A Slow Awakening: An Early Spring Photoessay

You might know that I've been having something of a difficult time. Part of that is probably due to my brain settling into an old, familiar groove as the rTMS treatment I received moves further into the past. Part of it is undoubtedly due to therapy -- engaging with trauma, or any difficult issue, often results in feeling worse over the short term.

Obviously, what we're most concerned with is the long term: will I survive this illness? If so, for how long, and with what quality of life? But the short term matters immensely, too. After all, I live in the here-and-now, not in the future. And anyway, what with the Morlocks and the Eloi, it isn't as if the future looks like that awesome of a place to hang out.

One of the first things I noticed during rTMS is that the color green was brighter.

Spring was the ideal time for me to receive this treatment, as it turns out. My senses were awakening at the same time as the world burst into riotous growth around me. From a landscape laden with dead, bare branches and hard, barren earth sprung up buds, and new plants, and the beginnings of life. 

I felt like things I had all but forgotten were growing within me: humor, and lightness, and hope. Like a seed dormant in the ground, I had not lost those things whose absence I felt so keenly and with overwhelming pain. They were only sleeping. I couldn't feel them, or remember them, or reach out and touch them. I felt like I would never feel happy again, that nothing would ever change, and that there was no point to struggling on in the midst of lifelessness. But, when I believed I couldn't take it anymore, not even for one more day, the world around me burst into life and reminded me that feeling like I could live was hidden, but not dead.

Under a layer of dead leaves slumbered a field of flowers. And under the darkness of my despair crouched a hidden sunlight. I began to have hope -- hope that I could get better, hope that I could feel differently. Hope that, one day, I might even recover. I looked at the world around me with hungry eyes and an open heart, amazed at the way my own mind could take me by surprise. I had been afraid that I couldn't get better, that it wasn't possible, that this was going to be my life. In the onslaught of vibrant color, I was caught unawares by the possibility of change residing even in me.

I felt an openness, an expansiveness, like a body of water in the breeze. I began to see that life could be beautiful. Life could be beautiful emerging from death, and going into death. Maybe life is beautiful too when it lies in stillness, dormancy, a dreamless sleep. If I can remember this, hold onto it, when I feel like I'm dead and wish to be dead, maybe I can hold the beauty and the suffering in my two hands at once, cradling and cherishing both. Both can be tended to, and both frame the boundaries of my experience.

 Spring is not all beauty and new growth and sun reflected off water. Spring unearths muddy ground, trees that have not survived the winter, stagnant water overflowing with the detritus of decay. Plants that greedily take more than their share of water come back to life, dominating the fragile seedlings around them. It isn't all easy, it isn't all pretty, it isn't all what you're hoping to find in your foray into new beginnings. But it is there -- an undeniable part of what it means for life to come charging back in.

In its own way it is beautiful, because it is true. As I started to feel better, I began noticing painful truths about myself that had been buried under the agony of suicidal, backbreaking depression. I had opened the door to hurting myself again, and the longing plagued me. I have difficult relationships that take up a large place of my life, that have contributed to my illness and that I don't know how to manage. I have enduring trauma and recurring memories that flow through my mind. I hate myself, and wish I didn't. I live with a lot of shame. I am somewhat obsessive. I have difficulty understanding my own emotions.

These things were hidden under the blanket of winter. But now I see them again, reappearing, taking up time and space in my life. There is a layer of decay that fomented under the snow, and it needs to be reabsorbed into the life around it; changed into life, it can once again bring forth goodness and color and meaning and strength. It's good for a tree to fall in the forest and be reclaimed. But it isn't easy when you first see it lying there, tumbled across your path.

It will be hard. It will be painful. And it may cause me, sometimes, to forget about the springtime. But I have to look hard at myself if I want to reclaim the parts of me that have been damaged by depression -- the parts of me that have fallen under the unbearable weight of ice and snow -- and integrate them into a healthy life.

As I struggle, it is too easy to focus on the bark of a decaying tree rather than on the seedlings springing up in its midst, drawing their nourishment from it. I'm writing this post to remind me of how I felt when I saw vibrant green and new flowers. And to remind me that spring is a coming into being that enfolds both the remains of winter and the beginnings of new life.

I Can Has Internet!!!! (Or, rejoining the land of the living)

Well, I finally moved out of my parents’ house into my own place, which was a milestone for me not only because at the age of 31 I’ve never had the opportunity to live on my own and be truly independent, but because I’ve never moved in my life. Ever. Yes, that’s right, lived in the same room in the same house, always.

I meant to blog about this whole process, but in the upheaval and overwhelmingness of all that was going on, I totally forgot that the internet can’t be magically and instantly delivered to your dwelling. A shame, really.

It was a long, drawn-out process because I hired movers for the first day I could take off work – July 11^th – but really wanted to move in before. So I had all my Ikea furniture, including a bed that was a nightmare to put together (apparently), delivered the Saturday before, and my family helped me build it. Well, my family built it while I washed dishes and then lay helplessly on the floor, curled into a fetal position when faced with the enormity of what I’d done. I mean, I made my family build a crap-ton of Ikea furniture together: it was a nightmare.

I’m the kind of person who hates change. My life is carefully structured into tiny and large routines that govern my days, everything from what coffee cup I use any given morning of the week to how I do my makeup, what I eat, what time I get up in the morning, to how and when I pay my bills, the kinds of jobs I apply for, and the rhythm of my days. I like routine, and structure. Sure, I make allowances for when things inevitably don’t go as planned, but when I’m facing huge adjustments I’m an absolute nightmare to be around. I run the gamut from sobbing hysterically, to withdrawing and shutting down, to hiding under the kitchen table only to be bribed out with jars of peanut butter.

When I was about to start kindergarten, my stress drove my brother so batty he moved out of our shared room and into his own space in the basement.

Anyways, this whole moving-into-my-own-apartment thing was a really, really big change. I spent every night the first week crying. The first day was particularly distressing because, even though I had a bed, I didn’t have a table or chairs, so I ate dinner sitting on the hardwood floor balancing my plate on a stepping-stool. I admit, the thought ‘what in God’s name have I done?’ crossed my mind a few times.

I had a difficult moment in my first week, when the Douglas hospital called me to say I was eligible for maintenance treatment one week a month, every day, for six months, the thought being that I would benefit by seeing an increased duration to the effect of treatment and a possible delay of recurrence. Unfortunately, none of this was included in any of my return-to-work medical papers, so I had to turn it down because I can’t afford the two-week exclusion period that comes with a new claim.

