Shame 2.0: The Dissertation

I was talking to my husband the other day about the role of shame in the PTSD response, and I thought it might be a good time to revisit the topic in the ol' blog.

"Shame" has always been sort of a tricky thing for me to parse, especially relative to other similar, overlapping tricky things, like guilt and anxiety.

With which I am also familiar. Hence, I would imagine, much of the difficulty.

As you may recall, I wrote about shame here before, way back in 2011, when I first discussed the theory that PTSD may be, to some degree at least, a shame disorder.

More about that in a minute (because whoa-- did I find some interesting stuff about that).

To quote myself, back then I... um... quoted Dr. Oz:

Dr. Oz says that shame stifles emotion.

I can see how that is true-- instead of feeling what you're feeling, you feel shame for feeling it. The shame swallows or eclipses the anger or the pride or the contentment or whatever it was that you were feeling before the shame spiral pulled you under. It also makes you distance yourself from others, stifling intimacy and preventing you from connecting with others.

Hmmmm. Yeah... no. 

I mean, yes, good, those are some things that shame does to us. But I still wasn't explaining-- to you or to myself-- what shame is, much less how to differentiate that particular monkey from all the other monkeys in my zoo (ooh, what a good metaphor! I'm a walking monkey house, me!).

But I needed a better definition than that, because I needed to get to the bottom of something my husband and I were talking about: the different types of PTSD responses, and the role shame plays in them. 

In some people, it's easy to see. 

Take me, for example.

My husband brought it up because he said he'd been thinking about something I'd said to him recently: that I was slowly realizing how much of my time and energy is spent simply trying to appear normal to others while all of this chaos is going on below the surface.

My brand of PTSD could be called "The Art of Getting By." I bet most people who suffer from it could call it that.

He thought that maybe shame drove a lot of that impulse-- shame over my internal struggles, shame over my perceived inadequacy, shame over my anxiety, shame over whatever.

Sure, I said. That makes sense. Although...

Whenever I try to apply a general statement about PTSD/PTSR to myself, I try also to apply it to the grizzled Vietnam vet ducking at car backfires and screaming at the sky. What I mean by that is that I try to see how he and I could be experiencing similar neurological malfunctions.

Doing that has been a good gut-check for how I figure out what is true and what is not about what's going on in my brain. It's also been what has made me feel increasingly connected to the plight of our veterans with PTSD and the quality and extent of their care.

Anyway, I had trouble with the shame thing. I've felt a great kinship with the hypothetical veteran in the past-- the theory that we are both stuck in a stage of the fight-or-flight response makes perfect sense, and our resulting behavior does as well. 

But it's much harder to see the link with shame.

So I looked it up again, just now, and found something really simple and clear on About.com, one of those websites I might otherwise have skipped, thinking it would have been too generic to have anything useful.

Wrong!

The article first differentiates shame from guilt:

Shame is often considered a "self-conscious emotion" and... occurs when a person evaluates or judges themselves in a negative light. For example, a person might experience shame if they view themselves as worthless, weak, bad, or useless.

Guilt, on the other hand, occurs when people evaluate a behavior or an action as negative. For example, if you borrow money from someone and then fail to pay them back, you might experience guilt because you did something that can be perceived as wrong or inconsiderate. However, if you judge yourself as a bad person because you failed to pay the person back, you would likely experience shame.

Then it tells you why the difference is important:

It is important to distinguish between shame and guilt because they influence our behavior in different ways. Guilt can motivate us to make amends, apologize, or correct a behavior. Doing such things will help alleviate guilt and may increase the extent to which we feel positive about ourselves. In this way, guilt can be a helpful emotion.

Shame, on the other hand, is rarely useful. With shame, people may be more likely to engage in self-punishment (such as through deliberate self-harm) or isolate oneself from others. This is going to do little to alleviate the shame in the long-term and can even intensify the shame. 

And then... the clincher (emphasis mine): 

Why might shame lead to PTSD? The experience of shame following a traumatic event may lead to the use of unhealthy coping strategies, such as alcohol use, avoidance, or self-destructive behaviors. These unhealthy coping strategies can interfere with the processing of emotions associated with the traumatic event, contributing to the development or intensification of PTSD symptoms.

In addition, if people experience shame due to judgments that they are weak or worthless, they may feel more stigma about having experienced a traumatic event. This stigma could then prevent someone from seeking out the appropriate care.  

Coping strategies. Shame is about coping strategies. 

YES.

In case you missed it, that was the light bulb turning on, right there.

So there's the link. In fact, there's the whole damn ball of wax, because without an unhealthy coping strategy, you don't have any PTSD to deal with.

And without that... you and I? We're not having this here conversation, folks.

O.o

Well. 

Damn.

There it is, then. 

Did I just figure this whole thing out? I did, didn't I. Ha ha. <cracks knuckles, leans back, places hands casually behind head>

Hi. Sherlock here. Have we met?

_____

So, before I go, one more (sort of really big) thing about PTSD-as-shame-disorder. You'd think it would be talked about more openly, considering all the evidence there is for it. 

And there is a great deal of widely-understood evidence. I am hardly the first to make this connection. There's enough that the US military (and many others, I reckon), includes shame-proneness as a variable when looking for candidates for special forces teams and other such intense, high-stress military positions. 

