Psych Lingo

Well, a month has passed since my last med check where I was ambushed by a filler doctor.  He had me taken aback with his recommendations for heavier medications, such as “real mood stabilizers” and replacing all my benzos with antipsychotics.  Apparently, in his professional opinion, my bipolar disorder was not well managed.

I’ll be honest with you.  Not only did his recommendations scare the bejesus out of me, they insulted me.  Typically, I would really refrain from faulting myself from being a particularly proud person.  With all of the knocks I’ve taken in my life, I can ill afford pride and arrogance.  But, in a way, it felt like he dismissed a year’s worth of legitimate complaints with the flick of a wrist.  It was almost as if he were nullifying all of the effort I’ve put into managing my mental health.

His suggestion?  A condescending tutorial on how to use Google to research my disorder and make informed medication decisions.

Ugh.  *Eye Roll*

That didn’t stop me from obsessively combing the internet, haunting message boards, putting messages in a bottle, and taking a battery of online assessments.  My assessment?  Don’t self-diagnose from the internet.

Ironically, there I was on Friday morning watching Silver Linings Playbook.  It was neither the first nor the tenth showing of that movie on that screen.  I had always admired the screen portrayal of Pat, and felt that it did justice to the disorder.  There was always something that I identified with, but not entirely.

I hopped in the shower, almost hysterical.  Before I’m about to meet with someone, I usually have a script ready in my head.  It’s just a set of questions I’ve already prepped myself to answer and topics that are safe and well researched.  This is especially the case when I’m preparing to meet a professional.  It’s easier than getting bullied into treatments that I’m not entirely familiar with.  At least I have some ammo when I go in.

But, I had no answers this time.  I’ve been to enough med checks in my life to know what to say and what not to say.  It’s a matter of knowing what’s going to get me in hot water and take me down a road I’m not willing to go.  Call that non-compliant, but let’s be real.  How many people are completely 100% treatment compliant?

I was ready to lay all of my cards down on the table.  Xan cautioned, “Don’t go in there guns ablazing.”  Again, eye roll.  I was panicked to the point of wanting to cancel.  It wouldn’t be the first time I’ve done that with a doctor.  But, Dr. K has this soft cleverness about him.  He’s far more observant than any other psychiatrist I’ve ever had.  And at the same time, he’s far less talkative, so he’s entirely less likely to show his hand.  Most doctors will give a tell as to their personal opinion, rather than a professional opinion if I engage them in a little extra conversation.  Dr. K just doesn’t bite.

Which brings me to what happened.

He was running almost an hour behind, which rankled me far more than I care to admit.  It’s amazing how cozy folks in a psychiatrists office can get when they’ve been in close quarters for more than a few minutes.  It was actually the first time anyone had the guts to politely ask why I was seeing Dr. K.  I always thought that there was some kind of unspoken code that it was almost forbidden to “fraternize” with one another.  I assured her the question was fine, and that I had been seeing him for bipolar disorder.  “Two,” I added, seeing a mildly startled look on her face, “Kind of the ‘lesser of’.  ‘Diet’ bipolar.”

An imaginary tumbleweed blew through the office accompanied by the soundtrack of a multitude of crickets.  A man’s voice sounded a boisterous, “BOO!”

Boo yourself!

I quickly and gently asked about her condition.  If I was taking home anything that day, it was the knowledge that folks in a psychiatrists office are a lot more eager to talk about their own conditions than I imagined.

Dr. K called me in, and I wished her well.

I guess all of the psych talk in the waiting room primed me.  I sat down in one of his plain black leather armchairs that did the rest of his ornate office no justice.  Naturally, he asked me how I was.  I admitted that I was well enough.  Then, somehow, I trickled into it.  I told him that I’m able to manage.  But the “insanity of it all” was just overwhelming.  The burning need to perform certain tasks in a particular way was killing me and causing conflict in my family.

He asked me to elaborate.  And did I!  I told him about the cumbersome nature of housework.  I like everyone to be out of the house, because I can do it the way I need to, without any interference.  And Xan, he tries to help when I’m getting more and more stressed and less and less gets done.

I told him about an incident where Xan did the dishes.  I don’t like when people do my dishes.  They can’t work within my system.  It’s infuriating, because the system is so easy, but I don’t expect anyone to know how, because it’s my system.  They have to be done in a certain order so they can be stacked in a certain order.  If they’re not, then something is going to break.  I described the awful Jenga game and how all of my favorite glasses and mugs have been broken by such carelessness.

Then, they have to be air dried to avoid any contamination.  The last thing I want is to accidentally give my family and friend food poisoning because I was being careless.  If there are multiple loads, then it slows the entire thing down.  But, then they have to be put away in a particular way, because that’s how they fit in the cupboards.  I try not to swear and complain when I go into the cupboards for something later, but it’s hard.  If they aren’t put away correctly, then they don’t fit, then things get lost, and then that delays all other kitchen activity.

