mental health, Uncategorized

Sleeplessness and the bureaucrat

I shouldn’t be doing this right now. I should be trying to grab some precious ever elusive sleep but I can’t. My mind is stuck reevaluating with increasing disbelief, the interaction I just had with the front desk of the mental health conglomerate that I go to. Here is a word for word transcript, annotated with my escalating unimpressed thoughts.

Me: Hi, my name is ___. I’m a patient of ___ and I have had insomnia for three days.

X: And how can I help you? (in a tone that said, yeah what about it?)

In my head: wow empathy must not be your thing.

Me: I need to schedule an appointment to see her.

X: Ok. (she proceeded to get the information she needed to look up my chart and schedule) Well your next appointment isn’t until March so how about the 22nd of February?

Me: I don’t think so. I’m missing work I can’t go sleepless until the 22nd .

X: So you’re looking for a med increase.

In my head: what did you just say to me?

Me: I’m looking for a solution. I’m certainly not chasing medication if that’s what you’re saying.

X: How about 2:30 on the 16th.

Me: How about something today or tomorrow with anyone who’s available.

X: Are you available at 2:30 today?

Me: Yes that would be perfect.

During the subsequent wrap up I got her name so I could report her because I don’t take this kind of shit anymore.

So let’s just recap: A patient called and said they weren’t sleeping. She had an appointment open for today and she tried to schedule that patient for three weeks from now. Did I mention she had an appointment open today?! That isn’t just a lack of empathy but a lack of ethics.

While it’s not an uncommon occurrence in mental health patients, sleeplessness in my book and among the medical community in general, is a very big deal. Lack of sleep leads directly to decrease in cognitive function and motor skills, not to mention the fact that lack of rem can lead to suicidal behavior. Here are just a couple articles about the effects of lack of sleep.

“Depressed patients who experience sleep disturbances are more likely to think about suicide and die by suicide than depressed patients who are able to sleep normally.”  From and article from Harvard.

“This study showed that REM sleep has a critical role in facilitating brain plasticity. ” from an article looking at a study of the effects of four days of sleep deprivation.

 

I attempted to go back to work yesterday after finally achieving 7 hours sleep in 48 because I love my job. But my job requires a level of concentration and reasoning skills that I was unable to bring to bear with my head spinning. I was not sharp. I could not focus and I sent myself home after just 3 hours because I recognized that I could not wrap my head around things that I had been fully on top of the day before all this started.

I wonder how many patients without the benefit of my bullheadedness, without my ability to tap into my well of petty wretched spite in order to not cave to people like that, would have taken the appointment three weeks from now and suffered. What if that patient then had an episode. What if they spiraled so out of control that they harmed themselves or killed themselves. What if they fell asleep at the wheel?

Bottom line this type of soulless behavior is not acceptable in any profession but so much less so in the medical world. As bad as my regular doctor’s office is, they have more compassion than that and mental health patients don’t need less empathy they need more because we are often at a diminished capacity to care for or advocate for ourselves. We don’t need anyone else making our lives more difficult and we don’t need someone taking advantage of that state to pass off sub par care. My opinion as of today is that if you don’t have a mental illness and can’t score really high on an empathy test, then you shouldn’t be allowed to be the front face of a mental wellness office.

The chief reason I see the nurse that I do and have changed practices every time she has, is that she doesn’t dole out scheduled drugs like candy. When my previous nurse had continued to up my klonipin to help me sleep without looking at other options until I was on the maximum dose and simply dependent on the drug, it was this nurse who took the time to ween me off it. She found a safe alternative which I was a little shocked to find was an old drug that frankly my other care providers should have been knowledgeable about and I feel should have been ahead of habit forming drugs on the list of possible solutions.

I have specifically chosen with no small degree of difficulty to pursue a course of medical treatment that avoids anything habit forming and the implication that I am some how looking for a fix was absolutely insulting to me in every way possible.

I bring this up to illustrate that what we are prescribed is not our fault. It isn’t within our control that someone we think is looking out for our well being is just handing out the latest thing the drug rep told them was a good treatment. We come to professionals because we don’t have the answers. This isn’t the first time a receptionist has done more than insinuate that I was chasing medication. I’m not sorry that yes, in the same way that I insist on having my blood pressure treated or my Lyme disease treated or a broken leg treated, I insist that I have access to the medically proven solutions for the problems with my brain. I don’t put up a stink that I have to check in every 90 days so they can bill my insurance for a visit that isn’t necessary if nothing has changed. I do however expect that when something does change and I need to come in sooner, as my nurse always tells me to do, that I am treated with dignity and respect. I don’t think it needs to be pointed out that everyone regardless of their medical needs deserves to be treated with dignity and respect.

It is not the job of a scheduling drone to judge what I do or do not need. That is why the professional I see in the office has a degree and she does not. It is not her job to do her level best to keep me from being seen as soon as possible. It is not her job to decide if I have addiction problems or not. Someone who does have addiction issues probably really really needs an appointment asap wouldn’t you say? Someone’s medical needs are not a character flaw and they are certainly not an invitation to make judgments about that person and never an excuse to act on those judgments by doling out your version of the law.

