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[angwion]

Antidotes to Fear of Death

Art by Olesya Umantsiva

Sometimes as an antidote To fear of death, I eat the stars.

Those nights, lying on my back, I suck them from the quenching dark Til they are all, all inside me, Pepper hot and sharp.

Sometimes, instead, I stir myself Into a universe still young, Still warm as blood:

No outer space, just space, The light of all the not yet stars Drifting like a bright mist, And all of us, and everything Already there But unconstrained by form.

And sometime it’s enough To lie down here on earth Beside our long ancestral bones:

To walk across the cobble fields Of our discarded skulls, Each like a treasure, like a chrysalis, Thinking: whatever left these husks Flew off on bright wings.

- Rebecca Elson

[angwion]

Lost Time

It's been a while since I last wrote. This usually happens when things get hard, and expression or motivation are choked by anxiety, pain, and depression. I've kept myself busy agonizing over the choice and process of applying for disability. I've attended countless appointments with my psychiatrist, therapist, pain management doctor, and the nurse who gives me bladder instillations.

Sometimes maintaining the bare minimum is all one can reasonably strive for. It's an uncomfortable position to be in, fearing and dreading each week, day, and hour. It is the mindset of survival and yields little, if any, progress. It's treading water to keep your head above water. This is all very common in my experience, and I've lost years in this mindset, particularly when agoraphobic. It is a twisted way of coping with one's situation as well as one's mental and/or physical illness. It's all just a way of getting by.

In the long term, this state of being can drain you of your personality, your natural energy, your passion and all of the the things that make you a living person. People around you notice and don't know how to engage with this husk of a person. It feels strained or artificial or empty. It makes relationships difficult. It makes everything difficult. The desire to blink and disappear into nothingness is like a cozy blanket enveloping your consciousness.

In real life, very little gets done, the people around you become concerned or confused, and one's own feelings... well, these real world consequences only feed the desire to escape, to avoid, and simply find any way possible to relieve the anxiety and depression and looping, intrusive thoughts. It is a desperate clinging to mindless contentment, in whatever form is possible.

There are times when I give in to it and times when I don't. I'm not sure which is better. In rare cases, fighting it allows the direction of the ship to be turned more quickly to a calmer course. More often than not, fighting it is simply painful, and only compounds the current issues, keeping you keenly aware of being on a sinking ship (even though the ship will stop sinking eventually - it's hard to keep that in mind in the moment).

Perhaps this is vague rambling, but it is a picture in to what has been going on and how things can be when it gets bad.

[angwion]

Sometimes the simplest words are the most profound.

[angwion]

“When you are not seen or known.”

“When you are not seen or known, that is the trauma.”

- Bessel van der Kolk

This is an incredibly open and insightful discussion about living as an adult with childhood trauma, and the path to healing.

One point in particular that hit me was the discussion of rage, and how easy it is to become stuck in unexpressed anger when trying to move on from trauma.

My father’s anger caused me to decide at a very young age that I did not want to be an angry person. It was a simple conclusion that anger was a bad thing - an ignorant reaction. Yet, I find myself to this day remembering specific events and screaming on the inside, imagining the revenge I would have if I could go back now and protect my child-self.

Until I can learn to process this anger, I cannot completely let go and move on from these traumas. 

If you'd like to listen to the complete podcast, there are various links to be found here:  https://roadtoresilience.buzzsprout.com/

[angwion]

Meeting with the Medical Director

This appointment had me anxious for over a week. My usual psychiatrist had suggested that I meet with the medical director concerning medication management and a second opinion. My klonopin has not been doing a very good job of reducing my daily anxiety (which has been very high), and my psychiatrist did not know how to safely proceed.

I could barely sleep the last two nights, worrying over what I  should say, what I needed to remember, and if this person was going to be able to be of any more help to me. My husband suggested, and I agreed, to make a list of topics I intended to discuss, just in case my mind went blank.

