All Things

“Seen the news?”

It was an innocuous enough IM to receive at work the Friday after Thanksgiving. Companies often announce things the day after a holiday, especially as it gets close to Christmas time, but this was no ordinary news. It was followed by a link that I followed to a small town newspaper in East Texas. It described a van that had pulled to the shoulder of the road, around 10:15 Wednesday night, and then made a u-turn directly in to the path of an 18-wheeler. A 35 year old man who’s name I didn’t recognize was killed, as were his 4 year old son and 3 year old daughter, and a 14 year old boy with a different last name. The man’s 28 year old wife survived, as did the 51 year old woman who was driving the van.

As it turns out, the driver is my coach, at work. The 14 year old was her son, and the 3 and 4 year old babies were her grandchildren. The woman who survived is her daughter.

She is a natural blonde with hair to her waist. I know she only ever lets her sister cut her hair, because she told me so when she was sitting with me last week, and I know that in all of her 51 years it has only been “short” once, and even then it was shoulder-length. I know she doesn’t trust the H1N1 vaccine, because she told me so the other day. I know she spends all of her free time taking her son to band practice, and shuttling him back and forth to football games and little league, because she told me so, many times, when she sat behind me my first several months on this job. Her cubicle is filled with toys. She is that unique combination of both kindness and hipness, traits that are not commonly found together. She is vivacious and grounded, and if you met her you would probably think, “earth mother”. She is a much-beloved member of our community, at work.

I can’t stop thinking about her. I can’t stop thinking about the wreck, can’t stop wondering if everyone died instantly, and hoping that they did and that she and her daughter were knocked unconscious. I can’t stop feeling horrified about the pain she and her daughter must be encased in right now, and I think everybody at work felt the same way. Of course, she has friends at work who have known her for years, and I’ve only known her for a few months. Someone is talking about starting a fund drive, because her son-in-law didn’t have insurance. I don’t know how helpful a fund drive would be for her, but I know it would be helpful for all of us at work. There isn’t a person who heard the news today who wouldn’t gladly have joined forces with everyone else to take some small part of the burden of her loss and her pain and her grieving on our collective shoulders. Having something to contribute to would be a relief to all of us, I think. I know it would be for me. And maybe it would help her, as well, when she comes back to work (if she does) to know that we all had a way to pay our respects without infringing on her grief or privacy.

David is out of town tonight, and I am here with my feelings, which is probably just as well.

I watched a program tonight that touched on the Buddha and his initial search for enlightenment, and the general conclusion he came to that all things are impermanent. There must be something very profound about that understanding, and it certainly is the nature of things. Why, then, does nature bring so much pain along with the most final of facts none of us can escape: death? Is the death of children equally painful across all cultures (I’m guessing it is)? Did this type of catastrophic accident wipe families out all at once because of a simple, split-second accident a hundred years ago?

No conclusions tonight, just observations. Please say a prayer, if you will, for my coworker and her children and her grandchildren. Please take a moment to close your eyes and imagine yourself to be part of that collective that would take on some small percentage of the pain and the grief she is currently drowning in.

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Just found this fantastic article out at The Dana Foundation (which I’m adding to my Expeditions page). If you have or have ever been diagnosed with Borderline Personality Disorder, you might find this interesting.


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I was in a horrible, embarrassing relationship for several years. I chased him. He let me catch him. He ran away. I chased him. He let me catch him. He ran away. This lasted for four-hundred-and-seventy-five years, which is longer than most prison sentences. The problem seemed to have something to do with my legs, which would not stop moving in his direction. I cursed myself the entire time, and cursed him too, of course.

It was just your typical, lopsided, obsessive relationship. Nothing special, really, except that it literally drove me crazy. Oh, everything was fine so long as we were together – but the minute he ditched me I lost my mind. I stalked this man in a way that would have driven most people to seek a protective order, but he was not “most people”, so in our case I simply stalked him until he suddenly decided we were dating again. From the very beginning he behaved in a way that would have driven most people way far away from his direction, but I was not “most people”. It was almost as if I said, “Wow, I really hate you. Where have you been all my life?”

