Drugs

Last night, I was up with fear; fear about drugs.

1) Thinking about micro-cultures where the use of street drugs is nearly inevitable. Third-worlders running to the cities for good work, not finding any; street kids in any city — when the choice is one meal for a week or one bottle of glue, what really makes sense? And the fact that people drink “alcohols” made with paint thinners and shoe polish and varnish — or anything else that is one part brief mental euphoria or relief and five parts deadly toxins…

Or just the mention on the regional news last night of meth lab trash that can be nearly instantly deadly to anyone unsuspecting enough to breathe close to it. (I didn’t turn off the TV fast enough after the show I was watching. Normally I avoid the news like the plague.)

There is something about all this that terrifies me — how can it be that such situations exist, that such substances exist. And what am I going to do about it, when I can barely keep up with my own puny local life and when so many other causes clamor for attention?

2) Thinking about this Nasonex I’m on, and the Claritin, and occasionally the Benadryl.

Thinking about how I’ve learned enough to be skeptical of everything and everyone, but not enough to have chosen anything or anyone to trust, other than God, and even him I question often enough, and he doesn’t seem to say anything super clear about how to treat allergies.

What is it in Claritin that makes it non-drowsy? Does it contain a stimulant? I don’t want a stimulant. Does Benadryl contain a depressant, or why does it make me drowsy? I don’t mind it making me drowsy when I take it at bedtime. But I don’t want to take it during the day. And if I take Claritin, which lasts 24 hours, then I suppose I shouldn’t take Benadryl at bedtime too. And I have no idea if the Nasonex is helping or not.

I think the neti pot alternative (bulb syringe) is nice, now that I’ve gotten the temperature right. Although it makes me think about other fads regarding cleansing of internal cavities. I bet the nose too is designed to keep itself clean.

Amy seemed worse today; is her Claritin helping her or making things worse? How long do I wait before asking the doctor about that? We put the humidifier in her room tonight and gave her an extra pillow. She had a warm shower, too, and tried the nasal irrigation; she did pretty well with it, at least at first. Wasn’t happy about having to do the other side. It did seem to clear her out at least a little, which is good since she’s not so great at blowing her nose correctly.

It’s funny. I sort of don’t really believe in allergies. Why in the world would anyone’s body react to ordinary normal things in such a way? Surely eating right and getting enough sleep and exercise should cure or prevent all allergies, right? So maybe a long-term prescription for Nasonex is God’s way of challenging yet another one of my precious principles. Just like when I had to quit nursing Amy purely for psychological reasons.

3) Related to 2, what about my Zoloft?

There is a large and vocal community pushing the biological model and the diabetes analogy, and there’s my own experience that suggests that this drug does help stabilize my mood, and yet — at this low dosage — does not remove normal ups and downs and full presence and awareness from my life. Then there’s my friend who has radically reduced her diabetes symptoms by changes in diet and exercise. Although I think she’s got the kind that doesn’t need insulin shots.

Then there’s a smaller and equally vocal community pushing anti-psychiatry, arguing that no drug can resolve distress, and that the psychiatric model does more harm than good by adding drug upon drug in order to deal with side effects and tolerances. And that most therapists seem incompetent at best and retraumatizers at worst.

My experience on this side of the issue is that there are certainly personal-historical roots to some of my distress and that certain kinds of talk therapy have done more work on these roots than drugs have, but that perhaps I’m at a place where I am more to be applying what I’ve learned and less to be seeking more therapy. I have also not experienced being pushed to do more drugs, granted the exception of the psych nurse practitioner who put me on Risperdal — but it was a small dose and after a year I was able to get off it without issues. And I don’t have harmful side effects with Zoloft. In the beginning I had some eye pain, but that’s gone away. The worst thing that still happens is I am a little more easily nauseated, but it’s quite manageable.

And most of these anti-psychiatry folks have been treated at the hands of the incompetent or worse, and have recovered from vast contrary cocktails of ever-changing, ever-increasing drugs.

The thing is, though, we still don’t really know precisely what Zoloft or other SSRI’s do or why that works, or why it works for some and not for others. (It reminds me a bit of how many other times I’ve wanted a more precise and complete line from the nuts and bolts of a thing to the image, model, or analogy of how we understand it in our own experience — like going from the 1s and 0s in computer code to what I see on the screen, or how traveling electrons make the toaster work.) Do we know precisely how other drugs, like Nasonex or Claritin, work? With Bones, sometimes I look aghast at the barbaric and invasive nature of our current medical knowledge and practice.

Then again, I am still quite skeptical of the various alternative approaches to medicine.

And having friends on all sides of all the issues doesn’t help resolve where I should land.

4) Fear itself is a drug. So is food, and sunshine, and health, and rain, and sickness. There are so many factors involved in any one moment of my thought or feeling, it’s mind-boggling. Especially late at night.