To be honest, I’m lucky my health insurance is so good that I don’t have to choose between food and medication. Please remind me not to lose my job!

I struggled in the middle of the first week when I unpacked a bottle of Remeron that I’m not taking anymore (but, of course, I hoard medication I’ve stopped taking). When I cried at my desk at work Wednesday morning, I reflexively dumped them all on the desk and counted whether or not I had enough to kill myself with if I needed to.

I know that having my own space, my own independence, control over my own life, is a stepping-stone in the direction of changes in myself that I need desperately. But, for today, I’m still battling to live with my dragons.

The Difficulty with a Difficult Recovery

Sometimes people get confused because I'm a chronic optimist despite living under the cloud of depression for so many years. Admittedly, this confusion is understandable since it only makes sense that an illness which robs you of a hopeful perspective of the future would make a person - well - less than hopeful about the future. Lack of rose-colored-glasses and all that. But I feel like looking on the brighter side has, for me, been the natural consequence of spending years searching and searching (and searching!) for the light even when it doesn't appear to be there.

If there's a problem, I think it'll be all right. My life is on fire? Oh, it's not that bad, I can make a new one. Oh, my academic career has been destroyed by my illness? That's okay, I'll find something else to do with my life. Oh, I lost my job? Well, that's not ideal, but I've been meaning to make a change anyway.

Having said that, if I smudge a freshly-painted manicure, nothing will ever be okay again because this is the end of the universe, so I think I'll just sit on the floor and sob hysterically for 20 minutes. I think what I'm mostly lacking isn't a sense of optimism so much as a little perspective.

Anyways, when I heard that having rTMS was a possibility, I was already thinking we are trying something new, and it will work. I was fully prepared for it to work spectacularly well. And it did: it gave me moments of clarity and feelings of well-being that were beyond even my expectations. I feel truly blessed that it worked so well for me. And when I had the opportunity to try adjusting my medication levels to try and alleviate some of my lingering exhaustion and bursts of inexplicable sadness, give me back a little pep-in-my-step, of course I jumped on it. It is a great plan, and this time we are going to go all the way and it will totally work, especially while I'm still in the consolidation period following rTMS.

Well, as it turns out, not so much. Of course, there's always a period of adjustment while medications are being changed, and that's only to be expected. But it might be that more of a good thing is sometimes just too much. I hate to admit defeat, in anything, but sometimes it just has to be done. I was wrong, universe: it is not a smooth line upward - though I do believe that upward will be the ultimate trajectory. Sometimes, it's just hard when the direction is more sideways than you were hoping for.

It's easy to tell people you're doing poorly - that you need their visits, their prayers, their support, and their offers of fresh fruit - when you are so sick that you're an inpatient in a psychiatric unit. It's another to tell people you're struggling when you're doing so much better. You, as well as everyone who has rallied around you, need the story with the happy ending. You need the recovery story. You need to tell it to yourself, and so you tell it to everyone around you. I am doing so much better. I am recovering. I am in recovery. Even, I am better. It's so, so easy to leave out the second half of those sentences: I am recovering, but I am still struggling. I am doing so much better, but the truth is that it's still really rough. I am in recovery, but the road is uneven and I am afraid of falling, and I have fallen.

The logical part of my mind reacts to setbacks as setbacks. I tell myself that this is part of the recovery process, that it will take time, that it will not always be smooth. The part of my brain that is still depressed tells me that this is just like before and I will never, ever be better. The truth is that when you live with an illness in which your brain tries to convince you that nothing will ever be okay, you're going to spend a lot of time arguing with yourself. It takes patience, and self-compassion, and determination to tell your brain that it is wrong. Your brain is saying two contradictory things at once, the one which you encourage and the one which you struggle against.

And it's hard. It's so, so difficult. And part of that difficulty lies in not knowing how to say that this is a story about recovery and also a story of learning to live with not being completely well all of the time, of learning that recovery is a process requiring you to learn and to grow and to stretch your fragile wings, and that you are not quite all the way out of the nest and ready to fly.

Short-Term Disability (Or, the Insurance Policy I Didn't Even Know I Had)

I went into the hospital at the beginning of January to get some stitches, because I knew that I literally couldn't do my job with a gaping hole in my forearm. Oh sure, there were some other reasons. For starters, I'd actually been making incisions in my arm in an attempt to locate my artery, because I was convinced it would look really beautiful when I sliced it open...luckily, my lack of stamina as well as my apparent lack of basic anatomical knowledge meant that I eventually gave up and decided to go to church instead, where a friend helped me get to the emergency room.

For another, I knew I needed some sort of help that I just wasn't getting. I was both relieved and devastated when I was finally admitted to the psychiatric ward at St. Mary's. I was relieved because I knew that I was incapable of doing my job, and this would save me from destroying my fledgling career. I was relieved because I'd been having an incredibly public breakdown all over social media and being unplugged from the internet would keep me from posting any more cartoons about how I wished I was dead, and generally humiliating myself any further (P.S. it's really hard to look people in the face after you've had a complete meltdown in public view for a few weeks). I was relieved because I didn't have to spend any more energy trying - and failing - to pretend that I am perfectly fine, goddamit!

But I was also kind of a little crushed inside, in the part of me that cares, the soft squishy vulnerable part of me that I have to shield at all time because weakness is a liability that just isn't acceptable. Weakness means rape, and pain, and all sorts of failure. I just can't stand it. Every time a doctor talks to me about allowing myself to be vulnerable I want to punch them in the face and throw myself off the nearest building.

But I digress.

It was crushing to call my boss every day during the first week and tell her that I was still in the hospital and wouldn't be coming into the office. It was humiliating to be so...I don't know...a terrible employee. I knew that I was protected from being fired because it's against the law to fire someone for being in the hospital, but I still felt pretty shitty. You've got to be thinking you've made the wrong hiring decision when your employee goes AWOL less than a year into the job; it wasn't fair to either my manager or my team for me to so completely drop the ball. I felt like someone had thrown me the ball, it was busy season and they needed everyone to be on their A-game, and I was like 'Oh, this ball? I think I'll just throw it back in your face.'

I hadn't been hospitalized at all since 2006, and my last significant stay was in 2002-2003. I felt like I'd wasted all this time and all these years only to find myself back in the same shit-hole. I was so disappointed in myself, in my failures, in all the things I should have done to get better but somehow didn't manage to get around to doing.

