This Isn’t an Empty Box

I created this collage about the experience of recurrent mental illness: how it destroys the positive aspects of me and how even when I do just what the doctor ordered I still have symptoms.

The blank space is for anyone else who is struggling to tell your own story. Make your own collage. Draw. Write poetry. Keep the conversation going about how mental illness impacts your life.

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Vacation Valium and College Chromebook

Late Saturday night I returned from a week+ vacation to Walt Disney World.  I had planned very thoroughly to fit in all the rides and shows and parades and random street performers, and then my mom encountered a medical issue and plans flew out the window.  We still had fun, we just didn’t get to do nearly as many of the fun things we expected to do.

Two days before vacation I had finally managed to get my follow-up appointment with the psychiatrist, and she prescribed Valium.  I was very nervous about taking it, fearing that she’d think I was taking too much, even though in reality I kept it down to less than half of the amount I was allowed and haven’t touched it again since returning home.  I really just needed help getting through all the crowds and stress of vacation.

My other stress was that I originally was scheduled to be taking a class right up to early August and we planned vacation in the short gap between the end of that class and the beginning of fall semester.  It turned out I couldn’t take that class and had a couple of months off, but vacation was already scheduled and paid for.  So I spent a lot of time receiving e-mails from professors about syllabi and Blackboard sites, and panicking that I couldn’t be at home preparing for the new semester to start.

On our way home we spent the night with my grandmother’s cousin and her husband and they were kind enough to let me print my syllabi and start writing assignments in my planner.  I still have one class in which the syllabus is not available (the semester starts today!) and my planner is already crammed full and I don’t know where I’ll fit those assignments.  I’m feeling very overwhelmed by the fact that I decided to enroll full-time this semester.

As we were riding in the car and I was trying to look at e-mails and Blackboard on my tiny little phone screen, I got very frustrated.  There was a simple assignment that needed to be written in Microsoft Word and uploaded, and I could have done it in the car if I could just figure out how to actually edit a Word document on my phone.  I also remembered that even as a part-time student I have struggled a lot with access to the computer.  I’m at my best academically when I first get up in the morning, but that’s the same time that mom plops down in front of the computer and goofs around online for 2-3 hours straight.  When I have to watch hours of video lectures and write on discussion boards and write papers for 12 credit hours of classes, there is no way this is going to work without me wanting to strangle her.

So I did the one thing I could do on my phone: read a bunch of articles and selected a convertible laptop/tablet.  I had very quickly decided it would be some sort of Chromebook, and my criteria were that it needed both keyboard and touchscreen, needed to be as small and lightweight as possible, and needed to be capable of running Android apps.  I found the Asus C100PA-DB02 Chromebook Flip.  It opens as a laptop but can be bent all the way back to use in tablet mode, or left partially open in a couple of ways so that it will stand up.  With a 10.1″ screen and weighing 2 lbs., it definitely meets my easy portability requirement.  And this is one of the few Chromebooks that has access to Android apps built in without having to enter a special Developer mode.

Our mail was on hold during vacation and I’m supposed to go pick it up this morning.  The Chromebook just arrived at the post office a couple of hours ago so it should be in the delivery that comes out around noon, but I’m hoping I’ll be able to snag it from the mailman when I pick up everything else.  T-minus 65 minutes until the post office opens!

Unmanageable Binders

In therapy today, Sadie asked if I look through my DBT binder when I’m feeling distressed and can’t think of what skill to use. I said no, that the size of my binder had become overwhelming and I don’t even like to flip through it to find the week’s homework for group. I have both editions of Marsha Linehan’s handouts, plus handouts from Moonshine Consulting and all the mindfulness exercises from group. She suggested I remove the extra material that we don’t use in group, but I frequently reference those pages during group and it gives me positive feelings about having contributed.

Sadie’s alternate suggestion was to create a miniature version with only the material that would be helpful to me in a crisis. I printed and assembled it this evening and am working to write in my answers on the blank handouts. The size is much more manageable.

Aside from DBT skills, the new binder includes a copy of my safety plan and several copies each of the Pros & Cons and Thought Diary worksheets I use. I plan to add a few coloring pages and some kind of word games that I can easily pull out to use for distraction.

I thought this new binder was just to make things easier at home, but mom assumed I was planning to take it on our upcoming vacation. I am hoping it won’t be needed, but it’s probably a good idea to pack it just in case.

Sometimes the Hardest Thing and the Right Thing Are the Same

I was absolutely delighted when I was hired for my job working in housing for people with mild-to-moderate mental illness.  This was back in January.  The delight did not last.  I spent most of the past 5 months becoming increasingly miserable, despite every attempt my supervisor, Tilly, made to help me fit in the position.  I made pages of pros & cons.  I did thought diaries until my hand cramped.  I exchanged a ridiculous number of phone calls and texts with Tilly.  I even took 3 weeks of medical leave, spending part of that time in inpatient, certain that the problem was me.

