Checking Off All the Little Boxes

As with any job there are trends that I have observed in the psych field that seem to occur every year. The transition from spring to fall is when we start to see those who are depressed come out of the wood work. Winter is when we see the more at risk population, low income, frequently homeless and those with a history of incarceration. Spring is when we start to see higher incidence of mania and/or psychosis. Summer is a bit of a hodge-podge, but I think there tends to be more family related stress and strife that plays into that. Kids are at home, there are higher expectations for temp workers to find employment and it’s hot. People get grumpy and pissy and irritated when they’re hot.

Let’s focus on that bipolar population, sorry, I really should say it as the population who has a history of bipolar disorder/suffers from bipolar (let’s call it BPD I/II from now on). Like I said above, most tend to go into a more manic phase at this time of year. Not everyone though. Some get the pleasant experience of a mixed episode meaning that they experience some depression symptoms and some manic symptoms. This group tends to be at the absolute highest risk of suicide: feeling suicidal, coming up with a plan and they have the fucking energy to be able to actually carry through with those plans. The sad part is that they have the highest rate of success. I’ll go look up the research again should anyone want to see that. My knowledge is coming from stuff I had discovered in 2007 when I was desperately trying to figure out the world of psych for my first job and then from observations throughout the years. Incidentally it’s also one of the major reason why people who start on anti-depressants are at higher risk for suicidal thoughts and carrying out plans; the antidepressants don’t affect their thinking and emotional state as quickly as they affect the physical symptoms of depression. They get the energy and even some motivation before they actually start to feel better. It sort of mimics what a mixed bipolar episode does for people.

Anyway, the point of this post is that I fall into the smaller group of people with BPD that are more likely to feel depression than mania at any change in seasons. That is partially because I have the type II version which nearly always tend toward depression rather than the hypo mania side. I think I’ve experienced hypo-mania only a handful of times in my life and those episodes are nearly always followed by a pretty strong crash into depression. I normally can observe the symptoms and act on them before they get to the absolute bottom. I start eating healthier, exercise more, attempt to read more, make a good go at trying to get better sleep, and all that good jazz. It’s actually the primary reason why I do any of these, not to lose weight, not to look better in my favorite jeans, though those are all really awesome bonuses.

This year hasn’t been so kind about it. Over the last 6 months I have continued to experience various symptoms of depression despite taking all the above actions and asking my doc for some med changes. What really has sucked is that the last three months I finally got hit hard by the complete lack of motivation to do what I need to in order to keep myself from tanking further. Exercise? Yeah, non-existent. Eating better? Forget it. Wanting to do much of anything? Ha! That’s funny. Feeling good about my job and what I’m doing there? Eh, still some of that, but it’s really damn hard to get myself to not be cynical and wanting to interact with patients much. By Saturdays I’m kind of useless. I try to get as much done in the morning since I developed that routine and if I don’t complete it, I’m fucked.

I wasn’t fully aware of just how bad things had gotten until my husband started to ask me about it. The fact that he was aware and able to ask about it is saying something because he really doesn’t have the awareness of such things that some/many people do. I had given him some reference material when we first started dating and even gave him a pretty clear (I thought) list of symptoms that I tend to experience, subjective and objective. A few months ago when I asked him about it again he told me point blank that he really couldn’t notice the subtle changes over time much at all. He’s never been very good at reading many of those things and whatnot so it’s honestly not much of a surprise. He’s a tech dude, he gets tech things really well and is great at problem solving but when it comes to things that he can’t do much about he is pretty apathetic about them. When it does get to the point that he is completely aware it really is hard for him to deal with. He wants to fix it. He wants to make it go away. But it’s not that easy, probably partially because I really am not good at listening to anything or anyone once I get to this point.

I think it’s probably a bad thing when all the things that I’m upset about in relation to myself are basically check boxes for the DSM-IV diagnosis for depression. Let’s look at this list from NIMH:
Major Depressive Disorder requires two or more major depressive episodes.

Diagnostic criteria:

Depressed mood and/or loss of interest or pleasure in life activities for at least 2 weeks and at least five of the following symptoms that cause clinically significant impairment in social, work, or other important areas of functioning almost every day

1. Depressed mood most of the day. Worse the last three or so weeks, but been experiencing some since November.

2.Diminished interest or pleasure in all or most activities. Reading? Meh. Exercising? None. Wanting to go out? Eh. I’ve really only gotten excited by a few select things, many of which I’m really not as excited about as I would have been a year ago. Even then it’s a very short-term thing. *sigh*

3.Significant unintentional weight loss or gain. Actually this one I’m not experiencing as much. Some weight gain, but that’s what happens when you go from a 1350 calorie a day diet and exercise to around 2500 and not exercising.

