Three Months Since…

I cannot believe it has been three months since I was involuntarily committed  when I tried to commit suicide. It seems like a lifetime ago (no pun intended). So many of the details have just become a hazy dream.

I still do not remember any of the events that led up to being committed. I guess I never will. At least I have all of the medical records to give me an idea of what and how it transpired—what a rollercoaster ride these 90 days have been.

I can say right now that I am in a much better space than I was on 11 October. It has been several weeks now since I have had any suicide ideation. For a while there, after I was discharged, it was a nightly event. I have done a lot of hard work in my group therapy sessions that ended 30 December. And, it appears that my psychiatrist has come up with a sustainable cocktail that has stabilised my bipolar disorder.

Do I regret what I have gone through? Absolutely not. The end result has been incredible. I am stronger mentally than I can ever remember since being diagnosed in 2000. I had what I thought was a pretty good cocktail all those years having nothing to which to compare. What I did not have before was a strong handle on specific coping skills that made the difference this time. Oh, sure, when I tried to commit suicide in 2005, I was exposed to DBT, but never felt it was for me. Truth be told, I thought it was all a bunch of bullshit. And, I’m not saying that I am totally sold on DBT even now—some of the tools have worked well for me; others have been not so much. This time around, I made a concerted effort to learn these tools even, if at first, I resisted strongly.

Lessons learned? I am not sure I can even address that facet yet. I am still feeling my through this maze. OK, one lesson I did learn hard was to never go off my medication. However, when I made the choice to go off my meds in April of last year, it was because I had just found out I had been laid off and could not justify the enormous expense. Now that my insurance has rolled over to a new calendar year, I still have to meet my $1200 deductible for this year. That means I have to pay 100% of all my meds at retail price until the deductible is met. Even though I have a job now, I am pretty tight financially and I am not sure where I am going to come up with the money. But, if I have to, I will put it on my credit card even though it pains me to have to resort to that possibility. I simply do not have the option to go off my meds.

Another thing I think I have learned is the enormous help therapy has been. Now that I am back at work, I can no longer participate in my group therapy sessions (they were always held for three hours three times a week during the middle of the day). I have hooked up with an individual therapist now and saw her last week (I had already had my intake appointment some time ago and one follow-up, but I had to concentrate on my group therapy then). I am not sure how individual therapy will help me as the dynamic is going to be different from group. When I met with her last week, I actually told her I was not sure where to start. She asked me what issues I had that were most pressing to me. Not wanting to bite off more than I can chew, I told her that I wanted to focus on my stress now that I am back to work after being on short-term disability for 12 weeks.

Now that my BP has stabilised, I am going to have to start to deal with my borderline personality disorder and my anxiety disorder. Now, that is going to open up a whole big can of worms. I think that I am only going to put one foot in front of the other and take everything slowly. I have made some significant process and I do not want to find myself in a spot where I begin to regress. I value where I am today and that is what I am going to hold onto—the here and now. As someone once told me, yesterday was over last night and I have no control over tomorrow.©2009

Outpatient Therapy-Final Session

Yesterday was the last session of my group therapy program. I began this intensive program 21 October and we have met three hours/day on Mondays, Wednesdays and Fridays. Yesterday marked my 30th session.

Initially, I was very phobic to these sessions. Similar to my attitude when I was involuntarily committed , and knowing I was only obligated to attend for two weeks, my original intention was to skate through those six sessions with no effort on my part. I was still pissed off at the world for how I had been treated to date; I did not want to be in therapy and I certainly did not want to get better.

You just cannot imagine the amount of rage that pulsed through my veins—think Incredible Hulk. However, as the mandatory two weeks came to a close, something was triggered inside of me. Somehow, I came up with the idea that I no longer wanted to go on feeling the way that I did. That level of rage and profound depression was eating away at me and I simply had no more energy left. I voluntarily agreed to stay in the program having no idea that it would take this long.

There was a very detailed daily check-in sheet we each had to fill out. It was basically a way for the therapist to determine and track our progress. The dynamics of the group evolved over time with old patients being discharged and new ones being admitted during my stay. While the overall group was large (in my eyes), averaging around 18-20 folks, once everyone took the 10-15 minutes to fill out the check-in sheet, we always split into two smaller groups. The groups remained split while everyone reviewed their sheets, and we all came back together as one group after the break to start the second half.

I could handle the smaller group in which we each shared what was on our sheets. Based on our input, the therapist would probe further with each of us and ask penetrating questions. The sharing half had a tendency to be somewhat tedious at times. Every so often, there would be patients that liked to hear themselves talk. Repetition is the key word here. They would go on and on about one particular issue and even talk over the therapist as if they had no interest in listening to her feedback. I could see the frustration on the therapist’s face every once and a while. As a result, sometimes the first half of the session would take a long time.

After the break, when we all gathered back together, I had a major problem. I had a rough time being around large groups of people. The noise level would always increase and sometimes everyone would talk at once. That started freaking me out. Therefore, I retreated from the large table in the room (it was actually five conference room-sized tables arranged in a large square) and sat in the chair against the door right by the back emergency exit—it was as far as I could get from the group. The emergency exit was not wired to an alarm, and when it got to be too much for me, I’d walk out the door and take a breather. Being that it was the end of autumn as winter approached, the cool, brisk breezes usually refreshed me.

The second half of the session was psycho-education [I’m sure that Alfred Hitchcock could have had valuable input here :)]. This outpatient therapy program was based on dialectical behaviour therapy (DBT).  When I tried to commit suicide back in 2005, I went through a DBT program after I got out of the hospital. At that time, I thought that DBT was pure bullshit. It all centres on learning tools or coping skills to manage various stressors (depression, anger, rage, anxiety, etc). Being that I had been diagnosed with Bipolar I Disorder (BP) and Borderline Personality Disorder (BPD), everyone thought that this type of therapy would be one from which I would benefit. Back then, I thought all these coping skills were stupid. Sure, it might work for some, but I just could not imagine me taking the time to think through whatever emotion I was feeling at the time and remembering which tool would help me through that situation most effectively.

When I realised that this time around would be centred on DBT, I was quite cynical. However, after about four weeks into it, I discovered some tools that could actually serve me well (see this for a list of tools). Without a doubt, using these skills effectively requires constant practise. You cannot expect to utilise a skill and then have it at your fingertips until you practise it. Once practised, when you face an emotional obstacle, you can more readily adapt effectively.

I also realise that there is a lot of controversy around DBT. Some who have been through the training think that it is bunk as I did. I can say that I do not agree with the entire skill set. I learned what tools I knew I could use and left the others behind (there are some I still think are bullshit). All I can say is that it is up to each individual to determine what works in his or her best interests.

That being said, the first half of my last session was great. Our small group only consisted of seven patients and our small group never had the loud mouths (I am grateful that Mr. Noisy was in the other group!). I knew three of them; the rest were new patients. When I finished sharing my check-in sheet, I received wonderful feedback from the therapist. She basically said that I had done a 180˚ from the time I started the program and was extremely pleased to see the progress I had made. It had taken me all this time to see the huge steps I had made. Don’t get me wrong; I am far from being all fixed up. That is why I am going to continue with an individual therapist. BP and especially BPD can take quite some time to manage. While some professionals banter about the word recovery, I think the best I will be able to muster is to manage my BP and BPD to a tolerable level. Only time will tell.

The second half of my last session was surprisingly smooth. While Mr. Noisy was present and accounted for (as well as the other few loud mouths), the group discussion on the continuing module of assertiveness was quite ordered. It was quite appropriate that my last module would be on this topic. As I have mentioned previously, despite my butch bravado, I really could bolster this skill.

Saying goodbye was harder than I thought. All of the patients who had been around for a while (with the exception of one other patient, I had been there for the longest duration) took their time saying goodbye to me and wishing me luck for my future. As someone laughingly said, “Hope to see you at Wal-Mart should our paths ever cross again.”

