Confusing the Psychiatrists

Well, I just returned from my second psych evaluation. I never blogged about the first, I don't think? I can't remember. Well if I did (or did not) here's a brief review.

Of course with my "doctor anxiety" I was nervous as hell. Add to the fact that I hadn't had a full consult in about seven or eight years. I had no idea what to expect. It went alright, however. The psychiatrist at this "institution" had a gentle demeanor and a soft voice and we actually ran over the allotted time. I felt okay with it and he allowed me to ask as many questions as I needed.

Alright, I thought, this whole evaluation thing isn't so bad. Granted, it was difficult to pack your entire life's woes and psychological/neurological history into such a brief time span. I didn't cover everything in perhaps as much depth as I wanted with this man. The reason being, this consult was a "one off" and I did not expect any further appointments or follow ups with him. And again, I was nervous, unprepared and it was difficult. However, we went through Medication History, Family History/Trauma, Bipolar Disorder, Self Injurious Behaviour, Hospitalizations, ADD and a little bit about Aspergers.

After it all, he said he would "try and put something cohesive together" for my GP. I had to laugh a bit at that one.

Today was a bit different, however. I was mistaken about a lot of things. First, my appointment duration. I was told an hour, I only received 30 minutes. Also, I was under the impression I would be seeing this psychiatrist on an ongoing basis. Nope. But more on that later. Also, this man was not as...well, he certainly had a different "demeanor" than the first psychiatrist I saw.

It was a good thing I was a bit more prepared for this appointment. 30 minutes! We very briefly touched on all of the above mentioned in the first appointment. He asked some fairly simple and straightforward questions and I answered them. I gave him my prepared "dossier" and he flipped through some of the pages. Basically some self-prepared notes about ADD and Aspergers and some highlighted notes from referenced materials etc...

He asked if he could keep all of it. I told him the copies were his.

He basically told me about a counselling group (i.e group therapy) for women who are trauma survivors and how I could take advantage of that. He also told me that I would not benefit from ongoing psychiatric treatment from a psychiatrist due to my problems with functioning and other issues. I have no idea what this means. I don't know if this is an allusion to the fact that I have Aspergers or not. He said that seeing a psychiatrist would only exacerbate my problems. He said that I already have a therapist, see a neurologist and have a GP so that is good enough. Well, then why offer me group therapy? During all of this I simply stated that people with Aspergers do not usually do well in therapy. He agreed.

I still remain confused.

I did manage to get out of him his med recommendations. He had five. Ooh, decisions, decisions! He also casually mentioned one of them, Risperdal, would be helpful with both Bipolar and Aspergers. I told him that yes, I knew this. I also had to remind him of another med that would probably be helpful. He agreed and wrote it down. I so often wonder what doctors think of me when I stroll into their offices and spout such things.

So at that point, time was pretty much up. I felt unfulfilled. I asked him what he thought of the ADD and Aspergers. He said it was hard to tell due to "other issues" and the trauma I had been through. Alright. I understand all about truama and it does not preclude neurological disorders. I also argued high comorbidity rates (and even had that reference material with me.) I asked him if he planned on reading what I had brought him. He said that yes, he would. As I was putting on my coat, I asked again, "So it wasn't all in vain, then?" He said that no, it wasn't.

Yes, I can be terribly blunt.

Now I understand that clinicians can not provide diagnoses on the spot and I did give him a fair amount of documentation to review but a little more feedback would have been helpful.

Shoot, I can't stream the song I wanted for my new MP3 so you'll just have to go with my second choice. "One In Ten Words" by The Spoons. Canadian Band and the poppy little song is from my youth...it makes me laugh about communication.

Today Is Self Injury Awareness Day

Apolgies for not getting this up sooner--busy day.

Thanks to Deb for posting about this earlier in the week as I knew it was in March but had forgotten the exact date. I do this often. My memory is abysmal.

I know it's hard as there are so many "days" commemorating and promoting this and that. Sometimes with the proliferation of these things it tends to take away the meaning. But I think I will take the time to blog about this one and give it a bit of show.

Now although this day is not formally recognized and is still more of a "grass roots" effort, I found through this site that two states in the US have actually proclaimed it an "official" day: Connecticut and New Mexico. The site offers some form letters if you feel like advocating to your local legislature. Granted, it's all done up for MPs in the UK but it will give you a template. It also offers some literature about self injury that is written by LifeSIGNS, the UK charity that well, basically seems to be managing the site.

Now on a more personal note, if you do not already know this, I am a self injurer. I have been and am a cutter. Please see the link entitled Cutting on the right for previous posts if you are interested. I have also engaged in punching walls, head banging. I have done these as a child and an adult--except the cutting, that came later.