4.Insomnia or sleeping too much. Ugh, yes. If I don’t take something to help me sleep I toss and turn the whole damn night. I don’t actually seem to fall asleep and stay asleep until sometime after 6 or 7 am. Given that I only got to sleep past 8-9am two days a week until this last week that was pretty significant. Now I get four days a week, but holy crap is it hard to get up. Work or school were pretty much the only things that could pull me from bed from 11am. Now that I am not in school, well let’s just say I haven’t gotten much of anything accomplished this last week.

5.Agitation or psychomotor retardation noticed by others. Anytime I am not at home. Especially if I am with or around people. It’s not as pronounced at work, but it’s been commented on several times the last few weeks. Yay for nearly autistic like repetitive movements to decrease anxiety…

6.Fatigue or loss of energy. Why don’t they have this as number 5 rather than 6? It goes so much better with the insomnia question. Anyway, yeah. This is probably my biggest complaint. I am freaking tired all the time. Doesn’t matter how much or how little sleep I’ve gotten, whether I have plans or things to do or absolutely nothing at all to do, I am exhausted. It sucks.

7.Feelings of worthlessness or excessive guilt. Not too bad, not yet. I’m starting to feel some of this, especially since I haven’t been much interested in doing things I need to like helping around the house. Blargh.

8.Diminished ability to think or concentrate, or indecisiveness. Worse so than usual, yes. Indecisiveness is something I always experience, but not to this extent. Lack of ability to think or concentrate? Oh yeah. I am slow to respond or pick up on what others are saying and am definitely more flighty than usual. The only thing I really seem to be able to concentrate on is a book when I’m reading, but even that is iffy.

9.Recurrent thoughts of death (APA, 2000, p. 356). I don’t think so, though it’s hard to tell since there is a lot of conversation at work about our suicidal patients. What I really want is just to be able to sleep until I actually have gotten enough *good* sleep to be functional again. I don’t know if that counts or not, but I’m leaning towards no. Maybe some of the therapists/counselors I know would disagree, but really I don’t care all that much whether they disagree with me or not. I don’t feel like I’m suicidal. I haven’t actually thought about what it would be like for me to die or even thought about plans. I have discussed what people do that just seem silly or don’t actually work, but that’s about it.

Just for shits and giggles, let’s take a look at the manic side of things too.
Bipolar 2 Disorder, in which the primary symptom presentation is recurrent depression accompanied by hypomanic episodes (a milder state of mania in which the symptoms are not severe enough to cause marked impairment in social or occupational functioning or need for hospitalization, but are sufficient to be observable by others).

Manic episodes are characterized by:

A.A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary) Ugh, irritated mood is one of the major things that my husband noticed. I’m irritable, easily agitated and more and more frequently difficult to get along with. I know that some people actually have irritable or angry depression so I don’t know if this is depression related or not.

B.During the period of mood disturbance, three (or more) of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:

(1)increased self-esteem or grandiosity Not so much, no.

(2)decreased need for sleep (e.g., feels rested after only 3 hours of sleep) Definitely not.

(3)more talkative than usual or pressure to keep talking Maybe pressure to keep talking, but I don’t believe so.

(4)flight of ideas or subjective experience that thoughts are racing Is the inability to really control where my thoughts go or what they do part of flight of ideas or racing thoughts? I don’t know that they are racing except when I’m feeling massively anxious, but maybe? Probably not.

(5)distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli) Ugh, yes. Too much of anything overwhelms me and makes it difficult to focus or concentrate on anything, but again, this is also a symptom for depression or at least one of the things that tends to come up with depression.

(6)increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation Psychomotor agitation, yes, but that’s also a symptom for depression and anxiety as well.

(7)excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)” (APA, 2000, p. 362). Luckily for me, no. The closest would be buying sprees, but I usually force myself to think about things for a while before purchasing. It also helps that I don’t have that much in the way of expendable cash.

So there may be some hypo-mania mixed in there too, but if so it’s nothing compared to this fucking depression. It’s interesting how easy it is to check those things off right now. Well, it’ll probably be more interesting when I come back and look at this in a few months, but I can look forward to that.

