Day 7 – 31 July 2017

08:19
I am out walking the dogs, and I hear the copyright information on Audible for The Case Against Sugar. Thank g’d I am done with that damn book. At least I won’t hear about sugar the next time I go on a walk. As Amy Poehler stated, “Good for you, not for me.”

11:33
I spent the morning writing, and I have not done any work. Fuck, fuck. I have to focus and get some work done. Love my job, hate the paper work.

15:31
I just remembered: “American Ninja Warrior” is on the television tonight. I love that show. I totally want to be a ninja. [Insert eyeroll from The Hub here.]

Evening
I am sad and anxious. Some of the patients that I have seen today are truly struggling. I am processing two sessions in particular, analyzing my every move and asking if it were the right intervention at the right time. I know deeply that there is no “right” thing to do as a psychotherapist (except in areas mandated by ethics or the law). My possible failures as a “good enough” therapist provide an opportunity for my patients to get angry and process all the times that others have failed them; however, the questions still roll like a fog over my mind.

20:38
I am late leaving the office and tired. There likely will not be time for all that I want to do: reply to my meditation instructor’s email, meditate and watch “American Ninja Warrior”. I know that the last item is silly, but I like to dream that one day I could do some of those things. There was a man who competed in his 60s this year …

21:58
Our young dog stands by the door and looks at me. These are the moments in a marriage: give or take. The Hub has worked all night on preparing dinner for the following day, so I pop up and slowly grab the leads. We walk the streets that are surprisingly quiet, and I feel time slipping away. I want to debit my sleep account.

22:28
The Hub and I crawl into bed. My smart phone lingers in my hand, and I can feel the pull to read – The New York Times, The Washington Post, Politico, Celebitchy, the day’s horoscope. I have not even completed the day’s word game. I consider the alternative to my Treatment Plan but know that the backlit device will stimulate my retinal nerves, and sleep vanish by the hour. I need to set my phone down and do so reluctantly, feeling like I’m missing out.

 

Day 6 – 30 July 2017

05:25
I wake up before my alarm, before our young dog. Holy sleep hygiene, Batman! I officially am one of those crazy people “who doesn’t need an alarm”. After one week. I take the young dog out and return to bed with the family – The Hub and the dogs. Despite seven hours of sleep, I am still tired. I read in bed until my fitness class.

07:47
You know that moment when you’re working really hard in a fitness class and you feel your muscles burning from effort but you really just want to punch the instructor in the face? Yes, that.

09:05
I love B, my mediation instructor. She is the most amazing person. At 20 years younger than me, I am jealous of her wisdom, her patience, her deep knowing. She is such a gift. B asks me to look for “synchronicity” this week. Aware that she likely is not referring to the album by The Police, I have to Google the term.

09:12
I find my family still in bed, and I am anxious. I made The Hub go to bed with me at 10:30 the previous evening, and he as not happy. Not one bit. I wonder if I have a mess to clean up or if he appreciates my intentions. Typical of our shared stubbornness, he reluctantly admits that he benefitted from the sleep with a qualifier. Always a qualifier. Being married to someone trained in math is a learned skill. Proceed cautiously.

10:32
We arrive home from walking the dogs and survey the contents of our kitchen cupboards scattered about from yesterday’s “flood”. If we want to eat, we have to deal with this mess, and the previous day has left us gun-shy of restaurants. I set to work, draining years-old expired food goods and washing pots and pans that were used to catch water. I know deeply that this moment would not be occurring if I a) stayed up very late and b) consumed ETOH. I am proud of myself.

13:19
I just cleaned the bathroom sink and toilet. What the fuck is happening? One week into this whole structure thing, and I have time to actually take care of and manage my life. I am both not-so-secretly pleased and secretly annoyed with myself. I work hard to not think about the hours that I have wasted in my life.

Late afternoon
I walk to the Salvation Army with a bag of donations and to the Market for meat and produce. Listening to a book on tape, The Case Against Sugar, has the opposite effect. My brain is just hearing “sugar” and then “sugar” and “sugar” again. I then think of every form of sugar that I love. I am also annoyed with the book for a variety of reasons. I cannot wait for it to end and to eat – you guessed it – sugar. My oppositionality can be such a pain in the ass sometimes. It’s like someone spent an hour telling me what to do, and I automatically think, “Oh, yeah! Try that again!”

