On Expectations

I hope you’ll indulge me in a bit of a personal update post. Emotion Regulation Part 4 is coming, I promise! It’s taking a bit longer to polish than its predecessors, but it’s almost complete. According to the schedule that I keep trying to implement, but almost never follow (please remember, I’m still quite new to this “blogging” thing and there’s a lot of stuff I’m still figuring out), Wednesday is meant to be some form of a personal post – usually one of my Scrawling Toward Sanity posts, or a tidbit from my personal life that has broader applications and relatability, such as When Someone You Love Dies by Suicide.

Tonight, though, I’d like to throw it back to the style of my older posts – like my very first post or On Shoveling, Fathers, and Forgiveness. Straight up reflection on something that’s been on my mind a lot lately in my own, personal life that I’d like to share with you. Maybe you’ll relate, maybe you won’t, but I really feel the need to give this line of thought some air time.

___

Prior to January of this year, I was employed at a fantastic (if stressful) job: one with great pay, amazing benefits, and the absolute best co-workers a person could ever hope to have. It was meaningful work, too: supporting young men as they learned to regulate their emotions and grow life skills as they worked toward independence. I loved my job. Truly. I looked forward to every shift and left every single night immensely grateful to be where I was. On nights that featured violent escalations, I was grateful for my teammates and the support and skill we all shared in keeping the situation safe for ourselves as well as our clients. On nights that included long, thoughtful, impactful conversations with those clients, I left grateful for the opportunity to walk along side those young men in their journeys; I was grateful and humbled to have the chance to make some lasting impact in their lives, however small it may be. On nights that were not particularly eventful at all, I was grateful to work in a “home like” environment: to have a job that sometimes consisted of geeking out to a Star Wars movie or the staff and clients enjoying each others’ company over a friendly, for chips, game of poker. Regardless of the events of each shift, I was always thankful to work in such an amazing place. And I miss it every single day.

As you know if you’ve been following my blog, my life changed pretty drastically in January. A seven day stay at an inpatient psych unit, another month and some change of Partial Hospitalization and Intensive Outpatient, difficulties navigating the mental health system as a patient, and a general lack of direction have more or less consumed the past six months of my life. Finally, though, I am on all of the correct medications, I am in regular therapy, and, as of today, I am once again a member of the work force! The part time, minimum wage work force, maybe, but a member of the workforce nonetheless!

But here’s the thing: going through something like this, living in this state of limbo of med adjustments and intensive therapy; meeting with professionals of all different specialties and areas of treatment; telling my story over and over and over and over again: these things can really start to wear a person down. And the truth of the matter is this: once you’ve gotten “into the system” as “mentally ill”, people’s expectations of you change. In a really big way.

Treatment professionals, I’ve found, tend to have generally low expectations of someone “like me” – you know, bipolar, PTSD, hospital stay. These things, these labels, these events, sometimes seem to carry more weight than anything I do or say. Never mind the fact that prior to this very difficult chapter of my life, I was employed – full time. Often working much more than full time, honestly. I was a student at the University of Vermont, trying to finish my senior year and earn my Bachelor’s in Social Work (and I made straight A’s first semester despite being mid-breakdown). I was an active participant in my own life. I had a pretty vibrant social life, actually. I had a lot of things going for me. But all of that sort of fell through the cracks of crisis stabilization, psychiatrists, primary care visits, and counselors.

I get it. When one is in an acute mental health crisis, it’s not the time to push getting back to full time work and school and all of the responsibilities of life, at least not all at once. I understand that. But, looking back, I realize that somewhere in the crisis stabilization process, the expectations placed on me became less and less.

When I was in the hospital, the doctors said I would just need a few weeks to complete the PHP program and then I’d be back to my regularly scheduled life. At the PHP program, they suggested I hook up with Voc Rehab to get some support around finding a different, less stressful full time job. I was discharged from the IOP with a note saying that I could “maybe work” in a “part time, low stress environment.” When I started up with my new therapist, there was only talk of further therapy. She suggested I join the DBT group the agency runs. I LOVE DBT. If you’ve followed this blog, you know that. And I say this with absolutely no disrespect to the members of this particular DBT group or to the facilitators, but the fact of the matter is no one in that group was a “peer” to me. The pace of the group was far too slow. The facilitator would spend thirty minutes explaining a concept I understood after five. I don’t want to sound like a judgmental, arrogant jerk here, but sometimes groups are just not a good fit, you know? There was nothing wrong with any member of that group. Their lives are theirs; my life is mine. But it was very clear to me that this group would not challenge me at all, and that I would struggle even staying engaged in it. I would not be getting much from the sessions. But my therapist (who I really do like) thought it would be a good fit, and honestly, that stung a bit.

But why wouldn’t she? By the time I made it to her office, professional expectations of me were so low that no one even mentioned a job. Those of you who know me personally know that such a low bar would almost be laughable, were it not for the fact that something started to happen over these months of the medical professionals’ gradually lowered expectations of me: they became my own. The consistent explicit or implicit suggestions that I was incapable of achieving anything remotely close to the life I used to have burrowed into my subconscious and set up shop. And I sat in resigned acceptance. I thought “Maybe this is all life has for me from here on out. Maybe I am incapable.”

IMG_20170525_013750_794.jpg

And it wasn’t until I realized this, until I recognized what was happening in my own psyche, that I knew I had to put my foot down a bit and refuse to allow others’ perceptions of me to run my life. I’m taking my recovery process very seriously, and I fully intend to continue with the treatments my providers believe will be helpful, but I refuse to do it blindly anymore. I refuse to sit back and have my capabilities dictated to me. I realized that this is just an attitude that I need to adopt for my own well-being. A little self-advocacy can go a long way toward boosting self confidence, I think.

And so, I told my therapist that the DBT group was not a good fit for me. She was a little disappointed, but I think she understood. And I applied for a job. Not through Voc Rehab, not through my therapist, not through the state offices, but by myself. Because I needed to do that. I think I needed to prove to myself that I could. So, I did some good old fashion pavement pounding and filled out applications and handed them in. TJ Maxx is the only place that called me for an interview (I assume because the jump from residential instructor to unemployed for six months to looking at retail jobs is probably a little off-putting to some potential employers).

