Admissions

This morning I had the “intake interview” at the psychiatry office in a tiny town twenty minutes away. I had planned on taking Amy with me, but it turns out Mark didn’t have to be at work until after lunch. (Classes are over; this week is meetings and planning.)

I thought I arrived on time, but I hadn’t realized that this town is in the next time zone, so I was actually an hour early. Fortunately, they weren’t busy and took me in early.

Some basic paperwork — identification info, insurance info, that sort of thing.

Then the interview. I guess it makes sense for an agency providing a variety of services and therapists and all to have an admissions process to figure out which service / therapist would be the best fit. But it still seems odd to me.

I have an appointment with a LCSW therapist next week. I wasn’t able to find out much information about her at the office’s website, other than education, areas of specialty, and the fact that she’s a runner and volunteers with the humane society.

I realize this is essentially unsubstantiated bias, but I confess I think I’m too smart for a social worker to help me. For some reason I think of social workers as helping the uneducated or the poor and so on. I think of the parenting class that the Simpsons were sent to, where the parents were all carefully taking notes as the teacher emphasized NOT to throw trash in the backyard. Plus I think the two therapists I tried in NY, who were not at all good matches for me, were social workers. I suspect that a social worker will think I think I’m too smart and will try to cut me down to size. If she’s good she’ll be able to correct my bias without direct opposition. Well, we’ll see.

Next month I see the psychiatrist. I could just have our family doctor oversee my medications, but the idea makes me a little nervous. I think at least one appointment with a specialist will make me feel more secure. See? There’s my bias again. I am so unique and so complicated and sophisticated that only a highly trained professional specialist can understand and help me. Heh.

Joe respected and worked with my intelligence, my delusions of grandeur, and my inferiority. If I could get a weekly $100 gig…

We’ll see how next week goes, first.

That was weird

I had glimpses of anxiety during the evening, but managed well.

Then bedtime arrived, and I became more anxious. What if something weird happens with the Ativan?

I took it — read for a while (fifteen minutes? thirty?), turned out the light and rolled over. Anxiety blipped and murmured. I cried a little. I got up and cried a lot. Apparently the Ativan hadn’t worked.

Through journal, computer, hotline, nurse line, doctor-on-call distraction and help efforts, the anxiety escalated into full panic, with severe rage and hopelessness at the same time. The fact that nothing at all helped kept making things worse. I wondered about taking another half milligram, which is why I called the nurse line (yes, it matches possible serious side effects — call your doctor) and then the doctor (first dose, low dose, unlikely it’s a side effect; probably you are just reacting to the fact that it didn’t work to put you to sleep). Finally the doctor on call said that if these symptoms did not wear off in an hour or two, I should go to the ER to be treated.

I tried to wait an hour but was not able to. So I woke up Mark and we discussed (remarkably calmly, thank you Lord) the options and decided I was safe enough to drive myself in. So I did. I didn’t wait terribly long. No one was very helpful (what did I expect, magic?) but they were all relatively nice. They suggested I go home and try another dose of Ativan tonight, but they also gave me a prescription for Ambien.

I am a little afraid of sleep meds, because of, um, interesting side effects I’ve known some people to experience. But I decided I should fill the prescription just in case I needed it. I hadn’t thought there were any 24-hr pharmacies in town, but the ER paperwork had a list. I started out, first one, then the next, and they are all closed, even Wal-mart. I return to the ER, and they say, oh, yeah, we know, we need to fix that in the computer. Not much of an apology. They couldn’t fill the prescription for me, but they did give me one night’s dose — except we had to wait for someone from the main part of the hospital to bring it over.

I finally get home, and Mark wakes, and we talk a bit about what happened, and among other things discuss how I need to stop thinking about the psychological and life issues right now — my mind is not in a sufficiently stable state to believe what it has to say about the quality of my life and relationships. I need to trust that, while I do have issues, they can be resolved or at least worked on, without drastic ultimatums or anything like that. That it’s the sickness that is making me feel quite so much that my world has fallen completely apart without hope or help for any future.

