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.


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.

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.

Don’t let me slip away

I want to write a post about a self-harm patient I saw last night. (Seriously – I guess the message for what I should be doing with my life is clear, medical treatment for crazies. I went maybe 9 months without seeing any psych patients and then this stretch of them just when I’m ready to quit medicine…) Especially since the topic of scars and regret has been going around on a few blogs lately (for example, here and here). I think as far as damage goes, it was a fairly severe case, though, as I said, I haven’t seen many.

My point is – if anyone wants to hear about that, remind me, sit on my ass to do it, because so much material gets lost by my laziness and losing interest or having moved on to the next thing and forgotten the incident that I wanted to write about in the first place. I write only a fraction of what I want to, and if I don’t write, I forget.

But I need to get some sleep before the all-nighter sets me off; I think this bupropion seems to be pushing me toward the manic side (that’s a good thing for me) – it’s ok as long as I am super careful about light and sleep and caffeine and exercise, but last night I worked until 2 AM or so, and then we split to sleep, and I couldn’t – because I was full of racing thoughts that jumped from one topic to another. Not worries or anything like that – the real true racing thoughts. And then the panic of realizing what that meant. I was in the stupid on-call room bouncing off the walls. Usually you PRAY for your phone not to ring at night. I think my most sincere prayers, considering I’m pretty much an atheist, have been those ones.

But last night, they called me at 3 AM and I was glad for something to do, another patient to see instead of lying there crawling out of my skin. I think I joked with them a lot more than I have been doing lately. In the morning, right before going home, I actually made a cup of coffee, because even though I was all over the place, I wanted to keep feeling good.

And now I came home, and instead of going straight to shower and bed, I made breakfast, and wanted to come see if I got comments, and now I’m writing this! And I could easily keep going all day. That’s exactly how my last manic episode started – a long night and then I should have gone to bed, but at 5 AM the sunlight was so tempting,  and I spent the day shopping on foot in the city, meaning I was most of the day in that sun. And boom.

Which means it is time for some heavy benzos. I got the shrink to agree to leave the Wellbutrin and no mood stabilizer if I’d take zolpidem or something similar when I start to not sleep. So I guess I better.

I went and pulled a lot more of the “cyclothymia” references at the medical library last night. Some were in the actual paper stacks, they were so old. I love going up there to the fourth floor where there are medical journals from the 1930s and back, in all kinds of languages. The material is interesting; I read some of it while I was bouncing around and not sleeping. If anyone wants, let me know – most of the files are PDFs. All kinds of funny little tips in there, as in, “They are the patients who like both uppers and downers.” Meaning, purely depressed patients like stimulant drugs, anxious patients like relaxants – benzos and so on. Cyclothymes are the few who enjoy both. Actually, you can tell a lot about a person’s psychiatric makeup by their favorite drug.

They are the ones most likely to refuse mood stabilizers because it flattens them (because their personality is greatly shaped by the mood states, that is the way they know themselves and not having that will make them feel weird).

Or, from way back, something like, “the job of the psychiatrist is not to try to change the person’s temperament, which cannot be done as it is almost certainly a biological substrate, but rather to be supportive through the numerous crises in which the cyclothyme will inevitably become entangled.” I seriously thought of copying that and passing it on to my psychiatrist. I think there was something in there about medications also not being great because we quit because of feeling flat; though when I feel good and not flat (which means that I am fairly unstable, with bad times too, just with also good times), I am incredibly med-compliant.

I answered some comments on the last post as well. I notice that the comments are getting longer, more philosophical.

So write me and tell me to write the damn post! (Oh no, is this the “uninhibited people-seeking” phase? Does my writing sound manic?)

My Answer to the Commenters

I started to put this in the comments and then just decided to post it as a regular post, because it was turning into one in length.

Thanks for writing, everyone. Thank you especially 5150 for reminding me that it will fade. I kept telling myself that during the worst of it…that it wouldn’t be forever like this.

I have zero benefits or anything. The one private disability insurance I bought probably wouldn’t cover this as a pre-existing condition and it only replaces about $700 a month of income anyway (a percent of what I am paid by the hospital and not the government – and the government pays most of my salary). Jjunior docs have no benefits at all – we are almost hourly wage employees – do not even have personnel benefits at the hospital that the cleaning staff has.

The option would be another job. I constantly remind myself that approximately 99.999999% of the jobs in the world are something other than “physician.” But it seems like such a shame, when I am so close to finishing training not to just suck it up and pull through.

On the other hand, when I find myself on the roof again and again, I keep telling myself, just walk away. You have a choice. You do not need to do this.

And the worst part of it is that it isn’t the practicing medicine that is killing me. It’s the bickering with the nurses who walk all over me, the paperwork, the phone hassles to get tests done. It’s not the essence of the job itself. Sometimes I even think that being decent to people and helping ease their way through something is what is keeping me going.

