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2015-02-25 10:02 am

One Year of Treatment

On this day one year ago, I was Celebrating February 14th.  It's been a long, hard year since then.  While I was released from that visit with a mere Contract for Safety, I was back at the ER a month later, being admitted to the inpatient unit because I was dangerously suicidal.  I had another three inpatient stays throughout the year, including one that followed an overdose of Benadryl.

I've signed at least half a dozen Contracts for Safety and laughed at the idea of many more.  I'm no longer asked to sign them.  I've had a total of 63 therapy sessions across 3 therapists.

I've gone every month or two to the psych APRN to have medications adjusted.  Each time that he has set the appointments 2 months apart, something has happened halfway between them.  The first time, I ended up in inpatient.  The second time, I had to call him with a problem, and still ended up in inpatient.  The third time, he gave me permission to call for a sooner appointment and I did.

Currently I take Wellbutrin, Latuda, and BuSpar, with a few leftover trazodone on hand in case I can't sleep.  During the past year I've also taken Seroquel (made me suicidal) and Abilify (didn't seem to help as much as the Latuda).

A month ago, I started attending DBT group therapy each week.  Next week I have an interview with Vocational Rehabilitation to see if they'll pay to have the supported employment services help me with job hunting, as anxiety led to me quitting my full-time job in December.

As I said, a long, hard year, but things are starting to look up.  Not only do I not want to kill myself, but I'm no longer passively suicidal and am even starting to find some enjoyment in activities again.  I still feel pretty hopeless about my life as a whole, but at least I have some ability to take steps toward a better future.

One such step, which I've been planning for some time, is the writing of a book about this first year of treatment.  I have some ideas of information I'd want to include, but am opening this question up to readers: what would you be interested in reading more about if I were to write such a book?


Originally posted at https://stuffthatneedssaying.wordpress.com/2015/02/14/one-year-of-treatment/. Please comment there.
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2015-02-07 10:46 am

Positive, Unconditional Regard

A few days ago my therapist warned me that next week we will have to update my treatment plan and ANSA yet again. I groaned. In my post ANSAs to My Questions, I discussed the first update that was done, and commented "All those needs exploded everywhere", as compared to the original.  My therapist indicated there might be some improvement this time, but I honestly can't see where there would be.  I suppose there's a slight chance that my depression could be considered less severe, given that at the time of the last update I had two back-to-back inpatient stays.  Other than that, I almost expect there to be new needs added, regarding topics that had not previously come up in our sessions.

The treatment plan should be easy to update, and look essentially the same as the last one.  I recalled that the goals from last time were rather long-term, and we set deadlines 6 months away, despite the treatment plan needing to be updated every 3 months.  I suggested that we would just be copy/pasting the information from last time, including the deadlines.

When I got home, I pulled out my records to read through these documents once again.  I was reminded of something on my treatment plan that has nagged at me these past three months.  One of the listed therapeutic interventions was "Therapist will provide positive, unconditional regard for Donna*."  *Not my real name.

This made me laugh when I first read it, but as time has passed, it has become increasingly less funny.  I get frustrated talking to someone who I know is obligated to be nice to me whether I deserve it or not.  I don't trust that she actually means any of the positive things she says, because I know she's not free to tell me that she thinks I'm being an idiot.  In fact, I pretty much assume that it's all lies, which makes me wonder why I try so hard to be completely honest with her.  In all the times that I've confessed to skipping pills I should take, taking pills I shouldn't take, or otherwise being self-destructive, the closest she has come to expressing disapproval is to say "I support the idea of you taking your medication this week."

With my previous therapist, it was clear when she thought I'd said something ridiculous.  She could say, "Really, Donna?  Really?!" in this tone that instantly smacked sense into me.  Now I'm seeing someone with whom my weekly struggle is to figure out what the hell she thinks of me.  We have issues come up where I have no idea what her opinion is, and I can't figure out my own opinion because there's nothing there to agree or disagree with.

I can't decide how much of my annoyance here is from not knowing which statements to trust, and how much is from feeling that there's no possible way any of it could be genuine, because I don't believe anyone who really knew me would have anything positive to say.  I want to say that I'd feel better if she wasn't always positive, so that the times when she is would hold meaning.  However, it's equally possible that I just want her to criticize me because it's more comfortable to deal with.


Originally posted at https://stuffthatneedssaying.wordpress.com/2015/02/07/positive-unconditional-regard/. Please comment there.
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2015-01-31 12:36 pm
Entry tags:

Can't Sleep, Clowns Will Eat Me

I commented to another blogger recently that my therapist and psych APRN have no idea of the extent of things that make me anxious.  They know I'm not good with crowds or social interactions, but that's about it.  So I decided to make a list.  I started it the day before a therapy appointment and thought it was pretty well complete.  Then I awoke suddenly in the middle of the night and a dozen more anxieties popped into my head.  I kept getting out of bed to add them to the list, and then my fear of making mistakes took over and I laid awake for hours obsessing over things I've done wrong.

My therapist got the completely random and illogical original version of this list, but I've tried to reorganize it so that related fears are together.

spider

* crowds
* having people behind me
* hospitals
* going to appointments, especially sitting in the waiting room
* standing in line
* mirror mazes
* haunted houses
* elevators
* tunnels
* asking for help
* making special requests
* talking on the phone, especially when someone can overhear
* risking rejection
* conflict
* talking in a group
* committing to anything
* being hit on
* auditions
* eating in public
* hearing languages I don't recognize
* risking failure
* change
* trying new things
* job hunting
* thoughts of mom dying
* dogs
* pictures of insects
* heights
* ladders
* walking on snow and ice
* uneven terrain
* fire
* lightning, especially when in a car
* crossing the street
* motor noises, such as vacuums, blenders, etc.
* driving, especially in bad weather, on unfamiliar roads, or with passengers
* roller coasters and most other amusement park/carnival rides
* men
* going inside banks
* the woods
* being followed on the road
* cell phone battery dying
* security guards
* police officers
* managing money
* shopping

When I shared this with my therapist, she commented that some of these are completely reasonable fears.  I agree, to an extent.  What made me sad about making the list was recognizing just how much of my life I've missed out on by trying to avoid these things.  I currently take BuSpar (10 mg 3x per day) and it has helped reduce the completely paralyzing anxiety that was afflicting me, but I still avoid the things on this list as much as possible.


Originally posted at https://stuffthatneedssaying.wordpress.com/2015/01/31/cant-sleep-clowns-will-eat-me/. Please comment there.
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2015-01-28 12:34 pm

DBTwo

When last we met in My First, My Last, My DBT, I expressed a great deal of anger and frustration about my first meeting of DBT group.  Following that post, I e-mailed a link to my therapist and told her she'd have 50 minutes to convince me to go back.  She replied that she had no interest in convincing me to do something I hate.  By the time I got into her office two days later, I had already decided I would go back and try it again.  I suspect she was secretly pleased.

Why the change of heart?  After talking with several friends, it became clear that I had spent several days experiencing hints of manic symptoms.  First, there was the extreme anger and irritability.  Also, I was feeling superior to everyone around me.  Most alarming was that I was losing my insight.  It sounds contradictory, as I obviously need insight in order to recognize that I don't have it.  However, I was writing some things in my journal that I wholeheartedly believed, despite the fact that I recognized how completely irrational they were.  I was convinced that therapy and medication were ruining my life.  I was convinced that had I not sought treatment last February, everything would have worked itself out and I'd be fine now.  The reality is that had I not sought treatment, I would be dead by now.

So when I got into therapy Thursday, there wouldn't have been any convincing to be done, even if my therapist had wanted to.  I knew I had to go back and give the group another chance.  What we did discuss made me feel better about the diary card I'd been given, in that I felt I could mention that it wasn't working for me.  We also went over the myths about Interpersonal Effectiveness again and I acknowledged I do need to work on challenging some of those.  Most importantly, we discussed my diagnosis.  My therapist said it's possible she's wrong, and also that diagnoses are fluid and can change as she gets to know more about me.  I admitted that it's more likely I'm just having trouble accepting the diagnosis.

