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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?

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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.

Climbing the mountain

I was feeling frustrated and annoyed and anxious yesterday, going to a counselling appointment I had to wait a full month and a half to get.  Jesus, I had to wait two weeks for the intake appointment for where they worked out where the hell they were going to put me and what sort of program they were going to funnel me into.  Having been going to this temporary, casual sort of counselling, the sort  of counselling which has been pretty typical in my experience, I was wondering what the hell the point of going to this guy too was going to be.

It turned out to have been worth the wait.

I suspected, based on some admittedly paranoid dissection of the questions they asked me during my intake, that they were sending me to someone versed in anxiety issues.  This turns out to have been true.

But this was not like any counselling appointment I have had before.

I was very anxious going in.  New counsellors make me anxious.  When I climbed the stairs and looked down the hallway towards reception, I realised abruptly that I had been in this building before, years before, when my mother had wrangled things to get me on Plan G.  Plan G is a provincial drug plan providing psychiatric drugs to patients who need them and cannot afford them.  At the time, it was for some antidepressants that were having a debateable amount of effect, possibly not much.  But this?  This was where we’d got the forms.  I hadn’t had any clear memory of what the building had been but this had been it.

I suffered a sharp spike of anxiety and loitered for a moment at the top of the stairs, aware that I could see other people in the waiting room, and that made it worse, but I took a deep breath and soldiered on, feeling progressively worse.

I was a bit early, and the recptionist was still on lunch.  Again, anxiety.  What was I supposed to do?  I picked up a magazine on anxiety and depression, and managed to read part of an interesting article on medication before the receptionist returned.  She gave me a form to fill out.  Again, another spike of anxiety.  I recognised it right off as what it was, actually.  It was the Beck Depression Inventory on one side and the Beck Anxiety Inventory on the other.  I have filled out many of these lately, many in my life, this is nothing new although having to do the anxiety test is a particularly new shade of thing.

But I hate these tests.  I am conscious constantly of self-editing and trying to see if I’m answering “right.”  Obviously there’s no right answer, but I worry constantly about my ability to judge this accurately, and my sense of what the various gradings on the scale mean, and it’s always in the back of my mind that if I do it wrong, they’ll send me away as not really needing help.  On the other hand, if I err on the other side, what will it mean if they think my situation is far more severe than it is?  And how severe am I?  I can’t judge myself against other people, I can’t say how much of the mess in my head is “normal” and how much is not.

And then I had to wait again, and the magazine I had been reading had vanished (and I didn’t see anyone else in the waiting room with it, either, so I couldn’t even blame anyone) so I fidgeted until my counsellor showed up, by which point I was in a state of high anxiety and building towards a panic attack, and had to be walked around the building until I calmed down.

And this was, as I said, not like any counselling appointment I’ve had.

He is versed in anxiety problems.  In fact, he suffers from them himself.

He says he doesn’t believe in “fixing” people.

He says he doesn’t approach this as “dealing with anxiety” or “coping with anxiety” but instead as “accepting anxiety.”  His view is that anxiety, or depression, or anger, or other sources of “negative energy” come from the emotional mind, and that the rational, thinking mind is trying to fix them.  And of course, they cannot be fixed, they cannot be suppressed, they cannot be ignored or diverted without suffering backlash and problems and generally just making things worse, which is something I am becoming aware of.

His process, he says, is to allow the rational mind and the emotional mind learn to work together, to accept what the emotional mind is doing, to allow oneself to experience anxiety or depression or anger without it taking over and without trying to “fix” it, and to then be able to tap into the wise mind.

This is a different approach than I’m used to, and the idea that by learning not to fight myself — because fight myself I certainly am doing — I can be better… well, it’s very appealing.  What counselling I’ve done in the past has been, when it touched on anxiety at all, was focused on learning to calm oneself down, which is impossible to do in a crisis, and does not prevent the anxiety from being an issue in the first place.  This is new.  This sounds promising.  Possibly I’m grasping at things, but it sound promising.

As he puts it, I’m scaling a mountain, and he’s climbing the same one, and he can offer me advice on which tool to use or which handhold to take, but he’s there with me when he knows  how difficult it is.

Of course, it takes time.  At any rate, I’ve come away with a Plan G form, so that I can afford the Cipralex in the meantime.  Assuming it helps.  I hope it does.

Catch-22

I’ve always been, well, not exactly a morning person, but someone who doesn’t sleep very much.

I wake up early by necessity, and have for a long time.  The alarm is set for a nice, round 6.  The job I had before this, dough cook at a pizza restaurant, required me to start at 7, and my alarm was even earlier.  I stay up because I get busy doing things, or because I am too anxious and upset to sleep.  There have been several incidents in my life where, rather than go to bed at a reasonable hour, knowing full well how early the alarm for the next morning was set, I stayed up far past midnight, or later, because I was simply too anxious to sleep.  Usually I would play video games until I was so tired I literally could not keep my eyes open.

On clonazepam, I am happy as anything, but I want to sleep all the time.

The 6 am alarm is now problematic.  Going to bed after ten is now problematic.

 

My appetite is awful.  Recently, after the event that has crystallised everything into Something Must Be Done, I went a week and a half hardly eating.  I simply couldn’t; I was afraid that forcing myself would make me vomit.  I would look at food and suffer a hideous contraction of my stomach.  At times I felt light-headed with hunger but it was an effort to eat because my stomach was so knotted I did not feel hungry at all.

This does not help the case of those who, not knowing exactly what’s going on with me right now, believe I have an eating disorder.  When you lose sixty-five pounds and then suffer some sort of mental breakdown at work, people tend to make connections.

And then the Wellbutrin, of course, didn’t make it better.  One of the side-effects of Wellbutrin is appetite suppression.  I was no longer fighting a stomach clenched with anxiety, but I simply didn’t feel hungry a lot of the time, either, and had to constantly remind myself to eat.  It would be better for a few days, and I would eat normally, and then I would have a Bad Day and be unable to eat and it would take me several days to get back into the swing of eating normally.

I’m no longer on the Wellbutrin, of course.

But this morning, I am looking at a piece of homemade honey-wheat bread, with chunky peanut butter.  I have a big mug of poor man’s mocha — coffee and hot chocolate mix.  It should be delicious; I can barely stomach it.  I have two pills to take: the clonazepam, and half of a tablet of Cipralex.

Cipralex is, of course, the long-term drug, the one I am waiting to work so that I don’t have to take clonazepam.

Cipralex must be taken with food, or it makes me very ill.

And I cannot get any food into me this morning.