The End of the Psych Road?

Because what’s worse than knowing you want something, besides knowing you can never have it?

James Patterson

I have two psych appointments next week, my last ones, hopefully forever. I can’t imagine how bad I would have to be that would make me voluntarily go back, especially to the meds nurse. I would actually like to have real therapy with my therapist, but that doesn’t seem possible, and it is not her fault.

I have been very energetic lately, with a racing mind. These are notes that I am preparing so I can make sure I cover everything I want to. I know I will not want to leave the therapist’s office for the last time, and I am just as certain that I will walk out of the meds nurse’s office within 30 minutes. She is a walking, talking red flag collection.

This is being posted for easy access so I can cover everything I need to. It is easy to forget things I want to bring up, even though I write them down in a notebook. My handwriting is so bad I can’t read it. So even if I remember to look at it, I usually can’t read it! My posts might not be coherent, but they are legible.

I know it sounds as if I am angry at the med nurse and I kind of am. I am also writing this a week in advance in the hope that I can be thoughtful and less confrontational. I am not a confrontational person, so I am bad at it. Hopefully, this will help me get my concerns across. If she dismisses them I can properly refute her and walk out while maintaining my composure.

There are a few viable options left. Before I give up completely, I feel I owe it to my therapist to see if I can try them. I know that is an odd thing, but I just feel like I owe her my best effort. ‘Given the med nurse’s attitude of only wanting to try the same things that not only failed in the past but did me great harm, I am not sure I have any options.

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Except you cannot outrun insanity, any more than you can outrun your own shadow.

Alyssa Reyans

My therapist suggested that I see someone to get help for my terrible sleep. I was apprehensive, but I thought it couldn’t hurt.

What I got was a horror show from a nurse practitioner, AKA med nurse.

First, she had no interest in helping to improve my sleep. She went straight for psych meds.

To be fair, she did go over my extensive history of psych med failures and pain.

That makes what happened from that point on even more terrible.

How could she miss the obvious next step?

That next step is not trying the same thing over again.

She did give me a light prescription of a benzo, but in keeping with the theme, she did it in a cruel way.

The size of the pills and the amount I get per month makes it necessary to only use it when necessary, and it is such a low dose, that it doesn’t help. To avoid running out, I usually don’t take it.

Even when it appears that she is trying to help, she does it in a way that hurts me.

I have seen her once, and she is pushing the idea of me being bipolar. Going by the insanely idiotic DSM 5 definitions, it is impossible. Despite what I wrote a few years ago, there really isn’t any proof I have had any manic episodes. I wasn’t trying to self-diagnose, but it was the closest word I could find to describe it.

The reason it is impossible is that I have never had a full mania episode - required for bipolar 1. Even though there is no proof, it is possible I have had very minor hypomania episodes now and again, nothing terrible or damaging. That could imply bipolar 2, but that is impossible because I have psychotic features, and that makes it exclusionary. Knowing the idiocy of the DSM 5, she will probably claim bipolar NOS, which is beyond meaningless.

This is the agenda for my next appointment, and if they are not doable, or she ignores me like last time, it is the last appointment.

1. She asked me to research two meds.
   • Both have nasty side effects, including dangerous ones that I have already suffered through.
   • Neither of them is more effective than any other psych med.
   • Neither of them is that much more effective than placebo.
   • It is just trying yet again what has failed and harmed me.
2. A day later, through my therapist, she asked me to consider Lamictal.
   • I told my therapist no.
   • A day later, another nurse called to ask for my input. I told him no.
   • No means no.
   • It is primarily an anticonvulsant, and I would refuse it to treat my epilepsy.
   • It has five ???!!!??? black box warnings. Those are bad.
   • Besides that, it has a large list of bad side effects that are common
   • It is prescribed for bipolar depression and has no effect on unipolar depression. I am not bipolar!

3. I talked to the therapist about my last appointment, and that discussion of my impression of it triggered a seizure. That is a good measure of how much damage psych meds have caused.

4. I came to see you for sleep meds - you pushed everything but. What sleep medications will not trigger my psychosis and help me sleep consistently?

