Should I be allowed to know this?

Yesterday, I ended up seeing the referral letter my general practitioner wrote for the psychiatrist.

I’m not sure why I got to see this, or whether I should be permitted to, but I did as part of a discussion of what/how much of various drugs I have been taking and some confusion over it, because while I did fill out paperwork permitting my psychiatrist’s office access to my prescription record, that paperwork hadn’t yet been filed.  New office, new practice.  I think they’re still having trouble with the computer system.  Dr. K himself expressed some frustration with having to learn how to fill out a prescription on the computer.

But I did see this, or part of it.  My GP’s suggestion is that, should the cipralex not work, I should be put on buspirone.  I spent some time reading that over.

This shit is scary.

Extreme levels of caffeine ingested while taking Buspirone may result in extreme nervous breakdowns, followed by amnesia of the event.

Define “extreme levels of caffeine.”  Define “extreme nervous breakdown.

Jesus christ, let the cipralex be working.

I’m not always very comfortable with taking psychiatric drugs.  They make me, as a rule, very nervous, far too nervous for someone who has so many bottles of them over her desk.  They do strange things to the chemicals in your brain, they are not always predictable in their effects, there are unfortunate side effects.  I am not entirely comfortable with the cipralax and the seroquel, but I take them because I’m hoping the former will work and I know the latter is working, even if it does still make me sort of sleepy.

But the potential for problems worries me, as does the idea of being on these things forever.

Then again, what doesn’t worry me?  Ba-dum ching.

Bad days.

Sunday and Monday were wonderful.  I felt in control and on top of things and capable.  I got lots done, I wanted to do things, I made things up for me to do.  I made cakeballs for my roommates and bread for myself, I went shopping and bought tea.  Can’t find decent jeans that fit, but we’re working on that.

Yesterday, though, was a struggle, and I feel the same way today.

I have no doubt that the seroquel helps, and it certainly doesn’t make me as ridiculously sleepy as it did before, although it certainly slows me down.  But this was a morning where I lay in bed far too long and stared at the ceiling and was miserable and anxious for no reason.  My bedroom was cold, still is cold, and that doesn’t help, but bed was warm and safe and as long as I stayed there I didn’t have to deal.

I said, in the beginning, when I began this blog that I was beginning to hate the term “mental illness.”  I’d like to rescind that comment.  Sometimes it is infinitely easier to think of this as something Other that comes down upon me and takes over that I must fight than for it just to be some indescribable quirk of myself and therefore a personal failing.  All the stigma of mental illness is one thing, but I’m getting help now, and I never was getting appropriate help before.

But sometimes it is such a battle, and such a struggle, and days like yesterday and days like today where it’s hard to drag myself out of bed, or out of the house, to run errands or to go to work, because all I want to do is crawl in bed and hide until everything goes away and I don’t have to deal with it… they’re very discouraging.  It feels like I’m losing.

It’s easy for me to tell people, my family in particular, that I’m having a good day, that I feel good.  It is fiendishly difficult for me to stand up and say, today I’m not doing so well.  There are going to be bad days, of course, there always will be, but on some level I still think of this as a personal weakness, and if I have a bad day, where my brain is so eaten up with anxiety I can hardly think straight, that it is my fault for not being strong enough to be better.

Pink Floyd is cathartic.  Pink Floyd is mental illness as music, much of it.  For a very long time I’ve loved the line, from the song Brain Damage, the last song on The Dark Side of the Moon: “And when the band you’re in starts playing different tunes/I’ll see you on the dark side of the moon.”  I love it because sometimes that’s what I feel like, like I’m out of sync with the rest of the world, like I’m playing the only tune I know but it doesn’t fit with what’s around me.  Why is my brain against me?  Why can’t I be normal? Why do regular, everyday tasks have to be such a battle some days?  Why don’t I have the same sheet music as everyone else, why can’t I deal with life like regular people do?

If I think of this as something else, as something other than myself, it’s easier.  I read, once, a memoir of a girl struggling with anorexia, and one thing that struck me was the way she named and personified her disease as Cruella, as something other, as something that was not her but tried to take her over.  I’m suddenly seeing this as being an extremely apt point.  What, if anything, do I name the anxiety?  Would naming it help me?

