Across and Inside my Universe

Bipolar Extremes: Responsible or Not?

That title is very black and white, is it not?

In a recent Psychology Today blog post, entitled The Elephant In The Bipolar Room, it is proposed that what if the paradigm regarding whether bipolar people caught in the extremes of their illness, the dark depressions and the really high manias, shifted from the view "that we are incapable of remaining in control when mania and depression reach a certain intensity", to something like "what if we could be highly functional while manic or depressed?"

They then go on to talk about how this might lead to, rather than being focused on the dis-abledness of being bipolar in the 'can't control one's behavior' paradigm, in which the goal is to remove the bipolar symptoms as much as possible, instead being focused on the capability of the bipolar to function during intense states of mania and depression and why some cannot (and how to change that from a behavioral perspective).

This was one of the first major internal struggles I had, and still have, regarding my bipolar diagnosis, living with it, trying to be able to live with myself (and behaviors influenced by the illness), and still hold to a standard of personal responsibility. 

One of the first really hard-hitting notions that struck me was that if I was bipolar, I might be more likely to sin than other people.  This distressed me greatly on a variety of levels, and I was quite upset about it.  However, eventually I followed a path to realizing that IF the illness meant I might sin more than other people, the Savior's atonement would make me the same as everyone else.

That's a gross simplification of the repentance process, including ignoring the fact that to repent, you have to take responsibility for your actions, among other things.  Not just sinning and saying while you do, "Oh, I'll repent later . . ."

Still, that was one big, early concern, and a nice, spiritual answer to it.  My struggles there were more about worrying that I'd be a bad person and the relief I felt when I realized the Lord would make me as everyone else, than it was about trying to dodge personal responsibility for my actions.

The issues and struggles I had, and still have in some ways, with issues of, "Does the illness become so severe that my judgement is impaired, say, as if someone was forcing you to get drunk, and then you did irresponsible and bad things?  If someone forced drink or drugs on you, I'd think you wouldn't be responsible for your behavior.  It is my feeling that IF the illness tampers with the judgement center(s?) of the brain, then how can you entirely have been said to be acting and choosing to behave in a manner that you would choose if the illness was NOT tampering with your judgement?  My psychiatrist in fact says that your (my) brain goes into an altered state, when manic and such . . . she is of the view that you can't be held responsible, in that state.

On the other hand, though, I was raised to take responsibility for myself.  There's also the spiritual implications . . . involving repentance, and other things.  In my religion, I was raised that we on earth have free agency.  We have the agency to choose, and behave in ways that we are responsible for.

Do I feel that there are illnesses that can impair, interfere, or even take away your ability to choose as a competent, capable person?  Yes. 

Would you hold someone responsible for running out into the street and causing a car crash, if internally they truly, really believed that they were super strong, invulnerable, and there was a baby crying in the middle of traffic that they had to save?  I don't think so.  I know I wouldn't.  They'd need some psychiatric help, if they survived, but I wouldn't judge them.

On the other hand, things are not often black or white, that clearcut.  I believe that choices can be made that may be influenced by your illness, but that you still could choose to avoid the bad behavior, although it's much, much harder to do so than if the illness wasn't coloring your entire experience of the world and how you interact with it.

What I eventually decided for myself, without having answers to some or all of these other aspects of the issue, is that I will always take responsibility for myself, as soon as I return to a state of mind where I can do so.  This implies that perhaps I feel like I enter states where I feel like I'm not responsible; I don't think that's how I'd put it. 

I'd put it more like . . . . your instincts to be responsible, apply the rules of life that fit who you are when not ill, are either hidden by a cloaking device, or covered in camouflage.  At your manic worst, you don't even realize there's something you need to search for, if it's really really bad. 

At somewhat lesser levels, it's like a Where's Waldo picture, sometimes you can pick Waldo out right away and/or easily, and sometimes you put alot of effort in but have a really hard time finding him.  Sometimes it takes just a moderate, but sustained effort.