Me and the hospital. I was like 'Please, please, help me. Please save me from myself,' and also, 'I don't deserve to be here, and I don't have what it takes to get better, so you might at well give me the boot and make room for someone who will.'

Anyway, in one of my many conversations with my manager, she mentioned that we'd been using up the two weeks of sick days I had in my bank, and then we'd be contacting HR to get started on a short-term disabilities claim. I was like, 'short-term what in the what now?'

I'd been thinking that I was really fortunate not to get fired, and that I'd saved up money for years so that if I was ever too sick to work I wouldn't end up homeless and completely bankrupt. But, instead, it turned out I had an entire short-term disabilities insurance policy that would pay 75% of my salary. It had come with my job, and I didn't even know it. I work in the insurance industry, and I knew the insurance they were giving me as part of my compensation package was outstanding, but I didn't even know short-term disability was a thing.

I felt so, so lucky. But, when week three of my hospitalization rolled around and it was time to fill out the complex paperwork, I also felt deeply conflicted. I was basically saying, to my employer and to myself, that I was a failure. I was incapable of working. I was worthless, a financial liability. I couldn't even do my job. I have always tried so hard, worked so hard, kept going no matter the personal cost, and here I was giving up. I mean, why couldn't I just make myself go in to the office? I'd been doing it before, hadn't I? I felt so overwhelmed and incapable. I'm not sure I've managed to work out all the things I was feeling.

When I finally did go back to work on a progressive return, and started to struggle with working four days a week, I wondered if I would ever be able to work a full week again, if I would be able to manage it. I was doing the best I could, but I was failing. And then, I went back on full disability benefits to receive rTMS treatment at the Douglas. I realized, 'I am disabled.' It wasn't something I thought I'd ever have to say about myself. I am disabled.

I still struggle with what saying that means. I was disabled. The part of me that's trying to learn self-compassion tells me that it's okay, that it's not my fault I was sick, that this is something that just happens. I was lucky to get through it. I was lucky that rTMS treatment worked well and I could get back to my old activity level without distress. I was lucky. I know that having been disabled doesn't say anything about my character, or my strength, or my worth as a human being. But I still feel somehow less than I did before. I still wonder what value my life has when I can't be a functioning, productive member of society. Sure, everyone needs a little help sometimes, but not everybody ends up disabled because they just can't handle their workload.

I am so, so lucky to be employed at a place that gave me such great insurance, because not everyone has that benefit. I am so, so lucky that my team and managers believed in me, and welcomed me back so seamlessly. I am so, so lucky that HR and my short-term disabilities case-worker were so compassionate and willing to work out a solution that would get me back in the workforce without making me sick again. But I also feel broken. And I'm not really sure when I'll feel whole again.

Clipping My Face On: Getting Back to Work

Every day when I leave for work, I'm secretly afraid that I've forgotten my ID at home. Not so much because I wouldn't be able to get into the office - I'm sure someone would let me in eventually - but because all the women's bathrooms in the building are pass-key enabled to make us more secure. I just can't hold it that long.

But I digress. 

Now that I'm finished rTMS treatment, I've started back at work full-time, though admittedly without the ability to control all metal objects in my vicinity with magnetic superpowers like I was promised. 

I was thinking about it on the way to the train Monday morning, and I realized this would be my first five-day work week since I went into hospital in January. I was nervous, to be sure, but also excited. Not disabled any more!!!  I felt like shouting! Of course, that would entail that people in my office knew why I'd been out...presumably they've been thinking I was kidnapped by aliens? 

The week seemed especially long and insurmountable from the perspective of Monday because I knew I'd be working late on Friday, every week, to make up the time I miss on Tuesday to go to my psychologist appointments. I discussed taking the time unpaid, but my manager made it subtly clear that it was either the opportunity to give the time back every week or using up vacation time. Given that I've spent, like, twelve weeks on sick leave this year (holy crap!!), this seemed fair.

I was all set to make this a post about look how awesome I am, I'm completely better, I went back to work full-time and it was great! There are ways that this is true: I was tired, but it was a normal tired. I'm moving at a normal speed. I'm making good production statistics in my data handling jobs, and I didn't do too badly my first day back on the industrial scanning machine. I was all like I am a success story!! Haha psychiatrists who thought I was pinning too much hope on neuromodulation! I was still having mood fluctuations, but I was so, so much better.

This is true.

But there are ways that this is not true. 

Today was my second day using the scanner this week, and my day started out poorly. I had an insurmountable system error at the first machine I tried to work at, and I couldn't manage to fix it using the process notes. In the end, I had to change machines and ended up beginning to scan late. As I tried over and over to fix my machine, I felt like putting my head down on the desk and weeping, or walking out the door and never coming back. The machine I moved to is not built for someone as small as I am, so I couldn't reach anything. The stacker door slammed on my hand as I was retrieving a document that got lodged in the gears of the machine. Everything was slowing me down, and I knew I'd never make my production target for the day. I was near hysterical tears. I was all like, everything was going so well, and I'm messing it all up, with my moods and my failures. I was thinking, thank goodness I have those xacto knives in my bag, I can go slice up my arms during lunch, or maybe I'll wait until I get home where all my bandaids are, because I shouldn't get blood on people's documents. 

And I was thinking, why aren't I better?

I've always been...something of an extreme person when it comes to myself. I'm very forgiving and flexible with other people, compassionate even, but I just can't tolerate my own failures and weakness. Maybe because I just have so darn many of them. I need to be the fastest, the smartest, the best. And, for a lot of my life, I have been. I expect nothing less than perfection. And isn't my recovery just one more thing to be perfect about, all in one swift go? I want a gold star on my exam, goddamit!

But maybe I'm wrong. Maybe it's not all one thing or another, but a shading and blending of both. I am a lot better. The right treatment has broken depression's crushing grip and I feel like I can breathe again. I am better. But I'm still fragile. My emotions are out of kilter. Sometimes things are too bright, and I feel that edge that comes on when everything is going too fast, when I'm thinking too fast, and moving too fast, and I feel like any moment it's going to spin out of my grasp in a million different directions, and all I want is to stand still. 

I've been sick for at least twelve years. I've accumulated ways of thinking and behaviors that are fundamentally maladapted to living a healthy life. I'm not sure I know how to live a healthy life. There are things I need to learn, and things I need to unlearn, and it's going to be a lot of work, and take a lot of patience, and demand a self-compassion that I still need to discover. I am finally in a place where I am well enough to start doing that work, instead of just treading water or trying to dig myself out of crisis. 