IMG_20170525_003655_931.jpg

When I was offered the job, I was understandably excited (because a part time job beats no job, and having something to get me out of the house on a regular basis is exciting, and the idea of being able to be a productive member of a team is motivating in and of itself.)

But again, those pesky expectations reared their somewhat ugly heads when I told loved ones and my therapist about it. More than one person responded with “Oh that’s awesome! You know, it’s really great that you have something to fill your days.” Other people said, “Oh, do you think you’re ready for that?” Some said, “That’s great! You know, some people make full careers out of retail.” My therapist asked, “So, what, you’ll working 4 hours a week?” Now, again, I appreciate the congratulations and I am excited about this job. Retail has always been fun to me, and I’m pretty excited about the discount, too! I enjoy helping customers and making upsales and all of that jazz – I have since I was a junior in college working at F.Y.E.

But do I see myself working part time retail for the rest of my life? HELL. NO. Could I consider making it a career if I got a managerial position? Maybe… but honestly, probably not. I enjoy retail, but I’m hard wired for a career that involves helping people beyond making sure they have a shirt in the right size and are signed up for a credit card to get savings. I’m still not sure what that looks like for me now. Will I ever work residential again? I don’t know, but I know I won’t be doing it in the foreseeable future. Right now, my job is about one thing above all else, and that’s money.

IMG_20170525_011621_321000.png

The fact is, one cannot live in this society without cash flow. I’ve got bills. I have a lot of bills, actually, with all the doctors I’ve needed to see over the past six months. And I need to start making a dent in the stack of collections notices. I don’t meant to knock retail by any means. As I said, I enjoy retail. And I have a lot of friends who have careers in retail. But they don’t just enjoy it, they are passionate about it. And that’s the key, right? It’s building your career around your passion.

But passion can get snuffed out pretty quickly in the land of low expectations. If enough people don’t believe you’re capable of something, and they tell you so, you can start to doubt yourself pretty damn quickly, regardless of everything you thought you knew to be true.

So, that’s where I’m at. I’m setting my own expectations for myself. And I’ll be sharing them with anyone who will listen for as long as it takes until they hold those expectations of me as well. And you know what? If it turns out they are right and I am wrong, and for some reason, a sales associate job is too stressful for me at this specific time in my life, then I’ll find a job with a little less commotion and a little less social interaction. But I reserve the right to determine that for myself. And frankly, I need a couple of people in my life to take off the kids’ gloves. I need my treatment team to know that I am not satisfied being the “unemployed crazy person”, and that I am not going to be satisfied working a part time sales associate job for the long run, either. Or even a full time sales associate job. I need my treatment team to recognize that these are stepping stones right now. I need acknowledgement that, yes, I am still hiking that mountain, but there’s no way in hell I’m pitching a tent and living here.

This post is, of course, very specific to me. There are many people who are incapable of work due to their struggles. And it’s feasible that I will be in that situation again at some point in my life. I certainly was not capable of working in January or February of this year. This is in no way a “pull yourself up by your boot straps and stop making excuses” post. I hope it’s not interpreted that way. This is not meant to minimize the experiences of anyone living with a mental health diagnosis or diagnoses.

I just know that, for me, the lack of faith in me by others lead to a lack of faith in myself, which then lead to further depression. That, coupled with med adjustments, lead to me kind of dropping off the face of the earth for a few weeks there. But I’m back. And, honestly, I’m more motivated than I’ve been in the entirety of the last 6 months to continue to recover, to learn to live within and adapt to my limitations (because I do have limitations), and most importantly, to grant myself permission to have the dignity of risk and find those limits for myself, through experience, and not from some checklist on a therapist’s clip board.

Creative_Typography_Design.jpeg

And that motivation is not limited to my employment status, either. It is for this blog; for the fight against stigma and against false assumptions and expectations around someone’s abilities; for the fight for support, understanding, and access to resources to those in our community who cannot work; for the dignity of risk for everyone who wants to give it a shot; and for a more comprehensive understanding of the ways that the same diagnosis can look very different for different people. I’m motivated to continue to educate and advocate, and to share my struggles and triumphs with anyone who’ll listen. Because that’s the single most effective method to attack stigma and misinformation.

Thanks for reading.

AS ALWAYS, I’d love to hear your thoughts. Have you ever been in a situation where others’ expectations of you dictated your own? When you were first diagnosed and receiving treatment did you feel helpless? Do you agree that finding and setting our own limitations is a good idea, or do you think it might be too risky? Whatever your thoughts, I’d love to engage in a deeper conversation in this topic! Leave your two cents in the comment section below, Tweet me @paradichotomy, or hit me up on the blog’s Facebook page

ALSO, in case you missed it, I had the opportunity to be on a podcast last week – check it out here! I’ll catch you all later!

 

“Trauma Informed Care” as featured on Betty’s Battleground!

I’m REALLY excited to share a guest post I did for my blogger friend and fellow PTSD Mama Betty. Her blog is amazing and I’m so happy I was able to contribute! Here’s my guest post on Trauma Informed Care. In it, I speak at length about my professional experience and training in trauma informed approaches and contrast my professional experience with the decidedly-NOT-trauma-informed nature of my experience with receiving crisis stabilization.

IMG_20170330_194842_555 (1)

When treatment is NOT trauma informed, and you’re dealing with trauma, it kind of makes you feel like this. 

I’m really proud of this piece, as I feel it’s important to the overall conversation on the state of mental health care in this country and around the world. I hope you’ll read and consider sharing it!

ALSO, please check out Betty’s site and connect with her on FacebookTwitter, and through her site (linked above). 

 

C-PTSD as featured on Sidereal Catalyst!