Or is it better to take the Bene Gesserit path, to accept it, live it, and dismiss it?

I will face my fear.  I will permit it to pass over me and through me.  And when it has gone past I will turn the inner eye to see its path.  Where the fear has gone there will be nothing.  Only I will remain.

I dreamt last night I was in a hospital, on a psych ward, and they were giving me brain scans to see what was wrong with me.

The Peanut Butter Analogy

This is what I’m calling the Peanut Butter Analogy.  It’s how I try to explain the anxiety to people.

The situation is that I am at the grocery store, and I must buy peanut butter.  I like peanut butter, and it is nutritious, and I always have some in the house.  However, I am required to make a choice.  Do I get chunky or smooth?  Natural?  Natural chunky?  Light?  Whatever the hell this “whipped” peanut butter is?  Organic or regular?  Kraft, Jif, generic grocery store brand, some strange organic gourmet brand?  Big jar or little jar?  There are literally dozens of choices.  I can only walk away with one.

And I find it absolutely paralysing.

With every choice comes the possibility that I have chosen wrong.  If one brand is more expensive, is the cost justified?  If I buy natural peanut butter (and I like natural peanut butter) will I regret it when I spill peanut oil over the counter when I try to stir it?  Is Light peanut butter worth even looking at as significantly different?  If I choose wrong will I end up gaining back all of the seventy pounds I have lost?  Does the brand matter?  If peanut butter X is on sale, should I buy it instead this time?  Should I buy peanut butter at all, do I need to buy it yet?

These are normal considerations.

But every single thought has all the weight as though it were a potentially life-ending catastrophe.  If I choose wrong, everything will be ruined.  My life will be over.

Because of peanut butter.

And if I don’t go into the store with a plan, without saying “I am going to get generic grocery store brand natural chunky peanut butter,” (which is what I normally buy) then I end up fussing and comparing anxiously for ten minutes in the store, taking jars and putting them back and getting new ones and putting them back, because I am eaten up with anxiety under the pressure of choosing peanut butter.

Now imagine going through that for every item on the grocery list.  What percentage milk?  What veggies should I buy?  Regular or extra garlic hummus?  What kind of deli meat?  Should I treat myself to a piece of Guinness cheese?  Do I need more granola and if I buy it bulk will I buy too much for my granola container at home?

It’s exhausting.  It is utterly draining.  And at the same time, I can’t not go grocery shopping, so I subject myself to this regularly.  If I’m very anxious, I often end up coming away without half of what I actually need, because I’m far too nervous to think clearly.  The register becomes an impossible obstacle, becuase not only am I subjecting myself to the possible judgement of the cashier, but whatever choices I have made become irrevocable.

In other stores, never in the grocery store but in  pharmacies and dollar stores, I have lost all my nerve at the last moment, backtracked and put everything back on the shelf, and left without buying anything.  I’m sure this looks weird, but I can’t seem to help it.  Sometimes that last obstacle is too much.

Old lyrics

I had a good conversation with my Dad last weekend.

It was partly a confession about how bad things sometimes are for me — the suicidal thoughts, my trouble with menus in restaurants, and what I’m beginning to term “the peanut butter analogy” — and partly just a brutally honest question-and-answer period for him and his wife.  Some of that I’ve never told to my mother, and some of it I never will.  Particularly the fact that I get suicidal during bad panic attacks.  She will not take that well.  My desire to censor myself when I talk about this is much stronger with my mother than my father.  My father asks questions because he doesn’t entirely understand and wants to.  My mother asks questions because she worries.  A lot.  Telling her that particular fact will only scare her and make her worry more, despite the fact that this has been something I’ve experienced for decades and I haven’t offed myself yet.  I hadn’t planned to tell Dad, to be honest, but we were looking at something I’d written back in 2002.

