Hello, World

I logged in having received notification of a new comment. I am always both somewhat embarrassed to come back to this blog, and also somewhat superstitious – that if I come back to this identity and look at it and revisit it, I might somehow fall back into this pit, or if I come here and write that things are better, I am tempting fate.

But reading the lovely comments left here again made me incredibly thankful that I spent the time writing this site when I was in the middle of the storm – knowing that it might be a light or comfort to someone else, or just plain old normalize the experiences, or help someone weather having to visit the doctor or emergency. I find the older writings of mine too painful to read, for the most part. I do live in terror of falling back into this place.

It still continues to get a fair amount of traffic – mostly people wanting to know what will happen at the doctor or for emergency care if they go for self-harm (the most hits are for some version of that question), if the doctor will know that they did it, why they have to wear paper gowns, various specific drugs I have taken, or cyclothymia. However, one of the top search terms is “doctors who self-harm” or “how to talk with patients who self-harm” or “can I be a doctor if I self-harm?” (YES!) Somehow I seem to have become an expert on this, though I’ve never done it.

As for me, for those following the rest of the story: I did end up relocating to the States and took a job as a GP in a smallish, somewhat obscure city, working at an urban clinic and hospital that do mostly charity work. Drug abuse is rampant here, including prescription drugs, and while that can sometimes be exhausting to deal with, often some of the underlying causes people end up in that situation are similar to what I have experienced and maybe I am helpful to some of these patients. Due to the financial situation of many patients, I am doing a lot of psychiatry because they cannot afford to be seen by a psychiatrist, and I think that my vast (ha ha) experience taking many of these medications and knowing what they feel like does help guide me. The bosses seem to appreciate me here, and I do feel like I fit in, in some ways for the first time in my life, as this part of the country is known for alternative spirituality and many of the GPs are involved in some kind of humanistic medicine, meditation, mindfulness training. One of the psychologists at the clinic where I work is starting a DBT therapy group, and I hope my schedule will allow me to co-lead with him, or at least participate in some way.

I continue with the same partner, stably. I have gained about 40 pounds from the medications, but have become the proverbial “fat and happy” woman. My writing talent has fled, however. I am no longer an introvert; in fact, one of the biggest changes I’ve seen in the medication is that people come up to me and ask me for directions. When they talk about personality psychopharmacology – well, that’s my clear evidence that it exists. Something has so profoundly changed that even passers-by notice it. I do not like this.

The sleep disturbances from doing the job are difficult on me. The other day I worked a night shift, and then went to a meeting and one of my new doctor friends said, “You seem a little manic, eh?” Joking, but that terrified be as I was a bit garrulous and inappropriately jocular. This terrified me. Sometimes, before sleep, I slip into morbid fantasies about what would happen and how various coworkers would react if I had another meltdown. My emergency plan is to take an extended sick leave and return to my country to recover if that happens.

At one of our meetings, another physician here who I greatly respect gave a talk about his experiences with mental illness which were astoundingly similar to mine (manic depressive spectrum disorder, long time of wondering if he was just “a self-absorbed asshole” before diagnosis) and left the same kind of relationship wreckage across his life. Unlike me, he stabilized and then went to medical school (definitely the easier path and the one I recommend if possible, but it can be done during medical school). He gives a funny, lively, and raw-honest talk about this and was open about his disorder while applying to medical school and further training and this job. I later found out he gives this talk about his suicidality at universities and medical schools all over the country, to try to reduce the stigma, prevent physician suicide, and give hope to other aspiring young people who feel like their lives have been derailed. I was incredibly proud of him, left in awe, but for a long time after that, every time I saw him, that was all I could think of. I wished I could be like him – someone people admire, who is strong enough to come out and tell the truth and remain standing, and not have to flee. But I’m not, especially since I came into my medical career with all of this stuff around me and was known in medical school and early career as somewhat unstable and highstrung. I don’t want to be like that again.

So yes, I am in some kind of remission, living in fear of the return; you can be a doctor if you are crazy; I don’t know what will happen if you tell your doctor you self-harm but a lot of doctors are crazy too and a lot are judgmental bastards. You can get better from being crazy but there will be changes to who you are. My answer to everyone seeking answers or solace here is an overwhelming yes, yes, yes.

Much love to you,my fellow touched, and may your next incarnation be more beautiful.

It’s been a while

I’m not sure it’s a great sign I’m posting here, but saw that I still get hits and comments so I thought I would. Having logged in after a long time off, I see that I have hit 50,000 reads. That blows me away. Thank you. I hope it has helped someone.

Unfortunately, the emails people sent me got erased so if you never got an answer to some burning question from me, send again. I know I used to get a lot of mails from pre-meds and med students and the like, wanting help on planning their lives with the crazy. I’m totally happy to help, for whatever I can do, but if you wrote me and didn’t get an answer, just write again.

I’m now working in an underserved community, doing womb-to-tomb medicine. It’s as good as it gets in the medical world, I guess, as far as people being a little more right-brained. One of the docs even gave a talk about his own struggles with the crazies, which seem to be much the same flavor as mine. It’s funny, I so admired him for being able to do that, but now every time I see him, all I can think of is that, and I know it’s just not a good idea.

Still doing the 80 hour weeks, though. I moved, and here they have seasons, and their winter was oh so cold. I hate the feeling of layers over all of my body, all the time, and always being cold. The days don’t shorten that much and I did ok, and now the days getting longer have made me a little funny – horny and too loud and overly energetic. I hope it will be just a little funny though. They seem to like me ok here, and I wouldn’t want to blow that by going all nuts. The one thing I am looking forward to at work is that they may let me run a DBT or some other kind of crazy girlz group, though I’m a little hesitant because the way I would approach things (melodramatic legend, myth, and metaphor) seems so far removed from the socioeconomic language of the patients here, and I do enjoy the palliative care stuff. It feels like a kind of holy midwifery to me, though I do hate the power of making people make decisions and messing with the course of their lives.

I still hate delivering babies, though. I can’t remember if I’ve written about that before or not. It always seems like I’m ushering in 80 years of suffering.

Things, on the whole, have stabilized, mostly due to medication, but of course, there is always the price of blunting. And getting fat. One of the meds, the one that makes me nice and cuddly, makes it nearly impossible to concentrate long enough to write. I have to keep away from thinking too much, and I do miss my sense of feeling, but the working so hard and long is good for keeping thoughts and dreams away. The patients I work with have often had such wretched lives that it helps me be grateful for what I have, for the blessing of being able to settle into a boring, mildly dissatisfied middle-class life. And that depth of experience, well, yeah, I do sometimes miss it, and do sometimes know that I’m walking someone else’s path, and have those grave feelings of not doing what I was put on this planet to do, and fear of being sent back next time ’round to do it right. But fortunately, modern pharmaceuticals can mostly keep that away.

So I’ll leave you with this.

for prodigal read generous
–for youth read age–
read for sheer wonder mere surprise
(then turn the page)

contentment read for ecstasy
–for poem prose–
caution for curiosity
(and close your eyes)

Thanks for reading.

While I wasn’t crazy

The meds (Goddess be blessed) seem to have been working out and things suddenly, almost overnight, turned OK. (For those who are wondering – it’s Lamictal-Paxil, both in very low doses.) It has stifled the writing a little, as well as taking away much of interest to write about here.

I had a lot of last month off – not necessarily for fun stuff, CME type stuff and credentialing mostly, but still…not work. This was wonderful.

I’ve been able to appreciate the world again, to want to see it and love it.

Last night and into today, after being back about a week, and again on shift work, though not as brutal as before, I had nightmares all night. I know some of the readers are into that psychological stuff, so I’m going to do a highlights recap here and see what anyone thinks is fun to toss out as interpretation.