I returned to group on Monday and it was a totally different experience.  Both therapists were present this time.  We had the same number of members present, but two of the ones I'd met were absent this time and two new ones were there instead.  As it happened, the two who were absent were the two who I thought overshared the previous week.  The conversations felt much more balanced this time.

When we reviewed diary cards, they weren't expecting me to have anything to share, but I surprised them with a summary of two pairs of skills I used that week.  In the first half of the week, when I was experiencing all that anger, I used a lot of Self-Soothe and Crisis Survival Network.  In the second half of the week, on a weekend trip, I used Mindful Eating and Participate.  There were other skills I listed, but nothing that stood out as significant.

I solved my problem with the diary card by coming home and creating my own.  My therapist had mentioned that when she led group they added the new skills onto the diary card as they were taught.  So I modified the one I received for group so that it contained just the 20 skills I've learned so far.

As a nifty coincidence, we did Mindful Eating with some chocolate cake.  That was the skill my therapist had just given me last week, which I was testing out on my mini-vacation.  I found it a challenge to do in group, because I was distracted by anxiety about eating in front of other people.  No need to be anxious - they were all way too absorbed in their own cake to even be aware of my presence.

We still didn't reach any actual skills yet, just covered some information about intensity of asking or refusing.  I left with a homework assignment to fill in about a recent situation in which I wanted something from someone.  As it turns out, I had a situation on my trip in which I wanted something, but wouldn't ask for it due to one of those myths - the one that says, "It doesn't make any difference; I don't care really."  As a matter of fact, I do care about a lot more things than I let on, but I have a terrible habit of sublimating my own desires in order to please others.

I feel 100 times better about group after this second meeting.  I still don't think it's going to be all that helpful to me, but I at least feel capable of tolerating it in order to give it a chance to help.


Originally posted at https://stuffthatneedssaying.wordpress.com/2015/01/28/dbtwo/. Please comment there.
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2015-01-19 12:33 pm

My First, My Last, My DBT

Apologies in advance that this is a very negative post.  I know I should be giving things a fair chance, but sometimes a situation just sucks so much that it's hard to set aside the frustration and try it again.  This morning I went to my first DBT group meeting.  I also may have gone to my last.

Going into the meeting, I was anxious.  It started hitting me about 45 minutes before the meeting time, when I was trying to figure out exactly what time to leave to be not-early and not-late.  I was anxious about figuring out how to pay - who to pay, what payment types would be accepted, and even whether or not I should pay, given that it will just be tacked onto my ever-growing bill if I don't.  I was anxious about being in a group in general, and especially about joining a group of people who had all been attending for years and already knew each other.  I was anxious about which section of skills they might be working on, and how well that would line up with what I'd already done in individual therapy.  I was so anxious, in fact, that I drove right past the place and had to turn around in a parking lot to come back.

I did pay, in cash, to some confused receptionists who weren't used to a client who doesn't have Medicaid.  I entered the group meeting room and found two women sitting there.  When they introduced themselves, I thought they were the group leaders, but it turned out they were both just members with thick binders of all their accumulated handouts.  We were soon joined by two additional members (one of whom was male), and one of the two therapists who lead the group.  The other therapist and several members had called to say they could not attend today.

The meeting began with each of the other members describing which skills they had used during the previous week.  Two people did this in a succinct way, that avoided too much backstory.  Two others rambled on and on about all the situations they were in when using these skills, which I had been told in the orientation was not the appropriate way to use group time.  However, the therapist made no effort to reign them in.  To be honest, I was sitting there thinking that I don't give a shit about these people or what they have to say.  It was mindnumbingly boring to listen to everyone whine about what all had gone wrong that week and then brag about how they handled it so well.

Then we moved on to actually discussing skills.  They had recently started the Interpersonal Effectiveness section, which is exactly where I hoped they wouldn't be starting.  I've done Distress Tolerance and part of Mindfulness with my individual therapist, so starting with one of those, or even in the Emotion Regulation skills would have been fine.  The therapist went back to the first page of the handouts and reviewed, partially because people missed group so much over the holidays and partially, I think, to catch me up.  Yes, review of the previous week is built into each meeting, but we spent the entire second hour on review and never got to the point where they teach new skills.  In fact, the review didn't exactly contain any skills either.

One member of the group would not stop running her mouth long enough for the therapist to get a whole sentence out, and also used a profanity for every third word she said.  The others could manage to wait their turn, but never seemed to be on the right track as far as what we were discussing.  I was asked at the end of the meeting whether I thought this was going to be helpful.  I said, "Not in the slightest."  This earned me a lengthy speech from the member with diarrhea of the mouth, telling me all about how much DBT has helped her in the FIVE YEARS she has attended the group.  Five years.  You complete the whole set of skills in 6 months, so she has been through it all 10 times.  I cannot even remotely count that as helping, if she still feels the need to attend the group and be retaught these skills over and over again.

At the break in the middle of the meeting, the therapist went and made photocopies of the Interpersonal Effectiveness handouts and put them in a binder for me, along with a few copies of the weekly diary card.  I nearly left the binder on the table when I walked out.  I was already 95% sure I would not be returning next week, and 100% sure that I would not complete the entire program, so it's hardly fair of me to come back and lead them on.  By the end of the meeting, I wasn't anxious anymore.  I was just annoyed and frustrated, and felt that I had just wasted 2 hours and $12 on complete drivel.  I'm giving my therapist one chance to talk me into returning, at our appointment later this week.

What do I hate so much about it?  Well, aside from everything mentioned above, it's repetitive.  The skills are just the same things said over and over in different ways.  I'm not an idiot who needs to hear things a hundred times in order to understand them.  In fact, I'm just plain not an idiot.  We went over a page about challenging myths about interpersonal effectiveness.  After just one of them, I said, "So in other words you just add a negative to the sentence."  The therapist looked at me as though shocked that anyone would pick up on that on the first try.

I also hate that, in looking over the list of skills on the diary card, I once again find that the skills are not the same skills my therapist has been giving me.  The same happened with a DBT workbook I bought.  Oh sure, some of them are the same, and some of them are clearly just different wording.  But there are entire skills that are missing from this list.  How can DBT be some proven program if it's not even the same skills when different people teach it?

I hate that the skills are not things I need to be taught.  We went over and over the idea that Interpersonal Effectiveness is about asking for help when you need it and being able to say no when you need to.  I don't inherently have a problem with these things.  I have a problem with these things because I experience social anxiety, but I don't need to be taught how to do them.  When my anxiety is under control, there's no problem, and when it's not, there's no skill in the world that is going to help.

Most importantly, I hate that I'm not doing this because I want to do it, or think it will help me.  I'm doing it because it's what my therapist wants me to be doing, and I feel that if I tell her I've had enough of the DBT and that I'm not going to the group or letting her teach me the skills anymore, then even if she can work with that there will always be a tension between us.

I don't even really believe my BPD diagnosis is correct.  I don't have most of the stereotypical symptoms, and the ones I do have can be easily attributed to bipolar.  I don't always use self-injury to cope or think about suicide, only when I'm depressed.  I don't always drive too fast or overspend, only when manic.  If the diagnosis is wrong, and the therapy is not what I need either way, then why the hell am I doing it?


Originally posted at https://stuffthatneedssaying.wordpress.com/2015/01/19/my-first-my-last-my-dbt/. Please comment there.
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2015-01-16 12:30 pm

Low-Functioning, High-Insight

Today Lauren Hayley posted Day 28: Do you consider yourself high-functioning or low-functioning?  The question is in terms of Borderline Personality Disorder, and she includes a description from BPD Central of the traits of these two levels of functioning.  As a general summary, low-functioning BPD sufferers are those who direct their pain inward with self-destructive actions, and are seeking help.  High-functioning BPD sufferers are those who lash out at others, destroying relationships, and are in denial that they have a problem.