5. The Benzo prescription
   • What I used to have prescribed was 1 mg of Klonopin, twice daily.
   • That dosage took maybe 90% of the anxiety away.
   • I took it as needed, and I never had to worry about running out if I had a few straight days of high anxiety.
   • When my last shrink needlessly cut me off I didn’t have to do a taper
   • Withdrawal effects with benzos are notoriously harsh.
   • I had no withdrawal effects because I took 2 or 3 a week normally and maybe 5 during a bad week.
   • 0.5 mg does next to nothing, and I have to be extremely selective when I take it because I get 15 a month.
   • It is worse than worthless, it is cruel.
   • I think I have earned trust that I won’t abuse them.
6. I told you that I demanded pharmacogenetic testing with my last shrink before I tried anything new.
   • I was told no back then, so I walked away.
   • You completely ignored me.
   • The VA has been doing these tests for the better part of a decade.
   • Will you order it?
7. Ketamine Therapy
   • I have treatment-resistant major depression.
   • I have a long list of meds that failed to work, most of them hurt me and some caused permanent side effects.
   • This went on for years and only got suffering in return.
   • How long will you want me to suffer before we try something that works well and has no real long-term effects?
   • You are willing to give me meds that we both know will not work and will cause bad side effects.
   • Why can’t we skip that and try something potentially useful.
   • I don’t ask this lightly because the treatments scare me.
8. My therapist suggested a few other things that I will discuss with her
   • If she is willing to set them up herself or if someone besides you sets it up, I might consider those options even though they are a reach
   • At least they don’t have long-term side effects, so I have nothing to lose.
9. You mentioned making the DEA happy during the first appointment.
   • If you are allowing low IQ thugs with no medical background and no moral or ethical reason to sway your medical judgment, you are not acting in my best interest.
   • Why are they in my business anyway?
   • They are law enforcement, and prescribing meds well within medical guidelines is not an illegal act. They have no place here.

I probably won’t make it through the list before I walk out.

She clearly wants to hurt me - this is not a delusion or paranoia. It is a justifiable conclusion based on provable facts. See, I have talked about this before in one of my earliest articles. One of the most frustrating things about the psych field is that one patient’s demon is another’s angel. Not that she is a demon, but I can’t think of a better way to put it.

I am so anxious and unused to confrontation that I am afraid I will mess it up. I am afraid of walking out, I just want to make sure that if I have to that she knows exactly why because I was able to lay out the reasoning. Of course, the better case is that we are able to get somewhere positive. I am shaking just thinking about this appointment.

I hate that I have “with psychotic features” tacked on to the end of my diagnosis. It makes it so much harder to be taken seriously. I don’t usually care about what made-up diagnosis they label me with. Most are so similar to each other, and the treatments are the same. What is the point? It seems to be just overcomplicating things to justify their paychecks. Medical people are using that label given to me to stigmatize, minimize, and dehumanize me.

That is fine. I deserve to be hurt and am not really human, but I wish that they were honest about their intentions.

Ironically, I could trust them a little more than I do now if they could admit that openly.

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What if talking about your feelings doesn’t fix anything? What if what you really need is to make the feelings go away?

Amy Reed

Therapy confused me. One appointment every two weeks for six months is not therapy.

I am not sure what it was, but I can’t say that it didn’t help. It certainly didn’t hurt. That feels weird to say. I have had so many horrific therapy experiences in the past.

We didn’t have enough time for me to understand her and her perspective, and she didn’t understand me all that well. Admittedly, I thought that for the first few sessions and realized she had a better understanding of me. Not as good as I think beneficial therapy would be, but enough to help some.

The therapy model used was odd(CBASP). That model was created by a psychologist whose book I read at her request. He seemed to misunderstand that he was accepted all his adult life, so it seems odd to base therapy on that, when it doesn’t apply to everyone suffering from chronic depression. Maybe, I am misunderstanding the whole thing and filtering it through my perception - which might be distorted. Ha! Now, I am talking like her. Not sure if she would be happy or horrified.

I guess I was supposed to take what she said about me as real when it was clearly just something predetermined from a manual that seemed to be based on a model that didn’t fit my experiences.