I’m really excited to share with you this guest blog I wrote for Sidereal Catalyst, a blog owned and operated by Abbie Zebrowski. If you’re not familiar with Abbie, I’d encourage you check out her work! She is a published author and poet and a force for change in the issues facing those of us living with Mental Health diagnoses! Depression: Catalyst for Change is a fantastic collection of helpful resources and a place for individuals to share their stories without shame. One more way to break down the stigma around mental health! I’m very thankful to have been given to opportunity to contribute to this blog, and I hope you will give Abbie a visit and take a quick peek around her corner of the internet (after you read, like, and share my post, of course! 🙂 )

 

 

Please welcome my Depression Catalyst for Change guest, Sheila, who shares her story and her struggles with Complex Post Traumatic Stress Disorder.

via C-PTSD by Shiela O’Donnell | #DCfC — Sidereal Catalyst

On Shoveling, Fathers, and Forgiveness

If you live in New England, you’ve probably seen a lot of posts about shoveling and snow today. As I write this, I’m sitting cozy in my bed, wearing a hoodie that once belonged to my Papa, acutely aware of the fact that there is a minimum of 2 feet of snow covering the ground outside. Why am I acutely aware of that fact? It’s not all the Facebook posts. It’s the fact that I spent about 2 hours today shoveling it.

Growing up in New England secured shoveling as a familiar task to these arm and leg muscles. Now that I’m a bit older, I can safely add back muscles as an affected area, too. Despite the physical strain (and the pain I will no doubt feel tomorrow), I’ve always enjoyed shoveling. It’s quiet. It engages your whole body, but is so repetitive, it leaves plenty of time to let your mind wander. It’s nostalgic, in a strange way. For me, each shovelful of snow scooped up digs up memories along with it. Tossing that snow to the side leads to a lot of reflection on the past.

When I was very little, snow storms meant playing in the banks my Papa made as he shoveled the driveway down to the cement. That was one of his things. He shoveled with a precision no plow could ever hope to achieve. Don’t believe me?

Look at these shots of his handywork in the snowstorm of April 1997.  IMG_20170315_184753_151

That’s no photoshop or trick of the light; this man, at the age of 77, did that single-handedly with his $20 orange shovel from Hoxie’s (an Ace Hardware/ convenience store up the road). My Papa’s idea of shoveling was insane perfectionism personified.

I, too, have channeled my perfectionist tendencies into shoveling, though not in the way my Papa did. (Back road living simply doesn’t allow you to shovel down to the ground, as the dirt is frozen and uneven and there are sporadic clumps of grass in the way). My perfectionism was in my strength. I was in a constant, unspoken, competition with my brothers, to prove that I was just as strong, to prove that I could do anything they could do. I took pride in my ability to clear the driveway without help. It validated my strength. It also elicited a genuinely proud “Wow! Good job, Sheil!” from Tom, my stepfather. And isn’t praise from one’s father what every child wants more than anything?

As I was shoveling today, listening to the same ’90’s music I listened to through my Walkman back when I was shoveling with Tom, I started thinking about how complicated my paternal relationships have been. I guess the association of shoveling and being praised for it and the idea that it’s traditionally a “man’s” job got the thoughts churning. I thought of that snowstorm in ’97, I thought of snow fights with Tom, I thought of times sitting in the snowy woods alone thinking about my life and God and the nature of love and fathers when I was a kid (I have always tended to wax a little philosophical, I suppose.)

I’m not even sure where to start digging in to those complex connections.  I guess I’ll start at the beginning.

IMG_20170315_190755_004 (1)

These three photos are all precious to me. There’s my mom and my biological father with little 6 month old me, then one year old me and my Papa, and finally 13 year old me and my stepfather, Tom.

My dad wasn’t around when I was a kid. He struggled with heroin addiction and Bipolar 1 and was in and out of jail for most of my formative years. I don’t want to sound silly or overly sensitive or anything like that, but having basically no contact with my father left me feeling pretty lost as a kid. My mom did her best to assuage this by answering my questions with honesty when I asked, but the truth is, not having your dad around leaves a sort of hole in the core of your self image. Father-Daughter dances were out of the question for me. Father’s Day was confusing. (It still is, sort of, honestly.) No one “gave me away” at my wedding. When I was in school and the other kids would talk about their dads and ask about mine, the reactions to the fact that I had a stepfather were almost always shame inducing. (Baptist school, remember.) And, as kids are prone to do, the curiosity would get the best of them and they’d ask, “Yeah, but what about your real dad?” And that shame would grow along with the burning in my cheeks. Because I never knew what to say. And almost none of the other kids had any frame of reference for someone not knowing their father. I felt, deeply and at a very core level, that there must be something wrong with me. And all of the talk of “God the Father” was simultaneously alluring (maybe God can fill this hole) and discouraging (I don’t even know what that word really means.) When I would pray to God to fill the hole and be my father (a prayer I uttered frequently) it never seemed to work. Maybe I’m saying it wrong, I would think. Or maybe I’m just not meant to have any father at all. 

I want to be fair, despite my father’s absence, I did have father figures.  Papa was my constant growing up. In truth, he was the biggest and most influential father figure I had. He taught me how to ride a bike, tie my shoes, play basketball, throw a punch, sail, and gave me my sarcastic sense of humor. Though he lived 300 miles away for most of my life, I talked with him and Nana on the phone every single night when I was a kid and visited them every school vacation. As I grew older, if I was in trouble or needed advice, Papa was the first one I would call. He loved me as his own daughter, and I never doubted that for a minute. But, try as he might, he could not fill that hole of not having a “real” father.

Then, there was Tom. Though he told me explicitly not to call him “dad,” he was also a father figure. While there were many times in my life that I was scared of him, I also have a decent stash of good memories – camping in the White Mountains in New Hampshire, driving around listening to Pink Floyd, watching Star Trek,  and playing Monopoly and Poker are some of the highlights. Tom was not an overly affectionate man, though. At least not to me. The picture above is one of probably 5 hugs I received from him in my childhood. And I cherish that picture as I cherish the good memories of Tom I have.

