Those Old-World Blues

a cure for what ails you, anxiety, major depression, memories, personal experiences, ptsd, therapy

I won’t lie, readers; I’ve been down quite a bit lately. Most of it stems from deep-seated guilt that’s been playing the long con on me for most of my 28 years–it likes to pop its ugly head up and hit me so hard that sometimes it feels like I can’t breathe.

I’ve been carrying around a back-breaking load of guilt since I was a child. Some of it was inflicted by others, some of it by myself. There were so many little things–messages, perhaps–that sneaked in and grabbed me when I was at my most vulnerable.

When my mother went to prison, one of my maternal aunts abandoned her life in Chicago–what I perceived to be a vibrant life of friends and work and independent living–to return to her hometown to help my grandmother raise me. She never tried to make me feel guilty, but the damage had been done long before her arrival. I felt that there was something “wrong” inside me, that I didn’t deserve to be treated well, that I had done something to deserve the early childhood abuse and neglect that made me into a cautious, anxious, hypervigilant kid.

It all began to snowball from there. Anytime someone would do something nice for me–even something as simple as buying me an ice cream cone–I would immediately feel terribly sad for reasons that my child’s mind couldn’t comprehend. (Fun fact: To this day, the music from an ice cream truck makes me want to cry. Brains are weird.)

As many of you know, I’m studying clinical mental health counseling at Hopkins. I never expected to get in, but I was ecstatic! (I still am, though thankfully, the disbelief has faded a bit.)

My fiance has generously offered to support me financially through this time, as it’ll be probably another year until I can land a paying gig in my field. He’s told me time and time again that he doesn’t mind doing this because he’s financially secure enough to do so and because he loves me (and I suspect it also helps that I’m incredibly low-maintenance–see above paragraphs on guilt). I trust him and try to take him at his word.

But more and more frequently, the old guilt starts to creep in, which leads to devastating lows. Lately, I’ve found myself wanting to cry but not quite knowing why. I think it’s because I’ve suppressed so many emotions. I deal with everything by not dealing with it, which I recognize as alarmingly unhealthy behavior. Once I’m added to his insurance plan, my first order of business is to find a really good trauma therapist (that isn’t based out of one of the sites I’m looking at for practicum/internship).

Today, my fella told me that he thinks I have things “more together” than I think. And he’s probably right–I feel very good most days, although there are little nagging low points on even the best days. I can usually brush them aside using a couple of methods I’ve learned, which I’ll describe below.

Tonight is a rough night. He’s at dance practice, which is awesome–I’m glad we each have interests of our own, and it gives me time to practice the piano without being embarrassed about how rusty I’ve become. It also means I have time alone to cry everything out without worrying about making him worry.

Earlier, I went out on our balcony and looked up at the sky. It wasn’t quite dark but the moon was out in full force. It reminded me of my Great-Aunt Mare and how she’d come to the house twice a day when I was young–once in the morning for coffee with Grandma (her sister) and once in the evening to watch Wheel of Fortune with us. (Side note: I was awesome at Wheel of Fortune.)

I decided that a good cry would be the best medicine, since I’ve been feeling kind of weird all day, emotionally speaking. Shortly after her death, I made a small album on Facebook of the best photos of me and my great-aunt–Halloween at a pumpkin patch, hugging me close for a photo at my eighth birthday party, holding me when I was a baby. I looked at them and I let myself cry. I let myself howl my sadness into the void. And then I sat up and said, “That’s enough; let’s go write a blog post about it.”

I find that if I don’t come up with ways to distract myself, the sadness will become endless waves of grief and shame and all of the emotions I’ve been hiding away all these years. Once it’s out of the box, it’s so hard, so exhausting, to put it all back in.

I apologize for the downer post, readers. I haven’t had a personal post in quite a while but I feel as though being open and honest about my emotions, good or bad, can make others feel less alone. There have been so many times when I’ve been endlessly Googling about a specific worry or fear and bam, there’s a blog post about it. Though it may not help right away or offer solutions, it does make me feel less alone.

