Considering How I Phrase Things

There is a prescriber at work who has made an interesting impact on me and I’m not sure if she is even aware. I have become much, much more conscientious about now I say that I don’t actually know the answer to one of her questions. When I first started working at the ATU I received some feedback from a coworker basically saying that this prescriber was more or less pissed that I was okay with saying those three words “I don’t know.” It was unprofessional and unacceptable. Since then I have learned, especially when speaking with her, to make sure that I always answer with something else. this usually means things like, “you know, I’m uncertain about that but I think so and so may know. It has also forced me to pay a lot more attention to what people say about a clients behavior or what’s going on with them because I don’t want to be caught saying anything resembling I don’t know if it’s at all humanly possible.Her opinion of me and my capabilities have shifted over the last six months or so. I don’t believe she is hesitant to hear what I have to say about what’s going on with a client. She trusts that if she asks me to do something I’ll get it done or at least do my darnedest to make it happen. I’m surprised sometimes when I consider what her opinion of me was a year ago and what it has become and it makes me realize how much changing one small bit of speech can really do for you. methinks it’s a lesson that can be applied to multiple parts of my life. Now just to figure out what other key phrases I need to be way of.

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.

A Bird in Hand is Worth Two in the Bush. Sometimes.

When I first read this prompt I couldn’t help but think, “man, I hate trying to remember this sort of stuff.” As it turns out, it took only a few extra moments of thought for me to realize that I was highly focused on those “two birds” more so than the “one bird” for months.

There was a time, not so long ago, a year ago actually, where I was desperately looking for something else. That something else was a job that could pay me enough that I wouldn’t feel that I needed to work two jobs in order to be more or less financial stable and not have to rely on my husband so much. I was stressed at my main job and really not all that interested or happy in my second job. I had little time to spend with family or friends and was pretty much just constantly tired. It got to the point that before I found that mystical different job I quit my second job. I still needed the change in employment. I really needed the higher pay.

So I continued to pretend that I was doing alright in my only job while daydreaming about something different, something inpatient or in a hospital or even in a completely different sort of outpatient clinic. I was thinking of all the things I could do with my magical new income. I was despairing that after 6 months of searching and turning in applications nothing was happening. No call-backs. No emails. No letters saying “sorry, too much inexperience, come back in a few years.” I was getting desperate. Work was harder to focus on, I was missing important things and my boss was unhappy with me.

The story actually has a happy ending. When I finally stopped constantly thinking about a change and jut tried to go with the flow, I got a call-back. I got an interview. A month later (a very long month later mind you) I got an offer. Huzzah! Sometimes, looking at those two in the bush can be very motivating and give you the extra drive needed to do change circumstances so you can let go of the one in your hand and “catch” the two in the bush. It’s not impossible. Yeah, it’s risky, but there are many things that are worth a risk and a leap of faith.

Social Anxiety

The last few months I have noticed that my social anxiety has increased. I am overwhelmed in public even more easily than I would have been a few years ago. I am even more intimidated by new situations, new people than I remember. I have started to get more of the physical symptoms including racing heart and occasionally even tightness in my chest.

All in all, it’s sucky, frustrating and scary.

I became acutely aware of this in the last week when I nearly started to cry while waiting to meet a new instructor for martial arts. I was making up a lesson from a few weeks ago and my normal instructor, hell any of the instructors that I knew, were not available so I agreed to work with someone I didn’t know. I got there a bit early and so had something like 7 minutes to work myself up nearly to tears, I couldn’t take a normal breath, I could feel my heart racing and I was uncertain if my stomach could tolerate much more acid build up before I would need to run to the bathroom and throw up. This was mostly because there was the one on one instruction with someone new in a place that I still am not familiar with and surrounded by others I didn’t know. It was compounded by the fact that I was stuck in a fairly confined space with over two dozen people coming and going. I haven’t felt that bad in a very, very long time. Once the lesson started and I began going through the new kata I’m learning I was able to calm down and I think even learn something. If there was too much time between different exercises the anxiety started to creep back up, but it was tolerable, especially since it was only half an hour and I was kept pretty active.

The other incident that comes to mind was Saturday night when I went out to dinner with Nathan. It was a Saturday night at just about 7, so of course it was busy and the restaurant was full of people. It was a pretty crowded space and it was so filled with people noise that I couldn’t hear the music. I couldn’t hear Nathan even when he spoke pretty loud, though I don’t know how much of that was because I had already hit my max for sensory stimulation and so my brain was shutting down the information overload to keep me from having a full on panic attack. There was again compounding in that I hadn’t slept well the night before and had been up since about 530am and it was the last day of my 3 twelves. It wasn’t until it had started to quiet down enough to where I could hear music (which is actually quite soothing to me) that I could even really start to think and was capable of responding to questions and carry on a conversation.