My father songwrites, as a hobby, and he had extended to me the offer that if I ever wrote anything that might work as song lyrics, to bring it to him.  There were a few things I wrote for him, but one in particular always stood out, lyrics that were very dark and uncomfortably desperate.  Dad composed something for it, a song that was just a little bit discordant and a little bit strained, but was at a loss as to what to do with the song, because it was just so intense.  It was good — he told me that then, and I hold it now as one of a few pieces of writing I’ve done that I have a hard time believing I actually wrote because of its quality — but too intense to do anything with.  In more recent years, he’s been making a concept album.  It’s the story of a nation that is brutally attacked and invaded by another, the rise of a hero who defends his homeland, and the subsequent transformtion of the celebrated hero into villified scapegoat and the hero’s quest for spiritual meaning for what he went through.  Dad used this song I wrote to bridge the destruction of war into the rise of the hero, trying to make sense of the chaos and the horror, on the very edge of choosing to act and change everything.

I know what I said and what I believed I was writing about at the time.  I look at the song now, and I think it’s the closest I’ve ever come to describing a panic attack in words.  It has recurring images of unending night and entrapment, fear of the situation and equal fear of changing it, acceptance of the horror, confusion about everything, hope that it might be better.  And for the first time, I told my father that’s what I see in it now.

I worry, sometimes, that I’m putting my family through the wringer, making them deal with me and my issues, and that it’s hard for them, and this is likely why I censor myself like I do.  But that night, my dad said to me that it was, as awful as it sounded, really great to see me go through this, because I’m understanding myself more, and I’m learning how to deal with things, and I am growing and strengthening visibly.

That was a good thing to hear.

The  seroquel… well, it’s not as dramatic a change as the clonazepam was, but it’s definitely a help.  It’s really a huge help.  I am calm.  I am also sleepy as hell, a lot of the time.  I don’t like that so much.  I’m not sure how much I like that.

Results

I saw the psychiatrist yesterday.  I think it went well.

He’s South African, which I did not expect.  His diplomas on the wall were from some university in Johannesburg, the name of which struck me as amusing at the time but I forget now.  He’s a big, black South African doctor with a moustache, and I like him.

And I told him everything.

Which was exhausting.

I told him how amazing I had felt on the clonazepam, but how it was losing effect as I was clearly building a tolerance to it, and that the last week had been hell.  I told him about how, during my bad panic attacks, I felt suicidal and inclined to self-harm, although I had never gone so far as to act on any of these thoughts, short of biting very hard on my hand.  During the entire appointment I was so nervous I couldn’t stop moving, restlessly shifting in my chair and wringing my hands and clenching my fists.  It felt like torture.  A few times, during lulls in the conversation, I looked out the window, couldn’t see much but the hospital and a parking lot, but it helped.

We ruled out diagnoses like bipolar disorder or schizophrenia or OCD.  Just… general anxiety, which surprises no one at this point.  I’m puzzled by the question, though, of if I’ve heard voices or experienced hallucinations.  I said no, but I said to my father last night, how would I know? What if I was unaware that they were hallucinations?  Dad thought that was pretty funny.

The doctor doesn’t like me being on clonazepam either, and since it’s unwise for me to go on a higher dose, and since the effectiveness of the Cipralax will be weeks away, he has given me something called co-quetiapine, or Seroquel.  It’s an anti-psychotic, which is weird to think of.  Also apparently if my parts of my life really are hallucinations, I’ll find out soon enough.  It definitely has a tranquillising effect, though.  Luckily I have a couple of days to get used to the loopiness before I go back to work.  Working on cutting down the clonazepam now, not that it’s doing me a lot of good right now anyway.

The Cipralax is probably a good fit for me, but he mentioned another drug we can try if it doesn’t help.  Again, it’s the sort of thing that takes weeks and weeks to work, so we should at least give the Cipralax a chance first.

Speaking of my father.  We got on the topic of self-medication last night, and he asked me why I thought I had never got into that alleyway.  I said I wasn’t sure, although perhaps if I was a chain-smoker I’d be more functional than I am.  With alcohol, the line between “buzzed enough to be unanxious and happy” (and I am the happiest drunk in the world, for good reason) and “uncomfortably intoxicated” is too fine to walk regularly, and I can’t drink every night, although there have certainly been periods of my life where I’ve had, say, a beer every night for a week or two.  And later in the evening, thinking more on it, it occurred to me that when I’m at the low point in this cycle that I’m beginning to recognise in myself, where I am anxious and depressed and more anxious and more depressed and doing everything in my power to force myself to go out to work and accomplish tasks, I do self-medicate that lack of energy.  The amount of coffee I’ve had in the last week is… astonishing.

