If you've ever dropped by Respectful Insolence, you've probably read the many posts on autism "cures" - in quotes because a child surviving them is a miracle.
Reading the New York Times article on the child deemed "psychopathic" (Damning word, and not an official diagnosis), along with the posts on Respectful Insolence, I've been thinking about children with mental disorder diagnoses and their families, notably the emphasis on parents.
We emphasize parents in the following ways:
1. Their kid's behavior is the parents' fault (Ask a child therapist about this one - their answer can be quite interesting).
2. Their kid's behavior is the kid's fault and most certainly not the parents' - typically applied to kids 12 and older, though sometimes as young as 8. I guess when you hit a certain age, the damage that was inflicted on you when you were younger is no longer relevant.
Subset of 1 and 2 - Oh those poor parents. Even if a kid is unruly due to the parents, we secretly feel bad for those parents because who wants to live with a juvenile delinquent. 2 is obvious.
The kids with diagnoses topic is complicated. I've heard several anecdotes on parents being threatened with a call to CPS for failing to put their kids on drugs for AD/HD - this is problematic because parents often don't realize teachers can't "diagnose" anyone (This is illegal), and pediatricians are often stuck doing AD/HD evaluations and writing prescriptions for stimulants because child psychiatrists aren't common in many parts of the US. I love our pediatrician, but I'm not trusting anyone with minimal neurology and psychiatric education to prescribe psychotropic medication for long-term use for my kid. Give me a referral? Sure. Making that diagnosis? Generally not qualified.
To make things more nasty, school systems will attempt to get out of paying for occupational therapy for kids, even though refusal to provide that as part of IEP is against the law. They'll also fail to tell parents that they can select a private psychologist to evaluate their child instead of the school psychologist, and the school system has to pay for it. Also against the law. And in the case of AD/HD, IQ tests are required for a diagnosis despite the lack of correlation between IQ and AD/HD - IQ tests take a long time to administer and a long time to score, which equals more money than anyone would like to spend.
Even more fun, special education teachers - who are often wonderful - have large classes and at times minimal psych training. This situation is not their fault, but it does affect the quality of education kids get.
It isn't surprising how much we support parents, at least compared to kids. (This is where the autism thoughts come in). At least in my neck of the woods, there are bi-weekly support groups for parents of kids with mental health diagnoses, case managers to help parents get resources for their kids, parenting classes, more support groups. There are national ads featuring happy parents of kids diagnosed with autism, who have received generous support via donations and grant money from viewers like you. Which are incredibly important.
There are no AA, NA, DBSA, survivors of suicide, or any other sort of recovery group for kids, at least where I live. Teens are welcome to join these groups in my area, but they sometimes feel uncomfortable - it's hard to relate to a person who is sober for the first time in twenty years when you haven't even lived that long. There are Al-anon groups, of course - perhaps this post should be more about how there is a lot of support for everyone who isn't "the problem person." For another day, I guess.
I think we forget that kids with mental disorder diagnoses become adults with mental disorder diagnoses. It's got to be a shock to come into adult mental health services with folks going, "Recovery, recovery!" - or even a "I know you're perfectly capable of doing this but I don't trust you to do it, so I'll do it until you buck up" - when we don't really talk to kids about what it means to be in recovery.
We may imply it, but I'm not sure if we ever explicitly say, "Look kid, you're going to grow up someday. You're going to be expected to act a certain way, to get along with everyone else. No one can blame it on your parents once you hit 18, especially you. You can minimize or even eliminate the torment you're experiencing right now. Life doesn't have to suck." Or something along those lines that's in terms the kid can understand.
Just my observation. I'm thinking the peer support movement needs to get more involved in this stuff, for starters. A lot of adults with a diagnosis were a lot of kids with a diagnosis.
To sum up: parents, get a lawyer; mental health workers, talk to kids about moving on with their lives.
Saturday, May 26, 2012
Thursday, May 24, 2012
Personality, Meet My Friend Shovel
There are a few recent articles floating around on psychopathy (aka Antisocial Personality Disorder in the DSM) in young children, the catalyst being in the New York Times featuring a violent nine year old who couldn't stand his younger brother. While that may sound like many nine year olds, the article describes behavior that is beyond the realm of what one would consider healthy to the individual and his family.
The article, as well as the comments, raised a few questions in my mind. One was on the treatment/research project the parents admitted the kid into. This program utilized behavioral modification, which works quite well for changing distressing behaviors for many issues (smoking, overeating, potty training) when implemented properly. However, it doesn't seem to work all that great for a lot of adults with an Antisocial personality diagnosis - if you really think about it, rewarding "good" behavior probably won't work all that great with these folks unless you're giving them a million bucks per incidence of "goodness" - so I wondered why on earth they would try such a thing on kids who supposedly face the same challenges.