This is where AA's HALT comes in: Hungry, Angry, Lonely, Tired.  If one or more of these are present, it's going to blur your focus on the Where's Waldo hunt.

These aren't perfect analogies, by far, but they're the closest I've ever come to being able to describe how these issues, and mania, are experienced by me.

Back to the Psychology Today post:  I think it's beneficial to question the prevailing view to see what might happen if people or society took a different view.  I don't think it's as simple as one view or another; I think life, and illnesses, are sometimes messy, and a balanced view would be somewhere in the middle, but with an open mind to looking to learn from those who seem to have learned to function during their manias and depressions (managing these (including w/meds) and learning when to take care of self, being part of this though), as well as having compassion for and working with those who seem to be unable to cope in the specifics of their bipolar illness.

Not judging either end of the spectrum, nor the middle, but learning from all positions, from the variety of shades of grey, understanding that there's a wide variety of experience and illness.  Some may be much more impaired than others, some to degrees that many people might not understand.

This subject really has felt like an elephant in the room, to me, for a long time now.

What's My Problem?

Why am I so upset about the group therapy?

It's not the end of the world if I'm faced with something unpleasant about myself, however awful it feels or seems.

It's not the end of the world if I feel as though I was manipulated by the psychiatrist.  Would it have been better if she hadn't done so? (If she actually, intentionally did; manipulation is in the intent.)

Sure.

Is it any surprise to me that she's insensitive, dominant, strong in her opinions, outspoken about them, and has a definite idea of what she feels is best?

Put that way, no, no it's not.

It's never fun to be receiving such things, from a doctor no less, and even more difficult to bear, from a psychiatrist.

Still, I can discount some of her "authority" by thinking of the above things that should not surprise me anymore.  Why would I put alot of weight on what someone like that says, if it's not specifically medically related?  Ie, if it's not medical advice she's giving me but therapeutic (both are medical in their way but I think you know what I mean).

So regardless of how she was, as I discussed in my last post, I can follow the chain of thoughts that led me to a very bad place, to a very . . . difficult view of myself to approach, let alone investigate.  That makes it hard for me to discount anything, and so leaves me with a feeling similar to the picture up above.

I feel kind of like it would be healthiest for me to set aside this difficult, painful view of self for awhile and just keep on plugging away, step by step, at improving.  It's hard though because this thing wants to pull out the rug from under me and just bring everything crashing down.

Perhaps I'll gain some more perspective and/or distance from it in therapy tomorrow.  I feel like I've already gotten a little, as I'm not flailing around emotionally, as much as I was.

Still, I really do not need another really bad thing to think about myself, when I get suicidal, to pile on top of the other really bad things I think about myself.

Life however doesn't care how many bad things come your way, it just goes on.  So I need to as well, hopefully putting this in a better place.

My Mother Lives In Her Own Reality

My mother posted on Facebook, "My grandchildren are bright, brilliant, and they take after their grandmother."

GAG.

This is the same woman who hit me on a regular basis as a teenager.

This is the same woman who thinks she did a good job counteracting bullying when we were kids.  The subject of bullying came up recently when we were down there, and she said, "When (my sister) was in junior high, there was one time (my sister) was being bullied and I nipped that in the bud!"

She said this like she took care of it ALL.  HEL-lo!  Um, Mom, we younger three kids of the 6 kids were bullied mercilessly for over a decade, EACH!  You think you did GOOD?  You don't even KNOW what was going on!

And, I think she's forgetting the time I and my younger brother were sort of kidnapped; I very fuzzily remember that I think that was one thing she found out about, and my parents talked to one of the teens involved (just one?  why not both?).

She doesn't know I was beat up, several times, and THAT's why my glasses were broken; it wasn't because I slipped and fell in the snow . . . she doesn't know I was whipped with a jumprope with all those sliding plastic thingies on it, and that the pain from that was like a hundred stinging bees . . . and so much other crap.

