Another Note To the Readers of Despair to Deliverance

As I wrote in the last post, one of the most important lessons I learned while living through 2003 with Robin, was to give up trying to control the inevitable changes of life. For those of you who have been faithfully checking in and waiting for the next post, thank you. I have not gotten back to my usual goal of posting approximately weekly, because life has gotten in the way.

After several months of ups and downs my mother-in-law, whose nickname was Peaches, died peacefully with my husband and I with her, on August 4th. At some point I will be writing about the whole process of caring for Peaches in our home for eleven years, then transitioning her to a nursing home, and then witnessing her amazing journey through the last few months of her life. It may become another blog, or it may become another book. Time will tell.

I appreciate the loyalty of our readers and trust that you will be patient as I get through the memorial service for Peaches this weekend, and then return to some semblance of a routine while grieving the enormous loss I have experienced. Writing is what I do, so I will be back to blogging and telling our story soon. Robin is working on her next posts too, and there will be much more from her in Part Two of our book. Stay tuned….

Posted in Note to Readers | 6 Comments

Sometimes Self-Care Strategies Are Not Enough

Note:  This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.

Self-care was something I regularly discussed with the clients I saw in therapy. I had been exercising consistently since high school and journaling since I was ten years old. I had a supportive husband and network of friends who I relied on to process things that were upsetting. While I was never successful at turning off my busy brain enough to practice meditation, I made sure as an introvert that I had enough alone time and silence in order to stay “centered.” Also, listening to music was an integral part of connecting with my emotions. Reading spiritual books helped me stay focused on my newly emerging perspective.

In therapy I would talk to clients about specific things they were doing to take care of themselves. The concept of balance was also a frequent topic of conversation. We would talk about the importance of balancing work vs. relaxation, time alone vs. time with other people, and consistent exercise and healthy diet vs. being flexible and realistic with themselves. When I was a therapist in 2003, I usually felt I was practicing what I preached in terms of self-care and maintaining balance. As a person with obsessive-compulsive personality traits, I had spent most of my adult life working to be more flexible with myself and to manage my significant anxiety.

During the first six months of 2003, however, my ability to maintain any sense of balance or control over my anxiety completely disappeared. I had a caseload of about 100 clients who I needed to be available for in addition to everything I was doing for Robin. I managed to do this, and also to do the various things I usually did to take care of myself. But, sometimes self-care strategies are not enough. During that time I was completely overwhelmed with stress, anxiety and worry. I lost weight, and I lost sleep. I was in what I always referred to with my clients as “survival mode.” My stress level was magnified by the fact that in April 2003 my husband and I moved his mother, who was 82, widowed and becoming frail, across the country and into our house. This was a stressful transition which caused me to go from having quite a bit of alone time, to very little.

In the six months after her meltdown Robin had begun to rely more on her family for support, but she was not being open with them about her ongoing suicidal thoughts or self-destructive behavior. I had continued to feel mostly alone in the ongoing nightmare with her. I knew my ability to be objective about Robin was somewhat compromised by the degree to which I had become emotionally invested in helping her, so I continued to rely on my professional and personal support network of therapist friends to confirm that I was doing the right things in therapy. These people were very helpful, but I could not talk to them about how overwhelmed and stressed I was. I knew it would concern people to know the degree to which I was allowing a situation with a client to consume me. I had never, during the course of my career, been so caught up in helping someone for such a prolonged period of time with no relief.

I’m not sure what the people I was talking to about Robin would have said, had I let them know how much I was being affected. If things were reversed and a colleague or friend of mine confided in me about a similar situation, I would have been concerned about them. All I knew was that to distance from Robin too much, at that time, was not an option. She needed someone with whom she could be open about what she was really thinking and feeling. If I suddenly stopped being available, there was a realistic risk that she would die. It was never a consideration for me to take that risk. I trusted I was doing what Robin needed, and I felt clear there was a reason we were going through such a difficult time together. I just needed to get through it.

When I left for vacation on the day Robin began her second round of ECTs in June 2003, I drove alone. My husband had work he needed to do and planned to drive separately to meet me at my parents’ house two days later. Having five hours of alone time in the car was a much needed luxury for me. For the first time in months I had some extended time to myself with nothing to distract me.

The timing of the trip was ironic. Robin had just hit rock bottom. After her dramatic meltdown, her new openness with me, my epiphany about her diagnosis, her getting worse and needing ECTS, and then needing to stop the ECTs prematurely to give her a chance to get back to work, she had just lost her job. She was overwhelmed about her financial situation and unable to pay her bills. She was grieving about what could end up being the end of her career. And, she was starting another round of ECTs.

Although I knew Robin did not want to kill herself, I also knew the degree to which she felt like her life had completely fallen apart. I knew how bad she felt about the idea of filing bankruptcy, and I knew she had no sense that doing so would make things better for her. I knew she was reeling from the sudden change in her diagnosis, the fact that she had been hospitalized twice, and especially that she had undergone ECTs and was still having ongoing suicidal thoughts. I had done everything I could possibly do, for such a long time, and she was still at significant risk for suicide as Dr. Rios had said so many years before. There was no way for me to trust that more ECTs would get her to a place where she would feel better enough to stop thinking about killing herself. There was certainly no way for Robin to trust this. I felt completely powerless.

During that five hour drive to my parents’ house, it felt like all the emotions I had been unable to process during the previous six months hit me at once. I was a sobbing mess. I felt completely overwhelmed with sadness. There was the therapist part of me, who knew I had done everything I could do for Robin and that if she killed herself it was not my fault. But the rest of me just felt bad…mostly for Robin who was completely at the mercy of her rigid brain and the depression that had completely consumed her. I felt bad for her parents and her brother, who knew at some level that Robin was struggling but had no idea how dangerous her depression had become. I thought about how shocked and completely shattered they would be if she committed suicide. I thought about her nieces and nephews, who she saw frequently, who would be confused and traumatized if she suddenly died. And, I tried to imagine my own feelings if it came to that. I couldn’t imagine it.

My overwhelming emotions that day in the car were about more than just Robin. Although I had been a psychotherapist for a decade and had treated many people with severe mental illness, rarely had I experienced so intimately the devastating effects mental illness can have on someone’s life. Robin just wanted to be able to live her life, do her job, pay her bills and be okay. She was completely at the mercy of her own brain. No matter what I did, Dr. Greene did, or Dr. Sanchez did as her treatment providers, and no matter how hard she fought to get back to just living her life, her mental illness could still kill her. It was unfathomable. I thought with a new perspective about all the patients I had treated over the course of my career and the impact their illnesses had on their ability to function in various ways.

I thought about members of my own family, going back generations, who had struggled with significant anxiety and probably also depression, without treatment (including a great uncle who committed suicide). I thought about how different all of their lives could have been if effective treatments had been readily available and the stigma of mental illness had not kept them from realizing they had symptoms of it.

As I drove, thinking about all of these things, I remembered my thought the previous January shortly after Robin’s initial meltdown, that this experience was going to be as significant for me as it was for her. In the car that day I suddenly began to get a sense of what that meant. It suddenly felt more clear to me that I was in the right profession. This had not been clear to me, for a number of years.

I had been feeling even before the experience with Robin began, as if I was starting to burn out as a therapist. I knew I was putting a lot of emotional energy into my work. Although I kept my boundaries clear and fairly rigid, clients often gave me the feedback that they felt I was very emotionally present for them. This was true. I was. It was exhausting to be so emotionally present for so many people who were feeling so much pain. But I loved being a therapist, found it very rewarding, and didn’t know how to do therapy any other way.

In 1997, only five years into my career, I began to take classes to become a certified financial planner. I knew, even then, I would never be able to sustain being a therapist for the rest of my career. And I was afraid taking a management position would be too stressful for me. So I thought about financial planning as a way to help people in a less emotionally draining way. I even did this work part-time for a while. During that drive in June 2003, I began to realize that whether I worked as a therapist or not, I was passionate about helping people with mental illness. I suddenly felt my motivation for my chosen career renewed.

