Tag: Introspection

Bad Brain

(Please note: this post has nothing to do with either the seminal 80’s punk/reggae band or the song by The Ramones from their 1978 album Road to Ruin. If that’s what you’re looking for you can stop here)

Anyone with an internal monologue1 will likely be familiar with this phenomenon. My brain will occasionally go into this mode where everything is broken and nothing can ever be fixed. It exists, in my case, solely to shit all over anything and everything I do. Progress is meaningless because you’re never going to finish, no matter how much you do it isn’t enough because you didn’t do everything, that sort of thing.

Bad brain has been rampant recently and I don’t have much explanation for why. If nothing else, November/December marks the beginning of the third year of me hiding inside playing video games, with no end in sight. That by itself may be enough but who knows? That’s the real frustration for me. There is no way to figure out what is going wrong or why with any certainty. I can construct a coherent narrative to explain my symptoms, but is it correct? no way to tell!

Brains are a waste of time.

  1. Something like 5-10 percent of the population have no internal monologue whatsoever, which blows my mind. How does that even work? ↩︎

It’s a Process?

As I have mentioned, something I’ve been learning, slowly, is I can’t ignore things anymore. I was really good at ignoring things. So good, in fact, I assumed that I was letting things go and moving on instead of continuing to drag all these things behind me. I had another example of this phenomenon over the weekend.

In the interest of providing full context, I am going to confess to something that will likely make more than one of the people reading this make the Look of Disapproval ಠ_ಠ. Due to very typical glitches in The Best Health Care System In The World™, I ran out of eszopiclone (brand name Lunesta) which Dr. Psychiatrist prescribed to help me sleep1. I was out of it for about a week and finally got it filled again on Wednesday or Thursday of last week. Keep in mind, I’ve been chronically sleep deprived for probably 30 years, so I assumed a few days with disrupted sleep was not going to have that much of an impact.

Another item on the list of things I didn’t think would matter was anniversaries. October 0f 2020 was close to the peak of my mental health implosion. The significance of anniversaries for PTSD is something that falls into the “Know vs. Believe” category for me. I have been assured by multiple sources who all know way more about these things than I do that your brain keeps track of these things and they can potentially be quite disruptive. The part of my brain that understands science knows this to be true. The part of my brain that doesn’t really believe there is anything wrong with me in the first place rejects this idea. As has been pointed out in other contexts, science doesn’t really care if you believe it, anniversaries appear to affect me whether my brain wants to admit it or not.

On Saturday, in the midst of these two things both of which I was firmly convinced were not affecting me at all, I took on something of an emotionally charged task. This was a project I had been dreading taking on for some time and had a number of factors, rational or not, that had built it up to something quite intimidating in my mind. It turns out this was probably not a good idea. I was an absolute basket case on Sunday and only started feeling like my brain was functional again Monday afternoon.

What I have learned from this experience is, I really do have to pay attention to my own state before I dive into anything. Not only that, I have to have enough on the ball to say, “I have too much going on, I can’t take on anything else right now”. My previous history has not provided me much experience with doing this.

  1. As an aside, I want to sing the praises of eszopiclone. My relationship with sleep aids is peculiar. Anything I have tried previously has either not worked at all, or worked too well. The last medication Dr. Psychiatrist tried, doxepin, turned me into a zombie for 24 hours on the lowest available dose. When I was working, the solution was to turn to medications to promote wakefulness instead of trying to help me get more sleep. Eszopiclone has been flat-out miraculous. My sleep patterns on this drug have been more normal than they have been, possibly ever. I sleep 6-8 hours, I’m a little dopey in the mornings, and then I’m pretty much a normal human. I have REM sleep every night. It’s astonishing. ↩︎

Clever Title

It turns out Dr. Psychiatrist is very likely correct in that I have found a plateau of stability with my current medication regimen. There are unquestionably still some bumps that need to be smoothed out. I still startle at just about any unexpected noise, although this is better than it was previously. I still have occasional episodes where I see or hear something three or four conceptual jumps from anything hospital related, my brain immediately decides to make those jumps, and settles on “Hey, isn’t this just like [$awful_thing]”? No, it really isn’t like [$awful_thing]. In fact it isn’t connected at all. Thanks for bringing it up though, because now all I can think about is [$awful_thing]. My brain is not particularly helpful a lot of the time. And, of course, I still can’t seem to tolerate being out in public for more than 2-3 hours. On the up side, the first hour or so seems to be getting a bit easier but when it’s time to go, it is still time to go.