CLUELESS.  Although she shouldn't be about the hitting thing, but then again at the time she saw nothing wrong with it; why would she now?  Then again, each of us kids holds a part in the fact that she's clueless; our relationship may not have been good enough then for us to want her to know?  But when older, we could have told her . . . I dunno that the relationship has EVER been good enough to tell her, though . . .

UGH ugh UGH.  Keeping my mouth shut when she exhibits her pride in her mothering skills, or anything else I've mentioned, is both hard and easy.  Hard because . . . I'd so love to verbally slap her in the face with reality.  (Hmm, the violent metaphor there, is probably not too hard to figure out why.)  Easy, because . . . she has no idea we look down on her for stuff, that these things happened (or that they were wrong), and we do, and she looks the fool to those of us who know . . .

It's sad, really, that she is so . . . out of touch.  Sad and pathetic . . . although I remember the raging mother coming after me physically and cornering me before whaling on me . . . and then I stop feeling sorry for her.

I dunno.  Empathy is good, but . . . when she throws this stuff in MY face, empathy is the furthest thing from my mind . . .

This whole situation reminds me of something one of the Mythbusters says, "I reject your reality and substitute my own!"  The difference here being that she either doesn't know she's doing it, or any glimmers of what reality is are too painful for her to face, so she lives in a constructed shell of glossed over (maybe painted over) memories.

Bedroom Progress - Small Moves, Ellie

I started in this corner of the room. Floor only, as I'm doing a mostly garbage pass, although if something's on the floor we'll put it to donate, chuck, or find a home or temporary home for it until I can tackle everything on top of everything, which is pretty much taking up the space that needs to be homes for (organized) things. These pics are the same as the previous post, pre-cleaning, but they're a visual aid.

I cleaned just about up to the small child's chair you see in the corner of the room in this picture; a bit over a quarter of the room's circumference. That small chair, by the way, was made by my dad for my daughter when she was THREE. She's in Junior Highschool now.

That may not sound like much to some, especially since it was just the floor, but I was dripping sweat after 20 minutes, and had filled a kitchen-size garbage bag.

As well, I've been struggling with just doing dishes and laundry (not even folding) on a regular basis, let alone most other chores; that's kinda one reason the place has gotten to this point. Yes, doing things consistently, or at all, is a struggle when I'm depressed, anxious, trying to distract myself from mania (although mania does sometimes result in a burst of productivity, which I'm afraid may be the impetus behind this project). Most of the time though I'm fighting the things mania urges me to do that aren't good; that means there's not alot of me left over for ADL's (activities of daily life, as they say).

Regardless of the reason for doing this, I'm hoping blogging about it will A) help me stay somewhat organized about it, B) help my sense of efficacy and build upon it as I can look at the blog and see the progress I've made, C) help keep me motivated and carrying on with this even if the urge of productivity should desert me, and D) maybe keep alive some unreal notion that my non-existent blog readers might be sending me thoughts of support.

Yeah, that last one, not gonna happen. I need to do this for me, anyway, and I recognize that. Support doesn't hurt, though!

So . . . small moves.

I've been feeling overwhelmed over the last 24 hours, just looking at the whole room. As Adam Savage of Mythbusters would say (and that's how I hear it in my head), "There's your problem!" I have problems with looking too far into the future, looking at problems upon problems (it's turtles all the way down), as if I was looking at the humongous pile of food you need to eat over the next month or year, and feeling overwhelmed by it all.

We don't eat all that at once. It's made up of smaller meals, and those are further broken down into food groups, or various ingredients, or various steps of the recipe.

You can make your moves as small as you like; moving forward, even if it feels equivalent to maybe one frog hop, is the important thing. Just because it feels like a frog hop, doesn't mean it IS one.

The first day, I made a list (a HUGE one), took and posted the photos, and blogged about this. The next day, I took one of the categories of items I needed to research selling/trading, and started that process. (I'll be trading some old collectable gaming figures for a game I want, that takes up less than 1/4 of the space the figures did; a win/win, there. Boardgamegeek.com is great for exchanging, occasionally selling, old or new games and related items.) So, a small move.

