Diffusing Stress with a Laugh

Every week in the middle of DBT group we take a break and then come back and do a Mindfulness exercise.  Today Sierra handed out sheets of paper and told us we were going to do the one where we make smaller words out of a big phrase.  I clapped excitedly.  She warned the group that this was my favorite and not to be upset when I get way more words than they do.  She gave us the phrase and said it should be easy to find words.  I said, “But there are no As or Os!”

The phrase was INTERPERSONAL EFFECTIVENESS.  Notice both an A and an O in there?  Notice how there isn’t a U?  After we all got done laughing at me, I wrote down the phrase at the top of my paper.  I started making words.  I was nearly down the first column when Rochelle said, “Have we started yet?”  Oops.  I got a little eager.  I said I’d sit out the first minute but Sierra told me to keep going.

As usual, everyone freaked out when they saw my page.  I counted it up and had 76 words, which is my new record.  Other people counted theirs and said they got distracted by the sound of my frantic pencil scratches.  I did have to volunteer to scratch out all the dirty words I used, in case they didn’t count.  (Come on, don’t tell me you didn’t immediately see “PENIS” in there.)

The best news about this is that I laughed when I said something completely idiotic.  Absolutely no flush of shame and no urge to go hurt myself for looking foolish.  The same has been happening for about a week in other situations.  I went from one scheduled shift to three in one week, then a coworker called in sick the last day and I worked 8 hours alone.  I took it in stride.

I got letters from my car insurance about paying (or not paying) for medical bills that had nothing to do with my car accident anyway – an ultrasound I had for complications of surgery.  Blood tests to follow up on the ultrasound.  An ER visit to get admitted to inpatient.  I laughed at the ridiculousness of the situation and calmly went to the hospital billing department to sort it out, only to find that the car insurance had actually requested all my bills that had already been paid by my health insurance.

Then yesterday I stayed calm when my dentist was being snarky to me, and again when I was driving down a country road and the cop behind me suddenly turned on his lights.  I’d never been pulled over before but apparently did what I was supposed to do.  He told me my brake lights weren’t working and when he found out where I was headed (not far) he told me to drive carefully and get it fixed right away, then walked back to his car.  I didn’t panic at all, and drove just far enough to be parked in a lot where mom could come meet me with replacement bulbs.

As it turned out, only the left one worked, so we drove back to the auto parts store and followed the manager’s advice.  It still didn’t work so he tested the bulb, found that it was defective, and gave us a new one.  I feel super loyal to this store, as he also helped out when I needed to replace a headlight bulb and couldn’t wriggle my hands into the tight space.

I made a comment to Sadie about how well I’ve been handling things lately.  She asked what changed, and was probably perturbed when I said, “Medication.”  Well, I’ve been using the coping skills she has taught me for a long time, but they are only so helpful when the medication isn’t quite right.

Advertisements

A Series of Unfortunate Events

Last night was the third meeting of my NAMI Peer-to-Peer class.  Last night was the first time I missed the class.  I spent the day nervously looking out the window to see if snow would start up again (it had snowed heavily in the morning but instantly melted) and decided that if the weather was clear at 4:30 I’d try driving to the class.  Normally I would leave at 5, but I was allowing extra time in case there were snowy patches along the way.

At 4:30 I stared out the window and was disappointed that it looked like a blizzard.  I gave serious consideration to trying to go to class anyway, despite knowing how unsafe it was.  I felt awful about having to miss, as though I had in some way failed to follow through on a commitment even though I know no one else in the class would have driven 45 minutes to be there even in good weather.  I texted the facilitator, and he said he really appreciated that I travel so far to participate and that he’d have this week’s material for me next week.

Since I was going to be home for supper, I asked mom if we could make a pizza.  We had the crust made and I was almost done spreading the sauce on when I remembered that we didn’t have any of the Italian blend cheese.  On any other day I would have run to the store to buy some, but since it was snowing we threw on Mexican blend and hoped for the best.  The crust wasn’t done, even after putting it back in for extra time, and the cheese was disgusting.  I ate one bite of pizza and had nothing else to eat the rest of the evening.

I went to bed with a sore throat, which is always my first symptom of a cold.  I managed to sleep through the part where I shiver with fever, but woke up with my head feeling all cloudy and my nose stuffed up.

This morning I went to DBT group, planning to have lunch with a friend afterward and then go straight to therapy.  I got a text when I arrived at DBT group, cancelling my lunch.  Then the one person I despise from group decided to rejoin today.  Then Nadia announced that she is leaving at the end of the month to pursue a new career.