Another realization was suddenly clear…I had no ability to control anything. I had been having glimpses of this realization as things had been evolving with Robin, but it suddenly struck me much more deeply and more completely. As an obsessive-compulsive, competent person, I was used to feeling like I could control my own destiny if I just worked hard enough. I had gotten caught up in this feeling when it came to Robin’s sudden increased vulnerability. I had automatically begun to work harder to help her when it became clear she needed to connect with someone. It felt clear that someone needed to be me. But, while driving north in Michigan to spend time with my family, I suddenly knew…I needed to let go of the need to try to control everything. It was impossible. I wasn’t ready to actually do this yet, but it was significant to suddenly understand this at such a deep level. I needed to get better at “going with the flow.”

As I continued to drive, and process, I was struck by another thought. Robin was probably supposed to be learning the same thing. Whether she actually learned it, integrated it, and got to a better place was not up to me. But, Robin and I both needed to get better at accepting that life is a process of change, that change can be not only okay but good, and that change should be welcomed rather than fought. I knew this would be impossible for Robin in the immediate future, but it suddenly felt less difficult for me. It suddenly made sense. It was a relief to feel like I was getting clearer. Unfortunately, what I still didn’t know was whether one of the changes I would need to accept was Robin’s suicide.

I kept processing and realized that during the course of the previous six months, without even knowing it, I had developed a different perspective about what warranted worry. As an anxious person I had always had a tendency to worry irrationally about minor things. If things happened that were outside of my familiar routine, it caused anxiety for me. I suddenly realized that I had not been worrying about any of the usual minor things during the previous six months. Worrying about trying to help someone stay alive, and having to make constant decisions about how to handle the situation, put everything else into a different perspective. I didn’t know if this new perspective would continue after the crisis with Robin passed, but during my drive to northern Michigan that day, I became clear that this change had happened.

When I arrived at my parent’s house, I was immediately surrounded by family. Parents, siblings, nieces and nephews filled the house with lots of activity. After such an emotional drive, it was very good to be distracted by all the children in my life who I love dearly. Over the subsequent week I was able to feel some distance from Robin, which was very helpful. But, in the midst of the time with my family, I made time to talk to Robin on the phone every other day, per her request.

“My life is a financial, occupational, social and emotional fiasco,” Robin said in one of our phone calls. She acknowledged that she still felt depressed, and was still having some suicidal thoughts. “I’m stressed because I know I need to file bankruptcy.”

“I think it’s time to talk to an attorney,” I told her. “I know the name of one who is really supportive and easy to talk to. I think getting more information about the whole process will help.” Robin agreed, and I gave her the name. Two days later when we talked, she felt better.

“I talked to the attorney. I have an appointment scheduled to see her, which helps,” Robin said.

“I’m glad. How did the ECTs go?” Her insurance company had only approved three treatments, and she had the third one that morning.

“The procedures themselves were fine,” Robin said. “But I’m concerned that they don’t seem to have helped enough.”

“How bad are the suicidal thoughts?” I asked, assuming she was still having them.
“They’re always there,” she said. “But I know my parents and my brother would be devastated if I killed myself.” I was surprised and thrilled to hear her say this. It was the first time her family members, not her cat, had been the biggest barrier for her in terms of suicide. It was the first time she was able to say they would be “devastated” and not just “upset.” Thank God, she was finally thinking clearly enough to realize this. The Robin I had known for so long, who was very sensitive to other people’s feelings, was returning.

“You are continuing to think more clearly, Robin,” I said. “You don’t even realize how much better you are. But there are many situational issues that are affecting your mood. We need to process everything that has happened in the last six months. You need to get the bankruptcy taken care of and feel able to support yourself financially.” I wasn’t sure how she was going to be able to do this, given that it was unclear whether she would be able to return to work. The idea of long-term disability had not even been discussed, because I knew Robin wasn’t ready to hear it. But I needed Robin to be clear that there were many factors contributing to her ongoing depressed mood, and that they were ultimately resolvable. I went on. “And, probably most importantly, you need to keep working on being open with people so I am not the only one who knows how you feel. You are still way too isolated.”

Robin and I talked about her continuing ambivalence about living vs. dying. Given her new awareness of her parents’ feelings, I asked if she was willing to either have a session with her parents or allow me to do so. I had not had a chance to meet with them when we had talked about it earlier in the spring, because Robin ended up being hospitalized before we could do so and then had been focused on returning to work. I was feeling a need to involve Robin’s parents more in her treatment, partly for her, partly so they were more aware of the extent of her continuing struggles, and partly so I felt less alone in Robin’s pain. I tentatively threw this idea out for Robin to think about it.

“I’ll ask them and let you know what they say,” she said.

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“I Feel Like I’m Losing Control Again.”

Note:  This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.

The weekend before Robin was supposed to resume working full-time in June 2003, she stopped taking all of her medications. She admitted she was feeling unsure about managing the stress, and was feeling pressure from me to refrain from acting on her strong urges to drink alcohol.

During the time between her ECT treatments and her return to work, Robin wanted to decrease the frequency of our contact. She indicated she was feeling “too dependent” on me, and she desperately wanted her life to return to normal after such a difficult time.

I decided to shift from automatically scheduling regular phone calls, to asking Robin to tell me when she wanted to talk next. This allowed her to have control and flexibility about the frequency of our conversations without having to be the one to initiate calling me after hours (which was still hard for her). She could stay connected or distance, depending on how she felt. I was relieved when she asked to talk after her first day of full-time work.

“I broke down and took Depakote last night, but I didn’t take the rest of my meds.” Robin said. “I didn’t sleep at all.” Oh no! I was instantly worried.

“Robin, I’m really concerned about you sabotaging yourself. You’re setting yourself up to lose your job. Why do you think you’re doing this?” I asked.

“I know it’s not rational,” she replied. “I’m just not ready to give in to having to take all those meds. I think the reality of everything I’ve been through in the last six months is really starting to sink in. I’m trying to assimilate it all.”

“We have a lot to process about what’s happened and I know this feels overwhelming. But if you don’t take your medication tonight and you go a third night in a row without any sleep, you’ll be seriously jeopardizing your job.” I was firm in the tone of my voice. I was concerned. But I was also, for the first time, feeling anger toward Robin. After everything we had been through in the previous six months and after all the extra effort it had taken to arrange the opportunity to return to her job, I was very frustrated about her clearly self-destructive behavior. Part of me understood she was reacting to the enormous stress she felt, along with grief about having to accept her new diagnosis. But she was not giving herself a fair chance to get back to work successfully. She was thinking more clearly. It didn’t make sense that she was setting herself up for disaster. I think she could sense the anger in my tone.

“I’ll take my meds tonight,” she said. “I don’t want you to be mad at me.” Good, I thought.

Robin took her medications, slept well, and said she felt “refreshed” at work the next day. But, that feeling didn’t last.

“I came home from work to lots of bills, and there’s a problem with my checks I need to deal with at the bank. And, my car is not working right.” Robin said she felt overwhelmed by all these new issues and drank three drinks to numb herself.

“I just wish the last six months hadn’t happened,” she explained. “I don’t want to be on antipsychotic medication. I’m really stressed about money and know I need to file bankruptcy, but that bothers me. I don’t feel good about it at all.”

“Robin, you’re experiencing completely appropriate feelings about your situation,” I said, trying to reassure her. “The fact that you are thinking clearly enough to be processing these emotions is a sign of the progress you’ve made.”

We talked about her suicidal thoughts. “My family has been really supportive since I had ECTs and they know I’m stressed about work. I know they’d be really upset if anything happened to me. And besides, I just can’t get past the cat thing. I can’t kill myself.” Wow. I was relieved to hear Robin finally acknowledging that her family members would be very affected by her death. It was another example of the degree to which she was thinking more clearly. And she was making huge progress in terms of being open with her family. But, she wasn’t better enough.

In our session that week Robin admitted she had again skipped all of her meds the previous night because she was drinking, and had then called in sick to work. She was not purposely sabotaging herself. The stress of trying to work full-time and process everything she had been through, as well as the financial pressure she was feeling as a result of not receiving her full pay for a number of months, was overwhelming her.

