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.

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.

Crying at the shrink

I did cry at the shrink’s the other day, and that was strange, because I’m usually so hard and in control. But I was so strung out by anxiety and three days of no sleep from the bupropion that it took me a few minutes to even calm down enough to talk (this kind of hysterical shit is very unlike me). In an ominous tone, from him, “You NEED a mood stabilizer.”

He wanted to send me home then and there with an injection of phenergan so that I would sleep a few hours before being on call; I declined. Not a fan of the sleep aids. Last time I took zolpidem, I was fine and awake in the morning, but almost got in a car accident, which had never happened to me before. (And while on call, I saw yet another acute dystonic reaction, so there about the phenergan.)

But at least the massive anxiety from this drug, as well as the calming of the affective storm, for once made me feel both stable enough and uninhibited enough to actually talk to the guy about something that happened in my life that was very meaningful to me, that happened a long time ago, advice that someone gave me that let me move on from grief and heal tremendously from a big wound.

Without going into a long and sort of irrelevant story, the gist of it was that an older woman knew me well, and gave me permission to grieve about something when I was a teenager, to acknowledge a severe loss and hurt. She was one of my mother’s friends, artist-spiritual type, and gave me a concrete ritual to do to give myself permission to grieve, and maybe open doors to a grief I didn’t fully realize I had, or was entitled to. I remember thinking the idea was silly at first, but I went home and tried it (starting by looking at old pictures and just thinking about the people in them), and it unleashed a tremendous flood of tears.

Let me state that the “ritual” she recommended wasn’t an exorcism or supposed to work on some bullshit supernatural plane; I think it was pretty sound psychological advice, if phrased in terms of spirituality. It allowed me to realize a loss I hadn’t acknowledged because it came at such a horrible time in my life anyway, and to free me from the past by letting me discover various feelings of anger, injustice, and ultimately, mourning. It was not “out there” by any means. It wasn’t like she told me to draw a crop circle so aliens could come heal me. It was just something to formally mark a loss, which gave me the opening to feeling it.

And sometimes even today, years later, maybe once every couple of years, I revisit those photos and what she told me, and I cry again, hard. But it is different now, in the way that grief changes. I look at the pictures, and it’s not this raw gaping wound, it’s just sort of a nostalgia, a sense of being sorry that things didn’t go the way that they would have in a perfect world. A love for times and people past, with all the imperfections.

She gave me the gift of being free from something that could have torn me down, destroyed any potential I had to be other than numb or in shock for the rest of my life. She gave me the gift of healing.

When I think about it…no, that’s not right, when I feel it, really let myself remember and feel, I can’t help but cry. And that’s what happened at the shrink. It wasn’t like I was sobbing hysterically and out of control. It’s just that the story opens in me some very bittersweet emotions – of the loss, of the gratitude of being able to let go, of the magic of healing, and of a million other things, too.

I noticed also that for the first time with the shrink, I was talking in terms of how I really think, how I used to be, because it took me back to so long ago, to a time when I was in my core state, when I was really ok. I spoke in terms of ritual and feelings and symbols, which is a reflection of how I see the world, how I grew up, in a world of artists.

I think I concluded the story by saying something like, “That’s what I think I need now…a priestess. An older woman who knows what happens to women, how they get so hard and cold, the way I’ve gotten to be. I wasn’t like this then. I was warm, and loved everyone, and was so idealistic and compassionate and forgiving. I wasn’t ice like I am now. I need someone who understands how that happens to women’s spirits, how they get lost in the woods and meet so many monsters that they start building up armor, and how to set me free again.”

I’ve said to the shrink many times, “We don’t speak the same language.” I don’t think he ever quite got what I meant. It became clear to me. I have always spoken to him in medical language, the language I’ve learned, the language of pathology and death. But that isn’t my real language. I think that I had forgotten my real language a bit, and speaking in it, of ritual, magic, symbols and signs.

After I said all this, the contempt was all over his face. Then he said, “Sure, she just gave you a magic solution.” Obviously he also wanted to say that he thought that she had probably done me psychological harm. But it wasn’t a “magical solution” and it didn’t solve anything overnight.

He thinks that at the core, there is something wrong with me that it will take expert reparenting or whatever (naturally, by my submission to his worldview and acceptance of it, by letting him be daddy). I think that at the core, I am actually healthy, and just need to be freed from a lot of things that happened to me along the way. I need to find my way again.

And that is what became so clear to me sitting in front of him. For once, I didn’t give a shit that he was so dismissive, so utterly un-understanding, because I know what is wrong now. I need my language back, my self back. I need to get rid of the chains that medicine has wrapped around my soul and return to the path. I don’t need to fix what is broken; I need to find what is whole.

