Across and Inside my Universe

Unsafe

Well, I'm not safe.

Lability is uncomfortably high (I hope I'm using the term correctly).  My state of mind, my emotional perspective, keeps shifting so much that any decision I make, even fully believing and commiting to it, I can be doing just the opposite five minutes later (or half an hour, hour, etc.).  The place from which I am interacting with the world from, feels as though it's on a mess of shifting tides and currents.

Part of me thinks, well, isn't this just weakness of character, not being able to stick to anything or operate from a stable state of self or being or mind or whatever?  That word, stable, though, is part of the key.  The whole shifting currents thing, is another.  I'm NOT STABLE right now; I'd not call myself UNstable in a crazy, psychotic way, but  . .. well, basically what I've described above.

It is tempting to fall into the trap of thinking, hey, since I'm seeing this problem, and acknowledging it, doesn't that mean I'm functioning well enough to be or feel safe?  I've fallen into that trap before.  While identifying this stuff, prioritizing it, taking some actions with it, etc. are positive and functional, healthy things, the very nature of being so . . . well, volatile isn't quite the right word, I'm not going to lash out in an extreme way (although I guess suicide and other things actually are pretty extreme) at anyone else (hrm, I've been highly irritable and rather snappish, which I've been not pleased to have acted out as much as has been, the last few days; it has been uncharacteristically frequent and drop of the hat.)  I've been quite reactive and on a short fuse, not even necessarily being aware of having a short fuse, until I snap at my husband.

I've been irritable and snappish before, without the high lability; mixed states suck.  There is more here than just that, although mania and depression certainly make matters rather worse . . . 

I have therapy tomorrow, and I don't know if my psychologist will recommend the hospital.  We've already taken some familiar and not so familiar steps, around here.  Any excess medication my husband has hidden.  A step taken once before, for a time, that I've asked of him again, is to not leave me alone at home for three hour+ stretches.  Two hours feels like it'd be kind of rushed for anything extreme, but that may be because I'm particular.  I hate to scare him like this, but on the other hand it feels the responsible thing to do.

So, he may need to stay home from church on Sunday.  This would carry us to next Wednesday, when I'll be home alone for most of the rest of the week.  If I am still highly changeable/feel like my behavior could turn 180 in the blink of an eye/feel like my mania or mixed state or whatnot is pushing me to danger, then we'll have to probably hospitalize me or figure something else out.  I am REALLY hoping that I'm not like this, then.  It usually has only ever lasted a few days, 3 or 4 tops, but I had this a week to 10 days ago for 4 days or so, and now again and it's just rather scary.

I dunno, maybe I'm a wuss and not taking responsibility, when I say that I can't seem to be able to say that what I decide right now will be the place from whence I could reasonably still be operating an hour from now, etc.

The pull to reckless and harmful, serious things of a variety of types is strong, although I am currently fighting them.  Some things you can't come back from, and some you maybe  shouldn't (okay, definitely stuff to bring it up tomorrow in therapy.)

Edit:  This talk of lability, and danger, and unsafeness, and my assessments thereof, are based mainly on how my psychologist has assessed me most recently last week when discussing the same kinds of things, as well as in the past, the few other times that it has been this bad (all since early 2012, really).  Things I'm saying here are based on concerns he's discussed with me about my safety and stability and such when I'm in this/these states, having experiences as I've been this week and being all over the place, and stuff.  My safety has been a major issue and concern to him, in many of the ways I posted about here, and some things I haven't posted.

Edit:  Also, I do have upcoming appointments with my psychiatrist, later this month and then in August as well, since my urologist cleared me for going back on psych meds/back to the psychiatrist (I know one doesn't necessarily mean the other but he has pronounced my kidneys fine, after a CT and a cessation of the most distressing symptoms . . well, I may need to check one more thing with him, but he did clear me.)  Still, I may be contacting her sooner, by email I guess, if my psychologist thinks I need to go to the hospital.  Maybe her emergency nmber would be better, I don't know?  I' ve left a message on there before.

When Your Doctors Don't Believe You

When your doctors don't believe you, you feel like you need to prove your problem/theory/what-have-you, if it is provable.

In my case, the Lamictal IS affecting my urinary system.

So the not brief but explained as briefly as possible history/experiences that I explained to all three doctors in September about these issues, WAS relevant, and I don't have to think of myself as a rambly, irrelevant person.

You see, I do ramble and/or am irrelevant at a variety of times to some degree or another.  BUT, I try to not do that at the doctor's office.

See, when I went and saw my GP a week after the Instacare guy prescribed oxybutynin, I did mention the bladder, urethra, and kidney discomfort/pain.  My GP said to keep taking it (because I'd laid out brieflly what happened after I stepped down off Lamictal, last year, unsupervised; it was what I consider to be likely a textbook case of how epically bad stopping a mood stabilizer on one's own can be.)

