RealMental

Oh hi, i have been absent from writing here for a long time, I have remained present on the inside reading comments, moderating occassionally. Keeping everyone in my thoughts.

I went off Lexapro last september for a variety of reasons. Most importantly i felt the medication was making my mania, depression and self-harming behaviours worse. My marriage had ended after my husband found out i had had an affair. The medication didn’t make me have the affair neither did being bi-polar, but those things definately had some influence on the choices i made. After being on medication for three years and being hospitalized for an overdose of prescription drugs,  a subsequent suicide attempt and two years of depression i decided to try life without medical intervention. I had a feeling that being medicated was making me worse.

I tapered off Lexapro over an eight week period. It was very difficult. I did it without doctor supervision for fear that my doctor would not agree with my self-diagnosis.

After three months i felt completely normal. Like the jess i used to know. I still had chronic anxiety and fears of depression coming back out of hiding. But, i could think clearer than i had in years. I could look, with perspective, at the mess my life had become. I saw, regretfully, the pain i had inflicted on those around me and the stupid choices i had made.

I could also see that i still had children who loved me and that i had managed to cobble together a life on my own. A home, a job self-sufficient. Something i had never been. Independent. Last spring and summer were monumental for me in regards to personal growth. It was an amazing time capped off by a trip to BlogHer in july. I was proud, strong and confidant.

In august my ex-husband and i began the painful process of trying to reconcile. I moved back into his home and we tried to come back together as a family. It hasn’t gone very well. The pain he has combined with my guilt has been incredibly difficult. It is a very tough path we are on and we have both thrown in the towel on several occassions only to crawl back in the ring and give it another round. The fight is nearly over.

Last week i went to my doctor because i have been having this irritating and frightening problem with orgasm-induced migraines. The pain is so intense and instant that i feared i was actually dying of an aneurism. I have started taking amitriptyline, an anti-depressant, to control the migraines. I don’t know yet if they are working as i have been too nervous to “test”.

I have noticed that my brain is slowly slipping back into it’s medicated state. My anxiety has lessened, but feelings of despair and depression have crept back in. Obviously, i am in a not great situation at home that is adding to the hopeless feelings, but i keep thinking is it really the medication? Am i a hypochondriac? Does anybody else feel this way on drugs? And really? Is it worth it, is a life without orgasm better than a life depressed. I think probably.

I’m on my way up. And there are signs—if I look for them, listen to them, use all my senses to detect them—if I don’t, then it’s the lurch in the stomach on the down curve of the rollercoaster that’s often the first sign.

If I’m really paying attention, then I hear it when my assistant says “Aren’t you Miss Polly Productive” when I leave him an enormous pile of dictation tapes, written motion and discovery work, and all the other legal detritus. If I look at my time sheet, I can see that I’ve billed a week’s worth of work in three days, though there’s no need to—I’m just blowing through everything, double time. It’s good work, too. Productive, concise, and necessary. The air’s clearer, the brain’s faster, and I feel more creative—am more creative. I write really well, and a lot, because I sure as hell only need about three hours of sleep.

If I miss that sign, then the next one is this. I’m still Polly Productive—except I’m now Misanthrope Polly Productive. I hate everyone—they’re all out to get in my way, talk with their whiny, annoying voices, bother me with inconsequentials. Every Little Thing They Do Is Enraging. I have road rage. I hate every cashier in every store everywhere who doesn’t blow through the things on the belt with superhuman speed. My critical voice snarks on each person’s shoes, haircuts, grocery selections, each one more worthy of hate than the last. My family and my husband bug the crap out of me, and I can’t understand Why Won’t They Leave Me Alone. There’s no objective perspective on why I’m so irritated.

The physical sensations start as I’m just about to crest from Misanthropic Polly Productive to Downward Spiraling Deirdre Depressed. The strange crown-like feeling on my forehead. That pushing sensation under my sternum. And the sweat. This is weird—but after three or four of these post-diagnosis, post medication episodes, I’ve realized something. When I’m in a high mixed state, and just about to start the long, long slide to the bottom? I sweat. Profusely. And it smells strongly. And my feet stink to high heaven.

