, temperament and reactions to me, but because he is in a position of power, because I (still) have difficulty trusting the authenticity of his reactions to me, because I sense a big part of his job, and therefore his relationship with me, is to judge me (to judge my wellness, my personality, my pathology, etc.), I feel fearful, that while outwardly he is accepting me, inwardly he just thinks I'm a complete loser. A failure as a human being.

There is absolutely nothing that Dr. X. has ever done that would lead me to believe he feels like this. He is consistently supportive, kind, caring and warm, but the feeling and fear still lurks in me for some reason. I try really hard to overcome that fear. Today I did bring my paintings in for him to see to with that goal in mind, but as I showed him I had a sinking feeling. I talked with him about it, but I couldn't really express why I was feeling that way. I still am having a hard time explaining it.

On top of sharing my paintings, I also shared my blog address with him. Part of me thinks it would be great if he could read what I blog about, because I seem to be able to be more open and articulate here because I have had a chance to digest how I feel.

The other part of me fears that I have left myself too open on this blog; that I am opening myself up for judgement. Giving him my blog address is in effect challenging that fear; understanding that I have left myself open and vulnerable to judgement, yet pushing myself to do that anyways. Maybe the more I allow that to happen, the more I will be able to overcome those fears.

Ascension

My second painting: "Ascension"

I am so creative right now it feels like the old me has come back. I feel like myself for the first time in 6.5 hellish years. I have a hyperthymic temperment and when well I can do a million things at once, but remain extremely focused on each task. That is how I have felt for 4 glorious days.

In those days I have completed 2 paintings (One yesterday and one the day before), and I have began two others. It is remarkable. I sat down to paint yesterday at 10:30 am and finished at 7:30 p.m. I was so engrossed in what I was doing.

This painting is titled "Ascension". Fitting that I painted it on Easter Sunday. I was thinking of lots of things as I painted it. it is a mixed reference to my increase in mood. The obvious portrayal is a cross, yet the Christ figure is a female. She is descending into the ocean (This is the way I would like to commit suicide).

I called it "Ascension" because of the belief that Christ had to die, before he ascended. (The woman is drowning). Sort of a metaphorical description of how I often see my only hope in suicide. I feel in suicide I will at the very least end my suffering, which is better than life when I suffer. Not that I see myself as a Christ figure. According to the bible his death ended others suffering. Suicide would end only my suffering, not others;>)

While I am not really religious I am very interested in religion and probably obsess over it.

I like the idea of the unknown woman under the shroud, chained and bound by something outside herself. Maybe also a reference to how I find it difficult to know who I am. If you look closely the chains around her neck are clasped with a padlock that repeats the cross in the place where the lock would be.

I know there are errors of perception in the painting, and the colours in the picture do not do it justice. The original has more yellow and blue in it. Despite seeing things I need to change in the painting I love what I did here though. It is approximately12 inches my 36 inches.

High and Full of Creativity

This is only the second painting that I have ever completed. I'm just learning to paint, but I think it turned out pretty well and I feel good about my attempt. For me to even say that I must be feeling better.

Dr. X adjusted my medication yesterday and today I have been feeling so incredible. He increased my Dexedrine to 10mg spansules (time release capsules) twice a day, once at 8am and once at noon. It did wonders for me today.

Before I was taking a 10mg Dexedrine spansule in a.m. and then a 5mg regular release Dexedrine at noon. I was crashing big time at 3pm. I had to sleep for 2-3 hours and had no energy or motivation to make dinner, eat dinner, clean-up. It was awful.

Today I didn't crash like I have been doing. In fact, I painted all day and only noticed it was 7:30pm when I was finished my painting. I even forgot to eat. That is a sure sign I feel better. Whenever my mood goes up I get creative and I stop eating.

This painting is a rendition of a picture I found months ago in the newspaper when the Myanmar riots were going on. I changed the original picture, but used its idea as a reference. I loved the idea of the peaceful resistance vs. the armed guards, the dark vs. the light, the good vs. the evil (and/or the difficulties in deciding what is right/wrong). I am sure the soldiers believe what they are doing is right, as do the Buddhists.

