Seeing the new doctor

I think perhaps G-d is taking care of me.

I saw my new psychiatrist's assistant today and I like her. She is very perky and energetic and talked fast today but she was running late and we had a lot of ground to cover in a short time.

She is leaving me on the Prozac at the current level and concurrs with everyone else's diagnosis of Major Depressive Disorder. I don't think, with my history, anyone can argue with that. She saw that my previous psychiatrist had indicated OCD and with as recent as that diagnosis is, she wants to work with it a little and see if it is true OCD or some other anxiety disorder with obsessive compulsive tendencies.

The thing she said that surprised me the most is that she thinks the fact that I'm not in as good a place as I could be is that we're missing--that is, not treating--something underlying. She said the things I described with my sleep and anxiety sound very much like post-traumatic stress disorder, PTSD.

I was diagnosed with PTSD years ago, but I assumed it resolved when I stopped having flashbacks and excessive hypervigilance. She said if it is PTSD, it might mean a slight alteration in my meds, but mostly she thinks I'm on the right thing.

Except for sleep. It's too hard to say right now, she said, if I've built up a resistance to Lunesta or if I'm just not at a high enough dosage to combat the Prozac or if there's something else going on. So until I see her again in about two months--her earliest appointment, she is very busy--I can increase the Lunesta up to 6mg/night.

I know I am sensitive to medicine so I'll increase 1mg (1/2 tablet) at a time and see what happens. I don't want to take 6mg tonight and wake up on Friday!

Or maybe I do. I have been thinking about how nice it might be to hibernate and avoid this difficult time of year altogether. But then I think of how many things I might miss out on, too.

One thing she said is that she wants me to expand my list of things I do for "fun." She thinks there is too much in each of my days that is about taking care of others and not enough taking care of myself.

Of course in my mind, it is just the opposite. How dare I take a full eight hours for sleep! Think of all the good I could be doing during that time!

I think I have just figured out that my taking care of others around me is related very much to my having high expectations of myself, and others too to some extent. I will have to explore that further.

For tonight, a little more Lunesta and hopefully a full night's sleep.

Limbo

I feel as though I am in limbo. But it makes me wonder, what is limbo anyway? I see now, it's a Catholic origin. The description fits, but I'd rather have a Jewish term.

All I know is that I am not in a bad place, but I am not in a good place either. My meds are keeping the depression and anxiety at bay for now, which is a very good thing. The anxiety has been tolerable and while I have times of higher anxiety and negative self-talk, the majority of the time it is manageable.

My sleep is another issue altogether. I'm still taking 4mg Lunesta a night but it takes 1-2 hours to fall asleep and I wake for the first time after only 3 hours, then nearly hourly after that. My mind isn't racing or busy. I'm calm, relaxed. Just awake. There used to be only dark circles around my eyes; now there are bags under them large enough I think they're going on vacation.

I would call to change this, but I can't. A couple of months ago, my primary psychiatrist, who prescribed this for me in the first place and said I could take up to 4mg/night left the clinic where I'm seen. That was okay, because my regular monthly med checks were with the psychiatrist's assistant. But she left the clinic last month and I'm waiting to get an intake with a different psychiatrist's assistant--supervised by a different psychiatrist--and until I have that intake, there is no one to sign off on any changes to my meds.

This has had me a bit stressed. I liked the women I saw before. I don't know how my relationship will be with these new people. And I have trust issues.

My intake is currently scheduled for next Monday. I'm going to tell her all about the sleep issue. It's only been this way since I increased the Prozac from 40mg/day to 50mg/day so I am hoping I can increase the Lunesta a bit to compensate for the increase in Prozac.

Meanwhile, I go through my days dazed from lack of any quality sleep. Last night, for example, I took my Lunesta at 9:30pm. I finally fell asleep at 11:00pm. I woke at 1:00am and thankfully was back asleep within 15 minutes. I woke again at 3:11am and did not get back to sleep until 4:30am. I woke again at 6:00am, fell back asleep, and woke at 7:37am when I finally got up.

But I am dizzy and forgetful and stumbling and I have a big day today with many things to do before Shabbos and today is a day I am actually glad we do not have company coming over because I simply couldn't handle it.

And so I am on some sort of edge (limbo). The edge of sleep, the edge of sanity, the edge of complete consciousness. I don't know. I only know that while I've been in worse situations and baruch HaShem I'm not there now, I'd kind of like to not be in this one either.

I (day)dream of sleep.

One step forward but how many back?

I am not doing so well today.

I tried to stay with the feeling I wrote about on Monday but it was elusive and by night time I was simply too tired. Yesterday I woke feeling even more tired and by last night my anxiety was really high. I managed to stop pulling hair and got out the brush from my anti-anxiety kit and proceded to work on pulling bristle hairs out. I should add it is not as easy as it sounds.

Then I felt the old familiar icky feeling, criticizing me for pulling bristle hairs out, that I was destroying this perfectly usable brush, commiting myself to destructive actions, and wasting the money spent on this brush just to tear it apart. Hairs at least, the feeling said, would grow back and wouldn't cost me anything.