I did not beat myself up inside about how little that seemed to accomplish in relation to the whole; the urge to do that came to me as it so easily does, but I countered those thoughts with, "No, it's not too little. You are no longer stuck and you are moving forward. FEEL how good that feels after being stagnant for so long!"

And I did. Feel good, that is. I transformed my negative thoughts and feelings not just into banishing the negative, but I created positive thoughts and feelings to replace them.

My mantra going forward will be, as you may guess, "Small moves, Sara. Small moves."

(P.S. Who wants to watch that movie now? Me . . .)

What You NEED Isn't Always What You WANT

So, a while back I posted for a heat-themed Grand Rounds blog carnival that was being hosted at/on Shrink Rap. http://sarebear.typepad.com/blog/2011/06/when-the-doctorpatient-relationship-becomes-heated.htmlUgh, I tried to insert a link the regular way, and it wouldn't.

This last week, for no reason I can figure out, I was thinking about that post, and how it led me to compare my first and third shrinks, and then further led me to realize that I could stand up to my first one (male) and not my third one (female). They were both strong, intimidating personalities. My second shrink was very laid back and mellow.

I thought to myself, "WHY could I stand up to Doctor Number One, and not to Doctor Number Three?" (Names changed for obvious reasons.)

Within about 10-15 seconds, a quiet, deeply felt thought came to me in response, even though I wasn't expecting a response . . . . "Because it was standing up to your mother that got you on the receiving end of her fist." I instantly felt the deeply personal TRUTH of this, and it felt like I'd connected up an essential puzzle piece.

I pondered then, though, that, "Didn't I already "know" that my problems with her were because she raised the same feelings of fear in me that my mother did? That I had already connected up what my mother did to me, with why I was afraid of Dr. Number Three?" What I realized was, I had intellectually realized the connection between #3 and what my mother did, and I'd even told #3 that I was afraid of her because my mother hit me; however, I'd never FELT this inside. It just made sense to me knowing how transference has shown up in the last 7 years of therapy, it just made SENSE. Yet I didn't FEEL it.

THAT's what the difference was when I had this response, this realization this last week. I FELT the truth of this, and it connected everything up on an emotional and other deep levels. It's one thing to KNOW something with your head; it's another to know it in your heart, in the depths of your being, not to get overly dramatic about it . . .

So, it's been a week since that realization, and I've come to another one because of it, and that is that I can now use the word "abuse" to describe the physical, well, abuse that my mother heaped upon me when I was a young teenager (and maybe pre-teen, but that part's fuzzy). Before this, I said in therapy that I just couldn't approach that word because it felt like it was too big, too painful, that the meaning of what she did to me would crash down on me and I couldn't . . . . I tried the word on, especially after my therapist asked me if I would think what my mom did to me was abuse if I heard of someone doing the same thing to their kid, and I said yes, at first, but after that session, I realized I'd HAVE to say NO, because I couldn't, just couldn't, approach the meaning of the word "abuse" and all the pain denying it was "abuse" was holding back.

I did try to cut through the bull a few days after that session, and say, "Really? Your first instinct was to agree that yes it was abuse for someone else, isn't it just you dancing around what's going on, to later say No?" And I thought, maybe it was, but it just felt too dark and horrible . . . this was about two months or so ago (not counting the first times I avoided approaching "abuse" several years ago when I first brought it up in therapy in more than passing.)

Back to the main point(s) of this post . . . Today I was thinking that I am actually quite GRATEFUL to my most recent psychiatrist, much as I dislike her, for helping me (not consciously on her part, as far as I can tell, given her objection to the notion of transference) to make more progress on a difficult, painful issue than I've ever had. For being what I NEEDED, even if it wasn't what I WANTED.

