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.

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“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.

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.

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.

I did not see this coming

The latest in my escapades – no essays or deep thoughts or medical stuff here, just my personal update.

The anxious racing episode, naturally, crashed into a depression that hit hard and fast. Or maybe not so fast, but I didn’t feel it until it was out of control.

I think I am more and more becoming a burden. I haven’t had many normal conversations with any of my friends lately, it all revolves around my condition. I feel like a burden, and though they’d never say it, we are all doctors in training and under so much pressure that we are very limited in how much we can give to each other. It’s sad, but it is how things are. I also just sort of want everyone to go away and leave me alone, so they won’t see all this, and I can return to my life after I’m better without having done too much damage.

It is very hard for me to accept help, and I just want my partner and everyone else, well, I want them to help me and care for me, but I don’t want them to see me like this.

Since the depression got worse and worse, I went to my GP, who is very sympathetic to these kinds of problems, having had a son commit suicide, so he treats people with mental illness like people, not diseases. Actually, I didn’t want to go, but the psychiatrist wouldn’t treat me further unless I did because he wanted to be sure I wasn’t physically ill. I had attributed a lot of the physical symptoms to medication side effects and the depression effects.

I went to the GP and told him to just sign off, send some basic blood tests etc, and to give the shrink a green light to continue treating me. I told him I was not alright, but I couldn’t tell him about the suicidal thoughts. He knows about the depression, not sure how much about the whole bipolar story. He said I looked bad, and asked if I had ever been this bad before – I had, twice.

He started to do a brief physical exam, like, put a stethoscope on me while I was just sitting in the chair, but once he heard my heart, he told me to get up on the table, and did a full exam. He started yelling at me (well, not “yelling at me” but he got surprised and upset) that I was in horrible physical condition – apparently malnourished and dehydrated almost to the point of shock – racing pulse, minimal blood pressure, gray, the whole textbook version.

I had been feeling dizzy and horrible, but thought it was some central effect of some drug so I didn’t really pay attention. I was surprised because I’d been working as usual. I knew I hadn’t been eating because the depression sort of took away my appetite and one of the medications or another was making me either unable to eat or throw up often. But I didn’t think it was so much. I had been trying to eat a lot of calories in whatever I did eat – adding butter and honey and always juice with lots of sugar. It’s my “depression diet” because I know that sometimes I lose a lot of weight fast when I get like this, so I try to pack as many calories as possible into what I do eat. I guess I didn’t start early enough this time.

He called the psychiatrist from the office right then and there. This felt really bad, like I was this wayward child who needed to be taken care of – all of the sudden I was the ward of these two doctors, playing ping-pong about what to “do with me.” I only heard the GP’s side of the conversation, but he said at the end, “Look, I really think we’re getting to the limits of what can be treated outpatient.” No idea if he was referring to mental or physical state.

He sort of vaguely asked me about suicide, asked if I could or would talk to the psychiatrist about that. I said, “Probably not.” But it got the idea in my mind that maybe I should say something.

I walked out of his office and I remember sitting down at a bus stop just to rest and catch my breath for a few minutes before going to the car. It was freezing. But I was so tired, two hours passed while I sat there, watching people and buses come and go, waiting for the energy to get up and leave.

I did the blood test and the H. pylori test, and then went to meet a close friend (also a doctor), and told him how scary facing hospitalization was (for either the medical or mental stuff, I wasn’t even sure which anymore). He told me, “You look terrible. I’m a friend, not your doctor, so I’m not going to tell you what to do, but maybe you should go to the fucking hospital.”

The next day, I went to the shrink and confessed the suicide stuff, even though it was hard. It seemed like the responsible thing to do. I think I was actually looking a little less depressed by then because going to his office makes me so nervous that it gives me a little energy. He basically didn’t react. Nothing. I asked what to do. Nothing. I felt ridiculous, like some drama queen. He didn’t ask any of the suicide questions that even I know to ask (Do you have a method? Plans? What do you think will happen if you do? What stops you?).

Finally I asked, “Do you think this is some sort of manipulative thing, just to get attention, or something?”

His answer was, “It would only be manipulative if you were doing it consciously.” (I guess that qualifies as a Shrink’s Line of the Day.)

Then he said he wanted to give me Zyprexa “as it recently got approval as a mood stabilizer.” He sounded like a fucking Lilly commercial. I absolutely refused. Then he got angry at me. “You just can’t work with you! You say you want help, but then you refuse the help anyone offers!”

I asked him if he would take a pill of that. He said that that wasn’t a fair question. I said I ask myself that every time I prescribe something for someone (true). At the same time, he told me to stop the antidepressant that he started a week ago – just as I had started to get over the nausea from it, way before anyone has any idea as to if it will work or not.

As usual, I left there feeling worse than when I went in. Maybe he was right, who knows? Maybe not reacting will discourage me from threatening suicide again. He’s a nice guy. He did call today to suggest maybe somehow finding some derm specialist who can solve the side effect problem of the old drug (or possibly that was the subtext for calling to make sure that he didn’t kill me after all), that he had searched around the area and there was some guy a few towns away who specializes in drug reactions in the skin.

