Yesterday a big storm blew through. Heavy winds and hard rain. I had a ketamine infusion and slept most of the afternoon and I’m sorry I didn’t get to my blog. I didn’t even take Dot for a walk but she was sweet to me all afternoon and to Jan as well.
Today is lovely with a few high clouds and no rain. The waves generated by the storm are washing up on our beach and the herring did spawn near the rocks of our beach so the kelp is nice and stinky which Dot loves.
Today I’m still a little sleepy from the infusion of ketamine. I was the first patient that received the treatment in Sitka and it was a bit different. The room was full of doctors and observers and I’m the kind of person who feels as if I should converse with people while they are studying me like a bug. “Where are you from?” I ask, “ How did you happen to come to Sitka? Does your spouse like it here? Don’t you think it’s interesting that the ceiling has turned to molten jewels?” That kind of thing. Their laughter sounded like barking sea lions. I was killing that room. It seemed like more and more people came in as time went on. But that may have been just me.
I like my psychiatrist. He worked hard to get Ketamine treatments in Sitka. He is very smart and learned, has a lot of experience. I don’t do much therapy with him. I had twenty years of therapy with other shrinks and finally came to the end of one session and asked what more was there? I felt like I had cried about every possible thing in my childhood that I could dredge up. My psychiatrist at the time said, “Well John, some people just enjoy therapy, and they go one with it for years. You appear to have a neurological problem that only drugs can treat..” So, I told him I didn’t enjoy talking to him enough to have my insurance pay him two hundred dollars every two weeks, so I just took the drugs and checked in with a shrink every six weeks to monitor the handful of pills I took.
Red chairs, listening.
But the depression got worse and more frequent. I started seeing this new doctor. I started telling him my problems…. not with my parents…. or my dreams…. but with the drugs I was taking… he took me off of everything and started me up on new things, When I reported I didn’t like the side effects or that they didn’t seem to work, we kept tweaking. I felt better. Much better. Able to focus and work. But still every six weeks or so I would go dark with recurring compulsive thoughts of suicide, and hopelessness, and self loathing. I knew I didn’t want to die, but the more these thoughts came on the more I hated myself for thinking the thoughts and the more I felt I deserved to die. Loop after loop of desperate thinking that would last about ten days then they would lift, to return again in a month. Other people have this and they report that the older they got the worse it got. I saw other Doctors in Seattle. It was recommended I do electroconvulsive therapy. But my eye surgeon said I risked blowing out my good eye and being totally blind, and that sounded depressing as hell. So last September I started the Ketamine. I have written about it here, and I find it almost miraculous in it’s effectiveness. After the opening treatments, I did not have any of the compulsive thoughts of suicide.Everything else seemed normal, no side effects. My memory was good, I was appropriately sad about painful things in my life, but no suicidal thoughts. Gone. I am now a big fan. I went four months without another treatment and the thoughts started coming back just as hard. So now I’m back on a treatment of every six to eight weeks. Do I like having to take medication like that. No. But I don’t like the alternative either. Life is not perfect and I can accept that now too.
Getting help, is not always easy to do. Particularly for mental health issues. Many of you might be thinking about this right now. We have lots of issues now in these extraordinary times that because the times are crazy our reactions to them are completely appropriate: anxiety, lethargy, sadness, worry, anger, maybe changes in appetite, changes in activity. Maybe drinking more? Maybe smoking more? All these things are or could easily be part of all our lives right now. But how do we know when to reach out for help. What about the things that want to block us from getting help?
Dot’s first reaction to “Lets go for a walk!”
Money. I’m lucky to have health insurance through my retirement plan. Many aren’t. Many don’t have insurance that covers mental health. It’s just short of a crime. I saw so many public defender clients who could have benefited from early mental health interventions, but now are in forever jail. I have too many stories but I did know a young man who went to kindergarden with our son who started hearing voices in his head received treatment off and on, and now is in prison serving more than two hundred years for murder.
This may seem like an extreme case, and of course I need to remind everyone that people who are mentally ill are far more likely to be the victims of crime than they are to be the perpetrators of crimes. Here, clearly was someone who did not ask for help, and did not take the warning signs seriously until it was far, far, too late. I sat with him at his sentencing, back on his medication. Healthy, for all purposes normal again, listening to the summary of his most terrible actions he can barely remember as if they were the actions of a phantom who lived inside of him.
Now, of course we have to ask, would he have taken his meds even if he had good insurance? Would he have stuck with his program. It’s not clear. He had treatment off and on in his life. We still don’t think of mental health as “real health care”. Often we think of it as a character issue. I know in my parents generation it was a sign of poor character to be unhappy. Patton slapped the shell shocked soldier. My father told me “to pull up my socks” after my first suicide attempt at 14, and this was just a few years after he had been hospitalized for a “nervous breakdown” when he woke up crying and couldn’t stop crying for several days. He self medicated with alcohol all his life. I don’t blame him, he was a good, funny non-violent man of his time, but it was a time which was unaware of the inner life and the effects it could have on a family. He honestly did his best, I think, just as we have done with our son. Time and our son’s health will tell us how we did.