I also thought the picture reminded me of the yin and yang of life. I was also struck by the dichotomous nature of the physical government authorities and authorities of the soul being combined in one picture.

Today I Lost My Best Friend

I took Bert into the vet today and had him put to sleep. His life was quickly becoming one of no quality. I couldn't watch him struggle and suffer anymore. It was the hardest thing to do; to make the decision to euthanize him. I wish I could have gone with him. I loved him so much and I feel lost without him at home.

Berty, I already miss you more than I can express. I hope you understand I helped you go because I cared so much about you.

Love Aqua

How Will I Know?

When my mom died two years ago I adopted her dog, Bert. Really he had been a huge part of our family for 8.5 years and I adored him, so the decision to take him was easy.

He is a boxer. His mom and dad were both white masked fawn boxers, but approximately 25% of boxers are born white or mostly white. According to the AKC and CKC any boxer with more than 1/3 white disqualifies it from the breed standard.

Some say white boxers are not as healthy as other boxers, breeders sometimes will euthanize white puppies. From what I understand there is no science that shows white boxers to be any less healthy than their coloured breed members. There were three white pups in the litter Bert was born into and all of them outlived there fawn coloured litter mates.The white boxers that are not euthanized are sold only if the purchaser agrees to have the dog spayed or neutered so as not to "contaminate" the breed.

I say that last sentence with sarcasm. You could not ask for a better dog. Bert has the most incredible disposition, is the best dog I have ever owned, Despite his size, all 102 lbs of him, he is unbelieveably gentle around even the tiniest of kids and the frailest of grandparents. He has a big and funny personality and is an all around joy to be with.

Bert is the last one left in his family. When he was young he was completely white with one black eyebrow until a few years ago when gave him some light brown age spots and turned his black eyebrow white. He is huge for a boxer. He stood at least 5 inches above his brothers. An average boxer weighs 50-70 lbs. Bert weighed in at an average of 95lbs. He was not overweight, just huge.

Since I have had Bert he has become increasingly sick. Within a month of having him he had an attack of pancreatitis. I took him to the vet. They gave him antibiotics. I began giving vet quality, low fat, easy to digest (very expensive...argh!) food. He became well, but continues to have gastro problems if we stray at all from his regular food and Pepcid AC regime.

He is almost 11 now, which is old for a boxer. Boxers have a very high incidence of cancer and often die around 7 or 8. Last winter I took him for a walk around the farm. He was being his silly self, and was running and spinning and running some more, when suddenly he collapsed. He lay there awake, but unable to move for about 5 minutes. Then he just got up as if nothing happened. The next day it happened again and then suddenly he began collapsing that day anytime he walked more than a few feet.

I took him to a dog heart specialist and they diagnosed him with "Boxer cardiomyopathy". Basically if he exerts himself at all he is at risk of his heart's electrical system just shutting down his heart. He had other heart problems as well, so he was prescribed Sotolol for the cardiomyopathy and Lotensin for blood pressure (I think), and we were told to not allow him to run, or exert himself. (easier said than done when a dog is bred to run)...but we have been very careful and he made a pretty good recovery, still enjoyed life, albeit a bit slowed down.

In between all this he was diagnosed with 4 separate kinds of cancer. He has a small tumour removed from his eye. He has a mass on the top of his head that has stayed pretty much the same size for years. He has lung cancer and another type of cancer that is growing very large (orange sized) lumps on his front leg. I had a couple masses removed, but they have grown back. The other cancers are slow growing and the vet says not painful, but they have definitely slowed him down more. He does have arthritis pain, and for this he takes Metacam, and NSAID for pain.

In November Bert began having seizures. They were awful to watch, but lasted only 2-3 minutes and happened once every three weeks. Then he had three in one day and it began getting really serious. The vet said he was unconscious while they were happening. I wonder though, because it seemed like he was starring helplessly at me while they were happening, begging me to help him. We put him on Phenobarbitol, and he has only had one since then and that was a month and a half ago.

As you can see, I care so much for Bert, and I have done so much for him to make him comfortable, and to help him be a happy dog despite all his illnesses. And he has been a really happy dog most of the time, until recently. He has slowed down so much he is having a hard time walking. All he wants to do is sleep (and eat...he still LOVES to eat, which is a good sign).

