Posted by Racer on March 13, 2004, at 12:12:54
First of all, I'm in a really bad space for advice right now, so I'll try to hear what you say, and I'll try to give it reasonable consideration, but I can't promise I'm capable of that right now. Even if I recognize something, it doesn't mean I can feel it, and some of this stuff I'm only vaguely aware of, can't put words to, and my terror is making it really difficult for me to express what I'm feeling, even to myself. So, before I tell anything about what's going on inside me, I have to thank you in advance for paying me the compliment of responding. Afterwards, I may be too messed up to take any advice in, let alone acknowledge its value.
Here goes. I'm in a terrible state, and have no confidence in any of the treatments available to me. None of that is news, but I'm at a critical crossroads right now, and don't know how to identify the paths before me, let alone how to figure out which one to try. I'm going to tell you all a little about the agency that's providing services, so that you can understand a little better.
This agency provides a wide range of services to the Mentally Ill, from basic living assistance to individual and group therapy to psychiatric medications. They serve largely people who are so sick they'll always be marginal at best in terms of survival skills. Many of them will never be able to hold a Real Job, both because of their illnesses and because of the social penalties that have resulted from those illnesses. We're not talking the Lumptonians here, we're talking people who can't make it to appointments because they're living in another time zone. I receive individual therapy, I'm in a DBT group that I don't think is helpful to me, and I get to see the pdoc for prescriptions. In theory, I have a case manager who coordinates all the services, and provides practical support as needed.
As you're aware, things have gone downhill pretty quickly recently. Getting responses has always been a problem, and now it's much worse. To make it even harder for me, emotionally, the reaction to me making noise about this has been to have the responsibility and blame for the problems set right squarely back on my shoulders. It's not that someone there isn't doing his or her job appropriately, it's that I'm asking too much. If I'd only get over it all, then the services provided would be more than adequate. Never mind that this just reinforces my existing habit of blaming myself for everything, even when I can see that externally observable evidence says it's not true. Never mind that being blamed for the actions of others only makes me shrink back even more from asking for the help I need. Never mind all that, it's exhausting to keep reminding myself that this empirical evidence supports my belief that I'm not at fault. It's exhausting, and then I'm told that it's an effort that is making me sicker -- "You can't start to get better until you accept Your Diagnosis, get past the denial, see that you really are at fault for all the bad that you experience in life." So, I'm pretty low, and, despite being able to express it here, I can't internalize it any more because of all the external pressure telling me to give it up and accept that, in effect, it is all my responsibility and fault. Someone tell me, what's wrong with me here? (And remember, while I'm trying to keep this light enough that I don't just hit the kill button on the browser, and while I'm trying to keep that Big Fact in the middle of my mind -- "external evidence supports the conclusion that something really is wrong here" -- it's getting harder and harder, and I'm beginning again to fall into the "It's All My Fault" trap. Deeply into that trap.)
Then there's the medication problem. Mind you, I *am* frustrating to treat. How much of my life am I willing to give up in order to be able to keep the rest of my life? That's a really difficult question to answer, and it's metaphysical, philosophical, psychological, and all sorts of other Medically Insignificant problems. It's not really relevant to the pdoc that, say, weight gain of over 50 pounds would create other problems in my life that might make the possible benefits less compelling. You know what I mean? It's easy for the pdoc to say, "Well, she's resistant to my efforts, as shown by her reluctance to take the drug combination that helped relieve her last major depressive episode." Never mind that that combination stopped working; never mind the side effects; never mind that, once the drugs stopped working, it took eight months to ween off them. To me, it seems reasonable to avoid repeating that experience. That doesn't really seem like me being uncooperative. It seems a whole lot more like the doctor refusing to cooperate or even communicate with me. (Mind you, he didn't even say that to my face -- I heard that from my old therapist. So, how do you combat something like that when there's not direct communication?) When you consider that I'm going to be on meds indefinitely, probably for the rest of my life, doesn't it make sense not to make it worse by starting something that has already proved itself to be a short term solution with really serious long term problems? OK, deep breath. Yes, that makes sense. It really does, and I don't think I'm wrong about that. One part of the problem is that I get so frustrated and so lost in NotBeingHeardLand that I get shrill about trying to MAKE myself heard. Then, it's a hell of a lot easier to dismiss me as being hysterical. I feel as if I'm in an adversarial relationship with both the pdoc and the therapist, and I'm scared and feeling really alone in this struggle.
This week, I wrote to my old therapist, who is part of this agency, and asked her to help me find out whom to contact about getting out of this vortex. She hasn't gotten back to me, which bothers me a lot since she was my last real hope. I don't just want to change treatment teams, though. I want someone to help me through that process. And I don't want to be punished for making noise, which I'm very much afraid will happen. And, being unmedicated right now, I don't even have the support of the meds. Just when I most need help, there's no help available. OK, that's not an empirical observation, so much as how I'm feeling right now, but it is an accurate statement of my perceptions. And, for that reason only, for no other reason, it is VALID. It is valid to say that I Feel Alone And Unsupported.
I'm worried like anything about going to my next pdoc appointment, and almost ready to cancel it. I'm so afraid that he's going to punish me for being such a problem. I'm afraid he's going to throw up his hands in disgust, and just say, "there's nothing I can do for you because you won't cooperate with me." I'm afraid that he's going to dismiss everything I say, because I've proved myself to be unreasonable. You know, really I'm afraid. It's pretty much as simple as that.
And I'm afraid of the meds, too, so deeply afraid that I'm not really in any hurry to get back onto something. I'm afraid that he's so fed up with me not responding appropriately that he'll just hand something over and say, "Take it and leave me alone!" I do feel as if he's done that already, and that he's told me -- through what he said to the old therapist -- that any self-reports of adverse reactions are by definition suspect. Feeling this way, can't you see why I would have major issues about going to that appointment?
So, advice, general or specific. One thing I'm most concerned with right now is that next pdoc appointment. I'm afraid to go to it, I'm afraid that if I don't it'll be worse, and I'm afraid to keep making noise to get reassigned. I'm just about paralyzed with fear right now, and just don't know what to do. Longer term advice is more than welcome, but if anyone has the energy to respond to that specific concern, please, please offer everything. Not just a single thought, tell me as much as you think necessary to clarify your thoughts. I'll try to get back here later to be more clear, myself, because I've pretty well fallen apart typing this. I know I'm not being all that clear, but it's the best I could do in the moment, and I'd rather get something done and out than have to come back later and try again -- and fail again. This way, at least something it out there.
Thank you all, for anything you offer here, and for all the support you've given me over the years.
poster:Racer
thread:323958
URL: http://www.dr-bob.org/babble/2000/20040213/msgs/323958.html