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I have a tendency to unconsciously appropriate other peoples' affectations, leading me to say things like y'all.

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Sunday, April 30, 2006

This is for Amanda

Dear Amanda,

I hope you'll forgive my responding to your post on my blog, but I'm hoping that other people who have experienced any of the things you and I have, might find some sort of comfort here.

First off, I think you have to stop putting so much pressure and blame on yourself. While on the one hand mollycoddling yourself all the time won't make the situation better, you have to remember that you've got a condition that is in a large part out of your control and that it's going to take baby-steps to find an appropriate pace at which to move in your life. You need to think about what's right and necessary for you to feel good about the world around you: what kind of stimuli set you over the edge? what kind of environment are you most comfortable with? are there changes in activity or diet or sleep that might support a higher level of functioning for you? do you need more time with friends who love you, but in smaller doses? could you make a deal with yourself to go out one night/day if you had friends in the night/day previous to that? Does any of this make sense?

For me, the process, which is clearly still very much a process, has been one of understanding how to construct the right conditions under which I can overcome the limitations imposed by my bipolar diagnosis. As we've recently found, sleep is a big factor...huge factor. Alcohol, I believe, is also a factor. Spending too much time in crowded places with too much stimulation is also overwhelming. These are just a few examples of what I meant in my questions above.

I can certainly understand your fears and concerns about meds. The first time the question of meds was raised was last summer when John and I were in India for a wedding. We were there with all of our friends, as well as Johnsmom. One morning, after a long night of celebrating, John suggested that maybe I would be more consistently happy if I looked into meds. I didn't smile as much anymore, or enjoy the things that had once brought me so much pleasure. He was right, of course, but I'd been doing such a good job of convincing myself that if I just lost another 7lbs or another 5 lbs everything would be better, that it never occurred to me that there was anything else wrong in my life. I should say: wrong in the way I felt about my life.

Needless to say, when he brought the issue up, I refused to consider it. I was terrified of meds. I had totally irrational presumptions that I would end up a fat emotionless vegetable if I started taking something. And that my brain wouldn't belong to me anymore. Worse yet, I was raised to believe that people who needed medication or had any kind of chemical imbalance were sick freaks that were discountable. That people like that were weak. Now, let's be perfectly clear, I didn't believe any of those things myself, but this is back when I was still talking to my family (for the most part) and the thought of their response to my taking meds was enough to close the issue. When my brother was 15 or so, he was diagnosed depressed and put on Prozac, then Zoloft, and my father acted like my brother was a pariah. Only when my brother went off his meds did their relationship start to mend. When, directly preceding my own diagnosis, my brother was diagnosed bipolar, my parents totally wigged. It was a good three months before I confessed to them that I was undergoing treatment for the same condition, but I refused to talk to them about it. If I told my mother I was having a bad day, she would suggest that my meds needed to be adjusted. If I told her I was feeling great, she acted like the issue had never existed. I swear, it was as if I was a dog who was learning to stop peeing on the floors...bad girl, good girl, here's a treat. Ridiculous. In her own way, I believe, my mother was trying to be supportive and even innocuous, but the best thing she could have done was to actually learn about my disorder.

I don't know what kind of relationship you have with your parents, but maybe (if they haven't done so) your parents could read about your anxiety...suggest that they read some of the same books that you are. They should make the same attempt to understand what your experiencing in the world that you are. I would guess that their questions about your condition are very similar to your own and that their behavior towards you is bred of ignorance. I don't know, I could be wrong since I don't have full back-story. I know that (in leu of my parents) having the support of a family (which is, of course, largely comprised of my friends) that I do makes a huge difference for me. It's what gets me out of bed when I can't do it on my own. I believe as well that if my parents were actually available in my life, really available, then the quality of this struggle would be, and have been, incredibly different.

Now, as far as meds go...again...I have friends who take (or have taken) them. One of my closest friends has found her way back to life through Zoloft. I mean to say that she was in the darkest hole I've ever witnessed and for her Zoloft was the light she needed to find her way out. I know that sounds dramatic, but it was. Another of my dearest friends takes Wellbutrin. He, like me, didn't realize that the emotional dips in his life were indicative of a long period of functional depression. Wellbutrin has worked remarkably well for him without side-effect...at least none that I know of. Unfortunately, the medication side of a clinical condition really is a total crap-shoot. I know that isn't very reassuring or inspiring, and I know that it will be even less so when I say that I do believe what a doctor prescribes often reflects what the pharmaceutical reps have encouraged them to sell, but...and this is an important but...if you have a doctor you can trust, that shouldn't be an issue. I know that my shrink, for instance, favors Depakote. She's had a great deal of success with it, so it's her typical go to drug when the condition and potential recovery of the patient seems to warrant that as a prudent choice. I know, however, that if the Depakote wasn't working for me she would try something else because my relief is more important than a pharmaceutical perk.