I am truly lucky that Nathan is as patient as what he is because I know he was getting frustrated and confused with me in both incidents above. He doesn’t like people much and can also get overwhelmed, but he is better at tuning out things and going into his own world. I can do that if I’m prepared, sometimes, but if I’m caught off guard then I just end up shutting down. That’s if I’m lucky and I don’t start to go the other way and begin to have building anxiety. Not so awesome. Not awesome at all.

I guess I just find it weird that my anxiety, which could be controlled, or at least ignored, a few years ago, has increased again. I can understand why it initially increased with starting a new job, but I’ve more or less settled into it. Yes, I have started back to school in the last two weeks, but I noticed the trend of increased anxiety before that, probably sometime in November. It was one of the reasons why I started doing yoga and working out again. I haven’t noticed any changes for the better despite better habits that have a lot of evidence behind them saying that they should have a positive impact on my symptoms. Actually, if there have been changes they have been in the wrong direction. It’s weird and I wish I knew what was going on.

Anyway, enough whinging. I need to find sleep and yoga and class. Thanks for reading and I hope you have a lovely day!

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.

Equality

There are a lot of people arguing over equality. Marriage equality. Wage equality. Equal citizenship. Equal rights to work. Equal access to health care. A whole schlew of things, many of which I don’t recall because they all fit under one big flag – every person has a few basic rights that should not be put under question.

Everyone should have access to health care. Done. This is the minimum, at least in my opinion. Does that mean that if you can pay more or have more resources that you are not able to get better health care? No. That just means that there is a certain very basic level of health care that everyone should have access to and that if you want more you can pay for it. It’s pretty much the same as what we have now, only it would elevate the people at the very bottom to have *something*.

Everyone should have the opportunity to work. That doesn’t mean that I think every company needs to have so many of each different “minority” or “special interest” group represented. What it means is that if you are qualified for a job, then you should be considered for it regardless of your gender, your religion, your race, your sexuality, or disability. If you have the brains and capabilities to do the job then that means you should be able to do it. This doesn’t only apply to minority groups. I have made arguments for why men are just as capable as women to be nurses and my arguments were enough to make it so that two nurses I currently work with were kept in for consideration and eventually hired. Job discrimination needs to end.

Everyone should get paid similar wages for doing similar work. There are still studies that are showing that women and other “minority” groups – side note, how is it that 50% of the population is considered a minority group? Let’s think about the origin of this please. – earn less income than their male counterparts. Some of it can be attributed to men overwhelmingly ending up in higher manager or specialist positions. However, women that are in similar or the same positions earn less income, usually by thousands of dollars a year. Why is that?

I don’t care who you are or who you love, but if you’re both consenting adults, no one should be able to deny you access to receiving a marriage certificate. Churches don’t get the final say in whether someone is married. My husband and I got married outside of a church and with no church backing. It is a civil/legal thing, not a religious thing. There are civil/legal changes that happen with marriage, not religious. The fact that I can get married but that many of my good friends cannot is frustrating. Nothing my husband or I do is anything special or different that means we should get treated differently. Why is it okay for anyone to deny them access to something that is pretty much assumed that everyone will do? I don’t get it.

Which brings us to everyone being treated as a citizen of their country. I am a white woman within the United States. I have access to rights that women 100 years ago were just starting up the fight for. I am not old enough to have been witness to the civil rights movement 50 years ago, but it was the next great step in slowly defeating bigotry and intolerance. Another side note, I hate that people use “I support tolerance” and other such things. I am against intolerance and am for inclusion. I don’t “tolerate” people for their differences, though I do sometimes tolerate individual people’s actions or words because the *facepalm* worthy moments are nothing compared to the person overall. I don’t even “accept” people for their differences. I love people for themselves, I enjoy spending time with them, I enjoy their company, I choose to be around them. I don’t have to “tolerate” or “accept” them, because both those words imply that there was another possibility, that I could have been intolerant or denied them.

I know it’s asking a lot, but I would love to see the rest of the nation (or world even) get to this point. We lay down certain rights and privileges and then laws and codes that lay down the consequences for people who go against those rights or abuse their privileges. The privileges of some should never overrule the rights of even a single person and the rights and privileges of individuals should be held above those of corporations, organizations, institutions, states or nations.