I hope you’re all staying safe and doing at least okay tonight. We all need to support each other, at our best moments as well as (and especially) our worst. We’re a community. We survived horrific things, and we continue to survive. Never forget that.


A Few Coping Techniques

  • I saw this one on Reddit last week and loved it. In a nutshell, the poster’s therapist advised them to think of someone they really dislike and imagine that all of the negative thoughts and worries are being spoken aloud by [whatever person]. The person this poster chose to use is Trump.
    • The way it works: Whenever worries or negative self-talk pop up, you go, “Shut up, Trump! [or whatever person you’ve chosen].” It actually does work, and it’s great for shutting down those thoughts at the drop of a hat. Of course, it’s always good to revisit those thoughts at a calmer, more appropriate time, but it’s nice to have a method to use when you’re in a situation where you can’t fully emote.

 

  • Another method I love (and promote to others quite frequently) is Ellis’ A-B-C-D-E method of challenging distressing thoughts. It comes from Rational Emotive Behavior Therapy (or REBT). Here’s the breakdown.
    • Step A: Identify the activating event–this is the event that triggers anxiety, depression, etc.
    • Step B: Look at the emotion you’re feeling and combine it with the activating event. Then, try to identify the beliefs that go along with that event and examine how they cause anxiety/etc.
      • For example, someone buying me something makes me feel guilty. This feeling of guilt and sadness comes from early childhood experiences. The end result is that I feel as though I don’t deserve kindness.
    • Step C: Look at the consequences of your irrational beliefs and realize that they can become a self-fulfilling prophecy. Because my response to kindness has been guilt and sadness for so long, I expect to feel that way every time someone is kind to me.
    • Step D: This is where you start to challenge those irrational beliefs and replace them with other, more positive ones. In my case, I need to work on building up my self-worth (long term) and thinking about the symbolism behind gifts and acts of kindness–“This person loves me and cares for me, and this act of kindness is coming from that place of love, not from a sense of obligation.”
    • Step E: This is basically the end goal and is usually called “cognitive restructuring.” At this point, you put all of the steps together and take special care to notice how the process has affected you and whether or not it has helped you to combat all the pieces that bring on the negative emotions (in Steps A and B).
      • You’re essentially re-conditioning your brain to replace negative associations with positive ones. It’s definitely a long road, but I’ve found it to be extremely helpful. However, it’s less useful to me when I’m in a crisis moment.
  • The last one is very calming to me, because a lifetime of CPTSD has led me to an incessant and sometimes self-destructive need for control. I worry endlessly about bad things happening to loved ones (because abandonment issues are fun!), so this little mantra really helps me chill out and remember that I can’t control every variable in my life.
    • Essentially, the saying goes, “If you can change something, do not worry, because you will find a way to change it. If you cannot change something, also do not worry, because there’s nothing you can do about the situation.”
      • This takes some getting used to if you’re like me and overanalyze and catastrophize everything, but once you’re there, it can be a very powerful tool for derailing anxiety before it hits its boiling point.

Reflection: Grad school so far.

Authoress

I’m entering my third week of grad school (online-only this semester because of the move) and man, it’s been a wild ride. I’m only taking two courses–Lifespan Development and Theories of Counseling and Psychotherapy, both of which I’ve had before in undergrad, so I’m familiar with the content. It’s a good thing I’m not struggling with that because the workload is something I was unprepared for, having been out of school for five years now.

Every day, I set aside two or three hours for work. Mondays are reading days, primarily. Both of my classes are heavy on Blackboard discussion posts, so I usually knock out a few of those on Mondays as well. My Theories class requires participation on four separate days, so I try to space out the rest of my posts throughout the week along with my papers.

Lifespan’s discussions are pretty research-heavy (as in, find an article based on these criteria and summarize it), which is something I’ve always hated. Thankfully, the summaries only have to be a paragraph or two, but I always overshoot in terms of length on all my written work because I have no idea how to thoroughly break down a twenty-page study into a paragraph.