Despite the drinking, the stress and the lack of sleep, Robin’s affect continued to remain brighter than it was prior to the ECTs. She said she felt okay at work, even with little sleep. She was more focused on the future despite ongoing obsessive suicidal thoughts. She reassured me she was not planning to kill herself, and she began to take all of her medications again.

Robin briefly began to sound better than she had since before her meltdown. She acknowledged feeling better as she was starting to feel a bit more settled into her job. She was still anxious about it, but said the anxiety was manageable. For a few days, she began to sound and act like her old self.

Robin had always enjoyed reading and watching sports on television. During the entire six months following her meltdown, she had not done either. Anhedonia, or the inability to enjoy anything, is a part of severe depression and Robin definitely had this symptom. She said she often had the television on without the sound, trying to distract herself, but couldn’t focus well enough to pay much attention to the programs. As she briefly felt better and believed maybe her life could return to the way she wanted it to be, she was able to watch sports again.

The improvement, though, was short lived. During the weekend after her first week of full-time work, Robin admitted that on Friday night she took “much more” Ativan than she was supposed to. She did not know how many pills she had taken, but said she woke up “groggy and thick headed.”

“Robin, we had just talked on Friday and you said you were going to take your meds as prescribed.” I couldn’t hide my surprise. She had overdosed? Really? “What happened?” I asked.

“I know it makes no sense,” she said. “It was impulsive. I just wanted to make sure I slept, and I wanted to see what would happen.”

“Robin, you seem to be trying to precipitate a crisis,” I confronted her. “You are pushing me to have to do something, and you are clearly jeopardizing your job. What’s going on?”

“It’s not conscious,” Robin insisted. “I don’t know what’s going on. I just can’t stop obsessing about suicide. I guess I haven’t decided about living or dying yet. Part of me wants to live and watch my nieces and nephew grow up, but I’m having a harder time controlling the other part.”

Thank God she was talking to me about her ambivalence. I was grateful for that. But, it was hard for me not to get anxious about the conversation. Robin was basically telling me she had impulsively overdosed. She could have easily misjudged the amount and killed herself by accident that night. We talked about the hospital, and she was adamant about not wanting to go. She insisted she was going to go to work the next day.

I started wondering, again, whether I needed to have Robin detained. I didn’t want to put her in the hospital, knowing it wouldn’t solve anything. It would just cause her to lose her job which would make everything worse. And, after three hospitalizations in six months during which she mostly refused to participate in the programming, I knew she would likely continue this pattern. The decision, as always, came down to a judgment call on my part about whether I thought Robin would be safe, or whether her situation was dangerous enough to warrant having the police haul her to the hospital against her will.

At that point, after we had been through this so many times before, I felt clear I needed to trust that if Robin wanted to kill herself, she would be dead. She continued to stay connected, even after she had said she wanted distance. I didn’t want to jeopardize her trust in me. My gut told me that to detain her would be a bad idea.

Overall I was feeling completely helpless, exhausted, and frustrated by Robin’s ongoing self-destructive behavior. In my own mind I started questioning whether I was doing her any good. I think she could sense my frustration as I again talked about the dilemma her behavior caused for me.

“Robin, you are putting me in a bad position again. Now you are overdosing. What am I supposed to do about that?”

“I’m really sorry,” she said. “I’m not trying to upset you. I can understand why you might be angry at me.” Great, I thought. Robin is depressed and suicidal and now has the belief that I’m angry at her, which will just give her one more reason to kill herself. This was not going well.

“I’ll try harder,” Robin insisted. “I’ll take my meds, as prescribed, and I promise I won’t drink tonight.”

We hung up the phone, and I was upset. It was clear that things were coming to a head. I had no idea what the outcome would be, but I was running out of optimism. Robin was clearly in control of her own destiny, and the probability of her keeping her job was looking bleak. I didn’t think she’d kill herself that night, but I went to bed and contemplated the very real possibility that after all we had been through, Robin was going to eventually end up dead.

The next day, at around noon, she called me at a time when we had not planned to talk. I immediately knew something was wrong.

“I called in sick to work today,” she said. “I feel like I’m losing control again.” She confessed that she had drank and skipped most of her medications the previous night, even after we had talked and she promised not to do this. “I wondered last night if I need to be in the hospital,” said Robin. “This morning I went to the river and had the urge to jump in. I was able to stop myself, but I realize I’m overwhelmed and not in control.”

“Robin I really think you need more ECTs,” I said. “You didn’t have enough of them before. I think it’s time we really get your depression under control.” I knew I was suggesting that she needed to quit her job. I knew what a big deal this was. But, it was clear to me she wasn’t going to be able to keep it. As we talked, this became clear to her too. I told her I would call her supervisor to find out what her options were in terms of her job and disability benefits, and I would call Dr. Sanchez about scheduling more ECT treatments.

In June 2003, six months after her meltdown, Robin lost her beloved job with the team of co-workers and supervisors who were so supportive to her. Thankfully, her supervisor told her they would “hire her back in a minute” if they had a position open and she was well enough to perform the job. The Human Resources manager at Robin’s place of employment said she still had three months of short-term disability benefits left, and that she would retain her health insurance coverage during the time when she was collecting those benefits. She also had long-term disability benefits which she could apply for if needed.

“I guess it’s better to take time off and get well rather than going to work, acting crazy, and getting fired,” Robin said when she learned about how her benefits worked. This was another example of the degree to which she was thinking more clearly despite her self-destructiveness in the face of the work pressure. We had a rational discussion about whether she needed to be in the hospital.

“I want to avoid going there if I can,” she said. “But I’ll go if I need to.” She admitted she was feeling more depressed about the reality of losing her job. She admitted her impulse control was weak, and she agreed to pour out all of her alcohol. And most importantly, Robin acknowledged she did not want to kill herself.

Dr. Sanchez was able to get insurance approval for three more ECT treatments, which were scheduled to start on the Friday after she lost her job. The day before her first treatment I arrived at work to a voice mail from Robin saying she didn’t sleep much the night before and was ready to go to the hospital. I knew if she was suggesting it, this was significant. I immediately got Dr. Greene to call in the orders and I called the admissions department at the hospital to get prior authorization from her insurance company. I was scheduled to see many clients that day, and asked Robin if she would be able to have her mom or a friend come with her to be admitted.

“I’ve already made the decision,” Robin said. “I’m coming in. You don’t need to worry about me backing out.” I knew she would be anxious when she arrived and asked the admissions staff to take care of her as quickly as possible. Later that afternoon I received voicemails from both the admissions staff, and from Robin.

“I couldn’t do it,” Robin said in her message. “Please call me.” What? She didn’t go? My heart sank for what seemed like the millionth time in six months. I was getting tired.

Robin said she had gotten to the hospital to find many people in the waiting room, complaining about how long they had been there.

“I almost had a panic attack. I had to leave,” Robin said. “I’ve changed my mind. I don’t need to be in the hospital. I haven’t been trying hard enough.” She said she would work much harder to avoid drinking, and would take all of her medications as prescribed. “I’ll spend more time at my parents’ house.”

I was not able to get Robin to agree to stay with her parents or her brother. But she did agree to allow me to talk to her mother and her brother about calling every evening to check in with her, which would provide accountability in terms of making sure she wasn’t drinking.

I was especially concerned because I was again scheduled to leave for a vacation, this time to spend time with my family. Although I planned to check in with Robin periodically by phone, I would be many hours away and it would be difficult for me to help facilitate a hospitalization if she needed it.

Dr. Greene and I consulted about the fact that he had called in orders for Robin to be hospitalized, her insurance had approved it, and she had then backed out. We had to be on the same page about whether she needed to be detained. We had to explain to the insurance company why we thought it would be safe for her to remain an outpatient while she received more ECTs.

“I think it is actually better for her to have her mother and brother call her every day, and to be aware of how out of control she feels,” I said to Dr. Greene. “If she was in the hospital she would just be isolated in her room and it would be harder for her family and friends to support her. And, it was Robin’s idea to go to the hospital. I think we need to support her and let her family be there for her, since she is saying she wants to stay alive.” Thankfully, Dr. Greene agreed.

Robin’s mother and her brother were both very willing to check in with her by phone, and her father agreed to transport her to the early morning outpatient ECT treatments.
I left town for a week of vacation on the day Robin began her second round of ECTs.