When I was admitted at Dartmouth, part of the intake process was explaining what brought me there, which meant going into some of the specifics of what caused my PTSD. After a few days on the unit, a nurse was checking in around something (I can’t remember what exactly, my first few days there are pretty hazy from a lack of sleep coupled with med changes). What I do remember, very clearly, is this nurse saying, “This man, if you can even call him a man, Tom… god, who does that?” She spat out his name. She had no regard for the fact that maybe I had some good associations with this guy along with the bad. (As children who grow up in chaotic or abusive homes often do.) I felt that old creeping shame at her comment. I’m not allowed to love Tom. I shouldn’t love him. But I do. And I realized in that moment that all these complicated feelings from when I was a kid didn’t just go away because I grew up. That sad, ashamed little girl is still alive and well in this grown-up’s body.

Now, I need to make something explicitly clear. I love my father. I’m happy to say that I’ve been in touch with him for the past 10 years, and I have been very grateful to get to know him and to have him not only in my life, but also in my daughter’s life. But having him in my life starting at 19 cannot undo the fact that he wasn’t there when I was 9, or 16, or when I went to my first prom, or when I graduated high school with honors, or when I was accepted to college.

I loved my Papa. For my entire life, he was there, and I placed him on a pedestal. (I imagine the same pedestal that most kids place their actual fathers.) His ability to perfectly shovel the driveway is the exact analogy for how I viewed him and everything he did: perfect. In my little girl eyes, he was absolutely perfect. But, as an adult, I can see that he was not without his faults and struggles. He faced many adversities in his life, and his mentality was to just keep shoveling through. Keep your head up and just keep pushing. And he occasionally did things that caused me pain. When I was a child, he told me not to tell others about what was happening at home. Hearing from him, the man I trusted and loved more than anyone, that I needed to be secretive and keep everything to myself did help cultivate that shame I felt so deeply. And, of course, eventually, my Papa was not able to “keep pushing”, and he left us in the messiest way possible when he died and took my Nana with him. Which was, and remains, the biggest curve ball this life has ever thrown me.

And, yes, I love Tom. Truly, despite everything. I love him for being there when I dislocated my knee in seventh grade. I love him for the time he and I hiked into Sawyer Pond a day before everyone else to set up camp and woke up with the sun to go swimming and cook oatmeal over the campfire before the rest of the family arrived. I love him for the entire summer that he spent introducing me to classic films like Casablanca and Cool Hand Luke. I love him for the time he said, “I promised you when you were 6 years old that if Pink Floyd ever toured again, I’d take you. I don’t think that’s going to happen, so I’m doing the next best thing.” and we took a trip to see the Australian Pink Floyd Show play in Manchester, New Hampshire. I love him for the times he threw me across Kiwanis Pool when I was a kid, and the times he’d “A-Bomb” splash me and my friends from the high dive. I love him for every joke, every laugh, every happy memory he gave me. But there are plenty of bad memories, too. PTSD-inducing bad memories. And those can’t be simply ignored or brushed over.

But I love him because I recognize that, through everything, he was doing his best. And my Papa was doing his best. And my Dad was doing his best. They were all doing their best. It wasn’t ideal. But it was what I had. And I can’t change that.

Psychologically, I understand now why I always gravitated toward tasks of physical strength, like mowing, moving heavy furniture, and yes, shoveling. Because, from my frame of reference (Baptist) those were “man’s” jobs, and if I could prove to myself that I was strong, maybe life without a “dad” was a little less scary. If I could handle doing those things on my own, maybe I’d be ok.

My relationship with my father, and with my stepfather, and even sometimes with my Papa, wasn’t at all what I hoped and prayed for when I was a kid, and there’s still that little girl inside of me wishing things were different, trying to make sense of everything and find her place in this world. Trying to balance the good with the bad, and internal strength with the ability to fall apart and borrow strength from others when she needs it.

And maybe it was her outside today, shoveling for hours through high drifts and layers of packed, heavy, wet snow and memories and thoughts and feelings. Hoping with each motion to prove her strength. Hoping to validate her adulthood. Hoping to prove to herself that she’s ok, even though she didn’t grow up with a “father.” Hoping to live up to her Papa’s standards of working hard and pushing through. Hoping with each scoop and each heave, to get somewhere closer to the truth, to understanding, to acceptance, to forgiveness, to healing.

 

 

 

 

 

 

 

On My Experiences With Our Screwed Up Mental Health System

This is not a jovial or lighthearted post. This is a venting post. I may even venture into ranting territory. I would like to apologize in advance for doing all of the complaining and none of the problem solving. I recognize that that can be non-productive. But I’ve got some issues with our mental health system which have been festering for months, now, and I really just need to give voice to my lived experiences. That said, should any readers have thoughts or suggestions to improve my current situation (or, what I’m sure, is the current situation of many more like me), please share them! And if anyone knows of any resources which may be helpful, send them my way and I’ll be sure to link them so that, hopefully, others in similar situations will be able to find some useful tools here. I’m feeling pretty out of options at the moment, myself.

I’ve been struggling to come up with an adequate metaphor for our mental health support system, and I still am. I can label it – consistently inconsistent, frustrating, slow, over-complicated, etc. But a really good metaphor? Maybe a maze. Yeah. A crazy-house-mirror-maze. Only the mirrors are shattered in some areas, so you’re gingerly tiptoeing on broken glass, trying to make your way out without getting lost or injured; trying to walk the line between self-advocacy and being perceived as “overly-demanding/rude/aggressive” (because these are “behaviors” which will get you put on hold, disconnected, or asked to “calm down” in a condescending, but slightly foreboding tone that promises you’ll be in trouble if you continue to “overreact” to the situation).

If you know me, you know that I’m all about being polite and patient. Sometimes to a fault. You also know that I know many case managers personally and professionally. I am currently one semester shy of my Bachelors in Social Work. I was literally studying to become a case manager. I’ve also been on the receiving end of “self-advocating clients” who were, truly, being belligerent and unreasonable more than one time. So, I am not speaking broadly about all case managers in this post. I have also carefully considered the facts of the situation and believe that my current frustration, anxiety, and general agitation are justified and valid, which is why I am sharing my thoughts and experiences with you now.

