Therapy this afternoon. We spoke briefly about the work that I'm doing at RMH, and how I can gauge whether I'm dealing with the emotion of bearing witness to some pretty sad events in an appropiate way or whether it is becoming a case of taking the sadness in too much, to the point that it begins to impact my own mental health in a negative way. I think at this point I am handling it pretty well, and it is not a major issue. But I am aware of the fact that I have to keep an eye on this. Speaking to my mother last night, she expressed similar concerns, and whilst she acknowledged it doesn't seem to be an issue at the moment, she urged me to be careful, explaining that in her experience as a nurse (and a number of year working in a nursing home.. which by nature is steeped in death) that the effects of bearing witness to death, can be culmative, and sneak up on you. She stopped working in nursing homes, because she began to burn out emotionally, after years of developing relationships with patients only to have them pass. And she pointed out that at least in that situation, one could derive comfort from the fact that it was an inevitable part of the circle of life, and the majority of the deceased had led long lives. At the RMH, it is children who are dying, and that will never be natural or acceptable. I think it will just be a case of having to carefully moniter myself to ensure that I am balancing the need to 'be there in the moment' with the residents, against the need to protect myself from the trauma of repeatedly being exposed to the sadness and unfairness of children passing. And I am only volunteering a couple of times a week, it makes me wonder how paediatric and neo-natal nurses manage to be immersed in it, and not burn out, or lose faith in the Ol Guy upstairs who allows such things to happen time and time again.
We then went back to the issues with lil sis, and more specifically to my inability to express anger or even to comfortabley allow myself to feel it. At this point 'The Voice' and some of his auditory comrades began to grow louder in my head, and when she suggested that perhaps I was angry with her, and that was ok, they began to make so much noise, I was finding it hard not to be pushed completely out of my own head. She went on to assure me, that it was ok to feel angry towards her, and that relationships can survive anger. In fact it was impossible to have a true relationship without it. She tried to explore my explanations that I felt anger was pointless and not productive... but must have noticed that I was having trouble trying to stay present in my head, with the entities that were trying to fight me, and each other for control. She stopped, and took a minute to try and assess where I was at, and who was talking inside my head. She asked me to share what they were saying, which I was promptly told (by them) not to do. To be honest, even if I was allowed to share, it would have been hard to, as it all becomes tangled up, and there is just so much competing din, that I find it hard to really here what each individual voice is saying.
The gist of it was a) "She is only saying that because she has to", "This is supposed to be about fixing up your fucked up behaviour, not getting angry at other people, you are the one to blame", "People only just manage to keep on caring for you, because you demand so little from them... most of them are just looking for an excuse to cut all ties... so go ahead, get angry, see how quickly you end up all alone" "Nobody wants to hear your pitiful complaints, you are nothing... less than nothing, you are not worth the effort etc etc.." (The Voice) b) "She is trying trick you, just shutup and let me take over" "Do not speak. DO NOT SAY A WORD" (Game face) c)"Get up and walk away" "Go on then, if she wants to see Angry, show her how mad you can get" (The Others) There was in fact, a lot more than that screaming around the corridors of my mind, arguing back and forth, but it gets to a point where it is so loud and so simultaneous, that I only hear brief snatches of it, the rest just blends together as a general din. And on top of that, I experience being 'pushed' out of the way and to the side within my own head, so everything begins to take a kind of disconnected, fog like feeling. A new one, (which now I write about is sounds really crazy) is the Paranoid voice, which has long been a member of the chorus within my head, but this was the first time he really showed up in therapy (with D anyway). He quite often will tell me that people are trying to catch me out. They can read my minds, they have cameras set up, they are accessing my computer etc etc. I can usually just dismiss this as paranoia, all though there is a persistant uneasiness that follows it, and I must admit it is a fairly pervasive thought... particularly about reading my mind. I suppose to honest, that has come up a little bit in therapy, especially since (D) tends to be fairly perceptive, and can often guess quite accurately at whats going on in my head, or at least is able to tell when something changes, like the voices ramp up. But Paranoid Voice, as a seperate entity to myself, has not really shown up in therapy till today. Today he was claiming that D was secretly filming me, and wanted me to crack up and get angry.. I don't know to what purpose she would be doing that, it obviously made no sense on so many levels. But there it was anyway. As I have mentioned before, these voices are obviously just seperate parts of myself that I cannot reconcile or 'own' as my own feelings, so they have been separated into discrete entities, masculinised or feminised. I really wish that I could experience these as what they are, MY thoughts and feelings, it would be a lot easier to reason with something that doesn't seem to be running its own agenda or battling me for control.