During the five hour drive to my parents’ house, I began to process the extent to which I had been affected by the previous six months, working to help keep Robin alive. I remembered that at the beginning, while she was still in the hospital for the first time, I had felt strongly that the whole experience was going to be as significant for me as it was going to be for Robin. As I drove, and thought, and cried, and felt many emotions, I tried to fall back to my spiritual perspective and imagine what the purpose for both of us could possibly be as we were living through a complete nightmare.

Robin was definitely better, but still very depressed. She admitted she didn’t want to kill herself, but still could not stop obsessing about it. If she didn’t stop sabotaging herself, I was quite certain she would end up dead whether she wanted to or not. I was realizing more and more clearly that I did not have control over Robin’s fate. It wasn’t completely clear whether she did either.

All I knew for sure at that moment was that I needed a break. I was exhausted…mentally, physically and emotionally. I knew I desperately needed some distance to get perspective about the life and death struggle I continued to witness.

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A Note to the Readers of “Despair to Deliverance”

Those who have been following our story know we were consistently posting for many months, and have not been consistently posting for the past few weeks.

Robin and I have both had life events interrupt our writing progress.  My mother-in-law, who just turned 93, lived with my husband and I for eleven years.  She began to show signs of dementia several years ago and has had several falls.  Although she was physically healthy, her balance and her cognitive abilities were becoming increasingly impaired.  My husband and I made the difficult decision to move her to a nursing facility in April 2014.   She was settling in, but then was suddenly hospitalized with pneumonia.  After a second hospitalization she was declared by doctors to be dying and was placed on Hospice.  Miraculously, several weeks later she has now fully recovered and is happily settled into the nursing home.  It has been a stressful, exhausting and uplifting experience to accompany her through this transition.

Robin has been going through a job transition which will be important for us to discuss later in our book.

We apologize to those who have been faithfully tuning in, looking for our next blog post.  We will be back soon to finish the story of Robin’s meltdown year.  Hopefully by next week we will be back on track.  Thanks to all for your patience and support.

Regarding Blog Awards:

Robin and I also want to thank everyone who has nominated us for various blog awards.  We are honored and grateful to be acknowledged and recognized.  Because our blog is a serial blog, focused on telling a serious story, we have decided not to interrupt the story by posting the various requirements of these awards.  We apologize if we have offended anyone who has nominated us.   Going forward, our blog should be considered “an award free blog.”  We always welcome comments and dialogue, as knowing the reactions of our readers, good or bad, is invaluable.  Thanks for your understanding.

 

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“I Still Feel The Same On The Inside.”

Note:  This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.

Robin returned to her job half-time on the Tuesday after Memorial Day in 2003.  After seven ECT treatments and a week to recover, she was less depressed than she had been in many months.  She was, however, very anxious about her return to work.  The stakes were high and she said she felt enormous pressure, knowing she would lose her job if she could not do it successfully.  On her first day back to work, the pressure magnified.

“I talked to Jennifer today,” said Robin in a phone call that afternoon.  “She told me I made some of my co-workers uncomfortable when I was at work before, because I was talking about suicide.  I don’t remember that, but I want to make sure everyone knows I’m better and won’t do it again.”

Robin and I briefly problem solved ways for her to do damage control with her co-workers.  Later that day I got a second phone call from her.  I was surprised, since she never called twice in one day.

“I left a voice mail for Jennifer asking if there were a lot of people who were concerned about the comments I made, and whether I could just talk to people individually about what happened,” Robin explained.  “She said she thinks I should talk about it to everyone in our treatment team meeting on Friday.”  I was horrified.  Jennifer did not know how anxious this would make Robin.  What a terrible thing for her to have to worry about on her first day back to work!  Robin said she was so anxious about the prospect of addressing her co-workers in a group, she was feeling strong urges to get drunk.

“I’m really afraid I won’t sleep tonight,” she said.  “I know you’ll be mad at me if I drink, and I don’t want to take too much Ativan.  That’s why I called.”

I was still sympathetic in terms of Jennifer’s situation.  She was looking out for her team of employees.  Robin was returning to work with the blessing of Dr. Greene and me, who had both declared her ready.  I assumed Jennifer figured that if Robin was able to do her job, she should have been able to handle talking to her co-workers about things she said that were upsetting to them.  But for God’s sake, did she have to bring it up on Robin’s first day back to work?  The last thing she needed was the anxiety of being so publicly vulnerable!

I actually had no idea whether Robin was ready to do her job successfully.  She had improved significantly with the ECTs.  But she was also still experiencing depression symptoms and intrusive suicidal thoughts.  I was concerned that she needed a few more ECTs in order to really alleviate her depression.

Dr. Greene and I had released Robin to return to work partly because she would not have dealt well with losing her job.  If she had been unable to even attempt to return, this would have ensured worsening depression.  Dr. Greene and I agreed we needed to give her a chance to get her life back.  I hoped getting back into her usual routine, surrounded by supportive colleagues and supervisors, would help Robin keep the momentum going in terms of the progress that had begun with the ECTs.

But, Jennifer telling Robin on the day she returned to work that she needed to make herself vulnerable to all of her co-workers, in a group, was a disastrous start.  Robin had severe anxiety about being open with her family and closest friends.  How was she possibly going to talk to a group of her co-workers about the experiences she had been through?  She expressed feeling humiliated by the fact that she had upset her co-workers with things she didn’t remember saying.  She said she didn’t sleep at all the night before the meeting.

Miraculously, Robin managed to get through the meeting with coaching and reassurance from me, and some anti-anxiety medication.  She called to tell me about it that afternoon.  We discussed the fact that she had made it through the first four half-days of her return to work, including the stressful team meeting.  I expected her to feel relieved and pleased with herself.  Instead, she sounded more depressed.

“It was a big step for you to make it through this week,” I said trying to be encouraging.

“Last night I was looking at some of the paperwork I got when I was discharged from the hospital the last couple of times, and when I had ECTs,” Robin said.  “I can’t believe that all happened.”  She was thinking much more clearly than she had been in months, and was continuing to try to process the reality of everything she had been through.  The ECTs had left some gaps in her memory, which we had been discussing so she could piece together the events of the previous few months.

“I know I look like I’m doing better on the outside.  Everyone keeps telling me how much better I am,” she said.  Robin had said her family and friends had been noticing and commenting on the improvement.  Her affect was definitely brighter and the psychomotor retardation was gone.  This was very noticeable to everyone.  Her sarcastic sense of humor, which is typically a big part of who she is, had returned.

“I may be better, but I still feel the same on the inside,” she said.  “I hate myself and I hate my life.”

“Robin, remember there’s a difference between biological and psychological depression,” I said.  “Your biological depression is definitely better.  The medication is managing the mania.  The ECTs have helped the depression.  You’re joking around for the first time in months, and all the outward signs of depression have decreased.  That’s what everyone sees.  But the psychological depression is related to all the stress and uncertainty about your job, your financial stress, and your need to keep working on being more open with people so you are less isolated.  I think you still feel depressed because of these issues.  We’ll keep working on all of this.”

“I have to tell you something,” Robin confessed.  She was still feeling compelled to tell me when she behaved self-destructively.  “I drank a wine cooler last night to help me sleep.”

“Robin, I understand you were really anxious last night about the meeting today.  I’m not excusing the drinking, but I know it was a hard night.  Remember, I can’t reinforce self-destructive behavior.  Please don’t continue to put me in that bind.”

Robin talked about her concern about the upcoming weekend, and her fear about having no plans and “too much time to think.”  Although I offered to plan a time to talk, she did not want to have contact with me over the weekend.  We had cut our sessions back to once a week and were talking less often.  Robin was trying to decrease our contact so she did not feel “too dependent” on our connection.  I would have preferred we had waited until she was settled into her job to decrease our contact.  But I knew Robin needed to feel like her life was returning to normal.  As she had gotten better, she felt more uncomfortable depending on me so much.  I needed to honor her need to distance from me.

Although I was concerned about how depressed she sounded, she promised to refrain from drinking and assured me she wouldn’t kill herself over the weekend.  We made plans to touch base by phone after her first full day of work the following Monday.  Later that afternoon, Robin completely freaked me out.