I'm relieved to report that the medical director was a refreshingly warm and attentive person, who was very thorough in noting my conditions, medications, and various traumatic experiences in my life. We definitely seemed to be on the same page regarding many topics, and I think it surprised him that I already knew so many psychiatric details, like the serious lack of study and treatment options when it comes to trichotillomania and dermotillomania. Let's just say, when it comes to mental health, I like to do my homework. It was nice to talk openly with someone who definitely knew what they were talking about. His concerns were also my concerns, which is often a rarity, but truly wonderful in these situations.

One topic we touched on was my suicidal ideation. He asked me if I had ever attempted suicide, to which I said no, but I had come close once. I'd repeatedly cut open my arm for hours in the same location, over and over, crying and wishing I had the will to truly end it instead of existing in this liminal state of wanting to die but being afraid to actually kill myself. This incident resulted in my first and only voluntary hospitalization, which I believe lasted for a week. Then, he asked why I had never truly tried to kill myself.

I had to take a moment to think about how to put it into words. Usually my answer is a glib, "I'm just too curious to actually kill myself." The truth is far more complex. If I had the option to snap my fingers and simply not exist, I probably would have done it by now. However, when faced with the feeling of wanting to die, I'm much more likely to do something completely out of character, take a big risk, or simply try something completely new in the hope that something will change. Even at my worst, even when I am suffering immensely, I always seem to choose to either endure or make a desperate reach for change rather than to end everything, removing all options, never to know what could have been.

I also cannot imagine doing that to my family, friends, and especially my husband. I know that grief intimately, and would hate to be the cause of it. I found myself saying that I could not take the route of suicide because my brother had already passed away - not by suicide, but through reckless, desperate actions over several years of drug use and, eventually, fatal overdose. He had taken that road, so I could not. The medical director immediately understood this line of thinking without any further explanation.

He ultimately offered to take over my future medication management, which I eagerly agreed to. Like my previous psychiatrist, he is still hoping to wean me off of klonopin enough to reverse some of the tolerance I've built up after taking it daily for the past two years. This would make the medication more effective again, and hopefully this course of action will work out for me. I trust that, should it have disastrous results, he will find another approach. That trust gives me hope and a sense of calm that I haven't felt for a long time.

We also discussed increasing my current SNRI antidepressant, Pristiq (desvenlafaxine), to hopefully decrease my overall depression and suicidal ideation. The increase will be incremental, as I am very sensitive to medications, and he doesn't want to rock the boat too much and end up making me feel any worse than I currently do.

All in all, I'm extremely pleased with the outcome. And yet, we're just getting started. He warned me that this will be a long journey, full of trial and error, and I nodded my agreement. It always is when you really start digging into these sorts of things - especially for someone who has tried so many different medications over 16 years. It's worth it when you're working with someone you trust and the hope that you will feel better.

[angwion]

Benzodiazepines and the Gatekeepers

It's always hard to start treatment with a new psychiatrist. First, there's the wait. Then, there's the prolonged questioning during the first session. And then, there are the issues that can last for months (in this case, 7-8 months) as you try to get them to understand that you've been at this for over a decade, and you know what works and what doesn't.

My current psychiatrist, like many, is generally opposed to benzodiazepines (for those who don't know, these are your standard anti-anxiety drugs, like Xanax). They're a Schedule IV drug, which means a doctor's license is on the line if they over-prescribe. These medications can also have unwanted side-effects when used long term, like short-term memory problems (anterograde amnesia), decreased ability to reason and think logically ("adverse affects on cognition"), and general sleepiness, dizziness, and next day "hangover" effects.

They can also be addictive - the most heinous of words to any doctor. Of course, when one has experienced the horror of full withdrawal from an antidepressant, one wonders how those aren't considered to be addictive as well.

It doesn't help that the standard treatment for anxiety, panic disorder, and even agoraphobia is an antidepressant coupled with therapy. (I should note that I have been in therapy regularly since seeing this psychiatrist, and have advanced to EMDR sessions). Doctors like to follow standard procedure.

Antidepressants are also marketed as anti-anxiety medications, and for this reason I have been put through the wringer with countless SSRIs and SNRIs in the hopes of finding the one that will do both. I've experienced a wide range of awful episodes, from extreme withdrawals to serotonin syndrome that sent me to the ER with truly frightening, invasive suicidal thinking. My best experience with an antidepressant has simply been to not feel so depressed all of the time. It has never helped with my anxiety (in fact, it usually amps up my anxiety - a possible side-effect that is listed on every antidepressant I've ever taken).

