RealMental

I don’t have the answer to this question, but it’s one that everyone faces at one point or another in their relationships with the toxic people in their lives. I’ve been contemplating it on a number of fronts– toxic friends, toxic employment, toxic family, but it’s the last that’s the hardest, at least for me. The crazier my mother gets, the more I question what relationship I can safely have with her.

“Family” is a loaded, loaded word. The family to whom you are born may be less than ideal, and you haven’t got a choice in the cards that nature deals you in the long game of family– genetics, personalities, economic circumstances, and psychological pathologies. With friends and employment, there is always an element of choice, even if it’s a selection between a rock and a hard place. But in a family, the lack of choice is constraining. I, at least, feel like I have to try to make things work. The social belief that we owe our families our lifelong involvement and devotion, repaying the debts of our infancy and childhood to our elders is one that deserves examining.

As someone coming from an essentially middle-class background in a western civilization, I’m not equipped to opine on other cultures’ notion of a lifelong debt to family, nor am I even sure about whether that’s the best way to characterize it. But in our culture, I do believe there’s a breaking point. There are circumstances that are so horrific that we can all agree that someone has the “right,” if not in fact the self-obligation, to cut themselves off from their toxic family. But when do the circumstances suffice in our own lives? And when deciding if your family (or certain family members) are too toxic to continue to be borne, is it “fair” to make your decision based on your own reaction to their behavior, compared with the “objective” assessment of their toxic behavior?

It’s a question I’ve struggled with for years. I’ve been in therapy off and on, and at different points in my life, different behaviors have been wounding. As I get older, I’ve come to peace with the fact that it simply isn’t personal, and that the behavior is due to the mental illness and personality disorder from which she suffers. Too, I’ve mellowed as I’ve aged, and gotten a sense of tolerance if not humor about some of the craziness. But even with all that work, some of it is just too much– it hurts, every single time, and nothing I say or do to be self-protective, including standing up for myself, will change the behavior. But it doesn’t just only hurt– the stress she creates by failing/refusing/being incapable of getting appropriate medication, psychiatric treatment, and therapy pushes me down toward my depression end on the spectrum. First anger, then indignation, then self-pity, then sobbing self-pity, then apathy and wishful thinking and ignoring the problem, pushing it off onto my brother and aunt. At the same time, who better than I to help monitor her moods, get her the help she needs? I’ve already learned that she will never, never, never, change anything about her own life– her narcissism and martyr complex will see to that. But does my “responsibility” to her as a daughter to try to make her elderly stage of life livable obviate my need to take care of myself, to live my own life, to stay healthy for the husband I chose, who doesn’t engage in behaviors that literally drive me nuts?

Distancing has worked for me in the past (I don’t think she’s noticed), and more is in order. I also have decided that “plain talk” of actions and consequences is in order, whether or not she’s capable of understanding or acting on such, because she does have the capacity of being a lucid and functional person. Babying her accomplishes nothing, and is destructive to my own sanity. But the breaking point? I haven’t decided if I’ve reached that yet.

Last week I was asked by a Real Mental reader to write about my decision to continue taking my antidepressants during my pregnancy. I’ve been reluctant to do so but if there was ever a place where I’m safe to write about these issues, it’s here. (Thank you Leah)

My depression was my main concern when my husband and I first decided to try to have a baby. I did a lot of reading and up to the point that I found out I was pregnant, I still hadn’t made a decision. I knew what my gut was telling me though and that was to stay on my medication.

I had two very distinct opinions from the doctors I saw during the first few weeks of my pregnancy. The first doctor I saw was a GP who I saw for the initial “just to be sure” blood test. When I asked him for his opinion about remaining on my antidepressant he was very firmly against it. I tried explaining some of my history to him but he wasn’t receptive- which was fine, it wasn’t his job to listen to my life story- but it left me feeling guilty and afraid. The most embarrassing part was his subsequent refusal to refill my prescription.

Based on the research I’d done I had a hard time understanding his reaction. There are risks associated with taking antidepressants during pregnancy but that risk is thought to be minimal. After having suffered through years of untreated depression, I knew what the risks would be if I stopped taking my medication.