To be fair, I’m not sure at all what I believe about dreams – whether they are from the unconscious or some kind of psychological source, whether a neurological cleaning and memory mechanism (probably I mostly believe that), or something metaphysical (“One-sixtieth of every dream is true?”).

I will note the following events over the last week. When I was at the clinic, a doctor was attacked by a patient and the patient’s relative. It wasn’t particularly scary when it happened, more like a high school type fight, and I called the cops to come break it up. I was upset by it but not terribly, more at the fallout regarding how the doctor was treated by management and licensing authorities.

Second, there was a recent break-in at the neighbor’s apartment. Simple theft, about a month ago, but I felt sort of invaded. It’s not like car theft, I mean, it’s someone’s home.

Third: I have been practicing lots of meditation/metta style (though that one feels oddly selfish to me) and various other techniques. I’m in the “noble failure” stage, but am still working at it. I’ve finally come to see the value in a settled, happy person as being kinder to the world (whereas in the past, I thought, very much in line with my culture, that a degree of righteous anger and discontent was necessary to keep one working to better things). Last night I came to bed somewhat anxious, and tried the deep breathing techniques, and tonglen, which has seemed scary in the past. I’m wondering that, if you believe in it, it’s psychological resistance to trying to calm anxiety.

Fourth: I don’t write about this a lot, but I live in a part of the world embroiled in a violent conflict. Last week, the government on “my side” (if one can say that, though in this case, that kind of thinking – the my side / their side just means everyone loses) did something violent and inexcusable. And it feels like there’s nothing that anyone can do to stop this, and my partner and I have once again been wondering: United States, Australia, New Zealand? Over the last ten years, every time I am in North America, I feel like it is very shallow, everyone having these long conversations about which tile to pick out. I was there recently, though, and my partner and I promised each other that if we go there, we wouldn’t become that. And when we came back here, and this event happened, we said, Fuck…maybe the conversations about floor tiles aren’t so bad. Especially compared to the ones about casualty numbers.

Fifth, the most prosaic: it has turned hot here, and sleeping during the day (and night) means a lot of sweating and physical discomfort and icky sleep.

Dream One Woke me up at 5 AM, panicky, to the point of having to turn on the light and check the house:

It is night at the clinic, toward closing time, maybe 1 AM. We’re trying to close up – the clinic in the dream is pretty much like it is in real life, nothing distorted in the layout, same auxiliary staff, and they keep letting people in (theoretically, we see everyone who walks in by official closing time). I’m sorta pissed off because they keep letting “one last patient” in. (Note: this actually happened last night.) At the end, everything is closing up, lights are off, doors are locked, and we’re trying to see the end of the patients.

Then someone comes to the door. He’s scary. He is tall, maybe 7 feet, and thin and has shoulder-length hair and doesn’t look quite human. His eyes are dark and blank, he looks sort of like pictures of Jesus, but scary. He’s dressed in white. He has no facial expression, but he is here to be treated.

And he is terrifying, and we tell them, “Don’t let him in,” but then something about having to treat all comers and ethics pops up and they let him in. It becomes immediately apparent that he is a murderer. Also, he removes two prostheses from his lower legs, revealing bilateral Syme amputations, and he walks on the stumps, and his shins are disproportionately long anyway so he’s still tall.

He has a medical letter describing that he is part of a white supremacist motorcycle gang (not really something found in this part of the world), and lost the feet in an accident. He is also described as having had sociopathic tendencies during the hospitalization.

We are terrified, I go to call the police. On the phone I calmly tell them where we are, and fumble trying to think of the street number (Note: this is exactly what happened when I called the police for the real-life incident, we’re in a shopping center and everyone just says that and no one knows the actual number, but they asked.)

Everyone tries to hide from him around the clinic, while still trying to treat him. I wake up suddenly with the image of the man in my mind, and wonder if this will be one of those terrible dreams that are almost forgotten by morning. My beloved cat is sleeping on one side of me, my partner on the other.

In the end I turn on the light and get up and check the house.

I have no mental association of a man of that description whatsoever. Or white supremacist gangs.

Dream Two

I am lying in bed, and for some reason I am sobbing and very ill. Sweating. I hear noise outside toward the apartment door (it opens onto a courtyard), and go to see what happened. I discover that the window and door have been attempted to be broken into; the window is open, and the metal and paint around the door lock is chipped away, and the thing that covers the gap at the bottom of the door has been prised off, leaving a gap.

The gap under the door is big enough for my cat to go in and out, and he is there creeping under and playing around, along with a strange cat who I don’t want in the house. Also, I know that now I have a hole where mice and snakes can enter and I think, Shit, what can be done about this?

I decide to call the landlord and tell him this needs to be fixed. I think I am in underwear and a T-shirt and I see my neighbor (a sort of friend, my age, her husband went to med school with me) heading off for the day, and I realize that my face is all red and it is obvious that I have been crying, so I try to explain that I’m ill, not crying. Somehow it all feels like a ruse – both the illness and the crying.

At some point in this dream, I am sweating and shivering and feverish curled up on a miscellaneous shrink’s couch, being observed. I think that also somewhere in the dream, I receive an invitation to my medical school graduation ceremony, an invitation which is vaguely threatening. I am trying to make the connection between those two events.

When I wake up, I am truly sweating because it is hotter than hell in the room, being mid-day in a bedroom that gets morning sun.

Dream 3

The last dream.

I am in my mother’s room – but the house of my middle school years, where we all were desperately unhappy, not the house of childhood that I loved, or the one in late high school where my mother lives today, which is her house more than anything. Whenever I have a nightmare that takes place at a childhood home, it is in this house, and whenever I dream about this house, it is a nightmare.

In real life: We moved there in my father’s desperate attempt to climb a social class, and all went to hell there when we didn’t fit in and life did not become the dream that this McMansion was supposed to buy him. I lost my neighborhood and school friends and he became more and more miserable.

In the dream:

I am in my mother’s bedroom and she’s sitting in bed, we’re chatting. My sweet cat is there, and he has found a little kitten that looks a lot like him. (Note: in real life, my mother recently visited a friend who is bottle-raising a litter of kittens and she told me that there was one who looked like a baby version of mine.) I am trying to convince her to keep him, as he is very cute and I feel sorry for him. The two cats seem inseparable, playing around various places in the house.

The two cats keep playing around. I see that the little kitten is somewhat dirty and has fleas. I take him into the adjacent bathroom – also true to the original floor plan of the house, down to the two vanity sinks, and wait for the water to heat up to bathe him, thinking that I need to go out and buy something as a flea treatment too.

I fill the sink with water and wash the little guy, chatting with Mom all the while about how long it takes the water to warm up, how much nicer he’ll look cleaned up. But the kitten starts choking a little, and I make sure to keep his head out of the water but he keeps choking.

Somehow, he seems to be getting smaller and in more and more distress. Finally, as the water drains, I realize he has become even smaller than a newborn kitten and has died, and changed shape. The core of him seems to shed the fur and creep off down the drain. I am terrified and don’t know what happened, what I did. I saw that something inside of him, something stick-like, slithered down the drain, so I wait, not sure he could be really dead. The skin and fur are still in the sink.

Then, a fully grown green dragonfly emerges from the sink, spreads and shakes out its wings, looks like a praying mantis. It flies around and I realize that whatever the thing was, it wasn’t a cat, or it was, and became a dragonfly. It flies around the bathroom. The turn of events is horrifying – how could this have happened? How could it have not been a kitten?

Downstairs, there is someone at the door, and my beloved cat goes to see who. I don’t open the door, because I know it is someone frightening. I think it is this trashy neighbor who lived a few doors down.