I’ve been trying desperately to use Radical Acceptance on this chain of events, but I’ve also been really irritable the past few days and can’t seem to stop fighting reality.  In my last appointment with Brent I mentioned irritability and he said it was normal if it was only one day a week, which it was at the time.  Now it’s been 3 or 4 days in a row and it is driving me up the wall.

The only break in the string of things going poorly has been today’s therapy appointment.  I felt like Sadie and I accomplished a lot, including making plans for Coping Ahead with the upcoming anniversaries of my grandparents’ deaths (the 13th and 21st).

Ungraduation

Two months ago I was planning for my Upcoming DBT Graduation.  I needed to make it to the end of the year without any negative actions, although I actually left group a little earlier due to being scheduled to work on the last Tuesday of December.  I did make it, although as soon as I considered myself “graduated” I slipped up a little.  I skipped my meds for two days until forced to take them in inpatient, and while I was in inpatient I got really upset one day and bit myself.  Although the social worker, upon seeing the bite marks, asked “Have you self-harmed while you’ve been here?”  So maybe biting doesn’t count?

At any rate, I did graduate and I was super happy to be done with DBT.  Why, then, did I attend the group this morning?  Well, I had lamented the fact that there weren’t inpatient-style groups that I could attend as an outpatient, and asked Sadie to try to find me some groups to attend.  It dawned on me that it was kind of silly to be looking for other groups while skipping out on the one that was definitely available to me.  So, after a little over a month off, I returned to group.

In the past two days, I’ve attended two groups: the NAMI Peer-to-Peer class last night, and DBT this morning.  As it happens, I’d been doing an activity for therapy that involved noting how I felt during each thing I did, and I had noted “exasperated” for one of the groups.  Sadie said, “You have trouble with groups, don’t you?”  I do.  I mean, I love having activities to fill my time, but I get very frustrated with other group members when they keep talking interminably about things that are completely not appropriate to the group.  Sadie and I agreed that I could make the best of this situation by learning to be more patient and attentive even when the conversation goes off-topic.

So what has taken place in these groups?  In Peer-to-Peer we created a list of ground rules for the group, and a list of difficulties that mental illness has caused for us.  Then we rated how traumatic (on a scale of 0-10) our mental illness has been.  I was surprised by some of the answers.  Many people said 10, and that seemed a bit extreme to me…have their lives really been utterly ruined by mental illness?  I think the fact that they are capable of attending and participating in such a class says otherwise.  Another person said 3, which seemed a little on the low side.  My own answer?  7.  Yes, my life has been really screwed up compared to what it could have been, but I also feel like I got lucky in that my problems started in childhood.  It would be much more devastating to get used to a “normal” life and have it ripped away.

We went over three stages: recuperation, rebuilding, and recovery.  Recuperation was about having other people meet your basic needs during and immediately after a crisis.  The kind of thing that happens in inpatient, where you don’t have to cook or remember to take your meds or even make decisions about when you will sleep.  Rebuilding was about getting those basic needs met for yourself, and recovery was about finding your purpose and making a difference in other people’s lives.  I felt like I was between rebuilding and recovery.  I still struggle with some of the basic needs, but I’m also working to help others.  I mentioned my book-in-progress and about half the class applauded.

There were two exercises we participated in.  First we were broken up into pairs and told to find things we had in common that had nothing to do with mental illness.  I was paired with a man who was a bit older than me, and it was a struggle to find commonalities, but we did come up with three: we are both cat-lovers, we both express ourselves through writing, and we both love to try foreign foods.  We also discussed some things that were different for us.  He is fluent in French, Mandarin, and Indonesian.  My only foreign language is Spanish and it’s a bit rusty, although I have used the “test out” feature on Duolingo to get up to 30% fluency so far.

Our final exercise was the weekly mindfulness exercise, something I have to do in both groups.  For this exercise we were each given a raisin and told to spend 60 seconds looking at it, then share what we observed.  I noticed the little spot on the end where the stem was when it used to be a grape.  Then we placed the raisins in our mouths for 60 seconds.  This time I observed that I didn’t like the texture of the wrinkles rubbing against my tongue.

The mindfulness exercise in DBT group today was imagery.  We spent five minutes visiting the place of our choice in our minds, observing the five senses.  I took myself back to an amusement park I visited last year.  It was fine for about four minutes, but that last minute was an eternity and I could not stay focused any longer.