Second, I have heard enough stories on PTSD issues being diagnosed as Antisocial - PTSD being induced by actions that are so horrific I once had to leave in the middle of a lecture to go throw up in the bathroom because the idea of doing such a thing to a child makes me want to hunt down people and make their lives miserable. Can't imagine how the person who manages that brand of psychological hell minute by minute feels. (On the bright side, I've run into quite a few success stories on good therapy and emotional support resulting in a complete 180 in terms of empathy and sense of meaning)
The notion of personality makes my head hurt a bit. I once asked a teacher, a trained psychoanalyst, for a definition of personality. He gave me a similar answer to what I've read and received by others: Personality is more or a less a person's view of the world and how they interact with it, and the bulk of it is formed in early childhood. I told him I didn't care for something that implies permanence, but he said that people can certainly improve to points where less-than-helpful personality traits are rarely an issue, but it's never ultimately different.
I'm not sure how I feel about this idea, which is pretty common in the mental health realm as well as with the general public. Nothing seems all that permanent, atleast on this earth (afterlife, who knows). My skin is showing a fine line or two, my hairdresser recently said I have three gray hairs (she refused to pluck them, to my frustration), my shoe size went up by a half after pregnancy, I'm constantly shedding skin cells. The box elder trees that came with our yard continue to grow, my next door neighbor has a new dog, pop music seems to get more intolerable by the year, and our country has gone from significant patriotism to a severe distrust of more or less everyone in charge. Life is one of those things that is in constant flux - bodies, culture, nature. I really can't figure out why in the heck people are so stuck on the idea that personality is permanent when nothing else is.
I do have a theory. I suspect the roots of the notion that personality is permanent is in the idea of mind/body dualism - basically the mind (personality, behaviors) is a separate entity to the body. This idea mostly came out of the thought that the mind = the soul. Seeing as that psychology is of the more recent fields to come out of philosophy (per ancient Western philosophers, thought more or less boiled down to mathematics or philosophy - including religion), it's unsurprising that it continues to include the idea of a permanent personality.
Besides the idea of how free will ties into the mind (I mean, if the mind = the soul and the soul is what we are born with and the soul is God-given, why in the heck are we to blame for some of our suckier aspects? Why would we even bother trying to change if change is futile? Why is it that therapy and life experience can significantly change our views of the world? Um, aren't we supposed to be responsible for our actions? Oh, and what about a possible translation for soul in Hebrew being "to breathe?"), it makes me think of Traumatic Brain Injury (TBI) and personality changes.
Personality, meet my friend shovel. If I took a shovel to your head enough times without managing to kill you, you could very well end up with a number of mental health challenges - including a change in personality. We have a diagnosis for this phenomenon in the DSM. One could argue that TBI is permanent, but then again, the nature of an individual's TBI is not. Early intervention for TBI can provide significant improvement in the challenges folks with TBI manage, and some may experience little issue after treatment depending on just how hard I hit you with that shovel and a myriad of things we plain don't know about the brain. Additionally, TBI challenges can grow worse without intervention. And people diagnosed with TBI are human like everyone else and have many of the same experiences as every other person on the planet, which will affect their perceptions of the world as they age.
Don't get me wrong, I have no problem with souls. I just don't think it has anything to do with brains, atleast for our intents and purposes in this universe.
We know the brain changes. We also know how ingrained behaviors, whether we're born with them or they're conditioned or a mix, are an utter bitch to change. Doable, but painful. Despite our knowledge that the brain changes, we can't seem to predict what treatment is going to work with what person at this point in time. It doesn't mean we should assume behavior that fails to serve someone can't be improved or even eliminated just because we don't know how to help the person sitting in the chair across from us.
So shove it, deterministic naysayers. You may think I'm being an optimistic grad student who will wise up by the end of my first clinic day, but I am one of many who one would think wouldn't be optimistic for anyone diagnosed with something psych-related. Multiple suicides in the family. Mental health outside of "normal" severely stigmatized by both father's and mother's families. Mom diagnosed with out-of-control Schizophrenia (which gets harder for her to deal with by the year) when I was three; Dad doing the depression, alcohol, sobriety, alcohol, sobriety, AA, depression, therapy, AA, depression.
But now a tortoise-paced ascent into some level of happiness.
Me from suicidal, angry elementary school kid to happy kid to suicidal and angry to determined to depressed to a weird cycle of who knows what to hypomania to mellowness to more depression.
But now feeling good about things, even with past dissociation and self-injury and avoidance of people.
Then there are the testimonials of Clifford Beers, Mary Ellen Copeland's mother, Kay Redfield Jameson, Carrie Fischer, Marsha Linehan, Ken Steele, and many others. And most dear to me, all of the wonderful coworkers and individuals I have served who identify as those with psych diagnoses - including personality - who have experienced change, better or worse at times.
Rather than assume people with Antisocial personality diagnoses are screwed forever, or assuming many have it at all, or assuming it manifests in incredibly young children, maybe we should carefully work with these folks with a nudge towards recovery. And, ya know, show some empathy (Do unto others). It's tough, and at times senseless, to judge how far one can go in life.