I realized, and I never thought I'd feel or say this about her, that I am GLAD she was my psychiatrist at this time in my life; things just came together to help me learn from her, and I can take what I've learned and appreciate both it, and the fact that she taught me, willingly or not, something that I'm not sure I'd have learned any other way.

Now, I am moving on and finding another psychiatrist. Could I perhaps have learned further from her, in dealing with her and processing my reactions, about how I feel about what my mom did to me and perhaps some measure of how to get over it? Perhaps. The thing is, I also NEED a psychiatrist I can trust, and I can't trust her to be emotionally safe, or to treat me and my feelings with respect. At this point, I think the "what if" of what I could learn from her is outweighed by my need for a safe psychiatrist; that, and it's an hour round-trip to see her and since I need to ask congregation members for rides to get to appointments sometimes, I really need a closer shrink. This next one is about 15-20 minutes away, which isn't as close as I'd like given I'm asking for rides, but it's better.

I am also quite grateful to the part that Shrink Rap played in my coming to these helpful insights and things; if it weren't for them hosting Grand Rounds, and picking the theme they picked, I'd not have come up with that blog post during the writing of which I realized the things that started off this chain of realizations. So, while they may have played a small part, it is an important part, nonetheless, and I am grateful to them for it. It also teaches me that maybe I should put myself out there more and participate more in things like this . . . Anyway, thanks guys (not that I know if they read my blog or not lol.)

When The Doctor/Patient Relationship Becomes Heated

I don't pretend to be an expert on this, or that what I have to say is, in fact, all that earth-shattering on this or any matter.

Still, ever since the Shrink Rappers announced a "heated" or "hot" theme for the upcoming Grand Rounds to be hosted on their blog very soon, I have NOT been able to get the above-titled topic out of my head . . . and so, I will get it out of my head and onto my blog, no matter any reservations I have about being so forward as to submit something for Grand Rounds . . .

I have had two different heated exchanges (actually, they were alot more one-sided than exchanges, with the heat all coming from the doc) with doctors, both of them psychiatrists. One male, and my first psychiatrist, and the other female, and my third and current psychiatrist.

I think it is a negative thing for ANY doctor to yell at or harangue/browbeat their patients, but I feel that with psychiatrists, even when seeing them just for medication management, that since it is usually expected that psychiatrists be sensitive to one's feelings etc., that when they act disrespectful and "heatedly", it's even a bit MORE jarring than it would be from another medical profession.

Now, doctors are human. They are not perfect; they have feelings and good days and bad days and life crises all happening just like the rest of us. I can understand this, and, in fact, in one of the two cases I mention above, it really helped me deal with the episode. The other episode, with my current, female psychiatrist, is harder for me to deal with, and in fact it still bothers me a great deal.

Before I get into specifics, let me say that as a patient, when you are sitting there on the receiving end of some "heat", or ire, or intense aggravation, or anger, even, it is shocking, bewildering, and causes you to wonder what is wrong with you or what you did wrong, as the patient, to deserve what is happening. You are shocked because, if you've had enough dealings with this doctor (about a year, in my first psychiatrist's case, when this happened) you know that he normally conducts himself much more professionally; to see and FEEL such unfettered, intense, unpleasant emotion, directed at YOU . . . well to say it is bothersome is an understatement.

It directly impinges on trust; you wonder, as you get past some of the shock, if you can trust this professional with the most intimate things that you think and feel, things that are necessary for them to diagnose and treat you correctly. If you HAVEN'T had enough dealings with the doctor to know that they usually act more professionally, OR if some of your dealings with them have been laced with discomfort from feeling they are forcing their agenda down your throat, then as you sit there feeling the "heat" you may also end up in "survival mode", doing your best to survive what feels like a verbal assault, trying to get through it as best you can. In my case with my current psychiatrist, this "survival mode" kicked in without conscious thought, and I didn't identify it until later that day or the next day.

