Where the dogs of society howl

Lots going on.  Mainly feeling lost.  I’m still on FMLA per my psychiatrist.  I’ve been off all this month and won’t be going back until next month.  I’m having a hard time keeping my medications down and we’re not sure why.  My moods are cycling rapidly and I’m thinking it’s because they aren’t being absorbed properly since the surgery.  I’m worried about having all this time off, how it’s going to affect my job.  It gets more interesting: I have an interview for another job next week.

I reached out to a friend of mine regarding a possible job opportunity in a private practice setting.  I was doing some research and found that working midnights with bipolar disorder is a no-no.  Apparently most people working midnights – mainly those in the healthcare field like nurses – with bipolar disorder have circadian rhythm issues, leading to shift-work disorder (which I’ve been diagnosed with).  This triggers mania and many times, hospitalization.  Sound like anyone we know?!  

So I got freaked, reached out to a friend and asked if she knew of any job opportunities.  She reached out to her boss who reviewed my resume and offered me an interview.  I miss doing therapy.  I remember my old supervisor said to me ages ago while I was in training after graduate school and doing therapy in an underprivilaged area with substance abuse clients.  I was burning out hard, between the clients and the administration I couldn’t seem to meet anyone’s expectations of me and wanted to quit doing therapy altogether.  I told him that I wanted to work in a hospital doing intake assessments and case management to take a break.  I said that it would be “one and done” – I’d never see the people again after they left; no need to build rapport and no need to terminate; they couldn’t accuse me of abandoning them if I’ve known them for 20 minutes.  He told me that I was an excellent therapist and working in a hospital setting was “a waste of my talent.”

He burned out too and moved out of state.

I didn’t listen and got a job doing assessments.  The population I work with tend to abuse the system.  I often see the same faces – sometimes 3 times a week.  I’ve had some people discharge because they tell me they are not suicidal, turn around in the parking lot and walk directly back into the hospital stating they are suicidal and homicidal and want 3 sandwiches.  The record turnaround is 7 minutes – I actually counted.  It is rare that I assess someone that actually needs help.  I got into this profession to help people.  Will I have better luck doing so in private practice?  I think so.  I think I will because people are paying to be there.  Sounds messed up, but it’s true.  This is your “managed” care/health system at work, USA.  I have “managed” in quotes because there is nothing manageable about it and you, my dear reader, know it.  I’d be ignoring the system by leaving, but I’m not single-handedly going to overhaul the health care and mental health system – I know that.  Contrary to popular belief by many recent graduates in my field, you cannot change the world.  You can only make a dent.

Here’s where my trepidation lies.  I would have to file quarterly and withhold my own taxes.  What a pain in the ass.  I’d also have to go on the exchange for health insurance.  God please no.  Right now every doctor I work with is in network because they all work for my employer LOL.  If I go on the exchange, there’s no guarantee they take that insurance and I’d have to pay astronomical premiums.  It would take several weeks to build a caseload and get paneled with insurance companies, which means I would not be paid by the patients or insurances for those weeks.  Weeks.  Flipping WEEKS, man.  I’m torn.  Do I liquidate my house fund to pay my bills while I’m not paid for those few weeks – if I’m even offered the job?  Do I leave my awesome co-workers because I hate the population I work with?  The population, the crushing rules of administration and low wages are what keep me from wanting to stay are my job.  I know once I get a full caseload as a private practitioner I could rake in double what I’m making now, but I’m afraid.

I’m terrified.  What if I’m not good enough?  What if I fall on my face?  What if I messed up my taxes?  What if my clients don’t like me and I end up without anyone and I’m broke?  My psychiatrist told me it takes a while to build a caseload too.  How do I work both jobs to cover my butt?  Work midnights and days?  I freaking can’t.

