Saying Good-Bye Well: Part 2

Today was my last appointment with my therapist, Megan.  Last week I had my last visit with my nurse practitioner, Sarah.  There’s been a lot of blubbing (as the BBC might say), and not all on my side of the couch.

I thought I would be a mess.  These two women saved my life many times over.  They taught me how to be bipolar and still function in the world.  When they set up their clinic almost three years ago, they created a sanctuary for me where I was always welcome to hang out with my art supplies.  They are the most professional care providers I’ve ever had.  And I know, without a doubt, that they love me.

I know, too, that their consistency is the reason I can leave them.  I take everything they’ve taught me, their humor, and their open-heartedness with me.  I will be fine, whoever I find in Muskogee to be my therapist.  It will be a new relationship enriched by the healthy, positive ones I had with Megan and Sarah.

Today, the three of us ate lunch in Sarah’s office, laughing and leaking tears in equal measure.  I know this sounds horrid, but their distress lifted me up.   I’ve been struggling with all the uncertainty of this move—not knowing when it will happen, making lists I can’t act on.  Today’s loving closure gave me a much-needed sense of a job well done.  I drove home feeling lighter than I had in weeks.

In her card to me, Megan wrote in part:

I am a better person and a better provider because of the things I have learned in our work together.  You are super fucking awesome, and I will miss you tremendously.

Sarah wrote:

“In a world of ordinary mortals, you are a wonder woman.” —Queen Hippolyta (Wonder Woman’s mom).  I will miss you dearly.

I am so grateful to have had them on My Adventure.

The Birchwood Team. Megan—back row, second from left. Sarah—front row, in the chair

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Out-Out Patient

Triggered by a traumatic event a few weeks ago, bipolar depression brought its bags and settled in for a long visit.  This past week I started going to my therapists’ clinic every morning to break up depression’s momentum and build my own form of Out-Patient Care.  I arranged the little alcove they set aside for me—a folding screen and white noise machine to make the patients in neighboring offices feel safe in their privacy plus the high table and chairs.  I brought in my art supplies and a large cushion to sit on the floor, and went about filling the tall, gray walls with words and colors that I needed.  But that wasn’t enough.

Yesterday, my therapist and I discussed how to create a real program that would help me tolerate this depression without resorting to hospital out-patient care.  I find the hospital programs themselves to be helpful, but interacting in the large group model difficult to the point of undoing any good done there.  So here’s what we’re trying first:

My daily schedule will be from 8:30-1:30, five days a week.  Daily, I will work on DBT (Dialectical Behavioral Therapy) worksheets dealing with tolerating distress, read one of Megan’s many children’s books and journal about it, and make art—either for the space or in my journal.

I feel a lot of dread and the usual suicidal litany gallops through my mind.  I’m uncomfortable and scattered.  My calendar empties out as I can’t tolerate most people or the pressure of going somewhere at a designated time.  But I did ask a friend to lunch yesterday, even though I phased out after twenty minutes.  Concentration doesn’t last long.

At home, I’ve put my TV in the bedroom, so the cats and I camp out on the bed as I try to work on my Solstice cards while half-listening to my go-to depression binge, Fringe (I just started Season Three).

I’ve also returned to Pinterest, where I can look at pretty pictures and hoard new photos of my Pretend Boyfriends.

Later today, I hope to go see the new Murder on the Orient Express and do my laundry.  That feels like a lot in my current condition, but I’ll try.  It’s really all I can ever do, keep trying, keep looking for new ways to get through the worst of the illness while waiting for the shift to come.

Some days it doesn’t seem like much of a life.  The distorted thinking makes that view darker and more hopeless.  Even then, I can see my courage at work, even when the list of obstacles grows like a Bugs Bunny nightmare.

This is my life.  Mine.  For better or worse.

Chicory Days

Earlier this week, mixed-state depression settled in like chicory coffee—black, thick, bitter—and I panicked a little over the mental discomfort.  Seems like I’ve lost all my stamina—physical and mental—and must remember to be gentle while I rebuild both.

Thrashing around last night, trying to find something to ease the cramped thoughts and emotional acid reflux, I remembered my Pinterest boards—particularly, the board I created for just this situation.  Braying Like a Donkey.  There are memes and videos that still make me guffaw, plus photos of celebrities and common folk laughing hard—lost urine and milk-squirting-out-the-nose hard.  While not everyone shares my sense of humor, I invite you to go look—just in case you need a pick-me-up.

Then, today at my regular Friday therapy session, I asked the staff to make marks in my art journal.  I knew they would, even though some consider themselves artistically challenged and prone to perfectionism (it felt sorta good to challenge them for a change).  I will take their marks (and the mangled flower one of them used as a paintbrush) and create something that that is ours.