Suddenly I could see a chain of events, a period of time, in which I became hard, and cold, and unrelenting, began to speak in a foreign and cruel tongue.

I saw that he didn’t get it. So I started to say something like, I just think I need to see a woman…because I just hate men too much. It was my way of letting him off the hook. It isn’t his fault he’s a man. It’s easier and kinder to say that than to say that it is his fault that he hasn’t seen me, not really, not once, in all these years. That managed to set off a huge argument over whether it is normal or not to hate men. Which was missing the point, but that’s ok. I finally see it: he’s just not going to get the point.

But I do. And that’s a start.

* * *

When I asked her what I/we could/should do, she took up her walking stick and walked expressively and purposefully across the room. Dipping a bit from side to side.

She said: Live by the Word and keep walking.

– Alice Walker

The Rest of My Life

I’ve been writing kind of heavy stuff lately, and I think it has skewed what this started out to be, which was a chronicle of how people who are crazy live in the normal world, how we are mostly invisible to everyone. Lately, you’d think that all I ever am is crazy.

Which is understandable. This last year my mental health has been perhaps the worst in my life (or second worst). And the Wellbutrin is making me anxious which makes me write. (Student loan panic set in tonight, which is always a symptom.) And I have been thinking a lot about my mental health, which I don’t usually do when I am well. It is the main thing on my mind, sad to say. I’m afraid many more important things have been forgotten in the mess, like the people I love.

So I thought I’d put in some balance of the perspective. Despite having an awful morning due to various symptoms, I pulled it together and worked a night shift last night that was perfectly fine. While working, or writing, or engaged in conversation, I am able to selectively ignore a lot of symptoms, just feel them less. I think it’s like sometimes when you have a flu or something, you really do feel better when you are up and moving around rather than lying around thinking about what hurts.

I thought I’d make a scattery list of things that happen in my average life, which are far underrepresented here.

1. I usually meet friends a few times a day. Having stayed more or less in the same medical system where I went to medical school, there is no shortage of acquantances and a few very close friends around all the time. Sometimes when it is very hard for me to go to work, knowing that they are there helps a lot.

My best friend is a friend from medical school who also stayed on at the hospital. We can often catch a few minutes to chat outside the building while he smokes. He’s tried SO hard to quit, and even tried taking the bupropion for that, but guess what – it gave him panic attacks and made him paranoid! He can’t believe I’m sticking with it. It does give me panic attacks (witness yesterday morning) but I find them infinitely preferable to depression.

He has a new baby and is utterly in love with her and shows me pictures on his cell phone. I haven’t been good about going to see her; haven’t given her the baby gift (partly because I can never find anything quite special enough). I am happy that he is so happy.

I’m afraid I haven’t been a very good friend lately, since all I can think or worry about is how crazy I am…and no one wants to hear about someone’s mental health, shrink problems, med problems etc forever. He has been very good about always coming to talk if I need to, though. And sometimes we just talk about normal stuff, laugh at ridiculous senior doctors, the fucked-up system we are in, and so on. If another friend joins us, it’s better sometimes because I can’t talk about crazy and it just rolls over into small talk.

2. My partner and I spend domestic time together, which is very quiet and pleasant. I tend to be something of a homebody, and he humors me. We spend a lot of nights watching DVDs of comedies (I can’t stand to watch anything sad or serious on TV. If I wanted reality, I could go to work.) We laugh a lot. We curl up and read. We are both nerds. Sometimes we talk about physics or other science topics one of us has read about. We had this weird discussion of Descartes and Maxwell after something he read a few days ago, lasted late into the night. We got into this discussion about whether mathematics is something that exists intrinsically, or something we made up.

3. I love my house. It isn’t anything fancy, and is really a rented apartment, and nothing in it is expensive, but it has my things in it, and I have set it up to be a shelter for me, a quiet place with warm colors. I think that sometimes this isn’t so good because I don’t invite people over much. But sometimes I curl up on the sofa with a book or a blanket and feel overwhelmingly content. I am surprised at how nice this feels. I guess when you grow up in a stormy, violent place, the thought of home is a strange pleasure. I’m surprised to have found one. I am overwhelmingly grateful to live so comfortably, to be safe and warm and sheltered.

Of course, because I am crazy, this can lead to worry that it will all be taken away from me somehow. But I know I can survive that too. I have been in very bad places, poor places, alone in life, and that taught me that really a human being needs very little to survive. You don’t need a bed, or a roof, or a change of clothes, or internet. You need food, and that is about it. I can be thankful for what I have now while still knowing that I could survive without it, have survived in scarcity, in violence, not knowing where I would lay my head. I love what I have and would hate to give it up, but I wouldn’t die from that.