In fact, speaking of the military, I saw an article recently that talked about the newly-emerging issue of women returning from combat positions, and their higher-than-average propensity to suffer from PTSD. I was hoping to see the connection made there.

It wasn't. Shame wasn't mentioned at all.

I think it should have been. Now more than ever, I think it's THE key element to understanding not only how to unlock the mystery of PTSD, but how to properly care for our returning veterans of both genders.

And before I get off this topic, consider this: this article discusses the commonly-held theories not only that women experience more shame than men, but also that men and women tend to express their shame differently: "women 'act in' ... through introversion and self-hate.... [while] men 'act out'... [through] extreme anger and violence."

As that first article states, female veterans are TWICE as likely as their male counterparts to commit suicide. (Acting in: check.)

And as all of these articles state, our veterans are very likely, and getting more likely by the day, to commit suicide.

And as we hear with alarming frequency on the news, sometimes they (as far as my research shows, exclusively men) don't-- or don't only- kill themselves. (Acting out: check.)

And yes, I'm conflating expressions of shame here with expressions of PTSD and/or expressions of clinical depression or whatever other neurological misfires have piled on in any given individual case... but it seems to me that there is useful information here. 

That the roots of these behaviors can be traced to something as simple and malleable as a coping strategy.

That this stuff can be, to some extent-- and maybe to a very great extent indeed--anticipated and mitigated.

Or at the very least, addressed properly, directly, with care and compassion, and without judgement or stigma when the men and women who risk their lives for our country return home, so that they don't end up sacrificing more than they-- and those who love them-- bargained for.

Update. Idea. Question.

For the past several months, this blog has been largely about migraines, medications, depression, and anxiety.

I haven't talked much about the PTSD directly, because I've been dealing more with some of the major, immediate symptoms and all the hootenannies that come along with them.

If weeks-long migraines and the psychotropic medication-circus can be called "hootenannies."

(And why the hell not? Makes them sound so much more delightful than "horrible death marches to nowhere." Hootenannies it is, then.)

Time for an update, then:

It's all still there.

Still get triggered, still hyper-vigilant, still get that weird cold/numb off-gassing feeling in my legs and arms when I start talking about the accident.

What's different is that I shut down less often. I succumb to the fog less often. I have learned to anticipate when these things will happen and prepare for them. 

I write things down. I take a lorazepam. I breathe deeply. I remind myself that I am alive. I think about how much I understand, now, about what is happening in my brain and body when I'm triggered, and that keeps me grounded in reality.

None of those things are the same as not getting triggered. None of those things mean that I now have authentic emotional reactions to things as often as I want to, or as often as I think I should. 

I don't. I wish I did. Someday I might. Someday hasn't happened yet.

But it's all a far sight better than it was, and that's something.

Knowledge is power. If you're of a certain disposition, that adage alone can get you through many a dark night.

I am of that disposition.

Hi. Sherlock here. Have we met?

_____

One thing that helps me feel like I'm moving this whole giant caravan of baggage forward is turning outward and looking for opportunities to connect with other people who might be suffering in similar ways.

I have been able to do that with some readers of this blog who have reached out to me. I have been able to do it with a couple of friends in real life. I am hoping to find ways to make a broader impact with this blog and with the book it will become, and by sharing my experience with people who are looking for guideposts on their own paths out of the darkness.

I've told you before that I'd like to turn this blog into a book at some point, and while brainstorming ideas about how to do that, I thought of this:

What do you think about me looking for venues to do readings from this blog? Who do you think would like to hear it? Where do you think I should look?

I have some ideas, myself, but I'm interested to hear what you might think about this.

_____

One last thing before I go. Mild migraine again, yesterday and today. My triptan didn't work-- my prescribed migraine medication. But once again, you know what did?

Lorazepam.

So I'm on a new course of research: Why does a benzodiazapine stop my migraine? 

So far, everything I've seen tells me that it doesn't. Benzos are not painkillers. Benzos are not vasodilators. They do not affect the cause of migraine. They are not effective in the treatment of migraine.

BUT THEY STOP MINE. Every time, without fail. So.

What the hell am I supposed to make of that?

Things that make you go hmmmmm...

A Shade of Awesome

Hi there. Skipped another week due to illness, houseguests, and various other calamities. Sorry about that.

But I'm back with news and things to do.

FIRST: before I go any further, a plea to any of you who read this blog and haven't yet signed up as "followers" in the right sidebar:

Will you do me the honor? Please?

I promise: no spam, no emails, no NSA surveillance drones over your house, nothing. Really, all that will happen is I'll have your little icon there and I'll know you've signed up and people who might look at my blog to see if anyone would want to read it if it were a book will know that yes, indeed, people would.

You're already proof to me. Be proof to them, would you? Conceal your identity-- take on a  super-alias!-- just sign up. Join my club. We're cool.

Thanks!

_____

Okay. So. Down to business.

This was a very, very, very strange week.

When we left off, I was in that weird middle zone, ramping down the Cymbalta, ramping up the Amitriptyline, feeling the worst of one and the barest traces of the other, and stuck in the no-man's land of the PTSD/depression void.

Tired. Forgetful. Vacant. Overwhelmed.

Oh, and bonus: sick with a horrendous head cold.