This relationship didn’t simply happen out of nowhere. It was one of many that followed a similar pattern. This one just happened to last four-hundred-and-seventy-five years instead of, say, one-hundred years.

I was so miserably, dangerously crazy when I was chasing this guy. Once I caught him, I was fine. Just another nice lady working in tech support. But this was a guy who wouldn’t stay caught, so I was crazy a goodly percentage of those four-hundred-seventy-five years. In fact, I started seeing a psychiatrist at the beginning of that relationship. I also went in to therapy. Because the relationship lasted for so many, many years I had plenty of time to try to figure out why I was in the relationship to begin with, and the general direction of my psychiatric and psychological treatments began to focus on Borderline Personality Disorder. BPD made sense to me (although I must admit no doctor or therapist – psychological assessment examiner notwithstanding – seemed to agree with me). I found a great textbook about the treatment of BPD, and I found a therapist willing to focus on Dialectical Behavior Therapy in a one-on-one situation. DBT became my focus, my talisman, my ticket to a future that didn’t involve running.

And then, suddenly, it was over. I met and married someone else. Someone I didn’t have to chase, who happens to love me, and who I love, too.

With the horrible relationship behind me, I couldn’t think of much to talk about in therapy, so I stopped going. The decision about who and what to fight was a no-brainer so long as the war still raged: the enemy was clearly identifiable as “my boyfriend”, and the war was for my sanity. Once the boyfriend was out of the picture I lost track of where the front line was, or if there was even still a war going on.

It’s difficult to know where to begin in therapy when I’m not standing in the middle of a war. A lot of the language I used to describe my feelings back then is gone because I’ve lost the context. If I were to see a therapist today and try to tell her (or him) why I wanted to see them and what I hoped to achieve I would be at a loss.

“What’s wrong?” they might ask.

I’d have to say, “Well, nothing, really.”

“And what do you hope to achieve through therapy?”

“Eh, er, I dunno to tell you the truth, hard to put in to words.”

I plan to crack open my old friend, Cognitive-Behavorial Treatment of Borderline Personality Disorder (by Marsha M. Linehan) this weekend and see where it leads me. And blog about it here, of course.

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“The most dangerous man in the world is the contemplative who is guided by nobody. He trusts his own visions. He obeys the attractions of an interior voice but will not listen to other men. He identifies the will of God with anything that makes him feel, within his own heart, a big, warm, sweet interior glow. The sweeter and the warmer the feeling is the more he is convinced of his own infallibility…”

— Thomas Merton

I enjoyed re-reading my old psychological assessment, yesterday. Typing it up for this blog gave me new insights in to what the examiner was reporting; insights that were quite incomplete when the assessment was done.

The assessment upset me a great deal the first time I read it, back in 2002. I was expecting a report all-together different than the 4-page map of my psyche it turned out to be. Key terms like “ego-inflation”, “narcissistic”, and “masochistic” glared back at me like charges in a police report, and my first instinct was to say, “I didn’t do it!”. In fact, I called my then-boyfriend in tears the night after I picked it up from the examiner. I read it over and over again for a few days before losing it somewhere in my multitude of personal papers.

Transcribing my psychological assessment made me think about each word individually, and I decided to challenge my assumptions about the meaning of the words that bothered me the most. I decided to Google “ego-inflation” first. The first thing I found was the Thomas Merton quote at the top of this post. I’m writing about it here because it resonated with me.

Those of you who have read some of my more recent posts may have noticed that I am contemplating going back in to therapy. I know I need to do just that, but trust is a problem for me. Because of that I tend to do my own research and fall back on self-help. At some level I know this is illogical, and that without discourse with another person all I can do is rearrange the same old ideas in my mind over and over again. I can even remember bringing this up in therapy. Unfortunately, I lost faith in every therapist I ever had and never finished working through the issue of trust. Distrust tends to fester and now here I am again, very much at the mercy of my own ideas and suppositions.

Yesterday, I realized that what the examiner meant when she referred to “ego-inflation” was my tendency to create ideas about the world and my place in it out of my own imagination and then to project those ideas on to my environment. This resonated with me because it is, in a word, true. I can’t speak for anyone but myself when I say this, but without the willingness to learn from other human beings I do, very much, tend to look solely to myself for leadership.

