Across and Inside my Universe

I Herd You

I went to what I thought was a support group that my psychiatrist runs, for adults with AD(H)D.   It turned out to be group therapy.

She had an agenda, that she guided and directed the group through and towards.  She lectured from time to time; she drew conclusions and presented them as "the" way to feel & think about things.

In some ways, she was as indelicate as a bull in a china shop; however, there was also a sharp mind behind the questions, conclusions, directing.  She knew what she wanted us to think, and she took us there, by leading, pretending to guide, snapping at our heels like a sheepdog if we weren't quite drinking the Koolaid she was dispensing, by running us into the pen she had decided was where we needed to be.

There wasn't much support, and what support she gave to others in the group eventually morphed into her adapting what they'd said, into her agenda for where she wanted things to go.

Now, before this group session I'd had an appointment with her, which went fine, since we'd made some things clear last time.  Such as the notion that I am my own person, in my own life, and I am the best one to decide what works for me, and not her.

That obviously applies to anything, but when you go to a group thing like this you try to leave yourself open to learning something, gaining some support, or insight, or something . . . by the time you realize there's a sheepdog at your heels, you've gone a ways down a path that may not be for your good.  You do your best to keep from bursting into tears through the rest of the appointment, to keep from going where it is that the sheepdog is pushing you, but you are already falling down that mountain.

So there's a knife in my heart, and you'd think it'd be relatively easy to pull it out by discounting the source; obviously she's not a sensitive nor observant nor supportive nor respectful therapist.  Why would one give much weight to what she wants, what she says?

It's not that simple, however.  I wish it was.  See, the things I thought and felt, the places I went to, the conclusions I found, well, there's a train of thought and feeling that I had during this process.  Both she and the group were stimuli in that process, but I can still follow the path in my mind and heart that led me to a really bad place.

I am having difficulty discounting that, erasing it, setting it aside, or whatever.  I can't un-think how I got there.

I feel it's a therapist's professional responsibility to not command the direction of things, to not make conclusions AND present them as what IS, to not herd you towards a prticular destination.

A good therapist, even if they had a particular destination in mind for you, even a general one, that they felt was healthier for you, they would discuss things, perhaps point out paths you might not have considered, discuss how you feel about them, objectively weigh the pros and cons, but they'd never take the reins and grab you and pull or shove you down a path of their choosing.  That's part of what I mean by herding.

I feel like a therapist should respect the vulnerability of the patient(s) and use care and concern, among other things, when working with them.

To not just willy nilly, but purposefully, push patients down a path that they don't know where it's going, and by the time they have some idea they are so distressed that just about anything at that point will settle in and try to take root . . .that is bad therapy, at the least.

Of course, I'm an adult and not just turning myself over to go wherever she wants, but I didn't realize until after this happened, how vulnerable going to something like this makes you, even if you are nervous, scared, and wary.  I had made a decision some time ago to try to learn what I could from whatever the source, sometimes having to set aside my feelings about the source and just consider the infomation.  This, too, made me vulnerable, besides all my other psychological/emotional issues.

I ended up in a very bad place.  Much of that is me, but the therapy itself and the manner of it, is also a big factor.

I'm starting to think, now, that what she said in our amicable appointment a month ago, that whatever she says, it's my choice what I decide is useful for me, is partially an excuse for her brash, forceful "therapeutic" manner.  That she can excuse quite a  few things by saying or thinking that the patient can chuck it all out, if he/she wants. 

If this is so, then she's at the least rather irresponsible.  The people who go to see a psychiatrist are often vulnerable in a variety of ways, and many are not equipped to fend off or sort through her forceful assertions, her "therapy" if you will.

So I think that her expecting her patients to be confident enough and self-aware enough to discount what she says if it's not best for them is disingenuous at the least, irresponsible and harmful at worst.

Second Psychiatrist Appointment of the Year

This was in June. 

Since I'm going to be seeing her again this next week, I'd better update the blog with this exceptionally positive step forward in our relationship.  Not perfect, but positive between her and I, to this degree, was unexpected.

I even brought up being afraid of her, and the last time I did THAT, she yelled at me.  Things went much better, this time.

She was running late, this appointment.  It was late in the day, and my appointment was for 5:20.  When she came out of her previous appointment (I assumed) right then, I prepared myself to get up and go in.  Instead, on her way back to the office, she called to a different patient, and as she passed me she apologized for being behind.  I indicated I understood and that it wasn't a problem, which she seemed to appreciate.

I could see that the next people to arrive, were startled/surprised to see that someone else (me) was called in, at the appointment time they thought was theirs.  I believe she apologized to them as well.

I like that she's conscientious of her patients like that.  It gave me the beginnings of a feeling inside that maybe today might be less confrontational in the past.  Just an inkling, really.