When first introduced to psychiatry and psychiatric medications, I was stubbornly against them. I fought it until I was nearly agoraphobic, and even fought it a few times while totally agoraphobic, because I was convinced I could work my way through my issues on my own. What I didn't realize was that when you have a problem in your mind, your mind isn't so good at fixing itself - especially without outside help.

So, I finally decided that the side-effects of things like benzodiazepines were worth the risk when compared to years of being sequestered in an apartment, attic, or basement, unable to care for myself. Having a chance at living became more important than my stubbornness or my fear of medication.

That story began 16 years ago. Now, I find myself arguing with psychiatrists to even get these medications. The fear of over-prescribing has infected practitioners across state lines, causing them to worry more about their licenses than the welfare of their patients. In a way, I can't blame them. However, one would think that with a history as long and torturous as mine they'd eventually get the hint.

Without medication, I cannot function. I cannot do basic daily tasks, keep up with minimal hygiene, or even answer a phone, text or e-mail without experiencing a panic attack. I become a husk of a person, shivering and twitching in a constant flood of adrenaline that overloads my body, making it easy to sleep for 13 hours without feeling rested. Nightmares and occasional night terrors overwhelm my sleeping world, and panic suffuses my every waking moment. It is hellish. I would not wish it on anyone.

My unfortunate burden and mixed blessing is that I'm very good at enduring. I am also very good at hiding the worst of my pain, depression, and anxiety in an effort to protect myself from the outside world while avoiding feelings of shame and vulnerability. Over many years I've managed to open up more to my various psych doctors, but there is still a wall that keeps me from breaking down completely in front of them. Without this complete breakdown, most doctors simply do not believe what I tell them. I've had psychiatrists force me off of medication to see the disastrous results themselves before they begrudgingly put me back on them.

I have only taken one type of benzodiazepine in my life - clonazepam (Klonopin). In the past month or so, I've noticed its efficacy waning to nearly nothing. My anxiety beats it within an hour, or immediately, depending on how strong it is at the time. After missing out on various activities I wished to partake in, but simply could not bring myself to do because of the overwhelming panic that set in at the very thought of traveling on my own or being in a new, public location without my husband, I decided I had to confront my psychiatrist and get a real solution to the problem. I even brought my husband with me, as I've found that having a partner corroborate my "evidence" is more effective than going alone.

This turned out to be true. My psychiatrist was much more coherent and direct when speaking with my husband, whereas she is usually vague or simply silent after I speak. We finally got a solid answer: I will have to meet with the Medical Director to get a second opinion concerning my medications and possible alterations. Of course, as with most "new patient" appointments, I will likely be unable to see him for weeks.

I am nervous to meet someone new - someone of greater authority - and to present my case knowing that there is a possibility that they simply will not make any changes to my current regimen. If so, I'm determined to go outside of the university system to seek the help I need.

What is most frustrating, and most enraging, is that this is a continuing issue in my treatment with almost every psychiatrist I've met. Each one seems to think the they'll be the one to "fix" me so that I can wean off of benzodiazepines without permanently breaking down. Each one has been wrong. 

I don't want to have to rely on any of these medications to function. I don't want to risk the side-effects, especially when it comes to my cognition; even more strongly, I don't want to waste any more of my life trapped by my mental illness.

I want to be able to go outside and enjoy the weather on a nice walk without panicking or never making it out the door. I want to wake up and get things done instead of distracting myself with the television, meditation, or an audio book just to get through the passage of time each day. I want to be able to go to new places on my own. I want to make friends and talk to people without a constant undercurrent of panic taking me out of the present, even out of my body, and skewing everything into a waking nightmare. I want to live.

I wish I knew how to convey this adequately enough to convince every single one of these doctors that I am telling the truth and that this is my experience. I wish that they could look beyond the procedure, the paperwork, the textbook expectations, and see me as a human being who is suffering, and who they can help.

I wish that people with mental illness did not have to work so hard to advocate for themselves every time they walk through an office door just to get some relief.

