Outpatient Fail

All of our therapy is outpatient. We see our therapist in their office every two weeks. We talk. They push us to talk about the things we’re obviously avoiding. Mostly it works. Until it doesn’t.

That was this week. This week therapy turned to shit. Shit. Complete and utter shit.

I’ve written about our excellent ability to zone out before. It doesn’t tend to end well.

Often it happens during therapy sessions. We’ll be discussing something and become emotionally overwhelmed. Often I feel incredibly anxious, sometimes sad or scared, but whatever the emotion – very overwhelmed.

By this point the conversation will stall. My responses become slower, my voice quieter, and I say ‘I don’t know’ repeatedly. I’ve already stepped back from my body without actually choosing to. At this point there’s nothing anyone can do to help me become more responsive.

Usually I’ll be asked to move by whoever I’m with (psychologist, psychiatrist, nurse) and be unable to. My body is frozen, and although I can hear and feel (and see if my eyes are open) I can’t move. Eventually my head tips to the side, the weight of it seeming to drag it towards my shoulder. From there my body can slowly slide sideways, and if I’m in a chair, out of the chair and on to the floor.

This time wasn’t that different. It’s just that this time was the first time this therapist had to manage it outpatient. They’ve dealt with it repeatedly in an inpatient setting. That’s much less dramatic. They let the nursing staff know what’s going on so I can be monitored, but generally leave me alone to come out of that state at my own pace.

Outpatient though? It’s a downright disaster. I couldn’t be moved. My therapist had other clients to see, but had to reschedule at least two of them. Eventually they had no choice but to call an ambulance to take me to the local hospital emergency department.

That’s when it got worse. I was unfortunate enough to get two male paramedics. Ordinarily that wouldn’t bother me. In such a dissociated state they were terrifying. They were men. Men are bad. Men are not safe.

To make it worse they repeatedly inflicted pain to check my level of consciousness. They did this four times with minimal response from me. Meanwhile I could feel all the pain, but wasn’t able to properly respond. The most they got was a mild grimace, yet they continued. Being conscious, but unable to move or talk is not fun. Throw in pain being repeatedly inflicted and it’s terrifying.

After being released from the emergency department I went home, crawled into bed, and slept. The following day was time to face the music. One super brief phone call from my therapist later, and we’ve planned a hospital admission for August.

August. The month where I had multiple medical appointments. The month where I was finally going to get my pesky wisdom tooth (last one!) removed. Everything has to be rescheduled.

It feels like defeat. Complete and utter defeat.

I can’t safely manage outpatient therapy. I have two more appointments booked with my therapist, but I’m not sure if I’ll go. I’m scared after this week. Scared that I’ll zone out again.

I did have a few thing against me this week. I’d overdosed (wishful suicide attempt) the day before and had a huge hangover from the medication I’d taken. I was rejected for the NDIS for my physical health issues. An outreach worker told me they’d be moving on, and someone else would be taking over my care. Then throw in a trauma anniversary, and the unrelenting depression that’s been haunting me for a year. All of that, even on a good day, is a bad combination.

Trying to stay present with all of that going on is next to impossible. Add in an emotional conversation with my therapist, and I don’t think I had any chance.

Anyhow, hospital it is. Hospital because outpatient therapy is a fail. Again.

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Cancelled

I’m free. No healthcare appointment for three weeks. By chance my next appointment with my psychiatrist is in three weeks, not the usual two. I cancelled the appointment I had with my GP today, and I’ve seen all my other specialists recently.

I’m just done. I’m so emotionally exhausted from talking about symptoms, treatments, response to treatments, managing medication side effects and withdrawals. Mostly the talking though.

I’m mostly housebound. I manage to leave the house for appointments, and that’s about it. I see family when there’s time for me to spend the night there and properly rest. I see friends most when they can visit me. Just getting to and from medical appointments all over Melbourne exhausts me.

I don’t drive because a) I don’t have a license b) I can’t afford to buy, or run a car and c) I wouldn’t be safe to drive a  car the majority of the time. That means relying on public transport. It’s pretty good in Melbourne. I can get to most places without too much trouble, but it does take a lot of energy. I’ve applied for funding for either a mobility scooter or power chair, but whether or not that happens is another matter.

I just need a break. Physically I need to rest and regain some energy. Emotionally I need a break from the near constant health talk. All of the healthcare appointments have meant talking to, and seeing friends even less. So the majority of the interactions I’ve had with people have been with healthcare providers about different aspects of my health.

I’m done. Just done. 100% done.

Will Therapy Ever End?

Our current therapist made a comment recently that made my heart sink. They said they thought we’re likely to need, at least, some supportive counselling for the rest of our lives.

The body is in it’s early thirties. If we make it to even eighty, that’s another fifty or so years of therapy. Maybe not weekly like now, but perhaps monthly.

Our current therapist will also be retiring in the near future. We’re trying not to worry too much about that, and trying to focus on getting as much DID focussed work done as possible in the time we have left.

That’s one of the hardest parts about having DID. Finding a therapist who has enough knowledge and experience to actually be helpful to us. In the last eight years we’ve just been lucky to come across therapists who are excellent at working with trauma and dissociation.

We’ve recently spent several weeks in hospital. None of us regret the admission. We got a lot of work done, and nearly all of us were able to talk to our therapist. No easy feat when there’s eighteen of us!