The article, as well as the comments, raised a few questions in my mind. One was on the treatment/research project the parents admitted the kid into. This program utilized behavioral modification, which works quite well for changing distressing behaviors for many issues (smoking, overeating, potty training) when implemented properly. However, it doesn't seem to work all that great for a lot of adults with an Antisocial personality diagnosis - if you really think about it, rewarding "good" behavior probably won't work all that great with these folks unless you're giving them a million bucks per incidence of "goodness" - so I wondered why on earth they would try such a thing on kids who supposedly face the same challenges.
Second, I have heard enough stories on PTSD issues being diagnosed as Antisocial - PTSD being induced by actions that are so horrific I once had to leave in the middle of a lecture to go throw up in the bathroom because the idea of doing such a thing to a child makes me want to hunt down people and make their lives miserable. Can't imagine how the person who manages that brand of psychological hell minute by minute feels. (On the bright side, I've run into quite a few success stories on good therapy and emotional support resulting in a complete 180 in terms of empathy and sense of meaning)
The notion of personality makes my head hurt a bit. I once asked a teacher, a trained psychoanalyst, for a definition of personality. He gave me a similar answer to what I've read and received by others: Personality is more or a less a person's view of the world and how they interact with it, and the bulk of it is formed in early childhood. I told him I didn't care for something that implies permanence, but he said that people can certainly improve to points where less-than-helpful personality traits are rarely an issue, but it's never ultimately different.
I'm not sure how I feel about this idea, which is pretty common in the mental health realm as well as with the general public. Nothing seems all that permanent, atleast on this earth (afterlife, who knows). My skin is showing a fine line or two, my hairdresser recently said I have three gray hairs (she refused to pluck them, to my frustration), my shoe size went up by a half after pregnancy, I'm constantly shedding skin cells. The box elder trees that came with our yard continue to grow, my next door neighbor has a new dog, pop music seems to get more intolerable by the year, and our country has gone from significant patriotism to a severe distrust of more or less everyone in charge. Life is one of those things that is in constant flux - bodies, culture, nature. I really can't figure out why in the heck people are so stuck on the idea that personality is permanent when nothing else is.
I do have a theory. I suspect the roots of the notion that personality is permanent is in the idea of mind/body dualism - basically the mind (personality, behaviors) is a separate entity to the body. This idea mostly came out of the thought that the mind = the soul. Seeing as that psychology is of the more recent fields to come out of philosophy (per ancient Western philosophers, thought more or less boiled down to mathematics or philosophy - including religion), it's unsurprising that it continues to include the idea of a permanent personality.
Besides the idea of how free will ties into the mind (I mean, if the mind = the soul and the soul is what we are born with and the soul is God-given, why in the heck are we to blame for some of our suckier aspects? Why would we even bother trying to change if change is futile? Why is it that therapy and life experience can significantly change our views of the world? Um, aren't we supposed to be responsible for our actions? Oh, and what about a possible translation for soul in Hebrew being "to breathe?"), it makes me think of Traumatic Brain Injury (TBI) and personality changes.
Personality, meet my friend shovel. If I took a shovel to your head enough times without managing to kill you, you could very well end up with a number of mental health challenges - including a change in personality. We have a diagnosis for this phenomenon in the DSM. One could argue that TBI is permanent, but then again, the nature of an individual's TBI is not. Early intervention for TBI can provide significant improvement in the challenges folks with TBI manage, and some may experience little issue after treatment depending on just how hard I hit you with that shovel and a myriad of things we plain don't know about the brain. Additionally, TBI challenges can grow worse without intervention. And people diagnosed with TBI are human like everyone else and have many of the same experiences as every other person on the planet, which will affect their perceptions of the world as they age.
Don't get me wrong, I have no problem with souls. I just don't think it has anything to do with brains, atleast for our intents and purposes in this universe.
We know the brain changes. We also know how ingrained behaviors, whether we're born with them or they're conditioned or a mix, are an utter bitch to change. Doable, but painful. Despite our knowledge that the brain changes, we can't seem to predict what treatment is going to work with what person at this point in time. It doesn't mean we should assume behavior that fails to serve someone can't be improved or even eliminated just because we don't know how to help the person sitting in the chair across from us.
So shove it, deterministic naysayers. You may think I'm being an optimistic grad student who will wise up by the end of my first clinic day, but I am one of many who one would think wouldn't be optimistic for anyone diagnosed with something psych-related. Multiple suicides in the family. Mental health outside of "normal" severely stigmatized by both father's and mother's families. Mom diagnosed with out-of-control Schizophrenia (which gets harder for her to deal with by the year) when I was three; Dad doing the depression, alcohol, sobriety, alcohol, sobriety, AA, depression, therapy, AA, depression.
But now a tortoise-paced ascent into some level of happiness.
Me from suicidal, angry elementary school kid to happy kid to suicidal and angry to determined to depressed to a weird cycle of who knows what to hypomania to mellowness to more depression.
But now feeling good about things, even with past dissociation and self-injury and avoidance of people.