I tried the self-talk I've been working on in therapy against the feeling: everyone else would rather see me pull bristles out of a brush than pull my own hair out; this is what I bought the brush for; better I hurt the brush than hurt myself.

And the feeling returned with images of my torturing this poor brush when I was the one who deserved the pain.

I told my husband I wasn't doing so well, about my anxiety. He thought it was due to exhaustion and he had a point. I had slept maybe 12 hours in the past 4 days. So I took my Lunesta and went to bed and fell asleep quickly.

While sleeping, I dreamed. I dreamed that I had a conversation with one of the Rabbis quoted in the Talmud. He expressed great concern over my urge to hurt myself, even to harm a single hair.

And then somehow in the dream I knew that he was quoted in the Jerusalem Talmud but not much if at all in the Babylonian Talmud and how the BT is generally considered more complete and consequently more authoritative than the JT and I wondered in the dream what it meant that I was visited by someone less prominent and if that was a reflection on me. And before he left he said something about how this was concerning that even in my sleep I was looking for ways to put myself down.

I woke groggy and still very tired and with a tremendous headache that encompasses the entire left side of my head. It is hard to concentrate. I think I should not be driving. I fear I am wasting time by not accomplishing anything productive today.

I was certain I was doing better, improving. Using my brush instead of myself. And on Shabbos I used my plan again. I was feeling a bit fragile and rather than invite opportunities to feel marginalized, I went up to a woman I know well, who knows what's going on with me, and said, I'm feeling a little fragile right now; can I hang out with you for a little bit? She said of course and included me in her conversations with others and about 20 minutes later I felt much better and was able to stand on my own again.

If I am doing better, making better choices, managing better, then why do I feel this way? Why do I search for a negative in what would otherwise have been a very intriguing dream? Does this increase in anxiety have anything to do with the overwelming feeling I had Monday? Am I expecting too much too soon? Why am I still convinced I have wasted today because I didn't get anything "done"?

And why does the thought of tomorrow bring with it more fear than hope?

Seeking

Now I must address the feeling I have been trying to avoid since the last post.

My mind wants to find easy origins: not enough sleep, going without Lunesta for one night, hormone changes, no view of the sun in the sky today. But none of these seem right because this is a pervasive, encompassing feeling. It led me to select certain books over others from the library this morning. It determined which articles and blogs I've read today. It has kept me from wanting to answer the phone when it rings, even when the caller is a friend.

I feel it in my shoulders and upper arms, like a physical longing for a hug or the need to cradle a baby. I feel it in my chest, tight and compressed like I know something is looming on the horizon but I can't see it yet. I feel it in my stomach, a sort of dread as if I know the truth is going to be dragged out of me one way or another but it will ultimately be a relief. I feel it in my legs, wanting to run from this but knowing there is nowhere to go.

It isn't a sadness, exactly, but I can feel tears nearby. It reminds me of the way I feel sometimes when I see a TV ad like this Hallmark commercial.

It isn't depression. There is definitely hope there, not hopelessness.

It isn't loss, I don't think. I haven't lost anything recently, big or small, but it does feel like I sometimes do when I remember someone close who is no longer living.

It isn't gratitude, but there is an element of thankfulness. I read today something my rabbi wrote recently (not to me specifically) about accepting each other's humanity--rabbis and congregants--and all that entails, and I was so overcome with this feeling that I momentarily felt weak.

It isn't fear, but there's definitely something there that I'm afraid of.

It is a feeling that flares up when I think about friendship and the sacrifices we make willingly--even eagerly--for those close to us. It is similar to how I feel when I hear about a police officer losing his life while protecting someone else.

It is how I sometimes feel--if I am lucky--in shul, davening and suddenly overcome with a need to convey through my prayers, Thank you, and I'm so sorry, and I miss you when I'm not paying attention.

I hear others around me, the whisper of silent prayers, and I know there are others here in pain and in mourning, those experiencing gratitude and relief and the realization of long-held dreams. And everyone has brought these parts of themselves to this one place on this one day to share, however privately or publicly, with G-d.

And I see glimpses of this humanity in action: one man trusting enough--or hurting enough--to weep openly and consoled by the man next to him. One woman surrounded by others, some of whom are offering comfort and others who are supporting her simply by being present. One exhausted mother relieved temporarily of her active children by a few teens who offered to help. One elder repsectfully helped to a seat. One rabbi passing by a congregant on his way to somewhere else, then stopping, returning to the congregant, and asking, are you okay?

I see this and I am humbled and moved beyond words. It occurs to me that this is what it's all about. Whatever it is, it is present here, now.

My husband called me as I was writing this post and I answered the phone and the display said CONNECTING before I put it to my ear.

What I am feeling has something to do with connection. Something deeper than community, more complex than love. It is seeing that connection, knowing that connection, having experienced that connection and also the loss of it when I needed it. It is wanting a constancy of that connection. It is recognizing that I need this connection in my life and knowing all too well what it's like to not feel it. It is hoping, struggling, craving, longing, physically and spiritually yearning.

I still don't know exactly what I'm feeling. But apparently it has something to do with seeking G-d.

