I guess I should have read the second part of the last p-docs report a little more closely. She says it’s not bi-polar, but Persistent Depressive Disorder. I’ve never been manic and the hypomania symptoms I’ve experienced are common with Borderline Personality Disorder, especially as one comes out of a deep depression. So the official diagnoses are as follows: Borderline Personality Disorder, C-PTSD, Persistent Depressive Disorder, and Generalized Anxiety Disorder. What I’m really curious about is how, if I’m not bi-polar, the atypical anti-psychotic is working. I’ve done some research into it, and as best as I can figure, it acts as a mood stabilizer, even in the absence of bi-polar or schizophrenia, as an adjunct to the anti-depressant. Which may or may not work without it. I’ll find out soon enough. My GP has a referral in for me to talk to the p-doc about lowering my medication. I’m on 20 mg of escitalopram (Cipralex), 20 mg of aripiprazole (Abilify), 4 mg of prazosin, and 1mg of clonazepam (Klonopin) as needed. The prazosin and clonazepam I’m fine with. I enjoy my nightmare free sleep. And I only use the clonazepam once in a while. I’ve been using a lot of it for my dentist appointments, but now that I have my partials, I only need to go every four months for cleanings. It’s the aripiprazole that I’m mostly concerned with. It’s a strong dose to be on, especially if I’m not bi-polar. I’ll probably need to be on an anti-depressant for the rest of my life, I can understand that. But if possible, I’d like to minimize the doses. The longer I’m on the aripiprazole, the more likely I am to get Tardive Dyskinesia. I’m already starting to get very slight hand tremors. Not bad enough that my doctor is concerned, but they’re still there. We’ll see, I guess.
Last week we talked about about how my therapist recommended I start reading about Poly Vagal Theory. That was quite the rabbit hole to send me down. I learned a lot about myself. About my emotional parts, about my dissociative states. My therapists have always expressed awe over the mind’s ability to save itself. I have always looked at is as a failure. Every time I dissociate, I associate it with failure. My failure to stay present. I have never been comfortable with my EPs. They make me feel crazy. But you can only hear so many professionals say that it is an incredible thing your body does to protect itself, before it starts sinking in. And that it wasn’t a choice. That seems to be the key that finally got hammered home. IT WASN’T A CHOICE. My body/mind connection were threatened, and the option that led to my survival was collapse, or fawn. One that isn’t talked about near enough. Everyone knows about fight or flight. But the other two pieces, freeze and collapse, not so much. And when it’s your father that has you pinned to the bed, beating you until you can’t breathe, you can’t run, you can’t fight. Freezing does no good, so you collapse. And it happens so often, that you start shutting down at the slightest threat. And then you start shutting down all the fucking time. Talking about the weather? Shut down. Having a shower? Shut down. Playing with your kids? Shut down. Having sex? Forget it. Fucking shut down. You learn to fake it, but those closest to you can tell something’s not right. Your kids ask why you keep staring off into space. As for sex, why bother? You feel desire, but it’s never really sated because you can’t stay present for the act. So you become hypo-sexual. Which is okay, because the meds you take for your depression and C-PTSD kill the libido anyways.
But back to this new approach I was talking about. A new way of looking at my self. Appreciating how hard survival was. From a young age. And then the abusive three year relationship at fifteen. The date rape three years ago. All of which contributed to my C-PTSD. And now I have an appreciation for just how hard my mind worked to keep me safe. And that I didn’t out and out split, I just have different facets that need care.
And I can do that now. Start to take care of myself.
It’s the eve of my last therapy session for three weeks while my therapist takes a well deserved vacation. After tomorrow, I will not see until the first week of October. My last sexual assault occurred the end of October three years ago, and I still start having issues around this time of year. Tonight I even coloured my nails as a distraction attempt. So she’s going to know tomorrow that I had a rough night tonight. And she’s going to think it’s partly because of her, and, honestly, I don’t know right now.
I understand she needs her time off. She’s a trauma therapist, so she deals with horrible horrible scenarios every day. But part of me still feels abandoned. Which is a very vulnerable feeling. I hate feeling vulnerable. Absolutely hate it. And if she asks me, I’ll lie. Because I know I’m not being abandoned. She’ll come back relaxed and refreshed and ready to dig back in. And maybe by then I’ll be holding myself together better and we’ll be able to start EMDR again.
We haven’t done EMDR in months because I’m so fragile. I suffer from major depersonalization and I zone out a frequent amount. As my hourly mindfulness checks have shown me, more often than anyone realized. Yes. Hourly mindfulness checks. I have a timer set to go off every hour. When it goes off, I ground myself, take a sip of water, and notice something I can hear. There are many, many times the alarm gently brings me out of the zoned state I’m in. Years and years ago, I used to come to in a totally different place than I “zoned out” in. The worst time was when I was at my friend Josh’s house, and next thing I know I’m down by the lake, in a city twenty minutes away from his house, down a busy highway.
Fortunately, those days are gone. Hopefully for good. Every day I feel a little stronger, a little more together. Eventually, we will start the EMDR again. Sooner, rather than later, if all goes well.
