Friday, July 27, 2012

The week from hell is finally over

I am so glad that it is a Friday.

There are a multitude of reasons why this past week was so terrible. Some of them biological- like not have a medication, and then going on Lunesta (turns out, it is even worse than Ambien for me), and then my reactions to my various failures of the week.

I think I finally understand my frustration with therapy. They have been trying to get me to be more resilient, so that I won't react so much when I lose things because I am disorganized, when I can't get my paperwork done, when I run out of medications. I want fewer things to be reacting to. I want to get more order in my life. I want a different brain. But that isn't coming. And mine, according to neuropsychological testing (that I just had to find again to bring to my psychiatrist)- my brain is fucked up.

I remember when I was in graduate school. I felt like I was getting depressed- and hoped to avoid a med change. So I dutifully hauled myself off to a CBT therapist- supposedly someone very good. I remember trying to explain my frustration to her about not being able to find a shoe- how I had a fit after being unable to find it for 15 minutes. I lived in 1 room at the time! And she kept telling me that this was normal. And it was not, so many of the things that I told her were not. (Like scheduling my awake time during the few hours of the night when I was the least depressed to do my studying- when I couldn't call anyone to find out what the homework was- which I had invariably lost).  But I think she either thought I was exaggerating- or she meant that the feelings were normal, not the situation.

It didn't work out so well. I got worse. I quit therapy, as it got too hard to get there on top of trying to study. The homework assignments did not prove helpful, but I think the fault was mine. I was too attached to outcomes- and still am. If I could have told myself- whatever happens, either you will be okay, or you will be dead (in which case nothing matters), then maybe I would have had a chance. Then maybe I could get through it being 2am and not knowing what the homework is and not feeling like killing myself. But I wasn't there then, and I am not there now. Whether the thoughts were logical or not- it all depended upon your assumptions. Whether they were useful or not- another question- but not one that I found very interesting at the time. I wanted to know what was true. I really didn't like CBT. It seemed to tell me that even my thoughts are wrong. It is not enough to criticize my behavior, now you have to go after my thoughts.

Anyway, running out the birth control pill is bad news. Losing my thyroid hormone pills for a couple of days and not taking it- bad news. Accidentally taking my PM meds instead of my AM meds, and winding up with a double dose of Zyprexa- bad news. And taking Lunesta for 8 nights, thinking it would get better- really bad news.

So even if there had been nothing going on in my life beyond the biological, I would probably be pretty messed up this week. And I really have been.

I found myself thinking today. We call people who feign illness malingerers. What do we call people who feign being well? I suppose we call them normal. At least if they are successful. And I was certainly doing a lot of anti-malingering this week! I'm surprised that psychiatry hasn't come up with a label for this yet, they have for everything else. I'm sure the next version of the DSM will remedy that.

Wednesday, July 25, 2012

Maybe I quit therapy too soon?

I've been going through a tremendously bad time the past few days. I can't seem to get my equilibrium back, even though I'm back on my BC pill.

I have learned over the years not to call my mother wanting sympathy or understanding. It's not that she doesn't mean well, it is just that she doesn't understand at all (but thinks that she does), and that she is so needy herself.

So today she called to tell me about all of her problems and the ongoing problems of everyone living in her household (Grandma's house) - now up to 5!. She needs someone to talk to, and I can't always deal with it. I was particularly unsympathetic today, and cut the conversation short. I think she needs a therapist.

When I think about the last time that I saw my therapist, it was weird. I wasn't even sure that I wanted to quit therapy. Maybe I thought I'd reduce the frequency, or change the forcus, or something. I went in and said that I was re-thinking therapy. Thinking that we would talk about it. But which she took as me saying that I was quitting- she asked me why- I told her that the past two sessions I really had not felt like I had anything I needed to say, and that I wanted to focus on studying. And then she thanked me for coming in to tell her, and told me that she wouldn't charge me for today- and asked her if there was anything she had done or said wrong,etc.