And then I woke up – the phone rang.

I have very few associations with this dream, except that this house appears from time to time in my nightmares. I’m not particularly afraid of dragonflies and have no associations with them other than admiring their long lifespan in high school biology. That bedroom and bathroom were on the third floor, don’t remember any kind of bug problem there.

My cat did once bring a praying mantis home (in my current apartment, he wasn’t even born at the time we lived in that house). Why did he have a double?

* * *
The only unifying theme I can see here is doors, closed doors, intruders behind the door. As a kid, door knocks when I was home alone used to terrify me, I’d run and hide, I think as a result of being a sensitive kid shown those “Stranger Danger” type filmstrips at school. I have never been the victim of a home burglary or assault. No one scary ever came to the door in real life.

So – anyone see any other threads? For whoever likes this kind of stuff – you’re invited to go at it. Is something coming for me?

Oddly, my partner also reported a night of nightmares, making me lean more toward either the metaphysical or heat explanation.

As I said…

Crazy doctors are better for crazy patients.

Other than that, I’m here, the new med seems to be ok, I mean, at least I function, but has absolutely shot my writing ability and drive. The words don’t fly, I don’t have the motivation, the little voice doesn’t talk. Trade-offs. I’m coasting through picking up odd jobs.

In response to a comment on an older post, I wrote this:

Since last posting, I found a different psychiatrist, and after a few more med attempts, landed on one that works, and I haven’t been back to see him since. And hopefully I won’t. The difference was immediate, the guy was … not great, but PROFESSIONAL. No mind fucks, no innuendo. I don’t really understand what exactly happened with the one before, I think in retrospect a lot of the drama and trouble was not my fault. The perspective of distance from the situation has let me see more clearly and stop blaming myself for someone else’s problems and emotional shit. I have not ever been in any kind of relationship like that before. The best explanation I’ve heard so far is that somehow we crossed in past lives or something. It is just one of those things.

Now that I am reasonably well medicated, all the crazy just falls away. It’s so strange.

Sorry for anyone waiting for me to write or anything. It’s just not there anymore. I’m a little sad about that, but at least I am back among the living.

Article Link

NYT Book Review.
Diagnosis: Female
Click here for link.

May have to read it, wish I’d written it.

The Medical Paper Gown

I recently got an email from a reader that included this bit:

I just left the hospital last night after a small cut needed 7 stitches. Nothing big, just obviously a self inflicted wound. The nurse tried to force me to put on a gown in the middle of the ER while no other patients were wearing one. I realize now it was to see how many other cuts I had. She yelled at me when I refused.

Which led me to realize that a good topic for a post would be “What’s up with those hospital gowns?”

About gowns in general, I assume the reader is in North America.  The whole gowns thing is an American thing. Sometime in the 1950s, some efficiency expert decided that doctors could work faster if patients were all naked when they came in the room. But naked seemed too awkward, so the NOT-awkward paper gown was invented. And they tell you to get in it before the doc comes in, presumably to save time! There’s no real medical reason. Most doctors today probably don’t know this. Incidentally, there’s tons of discussion online between medical professionals about what is more sanitary/cheaper/classier – paper or cloth gowns, but no one seems to question much the whole necessity of the things. Check out this article, and don’t miss the comments! They go over and over when to gown, what kind, how to put it on, but NEVER ask why to do it at all.

Nakedness/gowning never caught on in the rest of the world. I suspect this might have to do with cost of either disposable gowns or laundry. I’ve never worked anywhere where those gowns even exist. Our ER has pajamas for people who come in covered in blood or whatever – but they’re just pajama pants and button-up shirts with a hospital logo. There are robe-type tops for people who are having heart attacks or something and might need very quick access to their chests…but nothing like the American hospital gown (except in labor and delivery, and those are also cloth nightgown type things and everyone brings their own clothes anyway).

So, when the reader asks, “Is this normal protocol for a forearm wound?” I have no idea. For someone who finds him/herself in that situation, what I’d recommend doing is just saying Ok to the nurse, and not changing. I seriously doubt anyone would notice.

I personally don’t think that any time saved by undressing a patient beforehand is worth causing discomfort/awkwardness. Every country I’ve worked in other than the US seems to agree. In most of the world, the standard practice is for a patient to come in the room and sit down and talk first, and then move to the exam table.

If we are on the subject of medical culture, I’ve also found that medical office rooms look weird in the US – most other places, the room is divided into the office part and the exam part, with a curtain or screen around the exam part and a locking door. The doctor sits at a desk, and the patient on the other side of the desk at first, moving to the exam table only later. It’s like walking into basically any other kind of office in the world. I have no idea what’s up with the weird rolly chairs and patients sitting on exam tables there.

To examine a patient, AFTER we’ve discussed what’s going on, we ask him or her to move to the table if necessary; if I only need to check their throat or something, I’ll just do it in the chair. No getting naked. They go to the table, and I either put my hand under the shirt or pull it up to listen to heart and lungs, pull pants/skirts down to the hip and shirts up to the ribcage to examine a stomach, whatever. It is NOT the world standard to do the whole gown thing or ask a patient to strip down to begin with. I guess sometimes, if I need to check feet or something, I wait a little for someone to take off their shoes…but I doubt it’s a significant amount of time. Not worth having every patient come in with shoes off.

I don’t do a lot of gynecological exams, but usually the standard is to just undress from the waist down, or pull a skirt up, and use a regular sheet to drape over the patient. I don’t give instructions, so some women wrap themselves with the sheet more like a towel after a shower, which is fine with me. If I know that the complaint is not likely to require a full internal exam (likely a yeast infection or something), I usually don’t even do this, I just have her lie on her back and slip her pants down to her knees and look like that while I stand at the side of the table. I think it’s less invasive if I stand there than between the legs, and it feels better to have pants around your knees than totally off. I do not use stirrups at all, just have them put their knees on the table and spread. I’m not even sure if most of my exam tables even have extendable stirrups. I think that the ass-hanging-off-table and feet floating in the air in stirrups is a much worse feeling than just lying down on the table.

Of course, I’d probably fail a medical school exam if I were seen doing this. And I don’t often do a really comprehensive gynecological exam where I need “full access.”

Other times I can think of where I need more exposure is during an orthopedic exam if I think legs might be different lengths or I want to check for scoliosis (both can be done in underwear or even with pants pulled down a little and shirt off, bra for the ladies), a full skin exam (which can be done in parts), rectal exam (which I do by just lowering the pants as little as possible while the patient lies on his side with knees bent, which I think is better than bending over, but if you’ve been through it, let me know if I’m wrong). Believe me, it feels better to have your underwear half pulled off or lifted than to sit around naked in a gown.

While we are on the topic, another practice that seems uniquely American in my experience is for the doctor to be running between multiple exam rooms at once. I’ve not seen another country where patients are briefly seen, asked to undress while the doctor leaves and sees another patient, and then returns. Most doctors have their own office where they sit all day, and patients enter, finish everything, and leave. Offices are therefore more personal as well, because they belong to a specific doctor and all of her shit is in there (well, especially if you are like me), not a clinic where doctors are bouncing all around looking for open rooms. I can’t wait to finally be settled in my own permanent office, where I can paint in warm friendly colors, and put in nice furniture and curtains and normal lighting rather than overhead.

One more thing: chaperoning! I personally hate this. My family doc is a man (I used to have only women doctors until I went to medical school and then realized that 1. it didn’t matter, and 2. I would be pretty pissed off if someone didn’t come to me just because I was a woman) and despite knowing me for years, he lately has started calling the secretary in for even simple exams.