I have absolutely no desire to be disrespectful, or to make what is already an immensely difficult job harder by being a “problem client.” But I have, over the course of 5 months, been put through the wringer on several levels, and, as the Cold War Kids said, “Hang me out to dry, you’ve wrang me out too, too, too many times”.

I am currently diagnosed with Post Traumatic Stress Disorder (PTSD) and Bipolar Affective Disorder (BPAD). I take medications to manage both diagnoses, and, in a perfect world, I would also be having sessions with a regular therapist once or twice weekly for further stabilization and management of my symptoms. But this is not a perfect world.

Here are the facts of the past five months of my life and my interactions with my primary doctor, the PHP and IOP programs I attended, the State of Vermont, and the crisis case manager I’ve been seeing at a local mental health organization until my insurance kicks in:

  • In early November, my life circumstances changed drastically, resulting in me living truly abuse free for the first time in…well… ever. And I was essentially hit in the face with 28 years of trauma and abuse. I developed severe PTSD symptoms.
  • In Mid-November, I did not sleep for 10 days straight. I did not eat. I lost 12 pounds in those 10 days. I was wired. I was having flashbacks and dissociative episodes like it was my job. I was depressed, but it was agitated depression. I could not sit still. I could not focus. I was making reckless and unhealthy choices. I was a complete and utter wreck. I went to Urgent Care on day 5 of no sleep, which happened to be a Friday. The PA I saw there was wonderful. She called the local mental health organization and was told by their crisis response that I’d be able to see the psychiatrist on Monday. She gave me a small RX of Lorazepam to help me sleep. Even with the Benzo, I did not sleep. I was doped up, but I was still wired and jittery.
  • Monday came. I was told I did not have an appointment with the psychiatrist, but the referral was in. All they could do for me was get me in to see a crisis counselor. The extent of the crisis counselor’s advice? “I get insomnia sometimes, too, and I count backward from 100 to sleep.” (I think I showed immense restraint in not yelling at her.)
  • I went back to Urgent Care that night. They told me if the Lorazepam wasn’t allowing me to sleep, there was nothing else they could do. They established an appointment with my PCP for mid-week.
  • I finally crashed on Wednesday night and slept. I crashed hard. I became very depressed, very low energy. This depression continued for a month. 
  • My PCP started me on a very low dose of Zoloft, and made another referral to the same psychiatrist.
  • I’ve been trying to get in to see this psychiatrist for 5 months, and I’m told it’s pretty much the only option available to me as psychiatrists in Vermont are difficult to come by.
  • Waiting on referrals, going to appointments only to be told I needed to wait longer, having my PCP assure me the referral was in and active while the mental health agency insisted it was not – these were all major contributing factors to me spending a week at inpatient.
  • After discharge from the inpatient unit, I spent the next month and a half in PHP and IOP. The case managers there promised me, up and down, that there was no way in hell they’d discharge me without adequate aftercare established, including therapy and psychiatry. Not only was I discharged without those appointments established, I was also discharged with no insurance and no means to maintain my medications.  
  • We only discovered that my insurance had lapsed on my second to last day of IOP. That was a Friday. I applied online for State insurance first thing Saturday morning. I called on Monday. I set up an appointment with Community Action to try to help get my application expedited. I tried so hard to be on top of my game and not be discouraged. The person I spoke to at Community Action, whose entire job is literally to help people get State Insurance, told me over the phone, “You’d be better off calling them directly. But have a book. And a phone that won’t run out of charge, because you’ll be on hold for a long time. I can’t see you in person until Friday, but I’ll set that appointment and if you don’t come, honestly, I’ll just be happy to get a break.” Verbatim. To me. Over the phone. I get burn-out, but how far past “done” do you need to be to say that to someone calling you for help? 
  • I called the State people, and I’m very pleased to report that that phone call was not nearly the hell the Community Action person made it sound like. I only read three sentences of my book before a real person answered. That real person, though, told me I was looking at an up to 30 day wait. Running out of medications with no money to get the final refills, no appointment to get further refills written, no therapy appointments set up, and nothing with the psychiatrist, either.
  • All of the back and forth and the apparent inability to communicate among my primary care doctor, the physician’s assistant I saw at Urgent Care, and the mental health agency for a referral to psychiatric services ended up costing me my career (and with it, my health insurance, which is creating the current stressors I’m facing) and my schooling, because, let’s be honest here:  if I had just been able to see someone back when all of this started, the more intensive interventions would have very likely been unnecessary and I would probably be writing this blog in my spare time between work and homework and mom-ing. (Ok, really, I probably wouldn’t have time for this blog. So, maybe that’s the silver lining.)
  • Today, the crisis coordination case manager I’ve been seeing in the interim until I can get established insurance and regular therapy sessions calmly told me I’m in serious jeopardy of not being able to maintain my medication routine until insurance kicks in, because of the out of pocket cost and because my primary doctor is unwilling to fill the types of psychiatric ‘scripts one needs to manage BPAD. In addition, insurance and all that aside, I can’t even get on the calendar to meet with the psychiatrist until I’ve met with my PCP and received a referral. A referral to the psychiatrist. You know, the very same referral that has, according to my PCP, been sent no less than three times already.
  • Today, I mentioned to my interim crisis case manager my concern that there may be a mixed-state episode in my near future based on what that’s looked like in the past (those 10 days without sleep, et. al.) and some current symptoms I’m experiencing: Screenshot_20170313-192328She responded by asking, “How did you even get a Bipolar diagnosis? That’s not Bipolar. I’ve worked with a lot of people with Bipolar and what you’re explaining isn’t Bipolar.” (How did I get diagnosed? By sitting down with a fucking psychiatrist and telling her exactly what I’m telling you, that’s how!)    
  • This interim counselor is not aware of this fact, but it took me a solid three weeks to even accept the Bipolar diagnosis. I was very resistant to it at first and did my fair share of pushing back against it before actually accepting the fact that the psychiatrist I was seeing through the PHP knew what she was talking about and was there to help me get well and stay well. So hearing the case manager (who, by the way, is NOT an MD and has spent a grand total of 75 minutes face-to-face time with me in the last 2 weeks) not only question the diagnosis, but essentially state flat out that I do not have BPAD was not only infuriating, but also incredibly invalidating of all of the work I’ve been doing toward accepting and attempting to manage the diagnosis.