I needed that.  I needed to engage with people who unreservedly adore me, who remember who I am when I forget, who ask nothing of me other than to be authentic.

This is stamina-building, finding new ways to beat back the darkness.

I did good today.

I Must Be Getting Better…

…because I have no more fucks to give.

Oddly, my bipolar and binge eating symptoms hibernated while I was sick with bronchitis, sinus and ear infections (Can my body not multi-task?  Is my brain too small to hold it all?), so the return of mixed-state depression/rage must mean the other stuff is on the way out.  Yaay (?)

While being physically sick is no fun, the vacation from mental shit-storms and out of control compulsion is heavenly.  It’s like being normal, only full of snot and really, really tired.

I’m still tired and semi-full of snot, but yesterday I rode sad anger back to bed and built a nest of portable projects around me to keep the yammering in my head at bay.

Henry and Emmett attended, but even they knew not to poke the bipolar bear who had no fucks left to give.

One of the hard things about coming back to my normal state of mental abnormality is that I’ve done so much cool art stuff these past two months.  When I could barely breathe, I read a bit in Susan Wooldridge’s Poemcrazy about collecting words, then made Word Cookies out of old art magazines.

I carry them in this little bag that fits nicely in my purse, and offer them like Fortune Cookies to whomever I’m with (which has mostly been people at the drug store, my therapist’s staff, and a few civilians willing to chance my germs).

I’ve been brave about drawing in my journal.

And I created a spread that fell together like a story.  Poor Tom Hiddleston, dumped by the harlot Taylor Swift, gave a heart-wrenching interview in February’s GQ that reminded me of Sting’s song Why Should I Cry For You?  A little research gave me details I’d missed just listening to the song, like “under the Dog Star sail,” which refers to Sirius, and “north, northwest, the Stones of Faroe,” which led me to the tiny cluster of Faroe Islands off the coast of Iceland.  I loved the metaphor of a broken-hearted sailor on the bleak, Arctic seas.  And I loved pulling together all the elements for the collage.

The wall quilt I started before I got sick is turning into a fabric collage—a place to try new skills like painting and stenciling on fabric.  Tearing apart my old art magazines for the Word Cookies, I found wonderful tips and examples.  When I gave a fuck, the possibilities thrilled me.

The materials to make three new art journals came out of my cupboard.  I finished two.  The third now languishes on my table, waiting for the fucks to come back.

The Buckaroo Banzai journal

My favorite quote from the movie by evil Emilio Lazardo.

Art by Andrea Matus DeMeng

I took a class with Andrea at ArtFest.

One week in therapy, Megan and I looked at commitment, not just making commitments to others, but also keeping promises to myself.  I realized that my longterm goal of writing a book to be published carried no joy for me anymore.  In fact, working on it was often painful.  Why was I doing this again?  So people at my funeral could get a party favor?  Morbid, bipolar-based reasoning.

I don’t have to prove myself a writer anymore, or leave something “of substance” behind.  I can spend my life pleasuring myself with weird art that practically falls out of me, instead of grunting over tortured prose.  So, I let that ancient goal go.  There are, my friend Sue tells me, only so many fucks a person can give.

Yesterday, in my Nest of Apathy and Rage, I emailed Megan, just to whine.  I knew, eventually, that the anger and depression would shift, but it was big and ugly yesterday.  Even if I had none, I wanted someone to give a fuck.

Have I mentioned that my therapist is awesome?  And funny?  She wrote back later:

I hope a fuck ton that you feel better soon. 

The Adventure Continues.

Second Helpings of Joy

Joy DietI’ve been reading Martha Beck’s The Joy Diet, a self-help/Life Coachy recipe for uncovering and going after your Heart’s Desire.  If you haven’t been in therapy for decades, and feel like there’s something missing or off in your life, this would be a decent place to start.

I started therapy when Ronald Reagan was President, so none of the material is new to me.  Still, I like hearing things presented in a new way, especially when the author has heart and a sense of humor.

Take her chapter on Treats.  These are the things/experiences we’re to reward ourselves for taking a risk toward that Heart’s Desire.  Very Pavlovian.  But Beck also wants her readers to give themselves at least two other Treats a day, just because folks generally don’t do that enough.  I liked that.

And Beck’s definition of “Treat?”  Anything that makes you feel like smiling.  Since most of us are programmed to grimace automatically in public, she gives homework to help the chronically repressed find what actually warms their cockles.  I like how she takes her readers by the hand, breaks each step to Nirvana into tiny, measurable actions instead of leaving them stranded in nebulous Woo-Woo Land.  And I like how she compares us to pigs.