Then there are the testimonials of Clifford Beers, Mary Ellen Copeland's mother, Kay Redfield Jameson, Carrie Fischer, Marsha Linehan, Ken Steele, and many others. And most dear to me, all of the wonderful coworkers and individuals I have served who identify as those with psych diagnoses - including personality - who have experienced change, better or worse at times.
Rather than assume people with Antisocial personality diagnoses are screwed forever, or assuming many have it at all, or assuming it manifests in incredibly young children, maybe we should carefully work with these folks with a nudge towards recovery. And, ya know, show some empathy (Do unto others). It's tough, and at times senseless, to judge how far one can go in life.
Sunday, May 20, 2012
Your shrink is insane
My school divides up summer into two condensed semesters. I am taking the first off because I was going to absolutely lose my shit if I didn't take a break. There has been a strong correlation between me starting graduate school and me being incredibly displeased with life. I hate that I took time off because it will just prolong my time in school, and yet I would have been stuck taking classes over because I'd end up dropping them anyway mid-semester, thus prolonging time in school.
It isn't that learning how to be a therapist is an intellectual exercise, despite the many, many classes on theory. There are two-to-three year programs that are significantly more intense than what I am doing: physician assistant, law, genetic counseling, nurse practitioner, etc. The culture of my graduate program along with my marshmallow personality makes for an emotionally draining experience for me. A good portion of it lays in the fact that I hate criticism. By that I mean I will cry and ruminate for hours after some constructive criticism. Shit, my first year I cried in two separate classes in the same semester. In front of people. It was absurd. Now I just pop Ativan before presentations. As it turns out, I'm not the only one who does that - so yes, your shrink likely takes psychotropic medication.
There is a chance my "personality" falls partly into the Avoidant camp. Kind of funny, huh, considering my field? I make a strong effort to ignore the garbage my brain spouts off, and while I do find myself often weeping in my car or in a bathroom stall or on my husband's shoulder, I try to put my mental crap aside and do what I enjoy doing. I spent a good chunk of time working in human services, and I didn't have issues with the people I was trying to assist even if there was a small amount of swearing, derogatory comments, or attempts at theft when I was standing in front of a group of ten people (The swearing, comments, and theft weren't all that common - we all have bad days, though).
Academia, and the rest of life, is intense for me. Even if someone is being incredibly gentle and sneaking in compliments throughout the conversation, I take it to mean I am an inexplicably worthless piece of a human being with nothing worthwhile to contribute to society and should just find a nice cardboard box to move into because I will never be able to do my job/marriage/parenting with any level of competence and I am hated with a fire of fury hates. I know on one level this is bullshit and on another level it is utterly true, and I let those contradictions peacefully exist in my head while generally giving the rational part the benefit of the doubt. It took a year and a half of DBT to get to that point. I would say that it gets easier, but that would be a lie.
For whatever reason, the line of "I suck at life" thinking will pop out even if I know the person is being an idiot and projecting their issues onto me. A teacher or two of mine has gotten borderline nasty with me because I didn't agree with their theoretical orientation (I lean towards third wave behavioral) during a lecture. I don't honestly care about your choice of theory - I think different people respond to different techniques and it takes all kinds in the mental health field - but I guess it's a big fucking deal to some folks. I think I'm very polite about the whole thing, and a classmate or two has even told me so at the end of classes. I can't even say I sound remotely critical, because I don't think I do. But who knows.
If you're wondering, those two teachers had two different theoretical orientations.
Along with that is the attitude that students and new therapists have little level of skill - it's almost criminal we unleash them on people - and thus they have no right to an opinion. Example: an instructor told one of my classes not to criticize a diagnosis made by a supervisor or a senior member of a team. Diagnoses are funny. Is it Bipolar or Schizoaffective? Generalized Anxiety or OCD? Hoarding or frat boy slob? A lot of subjectivity goes into making a diagnosis, and there often isn't a correct answer. Here's my problem, though: if a clinician is going to slap a Cluster B personality disorder label on someone just because the person they're working with gets pissed off at them for not returning calls or being late to appointments (I've seen it happen), I might just have to step in and say (tactfully) that is some bullshit - freshly limited-licensed or not. Restraints in the middle of a hallway even if someone has voluntarily checked themselves in? (I'm against restraints anyway - they aren't evidenced-based and are just plain mean - but seriously? I've heard that story more than once) Some things simply aren't okay, and you don't need ten years of experience under your belt to figure that out.
Ugh. I have been frequently wondering why I am bothering. I can take what a client/resident/individual served/whatever dishes out with no problem, but supervisors and teachers make me want to curl up into that cardboard box and wait for winter to come and freeze me over. I have another year of this pain to go, and it hasn't felt worthwhile since I left my decent-paying job to try to finish up school quickly last June. It hasn't helped that I had some depression and a viral infection from Hell at the end of the fall semester partly resulting in tanked grades, and another viral infection that lasted a month and a half during the winter semester that made life way too difficult, and wicked back pain that made it nearly impossible to sit or stand for more than five minutes, and now there's some mystery pain that is possibly autoimmune-related (Oh yeah, and my winter semester grades sucked - before fall, I had a 4.0 GPA).
