P Is Back In Therapy: The Crisis Plan

July 29, 2012

Fuck my bleeding ears! I’m trying to stay positive. I really am. I’m relying on my inner wisdom.

And these days, I’m maintaining a better outlook more than not, which is the complete opposite of what could be said a month and half ago. I feel funny though, and not previous-post funny. The anxiety has just been maddening.

On Friday night, when I hung out with my brother, I ended up staying over the night. Well, around 4am (as usual these days), I woke up with chest pain, feeling like I was having a heart attack. You’re not having a heart attack P. This is just anxiety. I was nauseated, felt the same old prickly feeling in my toes and hands and was shivering too. So I woke up my brother and asked him for another blanket. I told him what I felt and he agreed about the anxiety.

Earlier Friday, I was eating lunch with my dad at the kitchen table. We had arepas and queso and coffee. I hadn’t even touched my coffee yet and my hands were trembling. (I swear, I’ve been cutting back substantially on the coffee.)

“Your hands are shaking really bad. Why are they shaking like that?” he asked.

“I think I’m just having a lot of anxiety right now.” I lowered my head.

“About what?”

“I don’t know. It’s a lot of things, I guess.”

“It looks as if you had Parkinson’s”

Ah my dad, good ole papi. Gotta love the way he throws in something that sounds both amusing and insulting or hurtful (to me) without even meaning to–but sometimes meaning to. I’d made a joke about looking like Michael J. Fox during an interview on my very second (or third) post here! So, yes, this isn’t new. But now it’s noticeable to my dad even?

Today, right now, I’m feeling the same way. I hope it passes soon. I hope typing will at least keep me at ease a little while.

********

I wonder if it’s the medication that’s making it worse. Almost every morning it’s the same.

At the end of May, a few weeks after the incident, I saw the psychiatrist. She had the Fluoxetine/Prozac upped. I keep wondering, how did I get here? Accepting drugs from a psych? For me, taking “medication” is last, last, last resort.

I saw her again this past Thursday. She said something that both surprised and didn’t surprise me.

“I’m thinking… you seem to have bipolar, bipolar two,” she said midway through our appointment. These appointments, by the way, are actually forty-five minutes long. Ok. Well, at the moment, labels don’t matter to me much. I just need all the help I can get. I don’t want another incident to occur, for the sake of those around me at least. But in part, for my sake too. And that’s a good thing! It means I’m seeing light at the end of the tunnel, despite the way I’m feeling.

Long story short, she prescribed Lamotrigine/Lamictal. I haven’t gotten it yet. I barely ran out of Tegretol last week and didn’t bother to get it filled. Well, there’s was more to it than that. There was the money issue. It’s rough right now. I just wish I could handle things better, without getting so frantic, so worked up inside… Swimming is the only time I don’t feel like I’m drowning!

And now I’m to try yet another drug?

I don’t know. I just don’t know…

********

But therapy. Right!

I finally got in three weeks ago. The very first week, we covered a lot.

She’s also a young brunet like Ex-Young Therapist, but it’s a university, so what was I expecting, an old student? Anyway, we covered basics, like what I did with my Ex-Young Therapist, what worked, what didn’t work. Turns out this new therapist (I’m going to call her Brunet Young) worked in a team with Ex-Young Therapist, so she already knew a little bit about me. A consultation team is part of dialectical behavioral therapy (DBT).

After going over some of the basics, like major problems in my life, she mentioned the overdose incident from early May. Has it been two and a half months already?

****

“In the intake interview, you mentioned that you didn’t consider the overdose a suicide attempt. Why is that?” Brunet Young asks.

“Um… I’m not sure,” I reply. I stammer around and stutter for a little while. “Maybe it’s because I have a hard time seeing it as that. But also, I think I was gambling. I was playing Russian roulette. I told myself that if I died that night, then fine, but if I didn’t, I would have to just try a lot harder. I mean, I would’ve definitely taken the entire bottle had I wanted it to be more sure…a more definite thing.”

“How much did you take?”

“About eight painkillers and two sleeping pills.”

“And you were ok with the fact that you might’ve died as a result?”

“Yes, I was.” It’s scary to think, but at the time, I was.

“You know, from a clinical perspective, there is a distinction between suicide attempts. There’s an active suicide attempt and a passive one. What you describe is a more passive attempt.”

She made sure to emphasis that it was still considered an attempt. Or at least that’s how I heard it.

****

We then wrote up a crisis plan, which looks a little something like this.