I find these definitions weird.  I don't see how seeking help makes a person low-functioning, or why being high-functioning requires fitting the negative stereotype of BPD sufferers being abusive toward friends and family.  By these standards I would have to describe myself as low-functioning.  Externally, I'm one of the nicest people you'll ever meet.  I take things out on myself.  I also am seeking help.

In my latest therapy session, my therapist and I discussed the fact that I often don't list many skills used on each day of my diary card.  One of our theories was that I'm actually using more skills than I write down, but don't think of them consciously when it's time to fill in the diary card.  In some cases, I'm using skills I haven't been taught yet, so of course I don't know to write them down.  One skill that has been referenced occasionally but not yet taught is "Opposite to Emotion Action", which is what I used today.

I recently complained about Dialectical Behavior Therapy in I'm a person, not a diagnosis.  I hate DBT.  I'm joining a DBT group on Monday.  In the orientation session I went to today, when I was asked if I wanted to join the group, my mind was screaming at me that it sounded like torture from hell.  I wanted to say no and run from the room as fast as I could.  Instead I agreed to join.

The woman who did the orientation said that they don't like to do "process therapy" with people who haven't yet learned these skills, because there is a risk of triggering negative reactions that the person can't yet handle.  This gave me a new perspective on my struggle with doing DBT in individual therapy.  It's true that when we discuss negative experiences from my past I often leave therapy feeling terrible, crying, and having urges to harm myself as a result.  I need to recognize that I'm in therapy for the long haul - as much as I want it to, it's not going to magically "fix" me in a few months.  I need to have patience with the DBT now, knowing that there's time for other approaches later, when I'm better prepared to handle them.


Originally posted at https://stuffthatneedssaying.wordpress.com/2015/01/16/low-functioning-high-insight/. Please comment there.
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2015-01-11 03:21 pm

I'm a person, not a diagnosis.

When I started meeting with my first therapist, who we'll call Wendy, I had just flown through a month of mania and gone crashing into a mixed episode. I find mixed episodes to be the hardest thing to explain to the non-bipolar. It's not that hard to understand depression - most everyone has experienced at least a brief, minor form of it at some point and can extrapolate from there. Mania is a little trickier, but again the idea of being filled with energy and not needing sleep or food and feeling like you're on top of the world has at least some basis in the average human experience. Most of us have felt very, very good for one reason or another, and could understand what it would be like to feel that way only magnified.

Mixed episodes? Now those just don't make sense. How can you be up and down at the same time? How can you be filled with energy and flying from one task the next, yet feel a deep despair about your useless, futile life? For me, mixed episode meant I was still sleeping a mere 3-4 hours per night. I still raced from one thought to another, talking to myself in words filled with rhyme and alliteration and assonance and somewhat lacking in sense. I still shared way too much with people I barely knew. I still drove too fast. I still felt enlightened.

I also felt agitated and disoriented. I was unable to focus. I obsessed over all the negative events of my past. I couldn't stand being home and would go out wandering in the middle of the night. I'd berate myself and cry and plot how I was going to kill myself.

So I started seeing Wendy. While we did discuss concrete steps for improving my life, these always stemmed out of conversations where I rambled on and on about my past experiences and current worries. A lot of times what helped was that I said things that it scared me to say, and found that Wendy didn't react badly. Granted, that's her job as a therapist - to be accepting and supportive even if she doesn't actually feel that way. However, it still tricks me into feeling less alone and less like anyone who actually knew me would immediately hate me.

Things were improving for me. I was managing to control my typical overreactions to negative events, and starting to feel a lot better about the past. Then Wendy's internship ended and I was transferred to a new therapist. We'll call this one Sadie.

Before I even start, I will mention that I like Sadie a lot. That's what has made all of this so difficult. If I didn't like Sadie so much, I'd have a lot more options for how to deal with this situation. What situation? Well, she's just so very different from Wendy. She's very focused on tangible things we can do. Don't like my job? Let's leap right into hunting for a new one. Stressed out? Here are seventeen different coping skills to choose from.

At one point, pushed to the edge of the cliff on the job search issue, I was prepared to call and cancel all my appointments and see if I could go it alone. I went to an acquaintance for advice, and she talked me into writing Sadie a letter to explain what was not working for me. I got waylaid a little by accidentally ending up in inpatient, but I wrote the letter while there and gave it to her upon my release. I told her that I needed more space to just talk about situations and how I feel. Also more space to talk in general, as she has a tendency to fill the silence when I'm having trouble finding what to say.

The same day that I was asking for less structure, Sadie was preparing to propose more of it. The inpatient unit had strongly encouraged the use of DBT. Her ideal solution would have been for me to attend a DBT group, but it did not fit into my work schedule. So we compromised, saying that I would get half of each session for my freeform talking, and then we'd go over 1 or 2 DBT skills with the rest of the time.

It was a nice proposal, in theory. In reality, it's now 4 months later and we've been doing all DBT, all the time. Learning a skill or two each session would be fine, except Sadie wants to go over the worksheets before I do them, and then go over them again after I do them. I am quite capable of reading and comprehending them on my own, so we only need to discuss my answers once I'm done. Also, she has me doing these weekly diary cards, to rate my urges for negative actions (suicide, self-harm, etc.) and my various emotions (sadness, anger, joy, etc.). Also I'm to note which DBT skills I used each day and how much they helped.

dbt-sheets

So what does a session look like now? I hand over my diary card (with a special notes page I make, because I am an overachiever). Sadie looks it over and tries to identify patterns. She may ask me a couple of questions. Then we go over my completed skills worksheets, then she basically reads the new ones to me, then when there are about 2 minutes left she asks if there is anything else we need to discuss.

Last week I'd had enough. I warned her in advance via e-mail that I was not getting enough time for just talking, and then that's what we did. I did give her my diary card, but then we actually discussed all the events that I had noted on it. We talked about how I felt, about why certain events upset me. We did talk about concrete things I could do, but in the context of the greater conversation. It all felt right. It hurt, but it also felt like there was hope. I even conceded to receiving a new skill worksheet, on the condition that I get to read and fill it in myself before we discussed it.

Sadie apparently didn't feel the same way I did about the session. She said, "I don't want to take away from your opportunity to just talk, but DBT is the best treatment for your diagnosis." I'm a person, not a diagnosis. Even if I were just a diagnosis, I'm not just BPD. Maybe DBT is the best treatment for BPD, but until you strip away the bipolar, strip away the non-disordered parts of my personality, strip away my past experiences and my thoughts and feelings and all that makes me a human, then perhaps it's not the best treatment for me.


Originally posted at https://stuffthatneedssaying.wordpress.com/2015/01/11/im-a-person-not-a-diagnosis/. Please comment there.
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2015-01-02 02:15 pm

Declutter Calendar

In late 2013, I started a blog about decluttering.  Initially I wrote about one specific organization project, and at the beginning of 2014 I started using the Declutter Calendar from My Simpler Life.  I had purchased a print version of the calendar, thinking that if it was right in front of me I'd be more inclined to work on it.  As it turned out, I never found a place to hang the calendar, and by the end of January I was desperately behind and couldn't seem to make myself jump in on the current date and go from there.  In hindsight, the point at which I fell desperately behind is the same point at which I passed from hypomania to mania, and started to lose my ability to focus.

This year, I've downloaded the electronic version of the calendar and saved it on my desktop, thinking that it might be easier to access than a print version.  I've also changed my perspective on what it means to complete the calendar tasks.  I found, in the brief time I worked on this last year, that I did better with grouping the related tasks and doing them in a single day.  For example, there were two days that said "Clear your left kitchen counter of things not used daily" and "Clear your right kitchen counter of things not used daily".  It was so much simpler to do both at once and then take a day off the next day.  So for this year, my intention is to look at the calendar a week at a time, and do the tasks in whatever order or grouping I like.