And of course, caffeine makes anxiety worse.

How much simpler would my life have been if I’d started smoking in high school?

The Value of Literary Role Models

Anyone who knows me will say this is true about me: I love Sherlock Holmes.

Madly, to the point of obsession.

My first exposure to Sherlock Holmes was probably from Star Trek: TNG, actually, where Data and Geordi muck about on the holodeck and end up giving Moriarty sentience.  I still love this episode more than it’s probably healthy to.  When I was twelve, I had further significant exposure: a point-and-click adventure game that I found fiendishly difficult, a poorly done dramatised version of “The Adventure of The Dying Detective” in our school reader (which we actually weren’t reading but I read everything in the book whether we were supposed to or not, even if most of it was very lame), and a cassette tape for car trips which had a reading of a couple of stories on it.

But, I mean, he’s Sherlock Holmes.  You cannot fail to know who he is.  He is far too much of a legend.

The cassette tape made the most impact on me.  On one side was “The Adventure of the Blue Carbuncle.”  This is a great story, and still one of my favourites, although Holmes’s logic that “well, he has a big hat, therefore he has a big head, therefore he is highly intellectual” doesn’t actually hold water, but it’s such an insignificant point in the story I can forgive it entirely.  It’s a Christmas story, it’s told backwards, it’s clever, it shows Holmes at his best.

The other was “The Adventure of the Musgrave Ritual,” which is… well, it’s not a bad story.  Not one of my favourites, either, but it’s a perfectly good story.  What caught my attention at the time, though, was the bit at the beginning in which the good Dr. Watson (truly, one of literature’s most underappreciated characters, because he is a bad ass motherfucker, make no mistake about it) lets off a little steam about what it’s like to have Sherlock Holmes as a roommate:

But with me there is a limit, and when I find a man who keeps his cigars in the coal-scuttle, his tobacco in the toe end of a Persian slipper, and his unanswered correspondence transfixed by a jack-knife into the very centre of his wooden mantelpiece, then I begin to give myself virtuous airs. I have always held, too, that pistol practice should be distinctly an open-air pastime; and when Holmes, in one of his queer humours, would sit in an armchair with his hair-trigger and a hundred Boxer cartridges and proceed to adorn the opposite wall with a patriotic V. R. done in bullet-pocks, I felt strongly that neither the atmosphere nor the appearance of our room was improved by it.

When I was twelve, I had no idea what a patriotic V.R. was, but the idea of Sherlock Holmes, the great and genius detective, casually shooting designs into his wallpaper with a revolver, shocked me a good deal.  Everyone, of course, knows Holmes, and everyone has a preconceived conception of what sort of character he is.  This didn’t jive.  I listened to Blue Carbuncle many times because I loved the story, but I listened to the beginning of Musgrave Ritual because this new bit of information fascinated me.

The summer I was sixteen, I think it was, I went to the library and checked out a massive tome containing several collections of the short stories, as well as The Hound of the Baskervilles, and I gorged on it.  I read through the whole thing, said “Wow,” and flipped back to the beginning to read it again.  Sherlock Holmes was not the man I had been led to believe he was, being far more eccentric and unconventional and, well, bohemian as Watson himself terms it.  I had never been much for reading mysteries.  I could not get enough of this.

I discovered one other thing, during this reading: Sherlock Holmes was a user of cocaine.

And this shocked me, too.

…while Holmes, who loathed every form of society with his whole Bohemian soul, remained in our lodgings in Baker Street, buried among his old books, and alternating from week to week between cocaine and ambition, the drowsiness of the drug, and the fierce energy of his own keen nature.

So Watson says in “A Scandal in Bohemia.”

Cocaine was perfectly legal then, available over-the-counter at any chemist’s.  Its dangers were only dimly beginning to be realised — Watson’s distinct discomfort with his friend’s drug use, and his strong feeling that it cannot be good for him in the long run, are actually somewhat ahead of conventional medical wisdom for the time.  And yet Holmes, in the early stories, uses cocaine between cases.  Why?  Because when he has a case everything is fine.  When he has nothing, life is boring, life is unbearable, and the cocaine (and arguably, morphine at times) makes it better.