I stayed in that zone for a while after I posted. Am still there, to a great extent.

And thusly I arrived at the beginning of this week, sick as a dog, with my husband heading to frigid St. Louis on business for four days, my sister and bro-in-law (the adorable newlyweds) in town to visit (and serve as inadvertent life-preservers--more about that later), and an unusually busy and appointment-packed week ahead of me with a brain functioning at about a 2 out of 10.

Overwhelmed to all hell.

The worst part of feeling that way is the certainty that it can never be better. Anxiety overwhelm is something that doesn't lend itself well to cognitive coping mechanisms. There's nothing in there that feels "fleeting." There's nothing in there that sits well with the adage, "This, too, shall pass." 

Anxiety overwhelm is a tidal wave of crushing panic, with a whisper in your ear: forever, forever, forever. 

It is frightfully hard to stand up under that onslaught, and remind yourself that no, actually, a few appointments and phone calls and errands and things to be done and conversations to be had in the course of a normal week are just that: normal, and doable, and manageable in time and space, and not at all insurmountable.

You can break them down by date and time, make a list of materials needed for each one where necessary, and put them in your calendar in separate time slots.

Some time slots are bigger than others. Some lists of materials are longer. Some items don't have lists, and don't take more than a minute of time. 

If you do this, if you write them all down, if you make all the lists and put all the things in your calendar, you can see all these things and know in the intellectual part of your brain (the part that had a career once; the part that earned two masters' degrees; the part that is a full-grown fucking adult human being who has managed to survive all these years somehow without cracking up; what the FUCK) that these things are small, and finite, and separate, and variable, and easily, easily done.

But if you are in the middle of anxiety overwhelm, with the last of the Cymbalta digging in its claws and leaving bloody trails as it slips inexorably out of your system; and with the brief, bright bursts of Amitriptyline still too few and far between to build a day upon, those tasks, from the phone call to reschedule the doctor appointment to the day-trip to the City, all look exactly the same.

They have the same weight and heft. They require the same time, effort, energy and planning. They tax my system in the same way. They trigger the same fear, fight, and flight. They are all too big, too difficult, too far beyond my ability to manage, and they are all extremely urgent, all at DEFCON 1, and all need to happen RIGHT NOW.

When the overwhelm is really bad-- and in this in-between state I've found that it can get very bad indeed-- the cognitive tricks don't work as well as they should. My inner Sherlock can't be convinced, despite the evidence, and for a while I am all lizard brain. 

To paraphrase some every misogynistic movie from years past: no matter how much my mind says NO, my body just keeps saying YES YES YES.

This actually happened to me this week. My sister Liz sat down with me and helped me talk out everything I needed to do, and we made a list of everything that needed to happen and when, and I put everything in my calendar, and I could see it all laid out and that there was plenty of space and time for everything and that it was all well under control.

And yet.

Even as I did it, my fingers were tingling. Then my arms. Then my legs and feet.

Why, you ask? Is it that PTSD thing, that energy off-gassing thing?

Nope.

No.

It was me, hyperventilating. HYPERVENTILATING. Hyperventilating, because I had to reschedule one doctor's appointment and attend two, take my kids to school three times and gymnastics once, let someone into my house to spray for ants, let another person into my house to fix windows, write a check, pay a bill, make a phone call, validate a credit card, and just generally keep everyone fed and clothed and non-bleeding.

Over the course of five days.

With help.

No kidding, if Liz had asked me, during that session, when I wanted to work showering into my schedule for the week, I probably would have either burst into hysterical tears or lost consciousness.

I am shaking and anxious just describing this to you, and it's several days later and it's all been done (successfully!) and I've had a Lorazepam.

Still.

The extremely capable, overachieving part of me is absolutely appalled at all of this. The unfortunate thing about being in this state is that you don't get to trade your inner critic for a new, nicer one in the interim.

Nope, she's still holding me to the same standards, even though those are wildly beyond my abilities at the moment while my brain tries to sort out its little chemical romance. Soooooo helpful. What a bitch.

_____

And speaking of that, this whole brain chemistry experimentation stuff is for the birds. Jesus.

But I'm officially done with Cymbalta-- I stopped my ramp-down early. I'd made the shift from 20mg every other day to 20mg every 3rd day, and I think the third time I did that, I felt notably worse after I took the pill than I'd felt before. It knocked me out and made me feel sluggish and awful. So I decided that the time had come to part ways, and that was that. 

So Monday of this past week, the Day of Great Overwhelm, was the first day I should have taken Cymbalta but didn't. 

Makes sense it was a worse-than-usual day. It was. As was the next. But the day after that? Better. And the next? Better still. And then: Pretty good. And today: Not bad at all. So. It was the right thing to do. 

It was just a thing to be gotten through.

Still, the reality of what I'm doing to my brain and body is hard to escape when its displayed in such extremes. Not that I have a choice about it-- life with this chemical assistance is so, so, soooo much better than without, right now-- but that doesn't make it any less terrifying or humiliating.

And it is. Both. It's terrifying to feel this out of control of myself, and humiliating to... well, to feel this out of control of myself.

Hi. Sherlock here. Have we met?