Twenty grand in student loans aside, my husband told me some people try to stay oblivious to everything that is wrong with the world and some people are aware of what's wrong and aren't afraid to address it, and I'm one of those people with awareness, and I should stick it out because I would be able to really help some people, and blah blah. I don't know if this is worth the few shreds of rational thinking I have left.
It's strange...I've talked to other students in other fields who say they get treated like professionals...and then that has not been the experience of me and many of my classmates. Unless my opinion is that of the elder's, it is worthless. Don't ask me how I'd be able to swing agreeing with everyone, considering so few people agree on much of anything. Yeah, my perception is clouded, but I know it's not just me based on conversations I've had with other people in my program.
I think from here on out I'm going to keep quiet as possible, only speak if required for a grade, and make sure I don't give my opinion at any point. That might be the only way I survive graduate school. I want to quit. I want to quit so so so much. The only reason why I'm not quitting is the debt.
It isn't that learning how to be a therapist is an intellectual exercise, despite the many, many classes on theory. There are two-to-three year programs that are significantly more intense than what I am doing: physician assistant, law, genetic counseling, nurse practitioner, etc. The culture of my graduate program along with my marshmallow personality makes for an emotionally draining experience for me. A good portion of it lays in the fact that I hate criticism. By that I mean I will cry and ruminate for hours after some constructive criticism. Shit, my first year I cried in two separate classes in the same semester. In front of people. It was absurd. Now I just pop Ativan before presentations. As it turns out, I'm not the only one who does that - so yes, your shrink likely takes psychotropic medication.
There is a chance my "personality" falls partly into the Avoidant camp. Kind of funny, huh, considering my field? I make a strong effort to ignore the garbage my brain spouts off, and while I do find myself often weeping in my car or in a bathroom stall or on my husband's shoulder, I try to put my mental crap aside and do what I enjoy doing. I spent a good chunk of time working in human services, and I didn't have issues with the people I was trying to assist even if there was a small amount of swearing, derogatory comments, or attempts at theft when I was standing in front of a group of ten people (The swearing, comments, and theft weren't all that common - we all have bad days, though).
Academia, and the rest of life, is intense for me. Even if someone is being incredibly gentle and sneaking in compliments throughout the conversation, I take it to mean I am an inexplicably worthless piece of a human being with nothing worthwhile to contribute to society and should just find a nice cardboard box to move into because I will never be able to do my job/marriage/parenting with any level of competence and I am hated with a fire of fury hates. I know on one level this is bullshit and on another level it is utterly true, and I let those contradictions peacefully exist in my head while generally giving the rational part the benefit of the doubt. It took a year and a half of DBT to get to that point. I would say that it gets easier, but that would be a lie.
For whatever reason, the line of "I suck at life" thinking will pop out even if I know the person is being an idiot and projecting their issues onto me. A teacher or two of mine has gotten borderline nasty with me because I didn't agree with their theoretical orientation (I lean towards third wave behavioral) during a lecture. I don't honestly care about your choice of theory - I think different people respond to different techniques and it takes all kinds in the mental health field - but I guess it's a big fucking deal to some folks. I think I'm very polite about the whole thing, and a classmate or two has even told me so at the end of classes. I can't even say I sound remotely critical, because I don't think I do. But who knows.
If you're wondering, those two teachers had two different theoretical orientations.
Along with that is the attitude that students and new therapists have little level of skill - it's almost criminal we unleash them on people - and thus they have no right to an opinion. Example: an instructor told one of my classes not to criticize a diagnosis made by a supervisor or a senior member of a team. Diagnoses are funny. Is it Bipolar or Schizoaffective? Generalized Anxiety or OCD? Hoarding or frat boy slob? A lot of subjectivity goes into making a diagnosis, and there often isn't a correct answer. Here's my problem, though: if a clinician is going to slap a Cluster B personality disorder label on someone just because the person they're working with gets pissed off at them for not returning calls or being late to appointments (I've seen it happen), I might just have to step in and say (tactfully) that is some bullshit - freshly limited-licensed or not. Restraints in the middle of a hallway even if someone has voluntarily checked themselves in? (I'm against restraints anyway - they aren't evidenced-based and are just plain mean - but seriously? I've heard that story more than once) Some things simply aren't okay, and you don't need ten years of experience under your belt to figure that out.
Ugh. I have been frequently wondering why I am bothering. I can take what a client/resident/individual served/whatever dishes out with no problem, but supervisors and teachers make me want to curl up into that cardboard box and wait for winter to come and freeze me over. I have another year of this pain to go, and it hasn't felt worthwhile since I left my decent-paying job to try to finish up school quickly last June. It hasn't helped that I had some depression and a viral infection from Hell at the end of the fall semester partly resulting in tanked grades, and another viral infection that lasted a month and a half during the winter semester that made life way too difficult, and wicked back pain that made it nearly impossible to sit or stand for more than five minutes, and now there's some mystery pain that is possibly autoimmune-related (Oh yeah, and my winter semester grades sucked - before fall, I had a 4.0 GPA).