Bumps aside, this calming of the inner turmoil has allowed me a bit more clarity than I have perhaps had in the past, which brings me to the point of this particular post1. I am improving, and I continue to improve, but I am not doing it quickly. Also, there really isn’t much I can do to speed up the process. It has been brought to my attention that putting pressure on myself to recover may, in fact, be counter-productive. This is a realization that has been growing for a while now and I am only starting to really grasp what it means.

Among the more obvious sequelae of not being able to hurry recovery is the effect it has on my prospects of returning to work. Previously, as recently as this summer, I had been operating under the assumption that when it came right down to it, and I had used up all the resources that have been made available to me, if I wasn’t ready to go back to work I would sweep everything under the carpet again and just go do it, much like I have in the past when I was feeling run down and burned out. What I have come to realize is, this is how I ended up here in the first place. There is no room under the carpet anymore and I can’t keep trying to sweep stuff under there. Not “can’t” as in “shouldn’t for my mental health”, “can’t” as in “am actually unable to”. I find that I can’t2 ignore things anymore, which may also explain why I jump every time there’s a noise.

I know I have posted about how I never really understood how people who survive disasters could describe themselves as lucky3. If you were lucky, your house wouldn’t have been hit by a tornado. My difficulty was misunderstanding the word. You can have Win The Lottery luck, or you can have I Didn’t Die luck. I bring this up because I am incredibly lucky4 in that I have a great many supportive people in my life. The time will come, sooner rather than later I suspect, when I’m going to have to lean on the people in my life even heavier than I am already.

  1. Penalty; unnecessary alliteration. Five word penalty and repeat the paragraph. ↩︎
  2. See previous discussion on the intended sense of the word “can’t” ↩︎
  3. Nope. Still not going to go back and look up which post it was. It’s back there somewhere. ↩︎
  4. In the I Didn’t Die sense of the word. Again, in the I Won The Lottery sense I wouldn’t be in this position to start with. With as vague as this goddam language is, it’s a wonder anyone can communicate at all. ↩︎

Medication Roundup

All I know is the steak tastes better, when I take my steak taste better pill

My regular appointment with Dr. Psychiatrist was today. I’ve been checking in with her regularly while medications are being adjusted. The good news is, there are no more adjustments planned. The bad news is, I have to do the rest of the work myself.

The only part of the current regimen I find unusual is the dextromethorphan. As previously mentioned1, it’s part of a recently approved combination with bupropion. It has a brand name, but the brand name is somehow harder to remember and pronounce than dextromethorphan/bupropion. At some point I intend to look up how teh fook it’s supposed to work and, perhaps more curiously, why someone decided to try a cough suppressant to treat anxiety. I have not, however, done anything about it. it’s not high on the priority list.

I think Dr. Psychiatrist is likely correct in that I’m probably about as stable on meds as I’m likely to get. Life still needs to get easier and who doesn’t wish for a magical cure-all pill. The challenge is remembering I can’t try to fix everything else all at once.

Edited to add – Doing things, and fixing things. These are vague to the point of uselessness so I’ll try to narrow it down a bit. Doing things would mostly include activities outside the house. Shopping and such. The ultimate goal would be something outrageous like being able to hold a job. Fixing things at this point mostly means putting the environment back together after two years of the entire house turning into a depression nest. Both of these things are requiring different approaches than they have in the past and it’s a bit of an adjustment.

  1. I know it was only a few posts back but I’m still not going to bother looking it up. Scroll back a bit and I’m sure you’ll find it. ↩︎

Non-Linear Progress

On Friday, [$_random_thing] reminded me of [$_random_patient]1 from a million years ago and I’ve felt a bit off ever since. I have been assured that events like these are more “speed bumps” than “setbacks” but it is difficult for me to not see it as something of a step backwards.

I’ve been feeling quite tolerable over the last week or so, Friday through today (Sunday2) excluded. Good enough that I had been pondering what the next step might be. Among the steps somewhere in the region of “next” is, of course, going back to work. I admit, in the past, I have had some unrealistic expectations about my ability to go back to work. This most recent event has helped to once again clarify my thinking on the issue.