19:12
The Hub and I have walked the dogs to the corner tavern and sit outside in the patio. I tell one of our favorite servers that I am just having a soda water. She asks the inevitable question, “Why?” I stated that I have to work later and she asks again, “Are you sure?” I think of all that I accomplished that day and say, “Yep.” It is hard in the moment, but the moment passes. The dogs soak up the sun and attention from other patrons.

20:19
I cue the Netflix to continue a series that we started the previous week and notice that I could give a shit. I am not involved and am on my smart phone. I stop myself, pause the show and stated, “I’m sorry. I can’t watch this now. The TV is yours.” I cannot watch TV sometimes; it just doesn’t garner my attention. I think that’s why I drank ETOH while watching television sometimes – to slow down my brain. The younger dog joins me in bed as I read The Ministry of Utmost Happiness. My body is weary, and I am ready for sleep to come.

 

 

An Old Friend

About six weeks ago, I was leaving therapy and had a “doorknob moment”. I looked at my therapist and stated, “It’s like I’m an adolescent and have to figure out how to live.” She enthusiastically replied, “Yes! Exactly.”

Half-way through my life I am figuring out how to live: how to not eat more than needed, how to pause before I act or speak outside work, how to directly ask for what I need, how to say “no” without explanation, how to eat vegetables beyond my small repertoire, how to set boundaries in relationships, how to manage my expectations of others, how to laugh when things go wrong and then wronger, and how to forgive.

You see, I did not plan to be here. Fifteen years ago, when I gained courage from my husband to see a psychotherapist, the script was this:

“[The Hub] will discover how awful I am just like my family has. He will leave, and I will have nothing left. Then I will jump off a bridge into water.”

I actually can tell you which bridge in this City because I walked over it many times, “rehearsing” as it were: gauging the depth of the water (I then could not swim) and noting the lack of witnesses. Now that I think about it, I don’t cross that bridge any more – in car or on bicycle or foot. I haven’t in years …

The first time I remember thinking about suicide, I was 11 or 12. My mother was on some bloody warpath over some small infraction that I could not have imagined then. Trying to drown out the sound of her still yelling at me after sending me to my room, I put the needle on my Mickey Mouse record player. Turning up the music as loud as the little machine could muster, I remember thinking, “I wish I were dead.” Everything got quieter and calmer in my head.

An A student who showed up at mass with her Catholic family every week throughout grade and high schools, I flew under the radar. I never acted out. I never did drugs. I spent my weekends in high school babysitting and saving money for my eyeglasses and clothes. When I didn’t babysit, I went to the video store and rented a movie to watch at home. I ironed church linens. I never went on dates. I didn’t consume ETOH until college. I read voraciously. While the thought of dying crossed my mind during these times, another plan was more pressing: get the fuck out of Dodge.

The proverbial “Dodge” was not of my choosing. After skipping a grade in grade school, I was very young for my class and graduated high school at the age of 17 years. The orders had come in: I had to go to a Catholic college or university, and the Federal aid had to be there. While I wanted to go to a large university far, far away from my family in a large City, there were no funds for transportation; the gas money to drive me to college was limited and that was if the car made it there. Sometimes it did not.

After spending 12 years of education with the same sixty Catholic kids who had all sorts of names for me – their favorite being the then-maligned-label, “lesbian” – I could not wait for a “do over”. I so desperately wanted to fit in, to find my “tribe”, to belong. After all, I belonged nowhere – not at school, not at home, not at church. (I fought my being confirmed and duly lost.) The fact that four other students from my high school went to the same college should have served as a warning, but I did not heed it.

Within weeks of my arrival at college, I again knew it: I was different. No hair bows hung on ribbons on the back of my closet door. I didn’t care about the football team. If the boys only dated girls with bows in their hair, I was never, ever going to get laid. Most students drove nicer cars than my parents had ever hoped to drive. My family took two vacations that crossed two state lines in my life. I didn’t have the clothes, the identity and most importantly – the self esteem. I had spent four years, pulling the grades to get into college and to get the fuck out of Dodge – for this?

With absolutely no emotional maturity to handle all that was thrust at me, I gave up being a “good girl”. I didn’t fucking care. I was going to have fun, g’d damnit. I was going to break every g’d-damn rule that I had so religiously [pun intended] followed since birth and have fun doing so. I found a department at my college that tolerated difference and found a few friends there. However, the faculty might as well placed a sign on the building, stating “Resettlement Agency”, because we all were refugees from the same dictate: go to a Catholic school, be a nice girl and find a good husband. If you can’t do the latter, be a teacher or nurse – a job that would work well for when you have children.