So it is a strange situation.

I did something so strange today- I accidentally took my nighttime meds in the AM. So I went to work on 5mg of Zyprexa. Not fun. Fortunately, no sleeping pill in the mix- not that it has been working too well. I did manage to make it through the day, but it was a struggle. But maybe it helped me to be more mellow. No tears today. And then I came home and napped. Maybe, though, this double dose of Zyprexa is just what I needed to get me out of whatever I have gotten into these past few days. I do feel less crazy today. But it is not something I want to repeat.

I have definitely wanted someone to complain to the past few days- just like my mom. But then to talk about a work issue too. Is it better to be though crazy, lazy, or incompetent? I mean, being mentally ill is not an excuse for not getting your work done- you are still responsible for it, and you can still get fired if you don't do your job. But at the same time, it is an explanation. I tried going in this past weekend, I got myself there, I just couldn't keep myself together- I was feeling too crazy. And perhaps that truth is better than people thinking that I just don't care. Or maybe not.

Tuesday, July 24, 2012

What has changed

It has been 10 years since I have been in the hospital, 8.5 years since I have been on disability.  What accounts for that? I have patients who need to be seen, who need to be treated. That is one major thing.

I ran out of my birth control pill last week- which I take so that I get my period only every 3 months, because that is about all that I can bear. Most of my hospitalizations have happened right before getting my period. And so what should have been 7 days off turned into 11 days (had to call a doctor who was not in, get it filled at a pharmacy that is not open on the weekend- but i forgot to pick it up on Friday, and so on...)

By Saturday I was miserable. But then that night I hardly slept, and by Sunday I was feeling crazy. Yes, crazy. I really don't know a good way to describe it. I tried to go in to work on Sunday to do charts, but I couldn't do more that a couple- I just felt too terrible- alternating between sobbing and rocking and wanting to throw things. I went home, stopped for ice cream (yes, I know, not good), and took klonopin. And I still didn't sleep very much. Of course, I did sleep towards the end of the night- so I didn't get up to go in early, like I wanted to. I went in, but was barely keeping it together. When my last two patients cancelled, I was out of there. I stopped for my my pills at the pharmacy, went home- more ice cream and klonopin, and cried and rocked myself to sleep.

This morning was pretty rough- but I know it would be. A lot of tears on the drive in to work. But I pulled it together in the parking lot. I talked to myself. I can do this. I chose to do this. And really, my patients were great- it was a good morning work-wise. Until lunch.

I decided to check my e-mail- and a message from my boss about my charts that were not done- the ones that I tried to do on the weekend and failed to do. And then I just lost it.

I had to run out of the office, the tears were coming so fast. I went to my car- I started to drive- not to anywhere, just to get away. I sobbed, I screamed, I was screaming that I was going to crash my car, which is what I really wanted to do. I was crying so hard I didn't realize I didn't have my glasses on.

Eventually I found a parking spot, and I pulled in and cried. No, crying does not begin to describe it. I sobbed- I cried myself to exhaustion. And then I wondered what I should do. And my thought ranged from killing myself to taking the afternoon off- but then I remembered. While most of my afternoon's patients could wait, my last patient of the day was a new post op patient who really needs to be moving ASAP, and I have to see him- there is no one else working today to see him. So I had to go back. I had to finish the day.

So somehow I did. I was so exhausted from crying, I don't know how I did. But I did. And I am glad I did. I think.

Because sometimes I am conscious of the small death that it feels like, when I push this big part of me away for the sake of function- even if it is for a good thing. Something that I want to do. That I chose to do. And I wonder how many times I can do it, and what it is doing to me.

But the few times I have really surrendered to the crazy part of me- and I have- and given up on function- that has had a pretty bad outcome. And yet, for a little while, it felt so liberating. I think even that first month I lay on the couch, that terrible depression I really gave up- and gave up on trying to do anything- it felt like such a relief. To just stop fighting for a little while. But the feeling didn't last- and the months got worse and worse. It didn't work out so well. That's how I landed up on Zyprexa.