Our therapist is confident that we’ll have the majority of our trauma and DID based work done before they retire. I’m not sure how realistic that is. As much as ongoing therapy (for the rest of my life) makes my heart sink, I also can’t imagine our life without regular therapy or hospital admissions.

Does therapy ever end when you’ve experienced chronic childhood trauma?

Adjusting

We’re home from hospital, and as excited as I was, it’s hard. I’ve been through this process before, and it takes time to adjust to being at home, but this time it feels harder.

Gone is the highly structured and enforced routine. Several weeks in hospital and nearly every day went like this:

7:30am – 9am: Breakfast

8am – 9am: Morning medication

9am: Community meeting

9:30am – 10am: Anxiety management group

10am – 11am: Morning tea

11am – 12pm: Morning group

12pm – 1pm: Lunch (and brief visiting hours)

1pm – 1:15pm: Lunchtime medication (if you have any)

1:30pm – 2:30pm: Afternoon group

2pm – 3pm: Afternoon tea

4pm: Walk/yoga/other group

5pm – 6:15pm: Dinner

5pm – 9pm: Visiting hours

8:45pm – 9:30pm Nighttime medication

10:30pm: Second round of nighttime medication for those who go to bed late (not me!)

All of that routine is gone. I didn’t participate in all of the groups because of my physical health issues, but there was still plenty to do. I also saw my doctor six days a week for what was often an intense therapy session. Plus chatting to my nurse in the morning and afternoon. Then throw in tidying my hospital room, washing my clothes, showering, and other self-care. Very little free time!

Now I’m home it’s really hard to keep any routine going. I can sleep when I want, for as long as I want. I can take medication when I want, eat when I want. Complete freedom.

Admittedly I was craving my freedom a couple of weeks in. Desperate to be able to have more down time, and time for Netflix. My focus was therapy though, so Netflix had to wait. Now I can watch as much as I want, but I’m finding myself bored with it already.

The hardest part? Loneliness. I’m an absolute introvert. I need time to myself to process my day, recharge, and plan for the next day. That doesn’t mean I don’t like socialising though.

In hospital it was easy. If I was feeling sociable I could sit in communal areas and chat with other patients. I could participate more in groups. I could stay longer in the dining room and chat with other patients after finishing my meal.

At home I’m almost always alone. My housemate is physically well and able, and is out a lot. It’s almost like living alone. It’s such a huge difference to being in hospital. In time I’ll adjust to spending more time alone, but for now it’s hard.

I wasn’t anxious about returning home, I was excited! I always am, and I think that makes me forget how hard the adjustment can be. Going suddenly from being surrounded by people, talking to multiple people multiple times a day to seeing one person, chatting briefly, then being alone all day is really difficult.

I feel so lonely. So isolated and alone. I’m working on it though. I’m not giving up and sitting in despair. I’ve got a couple of things planned with close friends and family. I just need to keep reminding myself that it’s okay to feel lonely. It’s okay to feel whatever I feel, but I need to remember that there’s something I can do about it too.

Onwards and upwards! More posts to come about the work we did in hospital.

The Stigma Of Treatment

All the important people in my life know I struggle with my mental health. That’s old news. I’m not even overly anxious about sharing some of my struggles with the right people at the right time.

On the other hand sharing what treatment I’m receiving for my mental health is so much more anxiety provoking and worrisome.

I’m on three psychotropic drugs, and there’s plenty of judgement and stigma from people about that. I need these medications to function, if anyone has a problem with that, they can get lost.

I’m seeing a therapist weekly. At this point in time the therapist is a psychiatrist. In the past they’ve been psychologists, clinical psychologists, and counsellors. Therapy is a really good way to help me manage my mental health. Again, if people have a problem with that, they can get lost.

Then there’s the inpatient psychiatric admissions. Five in the last two years. Most of them for about three weeks. Not all in times of crisis, but of great stress, and with multiple crappy coping strategies being used.

I’m heading for my seventh admission with the same doctor at the same hospital. I trust my doctor, and I trust the nursing staff. I know the admission will be helpful, they always are, but I’m scared to tell anyone.

I worry so much more about what people might think about me being in a psychiatric hospital, than being on medication, or in therapy.

Is it really that bad that I need to be in hospital?
Yes. Doing the same amount of work in therapy outpatient is impossible. Plus I’m stuck, again. DID chaos, and multiple shit storms brewing beneath the surface. That doesn’t even cover the issues I’ve had with mood (both hypomania and depression in the last month). It is that bad.

Can’t I just get over it? Isn’t therapy enough? Can’t they give you medication?
I’m doing the therapy, and taking the meds. I’m still struggling. As for getting over it? Get lost.

I know hospital is a safe place to crash land. I can be a mess, be emotional, struggle in any kind of way and it’s okay. I don’t have to keep it together. I don’t have to keep smiling. Staff are kind and supportive. I have time and space to unleash the chaos, work through it, and put myself back together again.

I’ve still only told a few people. I’m so fearful of their reaction to, and judgement of inpatient treatment that I stay silent.

I think the stigma associated with psychiatric or psychological treatment can often be so much worse than the stigma associated with a diagnosis.

It’s okay to not be okay, and it’s even more okay to get whatever help you need to be okay again.