Tag Archives: therapy

Reveal or Conceal; Suicidal in Therapy

First I must be clear that I am not recommending people avoid being open with their therapists, especially about being suicidal. I simply have found myself in an odd situation that I want to write about because I think I am not alone in facing this conundrum.

When visiting my new psychiatrist last week I told her that her inability to help me with drugs (something I somewhat expected due to the treatment-resistant nature of my current symptoms) was really only secondary as to why I wanted to see her. I also desperately needed someone, one person in my life I felt confident I could talk openly about my symptoms with.

“Don’t you have a therapist?” she asked.

I replied rather hesitantly that I did, but then made an effort to describe the issues that arise from being so open with my therapist (or GP or any other doctor, really).

The first problem generally arises from the conversation itself.

It is not uncommon for me to have symptoms that involve thoughts of violence or suicidality, and when expressing these symptoms to people they have generally produced a sort of… physical and emotional recoil. The result is something similar to taking a bandage off a wound and showing it to someone who can’t stand to look at it, and they say, “oh yes, no, that looks just fine…” but their body language denies these words completely.

As one might imagine, being able to express that these thoughts and feelings even exist within oneself takes an incredible amount of courage and vulnerability, and a reaction like this tends to make the pain from that exposed wound pulsate even more deeply.

It took me many years to begin to believe that I am not something horrible, a creature, or a villain, or unworthy of help or kindness because of these symptoms I experience. When I see the pain and fear in peoples faces when I even just mention them (when I have been living with them for ages on my own), sharing begins to feel less helpful and more like salt in the wound.

Keep in mind, I have never had a friend, relative, doctor, or therapist who could avoid presenting this kind of reaction. The only people who I have ever been able to talk openly about my symptoms were psychiatrists because the ones I have met have had the best totally blank poker-faces I have ever encountered.

Realistically, I am capable of blowing right past this issue if I genuinely need help managing these symptoms or if I require immediate medical attention. At that point, let people grimace all they want, I am usually in too much emotional turmoil to care.

The problem I have with discussing suicidality or other symptoms with my therapist(s) come most often from discussing symptoms that are present but within my ability to withstand. Which leads me to the second problem…

In Therapy, every second of suicidality is an emergency.

Today I told my therapist about the last two weeks, and it didn’t occur to me to edit anything out or omit certain details. Normally I like to be open and honest all the time, so what benefit could I possibly get by editing myself (in therapy, the one place I want to be the most open)?

The mention of last week’s suicidal thoughts put my therapist immediately into red alert.

I am happy that therapists have been taught to take every mention suicide seriously, however this method has also left a big black hole in the area pertaining to issues we can talk about involving my symptoms.

My therapist was so revved up all she wanted to talk about for the rest of the hour was suicide and while I tried my best to try to explain to her that suicide isn’t a “one hit wonder” for me (only popping up in times of emergency), the notion that anyone could live with suicidal thoughts for long periods of time and be able to simply sit with them, to prolong one’s existence by constant negotiation with these thoughts… or that there might be varying degrees of suicidality, well, it was all lost on her.

I’ve met so many people who, like me, live with suicidal thoughts that linger for days, weeks, months, maybe even years at a time. If I were to immediately be hospitalized for every situation involving suicidal thoughts I’ve had, I would probably be spending at least 1/4-1/3 of my time hospitalized or have an extraordinary number of individual hospitalizations.

Over the years I have become very familiar with my suicidal thoughts. If they are out of control I absolutely have cause for immediate concern, but that might occur in the span of a few hours, or it might take months of constant nagging to reach that point. I find these thoughts, these feelings and urges to be as fluid as my other symptoms, and coming up against my therapist (and many doctors or healthcare professionals I’ve worked with) who believes they are as rigid as a diagnosis must not have ever experienced them for themselves.

Overall, I wouldn’t want the whole system to change. I think it is important that when people begin talking about suicide there can be immediate action taken to help the situation. I guess I just wish there was more room for suicide (or other difficult symptoms) in conversation, more room for a more broad understanding of how these symptoms operate and how absolutely strong the people are who live with them every day without being able to tell anyone (for fear of recoil or blind panic or unnecessary hospitalization).