He's happy to see you when you come home, but he has a really hard time getting up to greet me like he always wanted to, and wants to, so he now waits for me to come greet him. The last few days he has been having some incontinence problems while sleeping. I took him to the vet today for blood tests, but honestly, on the way there I was thinking it really might be better for him if I had him put to sleep. I don't want him to suffer, and I don't want to end up stranded in the middle of the night with no vet and a crisis situation on my hands.

All the way to the vets I cried and I tried to figure out if I want to let him go because I cannot handle all his ailments anymore, both emotionally and financially (I'm spending $500.00-600.00 plus/month on his medications and his special diet and probably another 200.00 for vet bills if I averaged them out over the past two years), or if it is the best thing for him. I only want to do what is best for him. I love him so much.

I also understand that the connection between Bert and I is so intense because for me he is my Mom's representitive. My mom is gone now, but in Bert she lives on. I see so much of her personality in him and he reminds me so much of her. They were inseperable when my Mom was alive. I know part of me is afraid to let Bert go because it means a finality of that connection to my Mom.

He is a representation of my Mom's physical presence on earth. He is a family member, no less so than my husband or I. I believe in euthanasia, both for people and for animals, but only if that decision is what is best for the being. I really want Bert to die with dignity. I don't want to be rushing him to the hospital because he has stopped breathing, or can't move. I want him to go with the ability to feel my love for him as he passes away, but I just could not make that decision today. How will I know when the decision is right for him?

Surging Creativity

Over the past week I have felt my mood and energy lift immensely. This feeling has produced and overwhelmingly intense surge of creative energy. I say overwhelming because the ideas are coming faster than I can even begin the paintings.

I took a class the other day where I learned how to stretch my own canvases for painting. Yesterday I went out and spent a small fortune on the tools, canvas, stretcher bars a staple gun, a few ready made canvases, more paint (even though I have lots of paint) and anything else at the store I decided I "needed".

I have so many great ideas for paintings, today, before I start a new one, I am going to actually try to finish the one I'm in the middle of (and have been for the last 2 months). I love this feeling. It feels like I am back. The real me is creative and energetic, and passionate and excited about everything around me.

The real me sees intense beauty in all the little things that surround me, the puddle of water being used as a birdbath by a robin returning for spring, the willow tree buds popping up each day turning weeping branches of the tree a beautiful shade of light yellow/green, the crocuses popping through the lawns, the mountain's winter water runoff racing down the river searching for the sea, the bald eagle soaring above the farm, climbing to heights that seem impossible and coming together to mate mid air, falling to the ground faster than Icarus fell as his wings melted in the sun. The eagles manage to part ways before hitting the ground and then soar higher and higher and begin their dance again. It is beautiful.

Despite this beauty, and despite my lift in mood I am thinking a lot about suicide, maybe a better description is having suicidal imagery stuck in my head. These ideas are fixing themselves into my artwork. I do not understand why, when I feel so much better.

Whisperings about the Word that Cannot be Spoken

On Thursday Dr. X. and I decided to add a stimulant to my medication regime and continue of with my lowered dose (600mgs) of Tegretol, 30mgs Prozac and 10-20mgs/day Valium. We added 10-20mgs Dexedrine. He left it up to me to decide how much was helpful. I started at 10mgs and by the next day I felt a lift in mood and I felt much less tired and fatigued.

I actually feel like doing things again. This is a huge change. The 10mgs right now seems like enough, because even at that small amount I am having difficulty sleeping. I feel a bit wired, but last night I slept a bit better, so maybe it was both a withdrawal effect from the Clonidine I have recently stopped and my mind learning to accept a bit more stimulation.

Could this be the magic potion that helps me? I am afraid to even think that thought, let alone write it lest the query magically destroys the effects of the medications; just like when I was a kid and writing the name of the boy I loved, immediately destined the relationship to fail.

You will not hear me whisper those words again. It has been 4 days of feeling pretty good I am going to try to accept each good day as a blessing and try to forget that these days always seem like transitory moments for me.