My Plan

When I feel upset and have thoughts of hurting myself or someone else, or I feel that I am in emotional crisis, I will take the following steps:

1. My warning signs are (e.g. very self-critical, hopeless, isolation, staying in bed)

-passive thoughts of suicide increase in frequency and become clearer, more of an urge/stronger urge
-insomnia and crying spells worsen
-triggers (e.g. Monkey Man, relationships, drugs, reminders, etc) –> anger/rage
-isolating myself –> not picking up calls, curling up in bed and staring blankly, dissociating
-being upset about hearing loss; being upset on days when I’m not able to go swimming
-chronic bone pain intensifies; facial nerve pain increases

2. My reasons to live are:

– I can do a lot for others. I have potential to do a lot.
-I don’t want to hurt my family

That’s all I have for reasons right now. I used to have career plans, but that’s not strong-holding at the moment. It has to be something that you really believe, something that will grab you, will keep you from doing anything permanent–a true deterrent.  I think I need to come up with more. I told Brunet Young this and she said, “It’s alright, we’ll come up with more later.” I thought of adding “love”. Just focus on the word love, the meaning of it for me, how I’ve managed to hold on to “love” in my life. But love of what? Art? Life? Beauty? Family? How can you focus on that in a “crisis” situation when all you’re thinking about is the pain you’re in and peaceful bliss of death and non-existance?

3. Do these things to calm myself or distract myself:
-Mindfulness exercise

-say serenity prayer and Buddha refuge prayer
-If at home, call Luna, pet and cuddle with her. (The good thing about Luna is if she hears me crying, I don’t even have to call her over. She finds me. Sweetest dog ever.)
-remember “Distress Tolerance” –> follow breath, deep breathing
-self sooth –> hum a tune, splash water on face, take warm bath, play ukulele
-write, write, write

-read, read, read

-watch TV (comedy preferably)

-stretch with yoga mat
-image focus –>meditate
-progressive muscle relaxation

-review “coping card”

-take a short nap and/or break from whatever you’re doing (e.g. go out in the fresh air and walk the dogs)

4. Contact a friend or family member that I can trust:

name & number: answering service at PRSC –>that’s the university’s psychological research and services center

Also, I’ve listed my brother, mom, and maybe B and Mansie, Ryden and Eloise, although I’m having a hard time with this one. I’ll really need to work at it.

5. Call PRSC and ask to speak with my therapist

6. If it is after clinic hours (M-Th 9-8; F 9-5) and I can’t reach my therapist, call the PRSC after-hours answering service at **********

7. Call a hotline for support or assistance:
1-800-273-TALK (8255)
I also have several other local hotline numbers included here. But I don’t do hotlines. It’s not how I roll.

8. If I am unable to get help quickly enough and feel that things can’t wait, I will call 911 or go to the nearest emergency room for help.

********

The thing about the crisis plan is that I have only been able to get myself to do steps one through three, maybe four. I’m able to recognize warning signs and use methods like distress tolerance and mindfulness, but contacting a “trusted” person is difficult. That’s the thing, on Friday, I did contact my brother, but I did it after too much thinking. Also, I don’t tell him how bad I feel, I just ask him what’s up. Brunet Young said that was fine, I don’t exactly  have to tell him, especially not now if I’m not comfortable doing so. The important thing is to distract in non-harmful ways.

Another difficulty I’m having with this crisis plan is knowing the “answering service” after hours aren’t open on weekends. I’ll have to ask her about this. But even then, I’m not the type of person who would call. I think I only called Ex-Young Therapist twice or maybe three times during a “crisis situation”. And that was after two years of seeing her! One of those times was a few days after I found out about Monkey Man’s death this March.

I used to hate the idea of therapy. Sometimes I still do. Right now though, I’m just glad I finally got in again.

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16 Responses to “P Is Back In Therapy: The Crisis Plan”

  1. Kyle said

    looks like you are doing all the right thinks paz and for all the right reasons

    keep on blogging

  2. DeeDee said

    Seems like things are moving forward – hope Lamictal is useful for you. It’s been great for me.

    • PAZ said

      I hope so too. I’m hesitant to try it as I am with any new drug (funny enough I’m not so hesitant with street drugs). And Lamictal has that funny and/or scary “rash” warning. I wish there were a genuine test that would prove that I have something in my brain, ya know?

      I feel like any anti-epileptic is only going to make my hearing worse. ughh…

      Glad it’s helped you though! That’s both encouraging and helpful to know. I vaguely remember reading a post where you started on it. What dosage are you on?