I have been debating about disclosing this for a while but since today seems to be all about awareness, then I suppose it seems an appropriate time. I engaged in a cutting about three weeks ago. It has been about two and a half years since I last cut myself. I'm not even sure why I did it. There were no obvious triggers that day. I'm still not sure.

I do know that my last year has been fraught with tremendous difficulty and it is very surprising that I haven't completely fallen over the edge in dealing with some of the things that have hit me. Perhaps some extremely minor trigger that didn't even register just tipped the balance? Again, I am not sure. I don't know if I ever will be.

Perhaps I just need to have a big Bipolar flip out ever two and a half years!

I mentioned this to my therapist and she (rather glibly in my mind) said, "Well, you can flip out here!" But that is not the point. When you reach that level of crisis, that critical mass in your brain, you can't wait for a therapy session. Especially if you don't even see the oncoming onslaught. I was dissociated. Absolutely. The last thing on my mind was calling up someone, anyone and talking. The only thing I wanted to do was hide away from my partner, use the knife and then quickly try and repair the damage I'd done and hide it all (which was impossible--I'd cut too deeply.) However, not enough to require medical attention as in the past.

So on goes the battle, I suppose. But just remember--be kind and gentle and patient with the self injurers you encounter out there. Don't be scared even if sometimes what we do can seem a little difficult to handle. Believe me, it's difficult for us too.

Well, That Wasn't Altogether Sheer Torture...

I have just returned from visiting Mommie Dearest. Yes, I am sick and twisted but so was my upbringing so I feel I am entitled to that. In fact, sick and twisted humour was the only thing that managed to keep my partner and I (relatively) sane throughout the entire evening. During one private moment, I whipped my Zippo out of my pocket and mocked self-immolation. My partner's a good egg. She even laughed as I quickly dashed to the computer the minute we got home as I signed on to start blogging.

In some fairness to my mother, she was actually more well-behaved than the last time I had seen her. We talked about quite a lot. My mother is a real motormouth and truthfully, the apple doesn't fall far from the tree. I can become quite engaged and really get going and in some cases probably annoy the hell out of a lot of people? I'm not sure. I'm too animated to tell and my own preoccupation with the subject matter I'm talking about supercedes my social skills.

Anyway, it was still a painful evening--and I don't mean in an emotionally sad way. I mean, rather, exhaustively, frustratingly and maddeningly.

As always, it's good to have a third party to observe. My poor partner, subjected to all of this. She's pretty astute at picking up social behaviours and just sitting back and watching people interact, tuning in to what might be motivating factors. And she knows key details of the family history etc... When we went outside for a smoke after dinner, we were trying to find out if I was being "antagonistic," "combative" or downright "looking for a fight." We finally decided that it was "none of the above."

My therapist says that I am "learning to find my voice." I have sat passive and mute for basically my entire life (up until now?) I am learning to "use my voice" but it's difficult. At times I still revert to wanting to just sit there and take it (or tune out) but not tonight.

For example, my mother is obsessed with The Blood Type Diet. No, I will not link to it as it is junk science and I fucking hate it. I'm sorry if you are reading this and you are a follower of this type of "thing" but I completely disagree with it. Anyway, Mom wanted to be a nurse so I feel I can slip into "amateur medico-scientist" mode and we had at it. She's actually extremely smart in a somewhat mentally ill, demented sort of way. Granted, she let me have my say and it was basically me just countering everything she said but it wasn't only that issue. There were more. Lots of them. A couple of times she slipped into one of her more "dissociative" states. She does not have DID and I don't mean a dissociative state or fugue in the classical sense. It's merely a diversion technique that she uses when she doesn't want to talk or deal with something anymore. It's very challenging to deal with. It's also very sad and possibly(?) the result of her own trauma but I can't focus on that. I've parented her ever since I was a child and if I slip back into that mode of thinking I'm doomed for sure.

Next, her husband. He is so absolutely annoying. I guess the worst of it is his continual sexual innuendo and commentary. Now I do not have virgin ears (or any other part of my body ha!) and I can talk just as trashy (or worse!) as the next person but I know where to do it, when and with whom. Unless I make a really bad unintentional pun or lose my filter by accident but that's just a bad joke/gaffe. And it's unintentional! I find it completely abhorrent that this man who is married to my mother (do I need to repeat that?!) at his age would continue to keep saying such things! I mean, I am the furthest thing from a prude but she's my fucking mother and I am her fucking daughter. Show some sense of decency and decorum.

Anyway, I am now in possession of my "bank draft," we celebrated Christmas (a month late?) and now it's over...at least until the next time.

Does Anyone Remember King Lear?

Actually, it's okay, I went and looked it up. But for any of you Shakespeare afficionados, please feel free to jump in!