All told, I probably spend about thirty hours or so per week on school stuff, so I’m thankful that Paul is willing and able to support my lack of a job right now–there’s no way I’d be able to maintain my mental health/overall sanity along with a full-time job plus the school stuff. My only concern is that I won’t be able to find another school in Baltimore that will take me sans the psychology undergrad (despite grad school credits in the field).

My plan once we move is to take a semester off to scout out schools and perhaps get back into the tutoring game to earn a little cash on the side. Aside from that, I’m just trying to chill out and get ready for the big move in a few weeks!

How are your summers going so far, readers? Are you taking time out for self-care? I hope this post finds you lovely and healthy as always.

Pain.

a cure for what ails you, abuse, memories, ptsd, relationships

My last pain doctor suggested that my history of abuse (especially sexual abuse) might be the main source of my pelvic pain, along with neuropathy. I have muscular trigger points that cause low pelvic pain, despite having had two injections and a nerve block. It’s true that my endometriosis has progressed from stage one to stage two, after essentially being “reset” by a laparoscopy in March 2011, but I’m taking two forms of birth control to at least slow the progress, if not completely stop it.

I have no more options for controlling or reversing the endometriosis. Lupron didn’t work—all it did was leave me with horrible acne scars on my left cheek and $2,000 poorer. Another surgery is out of the question, mostly because of finances but also because there’s a very good chance it could cause more scarring and adhesions and actually make things worse. All this has led me to reconsider my stance on the mind-body connection, which I’d previously scoffed at.

I was looking up information on pelvic pain related to a history of abuse and found a study on the topic from 2000 (http://www.ncbi.nlm.nih.gov/pubmed/11084180). Some highlights:

  • 22% of patients with chronic pelvic pain were sexually abused before their 15th birthdays
  • 25% of women with chronic pelvic pain were exposed to emotional neglect, especially during childhood
  • 38% were exposed to physical violence

I haven’t written as much about sexual abuse as the other forms I’ve suffered, and I think that’s probably because I still haven’t connected with any of it emotionally. Now that I’m in a functional relationship with a good person who makes me feel safe, appreciated, and generally cared-for, I’m beginning to feel better about myself and more secure and confident in my self-worth.

In short, I think I’m finally ready to talk about it, though in the interest of protecting their privacy, I’m going to avoid all but the vaguest references to abuse within my family.

I’m still not completely sure whether or not I was molested as a child, although more therapists and psychiatrists than you can shake a stick at have all told me that my partial memories, repression, sexual precocity, and general attitudes toward my body and sex are strongly suggestive (no pun intended) of early abuse. I was terrified of men until I was fifteen—I stopped crying and completely losing it around them around age seven or so, but I kept my eyes down, or at least averted, and would cross my arms over my chest and hunch over—anything to keep them from seeing me or even noticing that I was there.

My mother had a boyfriend who made me profoundly uncomfortable from the time I was five until she went to prison a year later.

I remember crying whenever she left me alone with him. They both drank, but I was especially frightened of him. He was tall and overtly masculine in a swarthy sort of way with dark eyes and hairy arms. I will never forget those arms, which I think explains my penchant for mostly hairless men with less testosterone-loaded features.

I have a memory from when I was about five-and-a-half of lying in bed in the room he’d set up for me in his house. (We frequently stayed overnight, and I’d always cry when she insisted I had to go with her.) They’d gone out on a date and had left me alone with his son, who was fifteen at the time and very kind and protective of me. He used to read me books before bed, but because he was pretty severely dyslexic and I was way ahead of the curve in terms of language and reading ability, I usually took over and read him to sleep on the living room floor before putting a blanket over him and tucking myself into bed.