Using the Declutter Calendar is going to be a task on my 101 in 1,001 list.  I'm not sure how I will set this as a goal - perhaps something like "Do at least one task from the Declutter Calendar each week for a year."  Of course I'm welcome to do more, but I noticed the calendar contains several tasks that are just not applicable, or that I'm not in a position to be able to do on the specified date.

For January 1st, the task was "Spend 5 min racing around tossing stuff out".  I did not race around and I did spend more than 5 minutes, but I believe I completed the spirit of the task.  I tackled the junk drawer in my dresser.

junk-drawer

I threw away a ton of stuff, including things like old debit cards and used up gift cards.  Also library cards for several libraries in cities I will never again visit.  I threw out tons of random bits and bobs that were on the "but it might be useful someday" list.  Really, none of it would ever be useful.  I also pulled out a small pile of items that need to either find a new home or find a new home.  That is, I need to move them to a new location in the house or add them to the donations pile.  It's still clearly a junk drawer, but it now closes with no effort and I can actually see what's in it without rummaging for half an hour.

When I initially embarked on this project a year ago, my aim was two-fold.  It was important to me to declutter simply for the sake of making my environment tidy and organized.  It was also important to me because I felt - and still feel - that my satisfaction with life is greatly dependent upon that tidiness and organization.  I am easily overwhelmed by the clutter, and have difficulty finding motivation when my environment is a mess.  At this point, my motivation level is high enough to actually do the decluttering that will end up helping me in times of decreased motivation.


Originally posted at http://stuffthatneedssaying.wordpress.com/2015/01/02/declutter-calendar/. Please comment there.
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2015-01-01 02:10 pm

101 in 1,001

Today I read an article titled A Kinder Take on New Year’s Resolutions for 2015.  Mere minutes later, my therapist handed me a set of questions asking me to reflect on the past year and set goals for next year.  She was quick to point out that she likes the term "goals" much better than "resolutions".

smart-goals

I had already planned a post about resolutions - I mean goals - and my goal involves revisiting The 101 Things in 1,001 Days Challenge.  My original end date for my original list was September 26, 2008.  Obviously a few years have passed.  I only completed 11 tasks from my original list, and had a few others in progress.  At this point I revised my list, because my life had changed drastically since creating it and many of the items were no longer relevant to my interests.

When I didn't get very far before quitting for months, I decided to create a new list and start over.  I made plans to restart on January 27, 2008, but never actually created the list of 101 tasks.  That is my goal for 2015: to create the list.  I'm not required to make any progress on it, simply to create the list of 101 tasks.

At the time that I planned to restart my list, I did some writing about how to create a list.  Confession: the rest of this post is nearly identical to what I'd written before.  Someone needs a nap before getting up to celebrate the new year.




"How can I possibly think of 101 tasks?" you exclaim. The flexibility of having 101 spaces to fill with your own choices is great, but also quite scary. Here's a suggested outline for giving your list a bit more structure:

  • 18 Categories X 5 Tasks

  • 9 Specific Tasks for the Past, Present, and Future

  • 2 Purchases


The first part of forming your list involves defining 18 categories of tasks that are important to you. My 18 categories are listed below as an example. It's unlikely that anyone could directly use my set of categories since we all have a different combination of interests (my list is heavily weighted toward the arts, since my education and most hobbies are in that area), but marking out the categories that don't interest you and then finding replacements is a good way to start.

My Categories:

  1. Education

  2. Theatre

  3. Creative Writing

  4. Photography

  5. Knitting/Crochet

  6. Music

  7. Culture

  8. Recreation

  9. Social

  10. Family

  11. Health

  12. Civic Duty

  13. Financial

  14. "Adulthood"

  15. Organization

  16. Adventure

  17. Overcoming Fears

  18. Special Skills


After you have 18 categories selected, list 5 tasks relating to each category. It may feel a bit restrictive having only 5 tasks for your current favorite activities, but this limit encourages you to think carefully about what your most important goals are and to aim for improvement in multiple areas of your life. Once this section is completed, you will have 90 tasks on your list.

The next 9 tasks on the list come from three groups known in brief as Past, Present, and Future. While you certainly aren't required to do these exact tasks, especially if they are things that are already done in your life, I feel they're important for everyone and you ought to consider whether you can improve upon what you've already done or replace the task with a different one that fits the category.

Recalling the Past

  1. Create a genealogical record for at least 4 generations of your family (yourself, parents, grandparents, and great-grandparents)

  2. Compile a scrapbook of your childhood, with pictures of yourself at each age, your close family, your friends, and your pets

  3. Start writing an autobiography (there are many great books out there with prompts to help you figure out what topics to cover)


Recording the Present

  1. Assemble a time capsule to be opened in 20 years

  2. Record your daily life in photographs for a week

  3. Start a journal (your choice as to how often is reasonable for you to write in it, although I'd suggest at least once per week)


Preparing for the Future

  1. Start a savings or investment plan

  2. Get health insurance (if you've got adequate insurance already, get life insurance payable to your next of kin...if you've got that, well, lucky you!)

  3. Write your will and advance directives


Now we're up to 99 tasks, and the last two are fun ones. Select two significant purchases you'd like to make. These should be within your long-term budget but not things you'd make a casual decision about purchasing. Many of us would probably choose a new computer as being one of those things we'll want in the next few years, but anything works so long as you wouldn't just hop into a store and throw it in your shopping cart without a second thought.




No matter how you choose to structure your list, here are a few tips for selecting individual tasks:

  • Make your tasks very specific and concrete. You have to be able to measure whether a task has been accomplished or not. Don't just write "learn to tap dance"...how will you know if what you've done constitutes learning enough? Instead, choose tasks such as "take a tap dance class at the community center". Class ends, you've had the experience, and your task can clearly be marked as complete.

  • Make your tasks achievable. There's a difference between challenging yourself and setting yourself up for failure. Base your tasks around your own actions, and aim for things that don't involve reliance on the actions of others. If you want to get a poem published in a literary magazine, you can't aim for getting published. It's not entirely in your control. What you can and should aim for is sending a certain number of submissions to the magazines in which you'd like to be published. Then your part is done, and it's time to let it go and focus on another task that you can do.

  • Choose tasks where you can apply the old adage "If at first you don't succeed, try, try again." The fastest route to misery in this project is declaring that you will do a specific task every day for the entire 1001 days. It's simply impossible. Forming a good habit doesn't mean that you have to be perfect from the start, but that you can pick yourself up and start again if you slip up. Tasks that involve forming good habits are great to have on the list, but you need to limit the duration so it's possible to accomplish them. For example, "quit drinking caffeinated beverages" is a purely evil goal to set for yourself. One little mistake and you'll beat yourself up and probably quit trying entirely since you've already "failed". Instead, try something like "Limit caffeine intake to one 20 oz. cola per week for two months". If you don't manage it on the first try, look how many more two-month spans are available in which to attempt it again!


The final and most important tip for success in this project is: don't trap yourself into completing tasks if the course of your life changes. If you find out that the task you listed a month or a year ago is no longer relevant, replace it! There's an important lesson here regarding willingness to assess a situation and make necessary changes. Making changes is what this project is all about.


Originally posted at http://stuffthatneedssaying.wordpress.com/2015/01/01/101-in-1001/. Please comment there.
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2014-12-24 02:08 pm
Entry tags:

Top Reads of 2014

I have read 158% of my goal on Goodreads this year.  Some of the books have been life-changing, others have been complete garbage.  Here are my top 5 to recommend, in no particular order:

2014-top-books

(Not pictured: Mental Health First Aid USA, because I gave my copy away and haven't replaced it yet.)

