Friday, March 27, 2009

Fan mail

I got a really nice email recently from a woman I'll call Marissa. My mood was first too anxious and then too depressed to reply when it landed, but I'm feeling more or less back to normal -- just mildly dysphoric -- so I'm going to tackle it now.

Hi Ayelet, First of all, thank you for your blog. I recently started reading it and have now made my way through all of the archives.

How cool is that! I wish all my readers were that thorough.

I have learned a tremendous amount and feel like I now have some insight into what life is like for a relative of mine who has the same diagnosis (she also was diagnosed with histrionic personality traits, in addition to narcissistic personality traits). I am grateful to you for your openness and hope that it has helped you, and others.

I'm not free of narcissistic personality traits, by any means, and I'm pretty sure I'm at least a little histrionic. I'm glad I've helped you understand a little bit about the strange, distorted, painful world we inhabit. Writing the blog has helped me because I can vent about my feelings, and it's also helped my friends understand and support me better.

I don't know if this is at all appropriate, but I had a few questions and would be most grateful if you were willing to address them either on the blog or in an email. (You've been very open, but I understand if you find this invasive, if you're not interested in thinking about these things, or any other of the myriad reasons you might have for not wanting to take the time to answer me -- and if I am asking inappropriate things, I apologize in advance.)

If you've read my entire blog, Marissa, you've heard about the men I've dated and you know I have a pretty high tolerance for inappropriate. In all seriousness, I'm always glad to use my illness to educate the public, so there's very little I would find too invasive. Remember, my clients have seen my thong and looked up my skirt during group.

I'm trying to wring something positive out of the pain I've gone through. If you were to ask anything invasive, I'd let you know I can't respond to it. Your approach has been supremely sensitive, so I know you mean me no harm.

1) I am very curious about how you came to be diagnosed: I would be grateful to read about when was it and what led up to it, and what the process was like for you? I'm particularly curious how long it took you to "embrace" the label -- it seems that many people close to you didn't necessarily encourage you to be open about it. Did you feel shame and bafflement? Did you deny it? How did you come to work through all of this?

I was diagnosed with depression in college, briefly medicated, went off medication, and was re-diagnosed and re-medicated at age 25. It was a very bad episode of clinical depression -- I went down to about 99 pounds, which meant you could see my collarbones through my clothing. I was put on Prozac, the first and strongest (and probably crudest) of the SSRIs. That propelled me into hypomania, and my doctor put me on Depakote but didn't tell me what was happening to me. I didn't like the Depakote -- it's a mood stabilizer, which I don't think I was told at the time. It made me sleepy, so I stopped taking it.

Then one day I went to the emergency room because I was breathing funny, and in the course of taking a history, the interns determined I was hypomanic and showed me the diagnosis for type II bipolar disorder in the pocket-size DSM. The diagnosis came as a relief. I knew I had a problem with depression -- pretty much all my life I've been moody. I didn't understand the hypomania, even when it was happening to me.

Amazingly, I didn't fire my psychiatrist (or my horrendous psychologist) immediately. But I understood more of what he was trying to do to help me. Unfortunately, he's not very good at his job. He kept putting me on and taking me off different medications, until finally nothing was working and I overdosed. That got me the help I really needed.

2) I wondered if perhaps in the last few months you have chosen to avoid writing about certain things or were feeling differently? In prior months, the blog seemed to give unfiltered access to your pain, anger and frustration at the difficulties you face. For whatever reason, in the last few months, you seem to be handling your life with even more grace -- you're speaking to your sister (and you didn't write about what effected that reconciliation), you seem to be bouncing back emotionally more quickly from the vagaries of dating, and you generally seem to have a greater store of flexibility (whether it's for being people annoying or ignorant or for something going wrong). Certainly, you're to be praised for this - but I wondered if something changed (the dating coach, maybe? A change in meds? A new insight you gained?).

It's funny how people view your life so differently from the way you see it yourself. I thought I was just as pained, angry, resentful, and frustrated as ever, and you see me as responding with more grace, resilience and strength. Thank you.

One factor, I'm sure, is that I love my job. The beginning of my blog details my nightmarish experience in a doctoral clinical psychology program at The Bad Place, where they abused and devalued me. That was absolutely horrific. I'm sure they took years off my life with all the stress and grief they caused me. Then I was enrolled in a great clinical social work program, but still suffered a lot of ups and downs with the administration, so I still struggled.

I was lucky enough to find my job within a month of graduation. I really love what I do, I like my supervisor and most of my co-workers, and I love my clients. They are hilarious, usually unintentionally, sometimes maddening, sometimes frustrating, but in general a really interesting bunch of people who give me tons of validation.

So I'm happier in general, because my job is going well. Work is a big part of our lives, and for the first 10 years I was out of college, I drifted from job to job, not knowing what I was supposed to be doing, outgrowing jobs and stagnating. I was miserable. Figuring out what I wanted to do and going to grad school helped tremendously, but actually doing what I want to do is fantastic.

As far as my sister goes -- what can I do but forgive her, when she and her children need me so much after the divorce? It's a basic principle of cognitive-behavioral therapy that you can't change people and you can't always get them to give you what you want; if you're a good behaviorist, you can, but I'm not at that level yet. All I can do is accept Jerusha as what Albert Ellis would call "a fallible, fucked-up human being." (He loved to curse. Thought it shocked and disarmed people, which caused more of a therapeutic impact.)

3) Finally, you've mentioned Kay Redfield Jamison's wonderful book on a number of occasions; I also really enjoyed it and gained what I hope is not too small an amount of understanding (I do think that, however much I try, I cannot understand fully just how much-as you wrote-"dancing backwards in high heels" is required to live life fully while coping with various disorders). I was wondering what your thoughts were on her strong opinion that she disclose her illness to the clinicians with whom she works so that they can be a check on her if she were to go into a manic or depressive episode. My impression from your blog is that your supervisors and colleagues do not know about your medical condition. Am I right, and do you think, ideally, that they ought to know?

Kay Redfield Jamison is at a point in her career where she can afford to disclose to her co-workers. She has tenure, she has stature in the field. She also has type I bipolar disorder, which is much more severe than my illness. If I got very sick and couldn't cope with my job, I would tell my supervisor. Until that point, I don't think I need to.

I really appreciate you taking the time to read my e-mail and would obviously be grateful if you were able to answer me, either in an e-mail or on your blog. And I certainly understand if you'd prefer not to. And, again, I apologize if my questions are inappropriate (or, Gd forbid, hurtful - as I wrote, I am grateful to you for your openness with your struggle and the last thing I mean to do is to be insulting or insensitive).

Marissa, I really appreciate you telling me that you found my blog helpful -- and providing me with such an amazing view of the recent change in my outlook and behavior. Nothing you asked was inappropriate or hurtful. Your relative is lucky to have a person like you in her life.
Copyright (c) "Ayelet Survivor"

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