      • DeeDee said

        I started at 25mg and slowly worked up to 150mg. Stayed there for awhile, and then recently increased to 200mg. It’s a very, very slow process to get to an effective level, but it really smoothed things out for me.

        • PAZ said

          Sounds good. Reason why I wanted to know is because I weigh 47 pounds and she started me on that too. I’m so paranoid at the moment though, that I started on Tuesday with half of the 25mg. heheh. She wants me to eventually go up to 100mg. We’ll see. I hope I chill out a bit soon. Thankfully the depression is lifted, but I’m still swinging really bad. I just want to be able to smooth out like you say and function a little better. I don’t know.
          xoxoxxx

  3. Would it help if I said you were funny and interesting? I think it’s great that you have a crisis plan; it must be a little terrifying to need it, but you should be reassured that you’ve got steps to take. I think that’s a lot more than others have.

    While my problems were not as serious, I know therapy did me a lot of good, so I’m glad you’re in again. The medication might feel like a step backwards in some ways, but many mental problems are medical conditions that benefit from medication. I hope it works out for you.

    • PAZ said

      Yes, it would Purplemary! When someone tells me I’m funny, I take it as a huge compliment.

      I have more faith in the therapy than in the drugs. I’m glad it did you a lot of good. It had done good to me too.

  4. Prozac gives me the really bad shakes at certain times of the day. I remember having to tie the umbilical chord on a baby guinea pig for the owner and my hands were all over the place, made worse by the guinea pig being minute, making it look like I was nervous and shouldn’t be doing the job. Grrrrrrr drug side effects cxoxoxoxoxo

    • PAZ said

      Sailor! You have such an interesting job, you know that? I mean a guinea pig. I could just imagine.

      As far as the shakes. Is it the Prozac? That’s for sharing. I suspected it was. I mean, I’ve had “the shakes” most of my life because of anxiety, but these shakes are hardcore. I mean, my dad even noticed, which is a rare thing.

      What time do you take it? I take it in the morning. Oh and I’m on generic Fluoxetine. Baggh. Drugs…

      Love y besos xoxoxxx

      • Yeah generic fluoxetine and they just upped it to 40mg per day so the shakes are even worse.
        I take them at 10.30 or 11.00 at night because it makes me really sleepy within half hour of taking it. I usually get the shakes around 10.30 or 11.00 in the morning which is odd now I think of it….. xox

        • PAZ said

          I’m on 40mg a day too. She upped it from 20mg to 40 after the incident in May. I wonder… I’m really small. That’s like me taking 70-80mg. I also have restless legs syndrome and its worse now. I’m not sleeping very much. Is my psychiatrist trying to kill me Sailor? lol. (note I’m joking but also serious…ahhh)

          xoxoxxx

          • Why would your psychiatrist want to kill you? I think if psychiatrists were murderers they wouldn’t be psychiatrists. I think your psychiatrist is probably trying to help, but it just feels unhelpful.
            Maybe Prozac isn’t the right drug? I mean it’s not doing much for my mood, but if the side effects are outweighing the benefits, then it’s probably time for a med review…….
            I actually heard voices the other night since I’ve been upped. That worried my psychologist a bit so now we have to monitor that…….
            love xsoxoxoxoxxox

          • PAZ said

            That sucks Sailor. I heard some voices while I swam a few times this week and last. But it wasn’t anything clear. For a minute, I thought someone was talking to me and I stopped to look around but the only other person there was just swimming…

            xoxoxxx

          • It was freaky. I heard a kids voice, in the middle of the night, telling me to go and check on my Nan. It was as clear as day, so I freaked! Especially because of what it said. I put it down to the Prozac, but then the next day I found out my Nan had been ill in the night and ended up calling an ambulance out. I dunno what freaked me out more! xoxoxox

          • PAZ said

            That is pretty freaky deaer Sailor Carrie. Sometimes I wonder if things like that are ESP related, though I’m inclined to think not. Either way, you sensed something wrong with your gran. Was she sick before this incident? Is she alright now?

            Sorry I’ve been out… Ugh. My mom had a dream once where she got up late for work and saw and accident on such and such street. Well, when she woke up, sure enough, she was late. And on the road, she saw the accident. Said the color of the car was the same. Maybe we link things to our memory? It’s like deja vu, perhaps? Also, could be Prozac induced. I finally started the Lamotrigine, hesitantly. I talked to the therpist about the Prozac and Lamotrigine yesterday. She and I agreed I could give it a try, but long term goal is do get off meds. We’ll see.

            BIG HUGS
            Love y besos xoxoxxx

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