[angwion]

I Deserve to be Loved

In my last therapy session, I was encouraged to work with the positive statement, “I deserve to be loved.”

With my eyes closed, I imagined myself being held by my husband and feeling loved. Then I would think the statement, “I deserve to be loved.” Inevitably, tears rolled down my face. My chest clenched and seemed to choke me. My brain writhed away from the thought, throwing up any and every reason it could to dispute this statement.

You don’t deserve to be loved. You are broken. You are irresponsible. You are a mess. You’re ugly, especially now that you’ve gained so much weight. You make people sad with your illness and your depression. You only drag good people down. You are a burden. You can’t even drive. You aren’t as smart as you used to be. You’re in debt. You wouldn’t even be alive if it weren’t for other people giving you money or a place to live. Every time you enter a person’s life, somehow chaos follows. You can’t hold a job without succumbing to anxiety and depression.

And so on, and so on . . .

Yet, if anyone were to ask me if they deserved to be loved, I would not hesitate to say, “Yes. Yes, of course you do.”

We can be harder on ourselves than we could ever be to a complete stranger. Sometimes it’s a good way of testing how valid your beliefs and feelings are. Is this the way I would treat a stranger? A loved one? Is this something I would think of someone in my current life situation?

No. I could only inflict this kind of pain on myself, shoring it up with agonizing experiences of rejection and neglect beginning from my earliest memories to the decades following. With anyone else, I would be more understanding and empathetic; I would provide more care and support.

So why do I do it? These are deeply entrenched beliefs formed very early on in my life. Those experiences I referred to shaped me without my realizing it. I did not receive much love or affection from my parents or anyone else, and as a child one will come to what seems an obvious conclusion: I don’t deserve love.

Going out into the world with this subconscious belief, I formed relationships with people who did not show me love. Cold, distant relationships felt natural to me. When someone truly loving and affectionate appeared, I would find myself pushing them away, deeply feeling – even fearing – that I was bad for them. They needed to be kept safe from the likes of me.

Only in the last few years, after choosing to be with the man who is now my husband, did I also choose to allow real love into my life. I chose happiness over fear and the controlling hand of a judgmental, manipulative partner (of which I had known many).

Despite this transformative choice, I am obviously still struggling to fully integrate the belief. I continue to be judged harshly by myself.

What to do? Well, in my experience, the only thing one can do is take each argument and whittle it down to the truth. Face those dragons you’ve stirred up and strip them of their twisted perceptions. Do this over and over until you come to what is left.

I deserve to be loved.

And so do you.

[angwion]

The Journey Begins

Do not let sleeping dragons lie . . .

All of us have things buried deep within our psyche that we are either unaware of or do not wish to see. For the purpose of this journal, I refer to them as sleeping dragons.

However, this title has a dual meaning. Not only do I wish to face these sleeping dragons by waking them and speaking with them, but one must always remember that these sleeping dragons do not always speak the truth. Our memories are as imperfect as our perceptions. Often this is the source of great pain and anxiety that lies beneath the surface of our everyday lives.

This journal is a practice in delving into these depths and hopefully returning with gems of wisdom.

I expect many potential “triggers” to be discussed here. My experiences with mental illness are life-long and include:

Major Depressive Disorder (MDD)

Panic Disorder

General and Social Anxiety (GAD & SAD)

Agoraphobia

Post-Traumatic Stress Disorder (PTSD)

Trichotillomania (hair pulling) and Dermotillomania (skin picking)

Self-Harm

Suicidal Ideation

Chronic pain is something I first experienced in August of 2018. It is due to a condition called Interstitial Cystitis (IC). Symptoms for this condition are different according to the individual. In my case, it causes severe pelvic pain, particularly if I don’t stick to a very strict diet. It can also increase how often I need to go to the bathroom – an inconvenience when traveling long distances.

If any of these topics are uncomfortable for you, I highly recommend you not read on and wish you well.

If you are interested in these topics, or care to read a first-hand account of living with them, then you’ve come to the right place, and I kindly welcome you.

Note: This journal is mirrored on Wordpress at https://sleepingdragons.home.blog/