Yes, that’s more about me than you want to know, really. But it’s a sensory sign—one that’s so weird that I notice it, even as I’m in the process of that catatonic withdrawal into my head, when the extreme productivity, the crazy irritability, slide by. Crazy has a smell for me, a clear, last-ditch signal. I might not be able to follow my mind all the time, but I can follow my nose. I wouldn’t have noticed it, maybe, if I hadn’t been serious about writing EVERYTHING down in my symptom notebook, but after talking it over with my shrink when I had my lithium toxicity episode, she said… tell me more about the sweating thing. Would I recognize that as a physical sign, even if I’m ignoring the emotional and mental ones? Turns out, I can.

Animals can smell fear. I suppose it’s not as weird as it could be that crazy has a smell that can wake up my animal brain, can trigger that self-preservation instinct that crazy makes it so easy to otherwise ignore. That smell says hey, put the brakes on this thing, slow this roller coaster car down– right now. I should be looking and listening and feeling for signs—but I’ll take the smell if that’s what it takes.

It sounds like one of those 1950 and 1960s era filmstrips we thirty and forty somethings like to mock, the irony of those pitifully naïve exhortations of the wonders of science now apparent– global warming, polluted oceans and seafood, tainted freshwater and food supplies, obesity, etc. The list is endless. But modern medicine, despite the very real ills of the healthcare and drug approval and testing systems, can, in fact, promote better living through chemistry. Antibiotics. Synthetic insulin. Blood products. Organ replacements. Sterile plastic and stainless steel instruments. Antidepressants. A wonder of products of chemistry, to address, if not cure, what ails you.

I know, full well, that chemistry doesn’t always effect a cure. And I took high school and college chemistry. I know, intellectually, that in order for a chemical reaction to come out the way it’s supposed to, you have to set up your experiment carefully. Maintain the controls. Measure your ingredients carefully. And keep an eye, at all times, on how the experiment is doing, once you’ve set it in motion. There’s a reason why the good professors make you take careful lab notes every step of the way. Even today, if you set me in front of a lab bench, with instructions of ingredients, order of steps, and possible things to watch out for, I’d watch every step, take careful notes, be meticulous in observing this external reaction, from start to finish. If something went wrong along the way, I feel pretty secure that I’d see it early on, and seek help to stop things from boiling over, or evaporating, or exploding, or turning into a rock hard lump so melted to the crucible that I’d have to throw everything out. I’d know that if not watched carefully, the whole process will be spoiled, and I would have to start over again.

And yet knowing that, I still fall prey to ignoring the process when it comes to myself. Moving the experiment from the lab bench, where I can see it, objectively, to my brain, doesn’t translate the way it ought to. I don’t have the right frame of mind. I still want it to be a miracle cure—not an ongoing experiment that if carefully watched, may succeed at maintaining its slow, nurturing boil for a while. But I still need to watch it. These compounds and chemicals run out of steam, and new inputs, like changes in diet, stress, sleep, the amount of sunlight, the seasons, all affect the reaction. If I stop keeping my lab notebook, meticulously, then I can miss the early stages of a downhill reaction, and don’t recognize it until it’s too spoilt to step in and fix it, salvage the reaction, achieve the same result after some tinkering with more or less of the initial ingredients. I let the Bunsen burner of stress burn too hot, don’t take that extra ativan when I stop sleeping so well, don’t call my doctor after the third night of anxiety dreams, because I’m not following the proper chemistry protocol.

The chemical reactions are only as good as the chemist watching them. It’s time to go back to school.