And Mom’s going into surgery.  They said it’s going to last 8 hours and due to the definite blood loss, she had to sign a waiver permitting them to give her a blood transfusion.  So I’ve been scared about that.  Lately her voice has been irritating me for some reason and I’ve been blocking out most of what she says, but I think it’s me being irritable because of my mood cycling.  I apologized to her if I had been short or curt with her and explained I had been tuning her out.  I told her I’m scared shitless about her surgery next week.  I wish she didn’t need it.  She’s going to lose 20% functionality of her back in all directions.  She seems excited she’ll never have to load the dishwasher again.  Lucky.  Not the way I would want to avoid that chore, but still lucky.  I’m just scared – I keep telling myself not to tune her out.  Not to put this bed vibe out there in the Universe, but if her being annoying is the last thing you ever hear her say, hear it anyway.  I try to remember that and listen to her give me instructions about how to feed her fakakta fish.

Advertisements

I can’t destroy what isn’t there

TRIGGER WARNING – RAPE

I met with my psychologist this past Monday. Aside from reminiscing about all my psychiatrists of the past (and their behind-the-scene proclivities), we talked about the moment I went nuts …no I was right. Went nuts is totally appropriate here.

She said that age five, I tried to kill myself. I know; I was there. I don’t remember the circumstances, only the where, the when and how. I remember my disappointment in it not working and my becoming even more depressed. I tried a few times. As a child that size, your resources and vocabulary are limited. I felt this deep overwhelming panic, anxiety, sadness, loneliness, hopelessness, anger, fear and helplessness and felt I had nowhere to turn and didn’t have the right words to express any of it.  So it appears, according to my psychologist’s theory, that my brain’s chemistry changed the first time. My body’s arousal system and my neurotransmitters went nuts.

I was majorly depressed and disordered by age 6 with at least 2 suicide attempts under my belt.  By age 16 I was full-scale self-injuring on the daily; it looked my dermatologist was Edward Scissorhands.  My mood was all over the place due to my hormones and my outright refusal to take medication until the next year when I was almost hospitalized for suicidal threats and increasingly intensive self-injury of which I still carry the scars.

I went to college at age 17, fully medicated for my safety and for those around me but it had little effect.  I went to a very large, very competitive, pseudo-Ivy League school.  I had very little social support and many of those I met didn’t fail to remind me of my social and racial status.  Yes, I was a part of the 49% of the students receiving financial aid and yes, I’m black.  (No, asshole – I got here on merit, not affirmative action.  In between slicing and dicing I managed to pull a 3.9 GPA out of my ass in high school.  I actually had people make comments in class about this shit to my face.  Unbelievable.)

Anyway, let me back up a bit.  Welcome Week, freshman year.  Exciting for kid fresh out of high school – getting to party in college!  I had arrived.  I was grown as far as I was concerned.  I could stay out late, meet guys, new people – have a blast!  My best friends from high school, now attending the rival college, were coming down for the weekend and we were going partying together so I was excited.  The four of us get some food at a local hangout near my dorm and start walking around campus to find a party that looks cool.  One of my friends, Tom, was a sophomore so he knew everything about frat parties since he was a frat member at Alpha Chi What-The-Fuck-Ever so we followed his lead.  We walk into this relatively jumping party – just wall to wall people, a DJ, jungle juice, the whole shebang.  Jim and Raquel start dancing (they were dating) and vanish into the mist of the crowd.  Maya, a sophomore at our school, fucks off somewhere, probably trying to find a rich white guy (she has a type – has since high school) and leaves me dancing by my lonesome.

At a frat party.
My first night on campus.
Awesome.
Well, this is the start of a Lifetime movie.

Boy did I call it.  This fucking guy comes up to me, introduces himself as “[inaudible due to the loud music played by the DJ]” and points toward the center of the dance floor.  I nod “okay.”  There’s 60 goddamn people on this dance floor.  I can’t be abducted in the middle of a crowd of 60 people.  It’ll be fine.  So we start dancing; no big deal.  He then moves behind me and puts his hands around my waist.  I can tell he’s drunk; I’m not having a good time anymore.  I need to find my crew and get the fuck out of here.  I’m looking for my crew so we can di di mao.  Before I get a chance to break away, he puts his hands down my underwear and ::ding-dong:: WELCOME TO COLLEGE.  Unwanted sexual contact.  I grab his hand and pull it out of my pants and walk away.  Of course NOW my friends are ready to leave and find another party.