4. Though it stretches my budget immensely, is my single biggest expense after rent, I can pay for my mental health care, for what I need to keep a job, to avoid the “bottom of the barrel” public mental health system. This makes me luckier than people thrown at the mercy of the public system. Unfortunately, this is also self-perpetuating: I am able to work because I can afford at least partial medical treatment for my condition, which is not covered by insurance. People who can’t will never get the quality of care they need to get better.

5. When I work in the emergency room, I sometimes pass through the pediatric ER just to see what is going on. Pediatricians are the nicest people in the world and I’m always able to say hi and smile. There are sometimes funny kids in there too, and they make me smile too, even though kids aren’t my thing. The best break room in the whole ER complex is in the pediatric ER and when I eat I go in there and make tea (they have the water cooler) and see nurses and staff I haven’t seen since I stopped working there. The hardest work I did was there, but also the nicest environment. And everyone there always says hello to me and smiles.

For someone as shy and introverted as I am, it is wonderful to know I have a place like that, a place where “everybody knows my name.” And not in the way the internal med docs or ER docs do – as the freak one who always was in a rage and never got along (last time I worked with them I was in a very bad state). The pediatricians know I didn’t like pediatrics and didn’t like working there much, but they like me anyway. For someone like me, it is very nice to have people who are happy to see me. Especially after this bad year, when I ruined so many working relationships.

6. Since I’ve lived in the same place since med school, the local businesses know me. I can walk in to grab quick take-out food, and see familiar faces. The nearest neighborhood with amenities is of a lower middle class to working poor area, and people haven’t gotten into the ideas of having cars for everything, so they walk and use local business. There is a sense of community that people don’t have in wealthier areas. And they know me by sight when I walk in, too.

7. I always can call someone on the phone from my cave. (Not that I usually would, but that’s a different issue altogether.) Somehow, I don’t know how it happened, I ended up having friends. I’m afraid I haven’t been as good a friend as I should always, but I am fortunate to say that I’ve never felt truly lonely. Alone, certainly, but I have received far more love in this life than I ever deserved. We don’t get together that often, but we chat, we see each other at work. Sometimes I feel guilty that I’m sick, sometimes I can’t love them back as well as I’d like. But I know that for a lot of the mentally ill, they drift out of society into increasing isolation and that loneliness is a huge factor in suicide. I think that I may have spread a lot of pain amongst the people who have loved me, but I never meant it, and I was never really left alone.

Last time I was really depressed, it was last spring. One friend, I didn’t tell him details at the time, just that I was not feeling well. Despite having a house full of kids and being a busy doctor too, he called me at least every other day to see if I was ok, and let me vent without asking for details. Since at the time I was pretty much confined to the sofa, those phone calls were incredibly meaningful to me.

He always invited me to a weekend dinner with his family and I always declined, but once when I started to feel a little better, I went. Of course, I was nearly non-reactive, and when I did speak it was a huge faux-pas with his mother-in-law. But no one ever made me feel strange about anything. Even though it wasn’t a particularly memorable evening, it marked a lot of coming back to life for me. I felt horrible, was minimally groomed, but I was out of the house and back among the living.

This incredibly kind gesture, those daily calls, which must have been miserable, for no reason, was something that stays with me until today.

And I know that if I ever really flip out and end up in a hospital, I wouldn’t languish there at the mercy of some fucked up psychiatrists. A few close friends with connections in the med world would come to my aid and beat them down from over-drugging me. I’d die of embarrassment and probably try to keep them from even knowing, but I wouldn’t be alone at the mercy of the system.

8. I read a lot, though since these episodes have been so out of control, it has been a lot harder to focus. But this month I finished two books. Not my normal rate, but better than before. It used to be a big part of my day, especially when I was a kid. It is probably some escapist coping mechanism that isn’t so healthy, but I enjoy it. In my bedroom, on my side of the bed, I have a big pile of books and note papers. My partner calls it “my world.” Whatever I’m reading, which is usually one or two new books, and a lot of old favorites for when the mood strikes, are there. There are lots of books on the edges of the sofas too, and all over the house.

9. Food: not much of a cook, when I do cook, it is healthy fare, or something that goes together quickly. A grain and a legume. I don’t cook with much that “you can’t tell where it came from.”  Often, as I said, it is takeout from a local place. There is only one that is close by. Too much fried shit, but it is quick and good. On call, I eat at one of the many coffee shops in the adjacent shopping center – salad or pasta, usually. Usually I go with whoever I happen to be working with that day, but not always.