A week after the initial doctor’s visit, I went to see my OBGYN. When I posed the same question to her she waved her hand at me and said, “Stay on you medication.” I started down my list of questions regarding the risks. She listened for a bit and then stopped me. She told me that there were risks no matter which decision I made but that she highly recommended that I continue to treat my depression.

That’s exactly what I did. I had plenty of fears about the possibility that the antidepressants might harm my baby, but I was more afraid of what might happen to both of us if I stopped taking them. I was afraid that halfway through the pregnancy I would end up a non-functioning, emotionally irrational, suicidal wreck. My fears were based on hard won experience.

I was also terrified that if I allowed myself to regress to this state I would not be able to care for my child once she was born. In retrospect I think that my decision to stay mentally healthy was most heavily influenced by my instinct to stay healthy for my baby.

It was a difficult decision but I am infinitely grateful that I chose to continue to treat my illness during my pregnancy. My baby is healthy and happy. Thankfully, I am in pretty good shape as well and am able to be an attentive and nurturing mother. I’ve said it before and it is worth repeating- I shudder to think where I’d be if I had made the decision to stop treating my illness.

It was the best decision for me, but I would never assume that it is the best decision for everyone suffering from depression. I think that I had to follow my instincts and not let guilt or social pressure influence me as I weighed my options. I had to stick to the facts.

For more information from actual professionals do a quick web-search on the topic. There is a plethora of helpful information out there.

Reading Belinda’s thought-provoking post about forced commitment and medication, and the thoughtful comments people have since made, caused me to think a little bit more about how medication, while a lifesaver when appropriately prescribed, is only the first step.  Once you’ve gotten past the big ifs of a proper diagnosis and a proper prescription, you’ve got to be willing to use the equilibrium that the meds bring you to eradicate the mindset that meds are a “cure,” rather than merely a means toward maintenance and repair.  It’s my personal opinion that even the mentally ill person whose “only” life trauma is the toll of the disease itself has serious mental work to do, adapting to the concept of being “mentally ill,” redefining their sense of self around the diagnosis, and adapting to the medical and emotional features of their long term diagnosis.  The grief, regret, relief, anger and confusion that come with a proper diagnosis can’t be overstated, and it’s not something to be gone through without the aid of a therapist.  Too, medications don’t work forever– even once you’ve hit on a good combination, it may not work indefinitely– and being able to identify that your mood is changing despite being good about your meds is crucial.

From my own experience, I’ve built up a variety of coping skills to deal with my anxiety, depression, and need to people-please that are very unhealthy and counterproductive as I approach the worst end of my depressive spectrum, and it’s hard for me to recognize, when I am in the midst of a depressive phase, what I am doing.  But once I’ve recovered some stability, I can use that solid ground as a base to look back from the corner I’ve worked myself into this time.  I can look back and try to figure out when I first started the most recent downslide, and see if there were any causes.  I can then try and map out what I did and didn’t do during that period, identify whether anyone tried to warn me (and if they didn’t, possibly why not), and look at what coping mechanisms came into play, and what resulted.

There are lots of good books on the subject of eradicating bad mental habits out there, but I think a good therapist is really key.  (The subject of finding a good therapist, with whom you can work, is a whole post unto itself.)  Working with friends or family to identify your “bad behaviors,” your mood cycles, your triggers, just won’t be complete, because they’re not objective, and inclined to either overlook unhealthy or exaggerate healthy behaviors.  While friends and family can be the best first defense against a recurrent episode, and have the concrete experience of your past episodes to guide them, you need these folks to be focused on the micro level, not the macro/meta level.  A therapist outside your circle, however, is objective, has training, and is someone in whom you can confide and to whom you must be accountable.

Support groups outside your circle can also be therapeutic– because they don’t know you, and take you at face value when you take part, there’s an objectivity there that allows a freedom of expression you might not have with friends or family.  Hearing others say they’ve gone through something similar, and come out on the other end, is tremendously encouraging.  And knowing that someone else understands the swirl inside your own head lends credibility to their advice and encouragement that a “normal” source doesn’t have.