1. Hyperbole and a Half: Unfortunate Situations, Flawed Coping Mechanisms, Mayhem, and Other Things That Happened by Allie Brosh
A lot of the content will be familiar if you read Allie's blog, also titled Hyperbole and a Half.  Yes, if you're like me and "clean all the things?" is your favorite internet line ever, you will find it here.  There's just something special about holding it in book form though, with the bright colors on pretty glossy pages.

2. Sharp Objects by Gillian Flynn
Not one to follow the popular crowd, I skipped over Gone Girl with all its pre-movie hype and tried this one instead, based on the intriguing blurb on Amazon.  Part murder mystery and part exploration of the main character's physical and emotional scars, I was impressed with the author's success at tackling the rather unsettling topic of self-injury without making the character one-dimensional.

3. The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You Are by Brené Brown
This book was a gift from my first therapist when she left at the end of her internship.  As I read each chapter I thought, "This is why she gave me this book!  No, wait, THIS is why!"  I found it funny that a book on imperfection could be so perfect for me.  Now, 6 months later, I feel like it's time to go back for a second reading to see if I've grown in any of the areas addressed in the book, and to really tackle any areas where I haven't grown yet.

4. Marbles: Mania, Depression, Michelangelo and Me by Ellen Forney
I first discovered this book when someone shared the page "What is a "MOOD DISORDER" anyway?", which is featured in this interview in The Guardian.  I read quite a lot of books on Bipolar Disorder this year, having just been diagnosed.  I have a couple of favorites, and this one (as a non-self-help book and humorous) is the most relatable for those who don't share the diagnosis.

5. Mental Health First Aid USA by Betty Kitchener, Anthony Jorm, and Claire Kelly
Designed as a textbook for the course of the same name, this book is a basic, straightforward guide to identifying potential mental health issues and supporting those in crisis.  Like physical first aid, the idea is to teach average people to help long enough to get the person transferred to a professional.  As I mentioned above, I gave my copy away after I finished it, because I felt that strongly about other people learning to use these skills.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/12/24/top-reads-of-2014/. Please comment there.
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2014-12-22 02:03 pm

The Cost of an Overdose

As it turns out, overdosing is mighty expensive. It has been 28 days since I overdosed, and the bills have poured in to my insurance company. Here is a breakdown of all the charges, with original cost and insurance-approved cost in parentheses:

AMBULANCE
* ALS1-EMERGENCY ($1,100 -> $400.06)
* GROUND MILEAGE ($112 -> $50.12)
* AMBULANCE O2 LIFE SUSTAINING ($35 -> $0)

EMERGENCY ROOM DOCTOR
* EMERGENCY SERVICES ($506 -> $332.16)
* ELECTROCARDIOGRAM REPORT ($25 -> $17.78)

ICU DOCTOR
* INPATIENT PHYSICIAN SERVICE ($501 -> $233.99)

COUNTY HOSPITAL
* MISCELLANEOUS SERVICES ($42.15 -> $34.14)
* MISCELLANEOUS SERVICES ($58.72 -> $47.56)
* MISCELLANEOUS SERVICES ($8.60 -> $6.97)
* MISCELLANEOUS SERVICES ($47.10 -> $38.15)
* MISCELLANEOUS SERVICES ($67.40 -> $54.59)
* COMPREHEN METABOLIC PANEL ($322.40 -> $261.14)
* ASSAY BLOOD ETHANOL ($105.00 -> $85.05)
* ASSAY URINE ACETAMINOPHEN ($159.60 -> $129.28)
* THERAPEUTIC DRUG ASSAY ($97 -> $78.57)
* DRUG SCRN 1+ CLASS NONCHROMO ($250 -> $202.50)
* AUTOMAT HEMOGRAM-COMPLET DIF ($77.50 -> $62.78)
* AUTOMATED, WITHOUT MICRO ($48.60 -> $39.37)
* CRITICAL CARE FIRST 30-74 MN ($693.20 -> $561.49)
* NONINVAS EAR/PULSE OXIM;SING ($88 -> $71.28)
* ELECTROCARDIOGRAM, TRACING ($207.90 -> $168.40)
* INPATIENT PHYSICIAN SERVICE ($584.70 -> $473.61)
* MEDICAL SERVICES ($75.40 -> $61.07)
* ELECTROCARDIOGRAM REPORT ($26.70 -> $21.63)

ON-CALL THERAPIST
* MEDICAL SERVICES ($82.50 -> $58)

MENTAL HEALTH CENTER INPATIENT UNIT
* MISCELLANEOUS SERVICES ($2,000 -> $1,050)
* MISCELLANEOUS SERVICES ($56.33 -> $0)

PSYCHIATRIC APRN
* INPATIENT PHYSICIAN SERVICE ($85 -> $85)
* INPATIENT PHYSICIAN SERVICE ($75 -> $65)

The grand total was $7,537.80, of which my insurance approved $4,689.69. Fortunately for me, I had already reached my maximum coinsurance for the year and did not have to pay a cent of this. Unfortunately for the purposes of this post, I cannot give an idea of what the out-of-pocket cost would have been.

niagara-river

The real cost of an overdose isn't monetary though. It's the risk of having permanently damaged internal organs. It's the awkward silence when you try to explain what you were thinking, or possibly not thinking. It's the knowledge that everyone is looking at you distrustfully, wondering how long until you try it again. It's the awful realization that you could very well be dead, and after coming that close you understand that you never wanted that to happen. It's the fact that once you've overdosed, it continues sounding like a legitimate solution, no matter how mild your depression may be.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/12/22/the-cost-of-an-overdose/. Please comment there.
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2014-12-16 08:53 pm

Thought Diaries About Thought Diaries

I'm telling my stories all out of order again, so to preface this I must say that I quit my job 10 days ago.  In those 10 days, I've struggled with many things, including the feeling that I must be busy 24/7 to make up for the fact that I'm not working.  Yesterday I had a huge list of things I could be doing.  I even did some of them.  However, one particular thing I didn't do made me feel like a failure, and as I journaled about it I kept pulling out more and more failures from my day.  I failed to make a dentist appointment.  I failed to apply for a new job.  I failed to do any exercises in any of my three self-help workbooks.  I failed to comment on any blogs, upload any photos, or add any information to my family tree.

Today, my therapist questioned why I did not do a thought diary (an exercise from CBT) regarding these thoughts of being a failure.  Oh, look, I failed again!  In fact, I have failed repeatedly, as I quit doing thought diaries within a few weeks of her teaching them to me.  I felt guilty as I explained that they are difficult.  I let her think it was strictly about the amount of work, but they are emotionally difficult as well.

My therapist is smart, and clearly knew that telling me to go home and do a thought diary was not going to be very effective, so we worked on it together.  One small event, or rather a lack of event - not making a dentist appointment - led to four negative beliefs driven by four different types of unhelpful thinking styles:

thought-diary

"I am a failure." (labelling)
"Nothing I do is good enough." (all or nothing thinking)
"I'm wasting my time." (should & must)
"Anyone else could do this." (magnification & minimisation)

As we moved on to disputing my "hot thought" of "I am a failure.", I listed all the things I didn't do yesterday as evidence of this "fact".  When providing evidence against the hot thought, my therapist asked me to think more broadly about my past accomplishments.  So while I included "I did write a blog post." and "I made other phone calls that day." as accomplishments from yesterday, I also came up with a few from the past.  I wrote a play.  I designed a style for a website.  I've been in a few plays.

Then she asked me to think about ways in which others have complimented me.  She mentioned that some people from my ex-job had probably told me I did well at things.  She was right.  I used to work with people from a department outside my own, and they frequently lamented the days when I was working on other tasks or was unable to attend work.  They told me how well I did at the job.