I imagine myself driving down a highway, utterly lost. I know where I want to go, but I have no idea how to get there. I am unwilling (or unable) to ask for directions. I’ve been driving for what seems like forever, and the feeling of being lost – the fear, the doubt, the sheer frustration – eventually becomes overwhelming and to counter that I convince myself that the road I’m on will get me to my destination, no doubt about it. I do this because it beats feeling lost, and I’ll continue down that road until the conviction wears away. The sense that my destination is near, but just out of reach, is maddening.

This reflects nicely in a recurring nightmare of mine. It usually involves walking through some kind of structure – a parking garage, or a mall, or even my own house – and suddenly finding that no matter what door I open, what stair I climb, what entrance or exit I pass through, I can’t get to where I’m going. The dream tends to go on and on and on.

The problem is not how to trust someone, or finding someone to trust, really. The problem, really, is being willing to ask for and follow directions, knowing that I am asking a complete stranger how to get where I’m going.

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When I was 35 I asked my psychiatrist for a diagnosis – but not just any diagnosis. I wanted something concrete. Something scientific. Something repeatable. She argued that a diagnosis wasn’t terribly important, and I argued for psychological testing. She referred me to Examiner X.


This was the result.

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Food For Thought

The author of Before You Take That Pill posts to his blog about common sense and pills:

Does America Have A Prescription Drug Problem?

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When In Doubt

?

My grandmother, Neta, used to listen to me tell her about the latest catastrophe in my life, and then she would tap her temple with her index finger, shake her head, and say, “Think! Think! Think!”.


Alternatively, she might say, “Stoooopid.” I loved the way she did that. Her minimal response was loud with the notion that the catastrophe had happened simply because I needed more practice thinking. Her “Stoooopid” was far from insulting; instead, it was an opportunity to laugh about the ridiculous mistakes we all sometimes make in life.

My husband listens to me tell him about the latest hard day that I’ve had, and then he simply says, “Uh huh.” And that’s about it. If he worries about me, he doesn’t say so. Last night, I told him I’ve been having some doubts about whether or not I have a mental illness. I told him I’ve been wondering about the power of suggestion, and he seemed to understand what I meant even though I didn’t go in to any detail. He smiled and said, “Uh huh.”

“You know, you have this unique ability to listen to me, no matter what, and never take a side, never give advice. I mean that in a good way.” I said.

“I pick sides,” he responded. “I pick your side.”

What strikes me about both Neta and David is their confidence in me. I can’t imagine either of them ever denying me the right to my own thoughts, my own ideas. Why, oh why, do I have so little confidence in myself?


I am critically and curiously reevaluating the assumptions and facts I have at my disposal about me and mental illness. I’ve done this often, over the years, never willing to pick a specific side and stick with it. It’s all a gray area for me, the area these doubts occupy. Sometimes I lay them down for a very long time. Sometimes I pick them back up and examine them curiously, like a puzzle I keep coming back to.

  • I doubt that I have a mental illness at all.
  • I doubt that my behavior isn’t within my control.
  • I doubt that my experiences are as extreme as I make them out to be.
  • I doubt that the worst of my mental states did not occur because I was experimenting with alcohol and psycho-pharmacutical medications, and because I was dealing with the consequences of immature and self-indulgent decisions I knew better than to make when I made them.

Over the past several days, as I’ve read more and more posts on other blogs by authors who are struggling with psychosis and mania and truly crippling depression, I’ve begun to doubt my diagnosis. More than that, I’ve begun to doubt the way I cling to my diagnosis, and I’ve started wondering if I’m hiding behind it. How many times have I made the decision not to do something I need to do – from cleaning house, to getting my dental work done, to eating a half-way healthy diet, to exercising – and blamed it on being bipolar?

Am I taking pills instead of making good decisions?

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Serohell

I have something I need to admit to, here: I didn’t take my medication as prescribed, last night. Instead, I doubled up on my Seroquel and skipped my Neurontin and Lamictal. I’ll explain why in a new post, but first let me talk to you about Seroquel.

