Wednesday, June 25, 2008

It's like Lent

Dudes! I'm down to the last 40 days of internship. I'm thinking of giving something up for the occasion. Except, I've already given up free time and sleep...

I'm on call at State Hospital tonight. I was lamenting earlier that I didn't have my camera when I drove over to the adolescent building to put some kid in restraints. The grounds are quite lovely this time of year, and everything is in full bloom. This really is an amazing place, full of history and stories and lives and souls. Although, as I commented to the PA on our unit earlier, when the patient we just started on clozaril (clozaril = big gun antipsychotic) was lying on the floor naked in the middle of the hall and wailing at the top of her lungs in Spanish, this place feels more and more like a "state hospital" every day.

I've got this one patient I admitted yesterday, she's driving me crazy. She apparently was manic and decided it would be a good idea to drive from Manhattan to Florida. And as always happens (you'd be surprised at how many crazy people decide this is a good idea), she broke down in North Carolina. I don't know why they all crash land here. Apparently it's a good halfway point - they can make it through Virginia, but not quite to South Carolina. So she gets lost, starts feeling physically ill, and so what is the logical conclusion to this? She gets out of her car and lays down on the side of the highway.

.....really? That seemed like the best thing to do?

So now she's my problem. Because she got taken to a crappy private hospital where they made five medication switches in seven days, and then her insurance ran out, so they sent her here. And she of course has started refusing to take medications because they're "too strong, too strong!" So I pull her to the side today, and I was like, what gives? And she goes on and on, in full Fran Drescher voice, about how I'm too inexperienced and I don't know my medications and I'm trying to kill her and I'm trying to drug her out I asked very private things about her yesterday and now I'm going to do her like this and she won't take the medication I tried to start because she read about that and it's poison - POISON - and she has a medical background too, you know.

And I'm like, lady, if I wanted to drug you out, you'd be unconscious right now. But now that you mention it, maybe we should give that a try. And two, there's a big difference between being a nurses' aide and being, I don't know, a DOCTOR. What I said out loud was, okay, well, here's the deal. I'm willing to work with you, but, if you continue to refuse your medications, well, the difference between us and ol' Bipolar Hill Hospital (it's an inside joke) is that I can make you take them. WITH A NEEDLE. Don't think I won't. We finally came to an agreement but I so just wanted to duct tape her mouth shut. We'll see if she actually takes anything tonight...

Ohhhh. If she starts with me tomorrow I'm going to kick her in the shins.

I did, however, admit an amazing lady today. She's faced so much adversity I can't even stand it. And she's been working her Twelve Steps for ten years now. She's articulate and insightful and is here because she just got overwhelmed by a life that would overwhelm the strongest of people. She's a breath of fresh air in this place, let me tell you. She's going to be an amazing sponsor some day. I think she's really going to do great things.

She appreciated that I knew about the steps and "the rooms" and could understand phrases like "life on life's terms" and "let go and let God". I didn't tell her that I think the Twelve Steps are...well...I think they're kind of crap.

Okay, that's a giant overstatement - I fully and wholeheartedly support AA and NA and encourage my patients to go and to keep going until they find the right home group. I think it has a lot of solid concepts and the community support from others who've been where you are is invaluable.

I'll tell you one group I can't stand, though, is Overeaters Anonymous. Every OA meeting I've ever been to was like a setup for a hard core eating disorder. Food, weight, numbers, food, weight, numbers. Restrict, banish, eliminate. Seriously, no, that only makes it worse.

I'll tell you a secret. When I hit the end of my rope in NH and had to just let go, my own eating disorder was totally out of control (I've mentioned on here before that I have bulimia). That's the thing about addiction, and eating disorders (bulimia more so than anorexia), and the like - they're not healthy, but they're wicked strong coping mechanisms, and that's why we keep them. The eating disorder is a HUGE repository for anxiety, stress, trauma issues, self-loathing, all of those things. It's a vast, vast hole you can keep pouring your angst into. It was the strongest coping mechanism I had, and I was under so much stress then that even it was starting to fail to compensate. I don't want to know what comes next.

But by the time I got back to Chicago, I was so off-kilter, and I knew that I couldn't just dive back into another residency without making some serious changes in myself. So the program in which I sought help was Twelve Step based, because they treated addiction as well (honestly? Lots of people like to lump addiction and eating disorders together. But when you get right down to it, it's like apples and lug nuts). That's where I learned about the Steps, and that's where I started to feel like they had some serious flaws.

A, so not helpful for eating disorders, let me just say that. The Eight Steps to ANAD? Much better. Particularly Step Two - "Recognize that 'food' and 'weight' are not the real issues, but that other underlying problems in our lives have led to our obsessions with food, eating, and weight."

I cannot tell you the number of times that I scrawled "FOOD AND WEIGHT ARE NOT THE REAL ISSUES!" across the white board when we got off track in our ANAD meetings. Because it really is the whole point.

