Hello, World

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

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

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

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

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

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

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

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

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

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Article Link

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

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

Sodium Valproate, or “Here we go again…”

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

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

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

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

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

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

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

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

* * *

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

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

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

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

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

* * *

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

Physical Versus Mental Illness

In an unpublished email, Milo wrote this comment to me:

Personally speaking, i passed a kidney stone last year, and being dead honest here, i’d  much rather the physical illness than having a paranoid episode… i really really do. i tell you one thing Sara, the pain was absolutely horrendous, but no one laughed at me. i felt much more dignified than i ever did when i was locked up in a psych ward… dead honest…

I think that almost anyone who has had a mental illness of any significance would agree with that statement. And the odd thing is that anyone who hasn’t would think just the opposite. Unless you’ve been there, there is a tremendous underestimation of how much mental illness impacts the quality of life. After all, there are very few physical illnesses – even ones involving extremes of physical suffering and death – that are associated with suicide in a way that even the “common cold” of mental illness, a simple depressive episode, is.

It seems to me that a lot of people who are writing journals like this one – experience journals – about their mental illnesses have a higher than average level of physical illness comorbidity, though I’m not sure that has been epidemiologically proven. There are probably cofounding factors – people plagued by crazy moods usually don’t take the best care of themselves (I am guilty here), destructive behaviors, substance abuse, being ignored by doctors.

But I’m also struck by how quickly physical illness is legitimatized by society, bringing with it what public health sociologists call the “sick role,” which is a social convention that is acceptable to society. Something about the whole construct and theory bothered me in medical school when it was touched upon briefly. I don’t like the blanket statements; I think people should be seen as essentially healthy, and by defining a sick role, you are encouraging sick behavior.  No alternative models are presented in medical school. But it does apply on a societal level as a descriptive model, if not the ideal one.

Yet it doesn’t apply for mental illness – the main two “rights” afforded the ill are not applicable – whether society says it or not, mental illness is seen as, maybe not quite active malingering, but something akin – not quite a “real” illness, not something that justifies the exemptions.  And the second right – that the sick person is not responsible for their illness – it is politically incorrect to disagree with this statement, but hell, if I, medically educated, liberal, and a victim myself, in short,  someone who should know better, insist on blaming myself, well, what can you expect from a society at large?

The “responsibilities” are also problematic. The idea that one should cooperate with a medical model which is infantalizing and patronizing and paternalistic, and often negates the core of one’s very experience with its drugs as well as its conception of pathology (something that does not happen, or at least not as much, in physical illnesses), is equally problematic. I do not agree with my physician – who, according to these same sociological principles, has the ultimate word and is considered the only “technically competent help” I can seek in order to conform with the sick role. Therefore, I in some way abdicate my rights to the sick role.

That’s ok with me on some level. I don’t want the sick role anyway, and, while I know it will probably make a lot of my readers angry, I am often against the institutional reward for the sick role. (Again, another disagreement I have with the basic premise of the theory.)  I think that by making it easier to get benefits for illness – and NOT just mental illness by any means, we infantalize people and encourage sick behaviors, define people as ill, create a permanent and all-encompassing sick role. We create patients who will never get better.

I am all for help, care, love, and rehabilitation – all things that Western countries tend not to give as easily as they give money (which they don’t give that easily either). But the welfare system writes people off, makes them dead long before they are, often encourages them to give up the fight.  It also exempts us as a society from working to improve their health, because they are maintained indefinitely as ill. It is relatively easy to cut someone a monthly check; it is quite difficult to encourage and help them find suitable work – and by work I do not mean employment, but rather “work” in the sense of “to work and to love” – something that gives life meaning. One can be a “healthy adult” with a mental illness. A physical one, too. But not while clinging to the sick role.