Oh how I love my Seroquel. It is the most reliable sleep aid I have ever encountered. Because of Seroquel, I can guzzle my beloved Diet Coke and iced tea from the moment I wake up until the moment I go to bed without having to suffer through caffeine-induced insomnia. Because of Seroquel, I can choose to go to bed at 3am without worrying that I’ll waste a moment of my precious bedtime tossing and turning. Because of Seroquel I never have to thrash around for hours on end in a torment of stress-induced rumination. It knocks me out, nearly every time. It doesn’t produce a “high”, but neither does it make me feel queasy or leave an odd taste or sensation in my mouth (a-la Ambien or Lunesta), and it doesn’t have any impact at all on the number of hours I am able to sleep at a stretch. I don’t build up a tolerance to it. I am never tempted to take it during the day.

In fact, Seroquel causes only two problems in my life that really bother me: 1) I am completely unable to sleep without Seroquel and haven’t been able to stop taking it since I started taking it many years ago; 2) Over the past several months I have developed a side-effect that is absolutely horrible: I lose the ability to swallow about an hour after I take it.

My dependency on Seroquel bothers me a lot, and it’s a problem I’ve read about again and again in posts all over the Internet by other people who take it. In fact, I often wonder if taking Seroquel for a long period of time changes something in your brain chemistry so that you are, literally, unable to ever fall asleep naturally again. I went through a period of several months, last year, when the only psycho-pharmaceutical I was on was 25mg of Seroquel. That’s the lowest dose of Seroquel you can take, and the pill itself is so tiny that it really can’t be cut in half. People who take Seroquel as a mood stabilizer are often prescribed 800mg or even 900mg of the drug per day (I can’t imagine how that would impact me – I would be catatonic, unable to function at all). When I tried to stop taking that 25mg per day I suffered extreme withdrawal symptoms, the worst three of which were intense itching all over my body coupled with intense joint pain all over my body, along with complete insomnia. I think the longest I made it without Seroquel was three days.

The problem of being unable to swallow started a few months ago, and it is the most miserable, awful feeling. The smooth muscles in the back of my throat simply stop working. I can usually trigger my swallowing reflex by sitting up and drinking something, but not always.

I haven’t spoken to my doctor about this problem because I know it means that I should stop taking Seroquel, and I can’t imagine how I would do that. I keep postponing the conversation because, after all, I do eventually manage to fall asleep despite the horrid sensation (that’s how thoroughly it knocks me out). I’ve also wondered if maybe it’s the combination of Seroquel and Lamictal and Neurontin, all of which I take before I go to bed. I started trying to space my medications out because of this side effect, so I usually take my Lamictal and Neurontin about a hour before I take my Seroquel. Spacing out my medications helps a little, but not a lot.

At any rate, since I got a wild hair and decided not to take my Lamictal and Neurontin last night, I arbitrarily decided to double up on my Seroquel, instead. My thinking was that I would be awake off and on all night because of withdrawal from Lamictal and Neurontin, and that doubling up on my Seroquel would help me sleep through it.

And this is what happened: I stumbled to bed, closed my eyes, took a few deep breaths, and then had the sensation that no matter how deeply I breathed I wasn’t getting enough oxygen. The sensation scared me so I sat up to gather my senses, and that’s when I realized that the real problem was that I couldn’t swallow at all and, more than that, my throat was collapsing every time I laid down. And then my legs got restless. I was kicking and kicking and kicking. Oh God, the misery! I got up and weaved in to the kitchen where I tried to drink a little water, and it was like this: fill my mouth with water, tilt my head back, wait and wait and wait for the swallow reflex to kick in and then gulp. I tried eating a flour tortilla, thinking that the chewing action might kick my muscles back to life, but gave up when I realized that I was at risk of choking myself. By then I was so sedated I could barely keep my eyes open. I said a little prayer, put faith in the fact that I’ve never heard of anyone dying from 200mg of Seroquel, and went to bed. My last waking thought was wishing I hadn’t taken the Seroquel.

I slept in, today. Awakened at 12:50, which is 4 or 5 hours later than I normally sleep (thank goodness it’s Sunday). Why in the hell did I decide not to take my Lamictal and Neurontin, last night? It doesn’t make any sense. I haven’t done anything like that in a couple of years. Why now?