The department where I worked had a small reception area and waiting room, and a large open area with ten offices where my co-workers and I saw clients.  The reception area, which was separate from the office area, had mailboxes for each therapist.   I would often see clients back-to-back with only a short break in between sessions.  During these breaks I would listen to voice mail messages, check my mailbox and chat with people in the reception area for a minute or two, and maybe make brief phone calls.

I was scheduled to see several clients that Friday afternoon, as I often was.  Because it was a short week following the Memorial Day holiday, I was especially busy.  Late in the afternoon, in between back-to-back clients, I came out of my office and went to check my mailbox as usual.  I was stunned and confused by what I found.

In it was a CD from Robin.  We had exchanged a couple of CDs by that time.  We had just talked on the phone a few hours earlier.  The title of the CD was “Thank You.”  Inside the cover Robin had written, “Sharon, this is an obnoxious repetition of the same song, but I could fill the whole CD with it and it would still not be enough.  I stopped at fifteen times.”

What?  I had no idea what to think.  Why was she thanking me?  Okay, I understood that she would want to thank me, but why then?  I had no idea what song she had copied fifteen times, intending to express her gratitude to me.  I had no ability to listen to it at that moment.  It would have to wait.

I knew Robin was having a rough time.  I felt and understood her need to distance from me.  She had been open about it.  My sudden fear was that this was the “thank you” that was really the “good-bye.”  It had been such an intense few months.  It had all culminated in ECTs followed by Robin’s return to work after disclosing to her employer she had needed ECTs to get stabilized, which embarrassed her.  She had been forced to publicly discuss her mental health issues with her co-workers, which was incredibly difficult.  The thought of returning to work full-time the next Monday was causing high anxiety for her.  She felt enormous pressure about succeeding at her job.  Mostly, she had endured the treatment of last resort and was still feeling “the same on the inside.”

It was completely out of character for Robin to just stop by and leave something in my mailbox.  And, I was aware research shows that people with severe depression are actually at a significantly higher risk for suicide when they are starting to recover (because they have more energy and ability to formulate and carry out a successful suicide plan).  I was worried that this is what was happening for Robin.

There were many reasons why, if Robin was actually going to kill herself, this was a logical time for her to do it.  And then she had just dropped off this CD….thanking me.  What the hell?  I really believed, more than I ever had before, that Robin might be saying good-bye to me as she then went to carry out her suicide plan.

Many thoughts went through my mind.  Mostly, I was just worried.  But I also found myself thinking about the reality that if Robin decided she really wanted to kill herself, I would not be able to stop her.  At that point in my career, I had never had an active client commit suicide.  My co-workers and I had talked about the commonly discussed concept that if one works as a therapist long enough, they would eventually lose a client to suicide.  I had supported several colleagues through this painful experience.  This was just part of the high stakes career I had chosen.

Despite all this, I could not just do nothing.  I quickly dialed Robin’s cell phone number.  I needed to check in with her and find out how she was.  She didn’t answer the phone.  Oh my God!  I left a message asking her to call me back.

I’m not sure how I managed to concentrate through my next client’s therapy session.  This was another automatic pattern therapists learn.  It is important to be able to give enough of one’s attention to whoever is in the office, no matter what else is going on outside the office.  I managed to do this well enough, but in the back of my mind I was worried and distracted.

After I finished the session, my last one for the day, I tried calling Robin again.  I felt somewhat bad about doing this because I knew I was meeting my own anxiety needs.  I had already called once and left a message.  As a therapist I knew I should stay objectively detached, and the fact that Robin had said she wanted distance from me meant I really should leave her alone.  But, in this instance, I couldn’t.

This time, Robin answered the phone.  “Robin, I got your CD,” I said.  “I wanted to thank you for it.  Where are you?”

“I’m just driving around,” she said.  She continued to sound more depressed.  I did not tell her how much she had scared me by dropping off her CD.

“Robin, I’m concerned about you.  I know you’re feeling depressed, and you’re anxious about working full-time next week.  You told me you were worried about the weekend and having too much time to think.  You’re feeling a need to distance from me, but I think it’s okay if we stay in close contact until you are settled with your job situation.  If you want to talk this weekend it’s okay.”  Boundaries should only be extended if it is in the client’s best interest.  I knew she felt she needed to distance, but with all the uncertainty about her job I thought it was premature.  It became clear as we talked that my fear about the CD she had dropped off…that she was going to go kill herself, was unfounded.  Thank God.  But my anxiety about it made me feel that it would be better if we talked later that weekend.  She agreed to do so.

Robin and I talked that Sunday.  She said she had continued to be more depressed all weekend.  “I’ve been thinking about everything that’s happened in the last six months,” she said.  “I don’t know if I’m going to be able to handle the stress of working full-time.”

Robin went on to say she had not slept much the night before and had “forgotten” to take her medications that morning.  She admitted she had been thinking all day about overdosing on Depakote, but did not do so because she was still concerned about what would happen to her cat if she killed herself.  She said she was also worried she would be unsuccessful in her suicide attempt and make things worse.

“Did you take your meds last night?” I asked, suspecting this may have contributed to her lack of sleep and increasing instability.

“No,” Robin confessed.

“Robin, you are sabotaging your treatment.  What’s going on?”  I was calm on the phone, but inside my heart sunk.  Just when I thought things were getting better.  The ECTs had so clearly been helping.  I had hoped she was better enough to return to work, but it was starting to become clear that the stress may just be too much.

“I don’t know.  Maybe I’m subconsciously trying to lose my job to give myself a reason to kill myself,” she said.  “I just don’t want to be on all these meds.  I know it doesn’t make any sense.  I just feel too much pressure.”

Robin went on.  I was impressed with how direct she was able to be with me.  “I know you’ll be disappointed if I screw up.  Maybe part of me is trying to get you to back off.”

Wow!  That was a reality check.  Robin had been trying to tell me she needed distance.  I certainly did not want to be contributing to the pressure she felt.

“Robin, if you want me to back off, I will.  You don’t need to sabotage your treatment to make that happen.  Thank you so much for being honest with me.”  I felt very, very bad about any possibility that I may be contributing to the pressure Robin was feeling.  The idea of distancing from her scared me, since I knew she would be at much higher risk if I did so.  But she was better in so many ways.  She was thinking so much more clearly than she had been in many months.  I realized, in that moment, that whether Robin wanted to stay alive and work through all the ramifications of being diagnosed with a severe mental illness was her decision to make.  I needed to let her make it.  I needed to back off.

This sudden realization made me very sad.  I couldn’t hide my sadness as I apologized for not hearing her when she told me she needed some distance from me.   I asked her if she needed to be in the hospital to stay safe, knowing she would lie to me if she planned to kill herself.

“I’m not planning to kill myself tonight, Sharon,” she said.  “I’m going to work tomorrow.  I’ll probably end up going back on all my meds,” she said.  “It will be unpleasant if I don’t.”

Posted in Chapter 4 -- Rock Bottom | Tagged , , , , , , , , , , | 2 Comments

Robin Discusses Her World View

Note:  This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.

Prior to and during my Meltdown year, if I had been asked directly about my religious beliefs I would have identified myself as agnostic. My dad attended the Methodist Church while he was a child, and I was baptized in that church as an infant.  My maternal grandfather was a pastor in the Missionary Church, so my mom attended church three times a week while growing up.  In spite of my parents being raised with regular church attendance, we didn’t go to church regularly when I was a child.  I’m not sure exactly why this was the case, but I think this lack of religious education left a place for me to develop beliefs based on my own experience of the world rather than any particular religious doctrine.  Unfortunately, my experience of the world as a child involved personal trauma and the death of my brother, Eddie.  Both of these life impacting events led to my belief that the world is a harsh place and to me questioning the existence of God in light of such terrible events.

I don’t wish to offend anyone of any religious faith. Religion works for many people all over the world. But everyone has their own beliefs and I personally do not support organized religion.  Too much hypocrisy, hate, killing and war has been done in the name of, and with the support of various religions over the course of history.  I believe a person can be spiritual without going to church.