This post has gotten waaaay too long so I’ll just leave it off here. If you got all the way down here, wow, kudos to you. You are now free to return to your regularly scheduled day and activities, whatever those are.

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Trying to Understand.

There are things that happen in this world that really do not make any sense. There are acts of violence that occur that confuse me. Why do people do things that have no purpose beyond inciting chaos, death and injuries?

I don’t think we will truly ever have the answer to that question. Most people are not capable of so wanton disregard for the well being of others, whether they know their would-be victims personally or not. Vandalism, burglary, theft, street and bar fights are crimes, but more often than not, they are isolated incidents. They are not designed to injure or kill a dozen, two dozen or more people.

Looking exclusively at events that have occurred in the US like the tragedy in Boston yesterday (Monday, 4/15/13) or the 9/11 twin towers destruction or the Oklahoma City bombing on 4/19/95 were all planned by individuals to harm the greatest number of people. That’s without looking at the hundreds of terrorist attacks that have occurred around the world. They were carried out by people who had some sort of motive whether it is understood or not. Mass shootings are typically also planned but there is a different component involved. The individuals that fired those weapons were able to see who they were injuring. In most cases they could have spoken or yelled at their victims. They had to seek them out. The terrorist attacks that used bombs or other means to harm and kill were more impersonal. In a way, those are easier to understand.

Is there something wrong with the people in the world now that wasn’t here a few decades ago? I don’t think so. I think we are more aware, it’s easier to carry out those impersonal attacks, there’s more notoriety in the personal attacks. Things still happened decades ago, but they impacted individual, small communities more than nations or the world. There is the Troubles in Ireland. The nations in the middle-east have been involved in some sort of conflict for decades. There were two World Wars that started out with smaller acts against individuals or towns which then grew into much, much larger conflicts.

Conflict and terror and war have been a part of the collective human culture as far as we can look back. It’s no surprise that these things are still happening. Only now they have a greater impact on more people, the national and global community. What is important to remember is that these are not acts committed by a majority. These all are acts of a small minority of people. There are always going to be far more brave people committing small and large acts of compassion, mercy and extraordinary courage to help in times of need.

Mr. Rogers, a man with compassion and understanding on par with Mother Teresa, shared some of the best advice I have ever heard.

“When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’ To this day, especially in times of ‘disaster,’ I remember my mother’s words and I am always comforted by realizing that there are still so many helpers – so many caring people in this world.”

This is what needs to be remembered, what needs to be passed on, what needs to be spoken about. Yes, we need to be aware that tragedies, terrorism, acts of violence all happen. What needs to be spoken about more is what people have done to come together, to help, to reassure, to comfort and heal the physical and emotional wounds of all those who were involved. There is kindness in humanity, let’s share and celebrate it more than we share and despair of the hatred and violence of individuals or small groups.

Equality?

Today is a pretty important day in the fight for civil and equal rights for LGBT folks in the US. Tomorrow is too. However, it also looks like the Supreme Court of the United States (SCOTUS) is completely aware of how important this issue is. They are also aware of the fact that it is only in the last year or so that the majority of people in the country support civil unions equivalent to marriage or marriage rights for LGBT couples. If they make a ruling about this divisive issue in the next few weeks they will be continuing the forward march for civil equality but also giving a new rallying point for those against equality.

Essentially, the justices really don’t want to make this decision until we’ve reached a greater than 60% majority in support. Or at least that’s how I’ve been reading it.

Some reasons for that assessment: The argument against Prop 8 (the California constitutional amendment from 2008 that banned marriage or civil unions for anyone besides a single man to a single woman) is literally only arguing against Prop 8. They are not arguing for sweeping, nationwide changes. They are arguing explicitly for the amendment to be overturned and made null and void. Justice Roberts verified the point with the Solicitor General of the Obama administration, “[Y]ou are willing to wait in the rest of the country,” Roberts said. “You’re saying [same-sex marriage] has got to happen right now in California, but you don’t even have a position about whether it’s required in the rest of the country.” I don’t believe that the court really wants to get involved in something so sticky as ruling one way for a state but ruling another way for the country, as could happen with the DOMA (Defense of Marriage Act) case they will be hearing tomorrow. There is a very high likelihood that they will defer ruling on Prop 8 and send it back down to the previous district courts (where there will be even more confusion about what to do next) because they will instead rule on DOMA.