But I want that feeling of liberation again, somehow. I feel anything but free, now. Even though I am living the life I am living because of my own choices. I could choice something else, but I don't know what to choice. What choice would satisfy all parts of me?

I thought I was exhausted, but it is looking like another sleepless night. I just took half a klonopin, to see if that can do what the Lunesta did not do- get me to sleep.

Saturday, July 21, 2012

The Drug Dealers Won

I saw my psychiatrist this past week. I often have more sleeping problems in the spring/summer, and that is true this year. I have also been especially anxious. The ambien just isn't doing it for me anymore- at least not the half dose that I have been taken recently since I realized that this was the medication that was making my concentration so bad in the mornings. Strange, since when I take a full 10mg of Ambien, I usually wake up feeling amazing. And not sleepy or drowsy. It is just concentration that is off. I can't do my paperwork until about noon. But the 5mg stopped working, and I had started supplementing it with a little klonopin at night, particularly with the anxiety. 

So I though I would ask for Sonata, which has a shorter half-life. Maybe I could take the whole dose, and not feel it the next morning. At least that was my thinking. And I looked it up- it was covered by my insurance, and generic, and only cost about 14 dollars a month anyway.

But my doctor didn't like my suggestion. Perhaps because I sometime have trouble staying asleep, and Sonata is not very good for that. Or perhaps because the Lunesta drug rep had just been in his office. Because I went home with a week's worth of Lunesta samples, and a prescription for Lunesta, along with a card that gives me up to a $50.00 discount each month.

That's right. I wasn't thinking at the time, but Lunesta is still branded. And when I looked it up, it would be costing me $200 a month! It is covered by my insurance, but I have a high deductible plan, so I will be paying the full cost for a while (unfortunately I have high enough medical costs that I do hit my deductible each year). Is that worth it for a sleeping pill?

Well, I thought I would try it. I have the samples. And I like it. I have been able to stop taking any klonopin at night- which means no rebound anxiety during the day. And I have been able to sleep. And no mental fog the next day, no trouble concentrating. And I don't understand why, because its half-life is even longer than Ambien- it should be giving me more trouble in that regard, but it is not.

I am less anxious on Lunesta than on Ambien. No more klonopin. Which is enough reason that I am going to pay the money for it. I suspect Sonota would not have this effect. I was reading that if you take double or triple the dose of Lunesta, it is almost like taking a small dose of Valium- so perhaps I am getting just enough of this effect to sooth me and less of a rebound effect than I would have with the Ambien (and I do get rebound effects from benzo's).

So there may have been good reasons for me to be given this drug- still the drug dealers (sorry, pharmeutical representatives) won. And just when all of my meds had finally gone generic, I am back on a brand name med. Well, I tell myself that the cost will just get me to my deductible that much faster- I'd go through it anyway- and then things won't cost so much. Perhaps after my exam I'll give Sonata a chance- I just don't want to be playing around with meds right now.

I'm rather at peace with meds right now. I know I can't do anything drastic with them until I take my exam in November, so I am not even going to try. And I have also realized that my concentration is not as bad as I had thought- I have periods of time when it is very good. I just can't sustain it. But maybe that, too, will get better.

As I can't make any major med changes for now, I'm not struggling with it. Not  now. That could change in a heartbeat.

I did quit therapy last week. I really didn't feel like I had anything much to talk about, the second week in a row- so I knew it was time. My main hesitation was the fact that I liked herhas a therapist, and she has been helpful, and it is rare that I find a therapist that I like (so I haven't been in therapy much of the past 10 years). But she said that I can always come back.

But then she said something which bothered me. She asked for feedback- was there something that she said, did, or should have done differently?