I won’t pretend I’m not frustrated about the whole thing. I think a great deal of difficulty is coming from my overall mood improving somewhat. I feel okay most of the time, so why aren’t I doing anything? Because when I start trying to do things, I stop feeling okay most of the time.

Frustrating.

  1. I am aware of, and could provide the details of both these random events but this was one of those patients where explaining what was wrong with her and what we were trying to do would take longer than it would to tell the relevant part of the story. Take my word for it, she was a doozy. ↩︎
  2. I know all these posts have dates on them but I thought I’d save people the trouble of looking up what day it was when I posted this. Except now you’re distracted by looking at a footnote. Alas. ↩︎

Timeline

There have been some events recently that have prompted me to think about what happened when. As I have mentioned previously, my memory of the period between Fall 2019 and Winter of 2021-2022 is pretty vague. Kind of a big blurry smear. Blurry enough that when I sat down and started thinking about this, I was sure I had misplaced an entire year somewhere in there.

Completely by accident, I stumbled upon a possible explanation for why I might have expected there to be an extra year between 2019 and 2021, and why the first six months of the pandemic seemed like a lifetime. The possible explanation came in the form of a BBC News article about how, and why, children and adults perceive time so differently. The TL; DR, as I understand it, is that memories are more likely to come from new, interesting, or unusual experiences. The whole world is new for children, so their brains take a lot of memory snapshots. As we age, the novelty wears off and long stretches can go by without much film being used up. The TL; DR for the TL; DR is that children’s brains work more like high-speed cameras, running at 5000 frames per second, while adult brains tend to run at closer to 60 frames per second. Adult’s brains are still capable of running that fast, but it takes unusual, exciting, interesting, or otherwise high-alert types of situations. Like a global pandemic for example.

Below (I hope) will be an attempt to un-jumble some of this in my head. I make no claims about accuracy. A lot of these dates I had to look up because I couldn’t narrow anything down enough just by memory. It will also include some non-pandemic related events, just for reference. This is also incomplete. I may try to add more later and I might not.

Okay, fuck it. I’m done trying to get this damn thing to format in WordPress. Here is a link to a pdf. Share and enjoy.

Inactive

The State of Washington requires 96 practice hours per year to maintain an RN license, a very low bar but one I am unlikely to get over this year. Fortunately (for a small, and ongoing fee, of course) I can put my license on “Inactive status” instead of just letting it expire. The reason for doing this is to avoid several layers of hoop-jumping should I be inclined to reactivate my license at some point in the future. If I reactivate it within three years, I wouldn’t even have to take a refresher course. Which I find frightening.

This will be the first time in 30 years that I haven’t had an active health care credential of some kind. I’m not sure how I feel about that.

Further Thoughts on Objective(?) Data(?)

Once again exposing some bias or another1 in my thinking, I assumed everyone knew what the PHQ-9, GAD-7, and PCL-C were and how they worked. I may have even explained here at some point. or maybe I didn’t…

Anyway, the point is, I want to give a quick explanation of what they are and how they work.

All three of these are screening tools for various mental health diagnoses. The Patient Health Questionnaire-9 (nine questions) and Generalized Anxiety Disorder-7 (seven questions) especially were designed for primary care providers to use to screen all their patients for depression and anxiety. The PCL-C2 is the civilian version of the PTSD screening tool developed by the military to screen troops. They rely on the frequency of symptoms like anhedonia, feelings of isolation or disconnection from others, nightmares, etc. as reported by patients. They were designed to be used by health care professionals and their patients in the setting of a therapeutic assessment. They were never intended to be self-administered, and certainly not self-interpreted. I am, in short, using them wrong3 and the numbers may or may not mean anything.

They’ve been scientifically validated and are relied upon by experts in the field so I’m more or less obligated to accept them as valid. When used as intended. I tend to have fairly concrete thinking when it comes to health care so having any kind of number to look at makes things easier. Whether or not the numbers are actually useful is a different question.