However, even though I would have said I was agnostic before 2003 I suppose I could have been called a Cafeteria Christian, as I believed in a few concepts consistent with Christianity. For instance, I believed in heaven and angels.  I think I incorporated these into my belief system as a child in response to Eddie’s death from cancer at the age of four and a half.  I was told then by my parents and all of my extended family members that Eddie had gone to heaven and had become an angel.  This was a comforting thought to me as a child, and remains comforting to me as an adult as I’ve lost other loved ones.  I believe that my dad, Aunt Sue, Grandpa, and even Epiphany are in heaven with Eddie, along with all of my other loved ones.

When I was a senior in high school, I was introduced to Existential philosophy in an Advanced Placement English class. Existentialism isn’t an inherently negative philosophy, but the concepts that attracted me reinforced my negative belief system.  The phrase used to describe Existentialism is “existence precedes essence.”  In other words, we are not born with meaning or purpose to our lives, so we must create it ourselves.  Adolescence was a particularly vulnerable time for me, in hindsight, as I was dealing with the impact of sexual abuse and probably the beginning of bipolar symptoms.  It’s not surprising that I became particularly interested in Existential philosophy, as it felt consistent with my depression and many of my life experiences.

In creating a purpose for myself and meaning in my life, I focused on helping abused and neglected children. I did this through my career in mental health.  This purpose, which had become my identity, was threatened by my Meltdown which contributed to my despair.  Also, when I was younger I assumed that I would create meaning in my life by getting married, maybe having children, and owning a home.  The fact that I had none of these things also added more and more to my sense of despair as I got older.  I compared myself to peers who did have these things, and it depressed me.

Absurdity, another existential concept that caught my attention, refers to the fact that the world is a harsh and indifferent place, uncaring whether someone “deserves” to have something bad happen to them. What happens, just happens.  Things like child abuse, genocide, and the death of innocent children all exist because of the absurdity of life, according to existential philosophy.  In my experience, Eddie was just a child so he obviously did nothing to deserve to suffer with cancer and die.  My parents were a young, hardworking couple when Eddie got sick.  They did nothing to deserve the pain of watching their innocent child die.  Growing up with the legacy of Eddie’s death as well as my personal experience with trauma contributed to my negative view of the world as an absurd place, as did my work with abused and neglected children.

In existentialism, human beings have free will which causes anxiety, or angst. An example of existential angst that my high school teacher described is a situation in which you are standing on a cliff.  You are not only afraid you will fall, you are also afraid you might jump.  I have often experienced this when I’m depressed while driving my car.  During the summers while I was in college I worked at a wholesale bakery I called “The Bakery from Hell,” because it was so hot inside.  The twenty minute drive to work took me along a curvy stretch of road along the river that was lined with trees.  As I drove to work I sometimes pictured myself driving into one of the trees along the route.  This example of angst, along with many others, continued to happen whenever I was depressed.  I have experienced a lot of angst during my lifetime.

So in 2003 my world view was pretty ugly. My beliefs could be summed up by the phrase “Life sucks and then you die.”  I questioned the existence of God in such a hostile world in which horrible things happened to innocent people.  Working with abused children and their families reinforced this issue.  I was pessimistic in general, and expected the worst of life.

This is the world view Sharon tried to address by making me CDs in response to the CDs I made for her.    Accessing and expressing my emotions was not something I did well.  I related to my emotions through music, and making CDs for Sharon allowed me to express to her how I felt.  My songs were filled with negativity and pain and reflected my dark world view.  Sharon countered my negativity with positive songs and notes, full of hope and life.  Rather than listening to my depressing CDs when I was feeling suicidal, I could listen to one of the CDs she made.

One of the CDs I made for Sharon in 2003 was less about expressing my emotions and instead was specifically meant to help her understand my world view. I called it “The Roots of My Perspective” and wrote notes to go with each song, discussing how the song impacted my belief system.  Sharon wrote notes of her own about this CD, discussing her views on the songs.  While she shared my opinions in general about many of the songs, she managed to put a more positive spin on them than I had:

(What’s So Funny ‘Bout) Peace, Love, and Understanding- Elvis Costello

Robin’s note–This song is a general description of the basis of my dark perspective of life, so it seemed like a natural place to begin. See, this song isn’t depressing sounding at all, yet still makes the point that a lack of peace, love, and understanding are at the root of much of society’s ugliness.

Sharon’s response–I think it’s ironic that I had already been thinking about including this song on a CD for you when you put it on your “Roots” CD. The ironic part is that you see it as a reinforcement of your world view, and I focus on the fact that peace, love, and understanding are the key to life’s purpose. I guess it all depends on your perspective.

I Don’t Like Mondays- Boomtown Rats

Robin’s note–Song about an incidence of school violence in England that occurred prior to the major events in this country. Guns are much less common in England than in the U.S., making this that much more of a shock. Too bad we didn’t learn anything from this incident. Everybody wants to blame someone else for the increased child violence in the U.S., and nothing gets done about it. Just one among many reasons to be cynical about politics.

Sharon’s response– I have no idea what it is about this song, but it plays over and over in my head after I listen to it. I think it is a great depiction of the “madness” of guns being so available, and the need to pay more attention to what’s going on with our kids. I am as cynical about politics as you are, and feel discouraged about the problems in our country (and, obviously other countries as well).  But, I try to stay focused on what I can do within my own small piece of the world, and on “staying centered” despite the madness.

Pride (In the Name of Love)- U2

Robin’s note–Discusses the assassination of Martin Luther King Jr., who fought to make a difference in the fight against racism. Forty years later we still haven’t fulfilled his dream.

Sharon’s response–Martin Luther King Jr. was a great man and this is a great song honoring him. I believe that he fulfilled his purpose in life by speaking out so eloquently against racism at a time when few people were doing so. I think his assassination may have actually contributed to his message being heard more strongly by so many people. Although his dream has still not been fulfilled completely, we’ve come a long way since then. We still remember him and his message 40 years later, which is a testament to his influence.

Dust Bowl- 10,000 Maniacs

Robin’s note–A very poignant song about poverty in this country. I could’ve picked almost any song from 10,000 Maniacs and it would’ve been issue related.

Sharon’s response–This song affected me emotionally too. It stirs up my strong feelings about the whole issue of how money (lack of it, inability to manage it, materialism issues, etc.) impacts people emotionally in profound ways. This is something I talk to people in therapy about all the time, and was one of the reasons I started to encourage you to file bankruptcy and give yourself a fresh start. In general, I think that we as a society do not do enough to educate people about how to manage their money (I think it should be taught to children in school).

Me and A Gun- Tori Amos

Robin’s note–One of the less pleasant songs I included, but it’s about an ugly topic so I went ahead. Covers the emotions of rape fairly well. This song makes my skin crawl sometimes (unless I have time to detach first).

Sharon–Wow…what a powerful song! I am impressed that you said you can detach enough to listen to it. Sometime we will talk more about this, when you are ready (we’ve got other work to do first).

Hold Her Down- Toad the Wet Sprocket

Robin’s note–Way too peppy of a song for the topic of rape- you’d never know the topic if you don’t listen carefully to the lyrics.

Sharon’s response–I have a harder time listening to this song than the last one.  I think it’s because it highlights the perspective of the perpetrator, which I have great difficulty understanding or tolerating.  This song emphasizes the complete lack of respect or empathy that some men have toward women, which just horrifies and angers me.

Chile- Toad the Wet Sprocket

Robin’s note–This song is specifically about the imprisonment of people in Chile for the expression of beliefs contrary to the ruling political party, but can be generalized to many nations. In spite of all its faults, we are lucky to live in this country, I suppose.

Sharon’s response–Yes, we are very lucky to live in this country, despite its problems. I try to remember this often. It’s all about perspective.  I think it is important to clarify and express our feelings about the “madness” in the world, as a way to get clear about and to express who we are.  But beyond that, where we focus our energy on an ongoing basis impacts us and our ability to carry out our true purpose in life.  Although I feel strongly about many of the same issues you do, I try to focus as much of my attention as possible on what I am grateful for, and on what I have control over rather than issues I can’t control.  I try to do what keeps me energized, so that I can influence what I do have control over in a positive way.