Blessed kindness, we slept.

I woke around 8:15. My eyes are very heavy. I feel just a little uncoordinated. Tired, tired, tired.

But otherwise not too bad.

Today’s schedule, if all goes well, includes plain old normal day at home with Amy, playing, doing dishes, making the bed, diaper changes, meals, etc. Then the science department’s picnic late in the afternoon.

I have taken my Zoloft.

I will take another Ativan later, when I am not so very tired but before 4, if I need it, so that I will be able to take one at 10 for bedtime. The doctor on call told me I could double the dose if I needed to, but no more.

Drugs in hand

Ahhhhhh…

I have a bottle of Zoloft and another of Ativan.

Ahhhhhh…

Yesterday I called the psychiatric associates to make an appointment — I don’t know why I thought I’d be able to get in that day or maybe the next, but I was really disappointed to find that not only would I have to wait for Monday, but that this appointment would be for paperwork only, not to see a doctor.

I tried calling a friend in Culver but the phone lines down there were not working. Then I remembered a woman from church who gave me her number this week, and so I called her. She had just been complaining to her husband about having no one to hang out with, so it worked out well for both of us. Amy and I hung out over there with her and her mom and her baby, and the older boys when they got home from their half day. We had pizza for lunch. We walked around their large property and saw the two horses and the cow.

But I had to come home for Amy’s nap and to put a load of diapers in the dryer (I was glad it was raining).

I was able to eat dinner.

Increasing anxiety in the evening. I tried to talk to Mark about some of it — about this sinking feeling that I must be fundamentally flawed as a human being, because having a poor social life has always characterized me. He pointed out that I expect too much from people. Well; yes; isn’t that a fundamental flaw?

Is it the kind of thing I can change or not? Is it rooted in the depths of the core of my being? Or is it merely a surface twist that I can correct with new habits and practice? Is it something that God will redeem in this life, or not until the consummation of the Gospel?

Joe told me that I have this Quest for what he calls Fusion — a longing for the kind of whole world that baby and others and environment form, with no distinction of self vs. others, no sense of loss or lack. And that my task is to grieve the impossibility of recovering or restoring that state, and only then, when I have given up the pursuit, will I be able to live less hindered.

But how does one do such a thing?

Without feeling that giving up the Quest is Death? The death of all my hope, all that I long for, the death of the self I would like to find and be.

Anyway, as I wrote last night, I was mildly anxious and it kept me up much of the night. I found some peace later in the night, but still stayed awake a lot.

This morning I woke anxious, and increasingly so.

I decided to make an appointment with my family practice doctor. He is out of town, but I got an appointment with another doctor in the same office, for eleven.

To keep busy, Amy and I first went to my friend Amy G’s house to retrieve my DBT manual, and Amy G also prayed for me. Then we went to the playground where the Wednesday playgroup was supposed to meet. It was only me and she who did not sit with me at lunch two weeks ago. A little awkward, but mostly just sad for me. Oh? And it was cold and windy. Fortunately I had a jacket in the car for Amy.

Then to the doctor, where we had to wait forever. (Amy cried all the way down the hallway but calmed quickly when she felt assured she wasn’t the one seeing the doctor. And she got a sticker.) But he listened attentively and agreed that some Zoloft and Ativan would be perfectly reasonable while I waited for the Monday appointment.

Off to the grocery to get the prescriptions (Mark has told me she sometimes falls asleep in the shopping cart, and now I got to see it myself), home again to eat lunch and do Amy’s nap.

I feel reasonably okay right now. I am tired. I think I will wash the lunch dishes, go out in the garden, and then maybe lie down with the kitty for a while.

I don’t intend to take the Ativan unless I need it, but if I need it I will take it. Just having it helps defuse some of the power of the panic. Funny, too, how every time I feel remotely normal, I completely question my self-diagnosis. And vice versa.

Wouldn’t it be nice if the Knox office (the psychiatric associates) had a therapist I could connect with?