It is unfortunate to enter into an arrangement (like therapy) where I expect to be able to talk about the things I might not feel comfortable talking to other people about and find myself having to edit what I say or hide the very aspects of myself that have led me to being there in the first place.

 

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Exploring Mindfulness; Anxiety and Bipolar Rage

I have a new therapist. So far I haven’t decided if I like her because we are total opposites in terms of our beliefs and methods. While this has been pretty helpful in terms of learning new things (like mindfulness techniques), it can also be entirely exasperating when it comes to explaining my point of view.

The first day we spoke she seemed confident that the practice of “mindfulness” would help solve a lot of my problems.

For those of you who haven’t come across this technique, mindfulness comes from a Buddhist practice involving keeping your focus on the present, including “regarding your emotions in a non-judgmental way” (that is a direct quote, I can’t say I totally understand).

The mindfulness meditation I took on takes about five minutes and involves taking deep breaths, focusing on relaxing my body, looking at my surroundings and finding 3 things that are pleasing to me (colors, textures, etc.) and then formulating an appropriate emotional response.

What I found was that after a week of using this technique (several times a day, sometimes 10 to 15 to 50 times as needed) my anxiety was somewhat responsive. I say somewhat because I often found a bit of relief after the exercise, but it wasn’t uncommon for the relief to last about five minutes and then I needed to do the exercise again. I could see how it would be easier to continue doing the exercise for someone who is seated much of the day, however when walking down the street or overwhelmed at the supermarket I was having a really hard time dropping everything to breathe and relax.

At the same time, I also was curious about using this technique to combat bipolar mood swing reactivity, but the results I experienced were somewhat catastrophic.

If you’ve ever seen the episode of Seinfeld (yes, I know, a common theme lately in this blog) George’s father begins using the mantra, “serenity now!” to help combat his rage. What we find out at the end of the episode however is that this practice was only bottling his rage up to a critical breaking point.

However comical, this is actually fairly similar to what happened to me when I was trying to use the mindfulness meditation to address (primarily) bipolar reactive rage. At first it seemed like it was working great and I felt quite pleased (less like breaking things or shouting or hurting myself), but within a span of four or five days the rage suddenly exploded out of me, and I leapt off the couch, threw the remote control in one direction and my glasses in the other and made a mad dash for the hallway where I very seriously expected to throttle whoever was on the other side of my door.

It wasn’t as if this was a situation that had gone on all day and I had been “stewing”, I felt perfectly fine one moment and then within two or three seconds (literally) I was ready to break someone over my knee like a piece of kindling. All I can say is thank goodness for my boyfriend, because if he hadn’t been home to divert me… well I am still shuddering at the notion of what might have happened. Instead I just stood in the bathtub and screamed and cried for a solid half hour.

I have a couple theories about why this happened.

The first involves George’s father from Seinfeld screaming “serenity now!” The thing about rage that I find makes it so difficult to deal with is the energy that comes with the feelings. For me, it has never felt like the emotion builds up if I don’t express my anger, frustrations, and rage, it is the energy. Since childhood my methods of expressing rage have all been physical because they allow me to address and release the energy that is overwhelming me. Unfortunately, they also have all been more or less unhealthy.

With this mindfulness technique I used, I was addressing the emotion I was experiencing, but not the energy that came with it. Once it built up it only took the tiniest moment to trigger it and… kaboom.

My second theory involves PTSD as I have encountered several situations where very minor things have seemingly flipped an invisible switch in me. Frankly I find this to be less likely in this situation because it did not involve any of my typical triggers (being in close proximity of a stranger, the bus, etc) but I can’t discount this as a possibility.

Finally, one could suppose the incident and meditation were not related. Frankly, I can’t say with absolute certainty that they are, but I am nervous to try again given how close I came to, well, certain incarceration.

At any rate, being able to try new “treatment options” that don’t involve pumping my body full of chemicals has definitely been a welcome change. And as frustrating as my new therapist can be, I think a little change can do me good.

At this point we are brainstorming ways to potentially address that rage-energy in conjunction with mindfulness meditations so stay tuned, I am sure there will be more to come on that topic!

Leaving on a High Note

If you’ve ever watched Seinfeld you may remember Jerry (a comedian) advising his best friend George that the best thing he can do is to “leave on a high note.” Lately I’ve been trying to change some of my habits to reflect this idea.