Just because I almost burst out crying at my work station doesn't mean I am not better. It doesn't mean I should give up on moving toward wellness. In the end, no one else could fix the machine either, and my manager had me switch stations with somebody taller so I wouldn't hurt myself. My day got better, and so did my mood. I left the office exhausted and hopeful. 

I am frightened by how much I'm affected when things go wrong. By how fragile my mood is, by how weak and vulnerable I feel. And that's okay. It doesn't mean I'm hopelessly sick. It means I'm human.

And there is so much more that I can grow.

Choosing to Walk Under a Grey Sky

Well, my daily treatments of rTMS are almost done, and I've got a lot of competing emotions about that. This is good, because it means that I have more emotions than just crushing despair. Yay!

A few days a week, I walk from the metro station to the Douglas (or the reverse), both to avoid taking the bus and to try and get in some extra sunshine and exercise. Today, the sky was grey and it looked like it might rain. It's a pretty long walk to get from one place to the other, so I debated waiting for the next bus. In the end, I chose to walk and enjoy the refreshing breeze.

As I walked, I felt just right: it wasn't too hot, and the sun wasn't shining blindingly into my face. I came upon a grove of blooming crab apple trees, and stopped to smell the flowers. It was wonderful! I realized that I haven't smelled flowers in a long time, not even on my own pink tree. I began to notice the smell of fresh-mown grass, the sound of bees, the warm, dusty smell of the road. I felt like the world was opened up around me, as if I was suddenly seeing it for the first time, even though it's always been here.

I ate lunch outside on the Douglas grounds, and then wandered around smelling all their trees. I felt this lightness, this buoyancy within me, like air filling my upper chest and lingering there.

I realized that I was feeling...a lightness. A sense of calm. And something I think was happiness. I felt...happy. I haven't felt happy in so many years, this quiet almost-joy, unlayered with anything else.

When people ask me how my treatment is going, I point to the obvious cognitive and behavioral changes. I can concentrate and understand things better. My memory is improving. I am talking and moving at a normal speed. I am smiling more, laughing more easily. I am having an easier time following my meal plan. Colours appear brighter, my sense of taste has improved, my thought patterns have shifted. I even have less headaches!

It isn't perfect. I'm still tired a lot of time time, and I have less energy than optimal. I find being around people for long periods of time to be draining. I have trouble motivating myself to do things I know I have to do. And, of course, I have had to give up a significant portion of my time in order to pursue treatment and manage my illness. I still feel overcome by inexplicable waves of sadness and tears. But I don't expect to be happy all the time, or for everything to always go smoothly. That is unrealistic.

But all the weeks in hospital, and then in treatment, all the medication changes, all the anxiety over trying to change doctors and treatment strategies, all the time off work, and all the things I haven't been able to do...it was worth it, all of it, for this one walk on this one day, and the way it made me feel.

I will keep choosing to walk even when the skies threaten to open, because I'm starting to feel that the world is worth being in, and that life might be worth living.

Why Yes, I Bought Myself a Card

One of the things I occasionally do which some people might find a bit on the odd side of the spectrum is that I buy myself cards. Sometimes. Sometimes it's because I like the picture or sentiment but don't have an occasion that matches the card. Sometimes, like yesterday, it's because I feel like the card is giving me something I need: it throws a challenge in my face about something I need to own up to, focus on, or just plain acknowledge. The card speaks directly to my soul, like some kind of voodoo psychic. It's watching me.

The card I picked up yesterday has this message in it:

I know it must be hard

having to stop

everything for awhile

and just focus on getting better.

But whenever you

find yourself

worrying about

the million and one things

you think you should

be doing instead

just remember...

This time is for you.

Your time to rest.

Your time to heal.

And nothing's more important than that.

Because you're important.

I've been pretty focused lately on trying to figure out some way to coordinate all my medical appointments with my upcoming return to work. To be honest, I feel like time is one of the things I don't have on my side. I was thinking I still had a week of 4 days left on my progressive return-to-work plan, but because of the way the director of my clinical trial filled out my medical certificate, my short-term-disability plan is requiring me to return to work full-time as soon as the treatment is completed. And, let's face it, it's not like a single day off would have made that big of a dent. It would have been more like a polite society lady nibbling a cucumber sandwich, and less like the way I tackle an ice-cream sundae. By which I mean a small, ladylike bite rather than an all-consuming bite of humongous gluttony. Beware my ice cream eating mouth of DOOM!!

It's just all so...overwhelming. I have at least two appointments with the psychiatrist at the Douglas once treatment is over so we can do an assessment; with the travel time, I know I won't be able to make up all the hours I miss work. I have to see my St. Mary's Psychiatrist at least once to adjust my medication levels, and probably a few more times for follow-up, which is time I won't be able to give back, either. This all strikes me as annoying, but ultimately manageable, as they are once-in-a-while things.

But I'm worried about the psychologist I've started seeing at St Mary's. That's probably going to be a once-a-week-thing, with me missing at least an hour and a half each time. For me, that means I'll be working an hour and a half overtime on another day, or spread out over a few days, to try and make up the hours I've missed. Every week. Until we've accomplished whatever our goals are supposed to be. I'm worried about it. I'm worried about always getting home late, and burning out a new and fragile remission. I'm worried because I know what disruptions to my schedule do to my mood, and my sleep, and my ability to do all of the other things that are part of my illness management. I don't know how I'm going to handle it all.

If I could work part-time, just until I get some solid ground under my feet, that would be ideal. Financially, I know I can do it. But, realistically, if I decided not to make up the missing time, that would mean a significant rate of absenteeism, and I'm not sure I could pull that off right now after already having taken so much sick leave. I wish I could have had treatment while I was an inpatient. I wish I could have left the hospital and returned to work having actually been better. When I think of all the time this illness has stolen from me this year, I find myself wondering what the point of it was, what it was all for. I worry that I will undo everything we've been working toward.

There was a woman in the hospital with me who was there by court order, and I remember her psychiatrist yelling at her that it was her time to get better, that it was her time to be well. I wonder what that would be like, really having that time, having someone in my corner who wasn't looking for a fix that would prop me up enough to keep going. I wonder if wellness would be worth that sacrifice, the cost and the effort involved. I don't know, I've never really done it, just taken the time to get better, work on all my shit. You'd think I would have done it when I took 8 months of sick leave from graduate school, but sadly my psychiatrist was not interested in exploring all the shit that was coming up and out of me, so I ended up stuck in the same place as before - except that I recovered less functionality. Win?