I should have said, IT IS NOT ALL ABOUT YOU! What I told her was that I didn't have anything to talk about, and wanted to focus on studying- which was the truth.

But someone quitting therapy is in a potentially vulnerable state. It is a personal decision. Don't assume that it is about you. Don't ask what you did wrong. That is unprofessional. This isn't an exit interview.

Life isn't all roses

That's what my grandmother has told me so many times. Trying to lower my expectations about life, thinking that I am depressed because I expect too much. Is she right?

I had a very good studying week, when I all I wanted to do was study. And then I came home Friday after work feeling burnt out, and did nothing. And I have done nothing all day Saturday, pretty much. OK, I cleaned for 15 minutes. Yes, I timed myself.

And I went online and read my blogs and news sites about the end of the world (no wonder I am depressed) and then tried to get some basic info on the oxygen content of our atmosphere and how rapidly it turns over and how vulnerable it is to things like deforestation and the burning of fossil fuels- but that will really have to wait until a later date.

The end of the world is coming- it''s just a matter of timing. And timing makes all the difference. Are we good for a decade or a billion years?

The problem is, the human species has been given way too much power to change our environment- but as individuals, we have way too little power. In a world of 7 billion people, it makes not one drop of difference if I get rid of my car and become a vegan- and I am not powerful or well-connected enough or charismatic enough to get the majority of the world to follow me in any kind of a movement. As individuals, we can't solve this. And collectively, we can't solve anything.

But I am not intelligent enough to figure out if we are in for a slow or a fast collapse. Is anyone? I know there are a lot of people out there who think that they know one way or another.

But it will be slow enough that I need to study for this exam! And I can only live in this world, in this society. I'm not going to cash out my 401K and buy some isolated property and learn to farm and "prep." Not because I don't think that is a realistic thing to do- but because I think I would be lousy at it.

I think all these things- but it doesn't change a whole lot for me. I haven't figured out how to live my life differently, or to what extent I should. I still have the daily grind. I still drive a car. I still eat meat. Actually, I was a vegan for a while, until I went on the MAOI's and then there were so many foods I could no longer eat, like soy, that it just became too complicated, that I stopped.

I think life is too complicated, that is what I think.

Friday, July 13, 2012

I don't believe in Santa Claus anymore

My mood is really not good. There was a time I would be all about the next antidepressant- let's try something else.

But I've become disenchanted with meds over the years. I'm in a strange place- too scared to try to go off what I am currently on, and too skeptical to want to try anything else.

My current thought is to try to change my sleeping medication. I can't take a full dose of Ambien, because if I do I cannot concentrate enough do do paperwork until about noon the next day. So, I take half. And it works in the winter, when all I want to do is sleep, but not in the summer. So now I am supplementing it with a little klonopin- but I don't think that is helping my mood, even though it is only a quarter of a milligram. And some nights, I still don't sleep.

But Sonata has a shorter half life. Maybe I could take that and take the full dose and be fine the next morning. Maybe that would help my mood, if I could reliably sleep- and no klonopin.

There are two different types of people in the antipsychiatry camp. Some say that the drugs don't work. And I am starting to think that they are more right than wrong. And then there are others who say that it is not just that the meds don't work- there is no such thing as mental illness. It is not just that we are overdiagnosising, there aren't any diagnoses- we are just pathologizing human suffering.

This is where I don't know if I can go. It is true on one level, there are no diagnoses- it isn't clear what we are treating. We are just trying to put our own categories on natural variations of behavior. But that doesn't mean that there isn't anything to treat, ever.

It is quite possible that if I had a very different life- if I was living in a hunter gatherer tribe, or if I was a nun during the Middle Ages, there would be very different demands placed upon me and I might not be experiencing the kind of distress I am experiencing now. But I do live in the now, in this present world and society. And it is this society that I have to function in- and in this society I am depressed. Maybe it is not a good fit.