Overall, I have to agree with the therapist. I have come a long way since I tried to commit suicide on 10 October. It has been a long road for me, some of it fought tooth and nail against any type of recovery. I know I still have a long way to go, but for now I will just accept the fact that I am in a better space than I was almost 12 weeks ago.©2009

Outpatient Therapy-Days 27 & 28 (December 21 & 23)

Monday was supposed to be my last day of group—the insurance company had only authorised sessions through then. I was not prepared for it to end. Despite my attitude at the beginning, I have gotten a lot out of this therapy and I think that I have made significant strides. I asked my therapist what process I had to go through for discharge and she told me she didn’t think I was ready, especially with the Christmas holidays coming up—she knew I would be alone as, once again, my family enjoyed their celebration with no nod to me. I am beginning to get used to the idea of spending the entire holiday season alone. My son came to visit me two years ago, but he lives out West and, for both of us, it can get rather expensive just to fly in either direction. So, the therapist told me to return on Wednesday as she was going to submit a request to see if the insurance would authorise additional days.

The second half was on self-esteem—something I am sorely lacking. Despite my butch bravado, I saw traits from the description of those who have poor self-esteem and I ranked right up there. That actually pissed me off a bit. Nevertheless, in reality, I do not always stand up for myself and usually take a back seat. I am not exactly a doormat, but I am not as assertive as I could be. It’s odd as at work I can take the lead with regard to directing projects (considering I have taken that blasted Six Sigma training), but when I am relating to others on a personal level it is more apparent.

As the session drew to a close, I wondered if today was going to be my last day. I gathered my stuff and flew out the door as I had another iron infusion directly after group.

I came back Wednesday morning and was pleased to find out that the insurance company had authorised three more sessions, including Wednesday, through December 30th. That would take me through the New Year’s weekend leading right up to when I was supposed to return to work. When our “small” group was sharing, I tried to process the difficulty and anxiety I was feeling about returning to my job. I fear that I do not remember how to do what I have painstakingly spent three months trying to learn. I try to stay in the moment as I still have another week to go, but I cannot help worrying about it. I feel stuck and do not know how to reinsert myself into the routine. I got a lot of good feedback from the therapist and others, but it did not necessarily quell my anxiety.

The second half of the session was on assertiveness—something that I am not very good at as I am more than likely to be either aggressive or passive aggressive. The entire group, as usual, gathered for this part and our entire group is getting way too large for me. It is enough that my little group, when we split for the first half, has too many people. I have discovered that there are a couple of noisy “talkers” in the other small group. As the therapist began her discussion on this topic, those talkers always had something to say about everything and would get into their own discussions if they disagreed with each other. The more they spoke, the louder they got and more people started getting into the action.

It was becoming too much for me. I wanted to listen to what the therapist had to say and ask my questions if any came up. After a while I thought, hell this is a topic on assertiveness, I think I will try it on for size. Rather than just jumping into the fray as everyone else had been doing, I raised my hand (OK, that does not exactly project an assertive position). The therapist piped up (she was pretty good about keeping the group on topic) and nodded to me. I waited for everyone to get quiet, looked around, and gave everyone eye contact. Then I explained that it was hard for me to be around large groups of people, especially when it got loud and everyone was interrupting each other. I told them that when they got carried away, I felt anxious and asked everyone if they could respect my position.

At first, everyone just stared back at me and then the therapist chimed in first. She said she was glad I spoke up and voiced my concerns and told me that it was an assertive position I took and was very appropriate (I thought to myself, “So there, hah!”). Then the noisiest of the bunch jumped in and said to the therapist, “Excuse me, but don’t you control our group?” She said it was a group discussion, but everyone had to be aware of each other. Then Mr. Noisy said, “Well, I’ll respect your position.” I looked at him and wanted to say, “What am I, chopped liver?” What I really wanted to say was, “Fuck you” but I did not (so OK, I was not completely assertive). For a while everyone seemed to settle down, but it did not take him long to go back to his diatribes and, once again, everything exploded. There were ten minutes left to go, so I just decided the statement I would make would be just to pack up my stuff and leave the room. I was not that quiet about it (here is where I was being passive aggressive), pushed back my chair and got up and walked out of the room. I though, “Well, we’ll have Friday off for Christmas, so that will give me a breather.” However, I was glad my insurance had authorised two more sessions.

Two more days until Christmas. To tell you the truth, this year it has almost snuck by me. I do not get out much so I have not been too exposed to the shopping traffic. Moreover, I definitely do not go to the mall. I have forgotten that it was going to be Christmas on Friday. For me, it will just be another day.©2009

Outpatient Therapy-Day 26 (Friday 18 December AM)

Today our regular group therapist was out. The person taking her place normally works as the inpatient intake therapist, so I was not sure how group would go. As I mentioned in a previous post, our little group was getting much bigger. When I looked around I noticed that we had three more new admits. I feet as if I no longer have a rapport with my group now that the original members have all been discharged. I have been here the longest—two months. Most people only stick around for four to six weeks.

I no longer feel that the group sharing part is meaningful to me since the other patients have no history of my background and what I have been through leading up to my time just before I joined the group. However, the second half of the session is still meaningful since we discuss the various tools to use to keep our emotions in a healthy balance.

Well, today was a little different. This therapist had a lot more to say for each person as each patient was sharing. I really liked his style. Looking back, I wish he had been the therapist all along. This is not to say that the regular therapist is not as competent—their styles are just different. I am still trying to process the increased depression I have experienced this past week as my financial situation looks so bleak. Most of the patients are on SS Disability full time. I do not see how they can afford it. When it got to my turn to share, one of the other patients suggested that I should file for bankruptcy. Aside from using the “should” word which imparts a value judgement, I cannot fathom filing for Chapter 7. I incurred this debt and I have an obligation to pay it off. He practically bragged about the fact that he filed two separate times. I just cannot imagine someone brushing off his or her obligations like that. Besides, I still have to get another car—how the hell I’m going to afford that one is still up in the air. My car is starting to make telltale noises, so I know it is not going to be around for much longer. I will never get financing if I file for bankruptcy. I have to be practical here. Because this therapist had a lot more to say with each patient, we spent the entire three hours going over our check-in sheets.

I cannot imagine not being apart from this group therapy. Despite the fact that I whined about it so much in the beginning, I have really benefitted from it. I found out yesterday that my medical insurance will only cover 27 sessions making this coming Monday my last day. Oh, yeah, I forgot to mention that the disability group that processes the claims did approve my extension through January 4th. I would like to be able to continue with this therapy for as long as I will be out of work.

Now that I have a fixed date to return to work on January 5th, I have to start planning for it. My FMLA runs out pretty much at the same time, so I no longer have any choice. I will be going back to work so I need to get that in my head and just deal with it. Oh how I wish I could afford to be on permanent disability. It is not as though I am being a gold brick about having to work. It is just that the job I have is very high profile and creates a tremendous amount of stress and long hours. It is going to be a rough transition after being out of work for two whole months. However, I am going to try not to stress out over that. Nevertheless, I cannot ignore it either.

Well, I have another appointment with my GP again today right after group to get another iron infusion. I sure hope that person from the lab is there as he has been far more successful at starting my IVs than the clinical specialist has been. You should see my poor arms and hands.©2009

Outpatient Therapy-Day 25 (Wednesday 16 December AM)

My group therapy session today did not go as well as I had hoped. I am feeling more depressed these last few days, since Saturday, but I did not realize how much until it was my turn to share. As I was going through my daily check-in sheet, when I got down to the section marked “current stressors,” I had written that I was facing huge financial burdens due to all the medical bills coming in and that I still had to find the extra money to support buying another car. As I was talking about this, the tears just started rolling down my face. I hate crying, especially in front of other people, but I could not keep up my façade. I was not even sure what the catalyst was of my recent downturn of my mental status, but as I was sharing this, it became apparent to me that my money issues must have been playing a good part of my increased depression. Of course, there was no real tool to deal with these emotions—anything I tried was fruitless. My bills were not going away and there was nothing I could do about it. The latter concept should have given me a clue as how to handle this situation—to accept it at face value and deal with it. But, how can you deal with knowing you have much more outgo that income?

