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! :) 

Wanderlust

I'm not going to lie, I've been having a difficult time. It's not too unexpected, but still I can't help but be disappointed. I was backsliding before the RTMS trial started, but for some reason I was hoping the sheer fact of being off work on sick leave again would help me stabilize back to the point I was at when I first left the hospital, where I was making it through the days without sitting on the pavement, or lying on the floor for half an hour staring at the ceiling. It's the nature of the beast, I guess.

I want this blog to be a happy, funny place; I want it to reflect that humour and intellectualization are my main defense mechanisms, but I also want a place where I can re-frame my experiences as something lighter, funnier, more bearable. I can always use the practice. I guess I've had a lot of it, but might still have a lot left to go.

Ever since the increased dose of Remeron (mirtazapine), I've had this horrible side effect; my mornings are as difficult as usual, and I don't feel hungry or like eating throughout the bulk of the day. I spend most of my energy trying to make myself eat or look decent...although I guess it's worth noting I've been wearing the same pants since Sunday now. Oh well, you can't win them all. Anyway, in the evenings I eat like crazy, sweet foods, things that I normally don't even crave. It's not like I'm hungry, it's more like my body thinks it's not full, and will never be full again. This had never happened to me before, and I don't know how to deal with it. It brings up a lot of questions about self-worth, about quality of life, about why I do these things that don't help me cope but, ultimately, are very self-destructive. I wonder if this is a new way that drive to tear myself apart, to destroy myself, to end my life, is trying to express itself. It's just so...intolerable. I hate what it does to my body, to my mood, to the way it makes me feel. I want to maximize my chances for remission, my chance at health, at getting out of this hole I've found myself in and making that last as long as possible. But I see myself doing this thing that I don't understand, and I'm frightened about what that means, what it will do to my future.

Ugh.

Today, I finished treatment and had lots of time to spare. I went wandering. I wandered back to the metro station. I wandered to the end of the green line. I explored an area I'd never been to before, found a Loblaws, went inside, and looked at things. I realized that I wasn't wandering or looking to try and smother some other feeling, or to try and distract myself from crippling despair. I felt...curious. I just wanted to wander around and see things I haven't seen before. The grass looked greener, and the sun felt brighter. Maybe grass is always this green, and I haven't noticed before, or don't remember.

Maybe it will be spring after all.

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.

Hansel and Gretel: They Ate that House

One day, a little boy and a little girl found themselves lost in the woods due to some negligent parenting and a couple of hungry birds. Their names were Hansel and Gretel: it doesn't really matter which one was which. In the course of their increasingly desperate wanderings, they stumbled upon a house made entirely out of candy and gingerbread and sprinkles and all sorts of deliciousness. Having been inadvertently raised by the media to blindly accept things as they are (rather than wondering 'why is there a house made out of candy?', or, 'why did our parents leave us alone in these dreadful woods, anyway?'), they immediately began to eat the house. They kept eating the house until the entire house was gone. They weren't thinking that now they'd have no shelter against a dark and stormy night. They weren't thinking of pacing themselves and saving the windowsills for morning. They weren't thinking that maybe someone lived in the house and would be perturbed at finding it, suddenly, reduced to crumbs.

After a while, they weren't even hungry. But eating the house was comforting somehow, probably because it was so sweet. So they ate the entire house, fondant foundation and all. And then they had horrible tummy-aches, ran around the forest until they crashed and burned, and felt absolutely wretched. They also, more than anything else, craved even more house.

Which is sort of similar to what happened to me after I had my Birthday followed by Easter and ate all the chocolate in the universe. ALL THE CHOCOLATE!!! I started small, with an egg or two, and eventually went into a tailspin where no confection within a 12-mile radius was safe. It was ugly.

Now, I'm not a complete moron: I've done my research, or at least I have done, in the past, when I wasn't so lazy and slow-witted as I am today. I know that eating a healthful diet high in fruits, vegetables, and lean protein and good fats, while being low in refined sugar and over-processed carbohydrates, is relevant to staving off recurring episodes of depression. I know that it makes me better able to weather the lows, though not the extreme ones. I especially know that even though eating much less sugar than I'm used to does sweet-fuck-all to cure my depression, it certainly makes me less cranky, less exhausted, and overall less gross-feeling.

I started my tailspin this fall, when I stopped being hungry and tried to stave off extreme weight loss by consuming sweet sweet Starbucks frappucinos. I continued my tailspin when I started taking a medication that leaves me feeling pretty much constantly hungry no matter how much food I eat. I could eat an entire box of cereal and still keep going strong. I've always been one of those people who understands that psychiatric medications can cause weight gain, and who in theory thinks it's more important to have your illness under control than it is to be thin.

But God-dammit, I've gained more than 10% of my body weight!!

So, anyway, I decided when I got out of the hospital that I should go back on my holistic health kick of yore, and stop eating so much gosh-darned crap. And, you know, I had less meltdowns. But, one thing led to another. Maybe I was working too much, maybe it's because my sleep started to get worse again, but my depression -- easier to deal with when that was the only thing I had to do all day -- started to deteriorate once I moved from working 3 days a week to 4. I needed more energy, and I just didn't have it. I needed to be awake, and I just wasn't waking up. I needed to have at least one moment every day where, however briefly, I didn't feel like I was about to break into a thousand sharp little pieces and have a spectacular meltdown, because everything was just too much.

So I started to make exceptions in my diet. And then more exceptions. And then a few more...because making mistakes in the past means that I will never be able to do anything right, and I am a colossal fuck-up, and why bother trying at all? The strategy turned into something like 'keep making bad choices and then have horrible moments of revelation when you realize that you are fat, and hideous looking, and you can't even stick to your own health-care plan even though you're the person who designed it in the first place, because you are worthless, and you will never, ever get better, so you should just kill yourself now.'

Wednesday morning, I ate a giant bowl of Easter chocolate and then polished off an economy-sized bag of M&M's. I immediately felt miraculously revived and awake, like my body had just been given a drug it was craving. It was before 9 AM. I realized that maybe, just maybe, I had a serious problem going on here.

Anyways, the lesson of the story in Hansel and Gretel, which I'm sure I have retold in the classic format we all know and love, is that I have to give up adding all this extra chocolate and candy and ass-tons of sugar to my diet, because I am stuck in an unhealthy, vicious cycle. And I have to do it now, and not 'later, after this one last cereal bowl full of Cadbury creme eggs.'

Today is day two, and I have a wicked headache, and also a surprising amount of I'm-about-to-have-a-panic-attack anxiety. I'm not sure how much is because of sugar withdrawal, and how much is from general stress, and how much is because my mother bought me special ice-cream today after I told her I had to stop eating sugar if I ever wanted a chance to get out of this tail-spin. But hey, I'm still going strong, though admittedly without much of a track record.

When you come across a gingerbread house in the middle of the forest, just walk away.