I do understand why and all that, but on the other hand I find it kind of offensive – like, does he really think I’m going to sue him? It bugs me every time, messes up the basic trust of the relationship. And of course, it makes me wonder that if I weren’t a psych patient too, would he do it?

Thoughts? Do you want the chaperone or not?

Sodium Valproate, or “Here we go again…”

I started taking it a few days ago and I think I’m having a bad reaction. The physical stuff hasn’t been too bad, a little stomach trouble but that’s it. No super-drugged feeling.

But my mood has crashed. It’s now an active depression as opposed to a passive one. I woke up this morning crying with guilt and hopelessness. I thought of an upcoming vacation I’m supposed to take with my partner, how much I wanted to enjoy it, for us to have a nice time and be together again. Between the crazy and work, I have barely been present over the last two years, and he really loves me, so he has hung around and not said anything. I just wanted…I don’t know…for things to be nice. For him. For me.

And the shittiest part of it is that I was looking forward to it, despite everything. From the day we booked to a few days ago, I was thinking how nice it would be to have a vacation, albeit a shorter, closer one than we originally wanted. I was looking forward to the sea. I was looking up dumb tourist attractions in the area.  I was finally sort of happy about something.

Then, this  morning I woke up sobbing, then yelled at him over one tiny part of the arrangements that I didn’t take care of.

And I felt so hopeless. Guilty, that he deserves better. That everyone who knows me deserves better. That I have no future, my career is ruined and I haven’t been able to find a different kind of job. That I never will. As broke as I am, last night I gave away a sizeable chunk of money, in the hope that generosity would make me feel better, and also somewhere the hidden thought that I really won’t need it much more, that nothing matters.

This all happened so fast and unrelated to anything that it has to be a medication effect. That has been the one thread I have been holding onto, the objective knowledge that this is some freak thing, not really me. Real despair starts much more insidiously, doesn’t just appear overnight.

So, I have twelve days until we travel. I will give these drugs a two day washout, and then go back to my old med. I think I have about a month’s supply, if I scrounge through all the drawers. I just don’t think my soul could take another turning of something golden into shit. I need this week to be nice, not a week of me curled up in bed, hiding. If need be and it makes me too eager, I’ll toss in a little lithium.

I probably will cancel the appointment after with the new shrink. I don’t want to go there and immediately, first visit, have dumped the med he gave me and all. I don’t want to go down that road again, to be that patient. I don’t want to annoy anyone else or cause anyone any more trouble.

* * *

There is a post up at Shrink Rap with some fascinating comments. Seems like a lot of people have been through the same shit as me with shrinks. A lot of them do manage, in the end, to get ahold of their records. I called a patients’ rights group, and they said that I have every right, but they also said that to push it, it essentially goes to a government agency that gets on his ass, and there is no privacy. They recommended to start by sending a registered letter with a formal, documented request, to get a formal, documented refusal.

But I know that without a lawyer or some agency, that will get me nowhere. And right now, I’m so broke that I don’t have money to get a lawyer to write a letter that will serve as a reminder of the law. That government overseeing agency will do it for a minimal fee, but then privacy is shot. A whole board of doctors sees it.

I still want those records, not even so much for what is in them as for the way that I was treated, like I don’t even exist, like a child – just refused with no regard to the law or anything. I’m just a psych patient, so he can refuse and there’s nothing I can do about any of it.

And there’s also the element of full disclosure. In medical school, they drilled into us that the ethical thing to do when something goes wrong with care is to open all files, be brutally honest. It is better for the patient to know the truth, and it is dishonest for the doctor to try to cover up. I just want to know the truth, what happened, why I ended up so hurt by the whole thing. Something went wrong, not unlike a botched surgery. I just want to know. To understand. To be able to leave behind.

Anyway – thoughts? Did anyone finally get records in an unusual or creative way? Or even a standard way without involving lawyers or courts?

* * *

So much for my resolution to stay away from thinking about how crazy I am. I hope this med wears off soon.

In Response to Comments on Previous Post

As usual, the comment discussion led to lots more writing – enough to make a post. Here are some points.

More than one person commented on the “pain” expressed in the last post. That surprises me; actually, despite being numb, at least things are stable. I wouldn’t have thought to describe things as terrible pain; if anything, this is the best I’ve been since stopping my wonder drug. Not good, and scary, but I’m not batshit crazy.

Aqua wrote:  To be mentally ill in ancient times and in pre modern times, was to be recognized as being behaviourally “different” just like now, but now we have different labels than before. Sometimes, maybe it was better, but many times it was downright awful too (think “witches” and all the burnings and drownings that too place. Sometimes it was better..I am sure being a Shaman has its perks.

Bearfriend says: It occurs to me that your inability to cry may be linked to medication? That they are making you unable to really experience any emotions at the moment. Of course, this can happen without meds as well. Once you are on the conveyor belt of psychiatric treatment it is very scary to contemplate stepping off.

Inside that statement is part of the problem for me: if I had not presented to any psychiatrist ever, I would not be considered mentally ill at all. My closest friends never guessed (though weren’t surprised when I told them, either), I function in society and the workforce well enough for enough of the time, I’ve not hurt anyone else, my behavior, while sometimes strange, has not been to the point where it can’t be smoothed over with apologies and a little bit of lying after.

If I were not in the medical field, but rather in a more artistic field, I would probably be considered entirely normal – well within the range of commonly found temperaments in dramatic fields. In high school, when all my friends were the freaky kids, I was among the most “mainstream” or “normal” of them all. And none of them turned out too bad. I just made the stupid mistake of trying to fit in into a world and social class that I am not especially suited to.

Once, I tried to explain this to the former shrink. (I might actually have written this before.) One of the biggest scams in medicine is back surgery for disc pain – it gets no better results than just waiting three months, and has horrible complications. Huge numbers of people come out of it with worse pain, urinary or fecal incontinence, leg weakness or gait problems, and other things. With a friend who is now specializing in rehabilitation medicine, we once joked about “Top 10 Things We Learned in Medical School” and one of them we both put down was, “NEVER have back surgery.” I explained to the shrink that essentially, I walked into his office healthy, and came out extremely ill and disabled, just like those people. If I had never walked in in the first place, I would not be “mentally ill.”

That has been one of the hardest things for me. I think that in a lot of ways, asking for help and getting it (sort of) makes things worse, encourages you to be “sicker” because all of the sudden, that gets you attention and a legitimate role as a patient. When I had to cope alone, the fact is, I did.

Bearfriend is right about another thing – that once you are in, it is nearly impossible to get out. I can’t leave for two reasons, mostly. One is that since I now have an “illness,” I keep getting promised symptom relief or improvement. That is a pretty strong motivator to keep being treated. The other is that now I am not just me, I have “manic depression” which now will be with me forever, and is a serious disease (even if I am more lightly stricken) that needs medical treatment…forever.

There was another statement in the comments about meds not helping. I just wanted to clear that up – for me, meds actually had me 100% symptom free and totally normal for about four years. During those four years, I didn’t see a psychiatrist at all – just got refills from the GP every few months. Then I had to stop taking it, and since then, my entire life has gone to hell. I do believe in at least some psychiatric medication because I was so helped by it at one point.

About my analogy of psychiatry / psychodynamic theory to religion: one of the most influential books I have ever read is Carl Sagan’s The Demon-Haunted World. Though I talk about myth and magic and stories and destiny, I don’t quite believe in those things on a practical level. Rather, they are a human construct that is very good for describing many aspects of the human experience. In day-to-day reality, and in medicine and politics, I am a rationalist.