So some of these ideas percolated in my hind-brain as I played with my art journal this weekend.  I worked on a cross-over spread, taking characters from a short story I’m writing and doing cool things with letters they’re writing to each other.  I adapted a Dixie Chicks song that I love and made it my character’s.  I treated pages from an antique, hand-written journal to use as their stationary.  It thrilled me to come at these characters and their story from a different angle, and to make something so gorgeous.

Claire&Richard BeforeBut, when I tried to write my new lyrics on this scrumptious paper, no marker or pen I owned made a consistent mark.  I worked for hours, going over the blotchy, ragged letters again and again.  It still ended up looking like a serial killer’s tease for the FBI.

I stopped when my hand cramped too much to hold a pen, and I was willing to let it go.  Some experiments don’t work.  That’s why they’re called experiments.

But as Henry walked across my shins in bed this morning, I got one of those lightbulb ideas.  The problem wasn’t with my pens, it was the paper.  I’d made it too slick.  How could I give it a little bite?

Clarie&Richard RedoI jumped out of bed and went to work, mixing matte medium with a few drops of gesso, adding paint, then taking fresh pages out of the hand-written journal and applying this concoction with a roller and paper towels.  I tested one corner with a gel pen before spraying the pages with fixative.  It took the pen beautifully.

The whole process filled me with joy.  Setting a problem aside, receiving the answer as I passed through the Creative Gold Mine between sleep and wakefulness, using media I didn’t own two months ago, and actually creating a thing the way I imagined it in my head.

Claire & Richard

When I finished the spread, I couldn’t stop grinning.  Here was everything I loved—my writing, my art, my music, Richard Armitage. . .  Layers of meaning overlapped like the layers of paper (I love a metaphor you can actually touch), and color fed some hungry animal inside me.

Probably a pig.

Daft Trek

Social Services, the Final Frontier.  These are the voyages of one unclassifiable nut-job.  Her ongoing mission: to explore convoluted government gobbledy-gook; to seek out new services that might actually help; to boldly leap over the cracks in the system where no one has leapt before.

ξ

After I finished the Intensive Psychiatric Rehabilitation program in late June, the search was on to find some kind of support that might fill the gap.  IPR wasn’t therapy, but working with Aly for two hours twice a week turned out to be the best therapy I’d ever had.  How can you not go deep and actually problem-solve with that much one-on-one time?  Most participants in IPR spend half their time in groups, but we had trouble finding peers for me (I’ve got so much insight, you know), so Aly and I just met by ourselves.

We both knew no social service could provide what Aly gave me, so we looked at the kinds of support I might find.  She and my therapist thought Lutheran Services of Iowa might be a fit.  I went through two-hour assessments with both my caseworker and LSI, was approved, and started seeing a caregiver in July.

I have a caregiver.  To say I have mixed feelings about that is like saying Emmett is a little nervous (though, here’s a barely-related photo of both guys sitting next to me as I write this with Em combed and smiling).

Together

Anyhoo, it’s taken me all summer to get used to the idea of being a person who could benefit from a caregiver.  When I look at it in terms of what I need to stay out of the hospital, I get it.  But, like everything else concerning my mental health, I don’t fit in the usual categories, so we had to get creative.

Leanne, my caregiver, and I met for coffee once a week all summer at the new coffee house (Yaay! Marshalltown finally has a coffee house!)

Brew House

This was all part of my care plan—to get basic support.  It’s not therapy, but more than friends and family can provide.  For that hour, I get to talk without worrying about my social skills or being reciprocal in any way.  Most human interaction is two-sided.  Conversation is give and take.  And, while Leanne and I do converse, the point is we don’t have to.  For that hour, she’s there for me, and if I need all that time to process, I don’t have to feel guilty, or selfish, or worry about ruining our relationship.  Over the summer, we honed that process to where we’re both comfortable with it.  And it is a true and valuable tool.  Like my new soaking tub, I can relax with Leanne now and just let go.

The other part of my care plan is for Leanne to help me keep my apartment clean this winter.  Since I’m allergic to dust mites, I need a clean living space in order to avoid the asthma flares that lead to bad colds and, often, pneumonia.  And, since winter historically brings more severe depressive symptoms, cleaning (like anything requiring effort) flies out the window.

Halli, the LSI director, told me that their caregivers aren’t housekeepers.  They help clients set goals and work alongside them.  I’m expected to do the real work.  I like that concept.  I asked my sister to do that once, to come over and just help me figure out how to get my place cleaned.  I remembered what a huge help that was.  If I could get used to a stranger coming into my home, I thought that kind of support might help me avoid getting sick so much.