Ask Me- Amy Grant

Robin’s note–I’m sure you’re familiar with this song, which is about sexual abuse. I know you’d prefer that I focus on the ending, but I’m far from that place. In my opinion, sexual abuse is one of the most shameful things to happen to a child; it definitely damages my psyche and self-concept to a point at which I wonder if I can be changed. Certainly a major factor in my perspective on life…

Sharon’s response– I agree with you that sexual abuse is one of the most shameful things that can be done to a child, and that it has impacted you in profound ways.  But I know it is very possible to heal, Robin. I hope that someday soon you will be able to relate more to the second part of the song.

I Just Shot John Lennon- The Cranberries

Robin’s note–Another song about gun violence and the focus on entertainers in this country. Guns are way too accessible, even to mentally ill people who obsess about stars.

Sharon’s response–Sorry…couldn’t get past the frantic guitar and drums. This song is too hard for me to listen to (the sound, not the words).  But, I wholeheartedly agree with you about the whole issue of guns being too available.

Talkin ‘Bout A Revolution- Tracy Chapman

Robin’s note–This one’s about poor people claiming their share of what life has to offer. Unfortunately, this revolution gets less likely each year as the state and federal governments continue to cut money for programs designed to assist the poor. Another issue that my work as a case manager emphasized.  I didn’t grow up wealthy, but we never lacked for anything and pretty much got anything we wanted. Working with kids who didn’t have any toys really opened my eyes.

Sharon’s response–Unfortunately, I think this kind of revolution is less likely than the politicians making slow progress toward reforming the welfare system.  I am very cynical about politics and generally get frustrated even listening to politicians, but the optimist in me believes we will make gradual change in the right direction in spite of the politicians. The way it works is that an issue needs to reach a crisis level where it affects enough people that it gets the attention of the politicians. This usually means they then have to do something to keep enough people happy enough to get re-elected.  It is terrible, but this is the way positive change usually happens within our existing political system… it’s a process like everything else.  I think it will work this way eventually with many issues including welfare reform, health care reform, re-vamping the social security system and the education system.

 

Sharon and I ended up exchanging many different CDs and notes about them during 2003 and the following couple of years. It didn’t have an immediate impact on my world view, but at least I wasn’t reinforcing my dark thoughts by listening to hopeless music.  As I kept listening, with Sharon’s perspective about each song in mind, my negative world view began to slowly tilt toward a more positive outlook on life.

The CDs and the notes that accompanied them became an integral part of my treatment. Changing my negative world view, which was accomplished through the use of music and also reading spiritual books, became an intervention that helped me, over time, become less prone to depression and more able to bounce back from it when it happened.

Coming Next:  Chapter Four–Rock Bottom

 

Posted in Chapter 3 -- Things Get Worse | Tagged , , , , | 14 Comments

“I Want to Get My Life Back to Normal.”

Note:  This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.

Robin had just received her second ECT treatment, and had to meet with her supervisor the following day.  She was very worried and upset about the prospect of losing her job.  “I can’t go back to living with my parents,” she said.  “I’d have to get rid of Epiphany.”  Her parents had a dog who would not easily adjust to having a cat in the house.  “And, I have too much debt.  I can’t go without income.”

“Robin, let’s just take one step at a time,” I said, trying to reassure her despite my own worry about what her supervisor would say.  “Just see what Jennifer has to say tomorrow.  Try not to make any assumptions.”

It was the worst possible timing for Robin to have a job crisis.  She had just started receiving ECTs.  Having to worry about her job and financial situation was the last thing she needed.  I had not told Robin how frustrated Jennifer, her supervisor, had sounded when we talked the previous week.  It concerned me.

“So, who makes the decision about how many ECTs I need?  And when will that decision be made?”  Robin seemed to be thinking quite clearly, despite having had her second ECT procedure earlier that day.  It was a good question.  I told her I assumed the decision would be made by Dr. Sanchez, the psychiatrist who was administering the ECTs.  Since I also wondered what he was thinking, I told Robin I would talk to Dr. Sanchez the following day.

“Usually by the second or third treatment I can tell whether the ECTs are helping,” Dr. Sanchez said when we talked.  “By the end of the week I will decide whether we should schedule more treatments for next week.”  This was helpful information, but I was concerned he would be making a decision so quickly.  Robin was so depressed, and we were out of other options.  I did not want him to decide prematurely that ECTs were not helping.  We didn’t have a back up plan.

The next day, Robin called after meeting with her supervisor, clearly upset.  “I’m blowing it,” she said.  “Jennifer said they are reassigning all my cases.  If I don’t go back to work by the end of next week, they can’t guarantee my job.  And if I go back and can’t do my job, I’ll lose it.  I have to let them know by early next week what I’m doing.  I don’t think the ECTs are working.  This just feels like another sign that I’m supposed to kill myself.”

I couldn’t blame Jennifer who was, I was sure, speaking for the administrators of the agency where Robin worked.  I didn’t blame them either.  They had all been very supportive and flexible about Robin’s need for time off.  I understood why, as her protected medical leave was expiring, they felt they needed to push the issue.  But this ultimatum could not have been more poorly timed for Robin, or for me in my efforts to help her get stabilized.

Despite the job crisis, Robin was showing subtle signs of improvement.  Psychomotor agitation and retardation are both signs of significant depression.  Robin had demonstrated agitation when she was experiencing mixed bipolar symptoms.  Once the Depakote stabilized her mania, she had begun to show significant psychomotor retardation.  When people experience this they are noticeably slowed down.  They respond to questions more slowly and they move more slowly.  Robin was not only significantly slowed down, but there was also her completely flat affect which had been present for months.  I noticed a difference in Robin in terms of these issues, even on the phone, after her second ECT.  She was responding to questions more quickly, indicating that her brain was processing things more easily.  Her voice sounded more animated.  She just wasn’t as “flat” as she had been for so long.  I had spoken to her mother on the phone earlier that day, who also said she felt Robin seemed less depressed during the previous few days.

“Robin, other people often see signs of improvement before the depressed person feels better,” I said.  “I think you’re showing these signs.”  We talked about what I had noticed, and what her mother had said.  I acknowledged that the bad job news had not helped her mood, but reassured her I still thought the ECTs were starting to decrease her depression.

“I’m planning to have the next one on Friday,” Robin said.  “I’ll see what Dr. Sanchez recommends.  I don’t have much choice.  Just so you know, I told my parents I’ll let them know if I feel like I need to go to the hospital.”

Wow.  This was huge.  Robin was thinking more clearly!  The fact that she had this conversation with her parents was an indication of improvement on many levels.  She was being open and letting them help her.  She recognized she may need to go back to the hospital, and was willing to do so if necessary.  She was basically saying, again, that she wanted to stay alive.  I was encouraged.

Robin and I met the following day, later in the day after her third ECT.  She was tolerating the treatments well.  They were being done early in the morning.  She said she was a bit groggy for several hours afterward, but then felt okay.  There had been no signs of significant memory loss or confusion.  She seemed to be thinking clearly enough to process the ramifications of the discussion she and Jennifer had the previous day.  But, I planned to call Jennifer to ensure Robin was remembering and processing the conversation they had accurately.

“I feel like they’re trying to push me out the door.  It’s making my depression worse, not better,” Robin said.  “I understand why they need to reassign my cases, but it upsets me.  I don’t know how I’m supposed to decide anything about my job by next week, when I may be continuing to have ECTs.”

I reassured her I would call Jennifer to get clarity about what the administrators at her place of employment were thinking.  This seemed to calm her down for the moment.  I decided to get clearer about the financial pressure Robin was feeling.

Robin and I had previously talked in general about her financial stress.  On that day, when she was so worried about losing her job, we talked more specifically.  She told me how much credit card debt she had and that she was only able to pay the minimum payments, even when she was making her full-time income.  This meant she had been making very little progress toward paying off the debt.

“If I lose my job, I won’t even be able to make the minimum payments,” she said.  “I have no savings.  I’d have to move in with my parents and get rid of Epiphany!”

I needed to, somehow, combat the enormous pressure and hopelessness Robin was feeling about her job, her financial situation and her future.  I needed her to be okay with the possibility of having to tell Jennifer she could not return to work the next week, since I knew she would not be ready by then.  Robin desperately needed a way to relieve some pressure.