Psychiatry is a belief system not supported by evidence. It is basically an unprovable science. It is similar, in that aspect, to myth – sometimes a good analogy for some parts of the human experience.

The problem comes when one uses that as a basis for medicine, for intervening with people’s lives, or presents it as a science. For example, one can be damaged in the anal stage, and according to theory, become either overly fastidious or super messy. Or may turn out fine. So what is the value of the theory? It is a non-predictive science, which means it is a belief system. (And yes, I know that it explains by delineating a whole set of reaction styles that cause the difference – but there is no way to tell why which person would react one way, or to prove that those reactions are the cause of the outcome. It is a post-hoc theory.)

It’s sort of like how one could say, “There is an omnipotent God who created the earth and the universe and controls all occurrences…” I suppose it is plausible, but it is NOT science. It is non-testable and non-predictive. Knowing that “fact” gives you no assistance in predicting what will happen, or even really in understanding what already happened…therefore, not science.

And I have often said, if I were to choose for myself a belief system about human nature, despite the secular appeal of psychodynamic theory, I certainly would choose a kinder, happier one than the one offered by psychiatry. If I am going to believe in bullshit, I may as well believe in bullshit that makes people happy.

Incidentally, this new shrink happens to be a very devout practitioner of religion, but also is classically psychodynamically trained. I think this is overall good for him, because it gives him a  belief system to compete with psychiatry. He isn’t a fanatic Freudian who believes that psychoanalytic theory explains everything and is the one true doctrine of human nature, because he has another belief system that also explains everything and claims to be the one true doctrine of human nature.

The more paradigms you understand and have in your arsenal, the better-equipped you are to be able to take part of one and apply it when it seems relevant, without being a slave to it and bending the rules to make facts fit your doctrine.

On the last post being hard to write: I wrote it, with great difficulty, fishing out words. Often, I found a word that fit by meaning and connotation, but it didn’t often have the right sound or rhythm for the sentence. (See: “emissary or oracle” – I ended up writing both because neither was quite right, oracle was maybe closer, but neither had the right rhythm, I wanted something like “channel” as the verb but couldn’t make it fit in that grammar; “misfortune” – wrong word altogether, but originally I had used “tragedy” twice there, so it had to go; “tenebrous” – not dark enough connotation; “farcical” is just not quite the right word, not enough ridicule in it; “adamantine” has the right connotation but the absolute wrong rhythm, that should be a hard, trochee word.)

On the other hand, I thought I wrote for about 20 minutes, but when I finished and looked at the clock, nearly an hour and a half had passed. So maybe there was some real writing, hypnotizing “flow” writing in there. And there is a bit that I terribly like, that did come to me sort of from beyond and is fanciful.

* * *
Another quick note – when I logged back in, I glanced over some search terms people are using to find this site and a few that I didn’t quite expect are showing up a lot. Unfortunately, WordPress doesn’t seem to register the whole search term if it is over a certain length, so I’m left trying to guess what someone searched for with “what role does medicine have to play in <blank>” or “are psychiatrists who yell at their patients <blank>,” and  the enigmatic “im getting signs that are pushing me to <blank>.”

But a lot of them are coming up with things like, “How to tell my doctor I self-harm” or “how to tell my doctor…” or “what doctors say about…” many different things related to mental disorders.

For those people, I hope this site has been helpful in demystifying what the doctor really thinks of you, and what to say or not say, and shows our limits and some of the biases common in the medical world.

* * *

Finally – thank you to anyone who comments on valproate and how it makes you feel. No one fucking tells you ever what meds will actually make you FEEL like, and it sounds like maybe valproate is one that looks worse on paper than in most people’s practice.

“I wept not, so to stone within I grew”

Io non piangea, si` dentro impetrai.
-Inferno, Canto 33

It is 3:40 AM, the witching hour, and my being awake cannot be a good sign.

Of course, I have been awake at this hour every day for quite some time now. Maybe wanting to get up and write is a good sign.

Things here are, well, empty. I suppose it is a depression of sorts, though fortunately like the ones I suffered as a child and teenager, before the “manic” part was added to the title. It is much more bearable, at least on the surface, than the episodes I have suffered in the last few years, because I am just quiet and still and numb. No racing mind or body torturing me with horrible thoughts that come faster than any human was meant to think. If I didn’t have the practicalities of running a life to worry about and could just crawl into bed until it goes away, it wouldn’t be bad at all.

It is strange how it has come full circle, taken me right back to where I started. It does remind me of that time when I was 12 and my mind broke for the first time, for seemingly no reason. It is familiar, if not comfortably so, ha ha. It makes me a little nostalgic for that time, when I thought that the worst that could happen, crazy-wise, was the need to crawl into bed for months. Before I knew what could really happen, all the ways a mind can burn and break that I know now.

It does get better throughout the day, and by evening I am almost normal. Unfortunately, 9 PM is not the best time to apply for jobs or deal with the mundane details of life. Every night I go to bed thinking of what I will do first thing in the morning, the interview I will schedule, the tax papers I have been avoiding (two forms, that’s it, two forms!) for months.

And then morning rolls around at 3:30, and I am numb and frozen and terrified again and nothing gets done.

I have not worked in four months. All solid job offers are shift work, night work, in busy, miserable emergencies for minimal pay. Seeing as that is what made me so crazy over the last few years, I have not accepted any of them. I don’t want the responsibility of not missing a heart attack for $5 of pay. It makes me physically ill to think about going back to medicine.

I wrote before that it wouldn’t be so bad if I weren’t trying to keep up with life, but I am not sure that that is entirely accurate. I woke at this atramental hour, and beyond the dampened terror of my bank balance, the horror at the thought of returning to the repugnant job that is the only one I am qualified for, a little voice dared to run through my head and say the one thing that I have not allowed myself to think: “Your hope is all gone,” the voice intonated. “Your mind will not work again. This is what you are now.”

I miss very much the streams of words that used to race through my mind, needing to be caught on paper before they got away. I miss writing, which used to be an automatic and unconscious activity. Whatever force I used to channel, whatever it was in the universe that fed me the words, has left. I have been alone, without even the words that I could always count on to come, unbidden. I try to force myself now to write, but I sit and try to think of words. I have to choose them, and they are never quite as right as the ones that come from without. I never used to “have to” make myself write. The words used to just come, words and phrases and alliterations and allusions would streak through my head, unannounced and at odd times, often surprising me and making me laugh or smile at their unexpectedness. All I ever had to do was appreciate them, and transcribe them, and be thankful for the electricity that ran through me when they were flowing, the sense of pure purpose, that this is what I had been put on this planet to do.

But whatever consciousness it was in the universe must have moved on, found another emissary or oracle.

Not only the words are gone. The more primal, wordless passions, the pathos and exultations of life, are muted into nonexistence. For months now, I have been walking around on the verge of weeping, with tears in my eyes that obstinately refuse to fall. I think that if I could weep, something might shift, maybe for the better, maybe not, but at least there would be motion.

I don’t understand where those tears are coming from, why they are so firmly fixed behind my eyes. Maybe when my muse left, someone else’s tragedy mistakenly got into the void left in my eyes, and I, having picked up the narrative in the middle, cannot identify the nature of the misfortune, and thus, cannot weep for it. I have no reason to be sad now (unless I think of the countless broken bodies and broken lives that surrounded me and sometimes touched me over the last years). So I am not sad. Just numb.

The lack of hope – another entity that has left me: something in my head keeps whispering, maybe this is it…this is the best you will ever be. Sometimes I wish that the “maybe” would disappear. If I were to be sure, I could figure out how to arrange some kind of half-existence around what is left. But as long as there is still a memory of how I used to be (abstractly, anyway – I cannot channel how I felt when I was alive and ready to do anything and conquer the world, but I can picture my younger self smiling and full of energy, doing things, doing everything), there is that little last bit that keeps me waiting, as the song says,  busco un mejor momento. In some ways, this keeps me from playing the hand I have been dealt. I am always waiting for the next deal.