For some reason, I was still awake that night when they came home, albeit in a drowsy twilight state. I remember them opening the door to check on me and seeing the dim, watery yellow light flooding in through the crack in the door. She walked away and he lingered there for a moment. I remember seeing him hesitate, then approach my bed. I remember his dark silhouette against the thin light from the hallway. I remember that hairy arm stretched over my chest, and then everything fades to black. The memory ends there.

It bothers me, not because of the implications but because I pride myself on being annoyingly self-aware and don’t like the idea that my brain, which I know so well, is still hiding things from me. I want to know. I don’t want to know. I’m curious, but I know there’s probably a good reason my brain is blocking that memory. What good would it do, anyway, knowing for sure whether or not anything had happened? I know that he was abusive toward both of us in other ways, and I feel like that should be enough.

But sometimes it’s not.

I’ve written about the other abusers—all four of them, for a grand total of five—in other posts and may revisit the topic later. But for now, I wanted to finally speak out about the one incident from when I was a child that’s still bothering me, that I still haven’t been able to untangle, in hopes that it might strike a chord in one of my readers. I don’t like to think about other people being abused, but I know it’s one of those horrible realities I have no choice but to face, especially since I want to specialize in trauma therapy.

It feels wrong to hope that someone will be able to relate, that they will reach out and that maybe we can have a dialogue and reach some sort of insight together (or at least achieve catharsis), but I feel like it would be incredibly helpful right now. I’ve learned that we need to lean on each other, because no matter how good the intentions of our friends, partners, and families might be, there is no substitute for being able to talk to someone who’s experienced what you’ve been through.

I am here for you, readers. If you need help, I will help as best I can. And if you need to howl into the void, I will be your void.

Roar, roar, the thunder and the roar.

a cure for what ails you, Authoress, explanations, major depression, rapid-cycle bipolar disorder, stigma, three hopeful thoughts

I am in the throes of my first major depressive episode in over six months. I know exactly what caused it—money problems, worrying about my grandma (who is now 91, essentially nonverbal, and raised me on her own, which basically makes her my mom), frustration over the slow divorce process, trying to figure out what’s going on with my headaches—but remained wilfully ignorant of the warning signs because I hoped it would pass.

I finally accepted/realized what was happening in my brain last night. I’ve been really horrible to myself lately in terms of inappropriate guilt and self-loathing. I’ve been blaming myself for a lot of things, most of which are completely out of my control. Once again, it’s not that I’m unaware of these problems. It’s that I have no idea what to do with the insights.

But I’m trying to stay positive because I know this will pass. My depressive episodes tend not to last very long—usually a month or two, and I’m about a week and a half into the really bad phase of this one. The final divorce hearing is on November 5th. Last night, my ex and I had an appointment at Green Path to figure out the debt situation, which is bad but not as bad as it could be. My fella’s coming back from his latest business trip tomorrow night. I’m one step away from completing my graduate school application; all I have left is the personal interview.

And I’m reminding myself of my plans for the future, too. Once I have my license, I plan to work as a counselor for a while, then go on to pursue a Psy.D and possibly a degree in Criminology as well, just for kicks. It’s looking more and more likely, given the progression of my various illnesses, that I won’t be able to have kids by the time I’m ready—and even if I’m able to retain some shreds of fertility, it’s probably not a good idea because I have so many health problems that are heritable. In other words, I have no reason not to go ridiculously hard at the school/career thing.

Once I’ve attained a certain level of credibility, I want to combine my love of/talent for writing with my passion for psychology (and, of course, fighting the stigma) and gain access to a psychiatric hospital with the goal of eventually writing a book about the hospital, perhaps some of the staff, and most importantly, the patients.

I want to tell their stories. I want to show people that we’re really not that scary. Even when our brains are doing some freaky and perplexing things, we still have hopes and dreams and fears and all the other little things that make neurotypical people “tick.”