I’m afraid of being wrong about anything, especially about anything important, like God, or some drug I’m probably going to take daily for the rest of my life, or what kind of chicken to buy and how much.

I generally try to look at my fears directly and see what the worst case scenario might be, and see that even that won’t destroy me. (And, late at night, I try to remind myself that my fears are always heightened late at night and that generally I have a better perspective in the day. A little voice late at night whispers that the recurrence of the night fears implies the existence of something that I’m avoiding in the day. I try to remind that voice that I am open to facing whatever needs to be faced.)

If my life is shortened by ten years because of medication or incorrect nutrition or not enough sunshine or too much sunshine, is that really such a terrible thing? Might as well add fear to the list of things that could so shorten my life. Fear certainly isn’t going to lengthen it. Healthy concern and research, sure; but not obsessive worry.

If God doesn’t exist, or is not the God of the Bible, most likely that would mean annihilation after death. And it would mean that living my life in faith would have been pitiful. But unless I am absolutely certain that he’s not true, why not hold on to the trust and the hope and the faith? There is good evidence that he’s true — not undeniable, not absolutely proven, but just as much evidence (more, I think) on his side than on the other side(s). So even when I am not solidly convinced, I don’t have to believe the fear that continuing in faith is just a gamble, one of two equal choices in the dark. I can remember that when I have researched and read and thought, I have generally seen that the scales tip decidedly lower on God’s side.

Even when my questioning and fear and doubt is ABOUT God, I can tell him about it in an attitude of faith and trust. I can tell him that while parts of John Piper’s arguments for God’s sovereignty even over evil and sin seem persuasive and even potentially comforting, it still makes me sick to know that some people got raped and sodomized as toddlers, and that others stay alive on glue-sniffing, and that others are tortured, and so on. What good could possibly come from any of that? And good must come from all of it in order for it to fit into God’s good purposes.

Even such little, but chronically recurring things as interpreting when something is good or not. Heard the “That’s good, that’s bad” story or played “Fortunately / Unfortunately” or heard the tale of “The Lost Horse?” Faith tells us that evil is truly evil, but that God’s goodness is sovereign even in the midst of evil, and that all things work together for the good of those who love him and are called according to his purpose (Somewhere in Romans 8). And yet, sometimes I feel like I’m living in “Fortunately / Unfortunately.” The cat visits me late last night, and I could say that God knew I needed distraction and comfort and a warm purring feline visitation would fit the bill nicely. But what if the cat hadn’t come? Would God be any less caring? And if not, what difference does anything make? If I should accept good and evil from the hand of God, like Job, how do I maintain understanding that good is good, evil really is bad, both are in God’s will, and God is always good?

I do think that Christianity’s insistence that evil really is bad is important — vs. philosophies and religions that consider evil and good to be meaningless categories, too subjective. Likewise Christianity’s insistence that God is sovereign, vs. evil and good as peers in the cosmic struggle.

What it comes down to, I think, is that our faith puts goodness primarily in a person and a relationship, and not in events and circumstances.

———

And there you have it: the myriad paths my brain and heart travel when the news mentions meth trash and I’ve just filled a new prescription and people are blogging about decisions and fear and terrible things and I’m likely in the throes of the monthly hormonal upheaval and so all the little bits of thoughts and feelings and concerns and hopes get tossed about again.

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Latest carnival against child abuse

A blog carnival is a collection of posts about a particular theme, gathered in one place. Several of the bloggers I read are survivors of various forms of child abuse, and one or more of them will post a link when the month’s carnival is ready. While I’m not a survivor of abuse, I sometimes read a post or two and usually find there’s a lot to relate to, considering my mental health history; it’s also enlightening, fostering compassion and respect for the survivors, known or unknown, among my friends, and there’s often also good food for thought as a parent.

This month, I just read one of the posts, by Marj AKA Thriver. It’s about working with your inner child. In general, I find myself somewhat sneering at that term — it seems so, sort of, sold out to the psycho-babblers. It reminds me of a cartoon where someone writes to an advice columnist saying “My inner child seems to be missing,” and the columnist replies, “Look for its picture on your inner milk carton.”

And yet, it can really be a helpful and worthwhile concept. I have to not think of my inner child literally, as if there’s a separate and distinct younger me living somewhere between my spleen and my stomach. I have to think of it more metaphorically — thinking about how wounds and other experiences from the past still influence the present self, and how the feelings and thoughts from those times can persist. If the painful moment was not metabolized well at the time, some attention to it in the present can bring healing that was missed before. And usually the healing work does need to be done in a way that the younger self would receive well — this is one of the reasons why just changing the way you think, or giving yourself a lecture, is not always deeply healing.

I find that I already do some of the things Marj discusses.