For my own record, since I do record this shit, I just saw a new shrink. It was horrific and humiliating, as usual, but no worse than most new shrink appointments. The decision was to raise the bupropion, give that two weeks, and if it isn’t enough, add valproate. I have a hard time seeing much logic in this; it seems to me that the last thing I need now is a drug that will slow me down or make me stupider. But I suppose I have nothing to lose (except my hair and my hormonal balance and my lack of diabetes and any potentially normal fetus I may someday conceive), so I’ll try. Mostly because I don’t want to be that patient on the very first meeting with a new shrink.

And things have undoubtedly improved ever since getting out of the miasma that was the previous shrink. I miss him, maybe, as a person, and on some level I think I like him more than this new one, but I cannot ignore the overwhelming experiential evidence that it was bad for me, and there were too many lapses in professionalism to ignore (see “refusing to release records”).

Sometimes, though, in these tenebrous hours, his words still haunt me: accusations he made, (mis)interpretations of things I did or said that nonetheless were hurtful. The insinuations from someone I trusted that something is so wrong with me that it is a miracle I function, and that I will never be “normal” without serious interventions, which apparently have not yet been invented.

For these reasons, even though it is all I think about almost every day, I am trying to avoid anything psychological or mental health related. When I am away from the whole paradigm, I’m just a flawed person, no more or less than anybody else. When I let them near me, I become an amalgam of pathologies and brokenness. Sometimes I wish I never had gone to any doctor. Then, I would have just been eccentric, or emotional, or melancholic, or even just plain crazy.

I have to remind myself that I don’t even believe in their system of belief, that people lived for thousands of years without shrinks, that 99% of the world’s population has never even heard of their concepts. I try to remember who I was before I ended up so entangled with this bullshit system. I was a person. I wasn’t perfect but I was alive and I did things and knew people and sometimes felt something.

Somehow, all of that has disappeared, and all I can think about are all of the words that have been used by the priests of this odd religion to judge my essential being. I do not believe in their religion, yet somehow, their damnation of my many sins, that they delineate in the clinical terminology of their liturgy (affective instability, noncompliance, Melancholia, Mania, narcissism, Cyparissusism, Axis I, II, III, x, y, z, the asymptote of mood-personality-behavior), haunts me.

I don’t know why I cannot break the hold this farcical cult and its practitioners have on me. I suppose it is my version of the person who doesn’t really believe in God anymore, yet somewhere deep down, is too frightened by the spectacle and rhetoric of the fundamentalist hellfire to actually get up and leave the pew.

And so…back to the title quotation. I feel that underneath the conspicous anodynia, there is a well of misery hiding. Hell, it keeps trying to creep out through my eyes. I can’t help suspecting that the underlying pain is for all that I have seen over the last few years and all the people I have lost. I would drain the well, cry profusely and feel deeply, if I only knew how to reach the stygian waters.

But it is too late. So many years of having wept not, I both created and became the adamantine stone.

On Chronic Depression and Myth

One of the things that occurs a lot in the mentally ill, especially, thought not exclusively, in the mood disordered, is that a mood episode is treated with medication, and the cycling of moods is stopped, yet the person remains miserable, suicidal, even, and suffers a lingering handicap. In the world of psychiatry, this is the stage in which the doctor says, “There are personality factors at work,” which is code for, “This person is nuts and I have no fucking idea what to do.” The patient is then referred for long-term therapy, which rarely helps.

I know because I experienced this recently.  My acute episode ended – the heavy cardinal signs of depression and mania were gone, yet I remained miserable. The same pattern is readily apparent on many of the blogs on my sidebar (Exact Science, Coloured Mind, PWH). The thing that is last to fade, it seems, is the temptation of suicide.

The doctors never seem to understand this. “We fixed the chemical symptoms, why are you still fucked up? Why can’t you just go back to doing whatever it is that you were doing before you flipped out?”

My partner has been traveling to the Far East a lot lately, and has become interested in Buddhism. I got him a copy of Siddhartha, which I only read in high school and remember not liking that much. I thumbed through some of the coffee table books on Buddhism that he brought back, and one detail of the life of the Buddha struck me: that the hardest part of his journey was not leaving home to seek out new knowledge; it was not the reaching Nirvana, complete insight into the order of the universe, and not spreading his teachings to his disciples.

The hardest part was, after reaching Nirvana, reintegrating into the stream of life, caring about other living beings. He was presented the choice, upon seeing Nirvana, to either remain there for eternity, or to stay and spread his teaching on earth. The Brahma itself (God) had to come and convince him to continue on the path.

This struck me as the crux of the matter, as the reason I continued to be suicidal well after the depression had lifted. It is not the descent into symbolic death that is difficult, nor the ascent out of the underworld. Rather, the most painful and difficult part of the narrative journey is the return to the flow of everyday life after the threshold experience.

Myth studies and Jungian psychology are the types that most move me, interpretation through metaphor, myth, and poetry, seeing each individual as a Hero. It gives strength to people to realize that what they are facing is not mundane, not a result of skewed object relations or personality flaws, or dysfunctional families, but rather a part of what humans have faced since the dawn of time, and helps awaken them to the fact that they will have to call on their own mythic strength to prevail.

Mental illness in its life-threatening forms – suicidality, depression, mania, psychosis – is a liminal experience, one in which, unrequested, people are forced to face the boundaries of normal human experience. Symbolically, suicidal depression is a descent into the underworld, in which all of the trivia of normal life is stripped away.

During my last illness, I considered whether I would live or die, nearly each moment of each day. I made preparations for my death, and saw the world differently, knowing that I might not reside in it much longer. Trivia fell away; the world seemed quieter. Preoccupied with thoughts of high cliffs and nooses, the overwhelming unbearableness of life, other things seemed to fade.

When the episode was treated, under control even, I stayed on the edge of suicidal thoughts. They didn’t go away, even though the misery that had led to them did. And the shrinks never understand why.

But myth does. A classic stage in the monomyth is “the return threshold.” Dying is one threshold, and every hero has to face a symbolic death and descent. The hero is then saved and brought back to life with new understanding, either by his own prescience or a force from without. Though it seems like that should be a central plot moment, it is very short, albeit dramatic.

The true struggle comes after. It is not easy, once one has seen the void and been swallowed by it, to return. Everyday life seems trivial, bland, meaningless. When one has faced the pit, how is one supposed to return to preparing dinner, to cuddling in bed, to laughing? To getting up and going to work, to petting the cat, to doing the million small and seemingly meaningless things that make up life?

The road back is long and not terribly exciting. It is nothing like the symbolic death or the symbolic rebirth. It is arduous, in many ways more painful, and its outcome less certain than the simple death or rebirth. It is natural, easy even, to be faced with this journey and to wish to return to the underworld, where things appeared more certain, if darker, more essential, more stripped down to meaning-and-unmeaning. It may be a horrible place, but it least it is a final one, unlike the slow journey up the mountain to a destination – life – that one hardly remembers, that does not promise to be less frightening than the life that led one to the threshold of death in the first place.

And so we stay suicidal long after the depression has faded. We frustrate our doctors by continuing to talk about death and pain and our wish to be freed long after we have stopped waking up at 3 AM and being restless and wrestling with God.