What I'm trying to say, I think, is that I bought the card for myself because in my fantasy puppies-and-rainbows world this is how things would be. But reality isn't like a skittles commercial, and ultimately I come away finding that what matters isn't so much me as it is my capacity to contribute, to be useful, to fill the roles that I am supposed to fill. I think I can do it: I've done it before. I'm just worried that I won't ever have the chance to really be well, which is - after all - what I was so desperately searching for in the first place.

RTMS (Or, What I Do Every Day)

When I first started rTMS last Monday, I didn't know what to expect. I didn't have the stamina to research anything about the procedure, and when I had been referred by my treating psychiatrist, all we discussed was that it was an alternative to ECT. I'm writing this post so that anyone else headed off for rTMS has an idea about what to expect. I also don't want to forget my experiences, and I know I experience memory difficulties when I enter periods of acute major depression. Plus, it's interesting!

It's worth noting that I am participating in rTMS as part of a clinical trial, which means data from my treatment will be collected and possibly used for research and publication purposes. I'm quite happy with this, as I believe in scientific advancement. I was relieved to know that this is not a randomized double-blind trial, which would have involved the use of 'sham' coils in some of the participants (in other words, a placebo coil that replicates the external conditions of rTMS but without the application of any actual current). Although I believe these kinds of trials are absolutely necessary for scientific advancement, at this point in my life - and at this point in my current depression - I would have been unwilling to try anything that would definitively have absolutely no effect at all.

Moving onward.

The first thing that happens is I go to the Douglas and look at this awesome sign in the waiting room:

Of everything I've been through, nothing quite brings home the fact that there's something wrong with my brain more than this sign. It's both comforting and daunting to think in terms of brains as the problem here. I can't reduce this illness to a moral failing, to not having tried hard enough, to some sort of problem in the way I make decisions and the effects of those decisions. Those are all factors in what it means, for me, to live with depression. But, somehow, I am not responsible. Because this is my brain, my body, going wrong. In a way I feel like I'm being betrayed by my own body, which brings up all sorts of old and new emotions. In a way I feel helpless, because my brain isn't something I can control in the way I could take responsibility for, say, consistent moral faults. In a way I feel relieved, because I can lay down the burden of feeling like my enduring depression is my own fault.

So, after looking at this sign for a while, the technician administering my treatment calls me into a room. I sit on a comfortable, mostly-reclined chair with a pillow on my lap that I can rest my hands on. RTMS utilizes a biphastic magnetic stimulator (coil) to indroduce an electrical field in a targeted area of the brain. The charge is greatest at the edges of the coil, and drops rapidly to null as you move further away from the coil. Hence, rTMS is much more targeted than ECT, and much less targeted than what would happen if you inserted an electrode (or 'brain pacemaker') into the subgenual cingulate (BA25) and turned it on.

During my first-ever session, and once a week for the duration of treatment, the coil was positioned over my left primary motor cortex, which you can sort-of visualize the location of  by putting a headband on your head directly in front of your ears; the motor cortex starts above the ear and follows the trajectory of the headband. The technician moves the coil around about 7.5 centimeters above the ear, finding the area that causes the right thumb to twitch. This feels very weird, and very cool. Your thumb really moves without any volition, it's awesome! The minimum intensity of current necessary to cause the thumb to twitch is called the motor threshold, and this measure is used as benchmark throughout the course of your treatment. The stimulation intensity during treatment begins at 100% of the motor threshold and is increased by 5% each treatment until you are receiving pulses at 120% of motor threshold. This allows a consistent measure to be used across the sample and provides a means of standardization. It is, however, somewhat problematic to assume that motor threshold is an accurate indication of activity in the prefrontal cortex, but this strikes me as a minor quibble. 

Anyway, once motor threshold has been established, the coil is moved to the area of the brain that will be stimulated during treatment. The technician draws on your head to find the correct area, in my case the right dorsolateral prefrontal cortex. This is because we're using the alternative protocol: most people receiving rTMS for major depression will have the coil placed on the left side of their head. The theory underlying rTMS is that people suffering from major depression have lower levels of neural activity in the left prefrontal cortex than in the right. Ordinarily, rTMS uses 'fast' stimulation at a rate of 10 pulses per second (10Hz) for 4 seconds, with 26 seconds of rest between bursts. In my case, I am receiving 'slow' rTMS, at a rate of 1 pulse (1 Hz) per second for about 20 minutes. I'm not sure if this protocol was chosen based on my symptom profile, if it's because I also have PTSD, or if it was randomized. I hope I have a chance to ask!

'Fast' rTMS is excitatory, causing the stimulated left prefrontal cortex to 'speed up' to the same rate as the right. 'Slow' rTMS is inhibitory, causing the right prefrontal cortex to 'slow down' to the same speed as the left. In both cases, the aim is to synchronize the right and left prefrontal cortex. The DL-PFC is involved in executive functions like decision making, conflict or choice resolution, working memory, syllogistic reasoning, planning, and cognitive flexibility.

Because of the noise involved, I wear earplugs to prevent damage to the auditory canal. Because I have tiny, child-sized ears, I'm not able to wear things like ear buds, so I find the sensation of having earplugs in to be unusual and somewhat disconcerting. I think, for a normal person, this wouldn't be an issue. When the coil is active, I can hear the machine making between three and five sounds: I was also surprised that earplugs don't result in complete sensory deprivation! Of these sounds, I'm absolutely sure the machine is actually producing two of them. The first is the loud, hard-sounding sound make when a pulse is produced, and the second is the constant loud soft-sounding hum of the machine being on. Two of the sounds may be actually produced by the machine, but they might also exist entirely inside my head, either as reverberations or as products of my imagination. One follows the loud rapping sound of the pulse as a slight-delayed, softer, rounder sound that feels slightly fuzzy; the other is a constant low-grade high-pitched hum and may be a secondary sound of the machine being on. I find both these sounds to have a different timbre or texture than the first two. The third sound is one I only heard once, and it was a sort-of grinding or mechanical sound that happened when the coil was discharging. 