Coping Strategies for Treatment Resistant Depression (TRD)

In a previous post: Reviewing Treatment Plans for TRD I borrowed a list of 9 treatment guidelines used to help with the management of depression that had been posted earlier on the Dr Shock MD PhD blog.

Dr. Shock, having read my post, responded in another post that he saw an important aspect of depression management missing from the list; that is coping with the depression. He suggested , "Some ordinary but useful measures can also help, such as running, light therapy, daily activity scheduling". He then asked if I had anymore ideas.

I have mulled this over for several days. My first thought was that I was unclear on the concept of coping. I remember a post where he commented "glad to see you are coping well" and I thought I was coping very poorly. At the time my understanding of the definition of coping was that in order to cope, one had to have strategies in place that were successful. In my mind, that meant strategies that rid me of my depression.

I looked up the definition of "cope" in two dictionaries last night:

Merriam-Webster Dictionary: "to struggle to overcome problems or difficulties" (this reads like my previous belief about coping....I have to "overcome" in order to be coping).

Webster's New World Dictionary: "1. to fight or contend (with) successfully or on equal terms 2. to deal with problems, troubles, etc."

The Webster's New World Dictionary's 2nd definition is more encompassing and fits with how I cope. This is the "cope" I will write about. These are strategies that I use to survive and that help me continue trying to get better.

I am sure as you read my list you will recognize I have positive ways of coping, and not so positive ways of coping. I will reserve being judgemental about all my ways of coping and allow the reader to decide for themselves what might be in their best self-interest if they want to incorporate some of my coping mechanisms into their lives.

My Coping Strategies: (in no particular order)

