Category Archives: meds

The coward’s thoughts on self-nullification

Good morn­ing,” I say, when I am at work.

How are you?” my cus­tomers some­times reply.

A swirling void of worth­less­ness and angry depres­sion, over­laid with some­what effec­tive anti-anxiety drugs, so long as I keep up with my sched­ule,” is not how I reply.

I smile and say “Fine, thank you, and you?”

They don’t want to know. I don’t, either. The state of denial is very appealing—its brochures are the glossi­est, shini­est, perki­est ever, like the Emer­ald City in the Wiz­ard of Oz. (Doesn’t every­one want to be like Glinda, the Good Witch? With apolo­gies to Gre­gory Maguire, Stephen Schwartz and Idina Men­zel, the answer is no—I do not want to have green skin. I want to be happy.)

The state of real­ity, with its cap­i­tal, Fac­ing the Facts? It’s all black and white, like Okla­homa in John Ford’s Grapes of Wrath abil­ity to reach out to oth­ers and express­ing your feel­ings turned to dust in your mouth also included.

If I do it, it’s got to be right. (No, wait, that’s the per­fec­tion­ist talk­ing.) And that requires research, not just the tak­ing of all the pills in the bathroom—because that might just fuck up my liver, requir­ing more pills, a life­time of pills and more pills, dif­fer­ent ones that require even more keep­ing track (as if the ones in the cab­i­net aren’t enough, all the –idines and –epams a clus­ter of end­ings numb­ing my nerves and my brain). Isn’t the up and down of that reg­i­men, that vig­i­lance, that need for con­stant atten­tion and report­ing to doc­tors at the slight­est change in one’s mood, one’s men­tal health, hell, one’s body odor, the very thing I’m try­ing to avoid? No. I don’t want to do research. (That’s the pro­cras­ti­na­tor butting in, too.)

Then there are all these sharp objects, a plethora of knives and mul­ti­ple sharp­en­ers. The elec­tri­cal one, bought by the hus­band who loves the elec­tri­cal gad­gets, the one he mostly uses because the noise sets my teeth on edge, a thou­sand nails on a million-ty black­boards. The hand­held device, swipe the blade through one side, the other– voila, an edge. It’s okay— not my fave. That’s the steel— that’s what I like to use, a gift from my father— its wield­ing requires some skill, since you’ve got to get the angle just right in order to get the sharp on the blade. You flick-test with your thumb until– ahh there it is, enough that ser­rated edges for slic­ing toma­toes? Those are for wusses. I want an edge on my knife to match the edge on my tongue. It’d be a shame to use one of my knives to that end—my end. So– maybe one of the util­ity knives except—ugh. They’re dirty from all of the tape on all the boxes I’ve cut through, open­ing boxes, as if flesh and blood through wrists (ver­ti­cally, not cross­wise, peo­ple always get that part wrong, and would my hands be steady enough after that first slash, I won­der?) would be any cleaner. Would I be strong enough, fast enough, bold enough, to cut down to bone? My high school biol­ogy teacher said my work on my fetal pig showed I had hands like a sur­geon, and I can butcher a chicken like nobody’s busi­ness. The snap-crack of the thigh bone under my hands, no hes­i­ta­tion as I slice through the ster­num and peel the meat from the ribs. Would that get­ting at the heart of myself was nearly so sim­ple. Each week in ther­apy, I stut­ter and start as I try to talk with my ther­a­pist, a well-meaning woman I like and with whom I’ve yet to really con­nect. She keeps ask­ing me “How are you,” you see. Per­haps I should print out this essay.

Step in front of a bus? The ones in con­ve­nient loca­tions where I wouldn’t have to go out of my way (see, this is the prob­lem with being depressed, get­ting some­place where the busses get up enough speed takes so much energy, damnit) are just pulling out of the station—there’s not enough speed to do the full job, and the per­fec­tion­ist in me wants it all done. At most, I’d get a bro­ken arm, bro­ken leg, maybe some ribs. It’d just gar­ner ques­tions, that and an increased dose on my anti­de­pres­sant– more fuck­ing pills, when after eight years of this round, I’m feel­ing done with the psy­chophar­ma­ceu­ti­cal game. The rest of my life, Plus, I’ve always joked with folks that I doc­u­ment steps at work, keep accu­rate records “in case I get hit by a bus.” I might hurt their feel­ings if I actu­ally did it that way. They’d won­der if I was leav­ing them clues. I wouldn’t want them to feel guilty.