I want to paint a picture of the hospital to prove that Hollywood has it wrong—I had the opportunity to tour the state hospital in Independence, Iowa as a senior in high school and found the facility stunningly different from what we’re fed through popular media. I’m tired of cringeing every time I hear the words “multiple personality disorder” on TV or see a straitjacket Halloween costume. I’m tired of being “The Other,” and I suspect most of you are, too. I’m tired of being seen as exotic and dangerous and unpredictable and sort of otherworldly just because my brain tends to misfire sometimes. I’m tired of having my struggles used for shock value. I’m tired of seeing symbols of our oppression used as fashion statements by the oblivious.

I want to fix that obliviousness or die trying. This is the one topic that has gotten me consistently fired up, regardless of my mental state. Even when I’m so far down that I can barely get out of bed, I can still muster up enough passion to call out the horrifying things I see, to correct the misinformation, to have a meaningful dialogue where I and the other person walk away feeling as though we’ve learned something.

As a nihilist, I reject the concept that anything has any inherent meaning; therefore, I don’t believe in the idea that anyone has a “calling.” That being said, I find this to be a very hopeful philosophy because it means each of us can choose our path in life. I believe that the things I’ve been through, the abuse and my brain chemistry and the various horrors I’ve seen, were formative in such a way that I feel compelled to devote my life to psychology. I guess this is how theists feel when they decide to become members of the clergy.

At the very least, I have to believe that my suffering (though I hate using that word because it feels incredibly maudlin and self-absorbed) has meant something. I have to believe that it’s redemptive and that it’s not too late for me, that my life has meaning. I constantly look for motivators, little signs that I’m meant to be here and that my existence has a purpose. I think that when a person is pushed to their absolute limit, they either try to find a reason to stay alive or they completely give up on life. I’m not ready to give up.

I am tougher than Chinese algebra and I am going to be okay.

Some thoughts.

abuse, ptsd, rapid-cycle bipolar disorder, suicidal ideation, therapy

It is physically painful for me when people thank me for writing, or helping them, or tell me I’m brave or a role model. I’m not a role model. I wake up most days hoping to die. I don’t know how or why I’m still alive. D.’s theory is “sheer dumb luck,” and I think he’s right.

I am a junkie. I cold-turkeyed it over a year ago, but not for noble reasons. I stopped because it was no longer taking away the physical and emotional pain in one fell swoop. It simply stopped working, so I quit. That’s all. I still think about it every day and I think I always will. This is one thing I’m proud of, however—that I was able to stop and stay clean despite all the awful things that have happened in the last year.

My therapist told me last night that I’m the toughest woman she’s ever met. She’s in her 60s, so I’m guessing she’s met quite a few people. I’m not tough because I want to be or try to be. I’m tough because of my animalistic survival instinct–in other words, I’m tough because I’ve had to be, not because I want to be.

I vacillate between strong feelings of self-loathing and guilt and equally strong moments of self-esteem where I actually feel good. But those feelings are always tempered by the fear that my meds have stopped working, that I am manic again, that I am going to ruin things and use people up like I have countless times in the past.

Right now, my pride is wounded and I feel terribly alone. I know I have good people in my life who care about me, but none of them can relate to being raped innumerable times and having people blame you for it because you were too afraid to actually say “no,” to trusting someone completely for the first time in your life and having it unravel all at once, to visiting your mother in prison as a child.

On top of it, I’ve been having horrible nightmares again and the partial memory that strongly suggests I was molested by one of my mother’s boyfriends when I was five is beginning to come into focus at a time in my life when rehashing sexual abuse is the last thing I need.

My therapist referred me to a clinic that specializes in sexual abuse and PTSD. I didn’t take it personally—as an aspiring counselor myself, I understood where she was coming from when she said that she didn’t want to risk making things worse because she doesn’t have much experience in sexual abuse or trauma. I’ve been through enough therapists to know that I wasn’t being “fired” as a patient. Therapists, it seems, are the easiest group of people for me to trust. Their motives always seem to be pure, and the confidentiality helps, I think.