Do I label what I am feeling as depression? What does that buy me? And if it is not depression, if it  is just that I am not up do the demands of living as an adult in the modern world- well then I guess I should just end it all now. Because after 8 years after getting off of disability, it hasn't gotten any easier. So I call it depression, because that somehow sounds more fixable, but I'm not sure that it is.

Thursday, July 12, 2012

What else would I do?

I have been having pretty extreme moods recently- something I attribute to my inability to sleep well most nights recently, but who knows. I was at work today and feeling sorry for myself. Feeling very anxious and overwhelmed. This is too hard, I thought, and it just doesn't get any easier. Not for any length of time. And now I have to function on top of how I feel!

OK, so what? Go back on disability? I was miserable then- at least as miserable, if not more than I am now. So I can be miserable and doing something useful and interesting (and self-supporting), or I could be miserable doing nothing. I'd rather be miserable doing something, I decided. Even if it is hard- which it is.

And the day did somehow get better by the evening- I was in a much better mood for my last couple of patients. And on the way home I even managed to get myself to stop and walk once around the park. OK, only once, but you have to start somewhere. I cannot tell you the amount of effort it took to get me to do that.

Some people think that if you can get yourself to work, you are all better. I have tried telling myself that. It isn't true. It only means that I can get myself to work most days- and barely at that.

I want life to be easier, but I don't think that is quite what I mean. I like challenges, at least to a certain extent. But I am tired of fighting myself and my moods. I am tired of so many things being such an effort, that I don't have anything left over.

I am also not feeling well physically, either the past few days. I am having joint pain in my hands and feet. A few days ago I had a lot of wheat, that seems to have preceded my last bad episode of this. However, I have tested negative for celiac disease. But I still think I need to really give gluten free a try.

Saturday, July 7, 2012

It's really hot today... does that mean anything?

One hot day, or even a hot decade, will never "prove" global warming. We can never have enough data points to perfectly model something as complex as the earth's climate. And even if the climate does dramatically change, and everyone is agreeing that it has- can your really prove that we did it?

By the time we reach the level of certainty as required by the skeptics, it will be too late. Science doesn't work that way.

But scientists need don't really understand people either. A huge portion of Americans still don't believe in evolution. And whether or not we "believe" in CO2 based global warming may not matter very much- we simply don't know any other way to live than dependent upon fossil fuels.

And then there is the game theory aspect to it. Unless you could get all countries to agree to cut emissions simultaneously, huge power changes will develop. If America decides to somehow cut fossil fuel use by 50% in 10 years, but China does not, China will rise in relative power. At least until the fossil fuels run out. (Peak oil is another matter... but one that I think will not happen in time to avoid major climate change).

Cutting emissions significantly was never going to happen. The cynic in me saw it all along, and people told me I was being negative. But if we look at nature, life changes the environment. Species use the resources at their disposal. That is why we have oxygen in the atmosphere- because plants changed the environment. Why should we think that a species as populous as human beings would be any different?

And if it isn't CO2, we will find another way to change the environment. Or, the environment will change on us, due to natural cycles of cooling and warming. We are just making things happen that much faster. We are spoiled, we are living in a sweet spot, and we don't even know it. But our civilization is adapted to the world as it is, it likes homeostasis. The people who argue that global warming is a good thing are being ridiculous. Yes, most people don't like cold weather. But if Siberia became the new bread basket of the world instead of America, a lot of people would starve.

I think that part of the solution, if humans are going to continue to inhabit the earth for a long time to come, has to be geoengineering. I know that is not a popular solution, especially among environmentalists. We could really mess this planet up. But if we do nothing, we will eventually wear this planet out, at least for our purposes. We will change the climate too much, or acidity of the oceans, or the oxygen content of the atmosphere, something.