Just to add to my worry and anxiety, today is the last day of my short-term disability. Both my group therapist and my psychiatrist have submitted extension requests, but when I called the third-party vendor that administers disability claims, I was told that the decision would be rendered tomorrow, my first day back to work. I am definitely not ready to face that stress. I left a voicemail for my manager indicating that, while tomorrow is supposed to be my first day back, I was unable to return and that the claim decision would be made tomorrow. I indicated that if the extension is denied, I would like to take my remaining vacation days through the end of the year (I had 14 days still coming to me, and while I was going to be using up 10 of those days, I would end up losing the other four as my company does not allow someone to carry over any vacation days). Then I sent him an email saying the same thing. If they do deny the extension and my manager does not go along with my vacation request I will risk losing my job according to the FMLA rules—I would no longer be protected by the federal guidelines imposed by FMLA. Why can’t the disability group make their decision by the end of today to give me a heads up as to what I should do about tomorrow in case I do not get a reply from my manager? My psychiatrist submitted his request along with the supporting documents on Monday, two days ago. They have previously decided with paperwork only submitted 24 hours ahead of time. Why did they need 72 hours this time?

I also have to go by my GP’s office right after group to get my third round of those iron infusions. I am not looking forward to that considering how many times they had to stick me Monday just to find a vein. I also had that weird reaction when I got home, but when I reported that to the clinical specialist yesterday, she looked up the reported side effects. While feeling tired was one, feeling that extremely tired along with the muscle fatigue and feeling bone-chilled made me think that something did not add up. I do not want to get the same reaction again this afternoon. I am worried in case these side effects start appearing while I am driving home. To be on the safe side, I put a tablet of Provigil in the pill container that I always carry with me. I just hope they can find a vein much easier today. I still have bruises from Monday’s attempts.©2009

Outpatient Therapy-Day 24 (Monday 14 December-AM)

I have been somewhat disappointed these last couple of days. I was doing so well last week. Since my short-term medical disability is only approved through December 16th, so I thought I would be ready for discharge from this group therapy program. The therapist recommended that I return today to wrap everything up, but after this weekend, I could tell that I was more depressed than last week. I do not know what the catalyst was, but I am glad I had the chance to return. My daily check-in sheet showed a marked decrease in my level to function since last week.

One thing that I am disappointed in is that there have been a lot of new admission over the last couple of sessions. I still cannot handle being around many people. When the entire group gathered this morning to fill in the daily sheet I sorta freaked out. I moved from my spot at the table to a chair against the wall in the far corner until everyone finished and the big group split. Unfortunately, that still left a lot of people in my own group. I miss the folks that were part of my original core group when I started, but with the exception of two other people, everyone is fairly new. I have no rapport with them. They do not know my history. When it comes to my turn to share what is on my daily check-in sheet, how can they determine my level of progress (or in this case, the steps I have taken backwards)?

Even though there were still a lot of people, once the group split, I assumed my seat at the table (I always sit in the same chair—the one closest to the back door leading outside if I have to escape for a short period of time). Luckily, the person already sitting there was part of the other group. The therapist asked who wanted to go first and I groaned because we go around the table and it was going to take forever to get to me. As much as I put forth when it is my turn to share, with all these new people I had no idea how long it would take them to get through their sheets. Some people have been known to go on and on about not much at all. Not that I am trivializing their plight, but to repeat the same scenario over and over again from one person can get to be a bit much.

Actually today, it was interesting to hear the new folks share. So many of them were in exactly the same mental space I was in when I first started. It gave me a new appreciation for the strides I have made even though I feel like I have taken a few steps backward these past few days. Then, finally, it got to be my turn. One of the things I processed was my interesting reaction to my first visit back to my church after a nine-week absence since I tried to commit suicide. Here I was anxiety-filled at facing all these people for fear of what they would all ask me about my absence. Sure, some of the folks knew the truth, but there were a bunch that did not. I can still remember how stricken I was standing outside at the front door for fear of what would happen once I went inside (see post below).

Once I described how lonely I ended up feeling after the service was over since no one approached me (I had to keep telling myself it was because they were respecting my privacy), the therapist thought it was quite oxymoronic.©2009

Outpatient Therapy, Day 23/Psychiatrist Appt #9

Today’s session went really well. My therapist said I had made such strides over the last seven weeks that she agreed that I could be discharged on the 18th. Today, in fact, we had some new people and some that have been in the group for a little while that had it rock bottom and the therapist used me as an example how things can really get better. I feel good about myself today—something that I did not foresee being able to say even a couple of weeks ago.

I have built up a small coterie of close friends that know me intimately—the ins and outs of my mental illness. This has become my support group, yet another thing I about which I did not even think about. I was isolating so much and vindictively pushing people away to purposely further isolate me. The ironic thing is that the majority of this small group is made up of people with whom I had gone to church. That is my next major hurdle—reinserting myself back into my church. I am feeling less anxious about it, but something is still holding me back. Perhaps it is because not everyone knows my complete story and I certainly do not want to share that with anyone who has not been along for the ride.

I still do not know what “normal” is, but I feel more content than I have for a long while. I have not had any suicide ideation for a while, but the main concern I have, feeling this good, is that I am not ramping up to swing into the manic dark side. I am carefully looking for signs, and my friends know what to look for, so they may see it before I do.

I am going to try to go grocery shopping by myself, cane aside, this weekend. I will see how I deal with being around a large group of people. This should be a good test for me. It has been the one hurdle I have not passed (aside from returning to church). I have gone shopping with a friend that lessened the anxiety, but it is time I try to do it for myself.

I also saw my psychiatrist this morning before group. He also seems pleased at my bipolar improvement. Now that I am getting about six hours of sleep these last two days he has agreed to start reducing my Zyprexa, yet one less pill to take. He is going to submit an extension of my disability (currently ending on the 16th) to return to work on Jan 4th for two weeks at half-time to gradually get accustomed again with full time beginning on the 18th. I hope they approve this extension, as I am simply not ready to return on the 17th. He is not sure if it will fly since I have made such improvement, but he is certainly going to try. He is going to send in the paperwork on Monday.

Well, folks, that’s my story for today and I am sticking by it!©2009

Outpatient Therapy, Day 22

Yesterday was the first day that I have driven anywhere outside of my own neighbourhood area for a couple of weeks, since I sideswiped the 18-wheeler on the interstate. I have not had one of those dissociative episodes when driving in a while, so I thought I would take a chance yesterday and drive myself. The weather was just awful. It was pouring and visibility was cut to almost 500 yards/457 metres. I left an hour early just in case and was quite anxious about driving on the interstate the whole way, but I got there OK.

Had the weather been fine, having arrived so early, I could have sat outside and smoked until group started, but I was relegated to sitting in our room for a while before some of the others started to file in. I had my daily check in sheet already filled out since I do it from home before I get there (gives me more time to think and try to remember the details).

After the huge group split we started out “sharing” routine. I volunteered to go first as I had to leave early since I had an early appt with my GP yesterday as well. I had a good report to share and even had a smile on my face that everyone made a big deal about. Afterwards, the therapist commented that I was showing marked improvements exponentially. I think it has a lot to do with my psychiatrist putting me on the Lexapro a couple of weeks ago. I asked the therapist if she could mark some time for me after one of our sessions as I want to talk with her about my discharge from the program. While I have made huge strides over the last eight weeks (it was eight weeks ago today that I tried to commit suicide), I knew it was getting to the point that I could no longer afford to be in this program. Yes, my insurance is helping, but 10% of this, that, and the other adds up with all of the appts I have been having. I feel that my seeing my individual therapist now, along with my psychiatrist should be enough to continue with my recovery. I do not necessarily want to leave the group, but I have to make some decisions financially.