A big problem I have been facing is that no matter what my mood is like during the day, it often takes a big downward spiral (even more downward in the event I am already depressed) in the evening before bed. Going to bed feeling so negative has lent itself to trouble sleeping and nightmares for me, so when I first discovered that the specific mindset I am in when I go to bed plays a big role in my ability to be fully rested the next day I began to do some experimenting.

Lately I have been trying to go straight to bed during a brief moment of contentedness. Sometimes that means booking it to the bathroom immediately after watching a show that has made me laugh or smile, or even going to bed earlier than I normally would (to cut off my emotional nosedive before it gets too out of control). Sometimes that means picking a moment where my rapid cycling is affording me a breath of fresh air from the depression I was experiencing moments earlier.

My general desire in these moments is to stay up later (because I may feel, for a moment, a bit better) but experience, at this point, has taught me that if I do the waves of depression and pointlessness can wipe out those small, good (or even just neutral) moments and leave me stewing for the rest of the night.

So far this experiment has provided me a slightly easier time falling asleep, and though I am sleeping slightly less, I am feeling more rested from the time I am asleep.

I have also been working to incorporate the idea of “leaving on a high note” with my therapy sessions. Let’s face it, they can get pretty… well… glum (is a nice word for it). Spending five minutes at the end of the session bringing the mood back to a happier or funnier place has helped me leave therapy sessions feeling slightly less like a sack of discarded potatoes.

This idea is also something that has made a big difference for me in terms of communicating with friends and family members as well. Leaving a conversation in the middle of something serious or even triggering without bringing things back around to a happier place has been extremely detrimental to my overall mental health. It is almost as if those negative topics, if not contained, spread through my system and drain me of all my energy. Encapsulating those moments in specific conversational bubbles (and moving to another lighter  bubble after hitting a dark one) seems to make a big difference for me, in terms of becoming triggered.

One of the things I like most about this idea is that no matter how dark, or weird, or awkward things get, there is always opportunity to make things a little lighter before moving on. While this is something I tend to do with humor, even something as simple as apologizing to the store clerk who I’ve just been short with has been enough to help me leave a potentially negative situation feeling slightly better. Sometimes it feels really important to me to recognize that I can’t always keep situations from being negative (or keep myself from feeling negatively about something), but if I do what I can to turn things around before walking away, that negativity seems to have much less power over me and doesn’t linger the way it might otherwise.

Maybe this holiday season a good option might be to leave on a high note. A polite goodbye before a party or gathering turns into total chaos could be the difference between a short, sweet appearance and that dreaded stressed out holiday meltdown. Not only that, but leaving when you feel good might also help keep you from feeling negatively about your friends, relatives, and yourself!

Circling America to Block Intrusive Thoughts

For a long time I have been falling into a pattern with mental health professionals (and, let’s face it, general folks as well sometimes) who seem to believe they hold the answer to my blight. The answer, it seems, is to let it go, “it” being whatever it is that is nagging at me for the moment.

Unfortunately, that has been about as helpful as telling me to solve my problems by digging up pirate gold. I have no map, and not one person I’ve asked who has made this kind of suggestion to me can seem to convey exactly how one lets something go. 

No matter how many children I see on the news singing the Frozen theme song I can’t seem to pick up this skill via osmosis. Likewise, I have never suddenly been able to perform an ollie after someone handed me a skateboard and said, “just do it, man!”

Seemingly more helpful suggestions have been to “focus on something else,” or “push the thoughts out of my mind.” I have been able to accomplish the pushing skill about four times out of the several hundred I’ve tried (but at least I know it can work if I put up enough of a strong arm) but trying to focus on something else has also been… spotty at best.

For whatever reason, I seem to live with the voices of all the rude, horrible people who have ever said hurtful things to me swirling around in my head. Try as I best to let go of them, they always seem to linger like flies and fail to allow themselves to be relinquished. They don’t seem to be interested in being set free, not when there is fresh meat (like me) around.

So what do you do when you let go of something that wont let go of you?

Well, first I discovered that if I shouted, “LA LA LA LA LA LA LA LA LA!” I could drown them out a little.