I hate all this Atkins shit. I love carbs – pasta and potatoes and bananas and grains. I’d rather give up fat than my carbs.

I can’t cook that well, but I’m a really good baker. I make all kinds of wonderful cookies and cakes. Nothing flashy or pretty, but the kind of thing you just can’t stop eating, out of simple ingredients. I haven’t in a while because of being busy and also not wanting to eat a whole batch, but it’s my secret skill.

10. I have a ton of makeup. Nothing expensive, but I used to be a sort of punk ass kid and I still have a lot of stuff left over from high school. I don’t get to wear it anymore much, but when I’m off work, I do. I wear my long hippie dresses, my slightly gothic looking black velvet stuff, my Wuthering Heights collar jacket. I guess some of it could pass at the hospital, especially if I wore just one piece, mixed with mostly business looks. But I hate having the clothes I like “contaminated” by work. The problem is that I don’t go out a lot to other places where I can wear them.

One of the books I’m reading is a pop culture version of a book on Schema Therapy – basically cognitive therapy that people with deep problems have them from deep assumptions rooted in childhood about themselves and the world. The pop culture book tells you all these signs of which false beliefs you might have. One of them was “Dressing more conservatively than you would like.” I think that was supposed to point at an “outsider” belief: that you feel like you don’t fit it, are somehow different. This can be a “defective” belief; you feel that you are somehow basically flawed, and damn well better hide it.

And damn if I don’t feel that way in medicine a lot. Most docs come from a very different background than I do, with very different social rules. Very upper middle class and conformist. I always feel like I’m trying to ape a look that they have…and I hate myself for sticking out because I don’t ever quite like them, and I also hate myself for trying so hard.

I remember in med school, there was this one girl from a very affluent city. She was a bitch, shallow, mean, basically obnoxious. Spoiled brat, rich parents who divorced and just threw money at her. She sort of pretended to be my friend, but always with an air of, I don’t know, like she would be my social guide. I didn’t really like her, but she terrified me because she was so mean. She always criticized my makeup, my clothes, whatever. One day I was wearing fishnet stockings (probably with Doc Martens but I don’t remember; certainly not with fuck-me-pumps or anything) and she came up and rolled her eyes so hard, and said to me with a snort, “God, don’t ever wear those again.”

This girl was a caricature; she was ridiculous, and no one else ever took her seriously. But she was from “the right side of the tracks” and this rich town and seemed to know the rules that I didn’t. And every time I let her do that to me. In high school, I would have gotten into a fistfight with someone like that. And I would have taken her down.

And I never wore fishnets to med school again.

Somehow I think that story is symbolic of what med school and the doctor world has sucked out of me.

And once again, I digress into psychological topics.

But I guess I can tie that in to this post, because it is something that, apart from my crazy, is prominent in my inner world lately. I am slowly coming to the realization of just how much I have let medical school and being a doctor kill my soul. How different I am from when I started. And I think back to all the times I should have said, “No. This far, and no further.” Years ago, in maybe the second year of medical school, with the animal experiments. And a million other examples. Right now, I am working very hard to recover my soul, my woman’s wild soul, from inside the soulless monstrosity that is modern medicine.

A funny thing happened lately…I have been so depressed off and on that I finally let my meticulous makeup go and have been going to work without it, with just a little bit. And looking generally disheveled, hair uncombed, because I just can’t deal with it. (I have finally grown a half-meter of hair, which I love, but it’s just so hard to wash it all after 30 hours on my feet, and I know I’ll probably cut it, but still, I worked so hard to grow it out.)

And I’m not sure, maybe I’m just imagining it, but it seems like I’m getting less disbelief when I walk in and say I’m a doctor. Most of the girl doctors look like that.

I’m not sure what bothers me more, that I am letting myself go like that, or that no one can imagine a doctor who doesn’t look like C. Everett Koop (and even he had some goofy facial hair going on).

I also hate how many comments I’ve gotten about how I look so much more “professional” without the makeup. (One from that attending who tore me down.) Even the shrink said I was “prettier bare,” that I didn’t need to “hide behind all that.” (Was that a borderline inappropriate comment? I’m never sure.)

If I want to wear it, none of their fucking business. Women have played with masks and veils since the beginning of time. Why can’t I?

At home, though, I immediately change into sweats, warm, cozy things that I’ve had forever.

But – I love playing with makeup and looking slightly like I stepped out of the wrong time century. Even if now I just do it in the bathroom alone before I get into the shower.