I told him that I felt like I knew that the level of obsession with such detail was unhealthy, but there wasn’t any way to fix that.  I’ve always been like that.  He asked if there was anything else like that, and I exclaimed excitedly, “Oh the closet!”  And I went on to talk about how the closet is arranged and how the clothes have to be folded exactly so they fit in the drawers without incident.  And again, I went into how I know it could be done differently, but it’s not right and it doesn’t work.  I’ve spent years developing these systems.  It is supposed to make everything easier, but it actually kind of makes everything more difficult when I don’t have the time or energy to devote to it.

I actually went into more length than I wanted to there.  But, I felt like I had to illustrate the entire madness.  To leave anything out wouldn’t do it justice.  I expressed to him that I didn’t understand why I had to do this.  But, in truth, the act of organizing and sorting usually gives me some peace.  Well, when everything goes as it should.

Apparently, I used the right key words.  He answered my questions about the “level of obsessiveness” with a sentence that contained the keyword: compulsions.

Note:  I usually refrain from using psych lingo or any clinical terminology.  Most doctors aren’t very receptive.

Dr. K explained something that I never really got until then.  Anxiety manifests itself in many different ways, sometimes all at the same time.  And there are many different coping mechanisms that a person develops over a lifetime.  Anxiety can manifest in obsessions, which often lead to compulsions to alleviate that stress.  His response was to treat it with Prozac.  I’m pretty hopeful.

He added that it’s characteristic of obsessive compulsive disorder.  In all of my education and research, I am still a little unclear on it.  This is going to be a new journey for me.

In a way, I feel a little vindicated.  I was right to trust my gut sense that bipolar disorder wasn’t the entire picture.  And I was right in believing that there was more to it, as if we fixed something, but uncovered something else.

Most of all, I’m glad it’s all resolved, and I’m on an appropriate treatment for it.

So I guess all it takes is a little bit of clinical reference to speak the language of a Pdoc.  I’ll keep that in mind in the future.

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The Costly Mistake

“A mistake was made.  Dr. G. needs a half an hour with you, so you have to come in at 4:15PM.”

The third attempt in three days on my doctor’s part to reschedule me.

I panicked.  The plan was for Xan to come home and cart me off to my 5:30PM appointment.  That in itself was stressful enough.  Xan rarely gets off of work on time anyhow.  I would be playing this pacing game where I wear a rut into the corkwood floor of my eroding living room.

“But, I can’t.  I don’t have transportation.”

She was uncompromising.  “Dr. G. leaves the office at 5PM.  It’s 4:15PM or she will not see you today.”

I anxiously stammered, “I’ll see what I can do.  I’ll call you back.”

In her cheery, patronizing voice she said, “Okay, we’ll pencil you in for 4:15PM.  Hope to see you then!  Bye!”

And the phone went dead.  I was cast off that easily.  Complete disregard for my needs.  She’s one of those people who is just doing their job and nothing more.  Patient care doesn’t matter.  My threads started coming loose as I desperately grasped at the fabric that remained.  Hope was dimming.  Trapped in my head, trapped in this perpetual hell called my life, completely alone with this demon so inadequately named Bipolar Disorder.

For a moment, I let the wholeness of the situation set deeply into myself.  I read my prescription bottles closely and they said in big, haunting letters NO REFILLSWaves of panic nipped at me at the shoreline.   The tide suddenly grabbed me, and ripped into murky, black waters with the undertow.  There was no sense of what was up and what was down.  The air escaped me, as if being viciously sucked from my lungs, and they shriveled into nothing.

My fingers flew fast as I texted Xan.  The idealization took control as my head filled with these surrounding waters.  My mind swam around my skull, looking for solutions.  Grasping at the fabric, the tearing fabric holding my sanity, my hope, any kind of connection to reality and sanity.

“Hold for a moment on this.”

I am a business call.  Twenty minutes elapsed.  It was like standing in a queue for my husband’s attention at a clear crisis.  Those glimmers faded as I clung to anger.  Anger, my failing life preserver as it began to deflate into complete hopelessness and despair.  I trashed with distress, but to no matter.  Anything.  Anything . . .

“I’m calling the scheduler.”  I warned him that wasn’t wise.  The ultimatum was set forth.  4:15PM or not at all today.  4:15PM I could see this new doctor, and maybe in coming days, I could exit the tunnel of misery and dimness.  I could reclaim myself, my life, and everything that awaited me on the other side.

I wanted to beg him.  I wanted to get down on my knees and plead with him to leave work early.  He would have put his eight hours in that day, and it would have been alright.  Be my knight in shining armor.  Save me.  Save me from myself.

I started crying, huge, loud sobs belting through my house.  My son, my little four year old son with autism spectrum disorder approached me.  And he said, “Mommy, are we okay?”  I cried even harder, despite any efforts to control myself.  My son’s first four word sentence, his first appropriately placed words relevant to the situation, occurred because his mother was hysterical.

I said to him, wiping the tears from my face and pushing everything down, “Yes, Beast.  We’re okay.”  I wish I could have meant what I said to him.  His first question, and I had to lie to him.

The phone rang, playing a melody that I hope meant promise.  Promise that someone had conceded or made an exception for my desperate pleas.  I answered despondently, even with my head overflowing with idealistic notions of the outcome.

“Here’s the good news,” he started.  My heart seized up, anxiously hopeful.  “The nurse agreed to put a fill in for your prescriptions.”

