Documenting my journey through the mental health system

The core of it, the core of so much suffering, aggravation, anxiety, and despair, is the inner critic – that voice inside that tells you how stupid and ugly and unlikable you are, how you never get anything right, how you’ll always be a failure. It’s a shadow that follows you around, no one can see it, no one can hear it but you. It tells you these things and of course you believe them. It follows you around for life, weighing you down, making you exhausted, making you lethargic and fatigued, leaving you overwhelmed with every task, even as simple as tying your shoes. Sometimes medication, sometimes therapy, a combination of the two, can alleviate the maddening voices, the weight of the shadow upon us. And that’s really all we have, when it comes to the basic foundation of mental health treatment.

The inner critic was a major focus of IOP today. The therapist asked if we related to the examples of behaviors and thoughts we have – feeling worthless, low self esteem, afraid of failure, etc. We all nodded and I spoke up.

“This inner critic has tried to kill me, several times. Still is, often enough. This is the core of it.” (Several nods around the room) “And for me, the voice is real. I get manic, I get psychotic, and it’s no longer just a voice, it’s a voice, know what I mean? It’s people talking to me, telling me I will decompensate no matter what I do, lose my mind completely, lose everything I did manage to scrape together from nothing, my whole family and I will end up homeless, I’ll end up locked in prison or a mental institution forever, and there will truly be no hope left, I’ll never not be suicidal.”

Quiet around the room. The therapist gently guided us on, validating me and telling me it was okay if I felt this way. It was maybe the longest I’d spoken in awhile, rapid fire, a little pressured, but it felt good to get it out. I participated more today than I ever have in IOP up till this point. I talked about my mom a little bit, I mentioned my new job and how the accommodation request was going, I said I was getting my house ready so I could move back in and try to have some kind of fresh start.

I have about two weeks of IOP left. I started, day one, in the interpersonal effectiveness module and it was the DEAR MAN skill for better communication that balances both your needs and the needs of the other person. Jack told me that day, as I was hearing him talking to me constantly at that time, “pay attention. You are inept.” My anti-psychotics were still being fine tuned and they can take awhile to take effect.

I have come a long way, I’d like to believe. I’ve worked really hard trying to incorporate the skills even if I don’t need them in the moment. I was overwhelmed but I stuck it out. I’ve tried to develop better coping and healthier habits. I’ve tried to develop insight into my bipolar disorder, as I lost it all just five months ago. I’ve worked with Dr Black to process the subject matter and accept the fact that I can’t prevent everything entirely and there is little, in fact, that we humans truly have control of at an individual level. If you can remember that – you have little control over the world around you, as much as you might try – you might be able to better find what you can control and act accordingly. Make a bubble around yourself. Some might disagree with me but I have felt powerless and depressed about it a long time and I’m not sure I can unlearn the neural networks. Riley, the therapist, says I can. To think of it not as scars that won’t heal that I have to radically accept, but to approach it dialectically – two things can be true at once. This concept is a huge part of DBT but I forgot to ask her more about what she meant. I did say I was working harder on the relationship skills instead of isolating and neglecting the few friends I have.

I had a short assessment after class and she told me don’t be hard on myself about missing IOP Thursday, that they were all glad I finally got some sleep. She went over the distress tolerance review and a sheet of each skill and a short description. I have a whole book of DBT material I’ve kept organized. She said my graduation from IOP was at the end of the month, as the DEAR MAN skill learning was in just a couple weeks. I decided to say I was ready. I’m ready to move on.

I’m scared for sure, but I will see Dr. Black for maintenance and continued safety planning a couple times a month. After a few months, then maybe once a month. I hope I have truly created some lasting stability. I have to admit, I feel more stable now than I have in years. The medication cocktail is one of the more effective medication cocktails I’ve had. I’m still not sleeping that great but I probably never will and my tolerance for that seems quite good. I have medications that force a few extra hours, it’s just a matter of discipline to allocate the time needed and I have improved in that regard too. After IOP, I will have three freed up weekday mornings for even more sleep time allocation.

I am looking forward to being done. It times out perfectly with the end of the year.