I cannot believe it has been eight weeks since I tried to commit suicide. The whole memory seems like such a hazy nightmare to me. On the one hand, I want to forget about everything. Yet, I have to remember it all to keep where I am at now in proper perspective. I have made some huge strides since then and I cannot forget this. So much has changed for me. There are more evenings than not where I can be in my house all alone at night and be safe. I am not sure what “normal” is supposed to feel like, but I do know that I am not as profoundly depressed as I have been. It seems that my bipolar is slowly being reigned in. The positive aspect is that I haven’t swung onto the manic side since starting the Lexapro, a valid concern my psychiatrist has as giving anti-depressants to bipolar patients in a profound depression can kick off a manic episode since the anti-depressant can kick you over to the other side. I have been carefully watching for that. I am getting more sleep now than I have been, and my talking does not seem to be any more excitable than normal. When I am manic, that is the first sign I can spot. I will get on the phone with someone and not shut up the entire time and I talk fast and excitedly. So far, I do not see any evidence to that.

Could it be that my bipolar is finally coming into balance? I am almost afraid to think that one aloud. Once my bipolar is in check, then I can start looking at my borderline personality disorder issues that, for obvious reasons, have been put on the back burner. I can continue that work with my psychiatrist and individual therapist, although I am not sure how to begin that whole scenario. There are some deep-seated issues that I have to work out, and this is going to take some time.

Meanwhile I am socialising more. My friend A called me as she was leaving work last night to check in with me and I asked her if she wanted to stop by my house on her way home. She enthusiastically said yes and I thoroughly enjoyed having her visit for almost 90 minutes. It is so nice to have people with whom I can talk about every day things. This is one area that I have seen positive changes in me. I am not isolating nearly as much. Right now, all my socialising is one-on-one; I have not tried to be in a group of people yet outside of my group therapy sessions, so I am not sure how I am going to handle that. I am going to try to start attending the NAMI meetings (National Alliance on Mental Illness) that take place Monday evenings right around the corner from my house. It is going to be similar to group with a different twist. According to the facilitator I spoke with the other day, there are only about 10-12 people that attend regularly and I will not have to say anything if I do not want to. I imagine I will just sit quietly for the first couple of meetings until I can get the lay of the land.

I am still on full-time short-term FMLA disability, but that runs out January 18th. Right now I am approved through December 16th, but I am now going to have my psychiatrist (instead of the group therapist) put in for the remainder of the time to see if they will approve the extension. My psychiatrist does not think I am ready to return to work anyway, and he wants me to start back only working half-days. I’m thinking, with the deadline coming up (yes, I could always convert to long-term disability, but that’s only at 70% of my pay which I cannot afford) I could put a return to work start date for the 4th of January to work half-days until the 18th. I personally think I need more time than that, but I am financially constrained. To tell you the truth, what I dearly wish I could afford is to go on full time SS disability, but I cannot afford what they would pay out, and Medicaid will not kick in until you’ve been on disability for one full year. I cannot afford to be without insurance. Sure, I could get COBRA from my employer, but since I cannot already afford what disability would pay, there is no way I could also afford the COBRA coverage. Caught between a rock and a hard place.©2009

Outpatient Therapy, Day 19 & My Early Christmas Present

Since I am not allowed to drive myself to group (at some point that will have to come to end and I cannot rely on the good wishes of friends who want to help; I just feel I am being intrusive.) I have to get over my fear of driving and side swiping an 18-wheeler did not add enough to my plate already! Therefore, on Friday I sat and waited for my “limousine.” K called saying she was on her way, so that should take about 20 minutes. Man, I hate winter. You bundle up like crazy for the early morning only to have to strip down by mid-afternoon when the temp gets up to 67˚F/19.45˚C. On those days when the sky is full of sun, I just sit in my comfy camp chair and put on my iPod and bask in the sun. I actually got a sunburn on my face last weekend!

I have made a template in Word to emulate the daily check-in sheet we must spend 15 minutes filling out. This way, the morning before I leave, I can just plug in the answers and be done with it. It buys me time to smoke a cigarette. I have even colour-coded my answers to indicate where my responses are.

I counted the number of pills I take every morning. There are 11: three for blood pressure, plus one for Selenium (those results finally came it and it was abnormally low) and one for the Thiamine. Moreover, I am back to giving myself my B12 injections once a month. That leaves me six daily for my bipolar disorder, not that they are working yet. That does not even count the five I take at night.

(later) There were a lot of fresh faces Friday morning, but I did well; I continued to sit at the table despite the full room. Then, after everyone finished filling out their daily check in sheet, we split back into our two smaller groups. However, out small little group was getting bigger. We did out “sharing” part and I was pleased that the therapist said I was showing marked improvement in certain areas. In the second session, where I usually resign myself to the corner away from the table, I decided to sit at the table and interact with my peers, clearly an improvement for me. We are still working on anger management issues which has been a good one for to listen to.

Well, high noon came and K was out there waiting for me. When we got home, she said she had some food she wanted to put in the fridge. Then, she put her hands on her hips and said, “Why don’t I help you clean up?” My dear friend spent three hours scouring my kitchen and cleaning my living room. In the pit of my depression, I just stopped caring for how the house looked and let it go to seed. I couldn’t believe the amount of work she did while she basically told me to go and sit down. What a caring gift that was to me. It was so nice to walk into a clean kitchen and sit in a clean living room.©2009 

Outpatient Therapy, Day 15

I have skipped posting on these group sessions on a regular basis because there was nothing unique about them, or anything of substance. However, I had some good news to “share” with the group this time that allowed me to rate some good scribbles on my chart for a change. I was able to successfully demonstrate skills that deals with my isolation issues since my past weekend had me actually enjoying time spent with friends outside of my house. The key factor for me isn’t just being able to connect with people, it also has to do with getting me out of the house and exposing myself to conditions that actually force me to isolate (being in situations where there are lots of people). However, it was no small feat for me to have initiated those phone calls that resulted in those plans.

While there are still four more problem areas as outline in my treatment plan, I obviously have much more work to accomplish. My therapist still feels I am not ready to go back to work this coming Tuesday and will be putting in an extension for my FMLA for an additional two weeks. I am frustrated with this because, while my job is incredible stressful, I love what I do. She just firmly believes I am in no shape at this point to handle that level of stress.

The second half of the group was spent on anger management issues, something that directly applies to me. While I have been able to deploy some of the tools to combat my isolation issues, I have so many additional skills that I have been taught that I still cannot use. Therein lies my problem. Anger is a big one for me. When I become rage filled, that last thing to enter my mind is any of the tools.

I wonder how many more of these sessions I will have to attend. What once started out as a two-week requirement for discharge has now stretched into five weeks (the additional three were not under any requirements, but voluntary on my part).©2009

Appt with Psychiatrist Week 4

The first thing we discussed was my weird reaction I had yesterday with Outpatient Therapy Day 9 (didn’t blog about it, as there was nothing new to report). When I woke up at 0200 I felt weak, my legs felt rubbery, and I was shaking all over. It was worse when I was standing, but even after sitting for a while, those effects returned when I’d stand again. At first, I thought my blood pressure was low, but it was normal. I was hoping it would pass by the time I had to drive for my group session, but it didn’t. I chose to drive anyway, but by the time I got to the location, it was worse. I couldn’t walk in a straight line and I stumbled a few times. I went right in and sat down and that helped a lot. The therapist thought it might be a reaction to my medication as I upped the Zyprexa to 40mg to aid my insomnia before going to sleep at midnight. I had my daily call to my psychiatrist later that day, so he dropped the Zyprexa back down to 20mg. This morning I did not have those same side effects.

Later, when I saw him, He had me go through a series of neurological exercises. The only one I didn’t do well on was the Romberg test where, while standing, you hold your hands out to your side, put your feet together and close your eyes. I couldn’t keep my balance. He is still wondering about my low B-12 values and a possibility that I may be low on Thiamine. I also see my regular doc this afternoon (God, I am so sick of having all these various appointments). We’ll be discussing the results of those lab tests I had drawn last week. I’m sure I’ll be told I have to go back to injecting myself with the B-12 shots monthly (cheaper to do it myself instead of paying for an office visit for the same thing). I wonder if you can test for Thiamine. If that’s low, I may be giving myself two shots for a while. My thighs will look like pincushions!

