Building Blocks

I’m trying to adjust to life outside the hospital and learn to care for myself again. I’m starting over intentionally. I crashed and burned really hard that last month in the hospital, and it would be natural to give up. But with the magic of meds, friends and therapy I found a way out.

Think about this. In the last 86 days since my first day in the hospital in mid-January, I have spent 58 days locked down in the hospital and 15 in outpatient treatment. That leaves 13 on my own. Of course I have to figure out how to live again!

But I have a plan. <You who know me are not surprised that I have a plan, are you?>

imagesOne of the many topics gone over and over and over again in the hospital is that of The Areas of Wellness. Depending on which literature you read / professional you talk with, there are 6-8 areas that each person develops and balances interdependently with the others:

  • Emotional (including mental health)
  • Physical (including nutrition, exercise and managing illnesses)
  • Social (including how we spend time with others)
  • Spiritual (including finding meaning and purpose in our lives as well as connection to something deeper or greater than ourselves)
  • Occupational (including how a person spends time, including jobs)
  • Environmental (including the space we inhabit in the spheres of our lives, even nature)
  • Intellectual (including how we learn and challenge our minds all life long)
  • Financial (including how we budget and spend money)

These areas of wellness are the building blocks I’m using to restart my life. Each of these areas has been disrupted and overturned in the last 6 months. When I fell apart in the last month(s), each of these areas became highlighted, crashed, and left me in a place where I had to start over.

Starting with my emotional/mental health. I could barely care for my personal needs at all for a while in the hospital  until we got a decent med cocktail going. And even when I was beginning to feel better I resigned my job because I just can’t work when I can barely take care of myself.

imagesSo, in the next few weeks, these are ways I’m working on these building blocks.

  • Emotional - attending the outpatient program; taking meds
  • Physical - eating nutritional meals, exercising for 10 min a day (This is a big one for me – includes grocery shopping and cooking!)
  • Social - interacting with people face-to-face each day; social media
  • Spiritual - reminding myself that I am part of balancing the level of good in the world
  • Occupational - doing the building blocks
  • Environmental - cleaning my house a piece at a time; fixing mechanical and cosmetic things on my car that have been put off
  • Intellectual - reading each day
  • Financial - paying bills on time

This is going to be very hard. I still have an energy deficit. And I’m still trying to figure out how not to be in the hospital.

If you are looking for some concrete way to help me in the next couple weeks, you can check in with me on one of these, or help me make one of them happen. I’ll be very happy for whatever help you can offer.

58 Days

Starting over.

I’m entering a new phase of recovery. While in the hospital this winter/spring, I told my doctors that I can’t keep going on this merry-go-round of getting a med tweak, forcing myself through each day, and then spiraling down into suicidal depression and landing in the hospital every 3 months.

They listened, and we tried many different kinds of meds until I was stable on a combination for 3 days straight with no changes. One of my med patterns is that a med gets tweaked or added/removed each day in the hospital or at each psychiatrist appointment. And somehow I still get discharged without that med combination settling into my body so that we can see that it is really showing the positive results we expect it to show.

So this time – these 58 Days in the hospital from January through April (1/6 of the year!) - I laid down the law, was an even stronger advocate for myself than I usually am, and insisted on this medical stability before discharge, even into an outpatient program. I need a chance to start a new pattern, one that moves forward, rather than cycling back. I flat out said I didn’t think I had it in me to face yet another spiral into suicidality and be able to keep myself from the edge. Something drastic needed to be done. I already feel ashamed each time I end up in the hospital. It took a lot to overcome the shame to admit this time that I wouldn’t be able to stay safe with the same pattern. And to overcome the shame of spending months in the hospital.

See, I have good coping skills. I have a regular, standardized routine of when I get up and go to sleep, and I eat at regular intervals. I strive for structure to each day. I am determined and driven to find recovery. I am the model patient, I’m told. But I ran out of any possible energy to keep going with life without the proper med support.