What does this mean for the fight for marriage equality? That it’s not going to be so easy as having one or two hearings before SCOTUS. It’s going to continue to require a state by state battle to get equality of some sort. It’s going to require enough political action to actually get people to the voting booths, which is no small task. It’s going to require that we wait for older generations to pass on before the younger generations, where there is a clear majority of supporters, become the majority of voters. Or it’s going to require someone bring forth a clear, valid argument against a defense that could actually be valid long enough to be considered in court for why there should be sweeping, nationwide changes like what there was for Loving vs. Virginia in 1967. The repeal of DOMA and even overturning of Prop 8 are not going to make it happen, though either one being overturned will be a huge victory and add momentum to the equality cause.

I hope, I really do, that I am wrong. I hope that SCOTUS will rule in favor of overturning/repealing both. As much as it will be a rallying point for opponents of same-sex marriage and equality, it could be enough to convince those who have been waiting to see who the winner is going to be that they ought to throw their support in for equality. That would be super awesome and make me a rather happy camper.

Honestly though, I think it would be rather nice if the whole marriage vs. civil unions thing would be figured out. I have a few friends that really deserve to be married but are only just now being given the opportunity to have a civil union. It’s nice and almost there, but not quite the same idea. Now, if government decided to get their noses out of marriage in general and only have civil unions recorded and all that for state records for everyone, I’d be down for that. Religious institutions could figure out what the hell marriage is and what it means and who or who can’t get married, but that special snowflake definition would only matter and be recorded within that particular institution. I think that would totally be a win-win for everyone. The religious folks could get a civil union with all the legal and tax benefits that come with it and get married through their religious institution and life would be good. There are enough open and non-denom and “we just like to have community!” sort of places that even non-religious folks could still get “married” if they really wanted to.

But hey, maybe I just don’t care all that much because “marriage” has always been an odd concept to me and I’ve always found it to be rather controversial anyway. The history of marriage has never boded well for women, even civil unions never really boded well for women. I would be completely fine with something that came with less baggage and was more personal. But, marriage is important to some people, including my husband, so… *shrugs* I say we make it so that everyone who wants to get married can. *nods*

Reflections on some not so awesome memories

Video

I have had this song come up several times on Pandora lately. I initially really liked it because it’s got a lovely piano playing in a predominantly minor key and the singer’s voice matches the tone of the song so well. I like the bridge transitions, especially the way she transitions from the bridge to the chorus by using what I’ve always thought of as chunky, melancholy chords. It’s one of those songs that kind of makes me want to cry, but that’s because the song is intended to elicit such emotions. That was all I paid attention to the first half-dozen or so times I heard it.

Then I listened to the lyrics. I was in the shower, my thinking place, and just sort of stopped to actually hear the story Ms. Grey painted with her words. It was sort of like getting punched in the gut. Or maybe the throat.

I’m sure I’ve referenced it a few times here, though nothing overt or glaringly obvious. My ex was something of an ass to the Nth degree. If it weren’t for the fact that he was in the Army and it’s a big no-no to get an Axis II diagnosis a psychiatrist would have diagnosed him with Narcissistic Personality Disorder with Antisocial (personality disorder) Traits. In case you don’t actually want to read the wiki articles about those two disorders, just know that they both are pretty much what they sound like they are. He was charming, suave and subtly manipulative the first 6-12 months that I knew him. Then he not-so-slowly transformed into something of a clearly manipulative, emotionally and mentally abusive, controlling, delusional, lazy-ass, *insert your favorite descriptor for a waste of space here* moocher that I had the pleasure of having to deal with outside of work. Except he was really great at sleight of hand maneuvers so that I and anyone casually interacting with either of us wouldn’t realize something was going on or that it whatever they noticed was my fault, my failing. He even managed to convince me that all our problems, his problems really, were my fault. He couldn’t keep a job because we lived too far away from all the places he could work. He lied to me because I wasn’t strong enough to deal with or know the truth. It was my fault that he turned to one of his exes for support, talked shit about me and was making promises to leave me and go off with her as soon as I was “strong” enough to not kill myself over him. The list goes on and on and on.

How does it relate to the song? Well, note that he started out only subtly off. Then he turned into the sort of person that I never thought I would attach myself to. Eventually I came to the conclusion that I didn’t actually deserve to be happy. I really was the cause of so much misery and heartache. The fights were all my fault. The things that went wrong were my fault. I just wasn’t enough. I failed again and again when I tried to make anything better. I was never good enough. I never knew what I was talking about, even when I did. I deserved all the bad things that happened, all the lies, all the half-truths and misdirection. It was what I knew, what I expected and it was, as so often happens, normal, comfortable in that horrifying sort of way. I wasn’t happy, but I knew the routine, I knew how it would end, change was scary. I accepted everything because, well, what other choice did I have? (I know the answer now, but not then.)