So this week, as I said, was a strange one. We hadn't planned it this way-- it was all sort of coincidental that my husband was leaving AND my sister was arriving AND I was stopping my meds AND my other meds weren't yet on the scene AND I had a more-taxing-and-triggering-than-usual schedule.

But guess what happened, mid-week, as Cymbalta's last talon tore itself loose?

Psychopharm doubled my Amitriptyline dosage (from 25mg to 50mg, which is actually just the lowest therapeutic dose, typical being 50-100mg, so not that big a deal). Coincidentally, I hit week 6 of the 6-8 weeks it takes to reach full potency in your system, and, right on schedule, I'm beginning to feel some positive psychotropic effects.

They're mild, because I've been ramping up on a very low dose. But they began to pick up right when I needed them. Thursday of this week, as if to celebrate my survival of all the appointments and errands and panic-inducing calendar items.

So far, Amitriptyline feels like... creativity. Thursday night, I went on a Pinterest spree and found patterns for about 50 new handbags that I want to sew on the new, two-wall-spanning desk I want to build in the office I plan to paint in the house that I am once again excited to be designing and decorating to its best potential.

The fact that these effects coincided with the doubling of my dosage is indeed, I'm sure, a coincidence, but it bodes extremely well for when I begin to feel the effects of the increase.

A manic spree of creativity, I will gladly welcome with my whole heart. I'm sort of kidding about the mania thing-- I'm about as in danger of a manic phase as I am of flying to the moon-- but creative inspiration AND motivation together are, for me, the surest signs of a well-functioning antidepressant, so I'm a little thrilled to see how much further this will go. 

I'm a terrific idea girl, and not so great with the follow-through (see Overwhelm, above). I've got a few really enthusiastic women on my team right now (Hi A, A, and L!) who are ready to rock on some of my projects, so if I (and Amitriptyline) can get myself together to the tipping point, my world is about to get a whole lot more active and interesting and aesthetically awesome. 

_____

So I'm still sort of in the in-between zone, in that I'm not yet sure if what I'm doing will be enough, or if there's another combination out there that will be better for my particular brand of crazy, but as of two days ago, I think I can say I'm past the worst of it and things are looking up.

And the Amitriptyline, a drug I'd never heard of before, is a bit of a rock star in ways beyond the psychotropic, for me, so at the very least, it will be part of my arsenal, ongoing. It helps me sleep, for one, which is awesome. And it seems to have closed the gap that the Topomax was leaving with the migraine propholaxis, and I've just gone a month and a half with only two half-hearted and quickly-extinguished attempts by a migraine to make itself known, including during a menstrual cycle AND a 2-week sinus-heavy cold. NOTHING. NO MIGRAINE. NADA!

So. THAT'S a win.

The rest is just figuring out what works and if what works works better than what doesn't work doesn't. If that makes sense.

If the benefit of the benefits outweighs the cost of the costs. Because with these drugs, there's always both, I'm learning, and you just keep comparing all the tics in the Pro and Con columns and hope, at some point, so come to some satisfactory balance. 

I told my sister the other day that I feel a bit like you feel after you've been dyeing your hair for years and years and years-- so long that you have no idea what your real hair color is anymore.

I'm feeling like that about my brain now. Who knows what "back to normal" is?

I'm learning that "back to normal" isn't the goal for people like me, and we're just setting ourselves up for heartbreak if we keep insisting that it is. 

And anyway, with what I'd done with my normal, why on earth would I want that again, anyway?! I'd like to raise the bar on normal, please. Supernormal. Ultranormal. 

UBERNORM with a side of fries!

Yeah, forget reverting to what I once was, whoever that girl was and when she existed is lost to the ages now, and as lovely as she might have been, she didn't know the things I know. She hadn't seen the things I've seen. She'd never loved who I love or been who I've been or done what I've done or lived what I've lived.

Wishing to revert to her feels like regret to me, and if you've learned nothing else from this blog, I hope you've learned that despite it all, I don't regret what happened to me or the life I've had because of it.

And despite the times of struggle, I always manage to end up back here, on the way up, feeling charged with purpose to keep on fighting, keep on moving, keep on working for the new me who I know is evolving out of all of this.

And I don't have to settle for any old normal. I can make her whoever I want.

I'm just going to pick a shade of awesome that appeals to me and aim for that.

Ramping

Hi there.

How was everyone's holiday? We went to Southern California to visit my family (6 days. 12 adults. 5 kids. 3 bedrooms. 2 toilets. 1 shower. No matter how you do the math, things don't quite add up. It's a good thing we get along rather extraordinarily well, no?).

Anyway: whatever holiday you celebrate, whether it's over or continuing or hasn't yet begun, whether you've been filled with the spirit, frolicking in sand or snow, or find this a joyous, pleasant, or just mildly tolerable time of year, I hope you and yours are well and your wishes have all come true. 

In the words of Charles Dickens, "God bless us, every one."

_____

I wasn't sure what I was going to write about today, so I went back and read my last post, and now I know.

I talked last time about that raw feeling, that in-the-moment feeling, that wow-I'm-really-doing-this feeling that I seem to get at the top and bottom of my med arc. 

I guess it makes sense for exactly the reason I said: it's the flip-side of the same coin. Feeling is feeling. Feeling bad, feeling good, feeling whatever. Whether I'm getting a tidal wave of chaotic emotion-salad or a clear channel of manageable micro-feels, being able to interpret and experience them in real time is something to treasure.

