I woke up tired to a painful level. Desperate. I shuffled down the hall, already shaking. Vitals were taken and unsurprisingly my blood pressure was high. Anxiety on full blast with a backup of absolutely wanting to die. My nurse, however, was really nice and we had a good long check in, being honest as I can, doing a good job so far, I think. She asked questions and said things that were clearly assessing me but also saying things to show support and sympathy at the same time. It didn’t help much, but it was nice for someone to really listen to me. I admitted to some passive self harm thoughts and to both active and passive suicidal ideation. No plan, no intent, and I felt safe here, but maybe not out of the hospital. Especially with the high anxiety levels.
I can’t quite remember the morning. Just that I was sitting in the TV area, full body shaking and feeling like I wasn’t getting better, I was getting worse. I knew I had to just make it day by day, or hour by hour, or even minute by minute. I saw the MD making rounds but they weren’t anywhere near my room yet.
I do remember that we had an OT group with creativity, and I drew an image I had been thinking about since the art of the previous day. I had imagined a darkly colored face smeared downward. The morning OT didn’t have access to colored chalk drawing sticks, so I used oil crayons. Wasn’t exactly what I had in mind, but maybe someday it’ll be worth a ton after I accidentally become a famous artist.
My hands were black with oil crayon, and I went and got another piece of paper. Nice, super textured, heavy weighted paper. I had no idea what to draw. So I used the oil on my fingers to just put fingerprints randomly across the paper. I was still bummed they didn’t have colored chalk, but they did have black charcoal sticks. And I loved the effect on the opening credits of the show/series “The Pacific.” The way the charcoal stick drew on the canvas but exploded bits of charcoal as it went, making a properly beautiful mess. So I drew lines from fingerprint to fingerprint. Which led to more doodles, which led to more. I drew some patterns and such, but it wasn’t until I started drawing long curving lines that I saw the hair. And the eyes. And everything. Honestly this image scares me, because it’s so pained and mangled. As a result one of my favorites.
When I’m arting I often have an idea in mind. It may change as I screw it up, but I’m usually working in a fairly determined manner. So here I was with two drawings that I loved, and it was 20 minutes into the session. I didn’t want to just keep making art, I felt I was done. But I didn’t want to leave, either. So I thought I might make something “happier” or more upbeat. Grabbed the horribly messy oil crayons again and just started with a shape. Filled it in. Another shape. Filled it in. And so on. There may have been an eye in there somewhere, but I was mostly killing time. And of course that’s when cool things happen. I just thought it was random brightly colored shapes. But I guess my mind was guiding my crayons like middle school girls trying to raise spirits on a ouija board. It wasn’t until I got home and was showing Wife my art when she said, “Oh, yeah, it’s a sailboat. I can see that.” Except I hadn’t told her what anything was. It was pretty cool. Wind in the upper left, looking down on the boat and cockpit. You can find enough other parts of a sailboat to actually see it if you try hard enough. Back to the theme of the magic eye puzzles and “Oh, it’s a boat!” from Mallrats, the movie. Yes, it’s an old-people comedy from the 90’s and surely somehow even more offensive today than it was trying to be back in the day.
So I guess I did find a way to distract myself.
Near the end of the OT group, my MD found me and asked if we could talk in my room.
That discussion put me on a whole new level of understanding, a new direction. She explained the Vagus nerve response, or the mammalian deep dive response. When I think of this, I think of a sea otter. It needs to dive deep to find food sometimes. But when you’ve been underwater, diving deep, the first thing that happens is that you are running out of air. You also cross into a much colder level of the water – and that is a very quick change. These things often give us the impulse to panic. But that sea otter needs to dive deep, so in order for that to happen, the Vagus nerve is looking for a sudden body temperature change, and the feeling of running out of air. This points me to one of the reasons for a Vagus Nerve Stimulator. It kicks the Vagus nerve every few minutes, so you’re essentially shutting down panic constantly, making sure it doesn’t happen. The VNS is also for TRD patients and it somehow helps with depression, which is what I’m headed for.
We can stimulate the Vagus nerve manually but doing a 4-8 breathing, meaning breathe in for four seconds, breathe out for eight seconds. You can’t do it for long because eventually you’re going to run out of air. The second, and most important part is the temperature change. The best way to do it is to place your face in a bowl of ice water for as long as you can, but probably not more than 30 seconds. An alternative is to place something ice cold directly under your eyes. You can also put something cold on the back of your neck.
I had learned all of these things independently, but nobody had ever explained how they connected and why they work. Or if they did, I couldn’t remember it. It made sense now, and would have back then as well, so I would think I would have remembered that. I like science.