11. Other things in my life every day: sometimes I promise myself a good cup of coffee on the way into the hospital and that is the thought that keeps me going as I get out of bed, get dressed in the cold bathroom, sitting on the bath mat as I brush teeth because I’m too tired and down to get up. I feel like a little kid, bribed with candy. But sometimes, that’s a big part of my day.

12. I worry about money a lot. Not paying the rent and bills and all that; and I never run up the credit card. I’ve always managed to live within my means, which at times were ridiculously meager…except for one thing: my massive student loan debt. I have no idea how I will ever pay this off. Or even make payments that make a dent in it. Once the deferments and all that are up, the payment alone will not leave me enough for rent. Hoping for a miracle. I guess I’m just like everybody else in this. I obsessively read the “get out of debt” stories, and “America’s Cheapest Family” and all that. But the thing is, there’s not much more I can cut. I don’t buy clothes, I don’t go out to bars or to eat much (the takeaway is cheaper than buying enough basic stuff to cook for me), really the only thing I do buy is books, and even most of them are used. I would try to cut back, but part of the problem with libraries is that what I read is always too obscure, or in the wrong language. No one ever thinks, when they move to another country, how much they will want to read in their native language – and how expensive it might be to find imported books.

My credit card statement is funny – it breaks the charges down by categories. All I ever have are groceries, gas, insurance payments, pharmacies, and books. Every time I open it in front of someone, they just laugh.

I guess I could go carless. I don’t really need one. Local mom and pop grocers deliver, and, while it does cost money, it’s less than a car. But after my contract is up, I don’t know where I’ll be working, and then I might need one, so I don’t want to get rid of one just yet.

13. I always keep a bus pass in my wallet, and sometimes I take the bus to the hospital. The walk to the stop is nice, and it is quicker than having to park there. The hospital is toward the end of the line, so the bus by then is usually full and I stand up. It is nice not to drive and worry about when my car is going to die.

14. I take something to write with everywhere. Often I get writing ideas that fly through my head, and if I don’t get them down immediately, they’ll go away, be forgotten. My life is full of the backs of receipts, of ticket stubs, of gum wrappers, on which are written things like the perfect end to my novel. My close friends laugh at me because they can see when I zone out into an idea, and sometimes laugh or am otherwise altered by the words that run through my head, how my attention is both in the conversation and far gone. People like that girl above think I’m weird. But the people who love me think it is just another part of me, a quirk.

* * *

I think I wanted this post to be even more about minutiae, things not concerned with my mind or medicine. I’ll try to let some more ideas come to me as I go about my day over the next few days. Maybe if I ride a bus.

* * *

Next time: remind me tomorrow to write about how I cried at the shrink’s a few days ago. I didn’t think I had tears left, I thought I was too cold. I think he kind of had contempt for what I cried over…but that’s ok, it reminded me of something important, pointed the way to me to the things I need to be able to cry about again, the things that I can’t, ever since becoming a doctor.

Today something happened to me that never happened before.

I got reprimanded at work.

I apologize for the quality of this post ahead…I’m too tired and my brain is too fried to write well. Here’s what happened.

The last few weeks went surprisingly smoothly, the anger was under control, I was performing ok, and things seemed to be moving along reasonably considering being off all meds. My mental well-being surprised even me.

I think if not for two things, I would have been ok.

One was menstruation, which always fucks me up, and the other was another marathon of on-call nights and sleep deprivation.

It started last Wednesday around 1 AM, I started to lose patience, a hand laceration came in to the ER. I didn’t feel comfortable closing it, so I wanted the plastic surgeon or ortho on call to do it. They refused…and I started to blow. I was exhausted and overwhelmed. I did not want to cause permanent nerve damage to anyone’s hand. After being so proud at how I’d held together so well, I lost it again, had a hissy fit of misery about how I hate my job. Mature, I know. I wish I could take it back. But I just snapped.

(I also ended up suturing the hand. I’m sure that after my vocal refusal and claimed lack of know-how, the patient was thrilled to receive me as his doctor.)

I was so tired, and on top of everything, the attending was jerking me around, making me see every patient (while she is paid ten times what I am paid to be there, and it is part of her job to see patients, she isn’t there as a preceptor or consultant, she’s the main doctor on call) – actually running over me about every decision I made, then going and re-seeing every patient I saw. I couldn’t figure out why she was riding me so hard. I wondered if I had recently made a mistake she had to cop to or something.

