It's Psychosomatic

Doctor 3 was actually good. I think my parents found her when they passed the psychiatric centre on the street and decided to go in and take a look. They asked for a doctor who spoke English and found someone who had undertaken part of her studies in the States. Yay for cultural common ground!

I don’t remember everything from the first appointment. I do remember that, in contrast to the previous one, the psychiatrist was extremely proper. She asked whether I wanted my parents to come in (I think she recommended they be outside, at least to begin with, but I’m not sure). She outlined very clearly at the start how the session was going to run. She said she was going to ask me a lot of questions and that I didn’t have to answer anything I didn’t feel comfortable answering or talk about anything I didn’t want to talk about. During the session, she asked for clarification about whether my parents knew x, y and z and how much I wanted to share with them. I don’t really have secrets from them, but the point was that she made sure.

As far as the questions she asked were concerned, my impression was that she went through checking all the major illnesses I could have had by screening for various symptoms quite systematically (again, in stark contrast to the last guy!). She obviously didn’t tell me what illnesses might be indicated by these symptoms but, having done an inappropriate amount of research myself a la hypochondriac, the implications of what she was asking didn’t escape me (as a side note, that is a bit of a problem because I have ideas about what illnesses I would prefer to have). She asked me if I was seeing strange things, if I could smell burning sometimes, if I had periods of boundless energy, and so on.

She also kept little notes (unlike the last guy) which seemed to me to be a very sensible thing to do. At some point I became really upset at the prospect of dying from a terrible illness and I broke down crying. I could not go on talking or answering her questions. I think I just kept saying “There’s something wrong with me!” or words to that effect. At that point, she saw fit to reveal her notes. Quietly, she said, “Do you want to know what I think?” “Yes please”, I guess I replied as I calmed down a little. She showed me a little checklist of letters and symbols that she had signifying the symptoms of depression and went through the items: sleeping too much but waking up in the early hours of the morning, loss of appetite and weight, lack of concentration, poor memory….. I don’t remember all of the items she had on there, but I think they were roughly the DSM criteria. She said that though I was worried that I had some kind of dementing illness, I seemed to be experiencing “pseudodementia” as a result of depression.

She also told me that depression is especially common in young women. For some reason, although this is hard to explain, I felt that this was a nice thing for her to say because she said it with such a lot of compassion, as though she was especially aware of the trials of being a young woman in the 21st century and acknowledged that I was somehow bearing this burden. Of course, everyone experiences trials of being what they are, when and where they are, and I’m not sure that I am especially troubled in this way, but it was still comforting somehow and I’m glad she said it.

She recommended doing an EEG to rule out epilepsy as suggested by the neurologist. She also backed up the prescription of Effexor that the neurologist had made, although she gave quite different dosing instructions. She gave me her phone number and asked me to please call in order to help her get a better picture of what was going on and also as a lifeline for me. I was to see her weekly for the time being.

Needless to say, I wasn’t satisfied with her non-serious diagnosis but I felt that now I was getting somewhere.

These past few days my mind has been filled with all the most upsetting thoughts and I cannot seem to get rid of them. It doesn’t much help that my parents (whom I live with) are away this week and I have to spend more time than usual with only my brain for company. I look forward to going to sleep at night because, thankfully, my ability to sleep well remains mostly intact and this is my only respite. I feel angry and sorry for myself because life could be wonderful right now but thanks to OCD it is really difficult. I don’t have anyone I can really talk to about this stuff when it comes down to it. I have nowhere to unload this burden and it is getting a little to heavy for me to feel that I can go on carrying it indefinitely. I am thinking about starting to take sertraline again since I have some in the cupboard but it won’t work that quickly if it works at all. I could call the last psychologist I was seeing but she probably doesn’t have time to see me, I scarcely have time to see her and it’s not exactly cheap. I could call the GP but she could only prescribe what is already sitting in my cupboard. Meanwhile I have a long list of responsibilities and to do’s that I can hardly cope with. I am scared and lonely :(

I suppose this is a feeling that we all have from time to time. What should you do with it?

In my case, first off, I do know that there is something wrong with me: I have OCD. But my life’s work now seems to have become figuring out what else is wrong, because I have always suspected that there is something more. Things I think might be wrong with me include:

1) Some kind of physical disease

At times, this belief starts spiralling towards the completely irrational end of the spectrum, when I think I am imminently going to die from something horrendous and I end up crying in the doctor’s office. The rest of the time I suspect something more subtle. I imagine that I must have an as yet undiscovered thyroid condition or a systemic autoimmune condition. Everyday I look in the mirror at my blotchy skin or, as happens occasionally, my prominent bones and I think that only a sick person could look like that. I wonder how everyone can else look so healthy.