Or a piercing. Or hair color. Or something. Something new. I just cut all my hair off and then pierced the top of my left ear and that will have to do because my kids tell me that anything else more radical is crossing some kind of ‘line’ and I’ll be that mom that doesn’t know when to quit while she’s ahead. ‘But my nose’, I tell them, ‘wouldn’t it look so cute with a tiny diamond right here?’ ‘No.’ they all agree.

This happens every year. My mania starts to go up and up and then I find myself looking for ways to reinvent myself. I’m on medication this year so it’s not as bad. I keep reminding myself – this year is not as bad. But I think so much about what new tattoo I would get. And where I would put it. And I wonder if it’s a ‘safe’ or ‘accepted’ way to self-harm and mutilate.

I’ve started quite a few new projects. I made 120 pieces of jewelry and 22 hats and then put up each item in an Etsy store. It took hours. I hope I sell enough to offset the amount of money I spent to get all the materials to make all of it. I was compulsively buying hundreds of dollars of findings and beads and chain (because I NEEDED it) and then staying up all night making things. And then I started writing a new book. And revising a children’s book I wrote 9 years ago. And organizing all the tiny jewelry parts into tiny containers according to color. No, wait. According to size. No, wait. How about by type?

The difference this year is that even though I’m starting a bunch of projects, I’m actually being able to follow though and finish them. And that is really different.

This was me last week.  I am really struggling here.  As I have said before, I am not sure people know what to say to me anymore.  Either the people I see day-to-day or my regular blog readers.  So I am re-posting  something from last week, with some changes.  I hope no one minds.

Love,

JenB

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I can’t answer in one word.  Let us try a few:  cautious, scared, worried, i can wear a size 14 jeans from the gap.  I am actually getting anxious writing this post.  I have been avoiding writing this post.  I have been avoiding: seeing the doctor, getting my blood work done, checking my sugar levels, eating as prescribed, working out as much as I should be, doing anything right really.  I have been: eating sweets, not eating enough protein, sleeping a lot, changing my (going off of Effexor) psychiatric medications, hemming my workout pants so I don’t trip on them.

I have been doing good thing in fits and starts.  Protein shake here, no white carbs there, seeing my trainer twice a week, but not doing even remotely enough cardio.  We b ought the Wii fit, for fun mostly, I thought it would energize me to do more serious workouts at the gym and some yoga at the very least.  I had no idea the Wii fit <strong>WEIGHS</strong> YOU.  I have not weighed myself or been weighed since March when I saw the orthopedic surgeon about my knee.  Then it became scarier and scarier and one day I would be convinced I had lost a few pounds over the past month and then I would be certain I was almost back to my heaviest (impossible according to what size of clothing I am wearing).  It is now become my great white whale, which is funny really, i mean you know FUNNY.  Whale = fat, okay, I am over explaining a lame joke.

I am worried this is it, I will either stay where I am, or I will slowly gain it back and be what I was before.  Which I cannot even define other than “fatter”.

I was always worried that when the goals of the weight loss surgery started turning into how I looked and buying new clothes and having people say I look good or I have lost weight or GOOD FOR YOU! We were afraid you were going to be the fat one forever.  I am plateauing or gaining, or fuck if I know, right?  My mom and dad “how is the weight loss thing, you know surgery and diabetes and everything going”.  I am defensive.  “What do you mean?  Do I look fat?  Does it look like I have gained weight?  WHAT ARE YOU SAYING?” Articulating everything in my own head that I wish they wouldn’t ask me about ever. That I wish I could just update people without having to answer to anyone or ever talk about it really.  I want to be the person who got to a reasonable weight after 11-12 month, stay at that weight and then be able to advise and muse about how it was to be so heavy and so reasonable and ok with my weight now.