The only other change he made was to reduce my Geodon from 240mg at bedtime to 160mg.©2009

Outpatient Therapy, Day 8 and my Phone Check-in With My Psychiatrist

This group therapy is getting old. It’s the same thing everyday—too emotional for me, at least as far as some of the others in my small group. I know this sounds callous, but from the moment I sit down, I am just counting down those two hours of “sharing” before we have our break. Yesterday was no exception. There is one woman who, they decided a week or so ago, that she needed to be hospitalized again. It wasn’t an involuntary commitment—evidently she agreed to it. Well, her first day back into the outpatient program, all she did was cry while she was sharing but refused to go into any details. She said she was afraid they would put her back inside if she told the therapist what was really evoking this emotion. I have a handle on that one—I’m certainly not going to voice that I am intentionally suicidal (they gauge how “safe” you are as to how forward thinking you are regarding your actual plans to commit suicide). I can say that I was feeling suicidal the previous evening, but I have to show a coping skill I successfully used to avert that situation. I can say without a doubt that there are nights when I am suicidal and I go through the motions of preparing everything. If I were to say that I have the intent to follow through, that would land me right back inside the Big House. I don’t follow through, not yet, but at one point when will the intent be stronger than the want not to do it?

I can feel my depression getting worse even with my doc tweaking the cocktail. So far, nothing he has done has yielded any progress as far as my depression and insomnia go. I am living one day to the next with, at best, two hours of sleep. Oh, and get this, the results of my fasting blood work has come in. My psychiatrist always gets a copy from my regular doctor. He looked at the results while we were on our phone call check-in today (I’ve been on the phone everyday between my weekly appointments even over the weekends so he can adjust the meds, if needed, on the fly and spare me the expense of an office visit). Evidently, while my haemoglobin is 11 (low side of normal), my iron stores are pretty low. My ferritin level is only 5 (normal is 15-200 ng/mL for females). Ferritin is a protein that stores iron and releases it in a controlled fashion, in single cells and multi-celled animals. It is a buffer against iron deficiency and iron overload. The last time, approximately 6 years ago, my ferritin level was only 2. I tried taking vitamins high in iron, then iron pills to no avail. My body wasn’t absorbing the iron. I ended up having to take Infed (used to treat iron deficient anemia) administered IV. I had to have three separate infusions over a few weeks. That cost me one hell of a bundle. I can’t afford that now in view of all of my other medical bills recently incurred. In addition, ketones and protein are spilling into my urine. Ketones are produced in the body when fats, rather than glucose are used to produce energy, but my glucose is 94. Protein in the urine is a warning sign. It may indicate kidney damage or disease or it may be a transient elevation due to an infection, medication, vigorous exercise, or emotional or physical stress. Well, yeah, I am under a considerable amount of emotional stress. I don’t know the other results yet, but I see my regular doctor on the 12th. I am sick of doctors; I am sick of medical tests. I just want to be left alone.©2009

Outpatient Therapy, Day 7, the Gift Bag at My Door, & My Attempt at “Radical Acceptance”

I do not have much to say about today’s session. The therapist is concerned that I am not eating except a small snack to take with my Geodon. She is also concerned about my insomnia. I did not have much to share. Not much had changed from Wednesday, but I was able to report that I was not having any suicidal ideation Thursday night. Very depressed, yes, but I was able to leave it at that. She pointedly asked me if I could remain safe through the weekend and I could only tell her that I have demonstrated successfully one tool, and that was all I could promise her. I also told her that my psychiatrist has requested me to call him for a check-in call on Saturday and Sunday. She seemed rather pleased with that.

In actuality, my blogging has actually helped me with the ideation Thursday night. I spent a good deal of time writing, reading others’ blogs, and keeping up with my LGBTQ-oriented Facebook account (OK, a translation for you straight folks: Lesbian, Gay, Bisexual, Transgendered, Queer/Questioning), along with my Twitter feeds.

Something weird happened at break. One of the folks in my small group came up to me and wanted to know why I ignored her after trying to say hi two times. I had to honestly tell her that I really had not noticed her (remember me; I am all about blinders around other people). She started crying and I did not what the hell to do as she did this in front of everyone. Then everyone stared at me. Well, I am sorry that I must have hurt her feelings (I can recognize that from classic BPD symptoms), but I am not responsible for her feelings, only my own. I felt, with everyone staring at me, that I at least had to apologize. I really didn’t want to have to interact with her at all, but what was I to do? It is not as if I go around intentionally trying to hurt someone, or be rude or uncaring. I just simply want to be left alone. Soon enough, break was over so I went inside where both groups join and found my seat on the far wall. I also asked the therapist if I could crack open the emergency door right beside me in case I had to leave the room (I do not want to make a spectacle of getting up and walking by everyone to leave through the normal door). She said that was fine (no alarm attached to the door)

I came home and found this gift bag by my front door inside my porch. Curiously, I picked it up and brought it inside. The attached note said, “For your walks around the neighbourhood…a few things I thought would come in handy.” It was signed from the only church member (outside of my pastor and his wife) that I had been relatively honest with about some things. Evidently she has been reading my blog and noticed my entries concerning with my dissociative states while walking or driving. Inside the bag was some pretty neat stuff. It contained an atlas with very detailed set of maps of my city along with a street index finder. I found my house (conveniently already marked with an icon as there is a large city fire department up at the corner. Nevertheless, I am going to put an X right where my house is anyway because with a past dissociation, the fire department’s presence did not mean anything to me. I’ve even post-noted my relevant pages). It also marks subdivisions and schools—things I pass by on a regular basis. In addition, there was a device with a red blinking LED visible to one km with a range of 180˚. It came with a strap and three batteries. I can attach this to myself to make me visible when I take my late-night walks. There was also an LED pen light with a magnifier lens that only weighs 38g and has a metal clip attachment. The last thing in the bag thrilled me to no end—a new tool. This seven-in-one tool is only 12cm long. Get this—it contains an LED light, compass, thermometer, clock, safety whistle, safety mirror and a 2X magnifier. It comes with a lanyard I can wear around my neck. Now I can be all decked out in LED!

OK, time for an honest reality check here—my perception vs. my reality. This person does want to be close to me—not because of the gifts, but because of the intentions behind them. I wrote her a long email thanking her (I did not feel prepared enough to actually talk with her at that point). In the same email, I told her everything. I even attached two documents on bipolar and borderline personality disorders to help her understand the effects these have on me. She responded with such a kind email; it gave me some contact with another person who now knew me the way I wanted her to know me—no pretence about anything. She let me know that she clearly knew what my boundaries were and that she was not going to be in my face, but essentially would let me make any contact. Fearing that I would lapse into my normative state of isolation, I told her that it was OK to call me, but if I felt I was not capable to talk, she could leave me a vm. I was OK with that, so after reading the email, I actually felt better prepared to call her. I am trying so very hard to reach out, but I can only take baby steps. I fear rejection; I fear abandonment.

Now, onto my next hurdle—trying to use “radical acceptance.” The principles are 1) solve the problem, or, 2) change how you feel about the problem, or 3) stay miserable, or 4) accept the problem. It takes away the “judgements” and removes the “shoulds.”

The hurdle—all of the anger and resentment I have felt toward my pastor for placing the 911 call and coming by the house to show the police my text message. My perception? That he was disappointed with me, angry because I did not call first and ask for prayer before I got in that state, and that he would think less of me. Therefore, I took a very deep breath and wrote down everything I wanted to say before I called him so I could focus and concentrate on what I really wanted to say.