2) More mental disorders…

…of various types. I look back at, I reckon, three episodes of depression (only one of which I received diagnosis/treatment for) and wonder if this could indicate that I have bipolar disorder. I look at a few incidents of apparently disconnecting with reality and wonder if I might be predisposed towards psychosis. I also wonder if I have a neurodevelopmental disorder that might account for things like my lack of coordination and my (mostly perceived by me rather than by anyone else) inability to navigate social situations and my general feeling of social disconnection.

3) Being an evil person

I wonder if I’m actually not a nice at all and I just sometimes act as though I am. Do I care about other people enough? Is my apparent selflessness really just serving my own ego? Am I actually hugely egotistical? And so on.

I’m pretty much unable to tell how likely these things all are. What is more, I live in two realities as far as all of the above are concerned. On the one hand I believe I am physically indestructible and on the other I believe I am dying. I feel that I am emotionally super strong but also think that I have about ten mental disorders. And I think I am a sweet and kind person but I also think that I am a monster. I really don’t know how this compares to most people’s experiences of themselves. This could be a facet of the OCD mind where being troubled by the belief that there is something wrong with me is my obsession and trying to figure out exactly what it could be is my compulsion.

So back to my original question: what should you do with this? 

What I have done in recent months is things like getting food intolerance tests and a referral to the clinical neuroscience department. I’m pretty sure that if this is all OCD-related then those were bad things to do as they are just contributing to the OCD cycle. And now, what am I to make of the fact that I do apparently have a long list of food intolerances?? I went in with no evidence of this to start with other than my general belief in the likelihood that “there is something wrong with me”. As yet, my clinical neuroscience appointment has not materialised, but when it does, how am I going to handle that and what can a conclusion offer me?

I think the truth is that, even if there are minor things wrong with me (and maybe even if there are major things wrong with me), the best thing I can do is act as though I’m perfectly healthy and good. In many ways, that is my best chance of making it all a reality, rather than discovering an exact problem and seeking a cure. However, I find it difficult to put wholeheartedly into action because for almost as long as I can remember I have believed that there is something wrong with me.

I read this article with interest. The subject didn’t recognize that he was suffering from depression, which is perhaps all the more surprising considering that he was studying psychology at the time, and experienced the symptom of blurred vision which made him “obsessed with the fear of losing his sight”. 

My mum actually pointed this article out to me, because she knew I went through something similar last year. I felt as though there were bits missing from my vision, I thought I could see mist all around me, the sun was too bright and I became hypersensitive to lights flickering. I was constantly prodding and poking at my eyes trying to get them to work right which obviously was only making things worse. This happened before I really descended into what could be identified as depression.

In the more distant past, a few times, I have also experienced the feeling of not being able to operate my hands properly and of generally losing motor coordination. I am not sure whether this may have been a depressive symptom (perhaps the closest thing on the standard inventory of symptoms is psychomotor agitation/retardation). In 2008 I went to the doctor about this and she got me to walk in a straight line and such. I don’t think I necessarily failed her tests but she sent me to a neurologist. He noticed that I had an inflamed optic nerve and thought there was a small chance it was multiple sclerosis. At this point I had a total meltdown. He sent me for an MRI but it came back clear and eventually the feelings went away. But for some time I was extremely miserable and it is all very chicken and egg.

I suppose the main point is that depression can creep up on you. You may have symptoms like this that you don’t recognize as anything other than a physical ailment. You may find yourself dropping out of life without any clear understanding of why and you may well not be sad at all. You can arrive at the brink of something catastrophic before you realise that there is something so wrong that it needs a name. As you search for it, your mind may not latch onto the possibility of depression. 

Also, I know there is some doubt as to whether these diverse symtoms really refer to one syndrome or to many. Is the depression dominated by profound sadness the same as the depression characterized by a general slowing down or a feeling of illness? I think it is likely that there are underlying differences. But even if there are, there should be a broader awareness of what the thing that we call “depression” can encompass because the standard inventory of symptoms is far from comprehensive and far from descriptive. It is very easy to miss the signs and delay, or miss altogether, receiving the appropriate help.

http://www.scotsman.com/news/health/case_study_i_started_to_feel_very_very_strange_1_2105452

I’m sorry if this is way off topic but I can’t think about anything else. I’m not sure who coined the term but, in case you can’t guess, it is an amalgamation of Greece and exit, referring to Greece’s potential exit from the Eurozone. This was once described as being unthinkable but now people are openly talking about the possibility of cutting Greece adrift. Being half Greek, having family there and having spent a lot of time there obviously means that this issue is close to me. Until recently I have continued to laugh at the predictability of it all and in particular at the playing out of cultural stereotypes on all sides.