So many obstacles in my way.  The hugest one is me, lots of parts of me.  The eating disorder, always lurking. Someone, (doctors, books, dietitians, my MIND, the interwebs, the world, THE MAN) is telling me what I should be eating, I almost automatically say FUCK YOU, I will have this donut, bowl of chips, ice cream bar.  Bingeing is decidedly smaller amount, but bingeing when you stomach is wee and you know you shouldn’t but you WANT to HAVE to, is still bingeing.  It is still a fuck you to the rules.  I am 13, 14, 18, 25, all over again.  I had a similar reaction when I found out I was diabetic.  Rebellion via diet.  I am so cool.  I wish I could just pierce my nose, or bungee jump.  Instead I retreat inside myself and eat in secret, hiding it from everyone, pretty much successfully, all the time.  Am I self sabotaging, my therapist asks?  I don’t know.  I am afraid of finally losing the weight?  Maybe, I don’t know.  Is it a control issues?  Fuck yes, I can control what I eat and I can’t control what I eat or don’t eat all a the same time.  I am the mobius strip of food control. Yes, I feel expectations from family and friends.  I do not feel understood because I do not understand myself.

I feel like this will be another thing I will not complete, I will fail at.  I have trouble starting things and even more trouble completing them.  I don’t think I know how to be successful, at anything.

I know the small steps my therapist, husband, friend, tell me I should start at.  Get my blood work done, make sure I am not anemic or my blood sugars aren’t totally fucked, or my liver enzymes are elevated or other things that could go wrong.  Step two would be to actually make a doctor’s appointment, well, the doctor would call mewith my lab results, I feel sure there would be something to discuss there.  Once I go to the doctor, they will weigh me.  Weigh me.  Weigh me.  My worth a 3 digit number.  My success, my progress, who I have been since having the surgery will be those numbers on the scale.  I want to talk myself out of that melodramatic bullshit, it sounds so juvenile, so junior school, so first true love breakup story.

I am so scared I have already fucked this up to a place where I cannot return.  So scared.  Terrified.  My bed is so less scary. My sleep, my books, my solitude.

My post about my first appointment with my (psycho) psychiatrist made a couple of waves in the mental health blogging world. Phil from Furious Seasons did a huge post on it, and told me it was one of the “worst stories I’ve ever heard,” which, coming from a dude who blogs exclusively on mental health injustices, is pretty bad. Liz Spikol from The Trouble with Spikol also picked it up, with the title, “This is why people don’t trust doctors,” calling the experience “bizarre” and stating, “I have heard of similar experiences, but only with cults.”

It was nice to have others recognize how horrible this situation was. Unfortunately, it didn’t really change my situation.

After that first appointment, I vowed I would never go back to psycho psychiatrist again. I went to my family doctor and told her what happened, (she was horrified and said, “Maybe she was hypomanic that day!”) and she agreed to refer me to another psychiatrist.

The problem is this is a small city with a limited number of psychiatrists, and the majority of them work in the same clinic downtown. I made sure that she referred me to a psychiatrist who had a private clinic so there wouldn’t be any problems.

A few weeks later, I got a call back from my doctor’s office saying that the psychiatrist’s office had rejected my referral, stating that it’s his policy not to accept any patients who have already been seen by another psychiatrist in the city.

My doctor tried to refer me to another psychiatrist, again in a private clinic, and his office also rejected my referral, based on a “conflict of interest” because I had already seen another psychiatrist.

[And may I also mention that before I even went to psycho psychiatrist, I tried to get in with my mom’s psychiatrist, and he also refused to see me because he felt it was a “conflict of interest” to see two members of the same family.]

So, not only is it really difficult to get in with a psychiatrist in the first place, once you get in, you’re stuck with her no matter what, because everyone else will refuse to see you because they don’t want to get involved in any drama that may be going on between other psychiatrists and their patients.

Aaaaaaaaaaghhhh!

I didn’t feel like I had much of a choice, because I strongly felt I needed a psychiatrist to monitor me because of my family history. Unless I wanted to try and get referred to a psychiatrist in one of the neighbouring cities, wait another six months to get in with him/her and then take time off work to drive a few hours to my appointments, I was stuck.

So, I did what any semi-sane person would do: I went back.