Also in DBT group I learned some exciting news.  I had been frustrated with the repetitive nature of the group last year, going over and over Marsha Linehan’s original material from 1993.  Starting this week, they are updating to the 2015 edition of her book, which has more skills and many more worksheets.  I’m looking forward to this new material, although I suspect that the numerous worksheets will make it take longer to get through it all.

When Sadie and I reviewed my treatment plan this afternoon in preparation for updating it in two weeks, she commented on me accomplishing the “graduate from DBT group” goal.  I said I didn’t, as I’ve now “ungraduated”, but she insisted that having done it still counts even though I chose to go back.

Not What You Need

While I was in inpatient I met a different psychiatrist, Dr. Flanders.  I really hit it off with him and several of his comments keep echoing through my head.  One of them was about Brent.  He asked who prescribes my medication and I told him.  He said, “He’s very attractive, isn’t he?”  I agreed.  “But that’s not what you need.”

If I felt confident about working with Brent I would have brushed this off, but unfortunately I don’t.  I go into my appointments afraid to be assertive because I like Brent too much and want him to like me too.  This would be okay if we were always on the same page, but we’re not.  For example, the Lamictal.  I had done a lot of reading about medications before I suggested it as a possibility, and he said we’d discuss it later if I needed a change.  Well, in the course of a year there were several times that I was not doing as well as I could be, and his idea of changes was to adjust dosages of my existing meds back and forth.  He never once came back to the idea of Lamictal.

When I finally did point-blank ask if we could try it now, he was willing, but he only wanted to make one change at a time (understandably) and I felt increasing my anxiety medication was more critical at that point.  I’m not sorry I made that choice, but I’m sorry that the next month, when it was time to come back to the Lamictal issue again, he didn’t bring it up and I let that slide.

As I mentioned in The Joy of Lamictal I’m doing much better since starting it.  I can’t say that I haven’t had some intense emotional reactions to things, but they are much rarer and I’ve recovered from them faster than I would have in the past.  Overall, I feel at peace.  I fear that when I see Brent in a week he is going to suggest changes that I don’t want (taking the Lamictal away again, or taking away the Latuda now that I’m on Lamictal) and that I won’t be strong enough to tell him no.  Or that I’ll tell him no and he’ll just send whatever prescriptions he wants in to the pharmacy and there will be nothing I can do about it.

While I was on my trip last week, I had a lot of travel time in which to think and I decided that I want to see someone other than Ben.  I wanted that someone to be Dr. Flanders, but I’ve since learned that he’s not in-network for my insurance.  Today Sadie and I talked about my choices.  She said there are two psychiatrists at the facility where I see her.  One of them she said would not be a good fit for me, based on knowing both of us.  The other one she thought I would like, but he’s only there one evening per week and it would be difficult to schedule an appointment.

I told her I’m happy to go to the other facility, which is no further from home.  She said there are some people there who she’s not sure see outpatients and there’s someone who only sees children and adolescents.  She mentioned Jean, but said that Jean typically only sees people as outpatients for a brief time after they are released from inpatient, before they transition to someone else for long-term care.  She does have some long-term patients, but she was seeing them before she started working in the inpatient unit.

In other words, there aren’t many options and they kind of suck.  Sadie did say she would send Jean a message and ask if she is willing to see me.  I’m not sure she will be, given our quasi-friendship outside of this professional setting (we are involved in a theatre company together).  I’d be more comfortable with Jean than with a stranger though, so I’ll let Sadie try to get me what I want.

Sadie was also supposed to be looking into groups I could attend.  She contacted Jan, who is in charge of inpatient, and was told to contact people in charge of the community support services (where I attended DBT group) and the dual-diagnosis facility.  However, Sadie’s idea that I might go to the art therapy group with the dual-diagnosis residents didn’t go anywhere – Jan told her I would not enjoy the group, and Jan knows me well enough that I trust her judgment on that.

What this all boils down to is that my plans for ongoing treatment are kind of up in the air.  The only thing I know for sure is that I have weekly appointments with Sadie scheduled through the end of February and the week between appointments feels like eternity.

Group Activities

 

Life in inpatient is centered around food and groups.  I’ve talked at length about the food before, but only mentioned groups in passing.  The first group each day takes place at 9:15 and is called Goals Group.  You are supposed to think about the circumstances that led you to be in inpatient, and set a goal for something you can do that day to help yourself.  My goals usually centered on reading or doing exercises in therapy workbooks.