I’m thankful for all the support I’ve been getting, both for the blog and in my personal life. Words cannot express how much I appreciate each message and each person who reaches out, whether it’s to reassure me or tell me how I’ve helped them. That’s what keeps me going—fighting the good fight. I want to feel strong. I want to beat this thing. I want to help people. If I can make things even a little lbetter for everyone living with a mental, I’ve accomplished more than I could have ever hoped for or imagined. If you’d told me what I’d be doing now when I was a motherless, lonely child being bullied and dealing with the prodromal phase of bipolar, I wouldn’t have believed you for a second.

My family, for all their dysfunctions and refusal to discuss the dark side (the way bipolar disorder has spread like wildfire down through the generations), has been immensely supportive. While there was a rough period when I first started my column in my hometown’s newspaper at age 19, they quickly warmed to it and realized that I was doing something most nineteen-year-olds wouldn’t be capable of and that I was taking all the pain and trying to turn it into something positive.

Some of my earliest memories are of my grandmother and beloved great-aunt and other aunts telling me that I was talented, that I had something special that I needed to hold onto. It’s difficult to believe some days—as we all know, knowing something and believing it to be true are two entirely different things.

But I’m trying. I do what I need to do in order to get through the day. Some days are easier than others. Some feel impossible. I’m a big believer in the “fake it ’til you make it” mindset; while it doesn’t work for everyone, it’s served me well over the years. At the very least, it allows me to save face and present as “normal,” even if I’m completely falling apart on the inside.

It’s another bad weather day in my head, which I guess is my reason for writing this. I also wanted to reach out to all of you and say that I’m here for you, too. I’ll always listen if you need to talk—all you need to do is reach out and I’ll be there. It’s the least I can do.

Manic Depression: A Brief Explanation

authoress in motion, explanations, major depression, medication, rapid-cycle bipolar disorder, self-harm, stigma

I finally got around to editing the explanation video on bipolar disorder/manic depression (I prefer the latter term as I feel it’s more descriptive).

In the video, I talk about the different categories of bipolar disorder, what each phase (from depression to mania and mixed states) is and what it feels like, and tips for dealing with a mixed episode.

A brief update.

authoress in motion, major depression, medication, rapid-cycle bipolar disorder, three hopeful thoughts

This is just a brief update on my current meds, treatment plan, and moods. If you’re into videos and want to see the authoress in motion, check it out. 🙂

Sending love into the darkness.

major depression, ptsd, self-harm, therapy, three hopeful thoughts

I met with my therapist last night after work, and she had some very good advice for me. I told her how I’m trying to make myself believe that my body is not the only thing worthwhile about me, the only good thing I have to offer other people. She countered that statement by saying it’s the “dark core” we all have that’s sending me those messages.

“But I want to fight it,” I protested. “I want to believe that I’m smart and pretty and funny and that those things, like the depression, are just a part of who I am. Right now, I feel like sex is the only way I can atone for being so fucked-up.”

She made me sit with those feelings for a while and over the course of the hour, we broke the false beliefs down in a less judgmental way. Instead of “fucked-up,” we said I was “sick but trying to get better,” which is a lot more than most people do. She told me how brave I am for making the effort.

She also advised me to stop fighting–fighting comes from a place of violence and hatred, and the darkness will always win. Instead, when the dark place tells me that I’m useless and a burden, I should look at it and say, with open arms, “I’m so sorry you’re feeling that way.” If I try to counter it by saying, “Well, I’m good at X, Y, and Z,” the automatic thoughts will come back with, “No, you’re really not.” But if I offer the pain compassion, I might be able to reduce the hold the thoughts have on me in the long run.

I cried a lot during our session. I think that’s going to be a recurring pattern, but I don’t see it as a bad thing–maybe it’s a sign that I’m starting to connect to my baggage and heal.

Numbers.

medication, ptsd, stigma, therapy

I started seeing a therapist when I was eighteen and saw my first psychiatrist around the same time.