For example – a 22 year old healthy guy comes back from a long, exhausting trip with mild diarrhea as chief complaint, and, as it turns out, upper respiratory symptoms. (Why he was in the emergency room in the middle of the night, god only knows…) So I write a quick discharge: Diarrhea – Presumed Infectious/URTI. She goes in there, makes this huge deal about how it is URTI with diarrhea, tears up my whole discharge letter because I wrote it as a “diarrhea” letter, including suggesting giardia check & stool culture if it continues (he had camped and drank from streams). I got a huge lecture on how the diarrhea is part of his respiratory infection, how I went way too far…yet on a similar patient, I got also yelled at earlier for not writing a referral to a GI to rule out IBD if symptoms continue. She was just being nasty, and I didn’t know why. On one hand I got knocked for being too thorough, on the other for not being thorough enough.

This weekend I started to sink into the same old depression. I did some meditating and other things, which helped (didn’t run, though) but it hit hard this morning with a busy ER. She kept doing the same shit. Asked me to present at the level of a med student, checked everything I did. Also, though there were three of us, she sent me all the patients, including orthopedics and urology ones, who are supposed to be covered during the day by ortho and uro. She made me see them just for the sake of making me do it. Then she would return their file to the ortho/uro stacks, meaning that they would be seen by ortho and uro, that my work would be useless.

I admit, I was doing a shitty job. I didn’t miss anything big, but my brain is so slow, I just can’t think quickly like you have to in the ER, didn’t delve into anything that wouldn’t have a direct effect on treatment plan. Presented sloppily – while in my head I had a clear picture, I was scattershot about presenting. I felt so overwhelmed.

I almost got to tears, even while dealing with patients I was trying hard not to tear up; I was already teary from the damn depression. I slipped out at noon or so and called the shrink, told him I wasn’t doing very well, asked what to do. He told me to take some benzo, and I said I didn’t need anything that would slow me down even more. I asked if I should start the bupropion again or what, and he sort of got impatient.

“You’re a big girl, you’re a doctor, you do what you want, you don’t need me to start it again. I can’t deal with this on the phone.” I really am not sure where the hostility came from, except I’m getting it on so many fronts that I know that I must be provoking it.

I just wish he could have been nicer. He’s sick of me too.

I also thought: Now I’m the kind of patient that they don’t even try to limit the benzos for anymore. Take as many as you want, just shut the fuck up.

Then I went in and one of the nice nurses who is my age saw I was falling apart and gave me a hug, said it’s a hard place to work, that that attending can be a bitch to work with, everyone knows (I actually get along with her usually, and I like her). Usual girlfriendy type stuff. I was immensely grateful.

Well, the doc saw this and dragged me off into a corner (in front of other people), and started in about how she’s torturing me for a reason, that I’m lazy and just because I’m smart that doesn’t mean I can be lazy and have such a bad attitude and do a shitty job and the whole reason she’s treating me like that is that I brought it all on myself. How everyone has days they don’t feel like working and they don’t get like me.

This went on for about five minutes. In front of multiple docs. Pointing out many of my failings, personal and professional, number one among them being my laziness.

Ironically, she also said, “I just don’t get it – sometimes you have these periods when you’re so ON, do everything beautifully, you’re unstoppable. And then sometimes you just don’t care and everything you do is shit.” My heart stopped, for one heartbeat I thought she was going to accuse me, then and there, in front of everyone, of being manic-depressive. But she didn’t. She just went on shitting on me.

And get this: I didn’t even care, really. I think that’s a pretty good sign of how depressed I am. Usually something like that would send me into a shame spiral. Now, I’m too far gone to get upset. It’s not like I need any more people telling me how wonderful I used to be, how shitty I am now. I’m living it.

As it went, I just mouthed off back, agreed in that sarcastic way I always did as a kid when I got in trouble, the one that makes them just want to pound you more.

I think I thought that it was better to let them think it was laziness and bad attitude than crazy.

* * *

On the way home, I stopped and bought a sweater for my partner. For some reason, this almost made me cry too. I just wanted to do something nice for someone. Show a little love, which is another thing that has been gone from me for a long time. I wanted to give him so much more, and somehow this crappy sweater just seemed so inadequate, a mute trying to recite poetry. A symbol of the broken shards of what I wanted to be able to give. I want him to be happy. I want him to be warm. I want him to be loved. But I can’t give him any of those things. I can’t give anything to anyone anymore.

Maybe I just cried because I sort of wondered if it was going to be the last thing I ever gave him, and was sorry it was so crappy.

* * *

I then drove to my family doctor, who has office hours this evening. I knew that without an appointment I’d wait, and that was all right. Where was I going, anyway? The shrink was obviously not going to be of any help. I can’t really bring this down on any of my friends. They are under as much stress as I am. I don’t talk to my partner about these things, they aren’t the kinds of things that need to be in a relationship. I didn’t have anywhere else to go.

