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.

Advertisements

Promises

I promised my GP that I wouldn’t cancel my appointment this week. That I’d come even if I were feeling terrible.

The promise was made as a safety plan of sorts. A couple of weeks ago I overdosed the night before my appointment with her, then used the app to cancel my appointment. I told her. I was honest.

So now I’m to show up this week without fail. There’s also the silent, un-discussed expectation that I won’t self-harm in any way. No cutting, no overdosing or misusing medication.

I’m holding on. Barely.

The eating disorder is screaming at me. ‘Don’t eat, don’t drink, don’t think, don’t feel’. The same negative mantra it’s screamed for half my life. It is getting the better of me. The eating disorder plans feel safe and familiar. I’m falling into the trap of thinking that if I just follow the rules well enough that everything will be okay.

I know following any kind of ED rules is the quickest way to end up in the local emergency department. Dehydration in combination with my medical conditions is a recipe for disaster.

I don’t see a way out right now though. Going with the eating disorder seems safe and comforting. At least it doesn’t involve binge eating and piling on even more weight. That’s what I’ve been doing for the last nine months. Binge eating so often that I’ve depleted all of my savings. I’m broke from this damn eating disorder. At least restricting is cheap. Plus I’ll lose weight. Winning all round, right?

I know I’m making poor choices. It sounds utterly ridiculous, even writing it all out. This is where I’m at though. Completely emotionally exhausted, overwhelmed, struggling, losing any remaining hope.

Trying to Tread Water

I haven’t written a proper post for close to a year.

That’s how long depression has been kicking my butt. Not constantly. There have been light, happy, joyful moments and days sparsely sprinkled amongst the doom. The doom, however, heavily outweighs any lightness and joy.

Tweaking my antidepressant no longer helps. I suffer horrid side effects when I increase the dose. My psychiatrist is hesitant to change medications, but it’s something I’ll be pushing for soon.

Along with the unrelenting depression has come almost all the unhelpful behaviours you could think of. Aside from alcohol or illicit drug use. I rarely drink, and have never used drugs. I have enough going on physically and mentally without adding unknown substances to the mix!

Self-harm. Multiple overdoses. Binge eating. Not eating. Not drinking water.

The same behaviours over, and over in moments of ‘I can’t do this anymore’.

I had an inpatient psych admission a couple of months ago. It was helpful, and I was discharged in a much better space. However… within a month I’d overdosed and self-harmed.

I’m supposed to be journaling when I feel anxious or otherwise not okay. Journaling instead of leaping into unhelpful behaviours. I did. Once. That stirred up something inside. Flashbacks started, and small, scared chatter began inside.

I shut that shit down and dove headfirst, straight into an unhelpful behaviour.

Damn it. Not unhelpful. Self-harm, overdoses, eating disorder behaviours. They all help in some way, otherwise I wouldn’t be using them. They are helpful, but in a very short-term way, and they have unhelpful consequences. They don’t help me longterm.

I feel like I’m drowning. I’m trying to keep my head above water, but I’m struggling to do that. I keep going under, gulping water instead of air, only to rise again, cough up all the water, and start breathing…. before going under.

I don’t know how to fix this, and I don’t know what would help.

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.

This Is What Depression Can Look Like

Depression.

Depressed.

Someone curled up in bed, hidden under the covers. Sunlight peeking in through the drawn curtains. Phone calls and voicemails ignored. Text messages unread. A dirty plate, and empty, coffee stained mug on the bedside table.

That sounds like fairly stereotypical depression, right? It is. The trouble is, not everyone with depression struggles like that.

What about the person who smiles, and chats happily to friends and family. Who cleans the house, keeps up with chores, and pays all the bills. The dishes are done, there’s food and leftovers from a home cooked meal in the fridge, and the fruit basket is full.

Is that person depressed? If that person is me, then right now, yes. It’s just so well hidden.

I smile and chat with family and friends because I adore them, but I also don’t want to burden them with my sucky (technical term!) mental health. I busily keep up with chores  so I have less time to think about how much I detest myself, my life, and everything about me. Keeping busy keeps me safe. Leftovers in the fridge are from a meal I cooked when I felt like eating. I swing between having no appetite and comfort eating.

No one sees the tears that slip out when I’m finally alone, or on the way home from visiting friends and family.

No one sees the self-hatred, pain, hopelessness, and defeat that flood my mind when I finally stop doing chores.

No one sees the torment that fills my mind over needing to eat, having no food, then ordering groceries, and not wanting to eat.

I usually manage to function until I’m extremely depressed and suicidal. On the way down into that pit of doom very few people know or see that I’m struggling.

Not being able to see it doesn’t mean that I’m not depressed.
Not being able to see it doesn’t mean that I’m not struggling.

Depression looks like many things for many people. Ask before you pass judgement on whether someone is depressed, or how depressed they are.