I said I was sorry for being such a horrible patient.

The next morning I went back to the GP for the test results and because he had said he wanted to see me again the next day. To make sure I was still alive, I guess. I told him what happened. I asked him if he thought I was being unreasonable to refuse the Zyprexa. He did the screening for psychosis (of which I have never had any symptoms). Then he said that Zyprexa seemed a little excessive (“an atomic bomb drug”), but that he didn’t know why a psychiatrist would suggest that or what psychiatrists consider.

You see so many psych patients who come in with lists of maybe 5 or 7 psych meds, from all different categories, and they look horrible, like zombies, and you have to think that whatever their illness, it can’t be as bad as that, and that there is no rhyme or reason to treatment, they just keep throwing more drugs at them, one on top of the other. That poor girl I wrote about was on something like two antidepressants, and old and a new antipsychotic, a benzo, valproate, and a sleep aid. No wonder she could hardly speak.

I felt like I was slowly turning into that. I was on a lot of peripheral shit at the time. The psychiatrists, including mine, mean well, but it’s such a strange field, no one knows anything, and they just keep throwing more and more drugs on people until they are just shells. I feel bad, so he gives me a med, and I still feel bad, so he gives me another – it’s all well-intentioned, trying to relieve my misery. But I got the feeling that that was what was happening to me – I was being made sicker.

So a few days before, I had also stopped taking all kinds of benzos and sedatives and phenergan and shit that the shrink had put me on, and only left the antidepressants, so I think I had a little more affect when I walked in to the GP, looked a little better, even if I didn’t feel better. I wasn’t like the walking dead.

The clinic was very busy so I didn’t want to take up a lot of his time. But it took me a minute or two while I asked him to wait so I could get up the courage to tell him that I had been checking my life insurances, making sure everything was in order. I didn’t tell him the rest. But he took me seriously, told me to go home, go to sleep, and come back in the morning again.

I was supposed to go with my partner to his parents’ for a few days, but when he got home from work it was late, and I had showered for hours and gotten minimally dressed to leave. But I was so weak and lying in bed, thirsty, sort of hungry. I couldn’t move (as had happened most of the week, lying down with no willpower to physically move my muscles). I just couldn’t get up and pack a bag and get in the car. The wind was howling outside, and the bed was warm and soft, and I was so tired, and thought of the uncomfortable bed at his parents’, and their yapping dog and the noise there…when I finally felt sleepy and warm and safe at home. I just told him to leave me a glass of water and go without me.

The prospect of a silent weekend alone was so tempting. I slept. Woke at 3 AM again, but not as restless as usual. Just relaxed in bed and listened to the wind until I fell asleep again at dawn. I got up in the morning at 9. I wanted to go back to sleep, but I figured that since the GP had been so decent, the least I could do was show up. (Friday is a half day for him at that clinic.) So I went in there, and sat down to wait, and started to feel faint so I went and bought some juice. I didn’t want to pass out and make a scene, or worse, be sent to the emergency room of my own hospital.

I told him that I thought all the drugs had really knocked me down and out, taken away the last bit of energy I had to cope with anything, including the depression, that they were slowly working their way out of my system. I kept taking the antidepressants but stopped all the heavy shit. And suddenly I could move again.

He asked me about my plans for the weekend, and I told him honestly…that I just really wanted to be alone at home. He said I deserved some rest. I was glad he didn’t try to insist I be around someone, that my partner be home or that I go with him. I thanked him and apologized for making such a mess and scaring him, and he hugged me and told me to come back sometime next week.

Then I went across the street and bought a newspaper and some bread and light food and went home and, for once, instead of dropping it all on the floor to deal with later, put the things away. I took out the garbage and minimally cleaned the floor. I drank and ate a little bit, then went back to sleep until the afternoon. Then I moved to the sofa and watched bad 80s movies. The quiet day, no one at home but me, the big bed all to myself…the sleep, for God’s sake. It was all so sweet.

I hate to say I’m getting better because every time I say that something horrible happens, but I wish this quiet could never end. I am just going to try to enjoy the rest of the evening, watch bad sitcoms. Try to sleep off the rest of these drugs. Not to worry about all the things that got me to this point or when I will go down again. Not to fantasize about suicide. To eat long enough before taking the meds that I will gain some calories from it. To drink. To try to orally fix the electrolyte mess that came back in the bloodwork.

* * *

I’m not sure if I learned anything from all of this or what the point of writing it down was. No profound insights. I didn’t suddenly find purpose in life, and I don’t know how long I will remain ok. I have to go back to the race shortly and I am terrified and still exhausted. It’s not a big happy ending. I don’t “know that I have more of a safety net than I thought” or that “people really care about me” (they do, but I already knew that and it doesn’t really matter when I’m in that place). And it seems like I have made a real mess of my body that will need some straightening out. I guess that there are probably some readers who read for the personal stuff, the same kind of stories as they go through. So that is why I am trying to be honest here for you.

I may go back and remove or edit this. It feels very raw and exposed. But for now, this is my story.