The second group, at 10:30, and the third group, at 1:00, are both activities.  Sometimes we fill out paperwork, such as the lengthy set of questions to reflect on 2015 and make plans for 2016.  Sometimes we answer questions from Life Stories (a board game about sharing random experiences) or Homeward Bound (cards about reflecting on your experience in inpatient and what you need to do to move forward).  Sometimes we do art activities, like the coping skills tree or the collage below.

2016-collage

The theme of this collage was things to do to improve our lives in 2016.  We had plenty of magazines to hunt through, and the activity therapist, Nikki, also had pictures and phrases she had cut out during some downtime.  She kept handing them to me and saying, “Here, this one’s for you.”  She apologized to another client, Bryan, for not knowing him well enough to give him any and I said, “It’s really depressing that you know me well enough.”

So, somewhat top-left to bottom-right, we have “Center Stage” for continuing my involvement in theatre projects, “Let yourself believe.” for believing in myself (like a coworker encouraged me to do with the Believe coffee mug she gave me), “Literature” for all the books I plan to read this year.  A birthday cake for doing something special to celebrate my birthday, maybe by traveling like the travel guides suggest.  Office supplies for trying to get more organized, abstract art for getting back into my creative hobbies, a cat for spending time with my four cats.  Sunshine for time spent outdoors, Prilosec for taking care of my physical health, a snack bee for cooking and doing cute projects from Pinterest, a little kid for spending more time with my cousins’ children.

We also had a 3:00 group with the social worker that was designed to be a therapy group, in which she liked to load us down with paperwork.  After I was the only one to complete it, she opted for an activity in which we were each given two emotions and asked to describe a time when we felt that emotion and how we coped with it.  The first one I was given was “depression”, and I commented that there were too many times to choose from.  “Scared” was easier, with me telling about my latest car accident and everyone chiming in about their own car accident stories.

The final group, at 8:45, was my least favorite.  It was usually some sort of worksheet led by a program assistant, and at that point we’d just gotten through 2 hours of visitors and I was ready to go pass out.  They wouldn’t hand out nighttime meds until after that group, however, so there was no point skipping it in favor of bed only to be awakened an hour later.

When I got out of inpatient, I missed the groups.  At least the three in the middle.  I lamented to Sadie that I wished I could go in during the day just for groups and not have to spend the night.  The options for groups in this area are not so helpful.  There’s the DBT group that I just graduated from, and despite Jan’s suggestion that I go back I will not be doing that.  There’s AA and NA and eating disorder and grief support groups, none of which are relevant to me.

Sadie suggested that there are groups for the residents of the dual-diagnosis facility, and they may allow me to come  in for those.  She also said that CMHC used to offer groups and had trouble getting people to attend regularly, but they might start new groups in the future.  She said she’d look into some possibilities for me.  I would be relieved to have a bit more structure and a bit more social time, since right now all I get is my one day per week at work.

Upcoming DBT Graduation

The Emotional Regulation module in Dialectical Behavior Therapy contains two skills designed to separate actions from emotions.  The first, Opposite to Emotion, is about doing things you don’t feel like doing.  Feeling fear?  Approach the situation that scares you.  Feeling guilt?  Repair the transgression.  Feeling shame?  Do what makes you feel ashamed.  Feeling sad?  Do something that makes you feel competent.  Feeling angry?  Do something kind.

99% of the time I use this skill when I’m feeling anxious about a situation, or wanting to back out of plans I’ve made.  I take a deep breath, tell myself “Opposite to Emotion”, and go participate in the activity anyway.  It works.  Usually things go better than I feared, the anxiety fades once I get involved, and I don’t have the regret of missing out on life to compound any depression I may be feeling.

The other skill, Feeling Not Acting, is about not doing things you feel like doing.  Not acting on harmful urges: to overspend, to gamble, to drink, to take drugs, to self-harm, to binge/purge.  You take a moment to identify the impulses you’re feeling, then choose to act in a healthier way.  This may be by using the Ride the Wave skill to just feel the emotion and then let it go.  This may be by using another skill to self-soothe or to distract.  The third suggestion is to “act on the impulse in less problematic ways” but I fail to see how accepting an action that is “less bad” is helpful in the long run.

I usually take the Ride the Wave approach.  Most of the time I mark those two skills down together on my diary card.  I rarely think to mark Feeling Not Acting when my way of avoiding the action has been by using another skill.  Riding the Wave is uncomfortable.  It’s hard to sit and just feel an emotion, an impulse without acting on it in any way.