Well, the simple answer is doubt. And I’ll write more about that in my next post.

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Mad Shrink

I haven’t feeling feeling great. Lots of trouble getting sleepy at a reasonable hour, and lots of trouble waking up too early. There was even one night last week when my Seroquel never took affect, which happens from time to time. I couldn’t focus yesterday. My speech was slow and my thoughts were slower. I had a little panic attack during my first break (because I was caught at work in this state). I tried to reach my doctor but her receptionist said the doctor’s calendar was locked in the doctor’s office, with the doctor, who was on a conference call. When I called back later the receptionist apologized and said she’d forgotten to get it from the doctor. Not that the doctor is going to be in, since next week is a holiday.

I have a chip on my shoulder about my psychiatrist. For one thing, she called me a couple of months ago and chewed me out because my pharmacy had contacted her. The situation was this: my doctor had given me new prescriptions for my medications, since my old ones had expired. When I called the pharmacy to get the prescriptions refilled they didn’t see the new ones on file, so they faxed a form to my doctor’s office seeking approval to refill them, then called to let me know they were waiting on said approval. When the pharmacy called me I corrected their error and they filled the prescriptions. The doctor called to tell me to tell the pharmacy never to contact her for a prescription, then went on to rant – and, really, I do mean rant – about how faxes from pharmacies cost her a lot of time and money, and about how pharmacies only do this to line their own pockets. I explained that it had been a mistake but she didn’t seem to hear me. It was a very odd call.

What I wish I had said to her was “Are you f’in kidding me? You charge $140 dollars for 30 minutes of your time, and you’re complaining to me about a fax?” Instead, I apologized.

So, the whole dollar amount thing… what I’m wondering, is, how does she justify it? 30 minutes per session means sixteen sessions per day, which comes out to $44,800 per month in client billings. Let me add that my doctor, like most other psychiatrists, does not accept insurance. Now, tack on to that the fact that she charges $25 per 5 minutes of phone consultation (i.e., if you don’t have time to make an appointment and need her to call you back). Now, tack on to that the fact that you are charged for missing an appointment with less than 48 hours’ notice. Now, tack on to that the fact that she charges $400 for an initial interview with first-time clients. Now, tack on to that the fact that you share your office office space and receptionist with 10 other doctors (so your overhead is nice and low). Combine all of this with the fact that your office hours are Monday through Friday, 8am to 5pm, meaning that those of your patients who work (i.e., most of them) are likely to ask you to call them occasionally, and are not unlikely to miss an appointment here and there… Holy crap, lady, how much money do you make every month, and why in the world would you think I give a s**t about your dislike of the fax machine?

Of course, I’ve signed the same financial agreement with every other psychiatrist I’ve seen. They like to be sure they get their money. I’ve actually paid much more for a doctor’s visit, in fact. I think what steams me is that it feels as if I’m being taken advantage of. It feels as if these psychiatrists are saying, “You patients really suck. You’re horrible to be around! I will charge you for the time I spend rolling my eyes when I think of you.”

I should add, though, that my doctor seems to be a pretty good doctor. Of course, she did forget who I was once, and that was after she’d been my doctor for a little over two years. Still, we all have our moments.

Psychiatry in the real world is nothing like psychiatry as portrayed in the movies, in books, or on television.

More about this subject in another post. Meanwhile, I’ll simply wait for this latest whatever-state-I’m-in to pass. Again.

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Our Sneezes Were Quite Satisfying

I heard someone sneeze at work, yesterday; a sneeze that sounded a bit like my brother’s sneeze.

My brother’s nose figured prominently in our childhood. He had a way of smashing it flat with the palm of his hand and then moving his palm around in a wet, vigorous circle while he pressed down on it, cartilage crunching away. He would do this, and I would say, “Oh! Ug! Stop!!!” when he did, probably because I, personally, found it too painful to mimic. Our noses were always itching inside because of our allergies, and this motion was his unique way of dealing with his itch. I probably just stuck my finger up my offending nostril. We were very itchy kids.