Except that I (finally) got space and time away from him. I lived half-way around the world from him and discovered that I could actually be happy. It took over a year, but I gathered my courage and told him I was no longer going to be his thing to manipulate. I left him. And I suppose that is where my story differs from the one told in this song. She doesn’t leave at the end. At least not yet. I escaped. I found a life that I am happy with. I found people who love and support me and whom I love and support.

Sadly, that doesn’t keep me from going back to those memories. I still have times when I revert to behaviors I learned while in that relationship. I suppose I’m still a work in progress. Aren’t we all? We’ve each got our own demons, some are just more obvious than others. I just wish they couldn’t haunt us after we have exorcised them from our lives. Their shades can be just as painful and scary as the demons themselves were.

Right. Well, something more pleasant to come in the near future. Probably something about Anomalycon or the zombie apocalypse or something.

A random nighttime observation

Last night as I was attempting to fall asleep I had an epiphany of sorts. I figured out what it is that makes it difficult to fall asleep and why quiet rooms are really annoying to me. It’s really rather silly that it took me so long to have this epiphany. I guess it goes to show how much the mind can dismiss even the most annoying of things as normal.

You see, I have tinnitus, meaning a ringing in my ear(s). Most people have experienced this a few times in their lifetime, usually after exposure to really loud sounds or music. Some lucky few like myself experience it much more frequently or even continuously. I notice it when it’s quiet, but it’s pretty much always there. Noise that varies in pitch and tone, music or talking, gives me something else to focus on and it recedes to such a low volume that I don’t realize it’s there. More often than not something like reading, writing, or some other endeavor that requires my attention will also distract me from the sound though it isn’t guaranteed. It’s loudest at night when there’s little noise beyond the humming of the fan and maybe the heater or a/c if one is on. Even though I’m used to the sound, it’s still really annoying and does keep me from falling asleep easily. It also may be an explanation for why I have trouble focusing or hearing things in an environment where lots of people are talking. My brain is so used to disregarding noises that are constant, which the hum of talking easily turns into, and the ringing will get really loud in such an environment.

Have I mentioned that I feel really silly for not experiencing this “epiphany” earlier?

Most people who experience it will hear it in one ear or the other, though for people like me who hear it constantly it is more common to be stuck with it in stereo. The chronic version tends to be caused by a head injury, medication side effects or significant damage to the ear drums from frequent exposure to loud and pounding sounds for an extended time. I don’t recall when I started to hear it, so it’s possible to could have been caused either by medication, a frequent culprit being antibiotics, or in high-school from winter drumline, or my time in the army when we were firing weapons, frequently without hearing protection. I’ve had a concussion once or twice, but nothing truly serious (if you can consider a blow to the head “not serious”.)

I’m really not sure what I can do with any of this information. There aren’t many things that can be done for tinnitus. Ear plugs make it worse. White noise is almost as bad as ear plugs. If I fall asleep to music I have a more difficult time waking up to any typical alarm. That’s without considering the fact that it would drive my husband crazy. Ah well. At least I like music for its own sake rather than the added benefit of making this silly ringing a little less annoying.

Human connection

The yoga class I enjoy going to on Sundays is a “gentle yoga” class. We do very little in the way of vinyasa – continuous movements – which means we pretty much spend the majority of the class stretching. Yesterday was even more relaxing than usual in that we spent most of the time on our mats on our backs or sides doing much more conscious breathing and meditation than usual. It is a great way to end the week or start the week depending upon how you view the calendar. There’s one other thing that makes it one of my favorite classes; Aliza, the instructor, is also a massage therapist and most classes will come through and do some brief, but pleasant shoulder or neck massage, at least for those who are okay with it.

I bring this up because for me, I experience very little skin to skin contact in a day. It’s one of the reasons why I cherish snuggling and cuddling with Nathan in bed. It satisfies a need that I am rarely conscious of. The only other times I get that skin on skin contact is through handshakes, which most days I avoid, or through massage the once a month or so that I pay for it.

