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

My Zyprexa Dilemma (and a Diatribe On Smoking Pot...Go Figure!)

It’s quite amazing the quandary I am now facing. For the first time since January of 2006 I actually feel as though I’m getting my life back. Everything seems to be balancing out the way I remembered it being so long ago when I was in remission. However, my remission is coming at a great cost to me. These little oval-shaped pills, while incredibly effective, has caused me to gain 20 pounds within a period of a month. At this rate, who knows how much I’ll weigh at the end of the six-month weaning regimen the doctor wanted to use. I told him I was willing to go back on Zyprexa under the condition that if I gained any weight I would quit taking it. In one of the videos I uploaded, there was a question posed: which would you rather have—a sane, balanced fat person, or a skinny psychopath? I think I’d rather be skinny again, not that I was ever actually skinny. But your talking to someone who worked incredibly hard to lose 250 pounds. Even a 20-pound weight increase is a depressing thought.

I am to talk with my shrink today on the phone and think I’ve finally reach a point where I am no longer willing to continue to take the Zyprexa. I will be the first to admit that this has been the one drug that has made a significant difference in my fragile state of balance. However, I fear gaining the weight even more so. In addition, the eating pattern is bizarre. I’m not eating because I am hungry and I am wrestling with an increased appetite. It’s like I’ve moved into this grazing mode where I just walk into the kitchen to see what I can eat—whether I’m hungry or not. It’s almost as if there is an oral stimulus attached (similar to problems people have faced when trying to quit smoking).

I really like how I have been feeling these past couple of weeks, even if I do miss my manic highs (which girl group of the 80s did “Manic Mondays”?). I can’t say that everything is perfect, but I am the closest I’ve been to balanced yet, and just in time for my 50th birthday this Friday. I find it absolutely ironic that I was born on 4/20…the international “smoke a joint” day. It’s a shame I don’t have any killer weed I can roll up to celebrate my 50th in style right at 4:20 pm. Life can really suck sometimes. It just kills me that I can’t get high anymore. You know, I don’t drive a forklift at my job, I don’t have to drive a van, or operate any serious machinery where I work. Why should it matter to some egg head in HR that I must pass a random drug screen? I already know what I want for my retirement gift. A QP of absolute golden buds. Thai stick would be nice, but I don’t think the kids these days even know what Thai stick is. Now, some golden hash, no, make that dark, tarry hash, would be quite nice as well. And forget the rolling papers on the killer weed. I’d only use a bong. Less waste and it packs a more powerful punch. Oh, yeah, I forget, I can’t call them “bongs” when I hit the head shops…they are referred to as ‘water pipes” no—like who is going to use them to smoke tobacco in them? Face it, anyone shopping at a head shop has only one thing on their mind…all of the accouterments of fine pot smoking (OK, I grant you, there are people that hit the head shops just to buy incense, but just a few). And, the other day when I was in one, I couldn’t believe how much “water pipes” were costing. Me? A nice ceramic pipe and some screens and I’m good to go IF it wasn’t for these stupid drug tests that I always have hanging over my head. Yeah, corporate America has it all backwards. They don’t care if you’ve got some burned-out alcoholic working for you who reeks of beer or whiskey by lunch and can’t do their job half of the time, but God forbid someone smokes a joint from time to time. OK, I’ll give the corporate dude his due as far as tweakers go, and the more hardcore junkies (one of which I was for quite some time), but cut me some slack if I just want to take a few hits off a bong now and then. And, you know what really bites—I found out from my son one day that an eight-ball of coke costs less than an ounce of some premium weed. Now that’s an insult. Hmmm—I think I have digressed from the point of this post…LOL I’ll get off my soap box now!

Anyway, I’ve made the decision to come off the Zyprexa and I hope I can shed those twenty pounds I’ve gained. I wonder what the shrink will say when I tell him this afternoon during our phone conference. I’ll be the first to admit that the Zyprexa has been the ideal drug bipolar-wise, but I’m not going to grow out of the clothes I have. We’re just going to have to come up with a new game plan.©2007