  1. I’ve never been clear on which of my many neuroses causes this to happen but for whatever reason I commonly assume that if I know something, everyone else must know it too. It was something I was consciously trying to change when I was working on my education degree and have, clearly, fallen out of the habit. ↩︎
  2. I’ll be honest, I have no idea what this stands for and I’m not going to bother to look it up. ↩︎
  3. Considering the disdain I hold for people who use the internet to diagnose themselves with various things, this may come off a bit hypocritical. I thread that needle in my mind by asserting my (still valid) credentials as a health care professional and that these are being used in the setting of receiving treatment for the relevant disorders. Hopefully I can swing a bit more nuance than someone lacking the appropriate organs diagnosing themselves with uterine fibroids. ↩︎

I’m Still Alive

Vicious circles are something I’m really good at. I’ve been feeling anti-social1, and I have a distorted view of my position in society which tells me if I’m not actively engaging, people tend to forget I exist2. This, of course, makes me feel even more anti-social.

On the up side, I do think my new combo med with dextromethorphan does seem to be helping with my generalized anxiety, and I continue to sleep reasonably well.

I suppose what this comes down to is another request to continue to bear with me, which I already know everyone will. Even if I don’t respond to texts, or comments, or phone calls, I read and appreciate the content. Not responding doesn’t mean I don’t care or I’m not paying attention, I’m just being Oscar the Grouch.

  1. Obligatory quote from St. Swithin’s Day by Grant Morrison – I’m not anti-social, society is anti-me. ↩︎
  2. This is not fishing for compliments. I’m aware people seem to think I have many redeeming qualities, the difficulty is I haven’t entirely persuaded my brain to believe it yet. This is a work in progress. ↩︎

Colorless Green Ideas Sleep Furiously

One of the bigger difficulties I’ve had with mental health medicine is, a good bit of the time I have no idea what those providing me advice and direction mean when they say things. Part of this is due to pop-psychology appropriating terminology and misusing it to the point of meaninglessness, and part of this is due to a large cognitive blind spot that seems to prevent me from parsing certain concepts.

I think the concept I have struggled most with, both in terms of time spent and results (or lack thereof) achieved, is the idea of “focus on the positive”. This has never made sense to me on what I think is a very basic level. All the words are common English words, the sentence is grammatically correct1, and yet I cannot figure out how it is supposed to be applied in the real world. It may as well be the sentence I stole to be the title of this post2. Or, more accurately maybe, its like looking at an Escher print. At a glance, everything looks okay but if someone told you to replicate it in three dimensions, you’d be hard pressed.

My trouble with the concept is not acknowledging the brief moments of happiness and joy that flit by occasionally, it’s with giving what I see as undue value and significance to them. I kind of see it like this3 – on one side of a balance scale, you have the core of a neutron star4. On the other side you have a pebble5. I have been assured that focusing on how much lighter the neutron star feels now that there is a pebble on the other side is the path to healing. I think my difficulty understanding how this is supposed to work in the real world is fairly self-evident.

Coming at this from a sightly different angle, my MHP has pointed out that I have a strong pattern of black-and-white thinking. Not a lot of grey area. Things are either all bad or not bad at all. If things are bad, they’ve always been bad. I can’t really disagree with him on this. Additionally, I have noticed in myself a tendency to rely heavily on avoidance and denial as coping mechanisms. These two traits combined, I think, explain the difficulty I have with the concept of “focus on the positive”. The pebble doesn’t fix the problem, and if you acknowledge the existence of the neutron star, then it’s there and you have to do something about it.

The trick, apparently, is learning to acknowledge the existence of the neutron star, while simultaneously being grateful for the pebble, even if it’s effect is negligible.

I’m not there yet.

Edited to add – The other difficulty I have with focusing on the positive is the challenge of being on fire and trying to focus on anything other than being on fire, but that’s a different post.

  1. Or, at least its close enough to not interfere with the meaning of the sentence. ↩︎
  2. Colorless green ideas sleep furiously was composed by Noam Chomsky in his 1957 book Syntactic Structures as an example of a sentence that is grammatically well-formed, but semantically nonsensical, demonstrating that language has a structure entirely separate from meaning. ↩︎
  3. I don’t know if these analogies help communicate anything meaningful but it’s the only way I can think of to try explaining what goes on in my alleged brain. ↩︎
  4. The typical neutron star weighs between 1.5 and 2 solar masses. 1 solar mass = 1.9891 x 1030 kilograms. ↩︎
  5. 1 cubic centimeter of pea gravel weighs approximately 1.8 grams ↩︎