So, I kept taking the oxybutynin and the Lamictal. However, over the last three months the abdominal and sometimes side/back kidney pain had been becoming more frequent and too common.  The bleeding had gone away, the bladder was somewhat calmed down (although not like last March), but it still seemed to be over-producing as well as could only go about 4 hours, so it was still getting me up at night.  (Also becoming harder to sleep with the pain and discomfort).

The worries about it and the physical interference with good sleep are two factors in why I think the mania has been breaking out more the last few months.  The other factor would most often be stress from a juvenile court case in which I faced speaking in court, and other things (It's about the victim, not me, but since I'm not going to expose her on here, I'll risk sounding like it's all about me.)

These things all acted to marginalize the effectiveness of the 150mg Lamictal that I've been taking.

A week ago, it was getting so bad I wanted to go to my pyschiatrist, with proof, so I'd be believed.  Plus, I wanted it to stop.  So I cut my dose in half for a few days.

I did not expect such a quick or significant difference, figuring the urinary tract had been so abused for so long it'd need time to heal.  Within a DAY a significant amount of pain and discomfort was gone.

I knew that cutting the dose in half wasn't the wisest idea, so after a couple days I went back up, but only to 100mg.  I couldn't bring myself to take 150 and be that badly off, again.  The pain and discomfort went back up within a day of bumping back up, though not as bad as it was at 150mg.

Proof, anyone?

Now, I did consider that my judgment may not be the best right now, what with all the mania and stuff.  Also, the last time I took myself off Lamictal, the end results were . . . bad.

Still, this time it will be in partnership with my psychiatrist (as soon as I email her later tomorrow).  If she says to keep taking it, which I highly doubt, I'll do it until we meet and can figure something else out.  However, I hesitate to keep taking it for longer than needed to step down off it, because after so much abuse to my bladder and kidneys, what's the risk of permanent damage?

So, yes I took medical matters in my hands, but I didn't intend to do it for long, and as well the doctors didn't believe me before anyway.  Just because my psychiatrist said that this isn't a side effect of Lamictal, doesn't mean in my opinion that it can't EVER be; it's not a KNOWN side effect, perhaps.  Also, there are statistical outliers, people for whom their bodies' response to medications can or does fall way outside the reasonably or even rarely expected effects.

It's happened to me before, and now again.

I am regretful and a bit fearful that there is one less med between me and the mania; however, I'm on some Seroquel, which I wasn't last year, and I've handled twice as much as the current 150mg before, I think even over that to 400mg.  It was eventually stopped because at the time it was being used for depression, and didn't do much for that.  I can tell it's helping stabilize mood a bit, now, though.

Now, I actually don't think the doctors were wrong in what they considered and what that led them to recommend, AT THAT TIME (although they were still wrong, then, about the bladder/lamictal thing.)  There were several seemingly medically reasonable (to me) reasons to suggest going forward as the doctors had said with the Lamictal and the oxybutynin.  I'm glad I did things their way for long enough to know that not following orders wasn't what was going on.

My GP considered things with his knowledge, but also deferred to my psychiatrist as, I think, was proper to do given the risk of possible death if I stopped the mood stabilizer, since if I even THOUGHT I might start down the bad path from earlier this year again, I wouldn't be able to live with myself.  My psychiatrist, of the three doctors, gave me the best impression that she was weighing the pros and con of a medication that was possibly (though not likely as she did tell me Lamictal doesn't do that) harmful, against the pros and cons of stopping that medication.  She investigated anew with me how effective I felt the Lamictal was, and such, and I appreciated her doing that; it helped me feel that my experiences would all be a part of what she decided.  She said for me to keep taking the Lamictal, and I did, though reluctantly, because I'd been so tired of the bladder problems.

Knowing for sure, now, it IS relieving to know that something hopefuly fixable (after this long, has there been permanent damage?) is behind the kidneys/bladder.

I don't know that anyone necessarily cares about all this, but I don't know what audience I have in mind or think I have with this blog, so I'm all over the place with what I post and don't post.

I Want To Crawl Out of My Skin

I just read here, after I googled it, that other people have had something similar, on atypical antipsychotics.

This has happened to me noticeably twice now, within an hour or two of taking my nightly meds (Lamictal & Seroquel; I'm supposed to take Lamictal in the morning but I always forget.)

I start wriggling around almost frantically; the sensation of wanting to crawl out of your own skin is quite awful and difficult to describe.  You feel  a very strong urge to get out of your skin (and for me, the left leg is particularly worse than everywhere else.)  You HAVE to wriggle, writhe, and otherwise move, because not doing so feels unbearable.

This sensation is so much worse in my left leg, that you feel not exactly a loathing for it, but you quite dislike it as a result of the distress it is causing you.  This distress, this crawling out of your skin sensation/desire, makes you want to leave your containment within your skin behind, especially of the left leg for me.