She also focused on my personal grief. Since losing my career and having my memory downgraded/changed, I needed to get a new identity. My career went back a long way, and one of the things it stood for was “I may have dropped out of college twice, but look at what I have accomplished.” Losing my previous identity in some ways was something I was going to have to understand and grieve. Also, losing that identity removed the support it provided. So this could place me back to my teen years, and by extension my younger years. Back to my childhood, which my therapist describes as “trauma through neglect.” So yeah, she packed my baggage, it’s up to me to carry it and work with my therapist to unpack it. So I need to build a new identity almost from scratch
In the short term, we needed to tackle the top of this pyramid. And that’s to keep me alive, stabilize me. The second layer is getting the right therapy going, addressing these identity and grief issues. And the third layer is quality of life – not just pulling me back from D, A and S, but getting me to a point where I am truly enjoying my life and continuing to grow.
Once I’m stabilized and can go home, there are three major points to work on. First, the biological. Switching my meds so I actually sleep, and doing TRD clinic outpatient. Working with my psychiatrist on meds, and continuing down the road the TRD clinic is taking me. That would be the ketamine, Vagus Nerve Stimulator, and whatever else they may have planned.
The second focus is Psychological. Learning and relearning distress tolerance skills and blocking the suicidal thinking. She simplified what suicidal thoughts were. I wasn’t in the clearest mind, but what I understood is that when in a (depression or anxiety) crisis, the brain wants to help reduce the stress. One of the things it does is offer different types of methods that will help us immediately. In the case of suicidal ideation, it offers that thought as a way of understanding there is a quick and simple way to fix the situation. It’s not your laziness or depressed mood or wanting to quit, it’s the brain saying “here’s one idea out of many..” Initially, it offers just a tiny bit. But as time goes by you build up a tolerance, so it offers more of these thoughts with increased intensity. Eventually you go from “I wish I was never born” to “the impulsive idea of seeing a way to kill yourself and considering it” to actual planning and seeking opportunities to act these thoughts out. It just keeps getting worse, as you continue in a crisis.
So it’s not my personality’s fault. And just understanding that science took a lot of the power away from S, my internal personality. By understanding why you’re thinking these thoughts, it makes the brain give up offering them just a tiny bit. So the more often you recognize those thoughts for what they are – a brain reaction – the less often they come, and with less intensity. That alone changed the way I thought about hopelessness and suicidal thoughts. Combined with understanding the causes of the worsening of my depression – childhood trauma, life changes in career and local family footprint – made me understand a few things. First, it’s not me looking for an easy way out because I’m weak. Second, I can science up my own reaction to those thoughts. Third, it feels like someone has really identified the things that I need to work on, by myself and with professionals. And finally, there is a plan of attack, a logical way of addressing my issues – not just throwing dart boards at a wall and deciding to try ECT or TMS or a new drug without any specific mechanism that it is likely to correct.
It’s all about balance between science and therapy. Understanding the physical aspects, but also what emotion aspects set them off. Those are distress tolerance skills.
In the drawing above (that she made conveniently in my journal) you can see the biological, psychological, and social elements to work on. Some connect to others, but for the three actions, there are understandings of what’s missing, and what needs to be reduced.
This is where it all changed. Not in a religious transformation type of change, but more like they slowed me to a stop and gently pushed me in a different direction. It’s up to me to do all of the pushing to get up to speed, though. And she stressed that it’ll be two steps forward, one step back, but keep an eye on the net progress. There will be bad days, but eventually they will come less often. One of the factors that made me buy this idea was that it wasn’t going to be “do this and it’ll be perfect” – which usually leads to a single failure and thus a lack of faith in the system. It’s a realistic plan going forward and I’m a human, so people will understand if it’s not perfect.
I asked about when I might go home, still thinking I was going to be stuck here forever. Understanding was half the equation, I still needed sleep and support and something to keep me off the bottom of the mood pool.
What she said surprised me. They like to have a typical three day plan. Day one they get to understand you and the crisis you’re in – and how. Day two is coming up with and presenting a plan to the patient. And day three is seeing if you can attempt some of the interventions, and get to a place where you can be assuredly safe. This was day two.
Given my depressed mood and anxiety, along with the sleep deficit, I wasn’t too hopeful. Friday would be my third day, and I still didn’t feel much different. I had to let the learnings of today simmer a bit. And I had a bit of optimism but not a ton of hope yet. So the fact that day three was a friday, I was expecting to be able to consider talking about my release after the weekend. And I really didn’t look forward to three or four more nights in the unit.
Back to the grind of the day, I was a bit late for lunch. When the nurse took the cover off she was surprised, and asked if this was all I ordered. It was the Caesar chicken day. Just a single, sad little piece of chicken, though it tasted pretty good. I couldn’t eat anyway between the exhaustion, trying to process the things the MD just told me, and the growing stress that Wife was coming to visit that night.