The most important thing to be gained from therapy is a firm sense of your self, knowing what you need and what you don’t need.  Personally, I’ve never joined a bipolar support group because the way my bipolar has manifested itself has been primarily anxiety and depression, and the course of my illness was and is usually very different from that of others in the groups I’ve tried.  Having never been frankly manic, psychotic, or delusional, much less hospitalized, I knew I didn’t “need” what these groups are offering.  But depression and anxiety sufferers?  I crave their company, search regularly for a group that meets after the end of the business day, eagerly read posts by others suffering from the same symptoms– because in hearing their stories, I learn something new about myself.  And by collecting these tidbits, I can hope that the next episode won’t be as long, as bad, as deep, because the work that I’ve done will allow me to see that it’s coming, and know that it’s arrived.  The meds provide the viewpoint, but I’ve still got to be willing and able to look around me– the therapy allows the rest.

Nauseous
Dizzy
Too many smells
Sweaty
All backed up
Got the runs
Spaced out
Shaky hands
Shaky legs
Shaky handwriting
Thirsty, always thirsty

Sleep
Laugh
Smile
Write
Think
Do
Feel
Nightmares are gone
Tears have dried
Rage subsides
Calmness resumes

Life returns.

Jon Armstrong wrote a particularly open and informative piece at his blog, Blurbomat, regarding being married and a partner to a person who suffers with mental illness. I highly recommend it.

There is an article re-affirming the existence of Seasonal Affective Disorder in the NYT today, and discussing the various treatments, including a new one called Negative Air Ionization. I don’t own a lightbox or dawn simulator, but I do use a humidifier and full-spectrum spot lighting. Bipolars tend to suffer from SAD a lot, and I am cat-like in my ability to lie in the sun and soak up the light. I’ve actually noticed an uptick in my mood this last week at home, because I’ve been able to work in my lovely sunny living room.

There are lots of folks who haven’t had SAD who don’t think it’s real, but it is all too real for those who feel it settle on their shoulders like a lead apron as soon as the light starts getting dim.  It seems so strange that we’d respond to light so drastically, that one’s mood can wax and wane with the sun, that one can respond like a plant to a bit of sunlight, and droop in its absence– but there it is, and to have it scientifically proven is something, at least.

See Why I Saw My First Psychiatrist, Part One and Why I Saw My First Psychiatrist, Part Two and Why I Saw My First Psychiatrist, Part Three and Why I Saw My First Psychiatrist, Part Four for the full story.

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For the first time in my life, I had someone to talk to about what was going on in my head. My history was littered with failed attempts at reaching out, which made Dr. Ragu’s intense attention all the more unbelievable.

For instance, when I was in grade ten, I joined a group called Peer Counseling that met over the lunch hour once a week. I had this idea that it was going to be some kind of support group, which I wanted, because I was fighting strong suicidal feelings at the time, but when I showed up to the first meeting, I was greeted by a circle of smiley-faced eleventh- and twelfth-graders dressed in expensive clothing and seated with their hands folded on top of their desks.

I’m sorry, I said. I think I have the wrong room.

Are you looking for Peer Counselling? the guidance counselor leading the group asked.

Yes.

Then you’re in the right place, she said.

I thought to myself, I doubt that very much, and took a seat near the door.

As it turned out, Peer Counseling was not a support group that was intended to help its own members; it was a support group that was intended to reach out to students in apparent need outside the group. We were all supposed to be well-adjusted good samaritans who kept lonely students from offing themselves in out-of-the-way bathrooms.

I am not kidding. The guidance counselor, to whom I will refer as Mrs. Lester, took a few minutes during our third meeting to give us all a heads up about a loner who was often found eating her sandwiches alone in the bathroom just outside the theatre. One girl shot up her hand.

Do you think she’s depressed? she asked.

Yes, I do, said Mrs. Lester.

She must be suicidal, another girl said. I totally would be suicidal if I ate my lunch in a bathroom. What should we do?

I think it would be nice if you all could make an effort to bump into her and let her know that she’s not alone, Mrs. Lester said.