I’m doing it, though, because I have a goal in sight.  A while back I notified Sierra and Nadia that I would be quitting DBT group, but then when something enlightening happened during a Mindfulness exercise I reconsidered.  When discussing my ambivalence with Sierra, she brought up the notion of graduating from group.  Not just randomly leaving, but completing the program.  It’s supposed to be roughly 1 year, with the series of modules being completed twice during that time, and I’ve reached the point that I’ve been through them twice, with the exception of missing a little of Emotional Regulation both times due to work.

Sierra’s suggestion was that I set a goal to show that I have learned and applied the skills.  My goal is to go two months without any harmful actions on my diary card.  Since starting diary cards in September 2014, my record is 5 weeks and 2 days.  At this point, I’ve almost reached 4 weeks, and the two month mark falls on January 2nd.  This is before the first January meeting of DBT group, so assuming I don’t slip up before then, I will not have to attend group at all in 2016.

Sadie and I have completed all the DBT skills from the material she uses, with the exception of her needing to look at my last two worksheets.  We are moving on to other approaches, and I’ve asked her if I still have to do diary cards after I graduate from group.  She said I don’t if I really don’t want to, and I think I don’t want to.  Rating my negative urges causes me to think about those possible actions even when I haven’t thought about them all day, and I find that sometimes I start feeling urges that I otherwise wouldn’t.  I just want to close the DBT chapter of my life and move on.

Of course I will still use the skills I’ve learned.  I just won’t sit there at the end of each day struggling to remember which ones I’ve used and trying to reinterpret all my experiences of the day in terms of DBT skills.  I will be able to color without thinking “oh, I’ll mark down Self-Soothe tonight” or give myself a pep talk during the work day without thinking “hey, this is the Encouragement part of IMPROVE”.  I’ll use the skills for their own benefit, and not because it gives me something to write down on my diary card.

A Blog Worth Blogging

Several times in the past the topic of finding my purpose in life has come up in therapy.  Sadie once said that a person’s purpose is usually related to her skills, so mine would probably involve writing.  I’ve never really nailed down my purpose, but today in DBT group the topic came up again in a way.  Among the giant binder of handouts is a sheet titled “Building a Life Worth Living”.  I first filled this out in January when I joined the group, did a similar exercise on notebook paper in May, and was given the same handout again today.  One thing that has stayed constant in the image of my life worth living is my blog.  Since the very beginning I’ve considered it one of the aspects of my life that helps support this life worth living.

What is the purpose of my blog though?  It’s not enough to just dump my thoughts on the screen – I’ve done that for well over a decade across journaling sites and social media and the blog is something different and special.  I read a post today titled “Self Centered and Angry” which addressed the trend of younger bloggers focusing mostly on their personal experience and not on the bigger issues.  I felt a twinge of something – a thing I can’t quite identify.  I wasn’t exactly offended, because I knew the author wasn’t intending to say these personal experiences are less valuable posts, but I felt compelled to say something which is rare for a conflict-avoidant person like myself.

It was in the course of writing a comment on her post that I realized what the purpose of my blog – and by extension my book-in-progress – must be.  It’s a purpose that I’ve been aware of in the past, but I never realized how important it was to me.  I blog about my personal experiences of mental health treatment for two reasons.  First, to let people in my life get a glimpse of experiences they have never had.  More importantly, to validate the feelings of people like myself, who have sometimes felt their diagnosis was wrong or their experience somehow less than simply due to not being sensational like the many memoirs that have been published in the past.  As one blogger put it to me, my life is interesting to other “boring mentally ill people”.

The other point made in the post I referenced was the extreme anger that some bloggers seem to feel.  I still struggle with my diagnosis, but I’m long past any flicker of anger I may have once had.  Instead, I struggle with the question of whether my diagnosis is even valid.  I fall into the trap of thinking those sensational memoirs detail “real” bipolar disorder, and that in some way I manage to even fail at mental illness.

My diagnosis was based heavily on my own account of my past experiences – the person who prescribes my medication now has never seen me even the slightest bit hypomanic.  I question whether I somehow over-exaggerated my descriptions.  What if all those bouts of hypomania really were a normal level of energy?  Intellectually, I know that spending two weeks working non-stop on learning a new programming language in order to enter a website style design contest is not normal.  Emotionally, I still look at the memoirs I’ve read and say, “But I’ve never racked up thousands in credit card debt or spontaneously traveled overseas or had sex with random strangers.  I must not really have bipolar disorder.”

This is completely invalidating and does absolutely nothing to help me manage the illness and move on with my life.  No one should have to feel this way, and if my blog in some way helps other people see their diagnosis as valid then it’s doing what it’s intended to do.