Listening to Tom Waits, The Smiths, Billy Bragg and P.I.L., we did our school work (sometimes) and bitched about the school, our parents and the boys from which we had to choose. I earned honors for my work until I didn’t.

At the onset of my junior year, I realized that if I did not find a job after this education, I would have to go home. I. Could. Not. Go. Home. Home = death. If I were to go home, I knew deeply that I would kill myself. I could not live another day in that house. No, nope, nyet. I cursed my ignorance – that I could choose a “trust fund” or “rich girl’s” major with no clear employment track. I loved what I was learning, but it was not practical. It was a fool’s errand. The joke was on me.

I spent my junior year trying to piece together a more marketable major. My grades fell, and I lost the support of my department. I will never forget crying in front of my peers when a professor stated, “I see nothing of value or interest here.” How the mighty fall. While my thoughts of suicide never translated into a “means” – there was no Internet or Google then – they were omnipresent.

Early in my senior year, I met my now husband at a bar. It is hard to separate my deep love and respect for him now from then; however, I do recall that I thought he was “very hot” and wanted to “hook up” with him. We did – and have been ever since. In many ways, he saved my life by helping me to see what I needed, by helping me to make choices that year – and now – that have kept me alive. I did not go home. Ever again. That choice has had awful consequences that I will discuss another time. But I can without a doubt say this: I did not go home after my senior year of university, and that choice saved my life. I am proud of that decision. It was extraordinarily difficult, and I did it.

As I write this now, I realize that my survival throughout my adolescence, early adulthood and adulthood – until I entered therapy – was always about the “next thing”:

  • “When I get to college, life will [be better in some way].”
  • “When I get married, my life [be better in some way].”
  • When I get [the next job], my life [be better in some way].”
  • When I get a [trinket], I will feel loved.”

The “next thing” would happen, and the hopelessness and anger would sink in all over again. I was different. I was ugly. I was fat. I was fucked. I was awful. My husband didn’t love me. I was “the poor kid”. I heard my father’s voice: “Life is not fair. Get used to it.” Every time one of these punches to the gut occurred, I sidled up to my old friend and felt comfort: “I could end this at any moment.” When things go wrong over and over and it feels “done to you”, you accept that sooner or later, you will take your life.

So, I had resigned myself to the fact that my husband would see what all the others who had left had seen: I was unlovable and deeply awful. He would leave, and so would I.

Through years of twice weekly therapy, I worked through a lot of shit. It wasn’t fun, but I recommend it. I healed through this relationship and still do. Through my training as a psychotherapist, I came to understand how trauma affected my brain, how my attachment pattern plays out in my relationships and how my not acting and suicidal ideation were forms of hope. Over a decade ago, I recall the session in which I looked at my therapist and stated, “I realized the other day that I’m not going to die by suicide – that it is not inevitable.” We both sat in silence for a few minutes, understanding the moment. I was deeply – and still am – grateful for her, for The Hub and all those who loved me in spite of myself during those years. it wasn’t easy to love me. I made sure of that.

My suicidal ideation now is a symptom. I am hawkish on it. If I ever catch myself uttering the phrase, “I am done [with life]” or “I fucking give up [on life]”, I know that I need to readjust. I immediately ask, “Why now?” “What stressors have exacerbated?” “What do I need to do to take care of myself?” It does not happen often – less than once per year- but when it does, I tell my therapist. She doesn’t freak out. I don’t freak out. We just treat it like abnormal blood sugar levels and get back to work.

While my depression is in remission, it is a pernicious disease requiring structure, treatment and vigilance. I never take a good day or the very fact that I am alive for granted. I have a really good life that took about half my life to build.

My Treatment Plan is both out of respect for the perniciousness of this illness as well as for my family and patients. I have spent a very long time wanting to live, now I want to stick around for as long as possible. Oh, the irony.

 

 

Day 5 – 29 July 2017

I did not journal at all yesterday. It was one of those shittastic days during which one starts to imagine the karma from previous lifetimes that brings one to this point in the here and now.

Here is a brief run-down:

  • Water heater in the unit above us cracked, sending gallons of water through our loft ceiling. It took 30 minutes to reach our neighbor for him to come home and turn off the water supply.
  • Whilst trying to get home from work to said home issue, a ride-share driver told me to “relax” after I spilled tea all over myself. (Note to men whom encounter me: telling me to “relax” is akin to telling me to “smile”. You have been duly warned.)
  • Lunch is delayed for said home issue, resulting in my getting hangry.
  • Do you know when you go out to eat, because your family is depleted and you just need to be taken care of but you get the server who really doesn’t want to be at work that day and you spend 90 minutes trying to get someone’s attention who’s laughing with his friends at the bar? Yep. That.
  • Do you know when one attempt at trying to recover a bad day (e.g., dinner at a restaurant) fails and you try again (e.g., sitting at neighborhood tavern patio), thinking that you can get the day back on the rails but then that TOO fails? Yep. That.

