Needing to Take Care of Myself

I feel exhausted this morning. I have this overwhelming sense that I somehow haven't been taking good care of myself, but I somehow cannot put my finger on exactly how. I've been eating okay--not perfectly, of course--but for the most part pretty well. I've been sleeping enough--perhaps too much? I've consumed some substances/medications that may have been best avoided, but certainly not in alarming quantities.

It's more this feeling that I haven't been taking care of myself emotionally, but I'm not sure exactly how. There are a few things I can point to: I've been emotionally investing myself in others to an extent that it's been harmful to me. I've brought up issues with others in ways that have turned out to be unproductive and potentially hurtful, and this has been stressful. To top it all off, I've been entertaining rather than resisting my obsessive thoughts, and have engaged in compulsions I thought I was done with for good.

My dreams have been intense the last couple of nights. I had one extremely vivid dream that I ate magic mushrooms that were fresh and moist and tasted like shiitakes. I started to trip. Everything was sparkly and beautiful and I woke up wanting to trip, but then remembered that mushrooms distort my emotional perception an order of magnitude more than they distort visual perception. A sparkly trippy world would never feel so light to me. My dream was so happy, but I felt sad.

I had another dream that I spoke to a friend I had a falling out with 6 months ago. He invited me into his apartment and was nice to me but then told me he felt like he was better off in his life without me. I told him I agreed and left. I didn't feel sad, I just felt closure: It felt good that we had agreed to go our separate ways. I went next door and then reconnected with a friend that I haven't spoken with in a while. Then tension between us was gone. I woke up and of course it wasn't real. My dreams are grasping at closure I'm not getting in real life.

It's not all bad. In the past few weeks, I've had some moments of intense focus on my work. I've had uncharacteristic moments of compassion for myself and others. That said, I feel like I have work to do in terms of taking care of myself. I just don't quite know what that means.

Irving Kirsch

Interesting video on antidepressants and the placebo effect.

Coping

I am going back to therapy tomorrow. The last 6 weeks have been too much. I am in the library and feel like I'm about to cry. I've done just about everything on my to do list, so I'm giving myself permission to feel shitty.

Everything feels like a compulsion right now. Writing, sex, exercise. A run would help me so much right now, but my legs hurt from how much I've been running. About a mile in, my thoughts start to disappear.

I don't feel hungry right now, but I should. Maybe Thai food would be tasty.

I don't even know if I like my therapist. He just understands OCD/skin picking/etc. and he's not involved in the mess my life currently is in. Or perhaps I should say feels like it's in. Everything is okay in some cosmic sense.

I don't want to spend money on therapy. I'm trying to spend less money. But my mood has been sour, so I haven't been cooking much. I'm spending too much money and now I'm going to spend even more too much money on therapy again. I suppose if not cooking and therapy are what I need to get my shit together, they're what I need to get my shit together.

Maybe I'll take klonopin tonight. I'm craving it right now. I know, accept that I'm craving it and think about what that means. It means I want to feel less anxious, I suppose. Therapy! SSRIs?!

Everyone around me right now talks about how sex is a coping mechanism for various things. Sex is never (or perhaps rarely) just sex. I use sex for intimacy, rather than just accepting that intimacy is a fleeting and inconsistent feeling.

God. I want to have sex right now. Too bad I have a raging yeast infection.

I don't skin pick as much when I cry or let myself show sadness, anger, or frustration. The urge disappears when I express intense emotions. I skin pick to keep myself together. I was trying not to cry in the shower the other night. I made my fingers bleed and then broke down and cried anyhow.

The Cycle of Meaning

I was feeling down today. More than just down, bad about myself. I've been unusually irritable lately, which has caused me to feel guilt. I took a nap, read some OCD forums, pet my cats--tried to do the things that tend to make me feel better. Finally, I got tired of going it alone and called a friend. I burst into tears and told her all the things that were going wrong in my life. Basically she told me that yes, there was a lot going on for me and I had every right to feel the way I felt and that I was being asked to tend to others needs which wasn't leaving me much room to tend to my own. I immediately felt better. Sigh of relief. Now, how had I gotten myself into this situation of talking care of others better than myself? I started to try to figure it out. If I can just set my life up as to take better care of myself, I won't feel bad again.

But wait! Doesn't this seem familiar? Wasn't this just the cycle of obsession, relief seeking, obsession? The obsession: I'm feeling bad. Why do I feel bad? Will I feel this way forever? Relief seeking: I called a friend for whom I supplied ample evidence for the theory she put forth that my emotional reaction was indeed a reasonable response to my circumstances and that I needed to be careful that others did not request too much of me. OCD sets up these perfect little problems for me. If I just do x, all my problems will be solved. If I just check the doors one more time, I'll stop worrying about them. If I can just figure out what's wrong in my life and then fix it, I'll be happy.

So, back to square one. Why do I feel bad? Is there a reason? Have people's requests of me really been the source of my dis-ease? Has there really been a lot going on? I want to avoid answering these questions, at least for the time being.

This goes back to a question in a previous blog post--Is anxiety meaningful? I've been reading Peter Kramer's Listening to Prozac. Despite the fact that we disagree on the evidence, I find Kramer's anecdotes compelling. He told a story of a woman held back by perfectionism, that is until she took Prozac. Once on the drug, her family relationships improved, she got a better job, and she felt more fulfilled. The social worker who the woman had been seeing called Kramer and was confused. She had spent hours analyzing this woman--breaking down the meanings in her conflicts and helping her become more self-aware. None of this helped, but drugs did. Clearly, this anecdote doesn't say anything about what Prozac does or whether it works, but it does speak to the fact that our anxiety isn't always meaningful. At the very least, doing the "hard work" in therapy doesn't always pay off. Understanding the origins and meanings in our conflicts and trying to become more self aware can certainly go a long way, but it isn't a guarantee of fixing things.

I see a lot of this woman in myself. I can get hung up on things and upset over little things. I can be very aware of what I'm doing and what I should do, but it doesn't always help. For example, I know I'm being hard on myself for being irritable. I'm trying to let it go, but I can't always let it go. If there existed a magic pill that would allow me to let go of my perfectionism and my hang ups, I would take it.

So, to go back to that list of questions:
Why do I feel bad?
The trivial answer is some combination of my surroundings and my reactions to them.

Do my life circumstances really warrant my reactions to them?
I don't think there's an easy answer to this question. What does it mean for my reactions to be warranted? Moreover, even if my reactions are warranted, do I want them? Are they useful to me? Much of the time I don't want my reactions and I doubt their usefulness to me, I just have trouble dismissing them.

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.