I called his house and thankfully, he answered. I am not really sure what I would have said if his wife had picked up instead…I wasn’t prepared for that scenario. I told him who I was not knowing if he would recognize my voice. Then I told him I had something to say and would he listen to me without interrupting me until I was done. I asked him if he would meet me because there were some things that I needed to say to him alone, that we could meet in a public venue of his choosing as long as I would not be seen as making a spectacle of myself if I got emotional, and it had to be a place where I could smoke (damn these city ordinances banning smoking to even include many outside venues). We settled on standing in the church parking lot (right across the street from me) for this Tuesday at 1630. When I finished what I said, he asked if he could say a few things. I hesitated momentarily—this wasn’t a planned two-way conversation. I wanted to say what I had to say, set the time and place and get off the phone, but I ended up saying OK. He helped fill in some more of the blanks. Evidently there were already three or four police cruisers and the EMS there across the street in the church parking lot before he arrived (I had been told earlier by one of the first responder cops that they parked there with no lights flashing on purpose so as not to alert me in case it was a situation of “suicide by cop”). The cops asked him who he was and he explained that he had placed the 911 call as a result of my text message. They asked to see the text message, but they would not let him cross the street to my house at any point. He told me that the only reason why he came over was that he was very concerned and worried about me. He said he had tried to call me after receiving the text message and I did not answer. Again, the problem with my perception vs. reality.

Am I ready for this conversation? I do not know. I have to find a way to let this anger and resentment go. While it is by no means my only trigger, I have obsessed over this a lot—primarily because I have always respected him. He is a WYSIWYG (what you see is what you get for you non-computer geeks) kind of guy—shoots straight from the hip with no guile. From the very beginning, he has accepted the fact that I am a lesbian and never has judged me. I owe him the same respect.

Well, I still have two days to process this. I am also going to discuss during my group therapy session on Monday. I also have my second appointment with my individual therapist on Monday afternoon as well. My question is am I sufficiently prepared to handle this type of conversation at this point so soon after everything has happened? I need to protect myself and not set myself up for failure. I am trying so hard to reach a point in my life where everything is in balance, but I have to put my needs first—a concept that never existed in my “I don’t give a damn” mode.©2009

Outpatient Therapy, Day 6

I couldn’t resist this video. It actually had ME chuckling a bit! It’s well worth listening to for you group therapy gurus out there!.

Yesterday I was a little more active about filling information on the daily check-in sheet we use for “sharing” (gag). I was able to verbalize and demonstrate (what they are looking for according to my treatment plan) three skills I have been using to further my treatment.

You know how I mentioned that I can be out driving my car and all of a sudden I don’t where I am, how I got there or how to get home? (which only causes an anxiety attack to no end). Well, what I’ve come up is this plan: I Google the map from house to location (and also do a return map) and I keep that in my car. I study the map so I know what exits to pay attention to if I’m on the interstate. I have been using “mindfulness” (skill #1) by concentrating hard on where I am at all times, mentally checking off the exits. In addition, I will call the location ahead of time (even if it’s been a place where I have gone before) and ask for prominent landmarks that I can start looking for as I approach the location. I mark these landmarks on my map.

When it comes to more locally centered destinations, I can zoom in on Google and it will note landmarks (restaurants, gas stations, churches, etc). It’s still up to me to study them ahead of time so I don’t have to be looking at them while I’m driving. I’ve have even had to resort to do this when I plan to take a long walk around my neighborhood. The other night, when I just wanted to get fresh air, I Googled the diameter of the area usually a minimum of a two-mile stretch (residential, no populated landmarks) and made notes on the map with regard to street addresses to go with the street names and would place arrows to make sure I would know how to get home. In addition, I take my walks when it is very late at night—no traffic, no noise. You might wonder if I’m taking a risk doing this so late. All I can say, pity the fool who wants to fuck with me whether he has a gun or knife. Besides, you’ve heard the phrase, “suicide by cop,” well, couldn’t this be just as easily “suicide by rapist?”

The other immediate issue I have been working on is facing being around a large group of people. When our whole group therapy rejoins us for the second session (we always split into two smaller groups for the “sharing” session), I can’t handle the room that is now filled of people. All of the chairs are taken. I can’t sit next to someone, or even be in close proximity. My coping skill has been to “retreat” (skill #2) where I find a chair alongside the wall, as far as away from the table that is possible. Again, I use “mindfulness” when I start freaking out and the walls feeling like they are closing in around me. I simply close my eyes so I don’t have to see anyone and just zone on what the therapist says. Sometimes I have to use my “deep breathing” (skill 3) when I actually have to open my eyes and look at the white board, or have to participate in the discussion (my extent of participation is usually having to ask her to repeat what she just said because I don’t understand something, or my poor concentration is acting up).

So, I am using three skills so far that seem to be working to an extent. I’ve developed quite a lot of neighborhood maps, by the way. I’m not one to retrace my steps every night. Since I am still alive writing this, the severe suicide ideation I experience on an all too familiar basis, what I have been doing for that one is to get out of my house, because it seems that being all alone in my house has become a trigger, so I “retreat” and take a long, hard walk. The exertion helps dissipate the wrathful rage I am experiencing at the moment, so by the time come home I am usually spent and exhausted. I simply take my bedtime meds knowing that they will knock me out for about two hours tops. When I wake up, the suicide ideation is usually at bay, even when I go into the other room and put all my “instruments” back in their lockbox for no one to find. I’ve carefully labeled it quite prominently Bank Statements, so no one would even bother looking there if the cops ever had the probable cause to search my house.

I am missing a time block from the time I left group therapy this past Friday from about 1215 until I woke up @ 0135 (you know, when I eventually go back to work, there is no point in having to set an alarm!). However, what concerns me most about the dissociative states is wondering what I do when I am in that headspace. I have to ask the obvious question: what happens if I become suicidal during a dissociative state? Will I have the frame of mind to attempt to use my coping skills? I only have this as a vital concern because the last time I committed suicide I cannot remember almost nine hours (which of course could actually have been precipitated by the incredible amount of ETOH I consumed along with the benzos).©2009

Outpatient Therapy, Day 5

This morning was rather interesting. Did the usual sharing, but when I commented that I couldn’t remember anything from the time I left group last Friday (but that I remembered Saturday and Sunday) she asked me if I remembered calling her Friday afternoon. I drew a complete blank. She said I wanted to meet with her afterwards today to discuss my treatment plan. It was news to me (as she scribbled).
Well, we did discuss my treatment plan. I asked why, under master problem list, it listed merely “depression” and no indication of persistent suicide ideation. She explained that I had not been honest from the beginning about that on my daily check-in sheets, and only just started mentioning it. I tried to explain to her that the ideation isn’t just something I think about here and there, but that I struggle with this almost every evening. The only thing that has kept me alive has actually been using one of the coping skills. I am discovering that my house…my fucking house (or rather, being in it all alone), has become a trigger. I have to leave the house and I end up going for a walk—a long walk. My reasoning? It’s late at night, and walking releases so much of my energy. When I finally get home, I’m worn out—physically and emotionally—utterly spent.

She looked at me and told me that she thought I needed go back inside the Big House—that this outpatient treatment program, in her opinion, wasn’t going to be sufficient to keep me safe. I pleaded with her not to make that recommendation (i.e., have me committed again), that I had shown that I was successful in using my skills. I practically begged her to let me go as long as I made the commitment to her that I would use my skills when I was in that head space. I tried to stay calm, although my heart was banging so hard. However, she relented but there was this look in her eyes that scared the shit out of me. All I kept thinking to myself was to just deep breathe and stay calm. I didn’t want to trigger any action on her part.