Now, I don't LITERALLY want to get rid of my skin as that would be, um, inadvisable, dangerous, deadly, etc. not to mention horrifically painful, and at least a little bit insane, or psychotic.

However, I can't emphasize enough how horrid it feels to feel like your body is something distressing, or like some part of your body is, or whatever.  I mean, I know most every health problem is unpleasant, but what I'm talking about is feeling like your body or parts thereof are to a degree separate from your self, from the whole of you, and that they are something it feels like you would like to have some distance from, if only for a time.  I'm not explaining this well, I know I'm not too fond of my head when I have a migraine, but there's not even a slight sense of otherness or alienness, alienation from your own body or parts, that there is with this.

The people at the link above say that the feeling is because of the intense urge to move, but for me it feels the other way around; the crawling out of your skin desire is what's causing the urge, the compulsion, the body's DEMAND to move.  Although I can see that the demand to move also contributes to want to crawl out of your skin, and thus shake the distress off.  The distress feels like the confinement of your skin is exacerbating the distress, and the distress is exacerbating the feeling of being confined by your skin.

Thank heaven it goes away within the hours, but oh is this feeling horrible!

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.

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.

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.

 

Double-Booked Psychotherapy Appointments: When It Happens To You

You feel unpleasantly surprised, when you arrive and see the waiting area (in my therapist's case, there's only seating for two) occupied, with a mother and teen son.

You feel brought up short, yanked backwards, because in the car on the way to your appointment, you've been shuffling through a whole host of important things currently going on with you, trying to prioritize, trying to decide what to talk about, and then BAM, the rug is yanked from under you.

Before the therapist's door opens to see the situation (he's running a few minutes late with his 4pm appointment, it's now after five) you start discussing the situation out loud with your husband, knowing the other patients will hear you. You say things like, "I could have sworn he said we were switching to Mondays," and other things that indicate you have a right to be there, too, as you feel as if you have to justify yourself (which you don't, at least not to the other patients, but my anxieties tend to run amok . . . .)

When his door does open, he greets the other patients and then steps out far enough where he can finally see you, and a look of being unpleasantly surprised crosses his face. There's no getting around it, seeing your psychotherapist seem to feel unpleasantly surprised by YOUR presence, by YOU, is slightly jarring to the therapeutic relationship; pushing forward through THAT awkward feeling, you realize that of course this is awkward for anyone (although throughout it all, the other patient(s) never said a word and acted as though the appointment was theirs all along).

So, you step forward to greet your therapist as he gets over his initial surprise quite quickly, flashing through some confusion as he queries you about what you are doing there . . . and you realize inside, feel, that "Oh no, I am really stupid; what and how did I get this wrong?" On the other hand, you DID bring your spouse up to his floor with you, which you usually don't do; this was done in case I remembered our schedule change incorrectly, although I had been pretty sure I'd remembered it right. I pretty much always bring my spouse up when there's been a schedule change, because of anxieties about getting it wrong.

So I explained what I was doing there, and what I thought he'd said during our discussion in December about how our schedule was going to change, and he told me, "Yes, but," and told me some other things he thought he had added that I didn't remember. Quite quickly he started apologizing since there'd obviously been a misunderstanding (it felt, to me, at the time, right there, that perhaps he was apologizing just to speed things up to get to the other people, and not because he actually thought he might have messed up), and I started apologizing as well; things before he went on vacation at the end of December WERE kind of hectic and who knows, maybe I remembered it wrong.

So, after that wrapped up, about 90 seconds total, I and my spouse left, and I said that I felt like an idiot.

Still, I got over it. One does, you know. Everyone makes mistakes, and misunderstandings happen. Whether it was his mistake or my mistake isn't very important to me, anymore, I realized after I got home. I had more time to think on it and really felt more badly for the awkwardness the situation had caused him, than for my being put out at all by it.

Still, it was VERY nice of him to call me a bit after his 5pm appointment was over; he apologized in a way that felt more thoughtful, less rushed to me, but then he'd had some time to think about it since it had happened. He said that he did feel that he'd contributed to the misunderstanding, and he was sorry that he'd had a part in creating such an awkward situation (well this isn't exactly how he put it but it's what I can remember of what it seemed he was trying to get across). I accepted his apology and gave my own; after some time at home (it took an hour lol) some of the things he'd said that he'd thought he added started to sound a little vaguely familiar. So I did indeed feel like I'd either not heard him due to distraction at our last appointment, or that I'd remembered what he said wrong; for his part, based on our conversation before his 5pm appointment started, it seemed like he had remembered our discussion a little incorrectly as well.

Regardless of who remembered and forgot what, the fact that he called me really made me feel better about the slight unpleasant feeling I'd had when he was looking at ME as though I were the cause of something unpleasant; it was really nice of him to call, and I think especially nice, as a professional courtesy, to do it.