But I can’t say that. I can’t say any of it. I have to hold it back, because if I start to say these things, I’ll likely end up yelling them at this point and getting myself in trouble. Because when you’re meeting with or talking to these particular caseworkers, you’re not allowed to be upset. “Upset” is for Therapists. “Medication concerns” are for Psychiatrists. “Referral requests” are for Primary Doctors. Polite acceptance, it seems, is all the Case Managers with whom I’ve been working have room for. And I am so far beyond “polite acceptance”. I am frustrated. I am angry. I am saddened by the stated of things.

You’ve heard of jumping through hoops? I’m bouncing around among five different agencies/offices and perpetually being told to talk to someone at one of the other phone numbers. It’s like a line of people holding the hoops through which I must jump, but every time I jump through one, the fucking person holding that hoop just moves to the back of the line and waits for me to jump through again.

It feels, in many ways, like this system is designed to allow people to fall through the cracks. If I wasn’t a stubborn, persistent, determined, sometimes pain-in-the-ass person, I would have completely given up on this by now. As I write this, I am discouraged, yes. But I am also genuinely scared. I’m scared that I’m going to have to taper off the medications which are still not even at full theraputic value in my system yet. I’m scared about all of this waiting leading to a destabilization and possibly another hospitalization for me. I’m scared of the implications of all of this. I see the “cracks” for what they actually are: gaping holes. And I’m terrified of the fall.

And, to end, I’d like to acknowledge a few things about privilege. In some ways, yes, I am in a position of disadvantage in our society: I am a woman, I am currently a single mother with no income, I’m an abuse survivor, and I have substantial mental health diagnoses.

But, in many other ways, I am very privileged. I am white. I am a Natural Born U.S. Citizen. English is my primary (and only) language. I am perceived as a cis-gendered, straight person. I am educated. I have access the internet. I am literate. I have some knowledge of and familiarity with the system which I am attempting to navigate. I have a steady work history. I have a car and a license. Despite being unemployed, I am not at risk of homelessness. I have family and friends supporting me in many different ways.

All of these factors place me at a great advantage over others who are attempting to gain support and services through this same system, and if I’m having so much difficulty with it, please take a moment to consider how hard it must be for those who do not possess the same privileges.

Our system is broken. And with the current administration’s plans for the future state of health care in this country, it is at risk of becoming irreparable. We need to fix it. We need to fix it before it’s too late.

On Meaningful Connections

This is not what I intended to write this evening. It’s actually the emotional opposite of what I intended to write. See, I’ve had an exhausting day of phone calls, waiting rooms, and non-productive meetings in an attempt to get everything situated. Red Tape is real and my god does it get in the way of things. I planned to write a rather scathing commentary on the impact of burnt-out workers, seemingly insurmountable hurtles, and the general way the system treats you as a number and a clipboard-check-list rather than as a human being on motivation to even try to get help and support. But that’s not what I’m going to focus on tonight, because I need a little positive energy and I’m just going to cultivate it for myself.

Rather than focus on people who seem to see me as “another case file,” I’d like to talk a little about meaningful connections and their importance in recovery and maintenance of mental wellness.

First, I have family members who have really stepped up in different ways to show their love and support. My mom has been immensely helpful in many tangible ways, from financial assistance to childcare, and emotionally, too, by just generally being around if I want to talk. My Uncle calls me frequently to check in. My foster sister, who I hadn’t seen in years, came up to visit me for a weekend and it was like we never missed a beat. She helped me in a lot of tangible ways, too, and I’m seriously looking forward to the next time I get to see her.

I’ve said it before, and I’ll say it again: I have some fantastic friends. Friends who showed up for me even when I was actively trying to push them away. Friends who gave me “space” when I did push them away but were there for me the minute that I, much like the Prodigal Son, came crawling back beaten and filthy and out of options. I do not feel I deserve such unconditional love and support, but I’ve been blessed to receive it nevertheless.

I named this blog “Parallel Dichotomy” because the two words are, by definition, mutually exclusive. Carl Jung had a concept he called the “Tension of Opposites,” holding two seemingly incompatible things in balance. This has been a theme throughout my entire life. In this post, I’d like to focus on one particular example: if I’m being honest with myself, I’ve always had this internal pull toward self-destruction, but I’ve denied it’s existence and kept it mostly in check by my need to be perceived as responsible and reliable. As with any aspect of Self, though, the more you deny something, the more it tends to pop up at very inconvenient times and in very unexpected ways. “What you resist, persists,” as the saying goes.

This has been the case for most of my life, I think. Too afraid to be honest with myself about my feelings and thoughts, I avoided them at all costs. I denied my anger at others, and thus, took it out on myself through self-harm rather than expressing it in a productive way. As I got older, I tended towards drowning my sorrows in alcohol, especially when alone, rather than facing my feelings head on. I tended toward indulging my self-defeat in private while publicly projecting a persona of strength and confidence. I tended toward being resistant to medical professionals (or support of any form, really) while holding a career in mental health support. I tended toward a lot of maladaptive stuff, and masked it all with a smile. I basked in the light of others telling me how strong I was while really, I felt weak and broken. I enjoyed the pats on the back I would receive for each accomplishment, all while feeling, at my core, that I didn’t deserve any of it. And whenever anyone would get too close to seeing the “real me,” I’d pull away. Only now am I beginning to recognize these patterns and work to consciously address them.

My friends, though, saw these patterns for what they were far sooner than I did. When I was in college the first time, I very nearly had a breakdown which likely would have required hospitalization were it not for such wonderful friends. Actually, I nearly had two: one slightly less acute episode my Junior year of college, and then the spectacular, blazing fire of self-destruction that was my Senior year blow-out.