The contact through massage, or truly a more conscious, gentle, and traveling touch, is special to me in a way that I have found difficult to describe. It is not just a pleasant feeling, but nearly spiritual. I feel an opening up within myself and a mutual exchange between myself, the person who is in contact with me and the world. I don’t feel drained after this exchange but neither do I feel “too full”. I feel balanced, buoyant, relaxed, and at peace.ven

I believe that the reason that this does not happen with all contact like handshakes is that I have learned to avoid opening up because there are too many draining people out and about. This is especially true at work. The people I see there are not just mentally or physically ill and injured, but there are deep gashes on their emotional and spiritual selves. They pull on everyone around them to try to fill and heal those gaps whether they are brand new or years and years old.

I probably don’t feel the same complete opening when snuggling because it is a different sort of intimacy, one of grounding and rooting and safety. I have noticed that when there is more massage or traveling fingers/very gentle tickles from Nathan that I experience the more spiritual opening rather than the grounding/rooting feeling I get from our normal contact. It’s incredibly lovely when I am experiencing both. The extent of my relaxation is something I rarely feel except at those moments when I have found a “zen” moment in meditation.

It does make me wonder if others are aware if they have the same experience. Do they realize that there is this different sort of connection with people? How does the lack of connection within most western cultures influence how closed off and isolated we feel?

New experiences at work

Hello there. I have left this blog inactive for too long. This is probably not the greatest topic to start up again with, but I have to vent somewhere.

I started working at a locked psychiatric acute treatment unit a few months ago. I’ve been working in psych for years. Five years I think. I’ve been in some pretty funky situations with people threatening all sorts of things, people out of control, and people acting out against others. However, I’ve never really been in a situation with someone who is not just actively planning suicide, but acting out on it.

Well, tonight that changed. I was just getting ready to leave work. Grabbing my purse and going out to grab my jacket and all that good jazz when one of the room call lights goes off. Since there were only two other staff in the facility and one wasn’t in the office I went out to see if they needed some help. Turns out the counselor found one of our patients in her room trying to hang herself with a part of her blanket that she tore apart and was trying to loop around the door handle. She had tried to block the door from opening with her body (why the doors open into the rooms and not both ways is still beyond me) but luckily it’s hard to block a door with your body if you’re not propped against something.

I think the thing that stands out to me the most is that she had written a suicide note and had it right there on the desk. This wasn’t a call for help, this was an outright attempt. A pretty good one too. I’ve had patients threaten to hurt themselves and declare they were actively looking for ways to do it, but they never actually managed to do so. This gal, she planned it well. She waited until right after a check (every 15 minutes due to risk) and tore the blanket, tied it, and arranged everything. Lucky for us, the counselor went to talk to her earlier than the patient had expected.

The good thing is that we worked well as a team. The RN took lead and the counselor and I were able to act on directions calmly and without tripping over each other. The other patients remained safe and most didn’t seem to even realize something funky was going on. I don’t know if that speaks to our handling of the situation or to how low functioning this particular group is.

I hung around until our program manager could come in since I have to be back in at 6 am and didn’t really get much of a debrief. I guess this is probably it for now. I don’t feel that I need it as much as the counselor does (did?) as she was the one who found this patient and interrupted her. I can only imagine the emotions associated with that, the number of questions, “what if…” that would come to mind. I’m sure she’ll get the debriefing she needs – our program manager made sure to ask how she was doing during their first phone conversation.

Regardless, I’m bringing some chocolate in for both of them and my manager. They deserve it for how well everything was handled and for remaining calm and collected while still at work. I already have my chocolate so it’s only fair that I make sure they get theirs too.

An Uncomfortable (Impossibly So) Feeling

Brene Brown is a therapist/researcher that I was recently introduced to through TED Talks and work. There are several patients that we currently have at the residence who have appeared to benefit a lot from this woman’s work. Honestly though, I think it is helping some of the staff more. Partially just through being out there. We struggle working with some of our patients who have particularly powerful and ingrained, negative thought tracks. It just doesn’t seem as though our typical DBT/CBT therapies are getting through to these patients. They “know” the words, they “know” the actions, they “know” the coping skills, but they haven’t been able to embrace them and open themselves up to the scary, dark places in the center of their beings.

You know, many of the people who work in the field have similar thought patterns. Sometimes they are just as ingrained, sometimes they are more temporary or related to stress levels. But we all suffer from shame and the dialogue this woman is opening up for us internally as well as externally is just as powerful as those thought patterns, that self-talk.