That doesn't mean we shouldn't try to scale back our impact on the environment- we should. It will give us more time, and make the job easier. There will be less that we have to fix. But to think that voluntary changes in consumption, or even environmental regulations are going to save us, I think is naive. I think that the environmentalists are naive. The only thing that might "save" the environment is a total world-wide economic collapse, but that is not a popular message. Instead, the popular media gives us the message that we can buy our way out of this- just buy a Prius instead of a pickup truck, and use recycled printer paper, and you are "saving the environment".

We humans may have to save ourselves from ourselves. And I think it will eventually require geoengineering. Because it is easier to change a planet than to change global human civilization.

I must be stupid or something...

I remember my first job doing hand therapy. I had just been transferred from doing inpatient rehab to the outpatient clinic with no warning. I had no experience in hand therapy, I was worried.

My predecessor told me that it really wasn't that difficult. She learned everything that she needed to know in 1 year, and after that, she really wasn't learning anything more. She had been there for over 5 years.

Well, I have been doing hand therapy for a good bit over a year, and I still feel like I am learning something every day- whether it is a better way to make a splint, or greater appreciation for a  patient's pain, just something. It has been more than a year, and I am still learning. So was she that much smarter than me?

Then again, I was replacing her because she had been fired, so maybe I shouldn't use her as a good comparison.

When I feel like I am no longer learning it will be time to change jobs, as it was once before.

I tried something different with an elbow splint yesterday, it worked really well. It was a pretty cool splint if I do say so myself. I learned something. That makes it a good day.

If I still have things left to learn because I am stupid, then I am enjoying my stupidity. Life would be boring if I knew it all by now.

I remember when I had just come back from a continuing education course, and we were trying to explain where I was to my step-niece. And she said, in amazement, "do adults still have to learn?" If only she knew- that is the good part.

Wednesday, July 4, 2012

I found an old picture of myself

It was my freshman year in college. I was skinny! OK, so by any BMI table I was not- but I have a large frame (no, really!), and I looked fine. Freshman year of college I was unmedicated. That would all change in the second half of my sophmore year of college. I would never be that weight again, as the meds, and the pounds, increased.

I actually did briefly get skinny one more time in my adult life when I had pretty much stopped eating during a very long and protracted depression when no one wanted to give me an antidepressant because I had just been manic. And then I was put on Zyprexa, and I blew up- I didn't know a medicine could be so bad for weight gain. It was pretty new, maybe no one knew. And when I tried to fight the hunger and diet, I started binge eating, something I had never done before. Eventually I stopped gaining, after about two years, but by then the damage had been done. I was morbidly obese.

I have lost some since- mostly with the help of metformin. I have not been able to get off of Zyprexa. I seem to have a new, slightly lower set point now on the metformin. I am no longer in the "morbid" category. But not by much. I start a diet several times a year- usually weight watchers online or calorie counting recently, but "fall off the wagon" when my mood dips, as it so often does, and then I regain what I lost. The new normal for me on Zyprexa is that, where as I used to lose weight while depressed, I now gain weight.

So far I have escaped diabetes. I take metformin to try to counteract the metabolic effects of the zyprexa (I just wish I had known about it years ago). I take resverotrol. I take chromium. I try not to eat too much processed food or sugar- but have the occasional ice cream lapse. I would like to say I try to exercise, but most of the time it doesn't happen, so I am not trying that hard. I know how vulnerable I am, and I could be just one blood test away from finding out that I have it.

So now the question is, do I want that to be a matter between me and my doctor, or do I want my employer involved? Here is the question. Would you give away your medical privacy away for $500?

I have a high deductible health insurance policy with a health savings account, and I spend a lot out of pocket every year. I can get up to $500 extra in my health savings account by doing 3 things. First, getting a "biometric screening" from occupational health (weight, blood pressure, and various blood tests). Then, I can go online and fill out a health assessment- but only if I have done the biometric screening first. And then, I can get more money if I get my yearly physical- something I was planning on doing anyway.