That should be the end of the story there. I doubt it actually will ever make it to that point, but I’ll do my part to make it happen, even if it is a far shot.

Surprising Revelations at Work

There are always people who surprise me by their belief systems or tolerance for others. The more educated an individual is, the more they are capable of surprising me. Recently, I have been not just surprised, but astounded by comments from one of my co-workers, a psychiatrist to be more specific. Some of the people who read this may actually know her, but just in case I will not name any names. Also, I hope this does not color negatively any opinions toward her. She’s still a wonderful psychiatrist and I still like working with her.

What is it that she surprised me with? Apparently she has a pretty significant misconception and negative bias toward GLBT persons and is much more conservative in her beliefs than I expected. She has done a very good job of keeping her personal beliefs from interfering with her job, I have to give her credit for that. I didn’t even know she had a bias against people who can be identified in the GLBT, sexually diverse/different, or pro-abortion, etc. groups until very recently. It does however make some of her comments throughout the last few years make more sense. For example, she was very surprised when a patient told her that she (the patient) had asked for the doctor who was the most tolerant of sexual deviancy and the front desk set her up with this particular psychiatrist. it probably had something to do with who had openings as well, but still, it was something that shocked the psychiatrist enough that she wanted to share her surprise with me (and another nurse) soon after the appointment was done with.

About 6 weeks later she shared with me her experiences at a conference she went to. It took place in southern California and there were many more GLBT professionals than she has ever interacted with. During the course of the three day conference she discovered that she could relate to just about everything the gay/lesbian men and women were sharing and even the way they shared their own stories. It was probably the absolute best conference for this revelation to occur at since the entire point was to discover how to actually hear patients and other people, basically let them share their stories without interruption. The participants could only speak one at a time and the ones who weren’t speaking could only listen, they could not comment except to the entire group after each exercise.

Mind you, the reason why this truly astounded me was because her nurse (the one for her outpatient caseload) is a gay man. It took me all of 5 minutes interacting with him to determine two things – he was gay and was an INTP in the Meyers-Briggs personality system. The second was just a nice thing to know, the first was just another thing to know so I could know how better to relate to him. However, this psychiatrist has worked with him for nearly two years and hasn’t a clue. When I mentioned my surprise to the other nurse he just shrugged it off as something he has seen before. People who don’t want to accept GLBT individuals are unaware of the vast number of people that are GLBT.

I do have to admit that while I’m surprised and honestly a bit disappointed to know that someone I highly respect has such a bias, I do have to respect how well she is able to separate her personal beliefs from how she treats and interacts with her patients. As far as I’m aware, she has never demonstrated any sort of negative, derogatory or unthinking behaviors towards her patients or in front of our other co-workers, especially when we are discussing patients. I don’t know how much our other co-workers interact with her regarding more personal matters, so I’m not sure if I’m either late to the party or someone she feels comfortable with and is willing to share such belief systems that are contrary to the norm within the agency we work for. Well, at least as far as I can tell that is. I could very likely be surprised by other people that I work with. In the same way though, I don’t believe it would decrease my respect for them for the same reasons. As far as I can tell they do not let their personal beliefs interfere with how they interact with our patients. That’s something to be proud of really. And they should give themselves a 4 on the diversity and tolerance/acceptance part of our self-assessment thingy. 😉

I do wish that everyone believed as I do – that as long as no one is harmed that any way of being and living and loving is okay – but I know that the chances of that happening in my lifetime are slim. However, I do hope that as we all learn more about each other, the more tolerant (accepting even?) we can all be towards others regardless of whether we agree with them or not. I think it would go a long way toward the world being that much better of a place to live in. When it comes down to it, that’s really what I want. I don’t want people to all agree with me, but I do want the world to be a better and more tolerant, and maybe even accepting, place. I also don’t think it’s too much to ask. Do you?

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.

Gratitude and Work

I was surprised earlier today by the emotional reaction I had while discussing a case with a therapist at work. The most surprising thing about it was that the emotions I was feeling were a combination of surprise, relief, and the acknowledgement of the truth of her words on top of everything else I have felt related to the patient we were discussing.

The patient we were discussing is a particular difficult case. We’ll call the patient Susan. Susan has been a patient of mine for the last year. She has been in the hospital or a residential treatment facility for something like 8 out of the last 12 months, if not more. Most of the breaks between were no more than 1-2 weeks, if that long. She would be in outpatient treatment and after some time without the support of staff 24/7 she would have an episode of high depression and hopelessness and helplessness and attempt to kill herself, usually through overdosing on her medications. After a few weeks in an inpatient setting she would step down to the residential house I work with and be there for months. It was not only hard on Susan, but also hard on all the people who have worked with her the last year, myself included. I have felt so many different emotions regarding her and her case that I do not know that I could name them all or describe them all.