Right before we go, this asshole gives me his number.  He wouldn’t leave me alone until he could put it in my phone.  He was too drunk to spell his name right.  Unless he was actually named after a tennis shoe.  I never told my friends – he was drunk, right?  No one’s fault – blame it on the alcohol…  I never told anyone.  Just buried it along with everything else.

Ah sophomore year.  This one’s gonna be tougher to talk about.  I met this gem on the back stoop of my dorm at the beginning of the school year.  We went on 1 or 2 dates.  He dropped me off at my dorm room and when he hinted that he wanted to take things further than a kiss goodnight, I told him I had a rule: 6 months of monogamy before sex.  He seemed outraged.  I made it clear I didn’t care – those are my rules.  Next date, we decided to stay in, were watching “Law and Order” when he said he had to tell me something: he was on parole for armed robbery.

Uhhh.  He knows where I live.  He knows where my family lives.  He’s 6’2”, 245 lbs – all muscle.  I was 5’4”, 145 lbs.  I was fucking terrified.

Someone tell me please: When an armed robber comes to your living quarters every few nights for several MONTHS, what do you do?  When you feel like you’re not given many options considering their size and tendencies to be ARMED?  Fucking terrified.  This went on for 3 months.  During that time, I isolated from my friends and family, I was “stealthed” countless times which resulted in a case of (CURED!) chlamydia.

When I finally broke down and spoke to the only person who I thought would listen, my ex-boyfriend Anthony, he helped give me the strength to leave.  I left and the man stalked me in my dorm room for a few months.  It took a key card to get into the building but somehow he would get in and leave messages on my door calling me “bitch,” “slut,” and “fuck you.”  I reported it to campus security but it was useless.  I moved out of the dorms into an apartment with Anthony the next year; we got back together after this.

Anthony is a story for another time.

So the intimidation-rape is trauma #2.  Trauma #1 was whatever happened at age 5 that triggered my suicide attempt – that is a mystery to me as of yet.  I’ve told my psychologist I’m considering going to a hypnotist because I’m tired of this Swiss cheese stuff – this holey memory of mine is ridiculous.  We either figure this out or we don’t.  My psychologist said something that has been weighing heavy on my mind all week.  She said that her theory is the chemical imbalances that have been caused by trauma can be reversed by re-training the brain.

…Excuse me?  If I’m understanding this correctly, bipolar disorder can be reversed through behavioral or cognitive behavioral therapy.  Are you shitting me?  

I’ve just been in limbo all fucking week, letting that sink in.  Think about it: if that is true, I’ve been able to fix myself this whole time.  I’m like Dorothy at the end of Wizard of Oz.  She had the shoes throughout her whole walk through Oz — the bullshit with the Witch, the Monkeys, the talking head of the Wizard, all of it — and she could have gone right home.  Unreal!  While I understand in Wizard it’s a little different – she needed to understand how good she had it in Kansas.  Someone tell me the point of walking this shit-brick road?  Where’s the fun in french kissing death?  There is none!

If this is true – what if I don’t get better?  It’ll be just something else I’ve failed at.  Can’t kill myself right* and can’t heal myself, so I’m stuck in the middle.  Fucking perfect.

*Ok, I may have lost a few of you there.  As a mental health professional, that’s a horrible thing to say and hear.  However, as a someone with a mental health disorder I can say that I may speak for a few people out there who have felt this way. when they wake up in the hospital, alive.  I did – I was pissed off.  You feel like a failure because you didn’t complete a “goal,” however this isn’t a goal – long term – you want, even if your depression says otherwise.  When I say I didn’t do it right, I mean that I failed and there’s no escape from this disease on either end – through death or living.  It’s fucking maddening and it makes me feel hopeless for a painless life.  While I appreciate the empathy I have gained for others like me, I wish for a life like anyone else’s.  I wish for happiness.  I’ve never known what that’s like because even what I’m happy I’m always wondering when the feeling is going to end.

‘Cause life is just a dream here

I saw my doctor this week. I told them the SSRI they prescribed isn’t doing squat – I’m still depressed and picking.