Singing is a great comfort to me, whether the trouble on my mind is some past hurt, or a spiritual snag (the two are often connected, even if only subconsciously), or some difficulty in the present. Playing dulcimer or another instrument can also be very comforting, especially at times when using my voice does not feel right — when I’m feeling inarticulate, or not able to affirm the lyrics of anything, and so on.

I also love to sit in a comfy place with an afghan, cup of tea, book, knitting, and / or the cat.

During my PPD hospitalization, Mark brought me some of Amy’s presents to open, and one contained the cutest pink stuffed lamb with a little rattle inside. I kept that for myself for quite some time. Likewise the kitty blankie (a blanket square with a cat’s head and paws sewn into the middle), when Amy lost interest in it. That one was especially comforting because a good friend made it for Amy. (I wish I remembered who gave her the lamb — I was diligent about writing thank you notes even in the midst of the PPD, but I forgot to write down for myself a list of who gave what.)

I love swinging. I can’t do very much, or go very high, because the Zoloft makes me a bit nauseated with that kind of movement. I would love to have a porch swing long and wide enough to lie down on, to swing horizontal and sideways, especially if someone or something would swing it for me. Sounds like I wish I had a cradle, eh?

Just being outside, or working with my hands, can be good. Something less mental and more heart / body oriented.

None of these things are failsafe for me, but all are helpful at one time or another.

Several of the commenters on this post talked about how they weren’t really allowed to be kids — no silliness, had to be serious, etc. That’s tough — it continues to be a challenge for me to accurately assess Amy’s maturity level and what appropriate rules and boundaries are for her.

She can’t be silly ALL the time, and while I don’t want to rush her, growing up in independence and maturity IS a major goal of parenting. But I also don’t want to squelch too much. I want to make sure she gets enough time for being silly and ridiculous and even loud. I want to make sure that she knows she’s allowed to be upset or angry or sad or afraid about anything, if that’s how she feels, and that it’s not my place to judge whether her feelings are valid. If it’s how she feels, it’s how she feels.

On the other hand, she needs to learn that there are more and less appropriate ways and times to act on and express her feelings. Mark and I are both getting especially tired of such patterns as top-of-the-lungs screaming when it’s time for bed or nap, and “I can’t — there’s too much!” when it’s time to clean up a lot of toys or a toy with a lot of parts. Or the persistent arguing with us when we ask her to do something. I don’t mind THAT much if she doesn’t cheerfully get up and do whatever we ask whenever we ask it — but I’d rather she didn’t feel the need to voice her displeasure every time, multiple times. We’re working on it all.

———

In the middle of reading over this before publishing, I thought about my hair. Amy has always enjoyed playing with combs and brushes — she tries to brush or comb her hair, or ours, and pretends to give haircuts. The other day I unbraided my hair to let her brush it, and it was glorious. I’d forgotten how much I love to have my hair brushed gently and attentively. Mmm. Did I enjoy that as a child, too? I remember nearly fainting with concentration and anxiety, trying to stand still while having my hair curled… and I remember the pleasure of having my hair washed in the kitchen sink… especially the sprayer held close to my scalp with that perfect temperature water… but I don’t remember brushing or combing much.

The decision that seems to be making itself

Have I had much positive to say about my current therapist?

It seems that, while it hasn’t been a catastrophic failure, this round of therapy has been relatively unhelpful from the beginning.

It could be that what I most needed at that point back in May was to try Zoloft again, and that talk therapy wasn’t as needed.

It could be that the improved social situation has boosted my resilience, hope, and confidence.

It could be that my current therapist really is fairly simplistic; perhaps good in crisis, but not so helpful in the subtleties of fine-tuning during functioning non-acute seasons.

The two bits of art therapy we’ve done were pleasant, but not particularly useful or insightful as far as I can tell.

Talk is usually short, full of generalities, and platitudinous. She points out negative self-talk. Reminds me not to try to read minds. Wishes I could get out of my head more and not overthink everything. Something about our interaction puts an end to conversations. It’s not so much that I feel she is wrong, or that I think she wants me to stop talking about something, but that when she brings out a statement of the obvious, I no longer have anything to say about the topic.

I tried to talk about that today, but it didn’t really go anywhere either. She expressed complete willingness to get specific and in depth, but it seems dependent on me to direct, and I’m not sure how to go about that.

Previous thoughts about quitting this round of therapy have been alarming and dismaying, but now I’m feeling a little more steady about it — I think I can survive without therapy right now. Not that I’m all better and no longer have any issues, but that I have some skills to practice and ideas to remember, and my life situation is fairly supportive.

I have another appointment in two weeks. I plan to go to that one and see how I feel then.

Meanwhile, some questions for y’all:

Do you think some people, sometimes, act out of mere politeness without actually being interested in you (or someone else), or do you think that people will let you know if they don’t want you around? How do people send the message if they don’t want you around?

What do you do when there are people in your life you don’t particularly want to be with much — do you try to send that message (if so, how?) or try to hide it?

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.