Zanzabar

I went back to my psychiatrist yesterday.  Once upon a time I was crazy.  Once upon a time seemed like a lifetime ago.  Things have been relatively stable for so long. Sure there have been battles here and there with depression, lack of energy, not having the will power to interact with people or get out of bed or even take care of my babies. Depression, I’ve heard it called the common cold of mental illness.  And it pretty much is.  As much as a cold or the flu keeps you in bed, slightly incapacitating at times, but mostly just an annoyance that keeps you from enjoying life and work and home and everything in between, it doesn’t break your grip on reality and as annoying and uncomfortable as it is and at the core of it, you are still you.

I usually only go once a year.  Check the box.  My head is okay. Come back next year. Since dad died I’ve gone a little extra.  Extra head checking. Extra box checking.  I’m sitting in his office waiting yesterday.  All the crazy floods back. I watch the girl waiting across from me.  She is obviously not quite right.  She smells funny…her hair is greasy. She looks like it’s been some time since she’s had a bath.  She talks quite a lot.  Inappropriately friendly and interjecting in conversations she hasn’t been invited into.  You can see the side effects from the meds all over her.  The thinning hair, the weight gain, the hormonal shifts oozing out of her oily pores, the jittery limbs of an akathisic body on poorly regulated psychotropic meds.  It is so very hard to tell where the disease starts and the medicine begins. I think how that used to be me.  The one sitting there and it was so easy to tell that there was something not quite right about me.  And I felt a bit nostalgic and a bit proud knowing I had been in this very seat for twenty one years. And I have worked hard to not be an other and to be more like everyone else.  For better or for worse.

Now it’s my turn.  He comes out.  He is ready to check boxes.  A little, not too bright and only a little more motivated medical student comes with me.  She is there to shadow.  To watch how he checks boxes. He is grumpy today.  Distracted by other duties.  Distracted by phone calls from the inpatient unit, by nurses needing orders, by social workers needing placement, by administrative folks and faculty.  Despite being an awesome doctor, today he is distracted.  He has no time to assess, to examine, to contemplate, to forge the patient, doctor connection.  Today, he is merely concerned with clicking away at his computer.  Making sure my boxes are checked and enlighting the student with a tiny morsel of knowledge that she ferociously scribbled in a notebook; nothing google couldn’t have told her just as well.

He asks me the handful of required questions about sleeping and eating and mood.  He half listens and he clicks away.  I tell him I felt better about dad.  That this current issue isn’t related to dad.  That yes, maybe it was triggered by his death, but that I didn’t see a clear relationship between my off kilter head and dad dying.  He says that’s what everyone says who is grieving and has a concomitant mental illness. That there is no relationship.  That the mental illness is a distinct beast apart from grief.  He says it’s not true.  He says this is no relapse.  He says this is grief.  I’m not sure.  It doesn’t feel like grief to me.  But what do I know?  Today I’m just the patient.

He is distracted.  Not listening.  He asks me if I have any questions.  Any questions about what?  We barely spoke a minute or two.  No, no questions from me.  I tell him no, nothing. But before I go, just FYI, I’m hallucinating.  He seems unmoved.  Typing away on his computer.  He tells me I’m not hallucinating that I’m not psychotic.  If I know I am hallucinating, I have insight, and this means I am a ok. No worries. Hallucinations are apparently no cause for concern. Good.  I feel so much better.  He asks no more questions, about the type, the duration, the frequency, the content, the situation in which they occur.  I don’t know, as a healthcare professional all the things I would likely ask a patient sitting in front of me.   But, I am not a doctor.  Like I say, today I’m just a patient. He’s typing away.  He says take these.  Types his prescription for antipsychotics into his computer and it transmits quickly to the pharmacy.  I protest.  The side effects – the weight gain, the hormonal changes, the headaches, the sedation, the depression, oh the sedation, the lack of motivation, the apathy.  I don’t want any of it.  He ignores my complaints.  Simply says, you’ve worked too hard.  You have too much to lose.  Has to be done.  No room for debate.  Paternalistic medicine at its best.

I feel defeated.  It’s like a death sentence. I cry.  Seven years weaning off these damn drugs. Hard, hard years of no sleep and feeling nuts and alternating between manic and depressed and psychotic.  All to start back again.  But I do what he says.  I am a good patient.  A couple days on these things and I feel worse than before I started.  The fatigue is crippling.  Driving is treacherous.  Thinking is so slowed.  My head feels like it is being electrocuted.  One tiny circuit and hair follicle at a time.  My brain is angry.  A million volts of internal energy begging to get out but not able to fire at all.  The dead and disabled body not able to respond to internal stimulus.  Just a corpse with so much pent up frustration dying to get out.  Already I am not myself.  Already I am not my own.  And what is a hallucination or two compared to the sick, horrible feeling these drugs impose?

How do you know when the meds stop and the disease kicks in?  How can you tell the dysphoria and sedation that come from the drugs from the negative symptoms of a schizophrenic disease? Who knows? Today I am just a willing participant.  Today I am hoping for normalcy in a world where it does not exist.

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