From there I moved onto using the chicken dance song as a personal mantra, singing it at various intervals to block out the scathing internal conversations. This helps, but is decidedly obnoxious to anyone around who can hear (as is the random shouting).

Last week I finally met with my new therapist who brought to my attention a technique where you move your eyes in the shape of the United States, along the border all the way around over and over again. I’ve tried it with my eyes both open and shut, and for whatever reason after two passes the noise and horror in my head seems to die down.

I believe this technique is based on the same school of thought that EMDR comes from (a therapeutic technique that uses eye movement to help the brain become desensitized to traumatic experiences), and though I am still looking into this method for my own PTSD symptoms I don’t currently have the finances to be able to afford to see someone who practices it.

Realistically, I can’t walk around and do everything with my eyes spinning around in my head but if this works I am certain there must be other silent, less obtrusive methods of blocking intrusive thoughts. When I find them, I’m sure you will be the first to know…

One Good (Manic) Turn Deserves Another

The last thing my (ex) therapist said to me (jokingly) was,

“…and I never got to see you manic!”

In my depressed state I shrugged and replied,

“it is rare these days… euphoric mania, anyway. It hardly ever happens anymore, frankly I can’t even remember the last time it did.”

Little did I know, within a week I’d be hunkered over my chest of drawers urgently rearranging my shirts because, well, is it better for them to be grouped by print or by sleeve length?? And, no, no, no, the underwear needs to be arranged in descending order of favoritism and then by color!

As much as I would like to say I saw this swing coming, I would be lying to you. Generally I would say I have a tendency to become manic in October, however I find that when I say that ahead of time it never actually occurs.

This time around I think I would like to blame the aggressive head cold that has been going around for my lack of catching the warning signs. Normally euphoric mania comes on largely in a physical way for me first, but I can’t say I felt any kind of awesomeness, electric humming, or skin-crawliness that I normally experience until much later on. This time around (because of the cold) I felt sinus pressure, ringing ears, a sore throat that lingered on much longer than I anticipated, and initially much more lethargy than I normally would when mania strikes. By the time I started to realize things were getting out of control it was a bit too late to divert it.

Of course, in hindsight I can say, “ahhhhhh, ok,” to the series of odd and rather impulsive actions that led up to my frantic laundry situation and subsequent hours of laying in bed awake, chest pounding, having rapid conversations in my own head. One would think I might have had a clue when the series of somewhat depressing situations I’ve found myself in lately became increasingly hysterically funny to me, or when I stopped each of five consecutive movies I was trying to watch halfway through because I no longer felt interested (and then the only movie that did hold my attention was The Silence of the Lambs), or when I cut all of the instances of the number “2” out of a cosmo magazine to see which one was “the best,” or when I spontaneously maxed out my credit card buying tickets to see The Who. I was even having trouble writing, many of my sentences were coming out backwards.

Contrary to popular belief, these are not things I normally do. I’m the kind of girl that usually just likes to wad her shirts up in a ball and shove them in the drawer, or look at the prices and fluid ounces of every bottle of shampoo in the store to make sure I am getting the absolute best deal before buying one. I know I usually claim I don’t do the “spending” thing with mania, but apparently this was an exception. (Boy, I hope I’m not inadvertently picking that habit up!)

To be fair, I think normally these are things my boyfriend would probably notice, however he was out of town for work all last week.

The episode seems to have peaked Saturday night and then turned to the dark side, leaving me experiencing four swings of “crazy girlfriend” type, hostile-agitated-mixed chunks appearing between mildly euphoric moments throughout the day.

I’ve been having trouble getting my thoughts together long enough to complete anything I’ve been trying to write, but I have a few ideas that I hope to get down soon. Thankfully I have been lucky not to experience any psychosis in the last week (knock on wood), however the sort of hostile, “I hate you” mood swings I’ve been having haven’t exactly been a walk in the park either.

I have my intake appointment with my new psychiatric clinic on Friday (hooray!) and though they are usually somewhat grueling, I will be happy to have someone around to help me untangle the big ball of emotional spaghetti in my brain again.

Back to the Basics

Things seem to have reverted back into a state of normalcy for me. Of course, when I say normalcy, I mean my normalcy. This change definitely has it’s plusses and minuses (less physical pain and vision problems, a return to a flip-flopping of psychotic mixed and depressive states, and the typical health care team issues I tend to run into every six months or so) but I wanted to address this return “back to the basics” that has occurred over the last two weeks before writing about anything else that has been on my mind.