In each case, I had friends step in and intervene. Junior year, my high school friend Kim was literally available for texts and phone calls every day, any time of day. That, in conjunction with therapy, was sufficient to get me through what I thought was intense depression and insomnia. (Interesting aside, around age 20 tends to be when the Bipolar switch gets flipped, and looking back on that month and a half or so and discussing it with a psychiatrist, it’s now clear to me that that was my first real mixed-state manic episode.)

Senior year, I was in a state of complete willfulness. I was just going to do my thing, get through the year no matter what life threw at me, because I was stronger than my depression and anxiety and trauma and dammit, nothing was going to stop me from graduating! I’d just act like everything was good, “fake it ’til I made it,” and self-harm and drink as stress relief. As I am now 28 years old and still do not have my bachelor’s degree, you, astute reader, have probably deduced that this approach was unsuccessful. See, there was no way in hell I could juggle everything life was throwing at me. Thankfully, I had these wonderful people called “friends,” you see, and one of them in particular realized I was on a very slippery slope, took away anything I could possibly use to hurt myself, and essentially dragged my ass to therapy (*cough* Paige *cough*). She also refused to leave me alone until everyone was sure I’d be OK. (There was a whole fiasco with anti-depressants making me hallucinate and a Halloween ER visit in which literally all of my closest college friends showed up, piled into the car, and hung out in the ER waiting room while Paige sat with me in the actual exam room. Again, friendship at a level I did not deserve. And another aside, such a reaction to an SSRI should have been a red-flag for Bipolar, but the doctors missed it.)

Many of these people are still around today, despite me really falling off the face of the earth after I found out I was pregnant, burying myself in work and my marriage and parenting, and generally being a shitty and unreliable friend.

As I gingerly claw my way out of the pit of self-hatred and self-destruction once again, this time actually learning ways to avoid the pit all together next time (a foreign concept to me), many of these friends have come back into my life in full force and demonstrated that even though I suck at picking up the phone, they are always there for me.

My friend Paige (the same Paige from Senior Year), who literally lives across the country now, supported me by listening to me vent, cry, get mad, and sometimes, just bitch and whine from October (when things were just starting to slip) on. She came to my house for almost a whole week right before Christmas and dealt with me and my flashbacks and panic attacks and dissociation which, at that point, were so bad they disrupted just about everything we tried to accomplish. I talked to her on the phone leading up to me going to the hospital and she gently encouraged it. And she talked to me every day I was in the hospital and in the ensuing weeks and months. She’s one of those good friends I’m not sure I deserve. (Ok, she’s one of the best friends possible.)

And then, there’s Cassie. Now, Cassie has known me for over 15 years. She’s younger than me, but she’s always kind of played “big sister” in a way. In 90’s kid terms, she’s always been the Cory to my Shawn. That self-destructive tendency I mentioned earlier? If Cassie wasn’t in my life in middle and high school, I’m honestly not sure where I’d be today. I’m quite sure, though, that I wouldn’t be taking positive steps to improve my well-being and over all quality of life. Because Cassie has always possessed the ability to steer me away from the stupid choices and toward the right ones. Gently, with compassion, without being forceful. She’s the person who is always on the other end of the phone if I call. I spent the weekend prior to my hospitalization at Cassie’s house, and she spent the weekend making phone calls, doing research, letting me sob on her lap, holding me while I rode out panic attacks and flash backs, comforting me after nightmares, and, ultimately, convincing me (with the help of Paige and Kelly – another fantastic friend I have) that the hospital was the way to go because things needed to change and I needed help and, despite my Irish stubbornness, I couldn’t do it on my own, or even with friend support and once-a-week therapy.

Once at the hospital, I had five different people who called me almost every day to check-in, and I learned about another very meaningful connection – peer support and the importance of spending time with people on a similar journey. It might sound weird at first, but I made some fantastic friends while on the psych unit and at the partial hospitalization program. And I plan to maintain those relationships, because spending time with people who “get it” is essential to success, I think.

And, as of today, I’m beginning to connect with other mental health advocates as well. Bloggers, YouTubers, and Twitter Kings and Queens. I’m feeling a little more confident about putting myself “out there” as a vehicle for impacting change and shifting perceptions about mental health struggles and successes. I’ve mentioned before that I have a drive to be a force for good in this world and a desire to have a positive impact. This has not diminished, I’m simply shifting it toward a more healthy (for me) platform.

The scathing post about some of the reactions I got today from “support” people will come at some point, but it felt important, tonight, to focus on the good people in my life, and I dedicate this post to all of you.

On Moving On and Bumper Sticker Wisdom (That Actually Helped Me)

(Photo – I wanted a selfie while admitting myself to the psych unit… because that made sense. My wonderful friend humored me. This picture is denial incarnate, I think.)

Today was my final day of Intensive Out Patient treatment. This is a massive transition for me, as my life for the past 2 months has consisted of some form of group therapy almost every weekday. In January, when I admitted myself to the psych unit at Dartmouth, I was not anticipating the length of the journey upon which I was embarking.

In Dialectal Behavioral Therapy (DBT), there is a concept called Radical Acceptance. The basic idea is that you have to accept reality for what it is. If you accept reality, while there may be pain, you will not suffer. If you refuse to accept reality for what it is, then you will suffer. Another way of putting it is “willingness verses willfulness”. Willingness is the ability to accept where you’re at and do what it takes to get better. Willfulness is rebelling against or refusing treatment.

I struggled with willfulness at the beginning of my treatment. Though I voluntarily admitted myself to Dartmouth, I spent the first two or three days I was there insisting that I could not learn anything from the group therapy because I had a strong  professional understanding of the topics being taught.

** A slight aside on my professional identity: I have spent the past four and a half years of my life as a residential instructor in a group home. My job was teaching emotional regulation and life skills to dual diagnosed individuals (think Autistic/Schizophrenic; Bipolar/Fetal Alcohol Syndrome, etc.) . In that capacity, I was very familiar with the concept of DBT as it is a resource offered to many of the clients with whom I have worked.

