“Do you really want to be on this stuff for the rest of your life?” - direct quote from my psychiatrist circa 2007. I was finishing up law school, getting ready to sit for the bar and although my mood wasn’t stellar, I could probably swing it, right? Let’s back up a bit.
In college, after years of undiagnosed mental issues, I had one weekend where I just laid in bed and cried. My boyfriend was at an all weekend coding, and my roommate went home. My parents, who probably mean well, had spent my life in denial that there was anything wrong with me, despite, in hindsight, obvious warning signs that I was having problems. I was all alone and couldn’t even muster up the energy to eat. I finally sought out something to keep the circle of darkness at bay.
From college until almost end of law school I was always on some combination of drugs, usually just rubber stamped by whichever psychiatrist I had at the time. No doctor really cared enough to question why I had been prescribed Lexapro or Wellbutrin by the previous doctor nor did they care enough to figure out what was wrong with me and make sure the meds were actually effective. Nor did anyone ever suggest going to real therapy. Still being alive was good enough, I guess. So the last psychiatrist I had in law school suggesting I just taper off of meds all together seemed reasonable. I mean, I guess - I was becoming a lawyer, not a doctor.
Fast forward three months and I just started a new job that drove me back into the abyss. I was suicidal and in really bad shape and I had to get back on something fast. My husband is now in business school and I’m the breadwinner - not having a job wasn’t an option. I found Dr. Walking Pharmacy who would literally give me anything I wanted. At some point, I had both a prescription for Ambien and Provigil. She also put me on other random drug cocktails to varying degrees of effectiveness. (I had a visceral reaction to Cymbalta to the point that I considered suing the company). We’d shoot the shit once a week and she’d write out a new script. She was the one who diagnosed me with Bipolar Disorder II which is the only value add (besides the Ambien) in seeing her. Never was there a suggestion that I try skills based therapy to deal with the symptoms of the Bipolar.
I sadly had to say goodbye to Dr. Pharmacy to move to Japan where I was able to stay on the drug cocktail (now at Lamictal, Valium, and Wellbutrin) through some creative connections between an American licensed psychiatrist and his Japanese doctor hookup who could write prescriptions. When I moved back to the States. I tried psychotherapy with this very very elderly woman who did the “explore your childhood” method of therapy which worked not at all, and I ended up dropping her in place of just going back to working with people who would just give me meds. I figured I’m still alive so that should be plenty of “therapy.”
So here I am almost 20 years later thinking I could ride the medication train - until I crashed into the station. I was trying to only treat the underlying disease without dealing with the most of the symptoms. Now I am in therapy (and it is tangible, results and skills-oriented treatment) working on handling the symptoms and it is actually pretty great. I’m also now on four different meds (up from two this time last year and includes the old throwback, Lithium). I now see the meds akin to insulin. A diabetic needs insulin to live and my cocktail is no different. But the diabetic also gets a toolkit of how to manage the symptoms of diabetes. I’m finally getting my version of that toolkit through good individual and group therapy.
Mindfulness is defined as "the psychological process of bringing one's attention to experiences occurring in the present moment…” In other words, the past is distorted by our memories and the future is distorted by our fears and hopes, but the present moment is the only "true" reality we can experience. This "true" reality can be awesome or terrible, but at the end of the day it is reality and we can either accept it or hide from it by going into the past or future. Deep, right?
I've been told by my therapists (yeah, I have a lot of people trying to fix me) that practicing mindfulness is important because it can help one be able to accept the present reality and work with it to act in line with my values. But, how does one get to a mindful place? Another question I grapple with is how to reconcile the past and be future-oriented while continuing to be mindful of the present.
In an outpatient group therapy I participate in right now, we do a mindfulness/relaxation module first. It is usually some form of guided meditation or a participatory game to engage everyone and pull them briefly out of their headspace. Sometimes I can enter this mindfulness zone, sometimes I just fall asleep, but more often than not, even if I quieted my body, my mind is still fully active, and I get stressed out. I'm sitting here trying to practice accepting and experiencing the present moment by trying to use the plethora of mental health skills, like thought diffusion, to get my mind as relaxed as my body. It's not working, I'm still freaking out and now time is up and I just feel like shit.
Of course, it should be noted that relaxation-based mediation isn't the only way to be mindful. Other forms of mindfulness include exercising and engaging in other physical activities. I participate in a performing arts musical ensemble, and when I'm at practice or performing in a show I have to stay in the moment; I have to keep my mind sharp and focused on what is happening in the here and now because it could lead to me embarrassing myself in front of a group of random strangers or worse, letting down my group. So although I am in the present moment, I can't help but move into the past and think about those fuck ups or think about what I'm going to do after this piece ends. So, maybe this isn't helping me train my brain to be mindful either.
In the hospital, I initially scoffed at but came to enjoy the recreational therapy (RT) portion of the day. In RT you just do something that allows you to focus on something you enjoy doing. Fuck the past, fuck the future, right now I'm coloring. When I came home, I looked around for something I could do that would be fun (I actually hate coloring) and in the realm of things I enjoyed.
My favorite place in a museum is the miniatures room at the Art Institute of Chicago. There are all these tiny little rooms, with tiny little tables and chairs and beds and just tiny stuff everywhere. I looked around and found that there is this company, ROBOTIME, that makes dollhouse style rooms that you can painstakingly recreate with the supplies they give you. I found that the experience of sitting there cutting out paper, gluing together wood, bending metal, was just a soothing exercise. I didn't need to think that I was supposed to be getting into a "zone" like with guided meditation and no one really cares what the end product is. I found that it has a) given me something to do besides ruminate and surf the web and b) keep me more present-minded even when I'm not trying to use a razor blade.
I made the ROBOTIME Ada's Studio, and although I'm clumsy and not as detail oriented as I thought, it was actually super fun. And mindful. I got a lot out of the process, and no one really cares about the end product. Well, except maybe Ada who totally is missing a paint can.
After 30+ years of dealing with depression, it finally happened. I was declared a danger to myself and given a choice. I can voluntarily admit myself into the hospital or be admitted into the hospital. Either way, I was not going home that night and I did not know when I would get to again.
During therapy sessions, you always get asked the questions about suicidal ideation - “Have you had thoughts of wishing you weren’t alive?” Duh. “How often do you have these thoughts?” Wait, there was an option not to have these thoughts? “How well can you control the thoughts?” My normal answer is, “It’s just there - it’s white noise. I can’t turn it off, but I can turn it way down and focus on other stuff” (although I say it way less eloquently than that).
That afternoon, I finally understood that another answer to that question is “No, I can’t control the thoughts”. I’ve been here before and usually just let it ride - usually it passes after a day or so. This time it didn’t. It had persisted for a good three days and was to the point where if you put a loaded gun in front of me, I would have used it. I wanted to do it, but couldn’t figure out the logistics - how, when, where. The fact that I didn’t just do something drastic was indicative (in hindsight) that I was probably not a completely lost cause.
Long story short, I was hospitalized and released into intensive therapy. I would still continue with my current therapist and psychopharmacologist but I needed a little more therapy to get therapy. Over the years inside and outside of therapy, I’ve picked up some hacks and knowledge.
After reading this article recently I realized perhaps I can make a difference or at least put another voice out there for people like me, or dealing with people like myself.
This blog is not meant to replace getting inpatient or outpatient treatment (in fact, please do if you have even the slightest concerns about your personal mental health or the mental health of a loved one) but I do hope that I can pass along some tips and tricks and information so that you will wake up tomorrow.