Well. At least appreciate on its merits. I mean, let's not go CRAZY.

So I try to do that. I do, don't I? You saw me. I do.

The middle part of the arc, though? SUCKS.

I am there right now.

I am not used to this. I've never been on the med circus train before. This ramp-up-ramp-down thing? Um, no thanks.

I feel foggy, exhausted, forgetful, creaky, vacant. I can't remember conversations. I can't remember things I did two days ago. I feel... like I'm on drugs.

The irony is that now that I'm back in the muddle of the ramping again, I realize that I'd actually begun to get to a good place with the Cymbalta.

Granted, there were many things about it that were not good for me. It was causing more problems than it was solving, although the problems it was solving, it was solving really well. I just realize that I'd begun to feel creative, as I said last time, I'd begun to feel motivated, I'd begun to make plans, I'd begun to get excited.

That was fun.

I want to get back there.

I don't feel like that now. I feel... well, I forget. Sigh.

Except.

Here are a few things that have happened since I started the ramp-down-ramp-up. I'll give you an abbreviated list in the order of occurrence, starting with a couple of weeks ago, when I first began. I detect a trajectory. See if you can spot it:

• Tired and muddled. Vacant. Forgetful. Occasional flash of hopeless overwhelm. Remember feeling like that all the time. Hope that isn't going to get worse.
• Tired and muddled. Vacant. Forgetful. Lorazepam not helping much. No more hopeless overwhelm.
• Tired and muddled. Vacant. Forgetful. Lorazepam helping. Need one every day.
• Tired and muddled. Vacant. Forgetful. Lorazepam helping. Prefer but don't need one every day. Occasional flash of creative enthusiasm.

It helped a lot to write that down. That shit is TRUE. I left out a whole lot of "tired, muddled, forgetful, tired, muddled, forgetful, irritable, tired, forgetful, what the fuck, tired, shut up, tired, leave me alone, forgetful, tired, muddled, tired, tired, tired."

But those are the main themes. That last one ALL HAPPENED TODAY.

Okay. Okay. Good. Yay me.

I've got a long way to go with the ramp-up for this Amitriptyline-- it doesn't reach full potency for 6-8 weeks, like most anti-depressants (because if there's one thing we depressives have, it's time to fuck around) (and okay, yeah, I've added depressive back to my resume, reluctantly, but with a lower-case r and in the fine print, because fuck you depression you're not the boss of me, that's why).

Ahem. Anyway, long ramp-up. As is to be expected. But there is more progress to report: 

Today was my second official "Day 3 of no Cymbalta" day, as I shifted from 20mg every other day to 20 mg every 3rd day.

And guess what? Unlike last time, I woke up this morning and I felt... 

Just fine.

I mean. Tired. Muddled. Vacant. Forgetful. 

But I've gone all day without a Lorazepam with no problem. And I've been feeling some genuine flashes of creative excitement about clearing out the room that is going to be my office and designing the DIY desk/storage system that is going to wrap around two walls in there and allow me to set up space for writing AND space for sewing projects in one room without having to set up and tear down every time I want to do anything.

Also:

I spent some time on the long drive from Southern California the other day thinking about paint colors for said office.

And get this:

While I was down south I met with the friend I mentioned a few posts back-- the one who asked me to collaborate with him on the screenplay project-- and he very kindly and generously (not to mention handsomely and intelligently and hilariously) lent me his time and talent and did a photoshoot with me so I could have some real, live, grown-up head-shots for author bios, ahem, should the occasion arise.

Because I thought of it during my Cymbalta high-point (see? SEE?!) and immediately asked him and my uber-talented hair-and-make-up-magician sister, the newly-married Liz, if they'd be interested in helping me out, before I had a chance to second-guess myself or otherwise self-destruct.

I've learned to undermine my own efforts to undermine my own efforts. This ain't my first rodeo, people.

Whoa. You see that? That's two and a half goddamn years' worth of therapy co-pay well-spent. Damn. That's worth the price of admission, right there.

Holy shit. It's a Christmas miracle.

In the words of Charles Dickens, God bless us, every one!

Like a Woman Scorned

So, Cymbalta was not ready to break up and went all psycho on me.

BITCH!

Yeah, apparently, this is a thing that Cymbalta does. Did you know this? I did not know this. Apparently, neither of the doctors I was working with this past week knew this either.

Cymbalta, she does not give up so easily. She gets mad when you let her go. She takes her revenge.

But I get ahead of myself.

Let's back up a little.

Remember last week, that great week I had?

Well, this week was fine, too. Until. I tapered my Cymbalta as directed.60 mg to 40, 40, 40, 40, to 20, 20, 20, 20, and then none, none. I'd only been on it for about 2 1/2 months, so no big deal, right?

Enter day 3 of "none."

Before I go any further with that, I'll tell you that I met with the psychopharmacologist (or the "psychopharm," I'd insist upon being called if I were her), who gave me some DSM evaluations and determined that I should still be on antidepressants, even if anxiety disorder is my main diagnosis, which is fine (as long as I'm on something that is making me feel better and not making me endure side effects for no tangible benefit, I'm down. And as long as I have a doctor willing to manage and supervise my pharmaceutical "experimentation" so I don't have to figure this shit out myself by clueless trial and error, I'm even more down). 