Sadie kept telling me I was a square peg trying to fit in a round hole and “it’s not the peg’s fault it doesn’t fit”.  I just didn’t know what to do if I quit.  Two weeks ago I finally took the leap and submitted my resignation.  My last day was supposed to be Friday, but after working Monday and telling the clients I was leaving, I started wishing that could have been my last day.  Tilly agreed that Friday would be very hard on me, and said if I wanted Monday as my last day she could make it happen.  So on Wednesday I went for my exit interview and turned in my badge and keys.

When I was lamenting that what I’m good at and what the job description consists of don’t overlap, Sadie encouraged me to take the StrengthsFinder 2.0 test.  I ended up with my top 5 strengths as Empathy, Strategic, Developer, Input, Responsibility.  These do fit in the mental health field well, but in a more administrative position.  That’s exactly what I was starting to discover while working – that I understand people and can help them, but I’d do better at more organizational behind-the-scenes work.

Even so, it took 5 months for me to stop being convinced that not fitting in at the job didn’t make me a failure.  I was so sure that I could do well at it and that clearly it was my mental illness standing in the way.  That’s how I ended up in inpatient, with Dr. Flanders dumping my entire medication regimen and starting over.  I thought clearly the meds weren’t working right and trying something radical would help.  In fact, it made things worse as the medication didn’t get to a therapeutic level so I was getting more depressed instead of less so, and I also had an array of unpleasant side effects, including being constantly drowsy and unable to concentrate.  I keep wondering if things would have worked out had I not changed medications.

My follow-up with the psychiatrist is not until the 24th, over two months after my discharge from inpatient.  I went to my family nurse practitioner for help, as she’s the one who normally manages my medication anyway.  First she increased my dose of lithium, after acknowledging it was the cause of my side effects.  Then when I started feeling tempted to skip my meds I returned, asking to switch back to the medications I was on before inpatient.  She was unwilling to make drastic changes, and instead of a gradual shift toward what I’d been taking before, she tripled my dose of Abilify.

Close to two weeks ago I couldn’t tolerate the drowsiness anymore and stopped taking the lithium.  A couple of days later I ditched my other psych meds as well.  Upon learning this, Sadie encouraged me to call the mental health center’s head nurse for advice on what to do until my appointment with the psychiatrist.  I was pleasantly shocked when the nurse told me to stay off the meds and just monitor for symptoms carefully and call if there’s a problem (or ER if there’s an enormous problem).  She indicated that maybe I don’t need so much medication continuously and they might be able to come up with a PRN medication instead.

It’s wishful thinking to believe that would actually work out, but I keep on wishing.  My mood is good, my anxiety is fairly mild, and the only thing worrisome I’ve noticed is a little bit of irritability.  Nothing unmanageable.

The Three Goals

Every three months Sadie and I have to update my treatment plan.  The first page reviews progress made since the previous treatment plan was created, and addresses strengths, needs, abilities, and preferences (SNAP).  It lists the members of my treatment team and any “natural supports” – people in my life who are helpful to my recovery.  The rest of the plan consists of overall goals and any smaller objectives within those goals.  Each goal is tied to a problem identified on the Adult Needs and Strengths Assessment (ANSA) which is updated every 6 months.  Each objective within a goal contains criteria for identifying when it is completed, a target date, and any interventions that will be provided by the therapist or other staff.

My treatment plans have varied widely.  They used to be crammed full of objectives that we sometimes never worked on, but they were there in case I wanted to work on them.  The benefit to this is that Sadie’s paperwork for each appointment (a Service Activity Record or SAR) requires that she choose a goal or goals from my treatment plan that we addressed during that appointment.  I’ve experienced firsthand the struggle to choose something relevant to the actual work, so I like to ensure that she has several choices and/or sufficiently vague goals that can apply to anything we do.

My last treatment plan had only one goal, pertaining to interpersonal problems.  It was about setting healthy boundaries.  We kept that as an objective, and incorporated another objective, with the goal of “have more realistic interpretations of other people’s comments”.  One of my major struggles in relationships is that I get disproportionately upset by things people say (particularly with my mother), so I am aiming to tone down my reactions.  The completion criterion here is to complete at least one thought diary per week.  We made it a small goal because sometimes I struggle with the longer thought diaries, but there are also forms that do a quick mini version where you can log several different thoughts on the same form.  I plan to keep one of those handy and fill it in as often as possible.