I forget what I first mentioned, which is a shame because she usually starts our discussion with something springing from that.  Ah, I remember, she commented on my positive demeanor as I settled myself on the soft green couch.  This startled me; she was the second person in three days to use those words to describe me.

She asked about it, and I said maybe it was from having dealt with formal church discipline and now it wasn't hanging over my head, I could move forward?  I'm not sure why I said that; it still hurts deeply, but with a bit of time I've come to see that actually it is better, now, moving forward with that behind me.

She went on with the discussion for a bit but her curiousity had been peaked and she had to return to the church discipline thing, ask about it, what it was, how it worked (briefly, very), why/what for, and such.  I had thought what for would be obvious, but I briefly, in about 40 seconds or so, described the situation, including that they were disciplining me for doing something for which my mania was a contributing factor.

She got indignant on my behalf, saying things like, "Mania is part of your illness; you enter an altered state of mind!"  She went into this for a minute or two, aghast that they would penalize me as harshly as they did, for something she feels was . . . well, that I wasn't in my right mind for, wasn't acting completely from who I'd choose to be were it not for the mania. 

For myself, I've always taken responsibility for myself and my actions as soon as I return to a state of mind where I can do so; however, I didn't frame it that way for my clergy, lest they think I was trying to not be responsible.  I was being responsible, but  . . . I framed it as, the mania was a contributing factor.

She went on to tell me that I should educate my Bishop and congregation about my illness and the way it works.  No one actually has ever outright said to me before that you go into an altered state of mind.  It would be nice if sometime someone would actually tell me more about it; yeah I can read on the internet, but I need a doctor to tell ME. 

My first shrink to my face thought I was borderline, not bipolar, and when I said that to my psychologist he pointed out that, well, he prescribed a mood stabilizer, and that'd be unethical if you're not bipolar . . . I never thought about it til now, that after that I just went into symptoms etc. with each new psychiatrist, and never asked for any education; no one had ever explained anything to me.  I got more explanation from the government-contracted shrink who evaluated me for disability than I did from anyone else, ever.

So, her advocating for me, showing that she cared that people had/were judging me for things that at the very least were influenced by mania, and that she was indignant that they wouldn't know or consider my illness to be much of a contributing/mitigating factor at all, well, this made me feel good, and more importantly, made me feel more connected to her as my doctor.  This strengthened a . . .turbulent therapeutic relationship.

As she made some notes and asked something to further our discussion on other stuff, I worked in my issues with her (some of them), such as that I was intimidated by her, scared of her, and that when she threw out advice to me as to stuff she thought I should be doing, stuff that I felt didn't fit my belief system (like the previous appointment's ridiculousness where she told me working on my marriage and family was selfish, I should look to serving others instead, I took this as her karmic point of view), that I felt like they were harsh, rigid orders and that she didn't understand or accept that I needed to take what I could from her advice, sort through it, despite any difficult feelings about her manner of presentation, and keep what worked for me and set aside what didn't.

She heard me out, and seemed a bit astonished that I didn't know that she wasn't ordering me at all; that she said what she did, and that it was my life and my decisions about what to follow and what not to.  That of course we're from different backgrounds, and that it's my life, I"m the one living it and not she, so who better than I to sift through what she advises and make my choices.

I was kind of stunned; I thought that if only we could have had this conersation 18 months ago!  I was so bouyed by her remarks I added some other things to the discussion of our relationship.

As far as meds, at our first appointment this year I had just gotten to 150,g Lamictal, with a mild non-sunburny rash.  In a different place than the last two times (and according to my hairdresser, there's an allergic-looking rash on my scalp, too).  I said the Lamictal was doing ok, though I needed more time to be sure.  I actually mentioned adding Seroquel; we'd tried it two years ago for depression, which it did not work for.  I didn't have any noticeable side effects except for being sleepy alot.

She said, "I thought we stopped that because of your PCOS?"  I was confused; what does Seroquel have to do with that, does it make it worse?  I ignored asking that and said, "No, we stopped it because it wasn't working for the depression; however, isn't it supposed to be a mood stabilizer, work on mania?  It didn't cause me side effects other than tiredness, so what do you think of trying it again?"

I went on to mention, a bit embarrassedly that I'd seen on someone else's blog that they were on these two meds.  Of course there's no guarantee they'd work well in combo for me.  Still, she seemed to want to know all of why I was asking, and so I told her. 

She was very open to it and, in fact, had prescribed the Seroquel at our first 2012 appointment in May.  At the June appointment, she asked if the meds were smoothing me out, making me serene.  They were definitely helping, and I told her, but I wasn't what I'd call serene.  In fact, I wondered if we needed to raise the Seroquel?  She held it at 150mg for now, and after some key things during our appointment had made her actively diagnose me w/ADD herself, instead of relying on other shrinks' diagnosis, we discussed Vyvanse.