Doc said that picking is near impossible to cure, so not to focus on that more than the depression. So I guess I’m back to nail polish and hand lotions to prevent cuticles and seeing my nails in the first place. Great.

I mentioned that I’ve been getting angry and irritable more often – Doc reminded me that that’s indicative of either mania or depression, in this case Doc believes it to be depression. Doc has me back on anti-anxiety meds to prevent me from stressing out, causing the anger and irritability, Doc also suggested I go back to therapy.

I told Doc about my drinking more often. Doc wasn’t pleased; they told me not to mix my meds and they’d rather see me take meds than drink at all. I don’t know how I feel about that – it’s really about which is the lesser of two evils, but I do see the point. I’m going to try and increase my usage of coping skills to prevent the use of either.

I spoke with my mother yesterday to inform her of the doctor’s appointment. She said she hasn’t seen me manic in a while – she didn’t understand what I meant when I ran away during dinner earlier this week in tears, ashamed of my behavior. My mother, who’s known me longer than I have, and also suffers from the same illness (technically untreated, however is medication resistant), said “that wasn’t you being manic and I’ve seen you manic. That was you being happy for once.” I froze.

I haven’t been “happy” in months. I forgot what it looked and felt like. Holy shit. It took someone else to point it out; I’m so out of touch with myself – I think that may be on purpose.

I want to scream at the top of my lungs; maybe I’ll wake myself up.

A sweet girl – POSSIBLE TRIGGER

I don’t like labels. I’m constantly telling my patients that it’s not about their diagnosis, it’s about their recovery, yet I find myself trying to label myself all the time.

Labels serve a purpose. As humans, we tend to categorize the things around us to help in our understanding of the world and its processes. If I described something as “that living thing that hides in a tree,” you may not know to what I’m referring unless I provide a category – Animal? Plant?

The intended purpose of a diagnosis is to help clinicians identify a grouping of symptoms. Labels get dangerous when people misuse, overuse, or make assumptions regarding a diagnosis.

You see misuse all the time. “I’m so bipolar today!”

Shut the fuck up; no you aren’t. You’re moody and perpetuating the stigma of mental illness. Honestly if one could be bipolar for only 24 hours…

Overuse is just as bad. “I have bipolar manic depression.”

…No you don’t. Manic depression, as a classification, no longer exists. The correct term is “bipolar disorder.” The danger of over-using these terms is the stigma that follows along with it. Why are we over diagnosing ourselves? Isn’t being on the multi-axial system ENOUGH?! /rantoff

The reason for all of this is a recent quest I went on. You see, I’ve been studying the new DSM-5 (I’m a tad nerdy) and stumbled across something called “excoriation disorder.” Now, under DSM-IV-TR, excoriation seems to be a symptom of OCD: dermatillomania.

Why is any of this important? Because I’ve been doing this for years and didn’t know it was a fucking disorder. I didn’t think it was a problem.

Granted, my mother thought it was disgusting that I’d “picked at my nails” so much that I’d permanently damaged my nail beds, causing my nails to grow short, brittle, and very misshapen. I just thought it was a bad habit to pull my cuticles until they bleed (and sometimes after they do). I thought it was just anxiety for me to take sharp objects (safety pins, push pins) and use them to pull the nail away from the nail bed.

It’s just something I’ve done for a while. It just got worse when I started working full time.

So I spoke to my psychiatrist about my symptoms; I tried not diagnosing myself, but I know me and I know the DSM. My doctor gave me some meds for impulse control/OCD.

I painted my nails tonight; maybe if I don’t see the beds, I won’t pick at them so much.

Sometimes it’s nice to put a name to the bully that’s been shoving your face in the dirt for 20 years. Knowing your bully’s name is only a part of it – you need to know how to fight them; that comes through education, support, and inner strength.

point of balance

I’ve been trying to avoid this blog for quite sometime.  Forced introspection is not something I’ve been looking forward to.  Recently, I’ve spent days wading through streams of countertransference and I’d like for that to stop.  The idea of therapy is just that – an idea – it passes as soon as I think of going back.  I miss my old therapist, but my insurance won’t take them and their office is almost 20 miles from work.  Other therapists just didn’t seem to “get it” – or better yet, me.