He’s self-medicating.

Says Sherlock Holmes himself, upon introducing himself to Watson for the first time:

“I get in the dumps at times, and don’t open my mouth for days on end. You must not think I am sulky when I do that. Just let me alone, and I’ll soon be right.”

And this, this is one very good reason among many why I remain obsessed with Sherlock Holmes.

Holmes has been “diagnosed” by various medico-literary experts as everything from bipolar to ADHD to high-functioning autistic to just a plain old ordinary addict.  Take it with a grain of a salt.  He’s a fictional character, he has whatever personality traits Doyle deigned to give him, and he’s very much based upon the typical portrait of the poor artist in an unconventional lifestyle with unconventional points of view, a confirmed bachelor living by his wits, and this isn’t even a literary convention that’s changed much over the years.  A similar sort of shorthand today would be to give the character a stash of pot in which he occasionally indulged, or to have them be a chain smoker, or some such thing.

I don’t care what it is.  I don’t care why it is.

All I know is that when I was sixteen, and first read these, I saw something in Sherlock Holmes that struck a chord: an occassional and persistent inability and antipathy towards dealing with real life.  The cases?  They are not real life.  They are adventures.  He listens for a while and smokes a lot and  jumps up from his chair, dragging his loyal and long-suffering ex-army surgeon friend, along with aforementioned friend’s service revolver, off to brave danger and intrigue and occasionally to dip a toe into the wrong side of the law.  It is exciting.  It is all-encompassing.

And it’s all he has.

He has no interest in society.  Without cases, without the rush of adrenaline, he retreats into himself, into his violin and his tobacco and, yes, his cocaine, because he will not, cannot cope with life.  By his own admission, he will lie on the couch and refuse to move and eat and simply suffer, he acknowledges these spells and gets through them as best as he can, because what else can he do?  What else can anyone do for such a case as himself in the 19th century?

And I’ve long seen the same in myself, before I could positively say so.  I get in the dumps at times, not because anything is wrong but because things are going on in my head that I cannot explain effectively to anyone.  When, in high school, I would retreat into my room with the lights out and my headphones on and listen to Wagner or John Williams soundtracks very loudly and on repeat for hours, it disturbed my parents.  Of course it did.  In retrospect they might have been more reassured to hear their teenage daughter moping to something other than things like Mozart’s Requiem, as that might have seemed more normal.  And then the fit would pass (it was intense anxiety, I can say in retrospect, though I couldn’t name it then) and I would emerge, and my parents brought me to the doctor and I admitted to feeling awful a lot of the time, but the antidepressants did nothing because the depression I felt was just a symptom, not the condition, and the counselling was not terribly helpful because I was not exactly depressed.  I can say that now.  I retreat from the world because I cannot cope with it, sometimes, because it makes me too anxious to consider doing anything else.  My reasons may not be what Holmes’s are, but our solutions are, unfortunately, the same.

And, unfortunately, neither are particularly effective in the long-term.

Yesterday I came home from work in a fit of anxiety of despair and the intense fear that it would never be better, that the two weeks of clear thought and functionality I had never had before would never return to me.  I curled up in bed and did not move, for an hour.  I didn’t sleep.  I just lay there and was miserable and wanted to die.  There were, surely, aspects of a panic attack there, but not entirely.  I don’t know how to categorise it.  I felt awful.

I took a clonazepam, hours early, a whole instead of the half I’ve been taking at night because I sleep better that way, and I felt… well, better.  Eventually, better.

And then, I thought, what is the difference between this and Holmes’s cocaine?

I have a prescription for mine.

That’s really the only difference.

I Has Snow

I am struggling along.  I seem to have hit some sort of valley in between the rush of the clonazepam and the effectiveness of the cipralax.  The last few days are a struggle.  My boss has been gone this week but the temporary replacement, the old manager (who I sort of replaced when she left and who comes back on occasion as a favour) coincidentally also has anxiety issues, and is also taking cipralax, and we’ve compared a few notes on medication.

