Well, I’m hanging in. Some people tell me that I’m doing great. From my perspective, the good news is that the med adjustment in the hospital has made the command voices subside. As for paranoia, when I recently went inpatient, I was troubled by three intense beliefs:
- Everyone wants me to commit suicide
- If I’m interacting with someone, that person is angry with me for not having completed suicide
- The only way to appease everyone would be by doing myself in
I talked to the team leader from my last entry, and she cleared a few things up. She knew that I didn’t want to have to go inpatient. What I saw as her trying to apply additional, external pressure, was actually her trying to not pressure me into doing something that I didn’t want to do.
A complicating factor is that from 2015-2019, I had this really unhelpful therapist who would absolutely lose her mind at me if I went to the emergency room. One time I was inpatient, and severely beating myself up for it. I thought that I could appease Dr M if I signed a 3-day to get out of there, and made it extremely clear how deeply I hated myself. This did not work, and the next time I saw her, she read me the riot act because she didn’t think I really, really understood how awful I was. So, I crashed my car off the side of the highway.
My point is, having that as my background, I generally go in with the assumption that the clinician I’m talking to will think I’m evil if I go to the emergency room. Now, I generally don’t want to go because it interferes with my goals. However, there are times when I do think it’s necessary, and I’m not great at communicating this to clinicians. Like, I really try. But although from my perspective I’m screaming at the top of my lungs to please let me go to the hospital because I cannot keep it together; from the other person’s perspective, I’m still hoping to avoid the ER. People unfortunately don’t always take me at face value. But there are also times when I’m certain that what I’m saying is that I’m in extreme crisis and cannot manage on my own, and I don’t understand why the other person won’t believe me. And the other person actually is trying to take me at face value and has no idea what I’m trying to tell them.
Anyway, the team lead asked me to write down what I need when I call for help. So, first of all, when I’m in crisis, I generally believe the three points listed at the beginning of this entry. I feel like I’m trying to appease everyone by doing myself in. Like I just want to scream that I’m SORRY, not for unaliving myself, but for being such an awful human. Unaliving myself feels like the least I can do to make up for that. So one thing I need honestly is permission to not do myself in. Usually, I don’t even want to die; I just feel like everyone else wants me to. So affirmation that my life is a net positive to the world and my interlocutor prefers me alive, would be helpful.
Additionally, I need permission to go to the ER if I need to. I have a strong history of going to the ER, being bounced, and then attempting suicide within 24 hours. That’s a huge fear when I think about going. So I don’t want the other person to force me, but I need them to let me know that it’s okay to go to the ER if I need to… and they won’t call the doctor there and tell them to bounce me.
Third thing, with regard to Coping Skills, a common question when I call these lines is, “What coping skills can you use?” This just feels so mean. Because implicit in the question is the assumption that I haven’t already tried using coping skills. If I could answer the question with “Oh, now that you mention it, I can go use xyz coping skill,” I wouldn’t be calling. A more helpful question would be, “What coping skills have you already tried?” After that, potentially a discussion could ensue regarding whether there are remaining coping skills that could help (if so, which?), or whether I’m at maximum benefit with coping skills and I need a higher level of care.
Anyway, things have been really difficult since discharge. The admission wasn’t the most helpful because I wasn’t able to connect with my attending doctor and I still pretty much felt like she would have preferred if I’d ended myself rather than coming in. Since then, I feel like my life goals are shattered. I needed to not go to the hospital so I could try to be a mom. It feels like I ruined all hope of that and the rest of my life is just going to be endless failure.
That was the backdrop against which Dr V said he’s terminating. I mean, I can see how he might have been discouraged by my complaining about him all the time. He says he just doesn’t have enough availability. It feels like what he’s saying is that I’m at rock bottom and consequently a huge time suck, which is hard to hear because I want to believe that I’m making progress. It’s also hard not to personalize with these things because the clinician can only point out things about me that are causing them to terminate; they can’t share what’s going on in their own lives because of boundaries. But this is a huge “setback” because my favorite thing about Dr V was his consistently not dropping me. I assume he’ll refer me to someone else, but that doesn’t mean that the someone else will actually take me. I have personal experience with being referred to so-and-so, only to be told at the end of the intake that they couldn’t take me on. This resulted in having no med prescriber. I also have overwhelming experience being passed along from provider to provider, which resulted in no consistency. It sucks dutifully going through yet another intake, knowing full well that the person before me probably won’t last more than three months.
As I mentioned, my primary reason for not wanting to go to the hospital was that I want to have kids someday. It’s also really tough with work. But the problem with “crisis” is that it removes the possibility of just going through life as usual. For example, paradoxically, going to the hospital is actually less problematic for job performance than showing up to work while incredibly forgetful and stupid, and at risk of sobbing uncontrollably at any inopportune moment.
Unfortunately, as much as I’m incredibly worried that going to the hospital destroyed any hope for the future, I’m also wondering if I should go back. There are a lot of red flags that I never actually made it out of “crisis.” I’m doing what it’s in my sphere of influence to do, and just crossing my fingers things get better than they are right now.