“Have you ever considered filing bankruptcy?”  I tentatively asked, not knowing how she would react to this question.

“I actually have thought about it,” Robin replied.  “I’ve never seriously considered it, though.  I’m afraid I’d feel too much like a failure.”

“Think about it as a way to get a fresh start,” I responded.  “Your whole meltdown is creating a fresh start in many ways.  Now that we know what we need to do in treatment, I still think you will eventually end up feeling better than ever before.  Since you are so seriously thinking about killing yourself anyway, why don’t you at least consider bankruptcy as an option so you can see how much it helps to get out from under all that financial pressure.  You really have nothing to lose.”  I would not usually be so direct with a client about recommending a step as drastic as bankruptcy.  But I was desperate.  I needed Robin to feel like she had options other than killing herself.

“Maybe I’ll talk to Bob about it,” she said.  I was surprised she was even willing to consider it.

I called Robin’s supervisor the next day.  I needed to help Jennifer understand that Robin would not be ready to return to work the following week, and to see if there were any options that would allow her to keep her job.  I left a voice mail for Jennifer, and received a call back from the Director of Human Resources at Robin’s place of employment.

“We value Robin as an employee,” she said.  “But we can only guarantee someone’s specific job position for twelve weeks.  Robin’s twelve weeks is done next Wednesday.  If we make an exception for one person, we’d have to do the same for others.”  We clarified the bottom line.  If Robin were unable to return to work the following Thursday, she would lose her job.  The HR Director was kind to say they would gladly hire Robin for a different position in the future, if they had an opening and she was ready to perform the job.  But, this was little comfort.

“I have to say, this puts us in a very difficult position,” I said, pleading with her.  “Robin is definitely showing signs of improvement and we think ECT is what she needs to get stabilized.  But she will not be ready to return to work next week.  If she knows she’s going to lose her job, I’m afraid it will make it impossible for her to recover.”  I didn’t want to be too dramatic, or to make her feel guilty.  But, I had nothing to lose by spelling out the reality of Robin’s situation.  After some discussion, the HR Director seemed to understand the dilemma and said she would discuss the situation with Robin’s supervisors.

My head was spinning.  I couldn’t believe this was happening!  After months of Robin being severely depressed and suicidal, and then reluctantly agreeing to ECTs which were clearly starting to help, she could lose her job before we even got a chance to stabilize her.  This would mean she couldn’t pay her bills, and she’d lose her apartment and have to move in with her parents or her brother.  It would be difficult for Robin’s rigid brain to integrate this even if she wasn’t deeply depressed.  In her current state, I could not imagine her surviving this reality.  What a disaster!

I felt like I had to do something, and went to see Dr. Sanchez.  “Do you think Robin needs more ECTs?”  I asked him.

“Yes,” he said.  “I think they’re helping.  But I also think she needs more.  I’m working on getting insurance approval.”

“Robin is getting pressure from her employer to get back to work, or she’s going to lose her job,” I said.  We commiserated for a minute about the terrible timing.  “How long after her last ECT would she need to recover before she’d be okay to work?”

“A week should be enough,” Dr. Sanchez said.  “I want to do three more treatments.”

Miraculously, the administrators at Robin’s place of employment were willing to make an exception to their policy for her, to allow for three more ECTs and a week to recover.  The agreement was that Robin would return to her job half-time for the four days following Memorial Day, and then full-time the following week.  It was made clear that if she was unable to do her job at that time, she would lose the position.

Robin was relieved to hear this news.  After four ECTs she continued to show signs of decreased psychomotor retardation and brighter affect.  She was processing more quickly and thinking more clearly.  Unfortunately, she was also starting to show signs of memory loss.  Because she was thinking more clearly, she was beginning to process and attempt to integrate the reality of everything she had experienced during the previous three months.

“I’ve been doing some research on ECTs,” she said in one of our sessions.  “I’m surprised I agreed to them without knowing more about them.  I can’t remember a lot of things about the last few months.”  She asked many factual questions about events and time frames, and I provided honest answers.  She was relieved that as we talked, most of the time her memory came back.

“Robin, this is a perfect example of the progress you’re making.  The fact that you’re now researching about ECTs and asking questions means you’re thinking more clearly.  You’re starting to process what you’ve been through, which is huge.  I know you hate the memory loss, but the ECTs are helping,” I said.  “You have no idea how much better you are compared to where you were.”

“I guess, but I’m still depressed,” she said.  “I still can’t stop thinking about suicide.  I have too much time to think when I’m not working.”  Robin was still experiencing another significant depression symptom, anhedonia, which is an inability to feel pleasure or to have interest in activities that are usually enjoyable.  For over three months Robin had not watched television, read books or done any of the things she normally did to pass the time.  With ECTs, as her brain was beginning to experience relief from such a profound state of despair, she was beginning to recognize more clearly that she was still not herself.

“I know I completely lost control,” she said.  “I don’t feel like I have it back yet.  I want to go back to work.  I want to get my life back to normal.”  It concerned me that Robin’s rigid brain saw getting back to work full-time as the only way for her to feel back in control.  I understood, though, why she couldn’t deal with the alternative of giving up her job, which would cause her to lose her independence.

With more ECTs, Robin’s affect continued to brighten.  She began to joke about things for the first time in months.  And most importantly, she finally began to acknowledge she was feeling better.  “I’m actually looking forward to going back to work,” she said.  “But I’m worried about the stress.  I’m not sure if I can handle it.  I’m still tired and don’t have much motivation to do anything.”  She verbalized the same concerns I was having.  I tried to be reassuring about how much her depression symptoms had improved.

After seven ECT treatments, although she was dramatically better, Robin continued to report feeling depressed and having some suicidal thoughts.  She continued to show signs of depression, although much less severe.  Because of the ECTs, she couldn’t remember how bad things had gotten just prior to her most recent hospitalization, which meant she couldn’t fully understand the progress she had made.

Although I was concerned about her remaining depression symptoms and felt it would be better if she could have more ECTs before returning to her stressful job, we didn’t have a choice.  Robin needed to try going back to the job with which she was familiar, with the co-workers who knew and supported her.  It would not have worked for her to give up her job and then have the pressure of knowing she’d have to start over in a new job position.  New jobs were always incredibly stressful for her, even when she wasn’t depressed.  Dr. Greene had made a recent adjustment to her antidepressant medication, which hadn’t yet taken effect.  I was hopeful this would alleviate her remaining depression symptoms over time.

I tried to be optimistic, and at the same time prepare myself for the possibility of having to keep being Robin’s life-line if she lost her job.  We were continuing to have frequent contact.  It had been a very stressful and exhausting few months, but I remained clear I was doing what I needed to do.  Robin was coming out of a severe depression, did not want to die, and was still not able to be open with her family or friends.  I knew she would need me to continue to be very available until her symptoms and her job and financial situation were stabilized.  Once that happened, I trusted we would be able to return to a more typical degree of contact, and to work on her anxiety about being more open with others.

I had plans to leave town for the Memorial Day weekend to attend a friend’s wedding.  I looked forward to the much needed break.  As I was preparing to leave, Robin and I discussed her anxiety about starting work the following Tuesday.  I offered to talk over the phone during the weekend, and was relieved by her response.

“It’s a holiday weekend for God’s sake!” she said.  “If I can’t go three days without talking to you, we definitely have a problem.”  And then, she laughed.  It was so good to hear her laugh.  Robin was finally returning.

I wrote in my journal that night, before I left town:

“Thank God, Robin is definitely better.  Because her memory is affected by the ECTs and the depression, she doesn’t remember how bad things got.  She says she is still having suicidal thoughts, but she can distract herself from them for the first time in months.  She’s joking more and is processing with me what has happened during the past few months, wanting me to fill in the gaps in her memory.  She’s referring to it as “the debacle.”  Now, that’s the Robin I know.  It’s like she’s finally coming back, after months of totally not being herself.  It has been wonderful to have a few rational, processing conversations with her for the first time in months.  I just hope things keep going in the right direction.”

Coming Next:  Robin Discusses Her World View 

 

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