Hard Day

Things have been going swimmingly for the most part. My anxiety levels have been pretty low since quitting my job. That is, until a couple days ago.

I've had a friend that I've been wondering for a long time whether or he's a positive influence in my life. Sometimes I've had a good time with him and sometimes I've left my interactions with him feeling bad about myself. I've tried to point out the behaviors he has that rub me the wrong way on a few occasions and he inevitably responds that I've too sensitive.

In any case, on Friday he invited me to hang out with him in a group. I said no a couple of times and he kept pushing. I was kind of like fuck it, I might as well be honest with him. I told him it was hard for me to spend long periods of time hanging out with him. He didn't take it well.

Then he wrote me a long email saying that he believes I am selfish, ungenerous, mean, and overly sensitive. I wrote an email back. I am feeling intense guilt for this email. I got 5 or 6 emails back about how mean my email was. My partner asked why I felt so much guilt and not more anger? I don't know. I don't know if I'm capable of anger anymore.

I feel like a horrible person in all this to be honest. Maybe I really have done all these horrible things to this person. Maybe I am overly sensitive. Maybe I am deserving of his harsh reactions. It's horrifying that I've hurt someone so badly without even trying.

I've forgotten what it means to be nice to myself. I've forgotten why I even brought this up in the first place--because choosing to hang out with him wasn't being nice to myself.

I feel so lost. Horribly guilty. Uncertain what to feel, what to think. I so strongly want to make things right, but I don't know that I can (at least without sacrificing myself an my values), or if I can if it would be good for me to.

I'm worried I'm falling back into a hole of anxiety. I can't be unselfish when I'm anxious. It's too much of effort to even take care of myself. I'm worried I'm not capable of being a good person.

The Meaning of Anxiety and Depression

It seems bizarre to me that a number of people seem to very strongly believe that anxiety and depression are always meaningful. My first therapist told me that anxiety was like a sign post directing me towards my needs. This was a terrible thing to say to me. I've also come across a number of books that say more or less the same thing. 

I'm not saying that there aren't external factors that contribute to anxiety and depression, but whatever one is feeling anxious or depressed about isn't necessarily related to those factors. Stress is a trigger for OCD, for example, but when I find myself obsessing, it's not like I obsess about what I'm stressed out about. Trying to find meaning in my obsessions is generally disastrous.

I understand where this idea that anxiety and depression are meaningful comes from. We live in a society where antidepressants are frequently prescribed and we are told that antidepressants are necessary to fix chemical imbalances in our brains. More are more people are taking drugs.

The people who believe that anxiety and depression are meaningful are responding to some of these disturbing trends in the over-medicalization of mental illness. They see finding meaning in anxiety and depression as an alternative to blindly popping pills.

But there's a third alternative I think. We can recognize that anxiety and depression arise from a number of complex factors, which include, but are not limited to:
1. Some sort of life situation or problem--that is, the anxiety and depression is meaningful
2. A structural or chemical issues with the brain
3. A lack of exercise or good food or sleep
4. An excess of caffeine or other substances that exacerbate anxiety
5. A health condition--thyroid hormone imbalances are linked to anxiety and depression, for example. 

Just because we recognize that anxiety and depression sometimes are not meaningful doesn't mean that popping pills is the only answer, either.

Various Things I've Taken for Anxiety

Taking drugs or supplements for anxiety is a tricky thing. I've come to believe that taking anything regularly to treat anxiety probably not a good idea. I'm always concerned about becoming reliant on any substance since I seem to suffer from anxiety so regularly. Chemical addiction is another issue. For example, benzodiazapenes work really well, but they affect your brain's synthesis of GABA if you take them long-term. This causes anxiety to only get worse. This may be an issue with other substances, but the consequences of long-term use may not be as well understood.

I haven't taken anything for my anxiety in a bit. But for those who are struggling and looking for something to help with anxiety, here's what I've taken and my thoughts:

Clonazepan 
Clonazepan is a benzodiazapene. I got it from my doctor for sleep issues I was having a few months ago. I was told I could take 1-2 pills at bedtime for sleep. I found that half of a pill more than did the trick. The first time I took it, I felt a bit drugged and groggy in the morning. Then again, I hadn't slept well in three or so weeks when I took it, so it could be I was just exhausted. I took it every night for a week, and then stopped without any adverse effects. I've taken a half pill from time to time when I've been feeling particularly anxious and unsure if I'd be able to sleep well. It makes me feel calm and a bit dizzy. It's not like the things that I'm anxious about magically disappear, but I'm too dumb to really think about them. If I've been having a lot of anxiety, it's nice to feel dumb for a while and then pass out. Clonazepan is super addictive though, so when my bottle runs out, I don't plan on asking for more.