The group in the afternoon was about values. Specifically values and goals. The therapist was young and new and nervous and read awkwardly from her guide paper. But she was nice enough and eventually chilled out a bit. It was just her, Singer, and me. Thank goodness there wasn’t just one of us.
The point was that values and goals aren’t the same thing. Sounds obvious, but in a previous program we always talked about value-life-actions. At check-in we might talk about what value-life-actions we did the night before, or at check-out they would ask us to name one as a goal. It was always hard to understand what a value-life-action was, because they were always usually tasks or things to do. But with this group it all just clicked. It’s a simple concept, but in short your Values are how you want to live your life generally speaking. Goals may have something to do with your values, but they’re not the same. Achieving those goals could help strengthen or weaken your values. The why of the goal, as opposed to the literal goal of the goal. I know it seems like a simple concept, but it’s key in your recovery because you often have to re-identify values and how you want to live your life. For me especially, since I needed to work on my identity, who I was, what I believed in, and what I wanted to guide me in life.
We also talked about control. We discussed understanding your situation and handling it responsibly and easily. The mantra the therapist offered was “Observe, Describe, Participate.” You observe what’s happening, describe it in a way that makes sense (or doesn’t) with your values and goals, and then you choose to participate or not participate. Singer offered up the phrase her mother used to say, “catch it, check it, change it” which is ultimately the same thing. Notice it, check that it matches your deal, and change it if it doesn’t.
The ever-so-familiar bus metaphor came up. Stick with me, this actually applies to some of the things I was having to mull over. It’s simple. You’re the bus driver. The passengers are things you feel: You like vanilla. You are scared of dogs. You feel shame for something. You hate homework. Anxiety. Depression.
Rather than drive the bus on the route you are supposed to, we often let the passengers tell us how and where to drive. There’s a dog in a yard in the next block, so let’s go around the long way to avoid it. You can choose between vanilla or chocolate, so “You like vanilla” tells you to go for the vanilla. Eventually you become so familiar with how the passengers are going to derail you, that you actually do their thing before they even ask for it. Sometimes we don’t want those passengers to control us as much, so maybe we push them to the back of our brain/bus. They’re still there, there are just a bunch of passengers in front of them. During my “perfect year” I had pushed Anxiety and Depression back into the very last seats on the bus, and ignored anything they said. But they were still there, waiting. Waiting for an opportunity, or just waiting for all the other passengers to get tired and sit down for a bit or get off the bus. So it was an apparently perfect year, but the whole time I was working my butt off to keep ignoring depression and anxiety.
And the final advice on the bus metaphor was that when you try to control the passengers, you lose control. Not exactly sure what the right thing to do is, but if I recall correctly, it was keeping the passengers in their seats, kicking the rude passengers off the bus, and driving your route.
During quiet time I tried to nap but didn’t get any sleep. It was so long since I had REM sleep, I had forgotten that I wasn’t dreaming. And I was buzzing about getting to leave some day. Tried to level set my expectations fairly loose though. But now that I had an ember of hope, and my mind was blowing on it and dropping dryer lint on it, it was starting to burn a bit brighter. So while I was excited about the prospect of my own bed and to get away from the as yet unidentified industrial cleaning product smell, I needed to be ready to spend the weekend here. And if I wasn’t, I was really going to have to finally take a shower.
As my outlook brightened with further internal discussions and debates, I started to think about what’s next, not “how can I make next not happen?” I called Sister, as Wife said she had wanted to talk to me as soon as she could. We’ve always been close, and she used to give me pep talks in high school when she would come back from wherever catholic school cheerleaders go on weekends. Don’t worry, nothing too horrible, but “kegger” is a major player in those stories. We would talk and when I was having problems she would dump endless cliches on me, which actually helped quite often. She said I sounded better than she’s heard in many years, and that gave her some hope as well. I didn’t know how I sounded, but I listened to myself for the rest of the call and realized I was brightening up.
Before seeing the MD, possibly even the day before, I wrote Wife a letter. I was taking responsibility for my actions, admitting that I had to earn her trust in my safety, and what I intended to do to better my situation. I talked about “the good life” – don’t worry, I’m getting there. After talking to the MD I re-read the letter and it was actually in line with what the MD said. Nothing earth shattering, but good logic steps with the right perspective and understanding that nothing is perfect.
The “good life” was not a radical change in beliefs or how I live my life. It wasn’t the “perfect” life, or even the “new” life. It was simply a guide to having a good life. The irony that it sounded like “the good place”(a show about where you go when you die, is it heaven or hell?) was not lost on me. It was something like this:
The good life
- Sleep discipline – lights out at 11pm
- No screens in bed, dead trees books ok
- 2+ meals a day
- 1 hour of creativity every day – play instrument, write, craft, whatever
- 1 hour vocational/career effort daily – when able
- Walk every day
- Minimize Alcohol. Not quitting, stopping and then moderation
- It won’t be perfect immediately
- There will be setbacks but it’s all doable
- Keep scienceing it. Learn the logic of therapies and treatments.