Six years later, we’re on to therapist #7 and psychiatrist #3 and I feel like if this isn’t the combination that finally does the trick…

Image

I’m 24. I feel that I am both too old and too young to be going through this tired old song-and-dance again. I am tired of feeling like I’m tormenting my husband (though he insists that while watching me suffer is upsetting, my illness is not a burden) and tired of trying to keep it all together. But falling apart is completely terrifying, which is why I get up every morning and put on the pretty dress and the high heels and the makeup and the perfume instead of doing what I really want to do, which is stay in bed and cry and drink or take assorted drugs until my mind is a big, blissful zero.

Because it’s a slippery goddamn slope and I’m too old to be such a mess but too young to give up.

Also, this is why having chipped nails or unshaven legs bothers me so much. It might seem silly to care so much about my appearance when there’s so much noise inside my head–some days, it is like having ten radio stations tuned in at the same time–but it makes me feel less sick. If I can be pretty and charming, even in all my infinite, glorious messiness, part of me believes that I’m going to make it through this.

But first I need to buck up and get over the “I don’t want to live like this anymore!” weepiness that’s been heavy on my mind lately. All these pills, man. All this therapy. All these bills that I keep putting off, paying in tiny installments because I know I’ll never be finished.

And maybe that’s okay.

Another new beginning.

medication, ptsd, stigma, therapy

I’ve decided to use my writerly skillz to document my latest round of treatment for the PTSD and major depressive disorder with the end goal of potentially selling excerpts or actually finally finishing a “book.” I realized that a memoir in the traditional sense would be the wrong move for me right now, since there’s no real resolution yet and I’m not ready to relive all the trauma. I also thought that writing it while I’m undergoing treatment–almost like a diary, but more polished and meant for others to read–will help me gain new insights into my conditions and my treatment as well as helping others understand what living with these disorders is actually like (hint: it’s a daily struggle). Below is the small bit I’ve written so far. As always, comments and questions are loved!

I meet Susan for the first time on a cool, rainy day in early June. We make polite small talk for a few minutes before she asks why I am here. My voice is robotic and well-rehearsed as I summarize nineteen years of trauma in under a minute.

“You’ll like Susan very much,” the on-call therapist had said to me over the phone a week before, trying in vain to calm me down during my first-ever panic attack. And I do–she is young and stylish, hippie-chic in her embroidered flats and colorful scarf. She gazes at me with concerned eyes as we begin discussing my dissociative symptoms. She asks me to describe what a typical episode of derealization is like versus depersonalization,  how long they typically last, how I know I’m having one. I explain the unnerving disconnect from my surroundings and between my mind and body from the moment I wake up each day until I go to bed late each night. This disconnect, this disquieting dreamlike feeling that has existed in varying degrees each day for the last year, is back in full force as I ghost my fingertips over the creamy leather of the armchair, my brain taking a second or two to catch up with the physical sensation, just as it always does.

When Susan speaks, her voice is solemn. “Well, it’s not great.”

I force a laugh in an attempt to chase away the sick churning that has started in the pit of my stomach at her words. It doesn’t work. “Yeah, that’s probably really bad,” I agree, trying to keep my voice casual.

“No,” she replies gently. “I meant that the prognosis doesn’t look great. A whole year of these dissociative symptoms without a break is pretty extreme.” I bite my lip and flick my eyes toward the ceiling, struggling to steady my breathing and ward off tears. This helps me calm myself and I fix my gaze once again on hers, fingers interlaced around one bare knee.

I mention a therapist I saw in June of 2012 who was disturbed by my “flat affect” and thought that any sign of emotion–even uncontrollable sobbing, which I frequently did in her office–was good. She pushed me to reveal too much too soon, and instead of having a dissociative episode that lasted a day or two, I’ve been plagued by feelings of unreality ever since. There is no relief for me, and in this moment, I feel that there never will be, that there is no hope, that the only escape from all this numbness will come when I finally kill myself. But I convince myself that I need to stay positive and tell her that while I understand the prognosis is grim and I understand that we could potentially make things much worse, I still want to try. Any chance at relief is better than living like this.