It’s kind of cool, at the end of the week, to look at your weekly pill box and realize that you haven’t missed a day, and it’s been a few weeks since you missed a dose. For someone like me who struggles with med complaince, this is huge. And I’m still struggling. I’ve been feeling pretty stable the last little while, so the first thing I think of is, “I can go off my meds!” Of course, my therapist,the wonderful grounding presence that she is, immediately responds with, “Maybe it’s your meds making you feel this good.” So, of course, I bring it up to my GP, who handles my meds. “I want to see you stable for a longer period of time. And back to work. Maybe once you’ve been at work for a year we can look at tapering back a bit.” Talk about feeling deflated. Stupid brain. Can’t make it’s own feel good chemicals. And I know, I know all about the comparisons to heart medicine or diabetes. The brain is just like any other organ that can, and does, malfunction. And there is nothing wrong if your brains happiness needs a boost from the wonders of modern medicine. But I have to wonder, if treated today with our vast assortment of chemical bliss, would Van Gogh have painted Starry Starry Night? Would Byron and Poe have been so eloquent and prolific if their fits of melancholy were treated with modern medicine? Would Shelley have written oh so beautifully? Byron was well aware of the connection between madness and creativity. He wrote, “We of the craft are all crazy. Some are affected by gaiety, others by melancholy, but all are more or less touched.” Sure, there are many examples of people being medicated and having successful careers. A quick google search provided me with the names of ten poets currently living with mental illnesses. I wonder how/if they’re all medicated. My medication makes me dull, and creativity is hard. When I’m unmedicated, the words fly to the page easily, too easily I’ve been told. Those words are hard to follow, syntax becomes strange. Even given the free nature of verse, mine becomes difficult to embrace. Kay Redfield Jamison writes quite freely about her battles with bipolar disorder. She knows the dangers of not being med compliant. Yet she wrote a whole book, “Excuberance”, about the very thing lacking in my life with my meds. I tried lithium, but the amount I needed in my system to keep it at therapeutic levels was too high, and the side effects too great. So I’m on the mood stabilizer aripiprazole, to help boost the anti-depressant that I’m on. And I can’t tell which one makes feeling deeply and passionately difficult. So for the sake of my mental health, my creativity suffers. Some days I have to ask myself is it worth it. Then I look at my two boys and realize a subdued mom is better than no mom.
Last year my doctor sent me to see a psychiatrist for an assessment and med adjustment. He’s generally a decent general practitioner, but we’ve been struggling for years to get me stable. I have a history of needed to take three months or so off of whatever job I’m doing because of stress. My previous therapist thought I might have a type of bipolar. No one was sure, so off for an assessment I go. PTSD, depression, anxiety, borderline personality disorder, and cyclothymia. Which I didn’t understand. I get depressed enough that I’m suicidal, and I’ve made an attempt in the past. That being said, a mood stabilizer in conjunction with my anti-depressant has made all the difference. That, and I’m now working with a trauma specialist. Doing EMDR. This year, I went for another assessment. A different psychiatrist this time, who read the notes of the previous one. Saw me three times, instead of just forty minutes. No bipolar diagnosis this time. PTSD, persistent depressive disorder, borderline personality disorder, and general anxiety. Says my symptoms of BPD overlap a lot with the BP, and that the meds often work in tandem together when the antidepressant isn’t enough even without the presence of bipolar. We talked about the BPD diagnosis, and the main reason for the diagnosis is history: self injury, suicide attempts, and, most telling, the feelings of self-loathing and feeling empty and numb. She said with the amount of trauma I’ve experienced, it was inevitable that I would wind up with BPD. So now I’m struggling with yet another identity, one that I have avoided for years. I remember my ex yelling at me, at one point, “I’m not the only borderline here”, yet I was the only one actively seeking help. My therapist told me not to worry about the diagnosis. It basically means I have C-PTSD, (Complex Post Traumatic Syndrome Disorder) and I’m doing the hard work to get better. So that’s something at least. It explains these long, empty nights where I feel so numb and the siren call of self-injury is so strong, even though I’m not feeling depressed. Just numb.
How good it feels to be away from the edge of The Pit. Despite being mostly housebound due to inclement weather, I have been feeling pretty good. Maybe because I haven’t had to be social. Who knows. I’m enjoying it while it lasts. Can’t help but wonder, though, if this is a shift toward hypomania. the pdoc I saw didn’t see a bipolar diagnosis. Borderline Personality Disorder, Complex PTSD, Generalized Anxiety Disorder, and, finally, Persistent Depressive Disorder. She said there is a lot of overlap with BP and BPD, so sometimes it’s hard to get a clear diagnosis.
A new year always brings with it some reflection. I’m not the type to make new years resolutions,; my goals change as I grow and change. And I wanted to take the time to give thanks to the woman who led me through the darkness to the light. I wrote a poem for her, and gave it to her just before we broke for the holidays. She never said anything about it, so I should probably not be embarrassed by it. I thought I’d share it with you.
A ship with a broken compass
Tossed on the waves
Hither and yon
Trying to find my way
By a North Star
Lost in a sky
Of darkness and despair
The clouds thick
Blotting out the light
Along came a guide
Showed me how to mend
That broken compass
To fight my way
Back to the light
Behind the clouds
The siren song
Is still loud at times
But I have a gift
With grace and skill
To heal the wounded