I brought my dark Soviet novel that I haven’t been able to concentrate on, sat down in the waiting room and tried to read with tears in my eyes. Some elderly woman sat down next to me and started chatting. She was tremendously nice, not annoying at all, but I really didn’t want to make small talk. Maybe she saw me and was trying to help, I don’t know. It was kind of nice finally being somewhere where they didn’t know I am a doctor…to have waiting-room chit-chat with someone on the outside. Someone who, thankfully, didn’t bitch about how bad her doctor is, and who wasn’t a sucking pit of need.

One of the staff members I guess had a birthday and they had a little thing with cake and candles and then passed it around the waiting room. I couldn’t even lift my eyes, though it was a nice gesture and feel in the room. The glowing candles and the singing, a little surreal.

The doc saw me sitting there and called me in fast. I don’t know if that was professional courtesy or what. Of course, having come from work, I was dressed semi-decently and still had on makeup, combed hair. I didn’t look depressed. I don’t think I ever do.

I just told him the depression was back, go ahead, pick a drug, doesn’t really matter what. He tossed me a prescription for citalopram. I also took one for bupropion. I can choose later which to take. He asked what I had taken before. I rattled off a more or less complete list. He asked why I took lithium. I told him, “Because I get like that, sometimes, too.”

He asked what about the shrink, and I told him that I think he’s just frustrated, sort of given up. “You know how it is,” I said. “The patients who don’t get better, no matter what you do. After a while, you just don’t want to see them anymore.”

He said I should try valproate, but that wasn’t his job to deal with. I told him that mostly what was bothering me is that I’d had a year of bad function and was scared I’d never be normal again. He asked in a general way about “dark thoughts,” the kind of thing I could answer, “No more than usual,” without feeling like a liar. He didn’t ask directly about suicide.

* * *

I guess I’ll start taking one or the other. Maybe the bupropion, because it worked so fast. Probably should cancel the shrink later in the week – I can’t see how it could do anything but make me feel worse.

I’m scared. I’ve had plenty of internal disasters, but I’ve always been able to hold it together externally. I know that in this last year, I’ve ruined my reputation everywhere I’ve worked, that no one wants to work with me because of my attitude, which isn’t really attitude but rather me doing my best through a granite tsunami of depression and mood problems. Mood disorders. I am mood disordered. I am disordered.

* * *

From the outside, I can’t escape a feeling that these little things are all harbingers of doom. I can’t help thinking about all those statistics and sayings, the ones about x% of people visit their regular doctor in the four months or week before suicide; about the typical case study, the perfectionist who fucks up, some seemingly inconsequential narcissistic insult that somehow is the invisible riptide that pulls him under. If I were watching this like a movie, like a novel, I couldn’t avoid the heavy-handed cues, the foreshadowing: Things do not bode well for our heroine.

Why I Don’t Fire the Shrink, and follow-up

I’m sorry to drop the last post down because I think it is one of my more important ones and would like it to get as much traffic as possible. Maybe I’ll make it a page or something, but I wanted to write a little more today.

Tony White over at Graffiti left me a beautiful post with a deep answer to a question about what constitutes a “characterological” or “personality” problem. I guess I asked since I have been accused of the same, though I don’t agree.

I have been trying to draft further questions to him but his website isn’t working. He did, however, inadvertently answer sort of what I guess this shrink is trying to get to do with me – make a connection that will be stable and somehow “heal” whatever is fucked up. Whether I believe in this or not – sounds like one step away from alien healing to me, well, that’s another story.

But I thought I’d give some follow-up to the shrink-related part of this post. I thought that if I’m so curious that I’m writing about it in depth, fairly eloquently, I may as well ask him. I did not go and say, “Hey, buddy, aren’t you kind of useless?” Instead, I phrased the question, “Do you think that maybe at this point, the right thing to do would be to stop trying to make me better and shift into working with the condition I’m in and getting me to a point where I can live with this?” After all, I am functional, I’m not in a state where I’m homeless or actively suicidal or beating my partner. It could be worse.

His answer was an emphatic no, that it is definitely doable to get me to better health.

Leaving me to wonder who in the room really has the denial problem.

* * *

I did call in sick, I think maybe for the first time in my life, the day after that post. I really was sick from whatever drug was doing that to me, had been writhing around and vomiting since 3 AM, but I felt incredibly guilty, and am waiting for the universe to punish me. I did make an appointment with the shrink that day, arrived pale and sweating, and he flipped out and tried to send me to the emergency room (shrinks don’t deal well with physical illness). But still, I’m waiting to be punished.