Twenty grand in student loans aside, my husband told me some people try to stay oblivious to everything that is wrong with the world and some people are aware of what's wrong and aren't afraid to address it, and I'm one of those people with awareness, and I should stick it out because I would be able to really help some people, and blah blah. I don't know if this is worth the few shreds of rational thinking I have left.
It's strange...I've talked to other students in other fields who say they get treated like professionals...and then that has not been the experience of me and many of my classmates. Unless my opinion is that of the elder's, it is worthless. Don't ask me how I'd be able to swing agreeing with everyone, considering so few people agree on much of anything. Yeah, my perception is clouded, but I know it's not just me based on conversations I've had with other people in my program.
I think from here on out I'm going to keep quiet as possible, only speak if required for a grade, and make sure I don't give my opinion at any point. That might be the only way I survive graduate school. I want to quit. I want to quit so so so much. The only reason why I'm not quitting is the debt.
Saturday, May 19, 2012
Lexapro, Life, the Universe, and Everything: My Intro
I'd have to say that suicidal depression was when my life truly began. Prior to that, it was pretty easy to deny that anything was going awry in my head. Yeah, I had a history of staying awake for 48 hours straight sans speed, and I did have some self-injury tendencies, and my marriage was rocky before rock bottom, and my employment status was iffy - but as far as I was concerned, all was within the realm of normal.
A little background might help you make sense of this:
I was born to upper middle-class parents and raised in a rural town. I was told that my parents were ecstatic about my birth, despite my dad later admitting I may or may not have been a surprise. Unfortunately, my mother was diagnosed with some form of Schizophrenia when I was three, and my parents' marriage started to dissolve. It was the late '80's, and antipsychotic treatment was a bit more unpleasant than it is now - not that it is all that pleasant currently. Typical antipsychotic dosages tended to be really high, and taking Clozaril can really suck for some people. Coupled with Reagan's slashing of mental health funds, it was a recipe for badness for a woman who had been showing signs of Schizophrenia for years prior.
My dad had a pretty good job with pretty good benefits, so he made it a point to get my mother into the best treatment that was affordable. Still, mental health treatment sucked royally, and my mom wasn't all that interested in it anyway. I'm not entirely sure to this day how much of her reluctance to medications and therapy is the result of her mental health challenges, or the result of being a jerk who lacked empathy. I don't say this as a person who is all hung up about my mother having the stuff she has - I've met plenty of people of different ages with her diagnosis who are great people to be around, and it's not like I don't have my own crap to deal with - it's more complicated. She has a history of self-sabotage and being all around cruel to blood relatives, and I can't help but wonder if there's a bit more to her issues than what's on the surface. Friends of her side of the family have (tactfully) said she wasn't all that nice of a person to be around, though both sides of my family said she was an absolute darling. Who knows.
Anyway, my dad was well-known in his field: published, taught a few classes here and there, and worked for a nationally recognized company. He ended up using alcohol to cope with the mess that was home. It wasn't long before CPS was in and out of our house, my parents were frequently in court to try to keep custody of me, our house looked like something out of Hoarders, drug use, me being neglected, and my mother taking off for days or weeks without telling anyone. My dad's career took a downturn until he entered treatment for extreme alcohol use. When that happened, my mom had moved several states away to stay with her family. My dad's brother and his wife had temporary custody of me until he got his shit together. After getting sober, my dad had full custody of me until I was eighteen.
Needless to say, psych issues weren't looked upon kindly in my household. My dad never quite recovered from losing my mom. He had some trauma issues to begin with, and I think the beyond helpful sadness he experienced never stopped. He had some OCD-ish tendencies as well. The house didn't get cleaned, well, ever, and I didn't have friends over because of that. It was pounded into my head not to tell anyone about the condition of our house. It ended up being a source of shame for me, and there were guilt trips along the way by my dad and his side of the family. There were some other issues, but I think the house was the big one.
I didn't come out of any of this unscathed. I was self-injuring, making cracks about suicide, weeping nightly, sleep walking, avoiding friendships, and dissociating starting in elementary school. I was pretty smart, though, so I think teachers assumed my dad got life under control after he got treatment. I mean, kids who get A's and aren't violent can't have a fucked up home life, right?
To address CPS's decision to keep me in the home: I don't know the reason why. I'm going to guess that it was the lesser of two evils. The foster care system is pretty wretched, and who would want to adopt a six year old born to a mother with Schizophrenia? No one else in the family felt able to take me permanently (one even admitted that to me a few months ago), and where else was I going to go? I don't know if that was the best thing to do or not.