I'll be trying it at what is it, 30-40mg?  Since the 70 I'd been on was seeming to be too much.  I'm just in a mess of getting the new dose approved by Medicaid, and dealing with her incompetent secretarial substitutes as her main secretary has been on two one-week vacations in 4 weeks.  UGH.  I may not have the prescription by this appointment!

Oh, one other BIG thing, is I will be going to a monthly group she holds there, for ADD adults.  No fee, at 7pm.  My appointment is at 6 or 6:30.  I'm nervous about this, but somewhat less so after clearing the air in our relationship.

What a Not So Beautiful Mess . . .

To riff off of a Diamond Rio song title . . .

I'm being brave in posting this. I want to track my progress on organizing this, although the rest of the house is a mess too (mostly not as bad, but this is BAD, so that's not saying much).

This is the master bedroom in our apartment. Much of the mess is craft items, information, patterns, and publications. There's a big variety of crafts and materials: Beading/jewelry making (including chain maille jewelry), knitting, crochet, spinning, and weaving (that's a four-shaft table loom under a makeshift dustcover), Rubber stamping, scrapbooking, and a variety of paper crafts, with a variety of die-cutting stuff (including a Cricut, a . . . robotic die cutter, if you will, for those who aren't familiar with this stuff), and a big wooden rotating tower of ink pads, reinkers, ink pens, and other things.

I have fabric in various places in the room, handed down from my mom when she was clearing it all out; I have no sewing machine though except a tiny one designed for stitching in scrapbooks and on other paper crafting projects. The fabric has come in handy for a variety of my daughter's school projects, though. I've even saved jeans she's outgrown, and jeans of mine as well, for a variety of recycled/upcycled craft projects. It's a good thing I saved some of my jeans that I'd lost too much weight for, because I gained the weight back and needed them. Lol. I'm working on losing weight again, though.

I have a couple drawers of adhesives, from a Xyron laminator/magnet maker/adhesive applier, foam tape, masking tape, double sided tape, photo corners, glaze-type glues, rubber cement, tacky glues, post it note glue, glue for metals, and a whole host of other adhesives for different purposes, materials, etc.

The thing about all these crafts, is, the last two years mostly doesn't count for me not touching them much, due to a year and a half of surgical recovery; with all the pain knitting simple garter stitch was the most I could handle, and I've picked it up now and again. Also, the last two years my husband's been either out of work, or at two couple months long temporary jobs . . . with jewelry making, buying the findings like jump rings, crimps, clasps, bails, etc. can add up, and so as with some of the other crafts, running out of consumables has limited those.

Also, I suffer from a variety of mental illnesses, disorders, etc. You'd think an OCD person's bedroom would look neat, but then there's ADD, bipolar with lots of depression, etc. and everything's overwhelming. These issues also lead to a lack of desire to do anything, including favorite interests and hobbies. My therapist has recommended I not ditch everything, since once (or if, in my mind) my depression improves I'll regret having gotten rid of everything.

SO. With that in mind, I'm analysing how often I've used stuff, over the last 6 years or so, and factors affecting that, in order to help with what to ditch and what to keep. The last couple years it's been mostly knit, with a little crochet and a moderate amount of weaving. A little spinning, too. The couple years before that, there were sporadic bursts of rubber stamping (often related to mania, but not always), mixed with alot of knitting and the like. Also alot of beading/jewelry making during that period. The couple years before that, was when I started the jewelry stuff, as well as the knitting/crochet/tiny bit of spinning. Scattered Rubber Stamping as well, with a year of digital scrapbooking. It's been longer since physical scrapbooking, but that's mostly due to organizational issues (ie, I can't find my stuff) as well as some money factors (do you know how much the scrapbooking and stamping industries make? It's ridiculous. TOO many commercial products, I think a simpler, less expensive approach will suit me better.

Still, at some point when you're in an apartment, you can't just leave all that space being taken up by stuff you don't use . . . I need to figure out where to draw the lines. It's gonna be hard.

I can do it, though, one step at a time. I have a budget of $200-$250, from birthday and special occasion money I've saved up for awhile. That doesn't seem like much compared to all the stuff in there; some small portion of which needs to go in other rooms.

There's SO MUCH organizing info out there, though, that it's overwhelming. I'm starting with a blog or two, like http://iheartorganizing.blogspot.com/, which has some great ideas and showcases a variety of organizing products, ESPECIALLY in use, so I can get an idea of what may and may not work for me.

Wish me luck? And also, that I don't get so overwhelmed I just quit.

No judging my mess. I should have an apron that says that . . . lol.

Next post on this project will be the list of stuff that I've come up with that needs doing in there. Although, with the rest of the house being a mess too, I'm not sure what I'll do with the stuff that gets kept but goes in another room, before I've cleaned and organized the room it goes in so there's a place for it . . . . it's like a Mobius strip. Or MC Escher stairs.