She’s perfectly happy to be on drugs for the rest of her life.  I’m not.  But I think, too, that her issues were always more centered around severe panic attacks (she told me her first one had her in the ER, because she was sure she was having a heart attack) and mine seem to be more around consistently high levels of anxiety with occasional peaks into panic attacks (which I have always, always had, although I was probably about twenty before I could identify them as anything other than periods in which I felt awful and ill and suicidally despairing and certain I was losing my mind).

It did mean, though, that the other day when she ran out for an errand, called to check up on me, and I, in a state of high anxiety and near a panic attack told her I was freaking out, that she returned immediately, and allowed me to go for a short walk.  It was -15 C or so, didn’t bother with my coat (I have a warm sweater, working partly outdoors) but grabbed my gloves and walked to the other side of the parking lot to calm myself down.

The parking lot ends in a high slope next to a radio station, almost a cliff, that overlooks an industrial area and railway tracks and cutbanks over the distant river.  There are trees.  It was quieter than inside.  I ended up sitting down in the snow, and then lying down with my eyes closed for a little while until I felt better.

I told a friend of mine about this, and she immediately thought of this:

I am okay with that, I think.

I am very anxious today.  I have to go out.  I don’t wish to.  It will be for my own good.  I have managed to shower and dress, I have taken my meds.  When I am out I have my counselling at 3:15 (weird time), which will be good.  I have to pick up groceries, since I’m out of the meal replacement bars I’ve been living off of when I need to but can’t eat and also had to borrow some of Audrey’s margarine last night.

I am not eating well.  I know I’m not.  It’s not a lot, and it’s not balanced, being mostly carbs.  My boss believes, I think, that I have an eating disorder, combined with my doctor-recommended three weeks off and my continued weight loss.  I am trying but food is hard to face.  I have to eat breakfast because the cipralax makes me very nauseous if I take it on an empty stomach, and we’re having meal bars for lunch, but besides that… all bets are off.

So I continue to lose weight.  In April, I weighed 200 lbs.  I don’t mind saying that.  Apparently I carried the weight “well,” whatever that means, but I was aware that I was eating extremely poorly, with the occasional tendency to binge eat, and that bothered me more than my weight.  I made a lifestyle change, a vow to eat healthy without dieting, not to starve myself but to not make bad decisions constantly.  I said to myself that if I lost twenty pounds it’d be great, thirty would thrill me, and then I just sort of kept losing the weight.  I’m at… well, somewhere between 130 lbs and 135 lbs.  I’ve gone from a size 14-ish to a size…. I’m not even sure, actually.  Size 3 or 4?  All my clothes are too big.  I haven’t bought more in some time.  Buying new clothes makes me, well, anxious, like everything else.

I was stable at 140 lbs for a while, and I was okay with that, but I’m not stable now, and I’m still losing weight.  I haven’t discussed that with anyone, because I don’t know what to say about it.  It’s a perfectly healthy weight for my height — I’m 5’5 1/2″, with a large frame, broad hips and broad shoulders, big hands and feet.  My family has joked that if I hit the point where I’m as thin as the Mongoose, they’ll intervene.  My youngest sister is one of those people who is just very thin by nature, much like my father is, with a speedy metabolism and a hyperactive nature, who never stops moving and naturally tends to graze constantly rather than eat heavy meals.  She’s only thirteen now, and still growing (though she’s only a couple of inches shy of me, now, and I’m the tallest of my sisters, and I suspect she’ll outpace me soon enough), but she’s never succeeded in packing on more than the smallest amount of body fat.  One summer she sprouted six inches over the course of about two or three months.  She looked almost skeletal, although she ate like a horse that whole time.  A thought, about the media’s influence on body image: she has a body many girls strive for, now, thin and lanky but becoming decidedly more feminine and curvy all the time, although still with overlarge hands and feet that suggest she’s got more growing to do (although we’ve all got big hands and feet).  The Mongoose, however, has confessed to me that she worries she’s too thin, and wishes she could gain just a little bit of fat.

I worry that that intervention will be necessary, though, because as I said, my weight is still dropping.  Slowly, but it is.

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