This is especially on my mind now because I suffer from a sometimes immobilizing feeling of shame, sometimes mixed with guilt, sometimes just the shame. Which is more than enough on its own, so the guilt just ends up being icing on the cake. Last night was one of those nights where feelings of guilt, anger, and more guilt led to being overwhelmed with shame. Shame over many things, some of which I have some control over, others are circumstances which I just happen to be a part of and others are things which I have felt that same shame about since I was a young child.

Feelings of failing in my life because I have not achieved what I should have. Feelings of not being good enough for the good things in my life. Feelings of still being the terrified little girl who can never do enough or be enough to satisfy herself and her family. Feelings of guilt about some of my thoughts or recent failings at work and then shame over those, again, not being enough for what is needed.

I’m pretty sure it was disturbing for my husband. I do not know that he has really tried to comfort someone in that state. I also know that there is some frustration and exasperation over feeling like he has repeated himself several times throughout the last year, “You sell yourself short,” “You are worthy of being loved,” “You are good enough for me and this life,” etc. He’s damn good in knowing what to say and how to say it, and in moments of low self-esteem or guilt, I am able to recognize what he is saying and process and acknowledge them. But those times when I am trapped in the dark place inside my head and there is nothing but the feeling that I am not, nor ever have been or will be, good enough or smart enough or empathetic enough, nothing he says can break through. Actually, they sometimes make me feel smaller because then I feel worse for somehow having tricked someone into thinking any of those when I am not anything that he is saying.

I can recognize that shame is a very intense emotion and faulty, broken thinking outside of those times when I am experiencing them. At this point though, I am not far enough into my own recovery related to shame to be able to do much more beyond that.

There are several things I’m doing to change that. One is that I am reading one of Brene’s books right now. I am watching her videos. And most importantly I am talking about how I am feeling. I was more honest about how I have been feeling last night than any other time before. I’m writing this now. Both things were very hard, but I think there is something to the point that shame is more powerful when we allow it to isolate us and prevent any dialogue, any understanding. In opening up and being willing to share my experiences, I hope to diminish the power that my shame has had over me, to start those dialogues and work on my recovery.

Thank you for actually reading through all of this, and I hope that maybe there was something there to help you to acknowledge your own moments of shame or to be more open and empathetic to others who are experiencing it. Any comments or reactions or thoughts are greatly welcomed.

Deaf or Blind?

I admitted a patient to one of the residential houses today who is deaf. It was an interesting experience and sent me back a few years time to when I worked for the Mental Health Center of Denver and worked with four different deaf patients, all of which also suffered from Mild to Severe Mental Retardation.

It also set off a thought wave that I’ve caught on several different occasions. If I had to experience being blind or being deaf, which to me would be the least difficult way to navigate the world?

This was a really easy question for my husband to answer – he would rather be deaf. He could not work in his field and be blind. He also would not be able to read books, work on a computer or any number of other things that he needs his eyes to do, but does not need to be able to hear. He also made a very good argument that it is much easier to introduce medical and scientific interventions that are more capable of replacing various parts of the whole system related to hearing sounds than interventions for most any part of the system related to sight. The eye is more complicated than the ear, which is really saying something since the ear is a very delicate and fine piece of work by itself.

I have to agree with him that in the modern world being blind is probably more of a handicap than being deaf. But, as I experienced today, the one thing that gives the strongest argument for “choosing” to be blind is that being deaf means a significant loss of the ability to communicate with the world at large. This means far more to some people than to others. I could not do the vast majority of my job as it is now if I could not hear and therefore easily communicate with my co-workers or my patients. At the same time, if I were blind, I could not do most of my job either. Too much hinges upon being able to quickly and easily navigate computers as well as be able to speak. Hell, nursing in general requires all five senses to be able to do a complete assessment, even as a psych nurse I use all my senses (though I sometimes which my nose weren’t involved…) and so I would have to conclude that if I were to be either deaf or blind, I would be stuck with finding a different career.

So, I stand where I have found myself every time I have evaluated this question – I have no idea. Do I give up easy communication, music, and the easy ability to have a general idea of what is going on around me, even behind me? Or do I give up colors, the ability to easily manipulate the technology of today, fewer bruises from bumping into things, and being able to see everything that is around me?

Today, I lean toward choosing to be deaf, but tomorrow I will likely say I would rather be blind. Honestly, it makes me appreciate more and more just how lucky I am to be able to correct my vision with glasses or contacts so that I can see the beauty in the world around me. I am blessed to be able to hear everything around me from the annoying hum of the TV to the gorgeous music in the background to the sound of my husband’s voice. I am blessed to have two legs of even length with feet with five toes each and two arms of even length with hands with five fingers. I have a heart and lungs and liver and kidneys and stomach and all my other organs that function normally and my brain is at least of average intelligence and capable of abstract and forward processing and thinking.