I’m not laughing anymore.

What’s going on inside Greece is scary. A European country is becoming a third world country where people can’t afford to eat. Ordinary people are giving up their children. They are being pushed to the brink, as demonstrated today by the woman who threatened to jump out of her office window after learning she would be made redundant. Her story is surely not unique. Hatred is being ignited to the extent that people are actually bringing up WWII which I would not have thought possible. I’m amazed that we have let this happen.

The fascinating thing is the seeming irrationality in the way this Eurozone crisis has played out. I’m finally getting a real sense of how senseless upheavals like wars come about. Despite the facade of refined diplomacy and calculated politics, crisis can stem from trivial cultural misunderstandings (see “Homeopathic psychiatrist” for possible examples…) and actions can be determined by basic instincts. I can’t help but think that human beings were not designed to interact on this scale. 

From a mental health point of view, I don’t know how Greeks will adapt to cope with the hardships that they are facing. Things are incredibly tough and also so far outside the realms of what people could have imagined a few years ago. However, with the prospect of a deepening recession with or without a grexit, I wonder whether it might genuinely be worth something to the Greek people for Greece to just choose its financial freedom and return to the Drachma. People might then be able to regain a sense of pride and dignity that they have lost and reinforce their collective identity. I’m not kidding. People really need that. 

My dad was against going to see any psychiatrist that had not been recommended by someone we knew. I agree, sadly, that you do have to be on your guard because, despite what some may claim, psychiatry is far from an exact science. My dad’s “recommended” psychiatrist turned out to be a homeopathic one, however, which strikes me as somewhat of an oxymoron. I am sceptical of the medical establishment but, to me, “homeopathic” is not a good place to start. 

But I really needed and wanted someone to help me, so I went into his office with my preconceived ideas pushed back in my mind. It started well enough. He didn’t speak much English but I had my parental tranlsators with me so that was okay. He had a reassuring manner and put me at relative ease, despite my general psychological discomfort. I was momentarily hopeful that help was finally on the way.

It didn’t last long. There were some initial clues that his practice was questionable. He made blanket statements along the lines of “your fears are unfounded” which, true or not, seem like a bad idea. If a patient has OCD, even if this provides reassurance it will be temporary and will contribute to a reassurance-seeking pattern. If they have depression, this is a little like being told to snap out of it. He also talked much more than I did when I would have thought that, at least in an initial consultation, he should have been gathering information about me and my problem. I know that with experience psychiatrists can find clues without much patient input, but that doesn’t make them mind readers. 

He then went on to leave no doubt in my mind that I was dealing with a quack, even if he was qualified. Without evidence (other than the fact that I was an only child and visiting his office with my parents) he proceeded to explain that my problems stemmed from the anxiety of being an only child and were significantly the fault of my parents. On the biological side, my pale colouring implied the likelihood of a lack of phosphorous. According to him, Sweden should be sprayed with phosphorous to lower their “12% suicide rate” (in fact, the rate is around 12 per 100,000…). He made disturbingly frequent use of a dream dictionary though I don’t believe I described any dreams to him. He also said that I didn’t spend enough time enjoying myself. In relation to this, he asked whether I had ever had sex in the sea. From my reaction (open-mouth, silence, physical preparation to exit his office) he must have realized that I wasn’t impressed. He finally declared, perhaps in a misguided attempt to reassure, that he had seen people in a much worse state than myself and sent me away with a prescription for a single phosphorous pill and something else homeopathic for panic attacks.

Funny though this all is now, at the time it was a huge setback. I couldn’t believe that I had been sent away without receiving a diagnosis (even an unofficial one like “the blues”), any suggestions for psychological intervention (maybe some kind of talking therapy, even for a short time) or some real medicine (seriously, one phosphorous pill??), though I would never have trusted these had he provided them. May I just reiterate, he was a real psychiatrist. I felt that I was desperately in need of help but now believed that it would not be forthcoming. 