Well, the biometric screening has to be done in July. In fact, a nurse will be coming from occupational health to our site to do weight/BP checks, and give us lab slips so we can get our lab work done. I wonder if she is just going to tell me my weight, or if there will be any kind of a lecture involved as mine is "not optimal." My physical- which I scheduled 6 months ago, is in August- and will probably do exactly the same- take my blood pressure, weight, blood work (plus a few other things like gyn exam), it makes no sense to do all this twice. Unless you are thinking in the strange logic of an insurance company.

I have to admit, there is a part of me that wants to say to my employer, if you want me to lose weight, fine then. I'm just going to stop taking my Zyprexa, and you can see how quickly the charges add up for an inpatient psychiatric hospitalization.

Because, really, I haven't had many medical charges due to my weight. Yes, I have high blood pressure, and I probably got it younger than I should have- that is about it. I see my primary care doctor 2-3 times a year for this and take a dirt cheap generic ACE inhibitor.

Extra blood work for glucose levels and lipids, etc., would have to be done anyway due to the Zyprexa and my other meds.

Will I give up $500 for my privacy? When I was looking for car insurance, I could have got a better deal with Progressive if I had just agreed to put a gadget in my car that would monitor my driving. NO WAY! But GEICO wasn't that much more, no gadget involved, so the choice wasn't that hard.

$500, and tax free at that, which I know that I will spend (I use up my HSA every year), is hard to pass up. I think I will swallow my pride and see how bad it is. Even though I weigh myself almost every day, I will let them weigh me. Even though I have a blood pressure monitor at home, I will let them take my blood pressure at work. And even though I am scheduled for my yearly physical the next month, and already have an appointment to come in the week before for blood work, I will let them take my blood. It will be interesting to see how results compare- how stable are values over short periods of time, between labs, etc.

What I won't let them do is lecture me. My weight, my blood pressure, my lab values- those are to be discussed between me and my doctor. Someone who knows all of me, my history and my meds. No one else is qualified to tell me anything.

Still, I am selling out. I should tell them what they can do with their $500. I suppose privacy is now a luxury- one that I haven't figured out how much I am willing to pay for yet.

A day off

I have a day off so I have been trying to study. And succeeding for only a couple of hours. How did I ever manage in graduate school? I don't know how I am going to get all this studying done by November. My only consolation is that I can take the exam over again if I fail.

I think I have another couple hours of studying in me, but not quite now.

I am feeling under a lot of pressure these days. Among my pressures, now- to keep it together so I do not become a problem again for my family, because on my mom's side of the family, they are having just one thing happen after another! A death, a very bad car accident, the need for multiple surgeries and problems with insurance, and now someone in jail. All in the past month, and all in addition to the usual troubles of no money, people with no jobs, cars breaking down, people fighting, and my grandmother steadily losing her hearing and her memory. It is just craziness. No need for me to be crazy!

And I have been, really, not too bad. Mildly depressed. Although mild depression doesn't get enough respect. When I am seriously depressed, I know to a certain extent that this is not how I always am. It can get better. But mild depression is not that far off from normal, at least for me- I spend a good portion of my life there- and it can really be the most hopeless state, sometimes. It just eats at your soul, whispering in your ear that this is all there is to life, don't hope for anything more.

My manias were so severe and so destructive I spent years terrified I could go back there- it was years before I could begin to trust myself again. But with the right meds, they haven't come back, just a little hypomania that is really nothing to fear. It is the depression that I can't keep away, that keeps coming back. Mania never felt like me, I became someone else. Depression feels all too much like me.

I am trying to lower expectations for myself. Telling myself that I am going to be a little bit miserable until November. Until I take my test. But I am finally dedicated to taking it, to studying, to really doing it. I had been on the fence about it for so long- just prolonging the agony. I just hope I didn't wait too long.

But come December, life is going to get a whole lot better. (assuming I passed...)

Meanwhile, I will try to not be a source of trouble for anyone!