But B, I think the Steps and the Program are sort of flawed in general. Which, nothing's perfect. But I dislike how, the moment you slip, even a little, you're back to square one. It's a nice idea, but relapse is a part of recovery. You have to accept that and anticipate it, not pretend that it doesn't exist. Because it's going to happen, and the point is to have mechanisms in place to pull out of that nosedive faster every time. To get the point, not to just avoid.

The other thing I couldn't handle was the concept of powerlessness. I had SO much trouble with my First Step (which is the only one I had to do, thankfully), because I couldn't give over to that idea that I was powerless over my disease (some would say that's sort of the point, but, nonetheless). Because wasn't that the very point of being where I was? To gain power over it?

The bulimia, for me, came out of being powerless. It's such a complex entity I can't even begin to explain all the layers to it, but the original point was to distort myself, to become unappealing, in the hopes that it would stop my molester. I was 11 when it began (even though I wasn't diagnosed until my third year of medical school), just starting into puberty, my body was changing, becoming more womanly. This heralded a number of potential disasters. So I fell into this thing, this disease, that accomplished so many of my goals. I was fat and thus disgusting and unattractive, so even if I couldn't keep my perp at bay, at least I could keep other men at a distance to avoid retraumatizing myself (that's about half the reason I'm not a puker, because my other compensatory mechanisms aren't nearly as efficient). It made me look as bad on the outside (or closer to it, at least) as I felt on the inside. It reinforced my negative self image. It was a self-mutilating behavior, in essence. And it helped me strengthen my superpowers of dissociation, it functioned as a place to store all my anxiety, it did all the right things, even if it wasn't so healthy for me. The whole point was taking back some semblance of control over my own body and my own psyche.

Now, of course, where it got me was almost two decades (so far) of being at war with my body and self-loathing and self-punishment and etc, etc. Although, you know, it wasn't the ED that did that. The ED was a symptom of that. But it certainly reinforced things.

So this concept of powerlessness was lost on me. And truthfully, it still is. I'm not powerless over my disease. Neither is my patient. She was telling me about how she found a bottle of gin in her daughter's room last week. She picked it up, she was tempted, but she walked away from it. Because she knew it wasn't the answer, that giving up her ten years of sobriety wasn't worth seconds, minutes, or even hours of gratification. That's a powerful woman, right there. There's nothing powerless about that act. I mean, I understand the concept, you know, but I think the application's all wrong.

And how do you get anywhere if you can't take the first step?

Was that more than you all wanted to know about me?


Danielle said...

When I worked at Texas Children's Hospital, one day I was in the giftshop stockroom entering things in the computer, and the main receiving guy was listening to a tape of himself speaking at an AA meeting.
He started with, "My name is Joe, and I am an alcoholic".
I knew Joe well enough to know that he hadn't had a drink in 7 years. So, I point blank said, "If you haven't had one drink in 7 years, haven't you earned the right to not call yourself an alcoholic?"
He started explaining all the powerless stuff to me.

Personally, I think that a lot of people take the idea as having power over their disease as some kind of suggestion that they chose to have the disease- or that it's their fault. Logically- if they have the power to overcome something, then they must have had the power not to get it in the first place. They don't want that blame. If you are "powerless", then it's not your fault. There was nothing you could do to cause the disease from happening, and nothing you can do to get better.

As a young person struggling with depression and MAJOR anxiety issues, I always saw things in the media and in the community telling people with depression: It's not your fault, you did nothing wrong, you are so brave if you seek help, etc. Then, when I sought help, it seemed like I got nothing but the tough love aspect, from my therapists, my parents, my friends, and so on. I felt shot. What happened to all the cushy love in the "seek help for depression" commercials? It looked so pretty on TV!

Years later, struggling with OCD, I find the therapy I mentioned to you in that email to be quite possible. I don't want to say easy because it's extremely EXTREMELY hard, but I have the ability to do it. I often go on OCD forums, and try to tell people- the cure is to go against the grain, resist, resist, resist, and they all seem to just reply that they can't. They tell me "must be nice" that I can do it, and that they "just can't help it".

These are the people that never stopped receiving that cushy, mushy, "It's never ever your fault" lovey doveyness that I wondered why I wasn't getting from seeking help. It's the "powerlessness" thing.

I don't know, this is just the association I made when reading this. Sorry if this is long.

penguinshrink said...

::hugs:: I like you for what's inside your head.


Braaaains, braaains!!! <-- Sorry, couldn't resist. ;) But you know what I mean.

Barb said...

No, it is definitely NOT TMI. In fact, it's the kind of information more people NEED. Summed up a lot of things for me.

Of course, it helped that when you got to that pareagraph that you started with "And B)" I knew you were talking directly TO ME. That's some good blogging right there.

I'm having one of those days when I am tired of being blind, you know? (Speaking of inside jokes.)