So, last Wednesday, Leanne came over and helped me replace the filters in my air vents.  It’s a big job, I even got the consultation from specialists of air duct cleaning in Kansas City, MO.  All the vents are in the ceiling.  I put filters in the ones I could reach by standing on a chair, but that was five years ago.  Last week, with a real step-stool, we replaced the black filters (ugh!) and got all the vents covered in the hour Leanne helped me.  I spent the rest of the day cleaning the grill on the intake vent (gross!) and laying filter material across that, too.

Intake Vent

Awesome!  Except I didn’t think to wear a mask.  Oops.  Now I’m fighting the very thing I tried to avoid—a bad head cold that will probably go south soon.  I should have known better.  I wore a red shirt that day, and we all know what happens to those guys.

I Think We Need a Bigger Boat

boatI found out today that my therapist and the nurse practitioner who provides my medication supervision are leaving to start a private practice of their own near Des Moines.

If you’re in the mental health delivery system, you’ve probably experienced this kind of trauma.  It takes years of searching to find a therapist who gets you, to find a psychiatrist or NP who works with you, only to have them leave, or the clinic closes, or whatever kind of insurance you have doesn’t work anymore.  The most essential piece of your recovery drops out of existence.  So you flounder, and in that vulnerable state, have to start searching all over again.

I’m lucky in that they will only be an hour away.  After talking with my therapist today, my plan is to stick with them if they can get Medicaid-certified.  Lots of “ifs.”  So, it doesn’t seem like such a big deal.  Except it is.

I hate how stuff like this confounds and unmoors me.  Even with a solution in sight, I feel hysteria crawling up my throat.  Just when my support system seemed to be jelling, just when it seemed safe to go back in the water…

I have to watch my catastrophizing—I see sharks when it might just be tuna.  I have to keep breathing.  I have to remember I’ll be fine no matter what happens.  I’ve been here before—back when my boat didn’t even have a motor.  So, I’m okay.  I just wish there wasn’t so much chum in the water around me.

bigger boat

March Madness

TumbleweedPhew!  February is behind us.  Enough, now, of the darkness and bitter cold and on to mud below and sun above.  Historically, March is the time I rouse from my mental hibernation and blink at the mess I’ve made while thrashing around in the dark.  I spend too much money when I’m brain-sick.  I eat compulsively.  Fat and broke, I usually overreact.  Last year and the year before, I put myself on strict money and food diets… and I ended up in partial hospitalization.  Hmmm.  Maybe this is a pattern I need to address in IPR.

The mission of IPR (Intensive Psychiatric Rehabilitation) is to help those of us with mental illness succeed at a goal we choose.  My goal is to keep living in my apartment, not taking sabbaticals in the hospital, so my caseworker, Aly, and I look at any skills needed to do that.

Partial hospitalization gives me structured support, a place to do the hard work of managing my illness when it’s overwhelming, and accountability to professionals who understand me.  One of my new skills is to seek out more structured support outside the hospital setting.

Seeing my therapist and participating in IPR every week are two kinds of structured support.  Recently, I added a weekly meeting with my Peer at Integrated Health Services (where I worked for a time last summer).  Allison and I sit for an hour and talk about doing the hard work of recovery.  The more I can get this kind of help, the less likely another hospitalization.  And since the Partial Hospitalization Program closed its doors last year, my only option now is full admission to a psych ward.  To me, that’s not an option.

So, it’s also important to look at this pattern of deprivation in the early spring.  As Aly and I talked through this, it seemed so simple.  Now is not the time to white-knuckle anything—not my budget, not my diet, not an out-dated version of myself as responsible and in control.  If there was ever a time for my Kinder, Gentler practice to kick in, it’s in March.  Now is the time to acknowledge how ill I’ve been and how well I’ve coped.  Now is the time to gently come back to cooking at home when the depression lifts enough to allow it.  Now is the time to remember that this is what my savings is for—to pay the bills my illness created over the winter and to give me space to breathe.  I’ll be able to live within my means again, but not right now.

This whole idea is radical—not clamping down to pay off my Visa bill or repaying the money I took from savings.  The idea that I can do those things later, should do them later, boggles my mind.  So simple.  So very Kind and Gentle.  It’s lovely to be my own best friend.

Huh. Okay.

Musical SawA few weeks ago, as I papered this space with handiwork from my little studio, I got an odd request from a self-proclaimed fan named Heba at PlusGuidance.com.  She liked my collaged cards, and my blog, and asked me to write a piece for them about using art as therapy.  Not sure about what I was being asked to do, I explored PlusGuidance a little bit.