Let­ting go of the wheel of the car is out of the ques­tion. Aside from the fact that I might lose my nerve—might not get up enough speed to do it right, make it final, all of that stuff—fact is, the insur­ance won’t pay for sui­cide, and then my hus­band will be out of a car, since it’s the only one that we’ve got and we haven’t got enough saved for him to just go buy another. I can’t do that to him, espe­cially since we’ve only just paid the thing off and wouldn’t that be a waste? Plus, I just got the oil changed, had it ser­viced, all of that rot. It’d be a ter­ri­ble shame to undo all of that work, espe­cially since it’s run­ning so nicely and they even vac­u­umed the rugs.

And then there’s the whole mess in the back bed­room. All that paper abyss from the job that I left (panicked–fled, gasp­ing for air on that third thrash to the sur­face, my arms so exhausted as I struck for the shore that some­times I’m still amazed that I didn’t drown), all the per­sonal mail I just couldn’t stand to look at or open, all those clothes that are too big or too small (I really should clean and Craigslist the cash­mere and suits, they’re in good shape and we sure as hell could use the money, it’s not like I’m going to wear most of them any­time soon). There’s so much that needs clean­ing and sort­ing and I think back to every death or famil­ial psy­chotic break or elderly move I’ve ever lived through— my breath catches in hurt for the peo­ple who’d have to do all that clean­ing. (The shame and panic I feel at all the secrets I still think I’m keep­ing of how messed up I am and how all that would be revealed if I left it for oth­ers? It’s some small deterrent.)

So per­haps I’m a cow­ard. Per­haps I am brave—this week, I sorted some mail and threw some away, keep­ing the top­most of some old, piled bills. I even made plans to call, to per­haps fig­ure out—well, I’m not sure, exactly, but I can at least ask some ques­tions rather than avoid the whole in blind panic. And then I swif­fered. Washed dishes. Made an appoint­ment with my pri­mary physi­cian, because I’d hate to make my poor hus­band have to go through my cal­en­dar, can­celling appoint­ments, much less explain why.

I choose to think that despite my bad choices, despite my bad moments, despite what may seem here as what aren’t quite what the shrinks might call “pas­sive ideation,” and what I pre­fer to think of as this.

She was always a ner­vous child,” my grand­mother once told my dad.

Ner­vous. Fine. It’s a bet­ter term than some oth­ers I could apply to myself.

How are you?” some­one will ask me tomor­row, because of all the deci­sions I’ve made, I’ve at least stuck to this—get out of bed, go to work, don’t burst into tears out in public.

Fine, thank you,” I’ll answer, then smile. I’ll even smile like I mean it. Maybe I will.

(Ed. for those con­cerned. This is a … con­den­sa­tion of feel­ings I have had in the last few weeks or so. Noth­ing nec­es­sar­ily current.)

NYT Sunday Magazine article on the Anxious Mind

There’s a long arti­cle in this weekend’s Mag­a­zine about the hardwiring/predisposition toward anx­i­ety as a psy­cho­log­i­cal dis­or­der, some­thing that adds to the Nature v. Nur­ture debate. This, in par­tic­u­lar, rang true:

“Two peo­ple can expe­ri­ence the same level of anx­i­ety, he said, but one who has inter­est­ing work to dis­tract her from the jit­tery feel­ings might do fine, while another who has just lost his job spends all day at home fret­ting and might be quicker to reach a point where the thrum becomes over­whelm­ing. It’s all in the con­text, the inter­pre­ta­tion, the abil­ity to divert your atten­tion from the knot in your gut. These vari­a­tions also hap­pen when some­one grows up from an anx­ious infant to some­one either fret­ful or tranquil.”

Envi­ron­ment mat­ters. Take a “nat­u­rally” anx­ious per­son, set them in a stress­ful envi­ron­ment, and what do you get?

Well– messy is maybe the best, most con­cise, least judg­men­tal way to put it.