Back to Milo: whether we accept the “sick role” concept or not, physical illness is afforded a legitimacy that is regularly denied to mental illness. Here’s my example: I’m not proud of it, but during this last year, while taking one of the meds that made me insanely restless, suicidally depressed, argumentative, and, on top of it all, physically miserable due to akathisia, I landed at one shrink appointment and ended up begging him to do something – anything, just to make it stop. Stop this med. Find another one, one that would work quickly. That I wouldn’t argue, I’d do anything he said, take anything, just to make it stop.

And what happened? I got an annoyed reaction. “You of all people should know that psych drugs take 4-6 weeks to work, that it just doesn’t work like that…and anyway, it seems to be doing you some good.”

This is from a psychiatrist – the kind of doctor supposedly most educated and aware of mental illness, the one who chose to specialize in mental disorders, who presumably thinks they are a source of suffering significant enough to devote his life to treating. If he can’t be sympathetic, how can we expect society at large to be?

I’m not blaming him. I am sure I was annoying and demanding and all that, and there was no easy solution that would have satisfied me. I have certainly lost patience with patients with unreasonable expectations and demands, which mine was. It happens. He also redeemed himself a few minutes later, saying something like, “I know you feel awful,” which was probably what I needed to hear in the first place.

My point: contrast this with the recent very physical side effects of some med or other he gave me, or, what it is looking most likely to be – a peptic ulcer. After all the misery of this last year, the depressions, the irritability, the instability, I hardly cared about the stomach pain and vomiting, which were occuring daily, often during 30 hour call nights. My mood had improved, and the physical shit, while not insignificant and certainly distressing, relative to what I had been through, was almost nothing.

And yet, when I reported these symptoms (which I did at first because I thought they were due to one or another of the psych meds), I was told to rush to a doctor on the same day, if not the emergency room. That got me the sick role, and pretty damn fast.

* * *

Stay tuned for the next post – this one went in a different direction than I intended. I intended to discuss Milo’s point more directly, the way psychiatric illness is seen in the emergency room, by the medical system, and instead ended up here, on a more theoretical note. Later I’ll try to write on comparative suffering – physical pain versus mental pain and whether they are the same or somehow qualitatively different – whether mental illness really is just another type of illness, legitimate suffering, and how doctors really see psych patients.

What Tarot Card Are You Quiz

First of all – a quick note – for some reason, suddenly I’m getting hundreds of hits from closed weight loss forum sites, especially to a post called Facing the Weekend. I can’t see who put my site on there. Does anyone have any idea what is going on? Did anyone come from one of those sites? If so, can you just let me know what the deal is? I have no personal connection to any weight loss programs or surgeries.

As for this quiz, this is insane. Do they personally know me?

You are The Moon

Hope, expectation, Bright promises.

The Moon is a card of magic and mystery – when prominent you know that nothing is as it seems, particularly when it concerns relationships. All logic is thrown out the window.

The Moon is all about visions and illusions, madness, genius and poetry. This is a card that has to do with sleep, and so with both dreams and nightmares. It is a scary card in that it warns that there might be hidden enemies, tricks and falsehoods. But it should also be remembered that this is a card of great creativity, of powerful magic, primal feelings and intuition. You may be going through a time of emotional and mental trial; if you have any past mental problems, you must be vigilant in taking your medication but avoid drugs or alcohol, as abuse of either will cause them irreparable damage. This time however, can also result in great creativity, psychic powers, visions and insight. You can and should trust your intuition.

What Tarot Card are You?
Take the Test to Find Out.

Psychiatry claims another victim

…or Dona Juana falls for it again.

I have been having a really horrible week. So horrible, in fact, that almost every night on call I get to a point where it is difficult to avoid thinking about suicide seriously…climbing up to the top of a tall building and jumping. I have been inconsolable. I haven’t really been able to talk about this to anyone. Just…all I can think of is the relief I could have from being me.

I wonder what happened to the version of me that was okay. But I know. Therapy happened.

Now, today I had to see the shrink again. I mentioned that I hadn’t been feeling well, that it had been difficult for me lately. I did not go into detail about the chronic suicidal thoughts and so on. Figured it would come up if it would. I went into the appointment knowing that I am in desperate need of some kind of relief, comfort – maybe a med change, definitely a little support…and also knowing well that I wouldn’t find it there.