Updating the Blog When You Have OCD

I spent 4 hours updating the blog today, and several the other day starting to add tags/categories to posts.

The thing is, I look at the Category Cloud and I can see a couple I can get rid of, which is good, but then the urge to add more as I categorize further back is hard to resist.  It's kind of frustrating and a little embarassing.

Much of the time spent today on the sidebar widgets, was spent super-fine tuning the size or the details like the order the books are shown in, their size, etc.  I think I spent two hours alone on the boardgamegeek widget, although that one required more primitive-level tweaking in the code itself.

It's going to take me some time to add categories to older posts; hopefully I can do just a few at a time, and not feel compelled to do a year's worth in one sitting . . .

My OCD is acting up, partly because I've been taking my Vyvanse, that lets it come out a bit more when I'm more active, and I'm under a huge amount of stress.

 

The Cheapest Care Possible

I don't want to offend any nurses out there, especially the ones who can prescribe.

BUT, when you have as many co-morbid (proper term?) psychiatric conditions as I do, AND especially when you have as many chronic physical health conditions as I do, you really would feel most confident having a psychiatrist, an actual DOCTOR, prescribe your psych meds, since you have so many conditions and medications that can interact with each other.

Now, as I'll apparently be seeing an A.P.R.N, which is a psychiatric prescribing nurse? I'm sure that they have extra education for that, and plenty of experience since they are working for the county's behavioral health system, and see the most disabled and/or severe cases, since they only serve those with Medicaid/Medicare. Lots of people on disability with either of those insurances, so this would be where they go . . . the LCSW I saw for intake interview went out of her way to reassure me that the nurses see severe cases and are very capable (does this mean she thought I was a severe case, or just that knowing they treat severe cases all the time means they are competent to treat anyone?). I got the impression that seeing a nurse instead of a psychiatrist for meds is something alot of people aren't the happiest about.

Anyway, while I'm sure these nurses are capable in many cases, I just feel like I have so much going on both mentally and physically that I'd only be really comfortable knowing a doctor was seeing me; how can I know that these nurses know enough about all the physical health stuff besides the mental health stuff to be able to manage all the issues?

Then again, who WOULD be happy that they'd be seeing a nurse for what they've traditionally thought is a doctor's role . . . I think this is partly based on that, but still . . .

There is part of me that feels like, because this is a government-funded mental health care system, as well as government funded reimbursement for them, that this is why they use the lowest-level providers possible; I was told that they do have ONE psychiatrist, but I'm guessing he only gets sent the most complex or resistant of cases. I was told I'd be seeing a nurse.

I feel like, because I am dependent on government assistance for this, that I will be receiving a lower, cheaper (not necessesarily incompetent) level of care than I would if I had private insurance. I don't think you can argue that these nurses AREN'T less expensive than psychiatrists, which means they are cheaper (although I am not trying to imply that their care is valueless or without dedication, expertise, etc. - it costs less and is less educated than a doctor/psychiatrist, though, is all I'm saying). This makes me feel like I am a second-class citizen, but then, without regular insurance, I kinda feel that way anyway.

I'm sure if something like this was posted over at Shrink Rap, there'd be an outcry from prescribing nurses, and maybe even non-prescribing ones . . . the thing is, though, I feel that prescribing nurses should SUPPLEMENT what a doctor does, not REPLACE them, and it feels like in this case they are being used as replacements. THAT is what feels wrong to me, what feels like I am being given the least expensive care they can get away with.

I'm also annoyed at all the hoops and forms I have to jump through and deal with just to see a nurse . . . I'm sorry if that offends anyone, nurses are very valuable, but I do NOT, I definitely do NOT see them as the primary provider of the medical side of my mental health care. I do not think that is appropriate.

I'd prefer something like initially seeing a psychiatrist, or a psychiatrist with the prescribing nurse present (they'd never do that last, too expensive) for the first couple of appointments and then see the nurse the rest of the time, with maybe a twice yearly check by the psychiatrist; more often if moderate to high problems come up. THAT seems like it'd be more, well, working with both a doc and a prescribing nurse . . .

I guess this post is amounting to a big whine, that might affront a variety of nurses . . . but it's how I feel, and I don't think REPLACING psychiatrists with prescribing nurses is a good thing for mental health care. Supplementing, okay, I can work on getting used to that . . .

I'll have to get used to seeing just a nurse, I guess, but I will not be happy about it. And here I thought I'd come to a new, more open mind about my next shrink, about being more open-minded, more open to different personalities and learning whatever comes to be learned from them. Turns out, I don't get a shrink at all. I'm feeling like I, and other Medicare/Medicaid people, must not be worth it, in the eyes of the government and the people who vote in the people who fund or restrict how such places are staffed.