SAMe 
SAMe is a supplement that is supposedly a fast acting antidepressant. It's regularly prescribed in Italy instead of SSRIs for mild to moderate depression. Like SSRIs, it's thought to increase levels of serotonin in the brain. I took it when I was feeling both anxious and depressed and having insomnia. I took it for just over two weeks and I did not have a good experience with it. I felt emotionally numb, had zero sex drive, and my insomnia got worse. It was only when I was thinking of going off of it that I did more online research and found that a lot of people find it negatively affects their sleep, which was exactly what I didn't need. SAMe may work just fine for depression, but I don't think it works for OCD.

Inositol
Inositol is a substance found in food and also sold as a supplement. Normally you get 1-2 grams a day in your diet, but therapeutic doses are in the range of 10-18 grams per day. A number of small studies indicate that it helps with panic attacks and OCD. It doesn't have an side effects, other than temporarily causing diarrhea in some. If you start taking it as a supplement it supposedly takes 3-6 weeks to work. I initially took inositol nearly two years ago when I started getting panic attacks. I worked my way up to taking about 10 grams a day, and found my panic attacks when away. I then weaned myself off of it. I took it sporadically a few times until this last spring when I started taking around 12 grams a day to help with anxiety and OCD symptoms. I weaned myself off of it again this fall. I don't really know what I think of inositol. I feel like it helps, but it's effects are subtle. Since the only studies of it are small, it's unclear whether it really works and what its long-term effects are. This is why I stopped taking it. I find that I get a lot more anxiety while going off it, which is why weaning is so important. This last time I went off it, I felt like I was getting facial twitching. This was likely just a sensory obsession though, and it passed after a week. I think I feel a little bit more like myself, and a bit more motivated since going off of it. Then again, I'd been doing a lot of work in therapy and thinking better about my life, so who knows. Since it really doesn't have side-effects and isn't addictive, I certainly wouldn't recommend against it.

Valerian, Passionflower, and Catnip
I took a mixture of these three herbs for insomnia. I think they helped me fall asleep, but I'd wake up in the middle of the night feeling anxious and physically weird. My skin felt funny while taking these herbs. I know people who have had success with these herbs, but I'm not a fan.

Other things
Pot sometimes helps with anxiety and insomnia, sometimes doesn't help at all. Unclear why it sometimes works and doesn't. It certainly helps me stay asleep, but not necessarily fall asleep. I feel very calm and happy while drunk, but I wake up feeling horrible the next morning, so I generally avoid alcohol nowadays. Caffeine seems to contribute to my anxiety and insomnia, so I avoid it all together. I even avoid tea, including green tea. Occasionally, I'll drink twig tea (about 5 mg per cup) and eat chocolate, but I avoid these things if I've had any sleeping issues.

Update

For anyone out there, who reads this and doesn't already know what's going on with me, here's an update:

A few weeks ago, I decided to quit my job. I went into therapy and told my therapist about it. He was ubber supportive and said I seemed happy about this decision. I then asked if I should keep seeing him and he said we was going to ask me the same question. I said I felt okay going it alone for a while. We chatted a bit about a few other things--skin picking, perfectionism, etc. And that was that. I left feeling certain of my decision to quit my job, so I went and quit that afternoon.

I know I've whined a lot about how my therapist suggested I take SSRIs. After our last conversation about them, though, he let the topic go. I think he realized it flustered me. It's odd now that I'm not seeing my therapist how much I notice his absence. There are so few men in my life who are consistently nice to me, my partner being the one notable exception. Also, my therapist and I had quite a few conversations about being nice to myself. At first, I think, I believed he was telling me this out of some sort of utilitarian belief that being nice to myself would serve me better. On some level I believed that he was just nice to me because I was paying him to be. I think, though, after talking to him more I kind of came to believe that he was nice to me and wanted me to be nice to me because that's actually how he fundamentally approaches people. I found this deeply encouraging.