My current psychiatric medications have returned to a regimen of  lithium only. 

I’m sure it was pretty clear that the seroquel I tried the last few months brought on some serious health problems, but it wasn’t until the issues with blurred vision, dizziness, nausea, and light and motion sensitivity that I began to suspect the wellbutrin I’d began in the last two months might be contributing to the problem. After having my eyes, ears, and stomach checked out I began a systematic stop and start of the medications I was taking at the time to see if any changed occurred. I pulled the plug on the 150 mg of wellbutrin I was still taking (after decreasing a week earlier and seeing some improvement and speaking with my psychiatrist) and about ten days later (Saturday) I was able to sit through watching a movie for the first time in five weeks without thinking I was going to vomit.

Not having been able to watch tv or movies for that long was pretty agonizing, movies are one of the few things I generally still feel passionately about and being without that sense of comfort was very jarring.

I was a little surprised (but glad I didn’t have to go see a neurologist about this) because the warnings for wellbutrin list “eye pain and vision problems” but that isn’t very specific. What really tipped me off was that I found out that wellbutrin can trigger problems with vertigo, and though I have experienced plenty of vertigo in the past and what I was dealing with this time was different, there were aspects of my symptoms that felt similar. At any rate, this issue is improving… and I wont be taking anymore wellbutrin in the foreseeable future.

The swings are back in action. 

While the seroquel seemed to keep me from swinging around the mood spectrum, it also kept me in the depressive end where I was sinking very quickly into a dangerous place. Now that I’ve stopped it, I’m back to my typical, sporadic swings lasting anywhere from thirty minutes to days or weeks at at time.

“From your perspective, which is worse?” I asked my boyfriend. “When I am depressed all day every day, or when I seem ok one second and then fly off the handle the next?”

He paused for a moment before replying, “I can’t really call one ‘worse’. They’re both equally devastating.”

I feel like I ask myself the same question a lot, because remaining in a single state (like depression) can sometimes feel better, more stable to me than rapid cycling because I can often do a better job of predicting my future mood; depressed. At the same time, everything shuts down and my mood rarely stays “somewhat depressed”, usually moving toward “earth-shatteringly depressed”.

If I’m rapid cycling, I can usually experience one or two hours a day where I feel relatively ok, and if I’m really lucky, maybe one day in a week where I feel relatively stable. Sometimes, just the fact that these moments are possible makes rapid cycling feel somewhat better to me.

I find the negatives of rapid cycling to be much worse though. It grinds on my relationships, I have no way to make any kind of predictions about how I will be feeling from one moment to the next, and switching into mixed episodes (which has become more and more common for me) becomes extremely dangerous.

Annnd health care team problems… as per usual.

I feel confident today in saying my concerns about my healthcare team the last week have had nothing to do with delusions.

Usually when I have problems with healthcare, it has been because of insurance coverage, or co-pays, or my old doctors not taking new insurance, or whatever element of the system seems broken at the time. This time, my concerns are a little different.

October has always been a fishy month to me, and I don’t consider myself superstitious but usually when something weird goes down or people are acting very strange, it is in October.

Anyway, first my general doctor started acting very strange and making me incredibly uncomfortable. He’s began giving me these long “pep talks” about how I need to look inside myself and find happiness, naturally this is one of the biggest turn-offs you can come across when you have a mood disorder. This has happened twice now, and though I understood when it happened the first time (I had a breakdown in his office) the second time it was completely unwarranted and generally had nothing to do with anything we spoke about in my appointment (regarding stomach pain). This man has always been a good doctor to me, very smart and professional for several years, and I know he is coming from a place where he is intending to help me, but for the most part while I was stuck in that little cold room with him trying to make extended eye contact it felt like if either of us is insane, it is definitely him.

Next it was my GI specialist. I needed a prescription refill order and she failed to return any of my calls, messages, or emails for three days. When she finally did send the order, she sent the wrong order to the pharmacy and never called me back. After calling the office again (to make another appointment) all of the notes from our last appointment have mysteriously vanished and there is no record of it. Needless to say, this (even more than the above problem) makes me extremely nervous. I realize she is a busy woman, but I feel like my experiences last week are definitely bordering on (if not already) unprofessionalism. I ran out of medication saturday, I still haven’t heard from her or her office.