The next goal, pertaining to depression, is to “work on accepting imperfection”.  The material from which the thought diary form comes also contains a series of modules on Perfectionism in Perspective, so Sadie and I plan to work through these modules together.  The final goal, pertaining to self-care, is to “explore Buddhism”.  I have committed to reading at least one book per month on the subject, although knowing me it will be a lot more.  I’m starting with Buddhism for Dummieswhich is probably not the most enlightening book option, but gives a thorough overview and suggestions for additional reading, which I can use to help me figure out where I want to look next.

I feel better about this treatment plan than the last one, as the things I’m trying to accomplish are more concretely measurable.  I like to be able to check things off a list, and these are all things I can check off if I work hard.

Self-Harm and Buddhism

At work there is a program called Illness Management and Recovery (IMR).  It was developed for the Substance Abuse and Mental Health Services Administration (SAMHSA) and consists of 10 modules on managing mental illness.  I am not trained to teach it, but have been working through the modules myself to learn more.  Most recently, the assignment was to explain a symptom to others.  I wasn’t sure which symptom to cover, until I spent 5 nights back in the inpatient unit last week.  I’ve struggled a lot with suicidal ideation and urges to self-harm over the past three months, and reached a point where it was beyond time to take a breather from life and go somewhere safe where I could focus strictly on taking care of me.

While there, I began reading The Buddha and the Borderline by Kiera Van Gelder.  It is a memoir of her experience of Borderline Personality Disorder and her path to recovery via Dialectical Behavior Therapy (DBT) and later delving into its roots in Buddhism.  Early in the book there were some fairly graphic descriptions of self-harm, which I only felt okay with reading because I was in a safe place.  It turns out, it wasn’t entirely safe.  They do the best they can with keeping dangerous objects out, but those of us who self-harm can get pretty creative.  At one point I found something dangerous that was built into the architecture.  I showed it to a nurse and she said she would report it to the director of the unit and that I should come tell a staff member if I was feeling tempted.  One night I did.  I’d been feeling anxious during visiting hours and when my mom left I called the same nurse over and told her I felt tempted toward the thing I had shown her previously.  I also handed over my statistics folder mom had just brought for me and asked her to please remove the staples from the packets of notes.

The nurse told me to stay put, but it didn’t totally register and after a different staff member handed back my folder without even speaking to me I started to get overwhelmed by the noise in the main commons and moved to a smaller area near my room.  The nurse came rushing in and happened to see some recent scratches on my arm from before my admission, which led her to exclaim, “Did you hurt yourself?  I told you to stay put!”  I explained that the scratches were older, and she told me that they would like me to sleep in the quiet room that night so they could keep an eye on me.  The quiet room?  That’s the nice term for seclusion room, which is the nice term for restraint room.  The only furniture was a bed in the center of the room, with restraints built in.  The lights were controlled from the outside, there were cameras monitoring the room, and there was no handle on the inside of the door.  Now on the bright side, they really just were putting me there for the cameras, and the door was not fully shut.  I was allowed to get up and leave to use the bathroom or go to the water fountain or ask for sleeping medication.  It was still rather intense.

It was also completely warranted.  The dangerous item I had found wouldn’t do serious damage, but it was in a place where no one would see and stop me, and I could have hidden the marks had I acted on my urge.  So why self-harm?  It can be many things.  It can be a punishment.  It can be a release of psychological pain in physical form.  Those are the main two things for me.  If I’m hurting intensely, it’s less painful to transfer that into something physical.  I’m also usually tempted toward it when I feel shame, which unfortunately I feel frequently and for sometimes inexplicable reasons.  The important part to note is that, while many people both self-harm and feel suicidal, the act of self-harm is not a suicide attempt.  Severe acts of self-harm could result in death, but it’s different if death is not the intent.  Self-harm is a coping skill, just not a very healthy one.  Some people come home from a hard day and have a glass of wine or eat a comforting meal or go exercise intensely for an hour, and all those things reduce the pain somewhat.  Self-harm does the same thing for some of us, and therapy (such as DBT) is about replacing that with a healthier way to reach the same end result.

I finished reading The Buddha and the Borderline last night, a couple of days after my release from inpatient, and toward the end the author asked one of her Buddhist teachers if suicide was the same as killing another person.  Likewise, is self-harm the same as attacking another person?  The conclusion was that it is impossible to fully practice loving-kindness toward others if you cannot love yourself.  I can’t say that I will never slip and act on those urges again, as that’s much too simplistic to think a line from a book is going to undo decades of experience, but the book did inspire me to look more into Buddhism.  I am not a spiritual person.  I am even less a religious person.  I have, however, found myself drawn toward Buddhism over and over throughout my adult life, and have benefited immensely from DBT and the elements of Buddhism Marsha Linehan incorporated into it.  So I am steering my upcoming focus on reading toward books on the topic, to discover if it is something I want to explore further.