When I got home later, I looked at my entries on the blog and, sure enough, there was my entry about Friday that I posted on Sunday morning. Evidently, I did remember at that moment actually coming home, but it doesn’t say anything else about the rest of the day. And today, the last thing I could remember was someone making a comment about the fact that I actually smiled for the first time just before we left group. My mind is so fucked up. I swear there are times when I don’t know what is real and what isn’t.©2009

Outpatient Therapy, Day 4: Treatment Plan and My Diatribe about Pot

Friday was an uneventful day again. I’m glad this program is only Mon-Wed-Fri from 0900-1200. Once the group split, I realized that there were a few less of us in my half. A couple of people, evidently, had finished the program. I wondered when I was scheduled to be finished. As usual, we went around the room “sharing” what was on our daily check off sheet. While I understand that this is the opportunity for the therapist to get a good view of the progress each of us is making from day-to-day, I have a hard time enduring what some of these mentals say. Some of them can just go on and on about nothing, or repeat themselves endlessly as if to really underscore the problem they are having with their “issues.” Yelling “I heard you the first time,” would accomplish nothing. Meanwhile, when it came around to me, I sorta just tonelessly droned through my list (nothing had changed from last Wednesday, except that I was still alive). I did underscore that I am having repeated states of dissociation and time loss. I swear, there are blocks of time where I can’t remember shit. Not that I go into another room and forget why I got up in the first place; I’ll forget an entire day and have no idea what happened (no, I am not drinking any alcohol and my meds have never affected me this way before). Or, I’ll be driving down the road and all of a sudden I have no idea where I am, how I got to that point, nor where I am going. Kinda spooky. Of course, she did some heavy scribbling here. Then I reported back to them how well I controlled myself when the cop came back to my house on Wednesday to answer my questions. Then, break time (I always arrange it so I am the last to report in).

The group as a whole has pretty much figured out to leave me alone while I smoke my cigarettes during the break. If there are too many of them around the covered picnic tables, if it’s not raining, I’ll just walk around the parking lot instead. When we came back in, I found out that the whole group would be together again for the second half, so I just grabbed my stuff off of the table and found my seat along the wall in the corner. A few people in the other half of the group looked at me, and I just stared back with this “What’s your problem?” look while I shrugged my shoulders and held up my hands. That usually works. In fact, I had to smile—one of the women in my half of the group saw me do that and looked at me and gave me a thumbs up sign. At least she gets it.

Then, the door opened and one of the other therapists called me out to her office. She wanted to go over my “Interdisciplinary Treatment Plan.” In other words, what they perceived to be my problem areas and their stated goals for me. Basically, this is how it breaks down:

ADMITTING DIAGNOSIS (DSM-IV):

AXIS I: 296.62 Bipolar Disorder, Mixed

AXIS II: Borderline Personality Disorder

AXIS III: HTN, Asthma, Arthritis, Headaches

AXIS IV: Financial, Social, Occupational

AXIS V (GAF): 50 (explained below)

MASTER PROBLEM LIST:

1. Depression
2. Intense anxiety
3. Work-related stress
4. Low self esteem
5. Impaired thoughts
6. Lack of social support
7. Grief (deferred to individual therapist)
8. Shame/Guilt (deferred to individual therapist)
9. Hypertension, knee pain, headaches (deferred to PCP)

GLOBAL ASSESSMENT OF FUNCTIONING SCALE (GAF): “41-50=Serious symptoms (e.g., suicide ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).” [Alix’s note: this description comes from a manual; it by no way implies that I shoplift…LOL]

LONG RANGE GOALS FOR TRATMENT (Discharge Criteria): Alix will exhibit skills adequate to maintain the gains made in therapy and establish adequate resources to function at a lower level of care.

PRESCRIBERD TREATMENT MODALITIES/SHORT-TERM GOALS:
Problem 1: Alix will verbalize and demonstrate 3 skills used to manage depressive symptoms, such as mood swings, feelings of hopelessness, isolation, low motivation, poor sleep, & the impaired ability to function. (Target date 11/27/09)
Problem 2: Alix will verbalize and demonstrate 3 self-nurturing skills used to reduce and help manage feelings of anxiety. (Target date 11/27/09)
Problem 3: Alix will verbalize and demonstrate 3 skills used to manage current work-related and financial stressors. (Target date 11/27/09)
Problem 4: Alix will verbalize and demonstrate 3 confidence-building skills used to experience an improved sense of self esteem. (Target date 11/27/09)
Problem 5: Alix will verbalize and demonstrate 3 skills used to improve memory and concentration, and decrease racing, irrational, and confused thoughts. (Target date 11/27/09)
Problem 6: Alix will verbalize and demonstrate 3 skills used to strengthen or build a support system in order to experience less isolation. (Target date 11/27/09)

Well, folks, there you have it: all my problems summed up in a neat tidy package! I’m supposed to figure out a shitload of “skills.” Hell, I don’t even know what most of them are. I sure hope that teaching them is going to be part of this program (since I’ve only been to a few, I really don’t know what to expect). I wonder if the target date means that is how long I am to remain in the program. I did find out that my current FMLA medical disability goes through 10 November. If the target date does indicate how long they perceive my need to continue in the program, does this mean they are going to re-file w/the disability group @ work and extend my FMLA? I know that, according to federal FMLA rules, I cannot lose my job. They don’t have to give me my exact job back, but they do have to provide minimally a similar job with the exact same pay scale. If my manager deems that the team can no longer proceed with my absence and brings in someone new to replace me, maybe my replacement position will be much less stressful and require less than 12-14 hour work days.

I’m not sure how I feel about returning to my current position. I love the interaction with my clients and being able to provide my services, but the overall demand of having approximately 150 high-end clients (major revenue-producing companies), coupled with the many ongoing projects in which I manage the majority of the work product (and so many of them all having approximately the same deadline dates) have become too much for me to handle. The mere hours I work have finally exhausted me. I have tried to manage my time as effectively as possible, but all it takes is one little phone call from a huge company to throw me all off track (not to mention the number of voicemails I have to address throughout the day). Meanwhile all those inbound emails continue to flood my account with more demands of my time and “invites” to numerous customer meetings. At the end of the day, when I physically can do no more, I look at what I didn’t finish and how many unread emails I still have that day only to realize that it will snowball into the next accompanied by a new day’s worth of meetings and unread emails. I have had too many people tell me that I can only do so much and to let the rest go; however, I am bound by Service Level Agreements as part of the contract signed with my clients. I am required to respond to their emails/voicemails within 24 hours (in some cases, within only one hour depending upon the problem). I also have to take into account that I work for a global company. While I sleep, Europe and Asia continue to send emails and voicemails. I am slowly realizing that, as much as I want to, I can’t be all things to all people. Moreover, this doesn’t even take into account the many hours of continuing in-house corporate training I must complete (e.g., Six Sigma). Vacation time? Sure, I have 17 days left. I’ve been too busy to take any of those up to now—too many projects always underway. (I actually took 09 amd 10 October as vacation days; however,the evening of the 10th is when the nightmare began).  It’s already the first of November. If I don’t use them, I will lose them (no carry over). Can you imagine how many emails are waiting for me right this very minute? How the hell am I going to be able to take off any vacation time between now and the end of the year? I just can’t do it any more, but with the way the job market is, I simply have no choice to not do it. With what I do, trying to find a comparable job elsewhere is a pipe dream—everyone is downsizing, even my own company.

When I got home from group around 1230, there was nothing to do. Yeah, my house could use some straightening up, a good dusting and vacuum job (at least the kitchen always sparkles). I can’t tell you the last time I actually made my bed. I just sit on my couch and listen to my music. Oh how I miss the old days when I could fire up a number, sit back and catch a buzz. When corporate HR policies everywhere instituted the mandatory compliance of random drug testing, all that went out the door. I never envisioned not being able to light up a joint again. I have a big problem with this whole scenario. Go after the tweakers and the hard ball coke and smack users, just leave us well-intentioned potheads the fuck alone. I never got high before or during work; it was simply my “martini” at the end of a long, hard day. Tell me who doesn’t have a beer when they get home from work (or goes out with the gang)? In addition, the drug test policy doesn’t even address the alcohol issue. I can’t tell you how many times, when I used to work in a corporate setting, I would be standing next to someone who smelled like a brewery first thing in the morning, or those that came back from lunch looking just a little too much bloodshot for my tastes. Why not address that pervasive problem. Their judgment is equally impaired. It’s just not fair.

Well, tomorrow is Monday, yet another group session. I have some questions about my treatment plan. At least I know I have something to do from 0900-1200.©2009

Outpatient Therapy, Day 3 and My Date with the Police

I was very uncomfortable walking into the group room today. While the entire group is split in two, everyone has to come into my room to pick up and fill out their daily check in sheets. Then they go to another room. The room is fairly large; there are 6 conference-sized tables arranged in a large square. There is a seat for everyone, but it still too many people for me. At least half of them leave after 10 minutes or so.