Time passed. I wasn't an overly rowdy teenager - I was pretty terrified of dying a painful death, which kept a lot of my impulse control checked (another post). I was moody, more so than a lot of kids my age. And unmotivated. And felt hopeless. For reason I'm going to assume now was hypomania, I changed my mind about wanting to buy a manufactured home and get a factory job after high school and decided to go to college. My grades sucked, so I couldn't get into a university - community college for me.
My dad didn't let me drive or work. I had nine hundred bucks in my bank account, savings from years of Christmas and birthday checks. I met a guy, dated him for three months, and then moved in with him three weeks after I graduated high school.
Yeah, that went well.
I got a job, a driver's license, and kicked the bastard out of my apartment a year after we moved in together. I never went back home. I had a roommate, who helped out with the bills and was consistent with that. I soon met another guy, who turned out to be the complete opposite of the idiots I dated in high school.
I graduated with honors and got married shortly after graduation. I didn't have the best job, but it paid alright and didn't honestly look bad on my resume. I was attempting to become a technical writer, and I volunteered my time as a grant writer in between working at a call center.
It didn't take long for me to crash, and crash hard. I noticed I was feeling a little down and exhausted towards the end of college, but I assumed it was senioritis. Three days after I got married, I had hives that mysteriously appeared. Sex drive went in the toilet. Insomnia. Muscle pain.
And then I made jokes about jumping out of windows.
And then I prayed I would get cancer or get in a terrible car accident.
And then I started throwing out stuff.
And then I wanted to end it myself.
I usually say it was my cats who saved me. I didn't trust my husband to keep my cats until they died, and I couldn't imagine the thought of them having to adjust to life in a new home. In all honestly, I likely didn't care for the idea of dying when the possibility felt intensely real. But I needed something to cling to, and my cats were it.
We didn't have health insurance during our first six months of marriage. My husband found a job with good coverage, and I dragged my feet on making an appointment with someone for another six months. After my husband questioning whether or not our marriage was over a few times, I went to see a family doctor. She told me I needed therapy and a psychiatrist immediately, though I conveniently left out the part about suicidal thinking. I can be a decent actress if I need to be.
I sat across from a therapist. I said few sentences during the intake appointment. One of them was refusing to get a referral to a psychiatrist because I was afraid medication would kill me and I didn't want to be like my mother. The therapist looked at me and said, "I have depression and I take an antidepressant. What's your point?"
I cannot tell you how great it was to hear from someone who came off as confident, empathetic, and happy and had a psych diagnosis. That kept me going for the three weeks it took for me to quit being stubborn about meds (I did not admit to suicide plotting), the absurd appointment with a different family doctor about getting an antidepressant ("Did your therapist suggest anything? Lexapro? Sounds good!"), and the slew of med changes that would follow over the next year.
Because my marriage was rocky and life all around sucked, my therapist told me to take a vacation with my husband. I had to kick my husband's ass into therapy as well, because it turned out he was experiencing his own delightful issues.
On the first night of our vacation, I stood in front of the hotel bathroom mirror with a Lexapro tablet in my hand. Thinking back to the copy of Alice in Wonderland my favorite aunt had mailed me in middle school during a summer she was fighting with my mom (Yes, my mom had visitation rights), I remembered a picture of Alice falling down a rabbit hole. With that image, I put my first psychiatric medication in my mouth and took one long, terrified swallow, along with a fear that the next morning would be entirely different.
A little background might help you make sense of this:
I was born to upper middle-class parents and raised in a rural town. I was told that my parents were ecstatic about my birth, despite my dad later admitting I may or may not have been a surprise. Unfortunately, my mother was diagnosed with some form of Schizophrenia when I was three, and my parents' marriage started to dissolve. It was the late '80's, and antipsychotic treatment was a bit more unpleasant than it is now - not that it is all that pleasant currently. Typical antipsychotic dosages tended to be really high, and taking Clozaril can really suck for some people. Coupled with Reagan's slashing of mental health funds, it was a recipe for badness for a woman who had been showing signs of Schizophrenia for years prior.
My dad had a pretty good job with pretty good benefits, so he made it a point to get my mother into the best treatment that was affordable. Still, mental health treatment sucked royally, and my mom wasn't all that interested in it anyway. I'm not entirely sure to this day how much of her reluctance to medications and therapy is the result of her mental health challenges, or the result of being a jerk who lacked empathy. I don't say this as a person who is all hung up about my mother having the stuff she has - I've met plenty of people of different ages with her diagnosis who are great people to be around, and it's not like I don't have my own crap to deal with - it's more complicated. She has a history of self-sabotage and being all around cruel to blood relatives, and I can't help but wonder if there's a bit more to her issues than what's on the surface. Friends of her side of the family have (tactfully) said she wasn't all that nice of a person to be around, though both sides of my family said she was an absolute darling. Who knows.