“And my appointment?”

He continued, “It’s a bit of bad news.  Dr. G. is booked up until December 11th.  I scheduled you in for that day.”

I choked on my own voice, the bile rising from my stomach and the wires of my brain sparking as they frayed.  “December 11th?!  I can’t wait until then!”

“It was the soonest she had.  It was the best I could possibly do for you.  But, at least you have your medication until then.”

The tears finally came, screaming down my faced as I sunk against the sink.  “I need a doctor.  I need to get this fixed.  I live every single day in this perpetual hell.  This was my last hope, my only hope.  It has been stolen away from me.  Is there nothing we can do?”

He started to become cross, “What do you want me to do?  What more could I possibly do?”

“You can’t leave work?” I pleaded desperately.

“It wouldn’t matter anyway,” he informed me, “The scheduler already complained to me about your poor attendance record, and gave your appointment to someone else, anyway.”

My poor attendance record?! I screamed.  “I have no way to get to appointments!  And people keep blowing me off, like I don’t matter!  Like I’m not in a bad way! Like this can wait and as if I’m doing so well.  The only time I get to go to an appointment is to get this stupid medication that doesn’t even work filled.”

I paused, only for the brief moment it took for catch my already shallow breath, “I don’t know if anyone noticed, but I haven’t been well.  I have spent almost my entire year in one episode or another.  It’s beyond discouraging.  It’s thrown me into the jaws of despair and hopelessness that I will never get any better!

We sat in silence for a few minutes.  I sobbed violently, just waiting for some kind of word.  Some kind of solace.  Any rescue from the deep, dark recesses of my own caged mind.  Finally, I asked, “Are you still there?”

“Read your text messages,” was all he could respond.

I have people three feet from me.  I can’t talk about it.

My being shattered so deeply that I had felt fractures of each bone in my entire body.  I became enraged at his choice.  Work.  Work over his ailing wife.  No exceptions could be made.  And in his mind, I’m sure the thought had occurred, This too shall pass.

“Goodbye,” I choked out without another word.

The anger, the scraps that remained, boiled in the water.  The blackness around me turned scarlet and thick like the blood coursing through my veins.  I grasped my phone with a crushing forced and launching it against a wall.  It exploded into three pieces, the unit, the battery, and the backing.

Screams erupted out of shrieking sobs, “I can’t go through this hell anymore!!!  Why do I have to go through this?!  Why?!  Endlessly, I raved and ranted like a mad woman.  A mantra repeated, “I can’t do this!!!   I can’t!!!”

“That job!  I hate that f***ing job!  His work, his work!  Nobody cares!  Nobody!” I grabbed my “Teacher”coffee mug from the cabinet and smashed it against the linoleum floor.  I’m not a teacher anymore.  It is a lie every single time I drink from that mug.  I am a nothing now.  I am a nobody.

I stood there staring at the pile of the remaining shards of ceramic, heaving panting sobs.  I slid down against the stove, next to the pile and pulled me knees to my chest.  A ball.  Nobody can hurt me.  I can’t hurt me.  No one can come near me.

Alone.  I am slated to be alone.  Alone in my own mess.

I WANT TO DIE.

It’s all I could think.  There is no life ahead of me that I want to live.  It’s only a life full of pain and misery, where I am tragically locked in my head.  No one wants to hear of these complaints.  I have no perspective to gain.  No more words left to give the world.  No hope for myself or anyone else.  I have nothing.  I am nothing.  I will always be nothing.  To anyone, anywhere.

And if I were to say goodbye, I would be wished well.  I would be let go without another word, another prayer or any thoughts left for me.

There is no treatment that will make better.  I will always be like this, with this crushing weight upon me.  My eyes are constantly fixed on the rear view when I’m not navigating the endless series of trials within this tomb of a labyrinth.  Even in the fleeting happy, peaceful moments, I will always be cautiously watching over my shoulder for the monster who will eventually gain on me, and overtake me.  I will never find happiness.  I can never find a place of peace and solace within this madness.

A plan started hatching.  There will come a day where I will take my life.  I can’t truly know when, but the day is inevitable.  I must make preparations.  I took a handful of Xanax and considered washing it down with a swig of rum.  No, it would be bad enough that I am doped up around my child.  My child.  My beautiful baby has to witness this in his already confused life.  It fueled the fire to hate myself even more.

I will get my house in order.  I will not leave a mess to clean up, because there will be enough of a mess when I am gone.  I will get my son into a program and have him taken care of.  My belongings will end up in boxes, so that they may easily shipped off.  I will leave nothing but mournful whispers behind.

I wish I had something inspiring to say.  I wish I could tell you that I went on about my life, went to class last night, and came back in better shape.  I wish I could tell you that the rays of hope descended upon me, and I am determined to hold out until December 11th.  I wish I could tell you that I look forward to better days, where this awful, gnawing feeling dissolves into some kind of happiness.

But I can’t.  I can only give up and start to let go.  I can only start to say my goodbyes and write my heartfelt letters to those that I love.  Because in the end, whether I want it or not, this is my fate.  To eventually succumb to my illness.  To eventually self-destruct.