My disease has taken an interesting turn.  My psychiatrist took me off my Lithium a few months back, only for me to have a meltdown 3 days later.  I called in the morning, that evening I was back on it.  Now, the doctor told me to take it in the morning – for years I’d been taking everything at night.

This makes a big difference.

You see, I’m not your average woman.  I don’t take long morning showers, followed by makeup and hair time, followed by picking out the right outfit for the day… My mornings are never that drawn out or glamorous.  I get up, usually 15 minutes late – after hitting snooze twice – and jump into the shower.  I spend a maximum of 8 minutes in the shower.  Eight minutes.  I put on socks of even length (Note: I did not say color, pattern, or style; I didn’t say they matched my outfit as they are the first thing I put on) and clothes that aren’t completely wrinkled and hopefully match when I turn on the lights (yes, they’re clean).  I brush my teeth for 2 minutes, hair for 3, no makeup, grab something from the kitchen that can be eaten while driving and I’m out the door.

…Didn’t see any Lithium in there, did ya?  Neither did I.

I told my psychiatrist – who was thrilled (remember, they wanted me off the stuff anyway).  But I was pissed at myself, pissed for my lack of “medication compliance.”  I expected better of myself than to be “too busy” to take the medication I credit as saving my life once.

So, my doctor put me on Seroquel full-time.  Now, seeing the damage it’s caused in my personal and professional life I was not thrilled, but I figured I’d give it a fair shake… Until it made my belly shake.  So, as someone who suffers with body image issues, this is not the drug for me.  Between that, the risk of tardive dyskinesia and diabetes this pill can kiss my ass.

Again, not “medication compliant.”  Now, I can understand where my clients are coming from when they just stop taking their medications because of side effects.  I’d love to believe that I know better than they, but I don’t.  I’d like to say I’m better about advocating for myself, but maybe they advocate just as much or harder; I listen but the system they’re in was not build to hear.

I’m still on my other mood stabilizer.  I’ve been on it for 15 years.  I don’t think that will change.  When I see my doctor next week, we’ll talk about more options for medications.  In the meantime, I’ll keep meditating.

what’s done in the dark

I’m cycling pretty hard and fast these past few days.

Yesterday morning, I found my sense of humor was on point; it became finer as the hours passed. By the time I came home from work, I was a hot poker. I was performing in my own Mystery Science Theater episode: everyone was the subject of my criticism and sardonic sense of humor.

Watching movies with my husband and mother was fun… for me. My cackling between the repetition of each punchline made me cringe inside; I couldn’t reel myself in. I finally blurted, “I’m hypomanic, sorry guys. Maybe I should’ve taken my Lithium this week. Oops.” Then I cackled even louder.

I don’t think my husband has ever cut his eyes at me the way he did last night. It was only for a second; I don’t think he even knew he did it.

This morning was a different story. I rolled over onto the chilly, yet sharp spikes with which I’d whipped everybody yesterday. I vacillated between irritated yet frank, depressed yet demure. My husband actually chose to work today. It’s fucking Saturday.

I better be right by Monday.

Danger Will Robinson

Nothing knocks you out of depression like a panic attack. My heart pumps faster, my thoughts race – everything that was slow about me begins to move at full speed. While I abhor the idea of depending on my rapid cycling to pull me through, it may have saved my ass this time. I don’t think I could have made it through the rest of the week without that bolt of anxiety-ridden lightning.

My doctor called. He put me back on one of my meds; we were trying to wean me off the major ones so my husband and I could start a family. Between the stress at work, unstable finances and other variables that affect my stability, children don’t seem to be in the cards in the near future. As much as me and my husband want them, we’re going to have to wait until we can afford for me to either work part-time or I can set my own full time hours without fear of losing my job (in other words, private practice).

Time to put my theory to the test. Shower and take the rest of my meds. And some self-care something. I’m not trying to push myself this week: a sure-fire way to screw myself over before Tuesday afternoon.