This part of the journey is much longer and more arduous than crawling out of the grave. We, and our doctors, deceive ourselves by thinking that the gateway out of hell is the end of the struggle, the hardest part, when in fact it is the easiest and shortest part. The only way back, as the Buddha knew, is to immerse oneself in the river of life, and forget the rest, let the questions of life and death fade away, at least until they are back for good.

Yet another Shrink’s Line of the Day

Yesterday I decide that I feel bad about quitting the shrink all abruptly and in a rage. That I didn’t want to end like that, if just out of politeness. I really wanted to call and leave a message apologizing, and wishing him a happy holiday. I said that I was going to be the bigger man here, be the one to let my ego come down off the high horse first. Because, true, he shouldn’t have gotten sucked into the whole yelling and power struggle, but I participated too. I felt bad. I decided that, for the sake of my own dignity, that no matter what he said or did, that I wasn’t going to get into another knock-down-drag-out. I was going to be mature and in control, like my first therapist taught me.

Unfortunately, he answered the phone, despite my best attempts at timing to get voicemail.

“Hi, this is Sara. I just wanted to say that I’m sorry for losing my temper, and I didn’t want to end on that note. So…I’m sorry for anything I said or did that was inappropriate – ”

At this point he cut me off and said ominously, “Well, I’m sorry too that you’ve chosen to be like this and end things this way.”

My blood pressure immediately rose and all of a sudden I was almost ready for a fight again. I mean, even if I and my personality flaws are 90% at fault, there was at least some unprofessionalism on his part.

I took a deep, deep breath, and said, “Let’s not go into this again. I really just wanted to apologize for yelling, and wish you a happy holiday.”

He could hardly control his anger and snapped back at me, “Happy Holiday!” and hung up.

* * *

I promise, soon to get to the post on recurrent/long-standing mental illness and what the Buddha has to teach us. You know, something that might be of use to someone.

But since this is my journal, I can use it to think in writing. This incident raised so many questions for me.

Am I so crazy that I am imagining the anger/stubbornness/power struggles coming from him? Is that projection or some other psychological bullshit I am doing because I’m really as fucked up as he says?

Is there a legitimate therapeutic reason ever for being obscure or concealing the therapeutic mechanism? Is it ever right to say to a patient: I don’t think we can discuss your condition, how we are going to go about treating it? Is it ever ok to refuse to discuss the kind of therapy you do? Is it ok to say, “You just have to trust me” – and not at a given moment, but as a guiding policy? Especially when the patient is going through considerable distress as a result of the treatment? I mean, if I give a patient steroids for a serious disease, and they complain of side effects, I feel obligated to explain why I think that the benefit of the drug outweighs the side effects, what it is doing to them. Is psychiatry really so different?

Is it ever ok to refuse a patient their record, especially while refusing to give a reason? (Thanks to Jay for some perspective on this one.)

Is honesty on the part of the therapist always an important part of therapy? I mean, to me, it seems like that’s exactly what I’m paying for – someone else’s honest and trained opinion. But maybe I am understanding wrong – maybe I am supposed to just let him do whatever it is he is doing?

Is there a rule that therapists should never apologize? I mean, this whole thing would have been avoided (in retrospect), if he could have just said something like, “I’m sorry you feel hurt.” I wouldn’t even expect an apology for the content of what he said or anything – just some sort of acknowledgment that I was upset. Is there a rule in therapy that it undermines authority/transference/focus on the patient to apologize? I mean, my natural instinct in a similar situation with a patient – no matter how nuts they are – is always to say something like, “I’m sorry you’re so upset.” And when I’ve lost my temper or gotten annoyed with a patient, I always apologize – but maybe out of my own sense of guilt and remorse rather than concern for them?

The reaction I got was, “Why are you upset? There’s no reason for this to be upsetting to you. Why should this (being called both narcissistic and borderline in two sentences, one after the other) be a cause for concern?” This seemed so invalidating after I had said it was worrying to me to think that that might be the problem and asked what the treatment would be, what to do about it. I think I would have been ok if he had said something like, “Yeah, it’s hard to hear.” But a total failure to understand why I was upset – and then to tell me to “not be upset” was incredibly invalidating. It’s ok to tell a patient, I think, that their feelings are colored by their past experience or knowledge, that maybe they are taking offense or being hurt excessively – that, after all, might be part of what brings them to therapy. But to flat-out say that someone has “no right/reason to be upset” seems sort of anti-therapeutic to me – I mean, isn’t part of the idea of therapy recognizing and acknowledging feelings (even if one wishes to change them)?

Is any problem always the patient’s pathology?

And most importantly: Why do I keep seeking validation and understanding in a place where I so obviously am not going to get it? Why am I seemingly endlessly attracted to going back to someone who repeatedly hurts me, hoping for a different outcome the next time? What buttons is he pushing in me, or what screwed up need do I have that I keep running right back in for another round?

* * *

I’d like anyone, but especially therapists working in various schools, to respond to any question that catches your eye.

Anyway, if anything, that phone conversation should have cemented my position. From time to time, the situation catches me and I feel kind of bad. Not abandoned or whatever – I mean, I know if I’d just give in and stroke his ego a little, I’d be welcomed back and “forgiven.” It’s not like he’s kicking me out. I am, as he said, “choosing to end this way.” I think the choice is being made rationally, for sound reasons. I mean, I have to trust my own intuition and logic – it’s the only source I have. The real question is why I’ve been ignoring the signs for so long.

But still, I think it’s ok to feel a little sad. After all, even if he never did offer me much in the way of comfort, even if I’ve gone downhill under his care and felt worse for it…it still is, as Tony White would put it, an attachment, even if not the healthiest one in the world. I did like the guy as a person, if not as a therapist. And we’ve known each other a long time. And he did try to help me. Maybe I’m just unhelpable or unreasonable. So I think it’s ok to feel kind of bad, knowing that in the long run I’ll be better off. And I think I really do need to examine why, after so long and so much of my gut and brain telling me otherwise, I kept being pulled back.

Is a big part of it hope and regression? That he promised that, as deeply flawed as I am, that there was hope of a “cure” if I’d just keep coming and talking to him? (A lot of my frustration that brought up the conflict was that this therapy seemed to be going nowhere – that it was just like chitchat…with no change in anything.)

* * *

About the comment on the last post about the colors and design of the blog being dark and depressing, well, true. But I rarely see them anyway – I just see the compose window and get the comments by email. I almost never look at the finished blog, so I forget the dark colors and photograph. I feel sort of like I do want to leave it, just because this is the place I can let the darkness out, my place to be the goth teenager I secretly always wanted to be. My other blog, the one about my real life and not my mental patient life looks nothing like this at all. Though it is a good point. I do take a lot of these kind of suggestions in real life – exposing myself to sun, to sunny people, exercising, keeping the Dali posters off my walls in favor of something warmer – definitely a good point.

Enough

I finally wrote what I thought was a reasonable letter to the shrink, since he never seemed to hear what I said…about how I can’t live in the dark about what is wrong with me or how to fix it, that I was deeply hurt and concerned about the borderline thing, etc. I hoped that we could work something out.

But today, we met. True, I knew I was in a bad mood going in. But on the other hand, he claimed I had nothing to be upset about, accused me of splitting between him and the GP (I knew from the minute they started “coordinating care” that sooner or later I would be accused of this and tried to be so careful not to say anything negative about either of them), said he couldn’t understand why I would be upset, that he was so sure I’m just trying to push away. It felt like always – I say and mean one thing, and he sees it through his filter. Refused to tell me why he thought I was borderline (and then later, when I was angry, said, “See – that’s classic borderline. You’re upset, so you’re trying to make me upset.”), what he thought my problems were, or how we planned to work on them together. (“Part of your problem is needing to just trust me.”) In short, it was the classic psychoanalytic bullshit – the shrink is always right and the patient is always crazy.