Today’s “sharing” session (which generally lasts for two hours) was the usual boring routine until it got to me. I have decided to be honest about everything: the isolation that is now bordering on the extreme to include not even wanting to sit near someone, the rage/anger, suicide ideation (as long as I can assure them that I am not going to act on it), etc. I told them about my egging the police cars Sunday afternoon as an example of how my rage is getting out of control since I am now acting out my impulses. I admitted the desire I have to want to beat the crap out of any cop, and that I have been looking for ways to provoke an incident. I also told them that the two cops who responded first to my 911 call back on 10 October would be coming over to my house this afternoon to answer some of my still yet unanswered questions. Boy did that get their panties in a wad. They asked me if I thought I could control myself while they were at my house. I told them I was seeking answers, and as far as this meeting was concerned, I needed their help so I could fill in the gaps. I’m smart enough to know not to bite that hand that feeds me. Then I was asked how I would respond if they told me something that made me angry, or if they patronized me in any way. I didn’t have an answer for that one. They’d better not patronize me. That’s about all it would take to send me over the edge. Who the hell do they think they are, anyway, strutting around flashing their badges and guns like they own everything? (but, of course, I didn’t say that!). They didn’t think it was a good idea, and suggested instead that I meet them at the police department. Oh, yeah, like I’m gonna want to go THERE (aside from the fact that there are too many people around). I just told them I would think about it, but most probably I was going to stick to my guns and have them over. Right now as I wait (should be here in about 45 minutes barring getting a call beforehand), I don’t feel that my anger is out of control. My driving force is to get these much-needed answers. I can behave, or at least play the game, to get what I want. We’ll see.

The second part of the outpatient program today was the presentation by the therapist. She usually touches on various stressors, reactions to stressors, and discusses possible coping skills (today was about anxiety vs panic and their associated decriptions/indications of the related attacks). However, as soon as we came in from our break, she announced that the whole group would be together for this. I immediately got up from my seat at the table and found a chair that was against the wall far away from the table. Everyone piled in and thankfully filled all of the seats so it didn’t look too abnormal to take a seat on the wall (however, I moved there before most of the other group had come into the room). I had a hard time during that session. Just too many people. And, God, can some people whine!

(later) Well, the officer just left. He was as nice as could be and sat down at the table I have on the porch. He said the police always respond to “suicide person” calls as SOP. He and the ambulance parked across the street (where the church parking lot is) so as not to alert me, reasoning being that the alleged “suicide person” may try suicide by cop (it’s a shame they know THAT trick). He went on to say, especially after interacting with me today, that I was highly intoxicated and could not walk without assistance. He walked me into my house to secure my wallet, keys and sandals, but said that he did not search the house. He can’t remember if all my house lights were on or not.

But, here is the kicker: my pastor arrived (he was waiting for the police. He also parked across the street) to show them the text message I sent him. That really pisses me off. OK, I get that he felt some professional obligation to call 911 based on the text message I sent. But to meet the police at my house??? That crosses the line in my book. That pisses me off to no end. Why couldn’t he just leave well enough alone? What was he out to prove?

The cop was completely courteous and respectful. He even said that he wouldn’t even have recognized me by my actions given the state I was in then vs how I was when he talked to me today. It said it was quite an amazing difference.

OK, I guess I have been able to fill in my blanks (except why the hell my pastor showed up…but I haven’t talked to him or anyone at the church since that night, nor do I plan to. Needless to say, I won’t be returning to church—that one or any other for that matter). Now I am just waiting on my medical records from my ER debacle and the copy of the .wav file with the original 911 recording. While I may now have my answers to what the fuck happened (no, I take that back. I can’t account for the hours between 2000-0300 or remember ever feeling suicidal), the whole nightmare has been very upsetting to say the least.©2009

Outpatient Therapy, Day 2 Friday, 23 October, 0900

At group, I was clearly still quite angry and was blatant about purposely not choosing to use any tools, and was very vocal about not giving a damn. Of course, the therapist tried to handle me (I hate being handled) and finally she let it go and went on to the next person. When I got home I was still pretty pissed off and feeling restless. Life really does suck. I can’t make up my mind. I sit in this huge house with a beautiful screened-in porch and all I end up feeling is so overwhelmingly depressed because I am so alone. Then I go off on the rage tangent because I can’t sand to be around anyone and all I want is to be left alone. What a fucking oxymoron am I?

I was reading Patrick’s blog today, catching up on what he’d posted while I was gone. (I still have a few other blogs I am behind in reading). So much of what he wrote resonated so strongly. All I want to do is just disappear and be where no one can find me—ever. Leave everything I own except the clothes on my back, walk out my front door, and drop off the grid with no notice to anyone.

No one will miss me—well, maybe except for my manager after the first day or so. I am currently on short-term medical disability leave totally screwing up my team’s workload. I generally get about 200-300 emails a day. By the time I eventually get back to work (perhaps by 09 November), I am sure my mail server will have shut down my email account just due to overload (I’m sure my clients will be thrilled to start getting “return-to-sender” notifications on top of the already existing “out-of-office” reply my manager had set up upon my admission to the hospital). I can’t even begin to imagine how many unread emails I will have waiting for me by the time I get back. If I get back.

I just plain don’t want to do “it” any more. I’m tired; I’m spent. There is nothing left in me. All I want is to walk out my front door and disappear into the wind leaving no fingerprints behind. It’s almost over now. Even though I had all my scripts filled (from the hospital, my regular doctor and my shrink), I haven’t taken any meds since my discharge. I have no clue as to what my blood pressure could possibly be (ask me if I care). Why can’t I just have a heart attack and die? Knowing my luck, I’d have a massive stroke instead, be left incapacitated and totally useless with no more control. God would find that amusing.

No, I still have the option to take control. I’ve been out of contact with everyone since the night I was taken to the ER. My CallerID was empty when I got home and only one personal email was waiting for me. Ever since I came home, I have only received one phone call and that was from my son. I am so proud of him. He’s 26 and has his head on straight. He has a great job and talks about going back to the university. Do you want to know what we talked about tonight? He was telling me how tickled pink he was now that he finally decided to get contacts (he thanked me profusely for my contribution to the gene pool) and went on about how long it had taken him to get the damn things in his eyes for about the first week or so. He sounded like a kid with a new toy. He sounded happy and that made me smile.

Do I feel guilty about what I will put him through? Sometimes I do because he will be the one to have to fly back east to pick up the pieces. But my job is done. I raised a great son and it’s probably the one thing I’ve done without fucking up to badly. He’s living his own life—he’ll be fine after a while. At least I can say, with past performances, he won’t be surprised. This last episode, however, he never knew of. He’s not listed on my emergency contact list (in fact no one is). But, to head anything off at the pass, the day I was admitted to the psych hospital I texted him that I was headed out of town on business for about three weeks, and oh, by the way, let mom know as my cell battery was getting ready to go. Kept the hounds at bay.

And while I was at the hospital, I missed two services in a row at church–something I hadn’t done in a long time. I’m not planning on returning. There is nothing there for me any more. The ironic thing is that the church is right across the street from my house (in this part of the country, churches are like gas stations—there is one on every corner). And all this time, my car has been parked right in front of my house. Oh yeah, that’s right, there was one member who left me a voicemail the other day wanting to know what was up since I had missed two in a row. Evidently, my pastor didn’t tell anyone what I had done. I just deleted it as soon as the connection broke. No one else at the church has bothered to call. I guess my pastor felt a professional obligation to call in the 911, but that was the extent of it.

It’s weird. I’ve only been home for three days and it seems like it’s been ages since I was in the hospital. It’s all just a distant, hazy memory. I just thought of something amusing. I wonder if there is someone at the hospital that is in charge of reading the obituaries every day just to figure out what their success rate is. But, it doesn’t matter. There is no one here to write mine and send it in.©2009