Finally, my therapist quit unexpectedly two weeks ago. He had scheduled a follow up appointment with me last week, but the receptionist called me that day and said he never showed up. By the time this happened I couldn’t help but laugh.

I don’t have much of a plan of action for the first two doctors (maybe they’ll get their sheezy together?) but as far as therapy is concerned, I’m ready to switch clinics. The one I have been going to the last three years I’ve had a lot of problems with, and the people who work there are very inexperienced. Instead I’ve began pursuing a community clinic specializing in patients on medicaid with more significant mental health problems (me!), at this point I’m just hoping to get in before next month when things become extremely (more) stressful.

Tonight I have an appointment with my psychiatrist and I am keeping my fingers crossed he hasn’t completely fallen off the deep end too.

Moving; Looking at Life in Hindsight

This Friday I thought I would start by leaving you with some good news; after a very lengthy application process and some big hiccups we’ve been approved for the apartment we wanted!

Living in Seattle has involved a lot of moving for me. Since moving here in 2006 I’ve moved 8 times, and the last three years at our current place is the longest stretch I’ve gone in one place since moving away from home at age 18.

When I got to the city I was moving around so much I didn’t accumulate much (in terms of stuff) but having been staying put the last 3 years has meant diving into a much more intense packing process. Beyond the usual stuff I’ve gleaned (boxes and boxes of fabric, more rik-rak ribbon than any one person rightfully needs) I have also accumulated an extraordinary amount of paper goods.

Part of the anxiety I have involves keeping pieces of paper that I deem “important”. Apparently… this means everything. Like, a doodle I did of a dog, or our light bill from the 8th month we lived here. Looking back while packing, I can see clear periods where I attempted to clean some of this up and then slumped back into depression, leaving behind piles representing particular periods of time scattered throughout the apartment.

Most of the papers I’ve gone through in the last week have been repetitive. SSDI paperwork. DSHS paperwork. Insurance (or lack-thereof) paperwork. Yes, important at the time, but now a year or more later… useless.

Every so often I strike gold and find something useful.

“Oh good, I’m glad I really DID put a forbearance on my student loans!”

Because… who knows at this point. I can’t remember a whole lot!

In one of the piles I hit the equivalent of a gold nugget; the workbook I filled out during my last hospitalization in 2011. 

I leafed through it knowing I had scribbled crap down in there right before being released because I had found out filling out the pages was required rather late in the game. One loose page fell out though, and this one looked genuine. It said:

Positive Momentum

1.) On the left side of the page, identify which one of these areas you are struggling with the most and write it out. (Think about why you came in the door).

(I didn’t have the left side of the page, but what I wrote seemed pretty self explanatory.)

“Wearing the mask – I don’t normally express my feelings in a daily setting.”

2.) Ask yourself how you might be able to think about or do things differently to get some kind of positive momentum going for yourself?

“I would like to see a talk therapist again and continue gradually letting my boyfriend in.”

***

A few days ago when I read that, bells and whistles went off in my head, particularly the response to question one. Frankly, even though my symptoms have gotten noticeably worse since then (overall) I feel eons better after dropping the act, “the mask”, and allowing myself to show real emotion (even if it is out of proportion at times) instead of trying to keep it contained internally or just in journals.

I was happy to see that the response to question two is one that I have followed through on. Not only do I have a therapist (which has helped me continue to express those feelings from question one) but I have talked a lot to Corey about the things I am dealing with and he is usually the first to help me brainstorm a workable solution (even if that solution is to do nothing).

Sometimes it can be hard for me to look back, I normally don’t allow myself to read my own journals because I find them triggering and my blog posts are structured much more differently than my everyday sort of casual, emotional writing. It can be hard to know if things have really gotten any better, but this one piece of paper (found in thousands) was a nice reminder that I have moved forward and by continuing to do the things I’ve set out to do, I am continuing to help myself.

In a stressful situation, it is amazing how finding a needle in a haystack has helped bolster my confidence about getting things done and moving on to something different. After all, this single page is a real reminder of how different can be great.