At 19:48, The Hub and I walk back into our apartment to see kitchen cupboard contents littering the counters, towels still waiting to be laundered and the smell of wet wood permeating our apartment. It was at that moment that we surrendered to “It’s been a shitty day”, resolved to forgive one another for any “snapping” for the remainder of the day and rented The LEGO Batman Movie and played the game of “guess whose voice that is”.

22:28
I crawl into bed exhausted and ready to start anew. While I hit the sugar again (a cookie that was so not worth it [sigh]) after a failed attempt at dinner, I did pretty d’mn good on a shittastic day. Sleep comes fast.

Day 2 – 26 July 2017

07:10
Despite a rough start on day one, I did it! I went to bed at 10:30. My alarm went off at 05:30, and I didn’t want to cut someone. #smallfavors

However, I have work to do this morning. I need to create some type of schedule to accomplish all that I want in a day. Not a list of work appointments or plans – an actual effing schedule with things like – oh, I don’t know – when do I eat? I am excited about this, because I do believe that: 1) it will make following my “Treatment Plan” easier (and I’m all about easier); and 2) it will bring more intention to my days. I’m all about intention these days; more to come …

Oh, and hey, good morning! 🙂

09:22

I was in therapy and mentioned my “Treatment Plan”. Instead of the “Go you!” that I expected, my therapist gave me the internal eye-roll. (I learned from pros.)

“Whatever happened to the ‘good-enough mother’?”, she asked, referring to the work of Douglas Winnicott. I rolled my eyes back at her – not internally.

What she essentially was saying was that I don’t need to be a perfect therapist to help others heal. In practice, failing a patient can produce anger and be as therapeutic as being “perfect”. Is this Plan another ill-fated pursuit of perfectionism for me? I don’t think so … I’m going to have to think about this.

p.s. If she figured this out before me, I am seriously going to be pissed.

12:08
A noon fitness class that I am choosing to leave five minutes early to see a patient in crisis hasn’t started. I immediately feel annoyed and deprived. I HATE RUSHING.  Thank g’d for meditation classes and Headspace. I am able to loosen my grip on my annoyance and anxiety and use the extra time to stretch my hip flexors that are always tight from biking. At least the work of the class burns off most of the emotions. This afternoon feels like one in which I am eking every minute out of it. Ugh.

17:51
I’m going to hang out with a dear friend. We normally split a bottle of Pinot Noir when dining out. O could care less if I drink ETOH or not. However, I am feeling pulled. ETOH – or as I call it, “liquid Xanax” – puts the brakes on my anxiety and work stress. The minute I take a sip, I feel the liquid Xanax muzzle the anxiety, tape its wrists and stow it in the closet. For now. Not tomorrow, when my neurotransmitters ask, “Hey, where’s that ETOH?” as they busy about. FYI: your body AND your brain are both assholes. They love, love homeostasis and work very hard to undo all that we do. Nothing, nothing is without consequence. G’d, I hate being an adult some days.

I recall Brené Brown’s Ted Talk: when one chooses to use a substance, one does not get to choose what to numb. If I numb my anxiety, I numb my joy, empathy and other emotions. In addition, anxiety might be a really good thing at the end of the night when choosing to hop on the subway, walk home or take a cab. Anxiety can be life-preserving. So, do I really want to wipe all of that away? I love O. They are one of those people who make me feel so good about myself, because they truly love me. Really, really love me. And they show it. That’s friendship gold. Do I really want to numb that?!

Kind of. I know, right?! That’s the pull of ETOH for me. I am fortunate to be very smart (i.e., common sense) and bright (i.e., intelligent), but I also have great difficulties shutting off my brain. I also spend the great majority of time around equally or greater bright people, asking tough questions, pondering important matters and challenging me to be better. When do I stop? The first sip.

I prepared O and told them that I wasn’t drinking ETOH for 365 days. Of course, they responded in their typically non-plussed way. Damn, I love them.

21:00
I almost fall asleep on O’s sofa. W.T.F. Who is this person? I make a strangely adult decision, state that I need to go home and get to bed. I have a bedtime now.