To top it off, I requested my medical records and was refused.

The whole scene was incredibly upsetting – to be so totally invalidated. But I had spelled out that I just am not interested in paternalistic care, where my problems and how they will be treated are hidden from me. That if this is the care he gives, I’m not interested…not interested in his diagnosis and not interested in buying a treatment that can’t even be explained to me. That I need collaboration, I want to change, but need the direction on how.

No good. “I can’t understand why you are so upset.”

I left, finally. It was sad, and it was scary. I’m now without a safety net and badly medicated, though I did meet a hippie clinical psychologist I sort of liked (woman).

I drove home and cried a little, felt like throwing up. It was so humiliating, invalidating. But – I also drew my lines in the sand. I can’t say I was totally calm; in fact, I was angry. But I spent months examining myself closely to see if what he said could be true, if there was justification in my anger. I decided there was, and that I needed some acknowledgment of that. I really didn’t expect not to get it at all. But I didn’t.

And that’s just not ok with me. No matter how sick I am, how bad I feel, how much I need help…I don’t need it that bad, bad enough to believe that I am so crazy that I am totally out of touch with reality.

So, through my tears on the way home, I reminded myself that I can save myself, that maybe only I can save myself, that I’ve done it before, and that I can do it again. That I’m somehow going to be ok. That I am a decent person, despite how broken I may or may not be.

I might go re-read The Color Purple. I think that is the message that I need to hear – remember Celie? Raped as a child, beaten, cast-away, unloved by anyone, half-literate…she knew somehow that she was a human being of intrinsic worth, one of God’s creations, one of the things that is included in the phrase “God love everything you love–and a mess of stuff you don’t.” That even if she was poor and ugly and a woman…the universe had created her with love. That God loved her, even if nothing and no one else did. That she existed, just as lovely as a wildflower.

I may suck at being happy. At being patient. At controlling my temper. I even may suck at loving the people I love. But I can do some things – I can comfort people and I, on a good day, can write words that mean something, that capture something real that happens to people. I can forgive. On a good day, I can be grateful, and on a great day I can pray, or at least I used to be able to. I can be part of the universe sometimes, and of the human race when I am not sick. I can overcome my fears. I can see the color purple. I can survive the dark night. I am a living, breathing part of the universe, and sometimes, that is enough.

I just need to remember that, to remind myself that during the moments when it seems like everyone is trying to tell me to the contrary.

• * *

Note to self for next post – remember to post the thoughts about chronic depression, the idea of depression as an addiction, why some people can’t seem to give it up, and the Buddha.

Still alive, beyond comfort of man or spirit

Thank you to everyone who left me comments or emails or anything. All much appreciated. Sorry I haven’t written back.

I am, indeed, still alive. In fact, the longer days are making some things easier. But I don’t feel better, am not getting better, am just biding time, this version of bardo, laced with apathy and terror. I started Wellbutrin intermittently again. The shrink has pretty much given up on me – tells me to just prescribe for myself and take whatever I want, because that’s what I’m going to do anyway. Not true, but it is very difficult to argue with a shrink.

Except when it isn’t, like the last time I was there, and ended up yelling at him for an hour straight. I feel bad, couldn’t have been very pleasant, but still, throwing psychodynamic interpretation shit at someone in my condition…well, seems like that’s asking for yelling. “Why are you so angry?”

Well, I guess I’m still angry about the borderline comment.

I wish my shrink weren’t so complicit with my self-punishment.

* * *

I woke up after a weekend of physical pain; unfortunately my GP is out until next week. I called the shrink  but then hung up on the answering machine.

Maybe, since I obviously am not going to work today, I should try writing something. I’ve thought of what I need to write, but haven’t been able to care enough, to drag up the energy, to do it. Which, in and of itself, is probably loaded with unconscious meaning that I also can’t quite seem to bring myself to care about.

* * *
Also, I have about 6 more weeks before finishing a certain stage in my training, after which I will have vacation. I have decided to try my hardest to avoid suicide until after that point, so that they can’t say that it was the pressure of the job or that I couldn’t take it or anything like that. Because, God knows, it isn’t that. It is me, all me.

Thanks for continuing to read

When a poster on a blog like this stops posting, usually one of two things has happened: either they’ve hit a significant remission and have somewhat lost interest in all things mental-health-related, or they have taken ill in a way that keeps them from writing, usually either a severe depression, hospitalization, apathy, or the black hole, in which there is nothing to say. And, I guess, sometimes they die.

Usually they come back to writing sooner or later, good for the second group, not so good for the first. As far as I know, there are no reports from anyone from the third group hasn’t returning to blogging.

I, unfortunately, belong to the second group, have had a tremendous crash-and-burn. I’m not sure why I’m writing now, and I apologize for the quality; it is written through a haze of legal psychiatric drugs that makes it difficult to stay conscious, let alone coherent or eloquent.

I just wanted to say that the other night, I went outside in a miserable state, where there was no peace to be found – not in drugs, not in music or poetry or adventure novels, not in trashy magazines, and not in sleep, which, anymore, is haunted by nightmares. I sat under the stars and smoked a cigarette. The moon was half full; soon, it will be full, and then, after that, the next time it will be full, it will be Passover.

And I thought: I really would have liked to see another Passover, that holiday I love so much, when I really do feel the holiness in the air, the meanings, the social and the mystical. The elision of time, when it is that same night as it was so long ago, in which we start out bound and by the end, hopefully, will be freed. And the merging of the physical and spiritual – the tastes of the bitter and the sweet.

I always loved Passover, the one time when my skepticism and atheism faded into a sentimental belief in magic. I would have liked to see this one. One more. One more full Nisan moon, one more race to bed before midnight. One more hope for Eliyahu to come and save us from this sorry world. To save me, on the wings of the Shechinah.

But I just know that it isn’t going to happen. That I won’t have one more Spring. I think it’s too late now. I’m too far lost, beyond a way back, beyond where I can even want one.

And finally, after all this time of numbness and dead souls, I sobbed. I could imagine something, anything, that I did want to see, would have liked to see, to be there for. Knowing that, I could sob. Not for missing the rest of my life and not for the gruesomeness of death or hopelessness or suffering, but for the simple, plain, yet cosmically significant idea that  I really would have liked to make it to Passover. One more time, I would have liked to feel that. And I most likely won’t.

Just that. I am beyond missing future adventures, past beauty, beloved books and books to come, future love, past love, present people and the spectacular world around me. I’m far beyond mourning any of that. Those things all have lost the hold they once had on me. I don’t love the things that I used to love anymore.

But I would have liked to see the Seder table, one more time, the poetry and ritual of it, the full moon, the sense of blurring of boundaries between present and past, the individual and the symbol, the present reality and the hope for a better day. I would have liked…to just be there this Passover. And oddly enough, when nothing else could, that was enough to make me cry. I was sort of surprised I still could.

I was so proud of her

I saw a patient the other night with a ton of psych meds in the ER for something unrelated. She was neither young nor old.

(Incidentally – definition of “a ton of psych meds” = more psych meds than me.)

And she was totally normal. If I hadn’t read the list of meds, I never would have known by how she looked, how she presented her pain, how she talked or reacted in conversation, how she was dressed, how she handled the interactions with everyone. No anger, no speech impairment, not slow through a drug haze, not hostile, not overly passive. Nice. Normal. I never would have known.

I always worry that psych patients are always so obvious to doctors after a few minutes, even if they function well or are only mildly ill, that I must be too, that it must be obvious to anyone who treats me. But she wasn’t. She gave me hope. And I was so proud of her.

But of course, I couldn’t say anything.