But I went back armed with six months of mood charts, a list of supplements and drugs I’m taking and a very guarded attitude.

It was six months after the first appointment. And the weirdest thing happened.

She was nice.

She smiled, she laughed, she was friendly and helpful.

It was like she had switched personalities since the last time I saw her. This was the woman my doctor had described when she first referred me to a psychiatrist. This is the woman I wish I had had during my first psych appointment when I was scared and vulnerable.

Maybe she has some kind of personality disorder?

I think I’ve also learned how to deal with her. One of the first things I did was hand her a piece of paper with all my supplements and drugs listed, along with the doses. She exclaimed, “Oh, I wish all my patients did this. This is so helpful!”

I then said things like, “I took your advice and started taking fish oil supplements, and I noticed a real difference.”

“I took your advice and went off the Wellbutrin, and I’m really glad I did because I don’t think it was a good drug for me. I feel much better now just on the Celexa, as you suggested.”

“I took your advice and kept a daily mood log, and I’ve brought a graph of all my moods for the past six months here with me for you to look at.”

She was really pleased. “You’re doing everything right! You’re doing so well!”

Of course I was: I had followed all her advice and made sure she knew it.

We looked at my mood graph together and she agreed that there was no hypomania there. I reminded her that the only time in my life that I’ve ever felt hypomanic was when the Effexor made me wonky and again with a high dose of Wellbutrin.

She hasn’t deviated from the initial diagnosis as far as I can tell, but she was much better to deal with this time, and didn’t push any additional drugs on me. She just said we’d monitor it and only respond if something changes. She didn’t try to get me to go off the Celexa either.

So, while the situation isn’t ideal, I think I can work with this woman, particularly if I only have to see her once every six months.

I don’t think I can ever fully trust her, though, because I will never forget the things she said/did during the first appointment and the horrible way she made me feel.

The main problem with this psychiatrist, as far as I can tell, is that she needs to be the authority figure. She doesn’t know what to do with an educated, intelligent women who has done her research and who knows her mind/body/mood well.

During my first appointment, my psychiatrist was very defensive and aggressive, and it seemed as though she was threatened by me asserting myself and not agreeing with everything she said. If I had to guess, it was that dynamic that led to the weird behaviour/accusations on her part.

I was able to diffuse that dynamic by appeasing her in the second appointment, but I did notice that anytime I spoke too much, inserted my opinion, or let my guard down and tried to crack a joke, she would cut me off and dismiss me.

So, it’s all about walking that fine line with her. Acting the part of the patient and choosing my battles in order to get the care that I need in the very weird system we’ve got going on here.

My next appointment is in December. Hopefully, I’ll get her nice personality again. Wish me luck.

In geography class, we learned that a plateau is a geologic formation, with a flat top and often, sheer or highly-angled slopes supporting it.  It’s easy to recognize when you’re looking at pictures, or approaching one on a hike through the desert.

In psychiatry’s life class, I learned that it’s what they call it when you’ve reached your maximum efficacy on the dosage you’re taking, and it’s time to go up.  The problem is that psychiatric plateaus are not obvious.  You know the lift from the desert of depression to the top, the stable flat line you can walk for a while, not tripping and stumbling as on your climb to the top.  You don’t realize you’ve reached the end, until you start sliding down the psychiatric plateau’s more gently sloped sides, until you’re halfway down, and then you have to stop yourself, skidding on the rocks and dirt, before flipping yourself over, and climb your way back up, sometimes on hands and knees.

I’ve been climbing my way back to the top, hands and knees scratched and bloody, head pounding and breath shaky from the screeching halt I’ve pulled myself to, and the flat top is once again in sight.  But I’m tired of sliding, and each time I slide I berate myself for not learning, yet, my internal geography, for not knowing the edges of my equilibrium, my flat surfaces, and for not knowing that the plateau doesn’t go on forever in my head, as it does not in nature.  Those mental plateaus, they surprise you, in a way the physical ones don’t.