Grief is such a strange and wondrous thing, if what you feel when you miss someone who is dead is grief. I heard this sneeze, it sounded familiar, and the bottomless longing engulfed me. I became paralyzed, like I always do. Immobile, fingers hovering over my keyboard, thankful I wasn’t talking to a customer, terrified my phone would ring, a deer in the fluorescent headlights of work. What am I saying? I wasn’t terrified the phone would ring, though I was briefly glad I wasn’t talking to someone. “You’re almost right here,” is what I thought, what I always think. “You’re just out of reach.” “You’re missing.” “Why can’t I just call you?” “Why did you die? Why you? Why me? Where are you? Is this, could this, can’t this be a dream?” My eyes misted over. I gulped. My lower lip quivered. I gulped again. Got up from my chair and pretended I needed to go to the bathroom for a few minutes so I could collect myself and stop missing him.

My break came up about an hour later, and I stood outside near the curb and smoked. I was thinking some profound thought about death, something to do with how I wished I could walk upstairs and say, “I have to go home and cry, my brother just died, this is going to take some time to get over.” I thought about how I couldn’t do that when he died, and about how I had known at the time it would be like this, these episodes, overtaking me, for years to come, and how resigned I’d felt to that. How secret you have to be about it when it hits, even though you’re talking about it being your only brother who died. Any person in their right mind would say, “Whoa, it’s been nearly seven years. You should’ve gotten over this by now. You’re mentally ill, eh?”

A girl I’ve seen around but don’t know walked outside for her own break and came up to me. “Are you ok?” “Oh sure, how’s your day going?” Instant mask. I am sunny and cheerful. You must have misunderstood me. Flash back to the plane ride to Dallas the morning you died, the steward walking up the aisle, kneeling next to my seat, placing his hand around my own, asking (quietly), “Did someone just die?” Me nodding because I couldn’t speak (because I would’ve starting crying). Him nodding back. “A close family member?” Me, hesitating, wanting to say (loudly) “My only fucking brother, oh fuck, oh my God, just hold me, please, just put me somewhere nobody will see or hear me, for God’s sake. Sob, oh Sob, oh Wail Wail Wail.” And just nodding. Pleased that someone had noticed.

The girl from work started talking about a call she’d taken earlier in the day, and I waited for some way to interject in to the conversation, “I was just thinking about my brother. Someone just sneezed like him. I am overcome with longing. Do you think it would be wrong to go home and cry? Do you think they’d give me an incident for it? If I get another incident they’ll have to put me on verbal warning.” And then she would hug me in a silent, comforting motion. And I would take a deep breath. And the missingness would pass more quickly. Instead, the skinny girl with the platinum hair and the very hip haircut walked up and they compared horror stories about the first girl’s weekend salon visit. And I pretended to be part of the crowd, but I wasn’t really. So I just finished my break.

I figured the kind of opportunity to tell someone about it, to tell someone my brother is dead, and to tell them about the sneeze, would probably come up. And it did, this evening, like a small, red-headed blessing. The guy who sits next to me told me his parents are both dead, of cancer, and told me about their last days. And then he asked me if I have any siblings (because he and his sister are the only ones left), and I said yes. I told him about the sneeze, and I said, “Because I have a very wonderful view of the afterlife, I feel that he’s with me all the time, except for when I really need him to be.” And he nodded, not too solemly, and said, “Sometimes it’s just so weird that my parents aren’t here. That it’s just me.” And then I told him how John Larry died. We are all so young to have lost so much. And neither of us became morose. We went from that to his last visit to Japan, to teaching school for Army kids, to “Engrish” translations he’d taken pictures of. Sweet relief.

I don’t know if he ever thinks to himself that these secret moments of engulfing, drenching, confounding missing are sweet. Are the most intimate reminder of the role you no longer play in this world, and the role that was just for you that someone else used to play.

My brother and I were itchy kids, and we sneezed all the time. Even though I have a painful lump in my throat just from writing this, the memory of feeling so close I could almost touch him is like that itch. Like that sneeze. So odd. So persistent. Our sneezes were quite satisfying, when we were kids. I miss him very satisfactorily, I think. Or maybe I just miss him.

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