1. Having a regularly scheduled therapy session with my psychiatrist to review my treatment plan , my mood and to work through current difficulties and/or celebrate successes.
2. Scheduled responsibilities and commitments. Like the volunteering I do. I am the type of person who absolutely will not break a commitment. This is often a healthy strategy for me as the external pressure gets me to leave the house and do things. However, and this is a big however, it is easy for this strategy to backfire for me because I have difficulty setting boundaries and will continue to keep my end of the deal, even if it is clear I am too ill to continue. I am working on developing better boundaries for myself.
3. Schedule social and cultural activities: Buy the tickets for the symphony, or a play, or a concert. Make arrangements to meet people for lunch, or dinner on set dates. Sometimes I get cajoled into doing this. I almost always don't want to go do these things If I did not have the arrangements in place ahead of time I would stay home. However, I am almost always glad I went and/or participated in the activities I scheduled ahead of time.
4. Setting boundaries. Knowing when to say no and when to commit to tasks, meetings, volunteering etc. (a work in progress)
5. Working: I used this for years to cope. The more depressed I became, the harder I worked. In one way, having a very set, strict schedule helped me maintain some level of consistency in my life. This MDE however, I managed to work for two years while severely depressed and then my work threatened to drown me. This coping strategy became my enemy and I had to leave work to save myself. I know I NEED to work again, even if it means only volunteer work. I do better with more structure, but I need to work somewhere, or at something, that has the flexibility to allow for the ebb and flow of my moods as well as something I feel is meaningful and full of purpose. Also, I worry so much about my long term income security while on disability income. When I work this fear is minimized, although it is still always there. I always worry about being laid off or fired (even though in performance reviews I have consistently been reviewed as a hard working and high performing employee). This fear is an OCD thing for me.
6. Volunteering: This is even better for me than working for money. I get to work so I have a sense that I am being useful. I have set responsibilities and 2 half days where I have committed to showing up, so I have the external pull to get me out of the house. On top of that I am helping others and that makes me feel really good.
7. Having a dog: the responsibility for his care and knowing he needs me has literally saved my life a few times in the past year. Also, when he was well I lost 10 pounds in the first few months I had him because we went for long walks so often. Even now he gets me outside numerous times everyday and we go for short walks, rain or shine. I never thought I was well enough to accept the responsibility of a dog while I was this ill. Now I see I not well enough to NOT have the responsibility.
8. My love for my sisters, my nieces and my husband. I stay alive because I do not want to hurt them
9. Fresh air, long walks: If I can force myself to get out of the house going for a long walk always makes me feel better. I love the outdoors.
10. Sleep: Sometimes as an avoidance strategy...if I sleep I will not kill myself. Also, getting enough sleep and keeping a regular sleep schedule as a strategy to regularize my mood (I have a really hard time staying asleep). This is almost impossible to do, but I do try to wake up and go to bed at the same time every night, regardless of whether I actually slept or not.
11. An S.A.D. Lamp: I sit in front of one for an hour almost everyday. Does it work? I don't think it helps my mood, but I like sitting in front of it to read the paper and I can't see it hurting me.
12. Lay on the couch and cling to life: sometimes, when I begin having obsessive and/or violent suicidal thoughts I curl up into a ball on the couch and just try to wait out, and get through, the thoughts.
13. Drink alcohol: to relieve anxiety, to disappear, to forget. This is a dangerous strategy for me as I tend to use it when I am most depressed and anxious. It calms me, but also brings down my inhibitions making me at greater risk of committing suicide. I am working on losing this coping strategy.
14. Write: In my blog, on my support group's website, in my journal. Writing helps me get all my thoughts out of my head and helps me search for a solution.
15. Sex: Something has happened in the last year and I have given up sex. I am to tired and too depressed. I have to get this gift back again. It used to be, if I was really irritable it was the best time for me to have sex. The physical connection, the energy, the release almost always helped me feel better.
16. Go for regular massages: I have a regular massage therapist that I see. I have seen him for years. I have told him all about my struggles with depression. I have known he has had troubles with depression before, but he recently told me he had a severe psychotic episode years ago and was treated as an inpatient for a very long time. This information really helped normalize me to myself, because he is doing so well now. Knowing this I feel I can be open and honest with him, and that helps me relax more throughout the massage. In a bizarre twist of fate his first name is the same as my pdoc's...so I call him my body "J" and my pdoc my mind "J". Just another funny coincidence. His wife had a baby on my sister's birthday, and my pdoc's wife had a baby on my birthday. I sometimes wonder if these cosmic coincidences indicate I was destined to have a strong relationship with these people.
17. Have my husband hold me tight: Sometimes when I am really irritable I just ask my husband to hold me really, really tight. Something about him squeezing me in a big hug calms me.
18. Pay someone to clean my house: It used to be I was depressed and could not keep up with the housework, but every once in a while I would get a spurt of energy, go crazy and clean it from top to bottom. I would berate myself in between these spurts for how disgusting the mess was. In the past couple years have not had any of those spurts of energy, so my house became even worse and I began berating myself more and more over my inability to manage and keep up. Even though I cannot really afford it, I now have someone come in once every few three weeks and clean my house for me. It has relieved me of my guilt and I have a cleaner house.
19. Drop my laundry off: For the same reasons as the above.
20. Lay in the sun: While I use sunscreen I do not worry about sun damage. The sun makes me feel better. I am more at risk of dying from my mood disorder than I am of getting cancer. Starting in February any time I get a chance I go into the greenhouse, climb up on top of the planting tables and lay down on a mat with my pillow and soak up the sun. It is relaxing. Come later spring I lay in the sun and fall asleep on the back deck.
21. Eat chocolate and carbs: (mashed potatoes, chips, cereal)...all fill some void.
22. Swim or Gym: I have not done either in at least two years. I actually stopped because I did not see my depression getting any better as a result of doing these things daily. I now recognize I was mistaken in the goal of doing each of these. They are not a means to an end. They are themselves the ends. While swimming I feel an intense calmness come over me. It is like a moving meditative exercise. While swimming and working out I feel strong and powerful. This is relief, if only for the time I am doing it. Also, while participating in both I like my body better even after I leave the pool or gym. This must affect my mood in some positive way even if it is not immediately apparent to me.
23. Listen to music: To anyone who loves music this strategy needs no explanation.
24. Get creative and enjoy creative things: draw, paint, creative writing, pottery, read, watch a good movie or an interesting t.v. show. I get lost in these activities IF I can manage to start them. Getting started is the hardest part, but once I begin my spirit becomes entwined in the creative process and all bad thoughts leave my mind.