Finally, I just asked rather simply, “What the hell is wrong with me? That I have everything and can’t just live.” I also may have mentioned how it seemed like being in therapy – again, his idea, not mine – seemed to just be making things worse. That instead of living my good moments and enjoying them, I was stuck on monitoring my feelings all the time, noticing pathology everywhere.

His answer to what was wrong with me: “I don’t think anymore that you have bipolar. It’s a personality disorder.”

This came out of nowhere, though I guess deep down I knew somewhere not to trust him. This is after letting me spend over a year mourning the fact that I had been diagnosed with bipolar disorder, taking that to heart, coming to see myself as broken and learning to live with that. All, of course, on the basis of his diagnosis.

I didn’t think it would be possible to go into that appointment and come out feeling even worse than I already did. But he did.

I just feel sick and betrayed. Someone who encouraged me to trust and trust – despite my better instincts – encouraged me to do talk therapy, despite the fact that it only caused me harm in the past, was so dishonest with me, never would have even told me unless I pushed for an answer, and even then couldn’t be honest enough to name the name.

The most horrible part: his solution was to increase the frequency of therapy.

No, wait, that’s not the most horrible part. The most horrible part is that I was reasonably happy with my life until I went back to him in late winter. Now, thanks to all this therapy, I’m back on the same med cocktail I was to start with after losing months of my life to the misery of many unsuccessful med changes, and am an absolute fucking mess.

So when they ask how therapy is harmful, here is my story. I feel okay, and that gets me a bipolar diagnosis. I spend a long time in mourning, trying to come to terms with that. It hurt. Then the so-called helper decided it wasn’t even a right diagnosis and actually did not even intend to tell me that.

I am out several thousand dollars, at least six months of needless suffering, and once again, cheated by psychiatry.

This wouldn’t be so bad if I hadn’t been through the same thing four years ago, promised myself to never, ever go back to therapy, for these exact reasons, and then walking into it again. Six more months of wasted time, wasted money (money is a big worry for me), and most of all, personal hurt and dashed hopes. I can certify that I came out of therapy worse than I went in.

For a while, when I quit last time, part of what I promised myself was that if I felt the urge again to go back to any kind of therapy, to immediately go out and spend the cost of a session on something that would give me pleasure. It made me feel infinitely better than therapy ever did.

So now, after another painful and expensive lesson, I am back to where I was four years ago, with additional hurt, in a fairly severe crisis with nowhere to turn, and with no med doc to fix this shit. And a new, deep wound to add to it all.

I probably should go out right now and buy myself something nice with the value of a session. But I’m too fucking tired, too fucking full of wishing for death, for relief. Of course, now I can’t even kill myself, because that would just be some crazy borderline manipulation.

God, I promised myself then never to do this to myself again. Back then, I said to myself, this is it. No more therapy. No more money and time and hope in a dead-end. No more subjecting myself to the judgment of some of the most fucked-up people on the planet. No more looking for relief, for humanity, for help, where there is none to be found. I swore to myself deeply then to never go back.

I guess with time, the reasons I was so adamant got blurry. I managed to forget. Managed to buy into all that crap about how people in that profession really care, are committed to service. Are sensitive. Are empathetic. May even care about patients.

So now, I am out a drug provider. And I am, if anything, worse off than I was this morning with no hope in sight.

I’ll probably call Jake. Just to get reassurance that I’m not personality disordered, a touch of real life, real people. The things that psychiatrists shy away from more than anything.

Thanks for listening, whoever is out there. And if you learn one thing from me, it’s this: don’t go to a fucking shrink. And if you do, never trust one.

More search engine terms

Even though I just did this, there have been a few that popped up in the past few days that are so worth posting:

i lost my ego

why i hate psychiatry

even my shadow is jealous my skin is mad

feelingless bipolar 

escape life seclude depression

The runner-up for best search term:

are psychiatrists strange

And my favorite:

what asshole i am

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