There are two books that I've read in my life that have made me cry. One was My Cat Saved My Life and the other was King Lear.

I read King Lear in my final year of high school and when I got to the end, I almost keeled over in huge, wrenching sobs. I mean, I really bawled. I didn't even know why. But something was triggered in my psyche, even if it wasn't apparent to me at the time.

This came up in my last therapy session after I had recently gone through a rough patch and was tearing up all over the place--not in the session but in days prior. My therapist was going to offer me a book to read and I laughed in her face. I haven't been able to read a book cover to cover in a while. Then I recanted and said, no, that wasn't entirely true. Over the last couple of years, I have managed to read two. So perhaps there's hope for me yet?

We went back to the aspect of potential triggers and I said that more complex visual stimuli (i.e. movies with faces, voices of characters etc...) were more apt to set me off than words on a page. I guess I can detach more when I read? That's when we got into the issue of these two books and how they've been the only books that have ever made me cry.

King Lear piqued her interest. I was clueless as I had lost barely all retention of the plot. She suggested that I read it again after all of these years and see what I get out of it now as it may be "therapeutic" and "very interesting." She also said that I "reminded her of Cordelia."

Egad. When my therapist pulls something like that out in a session I sit up and take notice! I also wondered just how "therapeutic" it might be. After getting a quick refresher online I think I see some things that might have been potential triggers as my family is so completely fucked up.

When out with friends last night, one of them told me that she had some books for me. I coincidentally asked her if she had an extra copy of Lear. She said she had two so she'd gladly give me one. I told her all of the above and she just laughed and said I had King Lear written all over me.

Hmmm.

Therapy Is Hard Work

For both participants.

I actually thought I wanted to become a therapist when I was younger. If you can believe it, I was reading university psych textbooks when I was about nine or 10, in vain attempt, trying to learn how to "fix" my mother. I was always told that she was Schizophrenic but now that I am older, that diagnosis doesn't really fit. Nonetheless, I continued to read about various disorders. The texts were old and "Manic Depression" didn't zero in on the type of behaviour that she exhibited, at least in my young mind.

I later learned about the phenomenon of "burn out" in the profession and as I soon experienced my own early symptoms of depression I realized that this profession could not be for me (note: this is sort of hindsight conclusion about my depression, I didn't really know what was wrong with me as a teenager--I just instinctively knew I couldn't be a therapist.) Coupled with that, living with my mother became more and more frightening. I grew to loathe therapists and psychiatrists. Mom couldn't be "fixed" and I knew it. Granted, Mom has never been diagnosed, Dad did little to help her as that would have shattered too much about family secrets and basically, there was too much at stake for him to lose.

I had seen a couple of therapists as a teenager at my father's bidding as he wanted to have me "checked out" and they were awful. One counselled my father to do whatever he wanted regardless of my sister's and my well being and another saw me separately for six months and found me "cured" after that. I felt no different and that it was a total waste of time. Oh yes, there was one other who tried to hypnotize me and one psychiatrist who saw me when I was oh...I can't remember...maybe 12 or 13 as my father was worried about me being ill due to genetic predisposition. I remained cold and distant and stoic through it all.

I am a trauma survivor and it's taken me a very long time to recognize that. To me, "trauma" always meant something extremely violent like sexual or physical abuse, living through or witnessing accidents or war but that is not the case.

About two and a half years ago when things were extremely bad for me I finally "broke down" and agreed to seek counselling with a qualified therapist. It has been good, it has been challenging and it is far from over.

One of the most difficult things for me is that I have virtually no memory of my childhood. I have some more of my adolesence but things only start to clear up during my adult years. And even a lot of that can be fuzzy. My therapist says that it doesn't matter and I can still heal and get past a lot of what has happened to me. All I know is that things must have been awfully bad for me to have repressed that much.

A good thing I have, an extremely valuable resource, is my older sister. Her memory is in tact. She has provided me with a lot to fill in the gaps. Even though they are her memories and it's still not quite the same, it is still information my therapist and I can work with. In talking with my sister this week, I have found out some more information and in light of what is going on with my family right now, my sister has expressed interest in joining me at a session (although I don't know if we can pack everything in to just one!) I had suggested this last summer but she hadn't gotten back to me so I didn't pry. I am very happy about this but I know it will probably be very difficult. Still, I think it needs to be done in order to keep moving forward.

Therapy may not be for everyone but if you've been through anything troubling in your past or if you are having difficulty in the present, I strongly recommend it. Doubly so if you have any psychiatric diagnosis. It's even more of an added burden then.

I'm not sure when we'll be able to co-ordinate it as my sister lives out of town and it will necessitate her having to travel a fair distance but she's willing so that's all that matters.