Back to the Dartmouth Psych Unit, sitting in a DBT group as a patient felt pretty unnecessary to me. On my third day on the unit, I had a good conversation with my nurse for the day. She told me that I needed to shut off the professional part of my brain, the part that “knew” DBT skills intellectually, and I needed to have “beginner’s mind” when approaching the material and consider how those skills could be applied to my current situation. This perspective helped me overcome my willfulness on the unit; but I was still willfully in denial of the scope and impact of the struggles I was facing. I was convinced I would return to work and school in a matter of days and that this little detour to the hospital would have no long-lasting impact on my life.

This, as it turns out, was a completely irrational belief. You can’t qualify for admittance to a psych unit one week and be back to business as usual the next. There’s all this follow-up care shit you have to do. (It’s not really shit. But that’s my angry, willful Bostonian coming out.) For me, aftercare was a month of Partial Hospitalization and two and a half weeks of Intensive Out Patient (IOP). Finishing up IOP, though, is also not the end of my journey to wellness. Now, I’ll be working closely with my PCP, therapist, a psychiatrist, and Voc Rehab to try to really get things evened out and get my life back on track. And I’m very excited to continue to learn and grow. Right now, though, I’d like to take a few minutes to reflect a little, if you’ll indulge me.

In the past two months, I’ve learned a lot about myself. I’ve learned that I have Bipolar Affective Disorder. I’ve learned that my PTSD symptoms don’t have some magic cure, and that I’ll have them, to some extent, for the rest of my life. I’ve learned that I have an unhealthy tendency toward numbing my feelings with alcohol. I’ve learned that the way to manage many of my symptoms is to set and follow a schedule (something I despise). I’ve learned that medications are essential for the foreseeable future at the least, and possibly for the rest of my life. Prior to each moment of learning were several moments of willful denial.

“Fuck off, I’m not Bipolar!”

“The PTSD isn’t a big deal. It will pass.”

“I’m not taking any meds heavier than Tylenol.”

“Schedules are boring.”

“I’m a night person. I’m not going to start being in bed and working on sleep by midnight.”

“I don’t even need this program.”

“Drinking with friends isn’t a fucking issue. I can drink whenever I want. Who are you to take away my social life?”

The above are all actual things I’ve said out loud to my friends and/or treatment team over the past two months. Honestly, there have been moments that I’ve been truly insufferable, I’m sure. But, one by one, I’ve moved away from my denial and toward acceptance. And you know? Accepting things as they are instead of getting angry about how they “should be” has truly helped me stabilize and engage fully in treatment, and I have come a long way.

Treatment isn’t over yet, though. And there are some immediate hurtles for me to try to jump over. I’m hoping I’ve got enough momentum to clear them. My insurance lapsed mid-February, which is making follow-up care tricky to coordinate and getting prescriptions refilled impossible at the moment. (I’m working on that, though, with both my PCP and a local mental health organization, and should hopefully have that resolved in the next few days.) But, it’s definitely a stressful note on which to leave the intensive, wrap around support of the IOP program. (There will, in the future, be a separate blog post all about the ridiculous struggles of finding and maintaining affordable, quality mental health care.)

For right now, though, I just wanted to take a few minutes to share with you some bits of what I like to call “bumper sticker wisdom” that I’ve learned in the last two months that I’ll carry with me for the rest of my life:

“Sometimes good is good enough” (for your inner perfectionist)

“Yeah but your yeah buts” (For the moments your self talk is not helping you.)

“Check your lens” (Also for the moments your self talk sucks and your inner critic is dictating your perception of yourself and others.)

“Your shit; my shit.” (For the moments you may struggle with being able to differentiate between your responsibilities and other people’s problems)

“There is no bad mindfulness practice, there is only practice or no practice.” (Even if you’re REALLY distracted, and being mindful is hard, as long as you practice bringing it back to the present, you are succeeding in practicing mindfulness.)

“Act Opposite” (This one is from Cognitive Behavioral Therapy – you feel like staying in bed all day because you’re depressed? Do the opposite, even if you only make it to the kitchen and do 10 minutes worth of something before going back to bed.)

“Use the 10 Minute Rule” (This is maybe exactly what it sounds like, you do something you are avoiding for 10 minutes at a time. Got an inbox full of emails you’re avoiding replying to? Set a timer for 10 minutes and start reading and responding. Wherever you’re at at the end of that 10 minutes, you can choose to stop or continue based on how you’re feeling, but at least you made a small dent.)

“Action Precedes Motivation / If You Wait Until You Feel Like It, You’ll be Waiting a Long Time.” (Mood dependent behaviors are going to keep you stuck in your cycle of suck. You’ve got to do something to break the cycle. 10 Minute Rule is great here.)

“It’s Simple, but not easy.” (All of these things seem simple enough, maybe even like oversimplifications of the struggles you’re facing. But no one is saying it’s “easy.” Doing this work is fucking work. But it will help improve your situation over time.)

“Distress Tolerance: Getting Through a Bad Situation Without Making it Worse.” (I literally have a card of go-to healthy coping methods I can use when things really suck. I also have a list of favorite activities – I call it my “kit-bag”)

“G.L.A.D. / What’s Not Wrong? Journal” – One thing you are Grateful for today, one thing you Learned today, one thing you Accomplished today, one thing you took Delight in today, and two or three things that are NOT wrong in this moment. Write it out every day. Keep track. Over all, it will help challenge those deeply entrenched thoughts of “My life sucks”, “Nothing good ever happens to me”, “Why bother?”, “Fuck it”, etc.

And finally, remember that we are all working as hard as we can, and we have been working as hard as we can, but recovery is based on finding a way to work better, not harder.

So, I’m onto the next step. Wish my luck in this insurance fiasco. I’m told going off my meds due to not being able to refill them at this specific point may undo all the work I’ve done in the last two months, and I’m really not trying to have that happen.   I have several meetings tomorrow, so I anticipate a more technical/ resource filled post at some point.

Movin’ onward and upward, as they say.