I've left a couple of our pieces of evidence out of the previous two paragraphs, because the act of doing the thought diary actually brought up two additional negative beliefs.  The first was that scores on standardized tests are not an accomplishment because they are just numbers that no one cares about (disqualifying the positive).  The second was that any positive comments made by my mother don't count, because she feels obligated to compliment me (jumping to conclusions).  This proved my therapist's point that I need to be doing these thought diaries regularly or I will never stop having negative thoughts that stir up negative emotions.

After the evidence for and against the hot thought, the next step is to answer one or more disputation questions designed to bring up positive alternatives to the negative thought.  I chose to answer "How might someone else view the situation?"  My therapist said, "What would Wendy* say?"  *(former therapist, not her real name)  I really hate it when she uses Wendy against me.  It just stirs up the pain of her having finished her internship and left, and even worse I feel like my therapist's subtext in these moments is that the two of us still haven't built a rapport.

I'm doing the best I can.  I wish she knew how much I like her and want to feel comfortable with her.  How much I beat myself up internally every time I sit in her office and deflect pain with humor.  I would give anything to show sadness or anger in front of her, to prove that I'm more than a really bad comedy act.  So now I feel like I need to do a thought diary about doing this thought diary.  Therapy is becoming entirely too meta.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/12/16/thought-diaries-about-thought-diaries/. Please comment there.
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2014-12-15 08:51 pm

Happification

My therapist is always throwing websites at me.  Sometimes they bounce off (I'm looking at you, O*NET), but occasionally they stick and I get to surprise her.  It seems like the sites that stick have a common theme: taking small steps toward increased happiness.

100happydays

First there was #100happydays.  I have posted 77 photos with this tag on Instagram.  I started 129 days ago.  So you could say that I have completely failed at this task.  Or you could take into consideration that I've had many days when I was completely without access to the internet, and many more days in which I spent nearly all my waking hours in a place where electronic devices are forbidden.  You could acknowledge that I keep plugging away at this task, despite the interruptions.  Personally, when I reach 100 photos I'm going to consider this accomplished.

The other website that stuck is Happify.  The main focus of Happify is choosing a track and completing a few activities per day toward that track.  Completing a certain number of activities will earn you silver or gold medals for each level.  So far I've completed the Cope Better with Stress and Conquer Your Negative Thoughts tracks, with gold medals on every level.  I've just started the Find Your Calling track.

Activities also give you points toward leveling up in 5 different skill areas: Savor, Thank, Aspire, Give, and Empathize.  Some areas are easier to level up than others, based on the types of activities that are offered in the tracks.  If you pay for a Plus membership, you can do any of your unlocked activities at any time, outside of your chosen track.

Plus membership also unlocks many additional tracks, and a strengths assessment.  My five signature strengths are: Humor, Love of Learning, Creativity, Curiosity, and Kindness.  If anyone has a great idea for a job that requires those strengths and does not require a college degree, I'm taking suggestions.

I've been doing Happify for 5 weeks.  I've been on the site every day, with the exception of a couple of days I spent in the inpatient unit and was without internet access.  Sometimes the activities don't have their intended effect (I get irritated by what I'm asked to do, like meditation, rather than it improving my happiness), but for the most part I am much more appreciative of the good things in my life since starting this journey.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/12/15/happification/. Please comment there.
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2014-12-14 08:50 pm

ANSAs to My Questions

When I wrote the post Medical Records, I was waiting on a third batch of records to arrive.  I've had that batch for quite some time, but never managed to write about what I learned from reading it.  On my first read-through, I laughed hysterically.  For example, at the line "Smiled inappropriately several times during the interview when talking about suicide and substance abuse."  Gee, you think maybe because I was nervous?!  I've been seeing my current therapist since May and she's still waiting for the day when I'm comfortable enough to hold a conversation without being sarcastic and cracking jokes.

There's also a note of "laughed when asked to sign a safety contract".  By this point, I've lost track of how many I actually signed, and how many times I laughed and said signing was pointless.  Initially this was because the contract relies upon a willingness to pick up a phone and call for help if having suicidal or self-injurious thoughts.  I knew I would never, ever pick up the phone.  Eventually I did call once, on a lunch break from work, to discuss the fact that I had a strong urge to cut myself.  Did that 5-minute call help?  Actually, yes.  Am I at all confident in my ability to call again?  No, especially considering my failure to call somewhere between nagging suicidal thoughts and the overdose that occurred days later.

Another example of the hilarity was a 3-page Emergency Services Assessment that managed to note not once, not twice, but thrice that I had walked in with a number of suicide methods written on my arm.  This was actually more of an intellectual exercise (or, as the inpatient psych APRN noted, "an academic thought") than anything else, but the on-call therapist (who I wanted to talk to about feeling stuck with my current therapist) fixated a bit on the content of my "self-decoration".

I'm also a bit enamored of the phrase "Risk for not taking medications as prescribed."  I've never quite been sure if that is a risk they consider specific to me, or simply a product of statistics about my diagnosis.  At the time this particular report was written, I had a couple of instances of taking leftover pills that were no longer prescribed, but had not yet experienced the 5-day stretch of willfully skipping my medication.  So perhaps they were leaning more toward statistics at this point, although my own stupid behavior would account for this risk assessment in the future.

The most informative portion of these records was an update to my Adult Needs and Strengths Assessment (ANSA).  This assessment has to be updated every 6 months, so this was my second time having it done.  I was curious as to how it turned out, because I was not actually involved with the production of this assessment.  My therapist did it herself based on information from past sessions, because on the date it was due she was too busy dragging me back to the inpatient unit.

ANSA

My reaction to this assessment was a sudden increase in depression.  Each need on the assessment can be ranked 0 = no problems, 1 = history/mild, 2 = moderate, or 3 = severe.  At the time of my original assessment, there were 5 needs ranked at level 2, and everything else was 0 or 1.  I went into this assessment expecting about the same.  I thought there might be a couple more at level 2, simply because my original assessment was based on 90 minutes with a stranger.

Reality was cruel.  Two needs (Depression and Interpersonal Problems) had leaped up to level 3, and I now have a whopping ten at level 2.  So my full list of needs to be addressed (as prioritized by my therapist):

Suicide Risk
Depression
Self-Injury
Other Self-Harm (Recklessness)
Criminal Behavior
Decision-Making (Judgment)
Medication Involvement
Impulse Control
Interpersonal Problems
Social Functioning
Family Functioning
Recreational

I noted on one of my diary cards that I felt sadness because "ANSA update was depressing."  In therapy I continued that by saying "All those needs exploded everywhere."  Before my therapist could even try to reassure me, I commented that I knew it was a matter of them being needs this whole time, just that they hadn't been recognized yet at the time of the original assessment.  Does this make me feel any better?  Not so much.  It doesn't change the harsh reality that there is so much to deal with in therapy that I will probably never go more than a week without it.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/12/14/ansas-to-my-questions/. Please comment there.
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2014-12-09 08:48 pm

Keeping the Stories Straight

At the beginning of Thanksgiving week, I got up in the middle of the night, stumbled around my living room, and went crashing to the floor.  I couldn't get up.  I screamed for my mother, who leaped out of bed and came to help.  Then, of course, I refused her help.  I managed to pull myself into a dining room chair, but was shaking too hard to drink the glass of water she brought for me.

After some interrogation she asked if I had taken a bunch of pills.  I denied it.  Then she asked again and I confirmed it.  In total, I had taken somewhere between 40 and 50 Benadryl.  When mom realized she couldn't get me to the hospital on her own, she called 911.

benadryl

Many hours of my life are a blur.  I thought I remembered the presence of "Deputy Wayne" from Celebrating February 14th.  This made no sense, so I assumed I hallucinated.  I remembered ambulance lights and being helped outside to get in it.  I remembered a bedpan.  That's about all until I woke up hours later in the ICU.