I guess I'm trying to say that perhaps some of the difference in how I feel about, and how I handled, the two different incidents, is based, in part, how my usual interactions with that doctor go; how much a partner in my treatment I feel I am with each particular practitioner, and perhaps partly based on my past history, in the female's case, with a dominant, physically abusive woman.

So, here's what happened. With my first psychiatrist, well, he's definitely a Type A personality as they say; very strong, very opinionated, but rather intelligent, always acting in a professional manner, even though he frequently had things to say to me that were difficult to hear. I didn't always agree with those things, but the times I did, were very profound. I don't believe the times I didn't meant he was right, I was wrong, and just wouldn't see it. I really felt that sometimes he didn't listen to me and would come to his conclusion before hearing everything he needed to to come to the most informed conclusion.

This became the basis for his going off on me, one day . . . he spent 25 minutes in angry discourse at me about how I go on too much and waste his time by taking up so much time. After getting over some of the shock, I thought, wait, isn't this the pot calling the kettle black? Who is taking up a bunch of time now? Wouldn't this time be better spent working out our apparent communication problem?

Basically, I sat there and quietly listened until he was done. The appointment ended very soon thereafter, and I was rather upset, although in some ways not . . . . because it was SO UNLIKE him. I also had reason to think that he might be personally going through some emotional difficulties, because the previous summer he'd been suspended by the, whatever the Psychiatric Board or authority is that disciplines psychiatrists. I believe it was an unfounded charge, based on a random meeting long after he'd stopped treating someone, but then, he COULD be rather aggressive in his opinions and ways of interacting (nothing inappropriate, just very assertive) and someone could easily resent that and want to punish him for it.

Regardless, after I went home that day I wondered if he was still dealing with the fallout from his suspension; I imagine it's not easy to get a substitute to cover your practice for 3 months, nor would it be easy to deal with the opinions of your colleagues once they found out you'd been suspended, and even harder, dealing with your patients' feelings about it. So that is what I suspected was going on, so I had an easier time dealing with this.

Still, at the next appointment he apologized for his behavior, saying something about he'd been going through something at the time. I accepted his apology and we moved on, though I did still continue to have problems with him not listening to me enough (yes, I could keep appointments to the 15 minutes, I didn't always go over.)

Eventually, he decided to close his private practice and become a consultant-liason psychiatrist at a local hospital; the timing of this decision was such that I knew he had to have been mulling it over that fall when he ripped me a new one. The deed was done less than 6 months after the harangue.

The second, more troubling to me incident, happened in January of this year with my third, and first female, psychiatrist. I'd been seeing her since the previous March, with a break at the end of summer into late fall. She has a very different philosophy, is an "integrative" psychiatrist, is Buddhist, and is a strong, dominant female personality. At various times I've felt like she's trying to shove some random agenda of hers down my throat . . .

In January, I had finally decided to tell her I was afraid of her. This is a good thing, no? Then the doctor can understand why I seem hesitant or other things . . . Well, apparently my "mistake" was in the type of insight that had led me to realize this; I had realized that because my mother used to physically abuse me, I was afraid of my psychiatrist since she was a strong female, with dominating characteristics. To me, the connection of the two seemed like a no-brainer . . . if one woman in your life beats you and tries to dominate you (there were reasons behind the hitting), then it may make you wary and even afraid of other strong, dominating women.

BIG mistake on my part. I told her straight out, "I'm afraid of you because my mother used to hit me.", figuring that psychiatrists are extremely familiar with the concept of transference . . . . She was instantly OUTRAGED upon hearing this and so angry it took her a few moments to be able to speak and then she assaulted me with angry questions about things like, was she my mother, what does one thing have to do with the other, and eventually she asked me if she was being scary right now . . . . by this point I had unconsciously retreated into "survival mode" and really could not identify ANYTHING I was feeling at that time; I tried, and couldn't feel anything, so I said "No.".