I am painfully aware of money lately; with current gas prices we have only $30 unallocated in the budget each month. Going to Culver or Plymouth probably costs a couple of bucks each time. To see Joe again would be out of pocket — because he is not in our insurance network they wouldn’t cover anything until after a $4000 deductible. And, folks, we already live so simply and frugally. I can’t imagine what we would cut out of our budget to afford Joe.

Besides, I still want to buy a freezer.

———

Woman: why don’t you ever stand up for me? or why do I have to beg?
Man: what, can’t you stand up for yourself? or why can’t you just ask?

Does this conversation ever resolve with not only mutual understanding, but with satisfaction?

Various

1. At Lowe’s the other day, going from the car to the entrance, Amy yells out, “Oh my goodness! Look at all lawnmowers!“

2. Greenness… is only a little thing, even though the possibilities and responsibilities seem so overwhelming and endless. What am I doing for the poor? Or for anyone else?

3. Sometimes, begrudging love is the only love there is. It’s unrealistic to expect people to never be annoyed or concerned about costs or whatever. Or to never find my quirks irksome or my flaws severe. A task I have been working on for years now — being able to receive begrudging love, the love that, however reluctantly, agrees to do what I am asking even though annoyance or concern or whatever is also in the picture, or agrees to be my friend despite irksomeness. Besides, isn’t my love for others almost always begrudging?

4. God’s love is never begrudging.

5. Amy walked on tiptoe at church this morning. She also likes to try on other people’s shoes and try to walk in them.

6. My paper journal entries, from late November (when I started this particular journal) until yesterday, are almost exclusively about being depressed and / or anxious and / or angry. Perhaps it’s just skewed, since the positive things end up here on the blog more often than in the private journal.

7. I am contemplating how I might respond. I could do a few months’ charts — chart my daily moods, chart what I eat, the weather, whether I exercise, etc. I could commit to work — to prescribe myself exercise, good eating, DBT skills practice, prayer, gratitude lists, etc. I could call Joe and / or my psychiatrist and talk about talking about maybe considering Zoloft again — but I said I would wait a year before making that decision.

8. I waver between feeling the need to take more responsibility for myself, take more action, and the feeling that I am already overburdened with work and death, tired of bearing all the responsibility for myself.

9. Amy can drink from a cup now.

10. The relationships in Christianity among work, death, grace, and life, are intriguing, confusing, interesting, promising.

11. (This one goes to eleven!) Baby Molly is home from the hospital. The trouble was with her epiglottis — she was aspirating the formula. Now she eats as much rice-thickened formula as she will take from a bottle, followed by high-calorie formula through her tube. She has good color and is nicely chubby.

Final meeting with psychiatrist

Was yesterday afternoon.

Told her about how I’ve returned to my former self, including the levels / frequencies of irritability, labile emotions, and so on, that seem to have been part of my life from a pretty early age.

She said that sounded like I wanted to start the Zoloft again, but I said no, I wanted to have at least a year to continue practicing my skills, get reacquainted with this self, etc.

Besides, I also remembered that during the buoyancy of pregnancy, and once drug-stabilized during PPD, I may have been less moody, but I was also less creative, less thoughtful, had less meaning in life.

Perhaps Zoloft makes me a more pleasant person to live with.

But is it my duty to do whatever it takes to make life more pleasant? Is pleasant really the highest goal? And what are the limits for “whatever it takes?”

I’m not incapacitated like I was by PPD — I’m just (sometimes) emotional, sensitive, and responsive, including positives and negatives.

After drugs

So I am experiencing more moments of depression, anger, and anxiety than in the months when I was on Risperdal and Zoloft.

One of the more annoying tendencies for folks experiencing these feelings, is to go meta with them — in other words, to have feelings about having feelings: to be alarmed by, depressed by, anxious about, angry about, the depression, anger, and anxiety. I especially don’t appreciate this in myself. I.e., I’m depressed; oh no, now I’m anxious because I’m depressed; oh no, being anxious about being depressed makes me mad, etc.