I have observed in myself and those around me as a bank teller that the authority to say no to someone corrupts pretty quickly and a tendency to say no without really considering the situation takes root. This is simply a human failing but compassion is a human responsibility and if you don’t have it you at least need to pretend and if you can’t even do that, then you have no business interacting with people who need compassion which by the way is EVERYONE in the world.

It is my assumption whether it’s a good one or not remains to be seen, but my assumption is that this practice as a whole has a low opinion of people with mental illness and thus doesn’t really require sterling behavior from it’s staff. It’s easy to declare a group of people second class citizens and then have little compunction about treating them as such.

As for my sleeplessness issue I have found that as the light returns I have more and more mania and anxiety at night which becomes a self perpetuating thing. Fear of lack of sleep leads to lack of sleep etc. Needless to say the dark of winter has become my favorite time. Spring and summer mania are not fun. Now I’m off to advocate for myself. Keeping yourself well is bloody hard work.

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mental health, Uncategorized

I am not Beth March

It’s true. I’m not but I’ve been attempting to play her for over twenty years.

Of all the March sisters Beth was brightest and best. She had no lessons to learn, no character flaws to fix. She was quite literally an angel.

Louisa May Alcott’s Little Women  is a beautiful piece of fiction but perhaps it was introduced into my life at the wrong time. We never know quite how things will imprint on a child do we? Sitting quietly with my mother and sister while she read the book out to us is a fond memory, idyllic really. How cozy were we, in the living room with the wood stove burning while Yukon’s winter raged outside. I was learning to crochet around that time further adding to the feeling of living in that era.

In my first memories of childhood I was incredibly happy. I was wild, boisterous, and queen of my own ranch. We lived on a 300 acre ranch in the middle of no where. I had endless places to play and I quite literally ran amok.  I had thought for a long time that moving to town had affected me so badly because I lost all that space.

No. I realized today that on the farm I was wild child but I was accepted. No one tried to make me anything different.

All that changed when we moved into town and I was exposed to people who had very strong opinions on how I should behave. Archaic, “children should be seen and not heard” views just to begin with.  Suddenly I was surrounded by other children, judgmental meddling adults and a religious doctrine claiming that we were “called to walk into perfection.” All of these things together was a recipe for disaster. Children can be cruel and if the adults are worse then you really are stuck in a nightmare.

I had a problem and since as my father is fond of saying “we are not your average bears” I turned my mind to it full time. At church I heard over and over that it wasn’t enough to repent you had to also completely stop sinning and when a sin can be as small as an unkind thought, that’s a pretty tall order. However I took it as given that it could be done, after all these were adults talking.

My behavior at school and elsewhere was a constant source of issue.  I was being bullied and always handled it “poorly”. A week into school I got tripped, so I slapped the jerk who stuck his foot out , I got detention. The boy got nothing. Through that and various other situations I learned eventually that my reaction to a situation would always outweigh whatever had happened to me in the first place. It’s a lesson I’ve learned so well I perpetuate in on myself without any help.

I decided that what I needed was a personality make over. All I needed to do was learn to be just like Beth. No one ever spoke sharply to Beth because she was so sweet that she never deserved it. I, of course, always brought these things on myself because I couldn’t be nice. Becoming Beth was possible. I was certain of it because this was my version of walking into perfection.

I took the wrong message away from that book because of my single minded pursuit of being the best version of myself that I could be even if it was not me at all. That part of my view of life never changed. All the while I rooted everything else from my child hood religion out, I held this one poisoned kernel nestled deep in my heart.

I worked at being perfect constantly like an athlete honing their skills and muscles I worked at holding my tongue, having patience, being kind. None of these goals are bad in and of themselves but if you believe that you can be perfect at any of them let alone all of them, you are quite deceived. I was. It’s taken me this long to realize it.

In some ways nothing has changed since child hood. Something happens, I “over react”, I’m devastated, I resolve even harder to be perfect. The fact that I’ve vastly improved over these years holds no comfort whatsoever. I’m not perfect and only perfection will do.

All I’ve learned is to internalize what everyone tried to punish into me, that I am not good enough as I am. That no matter what happens my reaction will always be wrong. I will always be wrong. It’s gotten so bad that I avoid people or situations where I can fail, or embarrass myself by being too loud and inappropriate. I leave even the best social situation with regrets strong enough to keep me up at night. I am reclusive and constantly afraid of doing the slightest thing wrong but tonight the light dawned.

No matter how hard I try, I will never be calm enough, kind enough, patient enough and quiet enough satisfy everyone or even myself. I just have to accept that. Also Beth was dying and I don’t want to live like I’m already dying.

Now, I guess, I get to learn to be me again and maybe I will be able to turn all of that mental energy to something more worthwhile.

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