Dis­en­tan­gling bio­log­i­cal over-responses to objec­tively stress­ful sit­u­a­tions– not easy. And how to say how much “bad” stim­u­lus is the tip­ping point, that makes some­one Offi­cially Anx­ious? (Depressed? Bipo­lar? Insert Your Biologically-Based Dis­or­der Here.) How much of it can be resolved through sys­tem­atic self-analysis and self-discipline? Can you talk your­self out of anx­i­ety? Stop think­ing there’s some­thing “wrong” (aka moral or wor­thi­ness notions) with you, and accept it sim­ple is what it is, and apply cop­ing mech­a­nisms with­out pro­cras­ti­na­tion and guilt?

No answers– and hardly from me, since I get that wash of tin­gles up and down my arms and neck when the phone rings some­times, break out in a sweat when I’m sort­ing the mail, though my anxiety’s more some­thing that comes along with the depres­sion angle of things. I am BOLD (and my house is damned clean) when I’m on a hypo­manic swing.

I’ve started see­ing my shrink again, am con­tem­plat­ing new meds after hav­ing been on (effec­tively) none since early this sum­mer (topa­max, trilep­tal, risper­adol, depakote monother­apy), and am see­ing a prospec­tive new ther­a­pist Mon­day. My prob­lem with my old one was that even though she was the one to sug­gest that Bipo­lar II might be what I was work­ing with, every­thing for her came from a Nur­ture per­spec­tive– I couldn’t just be hav­ing a bad day, I always had to be react­ing to some cur­rent stres­sor trig­ger­ing a past trauma. But it’s not true– some­times you just feel like shit, and things really are Fine all around you.

Per­haps I could do a bet­ter job work­ing on that angle of things– it’s work, think­ing about how par­ents are messy even as they’re well-intended and every­one has their own crazy to deal with, much less admit­ting what my stum­bling blocks are and acknowl­edg­ing that I am now doing things to mess up my own life– but we never really talked about cop­ing mech­a­nisms and con­crete ways of ask­ing for help, and I think work­ing from a set “You will always have a cer­tain level of X” and not try­ing to attach blame or feel­ings of psy­cho­log­i­cal lazi­ness to the mat­ter on top of every­thing else would be useful.

Sigh.

Being a grown up sucks. Well-timed arti­cles prim­ing me to act like one and actu­ally try to have a game plan? Not so much.

The right few words

I’ve been feel­ing up and down again– not the deep crashes and stom­ach lurch­ing heights of truly bad mood swings, but repet­i­tive lit­tle lurches that have me feel­ing cranky or sad or lethar­gic or anx­ious– and feel­ing very, very sorry for myself.  A la “I want a magic pill,” and “I don’t want to do this any­more” and all that use­less, self-pitying jive.

With the help of my shrink I’ve gone up on my meds, switched the extended v. imme­di­ate release dosages, added some down­ers at night to coun­ter­act some of the upper effect of the new reg­i­men, and oth­er­wise engaged in lots of lit­tle tweaks.  And I’ve felt great (okay, try just bet­ter, but bet­ter is good) for almost three weeks now– which is why I started feel­ing sorry for myself as I drove us home from din­ner last night with two dear friends and real­ized I was feel­ing too alter­nat­ingly weepy and irri­ta­ble at the wrong point in my birth con­trol pack for it to be mere PMS.  The thought that I was shad­ing up into a mixed hypo­ma­nia again from just a 25 mg. increase in one pill had me teary eyed as I hes­i­tantly expressed this con­cern to the BH (and yes, I’m going to leave a voice mail for my shrink)– and he gave me a long reas­sur­ing response about how it was hard, but that I was work­ing hard at it too, and that I had good providers, and that if any­one deal­ing with this could keep it under con­trol, it was me.

Which was all lovely and kind and what I needed to hear, but I still felt sorry for myself– so I asked him if he ever regret­ted not know­ing about this when we got together, then married.

My only regret is you’re not richer,” he says.

It was just what I needed.  I’ve still got to call my shrink, but I’ll be laugh­ing all weekend.

Happy Valentine’s Day, sweet­heart.  I’m cer­tainly richer for hav­ing you.

Today’s Real Mental Post

Today’s post, “Sens­ing out signs,” is up at Real Mental.

Meds Question

Any­one tried trilep­tal?  After a hypo­manic surge at 200mg on lam­ic­tal, what I hoped was my old standby, and con­tin­ued mild migrain­ous symp­toms at 100mg, it looks like I get to hop the new meds roller­coaster for a while.

Please feel free to email me offline, bipo­lar­lawyer­cook AT gmail DOT com.  Thanks, all.