Supposed to Be Better

The last time I made a Safety Plan I did it in an appointment with Sadie.  She had asked me to bring in some possible templates to use, and the one she preferred started with 3 lines for listing “Warning signs that a crisis may be developing”.  One of my warning signs is “start making suicidal comments to mom”.  The day before I overdosed last year, mom asked, “What am I going to feed you?” and I replied, “You could feed me all my pills.”

Last night we were in the car on the way home from a family event, and the topic of death came up.  I’ve been feeling a bit hopeless about the possibility of life ever improving enough to be worth living, and made some comments about not wanting to outlive mom.  She said, “You’re going to outlive me by 20, 30, 40 years.”  40 years, even if she died right now, would make me 75 years old.  I’ve never wanted to live past 50.

I didn’t tell her that I’m feeling down, but I got home in the evening and wrote in my journal about how there’s a month’s worth of Wellbutrin on the kitchen table that hasn’t been locked up yet, and I don’t understand why I’m not just swallowing the whole bottle.  I don’t feel depressed.  The two stressors in my life are my work and mom’s health, and both are in a state of wait and see.  I’m not curled up in bed or pacing the walking trail while I sob and ramble incoherently to myself.  I shouldn’t be thinking about death, but I am.

I can’t imagine a future in which I’m worth anything.  I can’t imagine having strong friendships, a romantic relationship.  I can’t imagine accomplishing anything of value.  I can’t imagine feeling joy to counteract the accumulated misery of the past.

It’s almost two full weeks until I see Sadie again.  She asked me a few days ago if the two-week gap between appointments was okay.  She mentioned having a few openings this coming week.  I told her I could wait until the one we already had scheduled.  Here’s the problem: I don’t feel like I can ask for help anymore.  Waiting two weeks makes me feel like I shouldn’t need help at all.  If I can do two weeks, why not three or four?  Why not discontinue therapy altogether?  I certainly can’t contact her in-between appointments and ask if she has an opening.  I’m supposed to be better.

We took the goal of reducing risk of self-harm and suicide out of my treatment plan, because it wasn’t a concern anymore, but that’s a lie.  It’s always going to be a concern.  It doesn’t matter how well things go in my life, I am always going to consider suicide an option.

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Spilling Secrets

In the first half of last year, I was repeatedly asked to sign Contract for Safety forms. I think I did a total of 6 of them before my constant laughing at the process made everyone quit asking me to sign. Come to think of it, that’s around the time they started shipping me off to inpatient at the slightest provocation. Oh well, I couldn’t sign the forms and mean it, because I had too much anxiety about calling for help. Those first 6 were technically a lie.

Yesterday my therapist, Sadie, asked me to sign one again. She told me I could laugh at her if I wanted. I actually didn’t. I fully understood why she was asking me. Last week I went into her office terrified I’d be sent to inpatient, if not by her then by my psych APRN, Brent, when I saw him the next Monday. I’d had a day of obsessing about overdosing, and swore to myself I’d call for help if I reached the point of researching what pills to overdose on. Sadie said, “You don’t need inpatient.” Sweetest words since Brent said, “You’re not psychotic.”

I made it to the appointment with Brent without any further serious urges. I thought about suicide every day, but it was background noise. I knew my medication needed adjusted because I’d been complaining about taking my medication, which is always a sure sign that it’s not right. Brent hesitantly agreed to increase my Wellbutrin XL to 450 mg. I brought the new pills home and stared at the bottles, thinking about how lethal they could be.

Mom has hidden all my medication from me, but the concern last week was that I started considering her medication, which wasn’t hidden. When I went into therapy yesterday, I had to admit that I had started researching the effects of overdosing on various pills. I also had planned to sneak some of my own pills out of the bag when mom gives them to me on Sunday to refill my weekly pill container.

Sadie and I filled out a safety plan together. With my consent, she called my mom to ask her to lock up all medication in the house and to monitor me while I refill my weekly pill container. It was easier to let her do this than to deal with having to talk to mom myself. I knew I would back out if I promised to do it. However, once I got home and had to face mom and be reminded that the release form (which was actually already on file due to inpatient forcing me to sign it in the past) allows Sadie to share everything from my records, I panicked.

I thought about suicide even more. I thought about skipping my medication until I saved up enough to overdose. I thought about drowning. I thought about hanging. I thought about setting myself on fire. Mostly I thought about how I could never speak to Sadie again, because even the information currently on file is way more than I want mom to ever know. What sick irony to be having a crisis that makes you unable to talk to the person you always talk to in a crisis.

I managed to calm my panic enough to e-mail Sadie and tell her we need to discuss the scope of that release form. Perhaps I could revoke it. Then I laid in bed begging my brain to stop obsessing so I could fall asleep. Eventually I did, and as a friend suggested, things do look a little better after some sleep. I’m still terrified I’ll end up in inpatient again though. I’m not terrified of being there – it’s actually quite pleasant – but it would destroy my work on the play, which is the only part of my life that isn’t sucking at the moment.

Sadie replied, telling me I could revoke the existing release and create a new, more limited one. I asked if I could just revoke it entirely and didn’t get a response. However, mom says that she has no intention of asking Sadie questions about me; that she doesn’t see how it would be helpful to do that. I still may choose to revoke the release, but I feel much less worried that all my secrets will be spilled.