I could just imagine it. Ten members of Peer Counselling were going to drop on this girl like Christian fundamentalists on a possible new convert, filled with the spirit of charity for the psychologically downtrodden. I was a bit of a loner myself, so I felt bad for her that Mrs. Lester had sicced a bunch of rosy-faced do-gooders on her in what might have been her only calm place in that whole high school. These people irritated the hell out of me, and I rarely even had to speak to them directly let alone be cornered by them in a dingy bathroom where no one could hear me scream.

A few meetings later, Mrs. Lester showed us a film that contained interviews with suicidal teenagers. She turned off the lights and started up the clattery film projector. As soon as an ancient, green, metal film projector made an appearance, you knew that you were going to be treated to a scratched 1960s educational movie with stilted line delivery. We spent the next half-hour watching teenagers who were now our parents’ age telling us how hopeless they felt.

Mrs. Lester asked us what we had learned from the film.

I think that you would have to be crazy to feel like that, one person said.

I agree, said another. No sane person would ever think that way.

I shifted uncomfortably in my seat. I had contemplated suicide off and on for six years already, and the other peer counselors’ reactions to the film seemed cruel to me. I finally figured out what I hated so much about all of them: they saw themselves as benevolent, psychologically superior, leaders of the lost. All I ever really saw them do was brag about how they had bothered to wave hello or say something nice to someone who looked sad, and Mrs. Lester did nothing to dispel their belief that other people were sad because either they did not smile enough or they were completely mad.

You’re all full of shit, I said under my breath. My hands and legs were trembling. I never spoke out loud in formal situations.

What was that? asked Mrs. Lester.

You are all full of shit, I said more loudly and stood up. I swivelled around and propelled myself toward the door. I was unsteady on my feet from all the adrenaline my glands were spitting out, and I was not sure that I could make it out of the room if I waited any longer.

Why do you say that? asked Mrs. Lester, ever calm.

Suicidal thoughts can happen to anyone, Mrs. Lester, and you should tell them that. I made it through the door and pulled it closed behind me. There was no sound from the other side. I felt like a freak. I was pretty sure that I was a freak.

A few days later, I was called down to Mrs. Lester’s office. She told me that she was worried about me. You would think that I would have seen that as an opportunity to share how afraid of my own brain I was, but I knew that I could not talk to her. I was less than impressed with her Peer Counseling group.

Can you tell me what’s going on with you? she asked.

It’s hard to talk about, I said, trying to buy myself a little time until I found a decent diversion. Then, I hit upon it. I think I might be a lesbian. Lesbianism: a surefire way to add tension to a conversation in the mid-1980s in a largely uninhabited agricultural province.

What? Are you sure? How do you know? She almost always spoke in questions, and they were almost always stupid. Do you want to talk about it?

Nope. Not really, I said as I gathered up my books. I’ll come back if I need anything. She told me to make another appointment with her on my way out, but I didn’t. I was gender-confused and bi-curious at the time, but I did not know enough about lesbianism to keep up my end of a fake counselling session.

That last meeting with Mrs. Lester following my outburst signalled the end of my Peer Counselling career. I decided never to go back. I was relieved, but I also realized that I had completely screwed up any opportunity it had afforded me to be honest about what I was going through. I had joined the group because I had a need to fill, only I did not tell anyone why I was there, including the guidance counsellor. Of course, I later discovered that they were all a bunch of nimrods, but before I found that out I had ample opportunity to tell someone, anyone, what I was going through and that I needed help.

I guess I was too used to keeping mum. I had managed to stay quiet about being suicidal for six years, so I wasn’t exactly itching to spill the beans. I just wanted to stop feeling so alone with it, and the other members of the Peer Counselling group only managed to compound my sense of isolation with their utter lack of comprehension.

Some days, I wish I could take that fifteen-year-old Schmutzie and drag her to a therapist already.

Oh, but wait! I did! Only she was twenty when I took her to see her first psychiatrist. I mean, I was twenty when I took myself to see my first psychiatrist, Dr. Ragu. It is a good thing that fifteen-year-old Schmutzie did not know that it would be another five years before she sought help in any sort of effective manner, because things got really hinky after that, and she did not need any more stress than she already had.

(This entry is also posted at Schmutzie’s Milkmoney Or Not, Here I Come)