I have truly wonderful, world-renowned doctors (truth!). And they listened and acted. We have taken a completely different approach to dealing with my mood. The anxiety is properly medicated and I have strong skills to work with it. The OCD shows up in obsessive thinking and visions of myself doing things, including violent images. If I’m not suicidal, these thoughts and visions are much easier to deal with!

But my mood’s baseline has been “Depressed” (say, 2-4 on a scale of 1-10) for the 3.5 years since diagnosis. I’m not here to give out med advice, and so I rarely say what meds I’m on. But what we are doing is really different and I actually feel that my mood and energy are both higher. I have a chance at a new start!

I realized while in the hospital this last month that what I really need is a chance – a real chance – at a new start. I have a new apartment that I’ve barely lived in because of treatment, and I am financially stable. I still have a marriage to grieve and new ways of living to get used to. I have coping skills and a strong support system who has shown up in spades during this long hospitalization period. But some pieces were out of place.

As it turns out, normal stress from my part-time job correlated with a few hospitalizations. And in the last 6 months, I think I worked a total of 2 months because of being in treatment. And so, with a heavy heart, I resigned my job. I can’t work if I’m not feeling well. And to get a new start, I need to focus first on my health.

So here I am, the evening before starting a daily outpatient program again, and I have lost a job, a marriage, a neighborhood and home, and health. That’s a lot to grieve. That’s a lot to start over with. First things first, starting with my health. I got a good med combination that we are putting to the test. Then working on grief. Time to put my life back together from the beginning.

Craving

I’m not doing well. It’s been building all week. Obsessive suicidal thoughts from the OCD are so intrusive it doesn’t matter if I’m engaged in conversation or activity. It’s always an option for me. Not that I want it, but I crave it with an obsession.

When talking with my doc today, she wants me to keep from isolating, take the benzo I have (which only makes me tired), and continue to use skills. The hospital is always there but she wants it as a farther last result.

But I’m working my butt off with skills. I’m exhausted from skills. I cried for hours yesterday at a safe place I stayed for hours. Finally could pact with myself to go home and just go to bed early. Hard but I still got to my outpatient program, where I heard the above from my doc.

Driving is dangerous, since I’m alone and crashing figures prominently in one of my obsessional visions.

Another example from today: I was at home picking up a couple things before going to a friend’s to be babysat basically. And I Almost overdosed. This is not funny. I’m so sick of this.

Sometimes they are just visions. Sometimes they are strong urges. I list reasons to stay, and when urges are strong the lists mean nothing.

I’m ashamed that I’m like this. But I can’t stop my brain. I just can’t.

Rat Nibbling at My Ankles

I’ve been having an up and down time. In good news, my depression is lifting a little bit. I have a bit more energy. On a scale of 1 to 1o, I went from 2 to 3. Not much but noticeable!

More good news: while talking with my psychiatrist, my therapist from the morning program I’m in finally understood that even though my depression is lifting a little bit, my suicidal thoughts are not going away, and in fact are of an obsessive nature (OCD). I explained this to him, but he finally understood it. So, he is looking for skills or something that can maybe help me with the constant suicidality.

ratWhen asked to describe what it’s like to have these obsessive thoughts, I said, “It’s like always having a rat walking behind you. It doesn’t always nip your ankles, but sometimes it does. And it enjoys nipping at your ankles. The rat never leaves, just like the suicidal thoughts. You can never get rid of it. It’s always in your mind, but sometimes it bites (urges become strong). And the urges, the nipping, makes the rat, the thoughts, stronger.”

Maybe that image will help you understand what it is like to live my life. The thoughts never leave. The urges get stronger. The cycle never leaves. Ever.

Roller Coaster and Carousel Week

Since discharge from the hospital, I’ve been in a M-F morning outpatient program. The therapist you get is randomly assigned. I was suspicious since specific therapies had worked for me over the last couple years (DBT and ACT). I did hear that this therapist knew those therapies very well, and even though the skills groups might contradict the therapies, at least my therapist should be a good fit. More on that later.