The thing about all of this is that her therapist, someone that I hadn’t met before because she is new to the center, and I met to briefly speak about Susan. Recently Susan had an episode where she felt hopeless and helpless again but managed to reach out to her therapist and myself. Her therapist took the opportunity to reminded Susan about all the people that care about her. Susan’s mother and son were not the only people she was reminded about, but also her psychiatrist and myself as well as all the clinicians at the residential house because her therapist was aware of just how much Susan meant to us and how much we wanted her to succeed.

She told Susan about all the people who care for her and Susan was able to recognize it and even helped her therapist compose an email to the some of her treatment team and her mother. I received that email and thought it was a great step for Susan, but hadn’t fully comprehended exactly why it was so important for Susan to compose it herself to some of the people who are currently helping her.

What made me realize just how much we had impacted Susan’s life was when her therapist told me today that se had recognized how much the people who had been treating Susan truly cared about her wellbeing and that Susan was able to see it too. That was why it was so important for Susan to write that email, why Susan was taking more steps forward in her treatment, why her therapist was working so well with the psychiatrist and myself; They knew that we cared and that we weren’t just going through the motions.

That was when I teared up and felt so many emotions that I could not process them all. I wasn’t expecting it at all. I am usually able to pull back and keep that professional barrier up, but it is rare to get that acknowledgement from someone who isn’t on the residential teams I normally work with. It brought up all the emotions I have had regarding Susan, plus some ones just regarding my work in general all at the same time. Most of all though was gratitude. Because I know that Susan is with a good therapist who can hear more than what is said, which I have found to be a rare talent even within the mental health field.

It was a very unique experience and I hope that I am able to learn from it. Just writing this here has helped me a bit, but I anticipate several more writing/blogging/journaling episodes will come around before I feel like I have processed through everything. I hope I will be able to tell Susan how much she has helped me to grow as a mental health nurse and that she will take that knowledge with her through her life and remember that she can make a positive impact whether she is the one being helped or the one helping. 🙂

Random Thoughts From Today

A list of several random thoughts I had throughout the day:

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I blog too much about the same sort of things. I need to change things up.

Wow, I do a lot more follow up on Mondays and take a lot more active role in the treatment of my patients. Or is it knowing that I’m going to be getting more things to take care of at work and knowing I need to be on top of things. Or it’s just a passing phase. That would suck.

I feel really sad for my friends. They lost a very sweet, young, and quirky pet this morning. I want to do something for them.

I’m catching up with some TED Talks on the Science Channel but was kind of annoyed last night. There were some interesting talks, but others were presentations from very biased individuals that don’t have all the facts or don’t want to give information about other ideas or theories.

There’s evidence that particular DNA codes have a strong influence on whether someone is more or less altruistic and/or humble. Need more information.

I have a patient that has an actual diagnosis of Dissociative Identity Disorder. This is fascinating to me and I will have to resist the urge to search her chart for more in-depth info about it. Maybe a post later about this?

I really want to take the MMPI for myself. But it does cost quite a bit and insurance tends not to pay for it because of curiosity. Sad panda days.

I wonder what it would be like to believe in God in the way that most of the people who follow a monotheistic faith do. There is so much here that I would like to explore. This deserves a blog all on its own. Noted.

It’s 4pm and I’ve totally lost all motivation for work today. I got done all the important things but there are still a few things that I should be doing. *sigh*

Martial arts lesson tonight was good. I really, really enjoy the learning the strikes and stances for Kenpo karate. Now just to work on my blocks and those damn katas. And I need to practice the self-defense things more. I stop to think too much rather than act. Bad.

Stupid cyst is still bothering me, though not so much with the pain. Now it’s nausea when I exert myself too much. Still can’t do the more interactive martial arts like grappling and sparring. Fail and a half.

Snuggling with my husband is the most comfortable place in the entire world. Nothing is better than feeling him so close whether he’s just relaxing or being silly and trying to make me react to the random things he does.

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There were many other things, and I had some other thoughts that actually could be blog posts on their own as well earlier this morning while I was on hold and driving, but I guess I will just have to hope I remember them later.

I have no idea why I thought this was worth blogging about, but it was a change of pace I suppose.