So day 3 of no Cymbalta coincided with day 1 of amitriptyline, my new antidepressant, which also helps with chronic pain, insomnia, and is a migraine prophylaxis!

They're, like, bundling my services, now. Comcast, is that you?!

Ah, but I digress.

Anyway, I woke up yesterday, day three after Cymbalta and I bid our final farewell. I thought we were cool. I thought it had been an amicable split. I still had three 20mg capsules left, and I'd been planning to continue the taper by taking them every other day until they were gone, but Psychopharm (see?! I mean, really) said not to worry about it and just go ahead and stop.

And thusly I came to day 3, and thusly I awoke to a racing, raging attack of anxiety. Right out of the gate.

Not a good start to the day.

My husband was out of town. I got up, discovered that a colony of ants had found their way into the girls' bedroom overnight to escape the rainstorm, had a moment of panicked horror, had several minutes of homicidal ant rage, got breakfast for the girls, deposited them in front of a movie, and climbed back into bed to get some space and calm myself and figure out what the hell was going on.

I fell back asleep, hard, for another hour and a half.

When I woke again, my anxiety was still incredibly high. I kept crying. My skin felt raw. I was restless, uncomfortable, irritable. I kept snapping at the girls. My head was spinning. Completely out of character.

Also, the ants were back, and boy, did they regret it.

I took a lorazepam. A whole one. First thing in the morning. It did nothing.

I didn't take another. Didn't want to go down that road.

After lunch, we went to the airport and picked up my husband. He'd been in LA for three days because he had a gig at the House of Blues in Hollywood on Friday night.

(For those of you who don't know my husband, I told you he was cool, right? Did you know he was that cool? Well, he is. That cool. Aside from being the best husband ever, he is also, among other things, a bass player. And in his spare time, he does stuff like this.)

Oh, what the hell. Let's have a shameless plug for the man. Ladies and gentlemen, may I present: 

Uniform Standard

That's him, in the hat. My cool boyfriend. Hands off, girls. He's all mine!

_____

Okay, so anyway, I picked him up and as soon as he was there, things started to get better. He told me to call the doctor, which was one of those great ideas that never would have occurred to me.

While I was doing that, we started talking about whether the cause could be the introduction of the amitriptyline or withdrawal from the Cymbalta. Both seemed a bit extreme, considering, but he got online while I was on hold and started looking things up, and sure enough, Cymbalta is a notorious withdrawal monster.

Like, SERIOUSLY so.

When I finally reached the doctor on call (not my NP, to whom I will be speaking this week), he said to go back on 20 mgs and taper more slowly. 20 mgs for a few more days, then every other day, then off. Even that, at this point, seems suspect to me after what I've read, but then again my experience yesterday seems relatively mild and manageable compared to some of the ones I've seen in the forums.

Some people actually do something called "bean counting" with Cymbalta, where they take apart the capsules and count out the grains inside and transfer them to smaller capsules and gradually cut the potency by hand.

Of course, these are people who have been on it for years and taper off over 18 months or something-- I won't need to do anything like that. But it certainly gives one pause.

And it also gives me a new research variant to consider before greenlighting any new medication: what's it like to quit?

Because if the answer is "Worse than the reason you're taking the fucking drug in the first place," perhaps I will reconsider that particular option. As should you.

Down with Cymbalta!

_____

Here's something else that occurred to me yesterday for the first time, though: that hyper-emotional feeling, which I hate so much, has a flip side.

In the past few months, I've had moments of genuine excitement about things. Engagement with creative projects and partnerships with creative people, and getting my creative house in order, mostly. I've felt passionate about those things in a way I haven't felt in many, many, many years. And that is coming from the fact that I've torn so many of those emotional defenses down in therapy.

On the other hand, now that those defenses are down, when stuff like this Cymbalta thing comes up, it's harder to get through, more grueling and frightening, because I can't protect myself from it the way I used to. My lockdown box is broken. I can't just make it disappear anymore.

I think yesterday was the first time I experienced both sides of the coin in the same day, saw them for what they were, realized it was a tradeoff, and thought....

Yep. Totally worth it. I can do this.

Like I told the doctor on the phone, if this is a known thing, a finite thing, a period that just needs to be endured and gotten through, I can do that, no problem. If you can tell me I'm doing the right things to manage myself correctly during this transition, that's enough for me. I will handle it.

I'm just not afraid of that kind of thing anymore. I get it. It's going to suck and then it's not. Fine. It's happening because the drug is doing it, but also, I am experiencing it the way I am because I have worked hard to be able to feel this horrible shit when it happens, and despite how it sounds, that's actually a victory.

To feel crazy and anxious and terrible sucks, don't get me wrong.

But to feel crazy and anxious and terrible right now, while it's happening, and have actual, authentic, real-time reactions to those feelings?

Don't underestimate that pleasure, friends. I bet it's something that every one of you takes for granted every day, and you shouldn't. You shouldn't.

Not all of us get to live in our actual minds and actual bodies all the actual time. 