As some of you know, I'm sensitive to certain kinds of sounds, partly because I have difficulty filtering and tuning them out. This is one reason I'm glad we're doing slow rTMS, because the rapid-pulse-then-silence pattern to fast rTMS is the kind of sound I find acutely anxiety-provoking. Yay for alternative protocol!

When the coil pulses, it feels like someone is tapping my head, and the area around my right eye twitches a bit. It's not uncomfortable, just a little strange. All in all, the experience of rTMS is not difficult, and kind of relaxing. I like to spend the time focusing on my breathing and on the roundness and quality of the sounds I'm hearing. And of course cuddling with Puffy, my magical unicorn, who comforts me when I'm feeling stressed out and anxious! I hope this gives you an idea of what I do with my day. :)

In terms of whether or not I've seen any difference yet, here's the breakdown. One person has said I seem to be smiling a bit more. One person has said my online comments are more sarcastic, which he thinks is a good sign! Personally, I've noticed that colours seem brighter and more saturated, and I spontaneously decided that I wanted to start taking pictures again (wanting something! It feels so good to want something!!). I tasted a subtle flavor the other day: banana! I have an easier time reading fiction, although I still have attentional gaps. I feel like I have more emotional lability, and my voice is less flat. These are all good signs. I do have a lot of exhaustion, which might be a side-effect of treatment. I still have a lot of difficulty writing, especially posts like this one that involve recalling, synthesizing, and integrating technical or scientific information. All in all, I think it's going well. 

The Douglas (Or, Where I Go Every Day)

I know that my family is a family that pays attention to each other, listens to one another, and is interested in each others' lives because my brother thought I'd been going to work all this week.

*crickets*

In reality, I've been going to the Douglas because I've started rTMS treatment. I can see the confusion, because I still wake up at 5:00 AM, but really? Really??

Anyway, the Douglas is this amazing, massive hospital that only treats mental illness. It's a teaching facility, research grounds, and hospital all-in-one, dedicated to understanding and treating the various things that can go so devastatingly wrong in the human mind. Ever since I got really sick 12 years ago, in 2002, I've secretly hoped that one day I'd end up there. They have resources I've never come into contact with before. I kept hoping maybe, one day, I'd be referred there and maybe we could figure out what's wrong with me. While it's obvious that I've had 4 episodes of Major Depressive Disorder, and that I have had / have PTSD and unresolved trauma, as well as recurrent suicidality and parasuicidal acts, what is less evident is why I've lived with some level of clinically significant depression constantly for twelve years, excluding the one 'healthy' period in mid-to-late 2006 through early 2007. Is it dysthymia? Is it refractory depression? Is it something else? Does it matter?

I guess I just kept hoping that maybe if I was sent here somebody could help me, that I could have a life truly worth living. That one day I could wake up and want to live.

Technically, I'm not at the Douglas. I've been sent here for a clinical trial, and then I'll be back off to my regular psychiatrist. Ah well, one day at a time.

It's a bit of a commute to get to Verdun from the North Shore. I wake up at 5, take a train at 6:35, take the Metro from McGill to De L'Eglise, and then take the 58 bus. Some of you know I hate buses because I am terrified of getting lost on them. Surprisingly, I actually like the commute. I get to take my regular train, which tricks me into feeling like a normal, productive, worthwhile member of society. I get to take the metro, and I like riding the metro. Then I take the bus.

The bus is okay.

Luckily, I don't miss my stop because there is a really helpful giant sign telling me that I am upon the Douglas. Like a YOU ARE HERE sign for my soul.

I like the sign. I find it comforting. I also find it relieving to get off the bus, because that means I will no longer get lost. But wait! The hospital grounds are huge! Still not likely to get lost though. :)

The first time I came to the Douglas I was lucky enough to have a good friend come with me. She had an app that told us when to get off the bus, plus if she hadn't been there I would have given up at the size of the driveway. The driveway is really, really, reeeeeeally long. I would have sat down in the snow and cried, unable to carry on any further. As it is, the driveway is getting easier. It also seems shorter because it's not covered in snow.

I also noticed, for the first time today, that the driveway is not actually straight. I was thinking it was straight as a pin, but in reality it has an s-curve. It's amazing what you notice when you look up instead of staring resolutely at the ground. 

Coming here makes me feel a bit...serious. I mean, I knew that it was serious. It isn't like I could ever successfully ignore it. I like to minimize, to joke, to make light of things, to turn things around, to re-frame, to positivize. I don't like to face it. But I know. I know I'm really sick. It's just that it's more undeniable at some moments than at others. Weightier. 

I knew I was very sick in 2002 when I found myself standing on the roof of the Arts building at McGill, looking down at the cold ground, wondering why I couldn't just bring myself to step off. My life falling apart, failing all my courses because I just couldn't do the work, the unbelievable pain, the whole world in grey-scale.  

I knew I was very sick when my local hospital transferred me to St. Jerome, where I was committed, and where I wondered if I could hang myself with the curtain around my bed. I knew I was very sick when I started spending every night in the isolation room, tied down in four-point restraints. I knew I was very sick when I tried to crush my own windpipe with the side-rail of the hospital bed, and I was transferred to the Intensive Psychiatric Care Unit. I knew I was very sick when they released me into the care of a university psychiatrist, when he had me come and see him twice a week, when I tried to jump out his window during a session. I knew I was very sick when I sat on the floor in school bathrooms and scratched my wrists with razor blades. 

I knew I was very sick in 2003 when I stockpiled small amounts of my daily-dispensed medication to make a cocktail with over-the-counter drugs and alcohol, when I had my stomach pumped and woke up in a freezing cold ICU to a doctor telling me it was a 'potentially fatal combination,' and to my own feeling of utter disappointment and despair. The feeling as I lay my head on the cold marble floor, losing consciousness, and thought, what if this is it? When I answered myself, I hope it will be over soon, and that this nothingness goes on forever, like the horizon. 

I knew I was very sick as I battled extreme emotional instability throughout the rest of my first undergraduate degree. Always certain that today would be the day when everything was too much, that I couldn't go on, but that I owed it to so many people to keep struggling, to keep going on, because everything I knew about depression told me that if I just did what the doctor told me, went to therapy, worked on myself, one day I would get better. I knew I was sick when I believed that my teachers were involved in complex plots to kill me by informing my rapist where I was and what I was doing. 