- Don’t rush it, but don’t lose sight & hope
- Need another PHP for structure and continuance of goals.
That’s it. (That’s it? That’s an awful lot of bullet points for “it”) And I am still trying to follow that guide a month later. It felt realistic. I began by understanding that if I break a rule or one doesn’t work out, that doesn’t destroy the effort before or after.
I was getting used to the danger people like Gangster and Tank. But I was working hard not to be near them or between their minders, and it was a nervous task to do that. Dinner was some random horrible thing, I think it might have been chicken tenders and the bread with cheese glued to the top. As people throughout the day found out they may be getting out of the unit Friday or Monday, the mood lightened. Dinner was good conversations, often funny, and often not just the table I was at with the fun folks, but everybody in the dining area. Except Mumbles, he just kinda rapped about whether or not he wanted a condiment through the dinner hour – but it sounded like happier rap, if that makes sense.
The Thursday night movie was Frozen 2. I had seen it only once and thought I could hang out for that while I waited for Wife to visit. The TV was turning the picture bluish purple – even the commercials. So it wasn’t just the dark mood of the movie. I was getting more and more anxious about the visit. It was a complicated feeling: excited to see her, scared of what she might say, worried someone on the unit would have a proper end of day meltdown, and so on.
I used the day’s learnings to calm myself. Ice directly on my face, 4-8 breathing, and focusing on calm. And it worked. I still think it was because I knew what it was doing now, not just doing a placating therapist trick to get my mind off anxiety. Cold as it was, it really showed me that what the MD had said actually had merit!
Wife visited, she was very quiet but it was good to see her. I gave her the letter, all four pages. Yeah, obviously I can’t shut up in speaking, writing, or blogging. I couldn’t read her, and I’m usually fairly okay at figuring out what she’s feeling. The dark side of me was worried she had come to say she wanted a divorce, that she couldn’t keep supporting me like this. She just said she was tired, no dire news or anything. I talked about the MD’s discussion from the morning, explained the unit as much as I could from there, and we chit-chatted a bit. I felt relief when she left, not because I didn’t want to see her, but I was so worried about how she was feeling. It didn’t make me feel too much better, but I was relieved that she was at least okay. She also brought my CPAP machine, which hopefully would help me sleep. They immediately locked it away, because, you know, ligature risk. Wires and tubes and such.
Got back to the TV area to watch the end of the movie. Two people are leaving for sure tomorrow – both of whom are in the fun group and we’ll all miss their energy. We also got a new person last night, so that might balance the numbers. I’m told weekends are both boring and rife with new patients. There was one new person, New.
I was still extremely tired, so I tried to go to bed early. Unfortunately, my overnight minder doesn’t start doing that until 10:30, so I had to wait. And wait. And wait. But I had a nice big dose of trazadone on board, a new sleep med. And now that I had my own CPAP machine with a properly fitted mask, along with the final cherry on top of the sundae – earplugs! Don’t know why I hadn’t thought of that earlier in the week.
And I slept. Leg-en-dary sleep. Slept so deep and well that I had tons of dreams. I didn’t realize how long it had been since I had a dream. Sleep deprivation will do that to you. My dreams are always fun dreams. Like letting the subconscious version of me out into the world, or my memories of places, just to have fun. Apparently it’s common for veterans to have dreams in which they’re back in boot camp or where they attended training or were stationed. I routinely have dreams about showing up per orders at my first training school. But as me now, middle aged and out of shape. Someone else was in my barracks room, I had just my street clothes on, no uniforms, hair out of regulations, and with absolutely no shits to give. I would stand around saying “Hey, you wanted me back, so none of that is my problem. You want me to look like a Marine, then great, hand me some uniforms.” It would eventually devolve into wandering around the base, maybe doing weird things. Like inflating the Post Exchange and watching it float away like a balloon, or seeing out of context friends and wondering how they got there, and why? It was just a military version of a college campus, but without any of the fun parts. Dreams like that.
So that night I dreamed that Wife and I visited Army Friend and Army Friend’s Wife in the pacific northwest. Hanging around with them at their house, with their pet – a brown version of Sonic the Hedgehog. Because that’s normal, right? We also went out to dinner and for a night on the town. But instead of having a cocktail, I had milk. I’m not drinking right now, but milk? I would have much preferred a ginger ale or a Shirley Temple if they didn’t call it a Shirley Temple. Pretty sure we broke into the house of the first CTO I worked for and avoided all the security lasers and just ran around. Snuck out successfully later. See? They’re fun dreams where I can simply goof around. Never ever scary, which is good. But also never, uh, sexy, which I guess is a bummer. Funny.