Realizing I'm doing it feels a little like the moment you're riding your first two wheeler down the sidewalk and you notice your dad let go two houses back and you are suddenly slammed with the knowledge that all the balance you've had for the past few blissful seconds has been yours and yours alone.

Does that knowledge make you freeze up with the burden of the responsibility and spill over on to the ground, or does it set you free, now that you're no longer held back and can go forward as fast as your feet will take you?

You have one, blinding second to decide.

NOW!

I Bought WHAT?!

Ever have one of those weeks where things are going along kind of normally/suckily and then all of a sudden you have what is probably THE MOST LIFE-CHANGING DOCTOR APPOINTMENT OF YOUR LIFE and then a few days later find yourself doing something you would, almost up until that very moment, have bet the entire farm that you would NEVER EVER EVER DO IN A MILLION YEARS?

No? Nah, me neither.

Oh wait. 

Yes. Yes I did. That is exactly the week I just had.

Check THIS out:

I told you a couple of weeks ago that I was going to find a new doctor, remember? I was going to bring my assertive husband with me, I wasn't going to take no for an answer, and I was going to get myself heard.

I also told you a while back about a psychopharmacologist I wanted to go see: a profession so mysterious I'd never heard of it. And neither, apparently, has my spell-check.

Well. I finally got all the information I needed to make that happen. It turned out that I needed to go to another doctor at this facility first and get a referral in order to see the psychopharmacologist. My friend had gone to a Nurse Practitioner that she really liked, so I made an appointment with her as well. As it happens, I'm dissatisfied with my current GP (as you might imagine) and am shopping around for someone new. This NP is in my network. I figured, what the heck.

(I don't know about you, but I have had excellent experiences with Nurse Practitioners in the past. I find them to be extremely thorough, caring, and just generally more human and humane than the average GP. I have never been let down by an NP. I've seen them for everything from gynecology to routine physicals. I would choose an NP over a GP every day of the week. If you've never seen one, give it a try!* Love 'em! LOVE!) *This statement reflects the author's personal opinion. The author has not been paid by any Nurse Practitioners to express this opinion. The author would express this opinion whether she were being paid or not. And since that is the case, would it hurt you to throw a little cash her way, Nurse Practitioners? I mean, Christmas is coming! "Tis the season of giving! God bless us, every one, or whatever!

Anyway. 

Where was I?

Oh yes, Nurse Practitioner.

So we all troop in there, me, the husband, the girls. 

The NP comes in, young, pregnant, glowing, adorable, perky.

 I am not sure what to think. I'm just there to give her my basics so she knows I'm not crazy so she can give me a referral to the psychopharmacologist.

She starts asking questions. I start telling her how I got to where I am. Immediately, it became clear that she got me. She picked up on every vibe, she heard every word, she asked every question I hoped for and wrote down everything I said even if she didn't ask for it.

I don't remember all the details of the conversation-- it was emotionally heavy, for me, so the fog has shrouded much of it; you know how I am-- but a few key moments are emblazoned in my memory for their singularity in my lifetime.

_____

Example:

Me: I've been going to doctors since the '90's, telling them that I can't breathe. I can't draw a full breath. I feel like I'm slowly hyperventilating, and it lasts for weeks, sometimes months, sometimes longer than that.

Her: (stares. blinks.) And no one. Has ever. Put you on ANTI-ANXIETY MEDICATION??!! HAS NO ONE EVER LISTENED TO YOU??!!

Me: (opens mouth. closes mouth. looks at husband. bursts into tears.)

_____

Example:

Me: I was diagnosed with major depression 13 years ago, during a time when I was definitely depressed because of a lot of things that were going on in my life, but I didn't know I had PTSD then and neither did anyone else, and I think it was an easy mistake to make, but I think it was a mistake. 

Her: You mean think your depression is episodic, but that your real diagnosis should have been anxiety disorder.

Me: Yes.

Her: Yeah, I agree. That sounds right. Let's correct that in the record here (types into the computer).

Me: It was an easy assumption to make at the time. I didn't understand the distinction between depression and anxiety until this past September, when I OD'd on Wellbutrin and had that huge anxiety attack. I had never felt it like that before, so I didn't know the difference.

Her: It's not your fault that you didn't know the difference. You weren't the one who was supposed to know the difference. Let's get you off these anti-depressants. They're doing nothing for you. Let's get you some anti-anxiety meds instead. Which one was the one you said worked for you?

_____

Example:

Her: What about drug use? Any history of drug use?

Me: Um. Yes. In the 90's. And... 

Her: Have you ever tried marijuana for anxiety?

Husband: She's tried some for migraines, and she says it doesn't do much for her, but the last time she tried it, she seemed to relax. I saw her smile. She doesn't do that very often.

Me: I'm not really much of a-

Her: It helps.

Me: I don't really enjoy-

Her: It heeeeeeeellllps.

Me: I haven't really found a strain that has worked for me. It hasn't helped with the migraines, and it hasn't really helped me feel relaxed, but I haven't exactly gone looking for my own medical grade stuff.

Her: I can write you a prescription right now.

Me: Are you kidding?!

Her: Nope. Want one?

Me: (looks at husband. husband grins hugely.) Um, sure. I'll try anything at this point.

_____

Forty-five minutes later, we walk out of her office, with a firm request to make another appointment with her within the next two weeks, before she's out on maternity leave. (Her: And there are plenty of great people here that you can see while I'm gone... but... (whispers) I'll make you a list of who they are.)

