Documenting my journey through the mental health system

I see my psychologist weekly, and had my appointment with her this morning after my shift. I’ve been back at work three weeks now. I told her how I’ve been doing, how hard I’ve tried to be normal –

“You’re not normal. This is the acceptance part of who you are. You’re different, and you’ll need to do things a little differently than most. How are the voices?”

I admitted hearing them most days. Jack tells me to kill myself, that I’ll have another psychotic break and end up in an institution permanently, lose everything, lose any functioning I had left. She asked if I’d thought about what she said last week, how I have to try to play therapist with them. “They’re a part of you – the scared and angry part. How do you respond?”

“I told him it seems that way, that death is the only way. That it’s rough,” I answered and she nodded.

“What are you doing besides work? Are you singing?”

I told her about the Veterans Creative Arts Festival, a competition that advances to nationals if selected. I entered the music category and will sing I Dreamed a Dream, from Les Miserables. I’m a male soprano. According to the organizer, there are so few music entries that there’s a good chance I will go to nationals. I listed off a few other things I’m trying to do to keep busy – karaoke at different bars depending on the day, seeing a voice teacher twice a month, writing, and next week – a ball.

I asked my friend Ceila and she wants to go. It’s kind of expensive but she’s never done anything fancy like that. I have been to a few balls in the past and learned to ballroom dance through different classes and events. I know Ceila is a natural when it comes to dance because I’ve danced with her before and she was a really good follower. I told Dr Black all this, and she was smiling.

“I love that you’re so adept at the arts – whether is writing, singing, dancing. These are huge coping skills for you.”

“I’m not working as much as I was. I only do one per diem a week, if any.” Those per diems are my second job. I work with a couple agencies that contract CNAs and nurses out to facilities in need. And they’re all in need. But I’m not filling every single night off with them like I was before.

She brought up my impending IOP (intensive outpatient) enrollment. I’m a little late on it, but I had to wait for the VA to figure out if it would be with them or with the mental hospital. The doctor in the hospital had told me the VA would cover their IOP program, and Dr Black was able to confirm that. I have to call in the morning to schedule an assessment which goes to the VA for authorization, then I am scheduled for three times weekly groups and therapy. I’m nervous about this. That is kind of a big commitment. But it was also kind of a condition of my release.

I’ve been court ordered to IOP and anger management in the past. In January 2018 I was arrested for DUI, spent the night in a jail cell, and I was referred to veterans court. They sent me in for an assessment and found me to have an alcohol problem as well as significant anger/depression issues and in need of IOP treatment as a part of my probation. I was required to spend three months in three times weekly groups and therapy, and once weekly after the first three months. By June, after a few court delays and continuations, I had significantly decompensated, suicidal and overwhelmed by the impending court obligations and fines. My doctor at the time talked me into admitting to 3 South, the VA inpatient psych unit, for withdrawal and suicidal ideation. I came out a week later better prepared to deal with the court and be on probation for the next year. This was the year I achieved my 70% service connected rating, after meeting another vet who referred me to the doctor who would eventually write a 15 page report on me to send off to the VA for my rating increase.

For what’s it worth, I don’t think I have an alcohol problem. I have cut back a lot. I don’t drink during the work week. They are 12 hour shifts, I don’t have time. I do drink socially and this is kind of valuable to me as I’m trying to be more social, to use my social supports, to isolate less, worried I’m bothering other people. I have no interest in total sobriety.

If I had a problem with anything, it’s cannabis, and this was found to be the case at that IOP assessment. I was forced to quit using it for most of that year and I had a harder time going without that than I did going without alcohol. To this day I use cannabis for anxiety and sleep and appetite, and I use it every day besides. I am dependent, but I don’t care about that right now.

Tomorrow I call the mental hospital to ask for the IOP assessment. Just driving by it the other day made my heart race. It’s not that far from my downtown apartment. So I don’t know how I feel about going back there three times a week. I will do it if the doctor tells me to do it. I am already nervous for this assessment. I am not sure what they will ask. The mental status exam puts the patient under a microscope, assessing cognition, behavior, appearance, and perception. I am scared of the voices. I don’t want them to sabotage anything.