An example, If I said things about me that she thought were bad, she would respond that it made her feel bad. That was clearly a response from a book. I have a hard time believing that anyone would actually care about my opinions about myself. It is difficult for me to buy into something that feels artificial. My psycho-therapist that I saw 16 years ago used to try to get me to role-play, and I just couldn’t because it felt fake. It is strange I guess and probably just a cop out or something.

Still, my therapist was very kind, very insightful - she just didn’t have time to really know me - and very patient. A rarity in my experience, I hate that the 12 appointments are at an end.

She said that we can have 12 more sessions whenever I need it, but I know that I can’t likely get myself to call, and I don’t think 12 more over 6 months is going to help me, even if I can be helped.

I legitimately feel sad that I might never talk to her again. I was dragged into these appointments. They aren’t something I can likely initiate myself, so this is it for therapy. That makes me sad.

Besides, I doubt I could inflict myself on her again. She was a saint to deal with my idiocy and maintain her friendliness and composure. I hate stressing people out, especially people who are kind to me. I know I will want to go back in a few months. That might be good, she gave me some understanding of the process and I think I let her guide it too much. I should have inserted topics myself. It wouldn’t be starting over from scratch, we could pick up where we left off, and I could just do better in the sessions. I think guiding the session should be 50/50 and not the 99/1 that it mostly was. This is me trying to talk myself into actually being proactive and initiating therapy instead of being passively dragged into it.

That might be too optimistic! It is also weird that I am talking like my therapist again.

1. I don’t understand the point of some of the homework.
   • How is talking to strangers and making eye contact going to help when it will not change the fact that I am very alone.
   • I now have no one to confide in.
   • She probably doesn’t know this, but in my entire life, all I wanted was someone nice in my life. Education, money, military service, etc. mean nothing to me.
   • I am close with my kids and grandkids, and I love them very much, and I know they love me.
   • But, when they go home, I am alone - day in and day out.
   • The hilarious part is that I know I do not deserve a close relationship and am too worthless to have someone in my life.
2. Say that I stick with the homework, where do you expect it to lead?
   • You told me in no uncertain terms that you won’t help me accept that I will be alone forever, but how does making eye contact and talking to strangers do anything but that?
   • It is not going to lead to any friendships, right?
   • Irina pulled me way out of my shell to an extent that would shock you. I didn’t have a chance to present her in the SO list - among other people - and what did it do besides show me up close and personal that it is exactly what I cannot have.
3. What does it mean that you feel like you talk to me, but I only have a conversation with myself in return?
   • You mentioned narcissism a lot, using as a contrast, but it makes me wonder…

4. Is this website healthy or a waste of my time?

5. Acupuncture
   • Supposedly, it can help with depression, headaches, and arthritis.
   • There is very little evidence but also very little risk.
   • With such little evidence, I am surprised the VA offers it.   - I don’t like the idea of a stranger being that close to me, but am willing to try if I can get “treatment” for all three things.   - The worst case is that I waste my time, and I have nothing but time.
6. Transcranial Magnetic Stimulation
   • I brought this up because it was a possible alternative to ECT, which I cannot do because of epilepsy.
   • I had looked into TMS in 2016, and it seemed safe, but now it is not recommended, in most cases, with people who are prone to seizures.
   • If my neurologist or primary doctor signs off on it and the med nurse has nothing to do with setting it up, I would try it.
   • No psychiatrists
   • The medical mistakes that I have seen psychiatrists make who are alleged MDs are embarrassing. Bad-intern level mistakes.
   • It is either my neurologist or primary doctor.
   • I don’t like my neurologist - they are all weird - but I trust her judgment.
   • I have been seeing my primary doctor for at least 15 years. I trust her judgment without hesitation. My primary doctor is more likely to sign off if she is willing to opine on it - she might want to kick it to neurology.
   • My neurologist is pretty cautious and would likely say no, even with the reduced risk of seizures with TMS over ECT.

If a grasshopper tries to fight a lawnmower, one may admire his courage but not his judgment.

Robert A. Heinlein