Things were not much clearer in the ICU.  From that portion of the day, I remember repeatedly getting out of bed.  I remember trying to yank out my IV needle.  I remember a really sweet nurse who offered to order my meals for me so I wouldn't have to make scary phone calls.  I remember the on-call therapist dropping by to determine whether I should be admitted to inpatient, but I don't remember the slightest thing about what I said to her.  I remember mom visiting and telling me that Deputy Wayne really had been there, but I had to ask her about it all again the next day because I wasn't sure I hadn't also hallucinated the conversation in which she confirmed his presence.

I told many different stories about the overdose - some of them during the time when I was not coherent enough to know what I was saying, and others during the course of the following week when everyone wanted an explanation for what I'd done.  Some of the stories:

"I did it for attention."
"I don't know why I did it."
"I wasn't trying to kill myself."
"I wanted to hurt myself."
"I took a few for sleep and it impaired my judgment so I took more."
"I overdosed on Benadryl."  (no reason given)
"I tried to kill myself."

In the beginning, "I don't know why I did it" was pretty close to the truth.  This was what I told my psych APRN when he came to see me the next morning in inpatient.  He tasked me with figuring out the reason(s) I did it so we could prevent it from happening again.

I told most of my friends that it was an accident.  That I took them for sleep and took a few more when they weren't helping, and took a lot more when my judgment became impaired.  The truth in that was that I did only take a few at first and my judgment really was impaired by the time I took the rest.

I told one close friend that I wanted to hurt myself, but wasn't trying to kill myself.  I did want to hurt myself.  I had wanted to hurt myself for days.  I didn't plan to kill myself, although suicidal thoughts had been stuck in my head just as long.

With a few people, I didn't give them a reason and let them make their own assumptions about what happened.  With one particular person, I needed to impress upon him the severity of the situation, so I said I tried to kill myself.  This is sort of true too...I did try, even if it wasn't entirely intentional.

It took me a while to figure out exactly what happened and why and how to explain it, so here's the truth:

I had been having suicidal and self-injurious thoughts for days.  The kind of thoughts for which I'm expected to call the local mental health center's emergency hotline.  The kind of thoughts I didn't think were that much of an emergency and surely I could handle them myself.  The afternoon of the overdose, a friend confided in me that she had been suicidal the night before, for the first time in her life.  She said the only reason she didn't do it is because she had a "painless and tidy" method in mind but lacked the tools needed to execute it.  I don't blame her for my thoughts, but it did spark something in me.  The idea that I really could do it; that nothing was stopping me.

I didn't really plan on dying.  I didn't make any sort of preparations.  I just knew that I had once taken 10 Benadryl with no lasting effects so maybe this time I could try 15.  I was clearly a chicken about it, because I only took 5 at a time, giving myself the chance to back out.  5 pills every half hour, until I reached 15.  Then 20.  At 20 I still felt fine, if somewhat groggy.  I dumped another huge pile in my hand, tossed them in my mouth, and swallowed.  I knew when I took all those at once that it could kill me, but it's true that my judgment had been impaired.  I didn't have the capacity to make a decision about whether I wanted to die.

I was terrified going into inpatient this time.  I was convinced I would be permanently committed.  In reality, they only held me 2 nights.  I got 5 nights once for lying about having suicidal thoughts, but when I overdosed I only got 2 nights?  This was baffling.  I can only imagine that they were trying to get me home for Thanksgiving.  I didn't argue on being released, not wanting to ruin Thanksgiving, but I was still very depressed the next few days and would have benefited from a longer stay.  I'm still working on learning to put my own needs first.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/12/09/keeping-the-stories-straight/. Please comment there.
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2014-11-22 08:46 pm

Never Too Old for Crayola

There was a post in a bipolar support group the other day that asked "Am I the only one who loves coloring?"  The response was a resounding "I love coloring too!"  Nearly every commenter expressed the same interest, with many talking about coloring as the best part of their inpatient experiences.

On my first inpatient stay, I used some dull colored pencils.  When they were beyond usable, I could go to the desk and, with supervision, use a pencil sharpener.  I sharpened a couple of pencils that I needed to finish my current picture, and was tempted to bring the whole box full and sharpen them all, just in case anyone else wanted those colors.

On my second inpatient stay, I didn't do much coloring as I wasn't there long enough.  Had I known what would happen in the next week, I'd have colored to my heart's content.

On my third inpatient stay, a week after the second, the colored pencils were all dull and we were no longer allowed to sharpen them.  In that intervening week, a client we'll call Stefanie had managed to get the pencil sharpener away from watchful eyes, break it open, and use the razor to make a deep cut along her whole forearm.  It required many stitches and staples, a big bundle of gauze wrap, and her placement on one-to-one supervision - someone staying with her and watching her at every moment.

The irony here is that Stefanie was more interested in coloring than any other client.  She was constantly having the staff print off new coloring pages for her.  At first she used crayons, and then her husband brought in the Crayola Twistables colored pencils.  Her only lament was that there were only 12 colors.

Upon my discharge, I found a package online that had 30 different colors.  I ordered them for Stefanie, and attempted to go visit her as she was still in inpatient.  The staff wouldn't let me in.  Something about being too recently discharged.  I was disappointed, as I had fought past a lot of anxiety to even make the trip, but I did have the staff member deliver my gift to Stefanie.

coloring-page

Recently when I've been stressed out, I've remembered how much coloring relaxed me in inpatient and pulled out my colored pencils.  It still helps in the outside world as well.  It helps so much, in fact, that when my therapist assigned the task of creating a "self-soothe first aid kit" I promptly ordered miniature coloring books and my own pack of Crayola Twistables to include in it.  Then I had to brainstorm a while in order to figure out what other items it should contain.

The idea of self-soothe is to use the five senses to comfort oneself when in emotional distress.  Coloring is obviously sight, and I also have photos of family and index cards full of inspiring quotes.  For taste, a pack of chewing gum.  For hearing, an iPod shuffle full of upbeat music.  For smell, a roll-on of scented oil.  For touch, tiny knitted swatches in a variety of soft yarns.  As a bonus, there's also a pill container with a few of my anxiety medication.

My therapist loved the kit.  She spent forever looking at it and said she just wanted to play with everything.  My only dilemma with the kit is that I can't actually have it handy when I need it.  I can't carry something like this into my workplace, where everything I bring has to be inspected by security on the way out.  At this point in the year, it's too cold to leave it in the car, and I wouldn't really have access to it in the moment of need.  I'd be waiting until lunch or after work to go out and fetch a soothing item.  So while the kit was fun to create, it doesn't fit my current life circumstances very well.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/11/22/never-too-old-for-crayola/. Please comment there.
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2014-10-25 08:44 pm

Medical Records

medical-records

In an online bipolar support group, I recently posed the following questions:
How many of you request copies of your medical records? If you do read them, how do you feel about what you read?

I have requested records three times (and received them twice...still waiting on the third batch).  The first time was in March, immediately out of my first stay in the IPU.  Aside from general curiosity, I wanted some specific information that had not been shared with me: my exact diagnosis and the results of my first-ever blood tests.  I got my answers, and a few moments of humor, and a few other moments of being really annoyed.  For one thing, my appearance when I arrived at the IPU was described as "bizarre".  I showed up clean, in dressy clothes and full makeup, and just happened to have purple hair.  This is not bizarre.  In fact, it was quite pretty.

I also was annoyed that every time someone did an assessment of my intelligence, they wrote down "average".  The staff members who have seen me over the long term would definitely laugh at the thought of me being average.

A few months later, in late May, I submitted a request for everything added since that first batch.  The day before they arrived, my therapist told me she had been notified of my request in case she had any concerns.  I would still receive the records either way, but she did tell me she was concerned that as a people-pleaser I may read things as criticism that weren't intended that way and become upset.  And possibly injure myself in response.  She made me promise that I would talk to her about anything in my records that upset me.