Anyways, I guess (D) must have decided to back off a little bit and give my head a chance to quieten down... I'm not really sure what we talked about next, it all gets a bit blurry. The next thing I became aware of, does not bode greatly for my sanity. I experienced a brief hallucination. I saw a snake slide its way from under her desk, and dissapear under the table beside me. Now, normally this would have probably caused me to gasp, or show concern like any normal person, but the fact is that this is the third such hallucination that I have had in the last week or so. I attribute it to being most likely a result of extreme fatigue from the prolonged bout of insomnia that I am experiencing write now (its been well over a month since I slept more than 3 hours a night) So, having experienced this little visual blip, I managed to keep what I thought was a fairly neutral demeanour. But once again, (perception? esp?) D managed to tune into the fact that something had just happened and asked me about it. I brushed her off saying it was nothing. To which she replied, "Its not nothing. You look so worried". Desperate for escape and not really wanting to talk about it, I looked over at the clock and realised ou time was up, so I told her I had to go or I would miss my train.
Oh, now I remember, I think we talked briefly about my appt with BabyDoc on wednesday and more specifically about my appt with BossDoc (the consultant psych who actually makes the decisions regarding treatment, and when to discharge a 'client' from the service) This will be at the beginning of January, and I mentioned to her I am feeling quite nervous about the whole thing. I'm not quite sure why other than the obvious not wanting to talk to yet another person I don't know and the anxiety I have relating to being trapped inside the rooms in the giant purple amoeba of a mental health building. I think some of it comes down to not knowing if I can adequately describe my concerns, worrying that he will brush over some of the more difficult symptoms I am experiencing. Like the insomnia. I am not by any means a drug seeker... I would love to cut all psych meds out of my daily regime altogether. But when a person is getting 3 hours sleep a night for a protracted period of time, it needs to be treated. Obviously, the most appropriate treatment is therapy, as there is no medical reason why I can't sleep... it is pure anxiety. But that is a longer term project, and I need help immediately, with the increase in seizures and now these little pseudo-hallucinations (I say pseudo, because in my mind, a complete hallucination would be a detachment from reality, I see the hallucination, but am cognitively aware in the moment that it can't be real, and that it is just my brain throwing something that is not real out there) Anyway, am not quite sure I want to tell Boss Doc about this, as I dont want to appear nuttier than I already am. My concerns from a medication standpoint, is that my general baseline of depression is not too bad with the Avanza, its there, and I deal with it, but its not that breathtakingly low black place at the moment, I am better with my ADLs generally, although there are days when I find it hard to get motivated and self-care. But in general not a major issue, right now. My anxiety is fairly constant and at nighttime or times of particular stress ie lil sis and bf screaming shoots through the roof, and the occurence of flashbacks and panic attacks, is on par with the way it was before I was hospitalised. And with that, and the sleep deprivation my concentration is shot to hell, and my school work is suffering. On top of that, my anxiety causes me to worry that everything I do write is rubbish, so I rewrite it and rewrite it, until eventually it makes no sense at all, but the deadline has come and I have to hand it in anyway. And the final thing i've noticed is that since I was taken off the Largactil, the voices are more constant and louder, which kind of worries me, as that would indicate if an anti-psychotic quietens them, that is might be a psychotic feature, which doesn't make a lot of sense to me, as I have insight enough to understand that they are not real, and if they were a result of psychosis, I wouldn't be in touch with reality, right? This is something I really do not want to tell the psychiatrist about, and I kind of wish there was a way that I could make him see that I need th seroquel or largactil without having to say anything about the voices.
Anyway, (D) suggested that we need to talk about the upcoming appointment, so we could find a way that I could comfortabley share the pertinent information (but not ALL of it). She thinks it is a priority to ensure that I am not discharged from the service just now, and as i have mentioned in previous posts, I kind of agree with her. I hve this sense at the moment that things are beginning to teeter on the edge. The culmative effects of the insomnia and anxiety are beginning to make it harder and harder for me to hold things together, and I am expending so much energy into fighting to maintain my responsabilities for school (and failing) and holding myself together for work, and for lil sis and just because I know its my responsibility to do so. I have a range of professionals supports who are willing (at present) to be there for the moments when I cant keep it together, that I feel obligated to make sure I am doing whatever I can to control, modify, self soothe what I can and to use the techniques and tools I've been supplied with. But when you are sleep deprived the energy you need to do all of things....school, work, self-maintinence begins to wane. That's the tightrope I'm trying desperately to walk at the moment.
Anyway. So I pitched my excuse about trains and hightailed it out of me.... dragging the voices along with me, and although they have quieten some, they are still there and arguing with every thought that I have. It is a horrible feeling when you are trying to write a blog entry having one voice decry that 'that's not what I said' another voice laughing hysterically and saying nasty things about what I'm writing and what a loser I am, and another voice telling me that we are alone and we need to call somebody to talk to us, even though its midnight and I'm trying to reason with 'the Baby" that we can't call somebody at this time of night.
Well, I'm going to leave it there... the entire post probably makes no sense, as my mind is a bit all over the place. Sorry bout that!
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