The worst part is, it doesn’t really matter if I’m there or not. The exact same work still gets done. That’s the bind of this job – it is an incredible amount of work with an incredible amount of responsibility, pay below minimum wage, and yet you are utterly expendable. I did call in, but no one even noticed I was gone the day after.

On the up side, I have started investigating other possibilities for employment when I finish. I think this is a positive sign; instead of helplessness and despair at the world of medicine, I’m being proactive and looking for solutions. Not depressive thinking at all.

* * *

I realize I’m down on the shrink a lot and a lot of the things he says are horribly insensitive and sexist, that everyone I know encourages me heartily to fire him. So for anyone who cares, here are the reasons why I haven’t.

1. He is basically a decent person and is trying to help. I realize that this argument could be made for, oh, say, Sarah Palin, but after seeing psychiatrists from the other side in med school, I know that there are some truly Machiavellian types out there. I could do so much worse. He means well, though our views on what is wrong with me, let alone how to fix it, are worlds apart. It is sad that this is an important point, but it really is. At least I can be fairly certain he’s not out there making jokes about me with colleagues.

2. He has seen my episodes on both ends of the spectrum. I can’t say that he really “knows” me, not at all. But I just do not want to have to start the whole history thing over somewhere else. I don’t want to have to go through admitting to manic behavior. And he has seen it, at least glimpses of it, what I don’t manage to hide, so he has a firsthand clinical impression. That counts for something.

3. He is available. He understands the vagaries of a junior doctor’s schedule and is incredibly flexible about seeing me when I can, including sometimes 7 or 8 at night. He can see me on short notice and understands when I disappear for weeks at a time. I know this also sounds like a dumb reason, but I had to quit the counselor I liked best since starting med school (one of those tough, New York feminists) because we simply could never find a time to have an appointment. Others have demanded a set hour every week, which is impossible for me. I also see this as an extension of reason number 1 – he really does care and is trying to help, even at his own inconvenience.

4. He understands the brutality of medical training. This is the first time I’ve had any kind of therapy with an actual psychiatrist, and one thing that is nice is that I don’t have to explain the concepts of on-call, of how it feels after 30 hours, etc.

5. He picked my good meds. This gave me 4 years of normal, good life. I guess in retrospect he fell onto it more out of luck than talent, but still, I am immensely grateful to him for those four years, in which I lived like a normal person and managed to build a decent life for myself, even if it is all going to shit now, and might actually be crueler to have had and lost than never had at all.

6. About anything not related to my mental health, we get along well. Though here it may sound like a lot of angry silences and friction, whenever we are just chatting about something, we mostly get along. We share an unusual hobby and can chat in a friendly way. Just as long as we don’t drift into points where his basically bourgeois or sexist views come out, but mostly they are only a problem when discussing my life and its twists and turns, which he can’t really understand, being from such a middle class boring place. This is a big issue – he misses a lot of what is culturally normal for me and sees it as psychopathology. We come from the same ethnicity, but grew up in different parts of the world – he in a very conformist (though not necessarily right-wing) place and me as a hippie liberal. He’s the kind of man who pays lip service to liberalism but sees marriage and 2.5 kids and a mortgage as normal and anything else as deviant.

But, as I said, if we stay away from that, it’s ok. Light banter is always pleasant.

7. He doesn’t fall for my manipulation. This is also a big one. For whatever historical reasons, I’m a master manipulator of men – by anything from mental gymnastics and rhetoric to sex appeal, I always get my way. I do get furious when I don’t with him, but I think somewhere deep down, it’s good for me.

8. He recognizes that I’m wasting my life and talent. In fact, has made that very comment to me. This is one of the hot spots of what is bothering me. Unfortunately, most counselors I’ve seen see that feeling, the feeling that I am wasting my talents, as pathological, and try to address it, because on paper I look like I’ve done a lot for my age. He once, unprompted, told me I was wasting my life…and I thought it was one of the most insightful things anyone had said – that he sees through my impressive resume to see the dilettantism behind it.

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But the main reason is #1 – I know I could do so much worse. If it’s all bullshit, I may as well stay with someone who means well.

And no, none of this excuses his obvious countertransference-gone-wild issues, the sexism of calling me borderline because I am an angry female, the utter unwillingness to discuss what he sees as the problem and how he plans to therapeutically fix it, the dismissal and blaming of the patient…but still, at least he’s nice. And that means a lot. Do I really want to go find someone with all that same shit, who also is mean or cold?

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Edit: Tony White read this and pointed out a reason number 9, one of which I was not consicouly aware, but of course, he’s right. It made me laugh to realize that I hadn’t realized this, when it was so obvious to someone else.