It’s a hip sort of site with lots of moving parts and graphics.  But the most interesting part is that folks can get online counseling or guidance.  There’s a section for articles and news about mental health issues.  Another section is more of a clubhouse for members to hang out and chat.

I thought, “Cool!” and sent them a piece called The Art of Distraction.

Thanks, Heba, and all the cool, hip folks at PlusGuidance for asking me to be a part of the club.

Intensive Care

Collage art, greeting card artSince July, I’ve been in a program called Intensive Psychiatric Rehabilitation.  It’s Medicaid-funded and designed to help those of us with “serious and persistent mental illness to achieve goals that improve success and satisfaction in living, learning, working and socializing.”

It’s like nothing I’ve ever experienced in any kind of health care service—thorough, gentle, involved, deep.  For these first six months, I’ve met with my IPR Facilitator (Aly) two to three times a week just gauging my motivation and willingness to go through the process—doing lots of assessments, looking at self-awareness and life satisfaction, and meeting in a small group to hear how others are doing the same.

I believe my participation in IPR is a big reason for my greater stability during the last half of 2014, but maybe not because of the actual work I do in the program.  I get to spend four to six hours a week with a caring professional, talking about my life and my illness, who gives me useful feedback.  Considering that I see my therapist weekly, that gives me up to seven hours a week of therapeutic support.

I can’t begin to explain how lovely that is, to have somewhere to go every several days a week where I feel safe, heard, challenged, and successful all at the same time.  I have felt parts of me relaxing that have been clenched for years.  The notion that I could be kinder and gentler to myself grew naturally from this place of safety and care.  The outrageous idea that everything about my life—the wild and warp-speed mood swings, the practical struggles with money and relationships, my weight, my compulsions, my delusions, my mistakes and mis-steps—could be accepted and given a place at my internal table became my new mantra.  “Yes, that, too.”

This increase in professional support prodded me to start searching in different ways for more natural support.  I found a wonderful, active community at the Des Moines Unitarian Church, signed-up for a class there in SoulCollage®, met some interesting people and sang.  I started reaching out to my old friends in Minnesota.  I joined Facebook, fer cripes sake.

World She InhabitsOver the last few weeks, my work in IPR has taken me on a new journey of discovery.  My focus in the program is on my Living Environment, to assess and eventually set a goal about where I live.  This could also include a “Staying” goal if my current home turns out to be best for me.  We looked at all the places I’ve ever lived, which ones I liked most and least and why.  Aly asked me to imagine my perfect space, perfect neighborhood, perfect part of the country—to dream big and with extravagance.  We’ve spent time tweezing out my values and preferences and laying them over my ideas about home.

One of the many assessment parameters Aly used was to imagine what the significant people in my life would say about my current living environment, about the idea of moving elsewhere, and what their concerns might be.  I try hard not to presume what others think about me, so I wasn’t sure.  But I thought in general they considered me successful  (This is an IPR term.  It means that you generally stay out of jail and the hospital, that you can perform self-care, do basic housekeeping, and partake in enjoyable activities in your home.  Luckily, I rock at being successful).

This exercise made me curious to know what my friends and family really thought, so I started asking them.  It’s always a little scary to ask people what they think of me.  They all carry memories that I’ve lost, things I’ve said in the past, events and experiences fried out of existence by ECT.  Plus, an outsider’s view of my often-times incomprehensible behavior can carry an emotional charge for them.  I’ve done a lot of weird and hurtful things in my bipolarness, and turning over those rocks can be deadly.  But, getting that outside perspective is valuable for someone with mental illness.  We get trapped in our own faulty musings.  Someone else’s reality can be shocking, but life-saving.

As it turned out, they do think I’m successful, but another theme started appearing.  As I’ve reached out to my friends in Minnesota, they all to a person have said, “We don’t know why you moved in the first place.  It never made sense to us.  This is your home.”  And even my sister, who orchestrated my exodus from Minneapolis, said, “You’ve worked hard, made friends and have a routine in Marshalltown, but Minnesota is home…”

My compulsive side would do something with this information.  I’m choosing to just add it to my IPR file along with all the other assessments and data.  It will be a while yet before I actually choose a goal in my Living Environment.  In the meantime, I want to keep practicing this kinder, gentler attitude.  I want to keep attending UU services on Sunday.  I want to schedule my next visit to Minneapolis and spend time with those people who still love me and remember me.  I want to spend time with the people here in Iowa who love and support me, too.  I want to keep an open mind, explore, evaluate.  I want to keep being successful.

Because, you know, I’m on an Adventure.

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