Another thing is that I quit taking the Wellbutrin and the lithium a few days ago and feel immensely better. One of them was doing something bad to me. I’m not sure which one…but I could feel it physically – shaking, throwing up, feeling drugged and surreal. You’d think that that was a creeping up lithium level, right? But it also came with a terrible agitation and that unreal feeling was never something I got from lithium. It felt like that first time I took the Wellbutrin and flipped out. Lithium, even at its worst, always chilled me out. I semi-wanted to call the shrink and ask what he thought but never managed to have a free moment to do that while it was a decent hour. And don’t even think about getting to a lab to have lithium levels done during business hours. I’ll probably slowly restart the lithium today.

The other thing I am slowly coming to accept are some limitations. While the idea of leave scares me, I realize that I just can’t keep up with my peers with the no sleep thing. They consider a day after call a day off. I can’t even move, and if I don’t sleep through until the next work day morning, I’m crazy. This saddens me. I used to be unstoppable, so ambitious, wanting to take care of everything, be the best at everything.

And I’m also coming to accept the idea that since my good cocktail is gone, I just may never feel totally well again. It’s been a year now, or almost a year…and nothing is any better than when I first started. That’s what sort of fucks up the idea of taking leave to fix the meds – the meds may never get fixed. I may never be what I was.

I think I could be okay with that if I could do a few things that are really important to me. First is to write – which I can’t really do in this state. Others are a creative habit that I can no longer do because my hands shake too badly, and flying, which I can’t do because I’m always on the edge of vomiting anyway. My three passions in life have been stripped away, which is hard. Maybe I just need to throw myself into medicine, which is something I can still do well, and find a real life in it, which is something I never have been able to do. Satisfaction, sometimes. Purpose, yes. Pleasure at using a skill for the good of others, yeah, I guess.

But passion…never.

Yes, I am a tremendous whiner, compared to so many people whose lives have been much more devastated than mine, I’m bitching about having a job as a physician. But still, a dream lost hurts, no matter how grand or small, and I dreamed of something so very different than this squalid sleepwalking broken-down life I am left with.

Sinking into a depression

It started really two weeks ago, was progressively getting worse. The last time I saw the (useless) shrink I mentioned it, to which his answer was, “The things that are bothering you are things that medication doesn’t treat anyway.” I am not sure what to say to something so unhelpful. Mostly because I know that when the medication is right, I wouldn’t set foot in a shrink’s office. Unfortunately, it isn’t right, and hasn’t been for a long time, and they are pretty much the only game in town.

Something about that comment really irked me. Medication doesn’t treat early waking? Pervasive guilt? Suicidal thoughts? Anhedonia? It’s not like I’m complaining of interpersonal difficulties or relationship conflict. I’m not under any particular stress elsewhere.

I guess it is belittling. When I say I’m depressed, slowed down, I really am. I could go on and on and spell it out for him, but I just am not that type.

Can someone explain to me why I can’t just fire this guy?

Tomorrow I go back to work after a few days off. No, they weren’t health days. I haven’t taken a sick day ever, not even at my most crazy. Sometimes I wonder what some of my locked-away evaluations say, the ones from when I was fully manic. I worry about that sometimes too, at least when I’m not medicated.

I’m supposed to see the shrink again tomorrow – why, I have no idea. So he can tell me I’m fine or even improved, I suppose, because all the energy to get irritated has run out of me.

I tried to read all day today, yesterday, this whole time off, and I can’t. I can’t focus, I can’t remember what I read five minutes before.

I guess I just need to get through the day tomorrow. Maybe even cancel the appointment, as it will almost certainly make me feel worse. Stop this fucking soul-draining lithium too.

I hate this person I’ve become, the true “mentally-ill” type, focused and closed in my own private misery, eating to swollen proportions I’ve never reached before, oblivious to others around me, to the amazing colorful magical world. I used to be a person, a good one even, one who was lively and alive and capable and funny. And I don’t even think it’s really the illness that has shipwrecked me – I think it is the treatment. I’m starting to hate this blog, because while it once was maybe interesting or insightful, now all it is is shit, which is oddly like my life.

Lithium has eaten my hope for a better day. The suicidality that I thought was gone is creeping back over me. It’s a cumulative thing. This has been going on for a year and a half, for I don’t know how many drug trials. Everyone has their limit, and that isn’t a judgmental statement. Everyone just does. I am reaching mine. I can’t take the self-doubt, the guilt, the dreams in which I sob and beg forgiveness of patients who have died.

People say, “Why not take some time off?” But time off isn’t time off from myself. It doesn’t matter if I go to work or not; sometimes I think it was vaguely better when I was working so much harder – at least I was busy. Now, the whole future seems insurmountable, and not worth surmounting at that.

And I can’t help thinking that all this psychiatric care is somewhat to blame. When I was on my own, forced to get by, I did. But with all this encouragement to get treatment, somehow I end up worse off than before. Maybe I am unhelpable; maybe we all are, ultimately left to save ourselves. “We’re all alone, until the day we die.”

So this will be my last random med trial. If this doesn’t work, that’s it. I quit, stretch me no longer on this rough world, whatever. All of this freaky talent, the freak IQ, the whatever it is that I’m supposed to have, well, fuck it, I didn’t ask for it, and I am tired of feeling like I owe the world something.