I think one reason why Mark and I are so sensitive about my moods, so reactive to them, is that my horrible PPD experiences are still fresh in our minds, and we are afraid of returning to such dark days.

I plan to print out some diary cards and start tracking my moods again for a while. I also intend to recommit to exercise, socializing, Bible and prayer, exercising the skills I’ve learned in therapy and DBT group, and whatever else I can think of to manage symptoms. I also have Joe’s phone number and am ready to schedule a session with him if I think it would be helpful. And I think I am going to take a break from reading my friends’ blogs, particularly those friends who have suffered much; I guess the lingo is to say that it might be triggering.

I also wish I could identify and resolve all of the things that lead to the depression, anxiety, and anger. I heartily disagree with the behaviorists for saying that the mind and heart, the subconscious, are irrelevant and the only thing that matters is changing behavior. On the other hand, I am aware that sometimes my feelings come first, and then I hunt for reasons. Since the reasons have always existed, they don’t explain why I am feeling X at a particular moment and not at another. So, I am thinking I will try to be open to reflection and analysis when it seems helpful, but to also take a practical approach to “managing symptoms.”

Reasons (just for fun):

• Weather / lack of sunlight
• Diet
• Lack of exercise
• Apparently, lack of drugs; but I’m not going back if I can help it
• Disappointments / unfulfilled desires in several relationships
• Insecurity, loneliness, navigating new social environment
• Frustration at the apparent impossibility of resolving or even talking about certain things with the relevant people
• My own failures and inabilities and negative impacts on others
• Feeling abandoned (by people and by God) to bear all the weight of taking care of myself, without sufficient resources, clarity, wisdom, feedback, etc.
• Current stresses like the cat’s illness and Amy’s rash
• There’s probably more but that’s what comes to mind immediately.

Goodbye, Zoloft

Took the last half-pill this morning.

A half goodbye to Zoloft

Woo-hoo!

I saw my psychiatrist yesterday (drove an hour for a five minute appointment and another hour back home) and Project No More Zoloft is in progress — took my first half tablet this morning. 50mg for the next month, then 25 for a week, then NONE.

What helps anger in PPD

Distance and time and earplugs and Risperdal and release and acceptance and therapy. At least that’s what has helped me.

Distance and time: I needed a more gradual transition to motherhood, so we created a support system where I could spend my nights away from home and have someone else at home with me to take care of the baby when I was unable to be around her. Not being around her constantly, and not being constantly responsible for her, I had room to breathe and be myself, and felt less trapped and therefore less angry. As I was able, I spent more time at home and more time in charge.

Earplugs: For me, the sheer volume of the baby’s crying — especially when it lasted for any length of time — was distressing and anger-provoking. Wearing earplugs allowed me to still be around the baby when she was yelling, and slowed down the escalation of anger.

Risperdal: I’m also taking Zoloft and Ativan, but I think it’s the Risperdal that helps with obsessive thinking, including things like feeling the baby’s screaming as a personal attack. It helped me keep a more reasonable perspective and more realistic expectations and interpretations of the baby’s behavior.

Release: Anger is a physical thing. It needs a physical release. My dart board works pretty well for me. Stomping and slamming and yelling also help, but need to be done where it won’t upset the baby. For some folks, a punching bag or box of cheap dishes to break can help.

Acceptance: Anger is an emotion. Emotions have no moral value. Emotions can spark behavior that is inappropriate, but the emotion itself is never “right” or “wrong,” it just is. The more you can accept the fact that you’re angry, the less you’ll pile on guilt and shame and the less you’ll try to deny or push away the anger, which only builds it up and postpones an explosion.

Therapy: Individual therapy (emotions always have roots, whether biochemical or historical or whatever) and a DBT group (teaching emotion regulation and distress tolerance skills) have been very helpful to me.

Why today might be interesting

This morning I couldn’t remember if I’d already taken my Zoloft. I didn’t think so, but I counted them to see. Except I can’t remember if I opened the new bottle this morning or yesterday, so counting didn’t help. So I took one. Which may mean I took a double dose. Hmmm. So far I don’t feel any different…