In my hand are the referral to the psychopharmacologist; the physician's statement that serves as a prescription for medical marijuana, which is legal in my state and plentiful in my vicinity (helloooo, Bay Area!); and a prescription for Lorazepam, the anti-anxiety medication that was so helpful to me when I needed it.

I'm being very careful with it, only taking it as needed, and usually only half a pill at a time. I'm quite anxious these days, but I'm not interested in forming a habit that's going to make it harder to learn what I need to learn to be less anxious in the future.

Because here's the thing:

I think what's happened is that I've had this anxiety disorder-- PTSD/PTSR-- running rampant in my body, unchecked, for the past 22 years, and while I've experienced a lot of it as stress and social phobia and shortness of breath and that sort of thing, I've experienced very little of the emotional side of anxiety because...hello... 

I experience very little of the emotional side of anything I don't want to experience.

QED.

But as I've gone through all this therapy and writing and work over the past two and a half years, as much as I've felt sometimes like I haven't gotten very far, I really must have, because I've been slowly but surely dismantling my ability to protect myself from the emotional impact of stuff like this. 

I've been breaking down those walls, bit by bit.

This is progress, people, don't get me wrong. This is all very good stuff. But all of a sudden, I've got only paper-thin layers between me and a twenty-two-years-strong anxiety monster, and I'm FEEEELING this thing, and my ability to cope with it has not developed at a comparable pace.

My survival instincts have quite heroically kept me from having to deal with all of that, for all this time.

So for now, and for a little while, I'm going to accept a bit of help in regulating my anxiety. I'm going to let that Lorazepam help me regulate my moods. And if it brings a few more smiles to my face than I usually manage on my own, well, I ask you: what could be bad about that?!

_____

As for that other thing, the thing I never thought in a million years I'd ever do, I bet you've figured it out already.

Yup. I--me-- I went to a medical marijuana dispensary. My husband, not having a physician's statement, was not allowed to accompany me inside. I went in, got approved, was given a tour and told the rules, and was shown where to go and how to choose and purchase medical grade marijuana.

I bought some. All by myself. Legally, after waiting in a roped-off line and being offered a "Black Friday Special."

I kid you not.

It was actually pretty cool there. They teach classes: yoga, tai chi, meditation, reiki, accupuncture. They teach you how to grow your own meds. They have support groups for seniors and cancer patients. The consultants are all very knowledgeable about the different properties of the strains.

Yeeeeaaahh... I will probably go full Sherlock if I find something I like about this. I'm not holding out much hope that I will, but you never know. At any rate, there's a lot of interesting science to learn.

I got tiny amounts of three different strains to experiment with, and see if any of them help. I figure, I can't really drink alcohol anymore, and now that pot is finally being legalized everywhere the reports are being released that suggest that it might truly be a miracle substance that we maybe can't afford not to use in some form or another, so what the hell?

I don't see myself becoming a regular pot-user, but a little vaporized anxiety-killer now and then, if I can find one that works, might be just the thing, especially since it isn't habit-forming. Beat that, Lorazepam, and then we'll talk.

_____

All in all, I have to say, it was a pretty good week, with a lot to be thankful for.

Casting off the mantle of "Major Depressive" is having a pretty profound psychological impact on me. Surprisingly so. It feels exactly right that it was wrong. And letting it go is transformative in a way that I didn't expect.

I feel lighter, somehow. I feel less encumbered. I feel like I've corrected my internal inventory and realized that I'm carrying 50 fewer pounds than I thought I was, and I've literally felt those pounds drop away.

Why is that, I wonder? Was it an expectation I was living up to? Or down to? Or something I felt I couldn't escape? 

I don't know. It's not like I traded it for something much better.

I think it's just... rightness. That was wrong, before. This is right. I know what's happening. I know where I am and what I'm doing. I know what I'm looking at.

The NP actually apologized to me, the other day, for that misdiagnosis, all those years ago, and the delay that it caused in getting me the right meds and on to the right path. 

"It's okay," I told her. "I didn't know what was happening to me back then. I wouldn't have known what to do about it. I know what I'm doing now. I know exactly what I'm dealing with."

And that's true. I'm sure I could muster up all kinds of regret over missed opportunities if I spent my time that way, but the fact remains that at this point in my life, I am ready for this healing, and I know how to go about it, and I have laid all the groundwork there is to be laid, and I have as solid a foundation as it's possible for me to have.

I am prepared. So I'll take my miracles now, please. Because I know exactly what to do with them.

_____

She said something else funny, the NP, before we said goodbye.

"I'm sorry this appointment was so long," she said. "I'm sure you have better things to be doing with your day."

I turned and looked her full in the face. "Are you kidding?" I said. "I have been trying to have this appointment for 20 years. You have just changed my life. Right now, you are my favorite person in the entire world. I would spend the rest of the day with you if I could."

She smiled. "Awww," she said. She thought I was joking.

She looked at me. I was a little teared up. And then she got it. She got a little teared up too. 

She nodded. I nodded. She smiled again.

"Thank you," she said.

Because what else can you do, when someone changes your life like that, but try to make them see?

And because she was just that awesome, she saw.