I am blessed in so many ways and I often don’t even think about it. Today though, I am aware of just how lucky I am and today I give my thanks to the universe for giving me this gift.

Perceptions

I wear glasses and contacts, which for most people isn’t that big of a deal because they put the contacts on in the morning, take them out at night and spend very little time with glasses on. I have the week long overnight contacts (huzzah for getting ones actually made for such things rather than just doing that because I’m forgetful and lazy) which means I often have to take them out long before it’s bedtime. What I have found is that my entire perception of the world shifts, enough so that despite the fact that I can see just as well, the world has moved. The floor is farther away or closer, objects I am reaching for are just slightly off from where my brain tells me they ought to be and my balance is off, at least for a few minutes.

Every time it always makes me wonder (once I’ve gotten over the initial vertigo-esque feeling) how much my visual perception of the world really rules how I think and act. It shouldn’t matter too much, right? Tell that to me when I knock a glass over or get another bruise from bumping into the door frame. To most though we all really only see the world one way for our entire lives. Except there are some intriguing theories and thought-games that I’ve spoken with others about. I dated a guy in high school who would always enter a new room with one eye closed. He would get three different impressions of that room, one with his left eye, one with his right and another with both eyes open. He never really said anything profound about what he saw or why it mattered, but just his attitude about it and why he did it were enough to make me think. Sometimes I remember to try it and I haven’t really had any major eye-opening, world shifting experiences, but it is still interesting to realize what one eye versus the other versus two will notice more or something different. Either that or just my attitude and ability to focus on different things each time I entered was different. *shrugs*

I know that how someone sees the world can make a huge impact. I’ve worn glasses since I was in 4th grade, but I should have been wearing them far earlier. The contrast between having to squint at anything distant and seeing clearly was immense. I went from struggling and getting frustrated with myself for failing at easy tasks at school, at home, in sports, even just watching TV, to being able to fully participate in all my life again. Every time I would go to the optometrist and get a new set of glasses I would experience that all over again and the wonder never really left me.

The thing that really stood out to me though was how much colors would change. I am not colorblind in the least, but without my glasses everything is so indistinct as to appear dull and even transparent sometimes. It has led me to wonder about how people perceive and process things like color. Do we all see the same colors the same way? We all learn that certain shades are called red, others are called blue, others green, etc. but that is because we have all been taught by others, by society that these names correspond with these light frequencies and that we all see everything exactly the same. What if we don’t? What if my “turquoise” is actually someone else’s “marine blue” but because we have been taught that this particular color is marine blue and this particular color is turquoise we still call them the same thing, even if they actually processed by the brain to be different colors.

The only reason why this is something that I want to know if there is something to it would be because I’m curious and I wonder if our different ways of actually seeing the world influence how we interact with it. Someone who has the ability to easily process the fine details of their visual world, colors are sharp, edges well defined, movement more obvious, maybe they are the ones who are more greatly affected by the beauty of the world all around them. People who don’t have those same perceptions, maybe they are more influenced by sound, or touch, or their own internal monologue and thus they will have different impressions, different talents, different ways of thinking, all because of how they process the same information.

For myself, I know that the differences between my glasses and contacts are both minute and extreme at the same time. I have pretty darn good peripheral vision even with glasses on because of band, but that is only for movement. Colors and actual shapes mean nothing to me if they are not in the part of my field of vision that is clear because of my glasses, so I process everything around me differently than what I do when I have my contacts and suddenly everything is clear to the same extent. And don’t even bother trying to talk or interact with me when I don’t have my glasses or contacts on and the lights are on. I am working so hard to “see” the world that I have a hard time focusing on conversations, on noise, on physical touch, on anything really. The way I interact with the world (or the lack of it) is something I am constantly aware of because of my visual deficiency, even though I have lived with it for fourteen of my twenty-five years of life. That has to have impacted how I think about the world, even if I don’t know any other way.

I challenge you to think about how your world changes, even with something as insignificant as walking into a room with one eye closed. How different is your world from so small a change? How many different worlds must there be if we all see the world with a slightly different interpretation, even if the differences are minuscule? How much would our interactions with others change if we were all aware of those differences? Would we even notice?