Anyway, my dad was well-known in his field: published, taught a few classes here and there, and worked for a nationally recognized company. He ended up using alcohol to cope with the mess that was home. It wasn't long before CPS was in and out of our house, my parents were frequently in court to try to keep custody of me, our house looked like something out of Hoarders, drug use, me being neglected, and my mother taking off for days or weeks without telling anyone. My dad's career took a downturn until he entered treatment for extreme alcohol use. When that happened, my mom had moved several states away to stay with her family. My dad's brother and his wife had temporary custody of me until he got his shit together. After getting sober, my dad had full custody of me until I was eighteen.
Needless to say, psych issues weren't looked upon kindly in my household. My dad never quite recovered from losing my mom. He had some trauma issues to begin with, and I think the beyond helpful sadness he experienced never stopped. He had some OCD-ish tendencies as well. The house didn't get cleaned, well, ever, and I didn't have friends over because of that. It was pounded into my head not to tell anyone about the condition of our house. It ended up being a source of shame for me, and there were guilt trips along the way by my dad and his side of the family. There were some other issues, but I think the house was the big one.
I didn't come out of any of this unscathed. I was self-injuring, making cracks about suicide, weeping nightly, sleep walking, avoiding friendships, and dissociating starting in elementary school. I was pretty smart, though, so I think teachers assumed my dad got life under control after he got treatment. I mean, kids who get A's and aren't violent can't have a fucked up home life, right?
To address CPS's decision to keep me in the home: I don't know the reason why. I'm going to guess that it was the lesser of two evils. The foster care system is pretty wretched, and who would want to adopt a six year old born to a mother with Schizophrenia? No one else in the family felt able to take me permanently (one even admitted that to me a few months ago), and where else was I going to go? I don't know if that was the best thing to do or not.
Time passed. I wasn't an overly rowdy teenager - I was pretty terrified of dying a painful death, which kept a lot of my impulse control checked (another post). I was moody, more so than a lot of kids my age. And unmotivated. And felt hopeless. For reason I'm going to assume now was hypomania, I changed my mind about wanting to buy a manufactured home and get a factory job after high school and decided to go to college. My grades sucked, so I couldn't get into a university - community college for me.
My dad didn't let me drive or work. I had nine hundred bucks in my bank account, savings from years of Christmas and birthday checks. I met a guy, dated him for three months, and then moved in with him three weeks after I graduated high school.
Yeah, that went well.
I got a job, a driver's license, and kicked the bastard out of my apartment a year after we moved in together. I never went back home. I had a roommate, who helped out with the bills and was consistent with that. I soon met another guy, who turned out to be the complete opposite of the idiots I dated in high school.
I graduated with honors and got married shortly after graduation. I didn't have the best job, but it paid alright and didn't honestly look bad on my resume. I was attempting to become a technical writer, and I volunteered my time as a grant writer in between working at a call center.
It didn't take long for me to crash, and crash hard. I noticed I was feeling a little down and exhausted towards the end of college, but I assumed it was senioritis. Three days after I got married, I had hives that mysteriously appeared. Sex drive went in the toilet. Insomnia. Muscle pain.
And then I made jokes about jumping out of windows.
And then I prayed I would get cancer or get in a terrible car accident.
And then I started throwing out stuff.
And then I wanted to end it myself.
I usually say it was my cats who saved me. I didn't trust my husband to keep my cats until they died, and I couldn't imagine the thought of them having to adjust to life in a new home. In all honestly, I likely didn't care for the idea of dying when the possibility felt intensely real. But I needed something to cling to, and my cats were it.
We didn't have health insurance during our first six months of marriage. My husband found a job with good coverage, and I dragged my feet on making an appointment with someone for another six months. After my husband questioning whether or not our marriage was over a few times, I went to see a family doctor. She told me I needed therapy and a psychiatrist immediately, though I conveniently left out the part about suicidal thinking. I can be a decent actress if I need to be.
I sat across from a therapist. I said few sentences during the intake appointment. One of them was refusing to get a referral to a psychiatrist because I was afraid medication would kill me and I didn't want to be like my mother. The therapist looked at me and said, "I have depression and I take an antidepressant. What's your point?"
I cannot tell you how great it was to hear from someone who came off as confident, empathetic, and happy and had a psych diagnosis. That kept me going for the three weeks it took for me to quit being stubborn about meds (I did not admit to suicide plotting), the absurd appointment with a different family doctor about getting an antidepressant ("Did your therapist suggest anything? Lexapro? Sounds good!"), and the slew of med changes that would follow over the next year.
Because my marriage was rocky and life all around sucked, my therapist told me to take a vacation with my husband. I had to kick my husband's ass into therapy as well, because it turned out he was experiencing his own delightful issues.
On the first night of our vacation, I stood in front of the hotel bathroom mirror with a Lexapro tablet in my hand. Thinking back to the copy of Alice in Wonderland my favorite aunt had mailed me in middle school during a summer she was fighting with my mom (Yes, my mom had visitation rights), I remembered a picture of Alice falling down a rabbit hole. With that image, I put my first psychiatric medication in my mouth and took one long, terrified swallow, along with a fear that the next morning would be entirely different.
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