21:07
I am on my way home in a cab when a message comes through from my partner. It’s a picture of one of our dogs in his lap. My heart and face smile. I love my family. I love O. I am very fortunate.

The Treatment Plan

If one came into my office with a mood disorder (regardless of additional diagnoses), I would assess the following as part of their assessment and, ultimately, diagnosis(es):

  • Their sleep patterns and sleep hygiene;
  • Their relationship with food;
  • Their relationship with substances;
  • How much they move/exercise; and
  • Their compliance with any other health professional’s recommendations.

Most people with mood disorders struggle with these areas of their lives as part of their illness or to cope with their illness. Loss or increase in appetite, hypersomnia (i.e., sleeping too much) and insomnia (e.g., inability to fall asleep or intrusive wakefulness) all are diagnostic criteria for major depressive disorder. In addition, patients who struggle with depression, anxiety or post-traumatic stress can use food or substances to cope with unwanted emotions and their resulting symptoms. As a psychotherapist, looking at how people cope can tell us much about underlying emotional disturbances. Said another way, if one is in a good space in life, they sleep well, eat for fuel and the occasional indulgence, do not abuse substances and maintain or increase their health through activity and following health provider recommendations.

So why don’t people with mood disorders do what is recommended to them to manage their health?! Because their life is one big Whack-a-Mole game of managing different, sometimes conflicting symptoms. There’s another reason: most suck at structure. (You know who you are.) If they are so depressed that they cannot get out of bed in the morning, imagine trying to go to bed “on time” that night. These patients laugh in my face when I ask about their sleep schedule. I could spend the next 500 words, providing examples on how some patients hate – even are oppositional toward – structure, but I have to stick to today’s topic: The Treatment Plan.

For the next 365 days, I am going to follow every single one of the recommendations that I make to my patients. 

My immediate response to typing that sentence: “FML”, which I imagine that I will be uttering much during the next 365 days. However, I truly want to “walk the talk” as a healthcare provider. I also want to be the best damn version of me for however many years I have left on this planet. So, here it goes.

1. Sleep hygiene
Go to bed on time (22:30) and wake up on time (05:30) six days a week. No reading backlit screens after 22:00. One 30-minute nap on one weekend day is acceptable, but not recommended.
Degree of difficulty: 10/10

2. Mindfulness
Meditate for a minimum of 15 minutes per day. Lying in bed for 15 additional minutes to “meditate” does not count. (That hurt.)
Degree of difficulty: 4/10

3. No added sugar or artificial sweeteners
To clarify, naturally occurring sugars, such as in fruit, are allowed. (More on this recommendation to my self and some of my patients to come … )
Degree of difficulty: 7/10 (A 10/10 if I am around my dear friend who is an excellent baker.)

4. No ETOH (i.e., alcohol) or other substances
Nerd alert: I have never tried or done an illegal substance or something not prescribed to me. So, I will be abstaining from the one substance that I do use: ETOH.
Degree of difficulty: 9/10

5. Close all the rings on my Apple Watch
This equates to seven 30-minute workouts per week, twelve hours of standing for at least one minute and meeting a daily caloric “move” goal (currently 800 calories). One doesn’t need an Apple Watch to measure these activity or movement goals, but it’s a consistent, workable measure for me.
Degree of difficulty: 2/10

6. Follow doctors’ orders.
If I’m prescribed a medication that I agree to, I will take it. If a physician orders a test, I will do schedule and complete it. I will not cancel my dental cleanings. (I hate going to the dentist.)

That’s it in a nutshell. It – like my stubborn head – likely is going to be very hard to crack.

*

*You cannot trust me. I will say it again: You. Cannot. Trust. Me.

While I will be as brutally honest with myself and you, I am an unreliable narrator.

  1. My traumatized brain fails me in so many ways: hyper-vigilance deprives memory. When relaxed and “on my game”, I am an excellent listener with a keen memory. When stimulated, everything goes haywire. (And, shit goes haywire a lot; we’ll get to that.)
  2. As a psychotherapist, I know that I am not immune from what plagues my patients: the long shadows cast by transference and emotions on memory and experiences.
  3. Truth is the intersection of two shared experiences. So, while I may write about my life, if you are an actor in it, you likely will disagree. If there is anything that being in therapeutic relationships has taught me, two people can experience an interaction in completely different ways.

Don’t go all Oprah on my James-Frey ass at some point in the future. Consider yourself warned.