I am writing up a report that is due the day after tomorrow. I have left it until the last minute so it’s making me anxious and it’s a bit confusing so it’s making me think. As a result, I cannot stop picking at my skin. This is making my hands dirty so I keep needing to wash them because I don’t want to dirty my keyboard. It is also making my skin gross so I keep needing to wash my face. Each time I say it will be the last but as long as I am still working it won’t be. I am typing this with my two remaining clean fingers before I go wash up. 

I had my third driving lesson the other day. The instructor got me to go around in a little loop on some fairly quiet roads. The main challenge was that there were a lot of parked cars, making it quite narrow (by my standards) in some places. I only had control of the wheel. She took care of the brakes, the gears (or whatever you call those in an automatic), the indicators and looking in the mirrors. We crept along at a snail’s pace and she got me to use a touch of gas when we had to go up a hill. 

After the third repetition of the loop I was exhausted. It was almost time to go home anyway so we stopped. On the way back, I asked the instructor if I am her worst case scenario as a pupil. She told me that I am far from it. I knew would be her answer but I hoped it would not be; I think this means that I’m not bad enough to be able to claim that I have any problem other than a severe lack of talent. 

I was never interested in being good at driving. I know I have other strengths. But if my lack of ability is not evidently pathological to an observer, I at least want to know why driving and similar activities produce the response in me that they do. The concentration makes my brain hurt. Within minutes tears are welling up in my eyes and I feel a kind of frustration that I am not familiar with in any other context. I end up doing strange things like biting myself in order to get relief. Thankfully, at the moment I’m managing to deal with it by squeaking. 

A few days ago a friend read me some of her old diary. The events she had written about against the backdrop of the school year were mainly parties, boys and fallings out. It was wonderful and strange to be reminded of the things that happened when we were 16 years old.

I thought back to the diaries that I have managed to keep with the most diligence. One of these was a food diary from the year that I became obsessed with healthy eating and counting calories. The other one (which extended into multiple volumes from I have no idea which years) was a diary of what are probably best characterized as prayers, which I was convinced I needed to keep in order to remain in God’s good books and prevent something terrible from happening. I should point out that I am not a particularly religious person and whether I believed in the God that I feared at that time is up for debate. So, it is quite sad that my most consistent efforts were probably the direct product of OCD.

In my other more standard diaries I could never bear to look back even a few days and see what ridiculous things I had documented. I always found the entries so trivial and badly written after the fact that their continued existence offended me. I ripped them up and tried again. I can see flickers of OCD in this too. I still have a drawer of notebooks from which half the pages are missing that were once attempted diaries, and I am still trying again.

I suppose, to an extent, that includes this blog. However, I don’t write here compulsively which is a good sign. Furthermore, I am learning that it doesn’t need to be perfect to be worthwhile. It can’t be, because I am not perfect. As I look back I can usually come to terms with what I have said and how I have said it, even if I don’t like it. I consider this a victory of sorts.

I am terrified of driving. Partly this is because I am uncoordinated and so in my thus far brief attempts, I have really struggled. I also struggle somewhat with ball sports and dancing. My mum thinks that this is not all about my lack of coordination but rather about my unrealistic expectations for how good I should be at something the first time I try it, a characteristic she claims I have had since I was a baby. There is also the OCD interpretation of my fear of driving, which says that I am afraid to have such a responsibility in my hands in case I accidentally cause harm. Lastly, there is the more psychoanalytic approach, which would say that my fear must have something to do with the fact that my dad is involved in motor sports and I have always been scared that he will have a terrible accident. 

Whatever the case may be, driving would be useful so I decided I’d have another bash at it, pun intended, when I noticed an ad for a school that specializes in automatics and anxious drivers. They sent a female instructor who, they assured me, was experienced in helping overcome difficulties. She came and was extremely nice and seemed to know what she was talking about. She asked me a little about what problems I had had in the past. I listed what I could remember, which includes problems with left and right, turning the wheel in the direction that will make the car go in the direction I was aiming for (!), remembering which pedal is which and which foot to use for which pedal, and doing multiple things at a time. She asked about my sporting talents and whether I was “more academic?” I said, yes, academic described me well. She reassured me that she had worked with lots of people with dyslexia, dyspraxia and Asperger’s, then hastened to add that she wasn’t saying I had any of the above. I laughed and thought for a second about telling her a long story about OCD. I thought better of it. The important thing was that I could see she had recognized my “type” quickly.

The lesson went well. I mean, I did manage to hit a curb and press the gas instead of the brake, but there was no damage since we were only going for 10 metres on a deserted road. At the end there were no tears of sadness or frustration. She said that within about five lessons I should know whether driving is “for me”….