You Don’t Say?

So, my psychiatrist thinks I am depressed.

More than usual, I mean; my general diagnosis includes a type of depression. But just because I told him about how often I’ve been thinking about death lately, and how much I’ve been struggling with food and other self-destructive behavior, and how much time I spend in circles that talk a great deal about the dark aspects of all our futures on this planet…he thinks I need more help with depression.

So out he comes with this particular health care organization’s chart of meds and starts suggesting things to add to my regimen.

Poor man. He means well. But either he hasn’t been taking notes at our previous sessions, or he hasn’t been looking at them.

The names of the meds are listed in little boxes by group, and as he proposes things I have to keep shooting him down.

No, we can’t add anything from this box. I’ve tried many of them, and they increase anxiety to a dangerous level. No, I don’t care if this one is new, I’ve seen the chemical formula. They moved a hydrogen atom so they could get a new patent, that’s all.

No, we can’t add anything from this box. They’re all addictive. I know my addiction history is in my chart. I made a point of putting it there.

Dear God, no, we can’t add anything from this box. Two of them almost killed me when I tried them; I’ve told you that before. You cannot give me any of these unless I’m an inpatient under close supervision so I don’t walk into traffic.

We could try a slight increase in this one med I’m already taking, or we could try one from this tiny box here…or maybe we could get me a therapist I could see more than once every six weeks.

Ha, ha, just kidding, I know that’s not going to happen.

Through the Cracks

I just found out I am one subject of criminal irresponsibility on the part of my particular health care system.

After some of the struggles of this spring and summer, I decided it was time to make a couple of appointments with my mental health team. When I went onto the website, the name of the psychologist I see was gone. I inquired with the department and discovered she doesn’t work there any more.

I assumed I would be scheduled with a replacement, but was told that it would take some time. Basically, I am going to be treated like a new patient again.

It took nine months to get in to see someone when I was new.

So, first, putting me back in the new patient group isn’t right. Second, even if they had to, someone could be letting patients know their care provider is gone and put them in the queue for upcoming openings, instead of only starting the process when the patient (who, hello, has a mental illness that affects their functioning) manages to reach out.

I’m upset on my own behalf, but I think I’m more upset about people who are doing worse than me right now. Being cut off like this may tip them from barely coping to needing hospitalization.

Not to mention the stress of losing what may have been an emotional support without warning, or a chance to say goodbye, or a single sign that anyone associated with their treatment gives the slightest fuck about them.

Discomfort Zone

When I grow, it’s because I did things beyond my comfort zone. Granted, there are times my comfort zone is smaller than my own skull, but whatever it was at the time, I made conscious efforts to leave it. In everyday living, in social interaction, and especially in writing, I try to push the edges and perhaps push them a little further next time. And, naturally, I dance with the questions of whether it’s wise to push a certain edge at a certain time.

It isn’t productive for me to push in ways that will render me nonfunctional for days. It’s productive for me to push just enough for discomfort, just enough to require some courage. Enough to have consequences in my thoughts and emotions for days or weeks, but have them be consequences that I can manage without being propelled into a serious dip that will make me useless.

I’ve been sharing poetry with others for two years now, and I recently began to share prose for the first time. My essays on my blogs, theoretically, have been shared for years, but never critiqued by other writers or otherwise given feedback. That’s the new thing I did this week, and it was a very different experience from sharing poetry.

One piece of feedback I got is that people wanted more personal detail in some of the pieces. They encouraged me to depart a bit from the conversational style of these essays and branch out into a more personal viewpoint. So this week, I’m writing a piece that focuses more on describing an experience and isn’t about outreach per se.

It’s hard. It brings back the memory in a more visceral way, without the intellectual and the clinical to soften the edges. Even without that discomfort, it’s just different. For the millionth time, I’m the new kid at school.

Just Sick Enough

When you have a psychiatric diagnosis, there are times when it’s obvious you need help. Other times, it might not be as obvious.

I had to jump through some hoops recently to get seen by a psychiatrist with my new insurance. Among these hoops were multiple rounds of the same questions about the nature and severity of my symptoms.  As I tried to answer as patiently and honestly as possible, I was aware of feeling anxiety about whether I would be deemed “sick enough” to be worthy of care.

You see, although I have been under some form of care for many years, it’s been seven years since the last time I was in a hospital outpatient program and nine years since the last time I was hospitalized outright. I’m only on one relatively benign mood stabilizer.

In recent years, I have been aware of how lucky I am to be where I am. I work hard not to throw this good luck away by falling back into addiction or other self-destructive behavior. But should “doing well” mean I don’t need help any more? Especially with bipolar, where patients are quite likely to float out the door while in a happy place, stop their meds, and wind up in the ER?

So it’s a dance. Be sure to appear “sick enough” to be taken seriously, without appearing so ill that you get a level of intervention you don’t need or want. Be eloquent enough about what goes on in your head to make sure someone knows you aren’t “fixed.”

Why? Why not just have enjoy having fewer appointments and one less thing on your current record? My reason is simple: my condition means that matter how well I am doing, it is possible for me to have a serious episode and need more help. Having a psychiatrist of record means having someone to call for an urgent meds adjustment. In the event of dire need, it means I have a name to give the ER staff.

It’s regrettable that people like me must defend our need to be responsible and prepared for trouble.