Well, HELL YEAH she was scaring me! Once I'd had some time and space between her and I, oh boy could I identify my feelings . . . . she was proving how RIGHT I was to be scared of her. She FORCED me to answer every question, in a way that made me feel stupid and insignificant, staring me down until I answered. "Do I LOOK like your mother?" "No . . . " "AM I your mother?" "No . . . " and she asked me some other things but honestly I was too traumatized to remember it all. I just remember feeling so verbally assaulted . . . .

In thinking about it now, I feel that she really missed an important opportunity, as a doctor, to connect with her patient and deal with an issue that would interfere with the doctor/patient relationship if left unaddressed. EVEN if she couldn't recognize the validity of the transference principle as something that could fit with her very strange and different philosophies, why throw the baby out with the bathwater and not stop to consider that I said I was scared of her? If she could have set aside the philosophy she couldn't stand, and seen the very real issue between us, then she would have done what was best for her patient, in that situation, in my opinion.

But, as I say, doctors are human too, and when one REALLY objects to a particular school of thought or psychiatric philosophy, perhaps that invalidated to her everything else that was attached to it in the statement I had made. I've often wondered if I had just said, "I am afraid of you", if the reaction would have been much different.

Perhaps, but perhaps not. I suspect she would've assaulted me with questions like, "Do I look frightening?" "Am I scary?" "What, specifically, scares you about me?" and when I couldn't come up with an answer, she'd satisfactorily verbally beat me down with the fact that I couldn't possibly be scared of her, just like she did this last January. But I may be being unfair; perhaps it really WAS the "unacceptable to her" psych concept of transference that was the basis for her going off on me. Perhaps she WOULD have listened if I'd put it differently, but you see, she's the doctor, and I'm the patient, and no matter what "could have" or "should have" been done differently by me, she acted unprofessionally and unacceptably towards me.

Why do I find her behavior so much less acceptable than my first psychiatrist's? Perhaps it is because she had a history of forcing her way on me . . . but then I think, didn't Psychiatrist Number One also have a strong way about him, where he tried to get me to think along his lines of thinking? Yes, he did . . . Then again, he'd never given me an ultimatum, like she had. He'd never tried ramming wierd goals for me down my throat, like she had . . .

In the end I think I can safely say that part of the difference in how I reacted to the two incidents is, indeed, related to my fear of strong, dominant women based on how my mother treated me. Part of it, though, I think is that I had more a feeling of being a partner in my treatment with the male psychiatrist; I wouldn't hesitate to stand up to him, which was saying ALOT for me, because I usually shrink from such things, and he had VERY strong opinions. Still, since I really wanted him to understand me, I knew I had to press for standing up for my view, or my experience, or my thought process that I wanted him to UNDERSTAND before coming to a conclusion.

I guess, after writing that last paragraph, it's easy for me to see now that my mother IS a big part of it; I could stand up to HIM, but not to HER.

Six months down the line from the "heat" I received from my current shrink, and I am still having trust issues, and definitely fear issues. I finally may be getting up the courage to bring up the issue with her again (sans mother), but I am not sure if I have the courage. I do hope that if she gets angry again I can tell her what I think of her unprofessional behavior . . . and lack of insight into the issues that can interfere with a good doctor/patient relationship.

Reassessing the Roles My Therapist Plays

I know I sort of recently said I'd get around to discussing the roles my therapist plays, at least that I think he does, but a week and a half ago I had a session during which a thing or two he did as well as didn't do, really bothered me, to the point that I woke up in the middle of the night that night and couldn't get back to sleep for hours due to thinking about it, trying to work through it, and trying to figure some things out.

It became clear to me when I woke up later after having fallen back asleep, that maybe I needed to reassess some of my attitudes towards therapy, some of the roles I think he plays or want him to play, and reassess my general orientation towards therapy. I kind of need a paradigm shift, about what I expect and want from therapy, and what I want it to do for me, and whether or not I've been expecting THERAPY to do for me what I should be doing for myself.