Since quitting, I've had a rough few weeks and wondered many times if my decision to quit therapy was hasty. Having to go to work has been really difficult. I have a lot of mixed feelings and I feel like I'm ditching  my coworkers with a lot of work to do. I find myself getting angry about things I tend to get angry about it work, and then reminding myself that I need to let go. I'll be saddest not to see my coworker every day, but we live near each other and can continue to be friends if we choose to.

I've had a really good past few days. I think not being at work has helped considerably. My anxiety levels are pretty low.

I'm concerned about January when I won't be working. I need to have structure in my life and I need to be working on things that I care about and seeing people every day. This will be hard without a job, but not impossible.

Letter to Robert Whitaker

I wrote the following letter to Robert Whitaker, author of Anatomy of an Epidemic. 

Dear Mr. Whitaker,

I wanted to first of all thank you for your book. I read it when I was having a difficult time with my OCD symptoms and was considering taking antidepressants. Your book, along with a few others, convinced me otherwise. Given that these drugs appear to have dramatic side-effects, both short- and long-term, and aren't particularly effective, I am grateful that I did not go down that path. I am now doing significantly better.

Your book, as well as other books, advocate for a shift away from treating mental illness with drugs towards a therapy-based paradigm of care. While I wholeheartedly agree that drugs are not the answer, I also see many potential problems with a therapy-based paradigm. It seems to me that therapy is frequently advocated for, like drug-based care has been advocated for, without thorough analysis of it's dangers and benefits, as well as an thorough understanding of its philosophy towards treating mental illness.

If I may share my personal experience, my first foray into therapy was about 8 months ago. I didn't know I "had" OCD, all I knew at the time was that I was finding myself extremely anxious about strange things. My first therapist failed to accurately "diagnose" me and failed to offer any sort of effective treatment. I found myself getting worse over the few months that I saw her. My second therapist has been extremely helpful both in accurately assessing my "condition" and offering effective, science-based treatment. The caveat, however, is that he has repeatedly suggested medication for me to supplement his treatment, which I have refused.

My sense, from my limited experience, is that two problems can readily occur in therapy: First, therapists can fail to offer effective treatment as a result of not drawing upon the scientific data and tools that psychology research provides us. This can result in harm to the patient. And second, therapists can offer effective, science-based treatment. However, those most likely to offer science-based cognitive-behavioral treatment are also most likely to see drugs as playing an essential role in an effective treatment plan. I don't believe that the science-based psychology is functionally distinct from psychiatry--the two work together oftentimes to offer treatment in tandem. It is sometimes difficult to get good psychological treatment while refusing drug treatment, as it's easy for the therapist too see the patient as uncooperative or to see the refusal to take drugs as symptomatic of the underlying mental illness.

I was wondering if you had considered the difficultly of getting effective, science-based therapy while attempting to avoid psychiatric "care." I would be very curious to know anything that you've come across in your research or if you have seen anyone else explore this topic.

Thanks for a wonderful book,

Thinking of Myself as Well

I've been starting to think of myself as more and more well again. It's hard to say what causes what, but thinking of yourself as well and actually doing well seem to go hand in hand.

This is part of the reason, I think, why my therapist's suggestion that I take antidepressants bothered me. Admittedly, I tell him all the ways in which I am not doing well--all the ways in which I am failing to appropriately manage my anxiety. But it's somewhat discouraging to overall feel better than I have in months and be told that I'm still not well enough.

But I am in charge of whether or not I think that I am well, not my therapist.

Frustrated

I'm frustrated with my therapist. He brought up medications again. I didn't really want to engage and I kind of made that clear. He kind of pressed me. I didn't want to fully engage him the sense that I didn't think it would be a good use of my time. So, I made the worst possible choice and half engaged him. At the end of the appointment I think I seemed flustered. I failed to answer a question because I was only half paying attention. He then asked me how I was feeling and I said I was fine. I wish I hadn't lied, but I didn't know what to say.

I don't know why I'm so frustrated. I guess he's well-intentioned, but I think he's wrong and I think all the arguments he presented me with were stupid. I guess I wish I had been more direct, so I'm frustrated with myself a bit too. Sigh. My next appointment isn't for two weeks. I have an urge to bring this up at my next appointment, but it's a waste of time and I will probably be over it by then.

I think I just want my therapist to be ideologically aligned with me. The thing is, he's a good therapist and I shouldn't expect to find someone who is fully aligned with me.