Over the last week and a half I’ve had a rough time in the program and keeping myself occupied and safe afterwards. It’s like a roller coaster because the week has been dragging me up toward something that works, then free-falling back toward suicidality. I’m very resistant and defiant to the therapy, skeptical that there is anything new under the sun that can help me pull my self out of this. That’s the carousel part: up and down and around in a circle with therapies and drugs to try to find something that will pull me out of this funk. There is nothing new under the sun in my experience at this point. I’m skeptical.

I found out from my dr (I’m back to seeing my regular outpatient dr) that I’m not being treating for depression at the doses I’m on. So, I’m basically in untreated bipolar depression. No Wonder I Feel Like Shit! She is slowly titrating drugs up. We won’t know if it works until it’s been at a therapeutic dose for several weeks. So, I have WEEKS until I’m treated and then more weeks to find out if this drug will work. I’m trying to hold out some hope that this isn’t yet another failure. This is basically the last possible antidepressant available to me. I have little hope.

Even though I’ve been very suicidal for days at a time over the weekend, enough to keep a packed bag in the car, my therapist wants me to stay out so he can work with me. He assures me that he is different. He knows the therapies I know. He knows my cycles that get me back into the hospital. And he’s also trying to call my bluff to see what I really, truly want to do: live or die. I honestly don’t know. In a perfect world, one I don’t live in, I want to live, yet without suicidal thoughts. Just a regular life with energy to do something interesting and lasting. This dream is elusive, especially for the last 4 days when I probably should have been in the hospital. Today, again confrontational, my therapist says not to be scared and jump in to life even if it’s manic. Yes, I’ll be fighting drs, but I may be fully living. I’m depressed now. It may not be as worse as it will get. Why not try to jump in/lean in/stop being scared of life?

So I’m deeply and untreated depressed. I’m plagued with on and off suicidal urges that I like the control of thinking I can follow though. And I’m challenged and sort of want to be wholly who I am, someone I don’t really know because I’m scared to be manic, which is the only person I know besides this depressed person for the last 3.5 years since diagnosis.

Hospital Diaries – Last Entry

I hope you’ve enjoyed, or learned something, from the ramblings of someone in the midst of treatment in the hospital. This entry is harder. No hard feelings meant. Just ramblings and truth of what I need.

February 13

Feeling a bit better today. Less irritated. Less angry and upset. I can handle life as a depressed person today – I hope. That will be my goal.

February 16

Cranky post. Heard for 4 days now that getting a visit. No visit. Some phone calls. In the 29 DAYS I’ve been here, I’ve been visited TWICE. Most calls are one I call out. What happened to visiting the sick and in prison? And everyday I deal with family who wants med info when I want to complain about how hard this is and so all that happens is a pronouncement that treatment must be wrong then.

None of this is providing support. How am I supposed to go home and get support when I’m constantly asking and only a few are checking in. What am I doing wrong.

Angry, irritated, irritable, depressed, suicidal thoughts again. I want to go home AND not feel like crap. Is that too much to ask?

Hospital Diaries – Feb 12

Horrible day yesterday. Angry, irritated, upset, crying, violent inside. Struggled with urges to tip/throw furniture, hurt people. So unlike me. Finally go doc to discontinue the drug and he’ll see me today. Meanwhile I’m knocked up on xanax. So lightheaded and tired, as well as impulsive. The benzo just make the thoughts and urges slower, not gone.

Woke up today still feeling angry and irritated but with fewer urges. That’s how  yesterday started too, so my antennae are up.

Saw dr. So I’ve been having a hypomanic episode – same as when on SNRI’s. A fast flip to a new mood. I still want to be destructive, even though I’m coming down. He thinks I might have something with my thyroid and will do extra blood tests, then treat. Got ok from primary care doc to treat thyroid, if that’s what the depression is. A stimulant might do it to. But I have to be off the MAOI first.

BIG HEAVING SIGH!

I hate my life