I knew I was very sick in 2005-2006, when I sliced into my skin every night with an Xacto knife, every incision deep enough to require stitches, but never going to the hospital, letting the scars accumulate. I knew I was very sick when I found myself thinking, as I dragged the blade through my flesh, that if I didn't do this the army wouldn't come and save me. I knew I was very sick when I swallowed just over a month's supply of sleeping pills. I knew I was sick when I woke up in emergency and, semi-conscious, tried to pull the IV out of my arm because I thought I could stab myself with it.

I knew I was very sick in 2009 when I was on the maximum dose of Wellbutrin (bupropion), with 4 other medications to try and augment it, and it was failing. I knew I was very sick when I requested, and took, 8 months of sick-leave from graduate school in 2010. I knew I was very sick when I had to go back to school and I wasn't better. I wasn't better enough to finish my degree, and I had to withdraw because I couldn't complete my program within the time limitations. I knew I was sick when I failed at the last thing that promised me I could have meaningful, rewarding work in my life that fit within the constraints of my illness. 

I knew I was very sick in September 2013, when something felt fundamentally wrong, and my doctor didn't listen to me. I knew I was very sick as I went into a downward spiral, when my psychiatrist finally agreed to try medication, when my cocktail didn't work, as I became more and more unwell. When coworkers and friends commented on it. When my boss told me to take a vacation, or a sick day, or do something, anything. I knew I was sick while I was having a very public breakdown all over social media. I knew I was very sick because I knew that if I took even one foot off the path I would fall off completely, and there would be no coming back. 

I knew I was very sick when I told my psychiatrist I was so tired, and he said I'd been tired for years. I wondered when that had become acceptable. I knew I was sick when I couldn't stop thinking about slicing my wrist open, about all the blood, about what my artery might look like right before I bled out. I knew I was sick when I started practicing on my thigh, and my doctor told me that I didn't want to kill myself, that we'd get me through this. I wondered when enough would finally really be enough. 

I knew I was very sick when I went into St. Mary's in January 2014 to get 15 stitches in my wrist. I knew I was sick when they were telling me I was stable enough to leave. I knew I was sick when I left the hospital one evening and swallowed a bottle of Advil and wandered around outside in February, without a coat, for hours. I knew I was sick when the police picked me up after the hospital called it in, and brought me back with a firm grip on my arm. I knew I was sick when I was returned to the hospital and strangled myself with my own belt. When my new psychiatrist told me we were going to try this again.

I knew I was sick when my case was presented on general rounds, and all they managed to come up with was that I needed to learn how to 'bother people' when something is wrong. I feel like I've been bothering people for years.

I know I'm very sick because this illness has decimated my life, destroyed capacities and opportunities that I once took for granted, and devastated my sense of self-worth, of hopefulness, of trust in a future worth hanging on for.

I knew I was very sick when my new psychiatrist and I filled out the rTMS referral and had to list all the medications I've taken over the years. I knew I was very sick. But I felt like if I could hide it, if I could hold down a job for longer than 6 months, if I could volunteer, if I could get up and go about my day and muscle through it, that it didn't matter so very much that I was very sick.

But there's something about the Douglas that makes being very sick impossible to ignore. Maybe it's the bigness of it all, the sense that now I'm at the place where the experts go when they can't solve something. Maybe it's the impressive size and spread of the facilities. 

You have to admit, it's really flippin' impressive.

Once I make it up (or is it down?) the driveway, I go around to the left of the front buildings and walk down to the building where my treatment lives. Presumably, when we're not there the treatment is having wild parties with the fMRI and PET scanners. At least that's what I like to imagine.  

My building is super pretty. I'd never actually looked at it until today when I decided to take this picture. I love the design, the glass, the red brick. I'm happy I looked at it, glittering in all that sun. 

Finally, I go inside the building and sit in this waiting area on the red chairs, where I usually try to read. I cuddle Puffy -- my stuffed animal -- and I wait. I like the quality of the light: it's very soothing. Mine is the first appointment of the day. I like the silence, the solitude, the softly falling light.

So, this is where I go everyday, and a little bit of the reason why I go here.

These are the first pictures I've taken since August. I even re-sized them and adjusted the colour levels. I hope you like them! :) 

TMI RTMS: I am Feeling ALL the Feelings

So...tomorrow is the big day: Day One of RTMS. Possibly also Day One of How I Got Lost On The Grounds Of A Massive Epic Hospital, because I am going to an unfamiliar building I didn't quite catch the name of over the phone.

Anyway.

First thing in the morning, I will remove all of my earrings so my ears don't start to resemble an extreme body-modification project. Project "Swiss Cheese," or "Magnets, Dummy." I will carefully place the earrings in a baggie so I can reassemble my personality once the second treatment is completed. Why yes, my self-identity is hinging on having multiple piercings in quite-conventional locations, thank you for asking :)

I am going to try and put on makeup and wear different, decent clothes every day, so I don't succumb to my depressive tendency to wear the same pair of pants and scuzzy sweater every day, for weeks, and to give up washing my face entirely and abandoning my makeup efforts at looking slightly less hideous. The theologian / psychologist William James believed that how you behave is how you feel. Smile: you'll feel happy. Put on makeup: you'll feel better. Brush your teeth: you'll feel like a normal human being. While I don't believe it's that simple, I think that self-care is certainly an element in successfully battling both major depression and dysthymia. Anyway, my goal is not to backslide on that, since I've been doing moderately well at it since my progressive return to work began.

I am feeling...hopeful. I tell myself that this is going to work. The research has shown encouraging results. I am due for some good luck, and this will be it. I have that good feeling, that this is my break, my chance, my turn to be well. So, I am feeling hopeful, and kind of excited.

I am feeling...nervous. I don't really know what the experience will be like. It isn't like anything I've ever done before. I am going into this alone, not knowing anyone who's ever done it. It always makes me uneasy to try something new, something unfamiliar, something I haven't researched the shit out of and tried my best to understand. It is unlike me not to have read the scientific literature on the subject, but I just haven't been interested. I have no idea how the procedure works. There's no maintenance protocol, so I have no idea what will come next. So, I am feeling trepidation.

I am feeling...desperate. I keep thinking that I'm coming to the end of the road in terms of what can be done. Of course, strictly speaking that's not true. I haven't tried acupuncture, ayurvedic medicine, ECT, MAOI-class medications, or pet therapy. And of course, I could just wait a few months and probably recover most of my pre-acute-episode functionality again, albeit with a long intervening period of debilitating depression. But it still somehow feels like I'm coming to the end. So I am feeling desperate.