At the same time my thoughts get so distorted and tangled sometimes I KNOW I can't always sort them out myself; in fact fairly often I cannot and get stuck. But is helping me see the distortions in my thoughts, and helping me to work inside myself to come up with alternatives to those distortions, ALL my psychologist is there for?

Often, he also reveals observations about my behavior, sometimes connecting things from months or more ago to something I just brought up, and it's sometimes a "lightbulb" moment when he does this. Other times it feels like he is observing, without connecting with what I'm feeling or thinking, when he does this. And so I then feel like he is being, well, cold, almost, or so neutral that it feels like I'm not interacting with a person; like WE aren't interacting at all, but rather that he's just stating his observations without other therapeutic things going on, like empathy and such.

I suppose the nature of observing, and being observed, is that the observer, in order to adequately identify and point out what they are observing, has to hold themselves apart, in some ways, to keep anything emotional or biased from affecting the observation. I think it is that "apartness" that I sense when he's giving me observations that bothers me, a little bit.

He does, though, give empathy when he determines I need it; he gives understanding, he gives patience, and even kindness from time to time. He gives objectiveness (which sometimes promotes that sense of "apartness" in me) and he gives no judgements (most of the time; he's not perfect and when I think he's judged me, I say so and he'll most often explore it with me for a minute and, if he thinks that he did, indeed, judge me, he apologizes for it).

I should say that he strives for objectiveness and lack of judgement; these seem to me to be two of the hardest things to accomplish, especially after you've been working with someone for years and could have some caring about their welfare. He has said, on a couple of occasions, when questioned about it, that he DOES care about his patients; he has said that is an acceptable thing in his work, and a natural thing to happen. It's my opinion that the better therapists (I've only had one, though, so it's a guess) DO care about their patients, on a basic human level. I'd imagine that those who don't would come across as cold all the time.

Even knowing this, I still have times I struggle with feeling less "connected" in our therapeutic relationship. Is connectedness, a feeling of give and take, a feeling of working TOGETHER in therapy, necessary, positive, etc. for the therapeutic relationship? I would suggest that yes they are essential for a good working therapeutic relationship. This does not mean that the times I feel this "apartness" I've described indicate big problems in the therapeutic relationship; it just means that maybe I should note these things to him so he's aware that I feel these things when triggered by specific things during therapy. It does NOT mean that he'll necessarily change his behavior, but I believe it's important to communicate with your therapist if and when you feel like it is more difficult to connect with them, or any other things that trouble me about the relationship at any time.

This makes me wonder, am I after too idealized of a therapeutic relationship? I am thinking right now that I know I tend to idealize people who treat me positively, and so I wonder if this is another attitude about therapy that I need to examine and perhaps change. I do not know that I necessarily idealize the relationship for sure, but this blog post surely gives me THAT impression. I will think some more on it and even talk with my psychologist about it.

There have been occasions I've taken one of my blog posts into therapy, read it, and then discussed it with him, sometimes point by point, and sometimes at the end of the thing. I think this one would be good to bring to therapy this week.

I don't know why it still surprises me after all this years that writing or typing out my thoughts and feelings on a subject will sometimes lead me to new discoveries, unexpected realizations, and even a reassessment of my own behavior or thinking/attitudes on a subject.

A postscript on the Lamictal rash: Well, welts never showed up and it became even more sandpapery feeling, so I was right that it was not the "bad" one that leads to Stevens' Johnson syndrome; on the other hand, I've had it for a week now and taking Benadryl changes it only a little, though I admit most days I've taken it sporadically.

What I do not know is if I should bump up my dose to 250 mg tomorrow as scheduled; the rash appeared the morning after I bumped it to 200; I may be too fearful and cautious, but I will keep it at 200 until I hear back from my psychiatrist via email; I don't think it's urgent enough for a phone call, and it shouldn't hurt me to stay at 200 for a bit longer (I hope!). I guess I fear worse allergic reactions like anaphylactic shock if I bump it up higher, with the rash not responding much to Benadryl.