Something that stuck out for me in your post was that you're seeing a therapist, but it's your internist who's responsible for monitoring your meds. You may find better guidance with a psychiatrist to prescribe this sort of medication to you since that's their specialty. More importantly, a psychiatrist will meet with you monthly in order to make sure that the medication is doing what it's supposed to and not messing with your system in some unexpected way. Most (or many) shrinks don't do the actual therapy work, so you'd probably be right to stay with the woman you've formed a relationship with (assuming you're happy with her) so that you have someone to continue talking this out with (you know, who's better at it than me).

Now, this is totally silly, but when you were a kid did you read the Little Miss and Mister books? Do you remember Mr. Jelly? He's petrified of everything in the world around him and thinks that every leaf falling from a tree is the world coming to an end or a band of ruffians out to get him? Well, towards the end of the book he meets a tramp who tells him that the answer to overcoming his anxiety is to count to ten every time he feels like he doesn't have a handle on things. I know, I know, it's so inappropriate to bring up a children's book when you're going through something real and serious, but Sophie was "reading" this book to us the other day and I can't get out of my head how true that is. How taking a few seconds to reevaluate and calm down can make a difference.

I don't know if any of this is helpful. Other people have given you good advice to your post as well, from what I gathered...reading was a helpful, less isolating, step for me. Finding blogs written by people who knew what I was going through had an enormous effect on me. And then writing a blog...exposing myself and exploring myself through writing, that moves the process along too. Just remember to breathe when it all seems like way too much, because often it probably is and I know how suffocating that can be.

Best,
I.

4 Comments:

Blogger CraniumBoy said...

I don't think it's inappropriate at all to bring up a children's book in the context of dealing with something "serious", especially when it can be used to further illuminate the situation. In fact, the tramp's advice to Mr. Jelly is not too far removed from Bertolt Brecht's notion that irony provides distance from situations and allows us to process them more effectively.

Also, I agree that a psychiatrist would likely be helpful for accurate "read" on how the meds are working. I met with one after experiencing some troubles of my own (http://craniumboy.blogspot.com/2004/08/this-world-over.html) and found the experience enlightening. One item of note: he told me that he wasn't allowed to engage in therapy, but rather only in prescribing; apparently there's some guideline or rule preventing psychiatrists from doing what psychologists do. Seems a little odd and unnecessary to me, especially since a holistic approach to the chemistry and functioning of the brain would probably be more efficient for the patient.

1:15 PM  
Blogger Irina said...

Michael,

Thanks for pointing these things out. I think you're absolutely right that it's ineffecient that psychiatrists only dispense medication. That said, I imagine it's unreasonable to expect someone getting their medical degree to simultaneously carry a course-load of psychology. Although, it seems like the world is filled with so many mediocre therapists at this point, some finer screening wouldn't hurt.

As for Mr. Jelly...I felt a little condescending telling Amanda to just take a deep breath every time she felt anxious. I wish I had the pleasure of knowing her personally, but as I don't I can only go by the impression she has made on me through her comments and blog. Amanda strikes me as an intelligent and self-aware woman, so I'm hard pressed to believe that she hasn't thought to take stock every time she feels a bad spot coming on. That said, we all forget the simplest option now and again, so I figured it couldn't hurt to throw it in there.

If you don't mind my saying so, I think you, like my John, are an absolute mensch to stand by your woman and do her so much good.

1:29 PM  
Blogger CraniumBoy said...

Thanks for the kind words; I especially appreciate being called a mensch.

From what I understand (although I haven't researched it too thoroughly), psychaitrists do need to learn clinical psychology - or at least the one I met with did. I know this because he expressed frustration at not being able to see patients for therapy on a regular basis. I believe the real impediment come (perhaps unsurprisingly) from the insurance companies.

I'm happy to confirm for you that Amanda is both intelligent and self-aware, and while I don't want to speak for her, I'm comfortable saying that you didn't come across as condescending at all - life's lessons come from many different sources.

2:37 PM  
Blogger Irina said...

You're totally right about the clinical psych, of course...I meant the dissertation element, really. The fact that psychologists concentrate their studies so deeply in theory and clinical research vs. the chemistry and such. If that makes any sense. I think the insurance companies have a great deal to do with that kind of stuff, but then I'm jaded from when I ran a medical practice before Sophie was born.

My shrink seems so very comfortable talking straight medicine that I can't imagine she'd be any good at therapy anyway. I guess it's not a totally bad thing that the division of labor exists because she's so good at what she does and I feel really confident in her, but I would hate to spill my guts to her.

There aren't nearly enough mensches in the world and I don't toss the term around lightly.

9:16 PM  

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