So, back to the question, when do you ask for help? if cost is against you you have to seek the best alternative. Medicaid, Medicare if you are of age, community, programs. Often, I go to public health centers or public Libraries and ask the person at the desk that is a good place to start. Ask a friend who is in your situation. Find a doctors office and ask them. Just start asking is the beginning and then looking at your budget and realizing that your feelings are a real medical health care need.
Okay, but when is it real enough to get help? Okay in these crazy times, being crazy seems normal. We all like to yell at the TV when the news is on… but do you yell at other people? Your spouse? Your kids, when the news is on? Losing your temper is a good sign of something out of whack. Getting into fights is frustration that is asking a question that doesn’t have a good answer. The question is “What the fuck is wrong?” If the answer you come up with over and over is, “Everybody around me is an asshole.” Then maybe you need outside help. Or maybe you are just alienated from your family? What’s up with that? Were you always? Why now? Can you just start by talking with your spouse? How would you start? Ask him or her, “Honey do you think we are drifting apart?” See what they say? If you are secretly angry at them it might come out boom or it might not come out until later. But asking is a good start.
Being sleepy is okay, and maybe you need a check up or some other of your medications is wacky, But maybe you are sleeping all the time to avoid being with other people? Maybe you love the night because you don’t sense time passing like in the day? Maybe no one else is around to judge you? If you go nocturnal maybe you need to talk with someone. Sleep patterns out of whack, always a good sign. Even in this social distancing, if you are the only one in your house that has gone nocturnal then you may want to have a conversation with someone.
Drinking more, being noticeably drunk everyday, when you weren’t before. What’s up with that? Does that have an effect on other things? Same with drugs. You have to judge those.
Suicidal thoughts. Okay, everyone has them. But how often? What kind? First you have to acknowledge that you are having them. Note down how often and what are they like? Are they vague, or are they becoming more specific? Are they shaping into a plan? Confront these thoughts. Can you turn these thoughts off? Do they keep coming back at certain times during the day? Okay if they do become specific, planning kind of thoughts that are coming unbidden. Talk with someone. If you take any kind of action, call someone immediately. You will not be jerked out of your shoes and put into a mental institution unless you are in an extremely dangerous situation and even then there would be a legal process where you would have a lawyer (your own or appointed) represent your best interests.
Dot’s second reaction to “Come on, let’s go for a walk!”
But here is the thing. The earlier you get help the better it will be. This is the truth with colds, cancer and mental illness. If you get help when you first start noticing suicidal thoughts you will walk into a therapists and you will have a nice reassuring talk and come out feeling better with an appointment for the next week. If you wait until you have a loaded gun on the table, a bottle of whisky with a dozen tablets of Dexedrine scattered across the floor while you are crying though your snot about how your are going to blow the head off the next person who comes through that door to the suicide prevention counselor you just found on Google, then you have waited too long and your life has already turned to shit without you knowing it. .
So of course the big ones that I always asked my clients at the PDA. Do you hear things that no one else hears? Do you see things that no one else sees? Actual things. These are not one time things, like a flutter of the eye, or even a waking dream of a dead parent during a time of grief. Or even a one time hallucination or ghost story. But persistent voices speaking with you that come from some magical source. Do not be afraid. No one will judge you or treat you badly. They won’t lock you up or argue with the way you feel. Just go talk with someone. These voices are coming to you for a reason, don’t you want to find out why? If you believe you are having a religious vision or message associated with these visions or voices, go immediately to share them with your ministers. They will help you interpret them, and hopefully they will get you to a doctor to help you control the voices so they are not worrying to you.
But eating ice-cream… as long as your diabetes is under control and your doctor says it’s okay. I’m with you. You can call doctors and I think you can get all the phone-in therapy you want these days. Lots of people don’t like it but lots of people are getting used to it. You can get your drugs in the mail or pick up outside the pharmacy. The important thing is to First: Ask for help, and second find a way to pay for it. In that order. Mental health is real health care. People suffer and die from the lack of it, we need it.
Okay…. that’s it. John and Dot’s guide to mental health emergencies.
No rain, on cold day
black dog rolling in the grass:
happy all the time.
jhs
Here is a recording I made this morning on our first walk of the day at six thirty. First your hear a loud raven and then a noisy eagle right above him. It’s just a short snippet.
Here is a recording I made this morning of another reading from The Big Both Ways. Dot was quite good while I read this time so I took her out for a walk right after.