I tried not to be upset by anything.  I knew my reactions were irrational.  However, some things kept nagging at me, so when I next saw her I told her we needed to discuss it.  Most of my concerns were things she couldn't really address since it was about other people's notes.  The only thing I was bothered by in her notes was that she refers to me by name instead of as "the client" like my former therapist did, and I got a reasonable explanation as to why that's done.

Last week I stopped in to submit another request, this time for the past 4 months worth of records.  Aside from being a longer time period, it is also one that was quite eventful, so I'm expecting a very large stack of papers, including:

  • Updated Adult Needs & Strengths Assessment (ANSA)

  • Updated treatment plan

  • 2 inpatient nursing assessments

  • 2 inpatient physicals

  • 2 admission notes to the inpatient unit

  • 2 discharge notes to the inpatient unit

  • 21 inpatient shift notes

  • 7 visits with inpatient psychiatrist/psych APRN

  • 3 visits with regular psych APRN

  • 21+ visits with regular therapist

  • 1 visit with therapist's supervisor

  • 1 visit with on-call therapist

  • 1 phone call with a different on-call therapist


In fact, I won't say "including".  I don't think I've missed anything, so if there are additional pages beyond a few more times seeing my regular therapist between now and when the records are printed, I think someone should take me out back and shoot me.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/10/25/medical-records/. Please comment there.
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2014-09-26 08:43 pm

A Perfect Life

I have a habit of taking things in to my therapist before she asks for them.  When I went to my first appointment - transitioning from a therapist who was leaving - she said she didn't know much about my family.  I handed her a family tree I had drawn.  She asked if I had supportive people in my life.  I handed her a copy of my safety plan.  She said, "How did you know to bring things to answer questions I didn't know I was going to ask?"

In a later appointment, I brought in a little essay I had written about what my current life would look like if it were perfect.  I had also created a checklist of the elements.  As it turns out, this is an actual exercise that my therapist sometimes assigns to people.

perfect-life-checklist
I live with my cat in a spacious apartment located in a quiet neighborhood within a large city. There are numerous amenities (banks, parks, post office, stores selling natural and exotic groceries) within walking distance. Just about anything else I could want to do is easily accessible via public transportation, or a short drive in my compact 4-door sedan that has a roomy trunk.

I work part-time at the nearby public library, helping people learn to use technology. I go to work wearing my own handmade cardigans and chainmaille jewelry. I take two college courses per semester, working toward a degree in psychology with minors in law enforcement and creative writing. When I have a week or two off from school, I travel internationally to do charity work.

In my spare time, I volunteer with a local theatre company and meet with a writers' group where I share excerpts of a play which will soon be professionally produced. I update my popular blog at least once per week. I enter poetry and photography contests, which I occasionally win. I am a member of Mensa and participate in their puzzle competitions.

I regularly cook for friends, either by hosting dinner parties or bringing food to other people's events. I keep in touch with many extended family members and bring updates on my genealogy research to our family reunions, where we hold board game tournaments. Some of my close friends have small children with whom I do art and science activities. I send greeting cards for all occasions.

For relaxation, I spend time at pools and water parks. I keep GAMES Magazine, Popular Science, and Reader's Digest on hand for filling spare moments while waiting at appointments or riding buses. At home, I always have a jigsaw puzzle in progress, and work on it while listening to mix CDs I've made to tell stories.

All of the elements of this scenario are individually plausible.  Putting it all together presents budgeting issues, both financial and timewise.  It would be impossible to pay for tuition and all the fun activities on a part-time salary.  Perhaps more importantly, juggling all those activities would require a level of manic energy that a.) cannot be summoned on command and b.) would inevitably lead to hospitalization.

My therapist thought it was cute that I had already checkmarked "cat".  I've had my beautiful, sweet, loving cat for 9 years.  So far, I have acquired the car, which is not compact but otherwise meets the description.  I have been making chainmaille jewelry, although it's for gifts and sale rather than for myself.  I'm getting closer to updating my blog regularly, but it's nowhere near being popular.  I've handed out a ton of greeting cards, just not as many as I'd like.  So I am making some baby steps toward what may not end up being a perfect life, but at least will be a better one.


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/09/26/a-perfect-life/. Please comment there.
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2014-09-12 08:40 pm

Beginner's Luck

rummy

On the first evening of my latest inpatient stay, I was surrounded by strangers and desperate to find a way to socialize.  A woman we'll call Stefanie had a deck of cards and a crowd had gathered around to play 500 Rummy.  She invited me to join, but I opted to just pull up a chair and watch for a while, as I didn't know the rules of the game.

The next evening, I joined the game.  I was 50 points from winning, and far ahead of most other players, when we were interrupted by visiting hours.  We never finished the game, but presumably that means I won.  The other players kept commenting on my "beginner's luck" and that they "taught [me] so well".

The next time we played I was again winning when we got interrupted by someone needing to speak to Stefanie.  I was sitting alone with a woman we'll call Yasmine and I confessed to her that I was not new to playing cards, I just didn't happen to know the rules of that particular game.  She thought that was hilarious, and she kept it to herself, so I left there with everyone else still thinking they were excellent teachers.  There was some luck involved though - everyone was frustrated by my ability to get multiple wild cards in every round.

My game of choice, which I started playing before my hands were big enough to hold all the cards (I borrowed the racks from Rack-O), is Shanghai Rummy.  It's been a long time since I've gotten to play, as I'm rarely with more than one other person who knows the game.  Maybe I should try being an "excellent teacher" with someone new?


Originally posted at http://stuffthatneedssaying.wordpress.com/2014/09/12/beginners-luck/. Please comment there.
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2014-09-05 08:38 pm

Distraction and Relaxation

In my previous post, DBT Freed Me, I mentioned having created distraction and relaxation plans.  There are many more ideas in The Dialectical Behavior Therapy Skills Workbook, which I'm using, but I thought I'd share my personal plans as a preview of what you might encounter in the book.

DISTRACTION PLAN

  1. Squeeze a stress ball.

  2. Recite the Fibonacci sequence.

  3. Remember happy memories in as much detail as possible.

  4. Hold ice cubes on wrists.

  5. Get out of the house and sit outside.

  6. Write thoughts in a journal.

  7. Listen to upbeat music and dance and/or sing along.

  8. Recycle old papers.

  9. Cook a new recipe.

  10. Help someone with a chore.


RELAXATION PLAN WHEN AT HOME

  1. Play with your pets.

  2. Run your hands through beans, sand, beads, shells, etc.

  3. Listen to a white noise machine.

  4. Turn on a soothing TV show and just listen.

  5. Burn scented candles or incense.

  6. Eat your favorite meal slowly.

  7. Create a Pinterest board full of inspiring images.

  8. Cook food that has a pleasing smell.

  9. Try a new food.

  10. Go through magazines and books to cut out pictures for a collage.


RELAXATION PLAN WHEN AWAY FROM HOME

  1. Carry gum or hard candy to eat when upset.

  2. Suck on an ice cube or ice pop.

  3. Carry something soft or velvety to touch.

  4. Rub a worry stone.

  5. Wear scented oils that make you feel happy.

  6. Listen to saved voicemails from family and friends.

  7. Listen to soothing music.

  8. Take a photograph of something beautiful.

  9. Make collages on index cards to keep in your purse or wallet.

  10. Go someplace where the scent is pleasing to you.


virginia-beach

One of the relaxation exercises asks you to choose a place, either real or imaginary, that makes you feel safe and comfortable.  At peace, in my words.  Then you are to review the details of that place using all of your senses.  My place is Virginia Beach.  I see the sun rising, the surfers out at dawn.  I hear the waves crashing on the shore, the seagulls vocalizing.  I smell the salty ocean water, the popcorn stand just down the boardwalk.  I feel the temperate breeze, the sand squishing between my toes.  I taste the salt water taffy, the cinnamon bears from a nearby candy shop.
Originally posted at http://stuffthatneedssaying.wordpress.com/2014/09/05/distraction-and-relaxation/. Please comment there.