Susan explains that my defense mechanisms, which were very helpful and kept me alive when I was a child, were likely highly triggered when I was forced to relive the trauma in one massive chunk during therapy. This, she says, is what will make our therapy difficult. She will need to be constantly vigilant, always looking for “cracks” in the facade, little slips of the tongue or small clues that give her an opening into my psyche. If she can get in that way, she says, we can work around the defense mechanisms enough to make progress. As she speaks, I imagine her as a cat burglar dressed in black, shining a tiny pen light into the darkest recesses of my mind. The work will be very slow and therapy will be very difficult, but I mustn’t get discouraged. And above all, we need to trust each other. I need to tell her when I’ve had enough, or perhaps set a limit–fifteen minutes of talking about one topic before “changing the channel” to avoid triggering my defenses is one suggestion, and I readily agree to it. I am so desperate for relief, any relief, that I am willing to agree to anything.

The next day, I see my psychiatrist again. I tell her in a flat, quiet voice how I feel I’m having a relapse of my depression; the Effexor doesn’t seem to be working all that well, and it’s been a year since I last had a complete absence of dissociative symptoms. As I recite these facts, my eye are fixed on the large digital scale sitting in the middle of her office. We talk about different treatment options–she is in favor of Abilify, but I balk at the drug when I learn that there is no generic equivalent. I’d been on Cymbalta for a few months in late 2012 but after I reached my maintenance dose, it stopped working, which was probably just as well; I couldn’t afford the $40-a-month price tag on top of my other bills and medications. We settle on risperidone, which my psychiatrist tells me is a “mood stabilizer” that should help alleviate some of the dissociative symptoms as well. Since it is to be taken at night, she says it may even help me sleep, though she warns me that it can cause weight gain.

She invites me to step onto the scale when I confess that I don’t know my weight; at this point, I haven’t weighed myself in several months, knowing from years of experience that it’s unlikely to go down no matter what I do. Besides, I have just gotten comfortable in my own skin again and don’t want to get hung up on a three-digit number when I have more important things to worry about, such as my rapidly declining emotional state.

I watch, mute, as “154.5” pops up on the little screen in fat black letters. I look at her and shrug, and this time I don’t even have to feign disinterest because for the first time in four years, the number means nothing to me. I sit through a brief lecture about how I’ll need to be re-weighed when I come back in a month, because even a few pounds gained can be a red flag that my body doesn’t like the drug and is likely to put on even more weight if I remain on the risperidone.

She explains that sometimes it takes a while to find the right combination of medication. I nod, we chuckle–silly brain chemistry!–and she sends me away with three prescription sheets and a lopsided little smile. I realize that I’ve just been prescribed an antipsychotic, but it doesn’t bother me. My interest in psychology began when I was a sophomore in high school and continued all the way through college; the term “psychotic features” and the names of various drugs don’t feel scary or threatening, but instead seem like familiar old friends. It occurs to me that perhaps I should be annoyed that my doctor didn’t simply call a spade a spade, but I have other things to focus on, such as navigating through the fog that descends every morning when I wake up.

I begin to see my defense mechanisms as a dragon, something living in the darkest recesses of my mind that I must be very, very careful to tiptoe around; I know from years of experience that waking them up, no matter how innocent my intentions, can have severe consequences.

I spend the day after my psychiatry appointment walking around in a daze. As I apply my makeup before work on Friday morning, I watch my husband in the mirror and jokingly tell him that it feels like being high without the benefits of actually being high. He smiles, but there’s something serious in his eyes; he knows it’s not a joke at all and that this weird detached feeling has become my new reality. It’s difficult for me, but it’s more of an annoyance than anything–something else to deal with. I can’t imagine what having a sick wife must be like for him. I worry that I’m turning him into a tragic Leonard Woolf type, but I feel helpless to stop it.