I am feeling...relief. Finally, something is happening. Finally, I can stop worrying that I am not doing anything, not doing enough, to try and propel myself in an upward direction. I feel like I can stop harassing myself to do something, anything, and take a moment to simply stand still.

I am also feeling like I might get lost, since I can get lost going in a straight line to a place I've been dozens of times before. I will equip myself for my journey with phone numbers.

In other news, the not-eating-sugar project has not been going well. Had lots of sugar, had a headache. But just because I made bad choices in the (really recent) past doesn't mean that tomorrow isn't a new day, or that today isn't a new minute. I can choose a better path.

RTMS: The Treatment I was Beginning to Suspect was a Hoax

Last week I was typing away industriously at my job, feeling hopeless and overwhelmed. Completely overwhelmed. I'd been keeping my phone on my lap for the past few weeks, waiting and waiting and waiting for someone -- anyone -- to call me.

I was waiting for a new psychologist to get in touch with me after I broke the last one. And, most of all, I was waiting for the Douglas to call and say they had an availability for my treatment.

I had had an assessment early in February, after finally being referred in January, having gone so spectacularly downhill that I needed to be hospitalized. They didn't call me back, and I had no timeline for my admission into the clinical trial. Finally, they returned my phone calls in early April to schedule a second assessment because it had been so long since the first one. Thank you. Basically, the meeting started with the doctor asking me, "So, are you still sick? Do you still need treatment?" and ended with "I hope this helps you."

Whereupon, back on the waiting list, for three to six weeks. I ran to the bus stop, missed the bus, and promptly started crying into my mittens while waiting for public transit. I was thinking, "I will never make it six weeks." I was thinking, "If I've returned to work full-time by then, my renewed claim will probably be denied, and I'll have to choose between my job and this treatment. I will probably die." (which, actually, is not that far off; my short-term disabilities officer is contacting the director of the trial directly to try and figure out if there's some way that I can work and go to treatment at the same time. Because obviously I should be able to work, and fuck the fact that I'm still sick.) I was thinking, "This is so unfair. If any of my doctors had agreed to ECT, which I said I was willing to try both in 2009 and now, I would probably have been treated by now, and maybe even have been all the way better, instead of living through months of hell."

But I digress.

I was sitting at my desk, industriously typing away, proving my corporate worth by shattering the hourly production quotas, and my cellphone rang, vibrating happily in my lap. I answered it, suddenly breathless, my pulse racing as if I'd run a marathon. This was it: finally, something was happening.

It was an automated message congratulating me on having won a cruise.

Fuck you, scammers.

I was so disappointed. I felt...I don't know...crushed. They were never going to call me. What was the point of hoping for anything different, anything better. I started to think maybe this whole thing was an elaborate ruse deigned to trick people with treatment-resistant depression into hanging on until they spontaneously go into remission on their own. Like a carrot, designed to keep us running after a last vestige of hope for months, never amounting to anything except one more strategy for buying time. I felt like, for all these years I've been trying so hard, but it wasn't amounting to anything at all. What was the point? One more day of tearing up at my desk, or running off to cry quietly in the bathroom, using up precious break time?

Finally, the Douglas did call me a few days later, telling me there was an opening, and it was mine if I wanted it. It couldn't have come a day too soon.

Repetitive Stimulation (!!)

Back in the day, before Freud made psychoanalysis so popular we can now joke about the libido with abandon, women suffering from neurotic disorders had quite a small range of treatments available to them. For one example, a woman could pay a series of visits to her physician, during which he would use a specialized apparatus to stimulate her nether-regions until she achieved climax.

Sadly, this is no longer an option.

In all seriousness, this is not the kind of repetitive stimulation I've been prescribed.

Repetitive Transcranial Magnetic Stimulation, or RTMS, is a relatively new procedure approved for cases of treatment-resistant major depressive disorder. If all goes according to plan, I'll be starting an accelerated course of RTMS at the Douglas hospital beginning on Monday, consisting of two treatments a day, five days a week, for three weeks. The hope is that it will be as effective as ECT, but without any of the effects to short-term memory. Just in case I do forget anything, please be sure to remind me at every available opportunity that I am a naturally-blonde, multimillionaire named Sarah. I am also very, very good at math.

Unlike ECT, RTMS is not meant to induce seizures, and that's one of the things I'll be monitored closely for during treatment. I need to have some of my earrings removed so they don't get ripped out of my head by the powerful magnets, and I need to wear earplugs. I also need to get an answer back from my short-term disability insurance and my company's HR department stating that my leave of absence for this treatment has been approved. I'm not sure what I'll do if it turns out they're turning me down. On the one hand, I like this job and the team I work with, and on a practical level I need it if I'm going to afford food and medication, not to mention housing. On the other, without successful treatment I will continue to suffer from crippling, suicidal depression until, eventually, I succumb to my illness and die.

This treatment is part of a clinical trial, so nothing else about my medication regimen can change throughout its duration. To give you some perspective, I've been on a waiting list since my initial assessment in early February, and my condition began to noticeably deteriorate in late September. I feel like I've waited long enough and, frankly, suffered longer than should have been acceptable.

I am terrified of this treatment. Terrified that I won't get the chance to do it and will be stuck like this forever. Scared that it won't work, and scared that it will. Worried about whether I'll have time off once it's completed to consolidate my recovery, or if I'll be working full-time immediately and all the risks that will entail. I don't know what will happen to my hospital-team's strategy of having me complete therapy to deal with unresolved trauma since I lost my psychologist, and there's not enough time in my progressive-return-to-work timeline to begin treatment again even if I had been assigned a new therapist right away. It's all very...unsettling.

I would love for RTMS to lift me out of the chronic depression I've been living with for the last 11-or-so years. What I need it to do is break the back of this acute episode so I can begin the long climb upward to a place of stability. Regardless of how it turns out, it's unrealistic to think that I don't have a lot of work to do on myself when this is settled. A decade of illness leaves its mark, and health isn't something that I remember how to live with, let alone feel comfortable with. I'm not really sure who I am anymore, either with this disease or without it. I understand that this illness is, by nature, chronic, and I'm not sure I've ever dealt with the reality of that, or grieved the life I will not be able to have. These are all things I'm hoping to explore, once I can breathe again.

In the meantime, I take comfort in the fact that cauterizing a woman's clitoris in order to dispel neuroses is a treatment that has, thankfully, gone as much out of favor as masturbating her to orgasm has. Bring on the magnets!