Competition, blogging, self-esteem and a bit of procrastination

I have been in the midst of a very intense emotion all day today and I can't identify it. Whatever it is, I'm afraid to go near it but I am drawn to things that touch on it, that resonate with it. I called my friend D while I was running errands this morning and D suggested I blog about it, that maybe by writing about it, whatever it is, I could identify it.

So that is what I will try to do. But not now. Because it's still too scary right now. Maybe when I'm done with this post?

Instead I will write about something else that has come up that has left me with mixed feelings. When I started this blog, I didn't really know what I was doing (I still don't, really). I looked at a lot of other blogs and here and there I picked up references to various aggregators and the whole feed thing that I still don't understand.

But I submitted my blog because I knew that if no one knew I was here, no one would read anything, and I knew--I just knew--that eventually I would use that as a weapon against myself, a way to prove that my depression was right all along and no one cared and I was just babbling away to no one and it wasn't going to make a difference so why bother?

I am moved beyond expression that the blogosphere in general and the Jewish blogosphere in specific has proved that train of thought very, very wrong. That potential weapon has been neutralized. And now with mixed feelings I have become aware of another.

I didn't realize that one of the aggregators encourages readers to rate posts, or that it automatically rates the post as soon as it becomes aware of it. The aggregator appears to rate the post based on the number of words; short posts, even if they speak of something important, are rated lower than long posts even if they are about nothing. One of my readers pointed me toward this aggregator (JBlogCentral) and explained to me about the ratings and how readers can rate posts and what it meant that I had an overal rating of 4+ stars with only a couple hundred points. And then I found out about the JBlogAwards.

It took me a while, clicking on things around the site, to figure out how it worked, and then I felt uneasy when the site itself encouraged bloggers to rate their own posts.

Because when I write something, it isn't here to compete with everyone else's posts or earn me international attention or win a Pulitzer prize. I'm not qualified to offer psychiatric advice or rabbinic advice or medical advice. It's just me, trying to muddle through life the best I can while dealing with depression and anxiety, and relying very much on the strength I have found in being Jewish.

I know that competition is a good thing, generally. Competition is what allows me to afford my prescriptions. Competition is what drives my need to give my children the Jewish education I never had. Competition keeps a paycheck coming into our family.

But how do I take it when some people rate a post that to me is raw and vulnerable and just lays my reality out there for everyone to see, a five and others rate it a three? Or a one? Was I just not angst-ridden enough? Not compelling enough? Not provacative enough? Not political enough? Perhaps I didn't provide enough gossip or badmouth people in shul or threaten to out my rabbi? Or perhaps I was too much out there, too emotional, too honest. I don't know.

I remind myself that I am writing this blog primarily for me because I have never successfully maintained a written offline journal. As a bonus, the feedback I've received is tremendously helpful. And a result I never expected was that it's apparently helping others, those who are experiencing similar issues, those who are caring for those experiencing similar issues, and those who want to help via their profession or vocation or simply because it's important to them.

At the same time I'm reminding myself of this, I'm noting that some of the blogs I enjoy visiting, like Rabbi Without a Cause and A Mother in Israel, are at least today on the Top 50 blogs list. Yid With Lid, who hosted the most recent Haveil Havalim, is today number three.

What do I feel? Disappointment? A touch of benign envy? Happy with the overall ratings despite individual votes? Does it affect my ego? Should it? Why does it even make a difference? Who relies on those ratings anyway? Is that last question at all a sour-grapes sentiment?

I want to be Seen and noticed and valued, and the ratings and awards seem like a good way to accomplish that, but there is dark territory in there for me.

My feelings are very mixed. The only way I know that my blog is anything positive in the world is from comments and email that people have left, and the occasional mention on another blog. I can't at this time trust ratings and awards. There is too much potential for me to criticize myself or stomp on an already wavering self-esteem if I allow ratings and awards to define the worth of what I write, which on this blog, is most certainly tied to the worth of me.

When three out of four IS bad

My doctors and counselor have emphasized that there are four necessary components to my success in coping with depression and anxiety:

1. Consistent medication
2. Proper nutrition
3. Regular exercise
4. Adequate sleep

I suppose I could add that a positive attitude helps, but that's just not always possible, and I don't want to sabotage myself by requiring a positive attitude when depressed because that will just set me up for failure.

I'm consistent with the medication. I'm still taking generic Prozac, still at 50mg/day. I know that my ability to cope with each day is due in part to my staying on the medication; forgetting or missing a dose for whatever reason will impair my near future, and I'm the one who has to live with me.

I'm doing better with proper nutrition, in part because my husband is taking better care of himself and is therefore better able to help me with grocery shopping, meal planning, fixing healthy meals and so forth. If it were not for his contribution, there are many times I'm not sure I'd eat at all, much less eating healthy. Keeping kosher usually makes it easier to eat healthy. Sometimes it makes it harder, or at least demands more creativity. It is possible to make a fleishig (non-dairy) chicken pot pie from a treif (non-kosher) recipe, and have it taste good.

I noticed today, in fact, that I have lost some weight and the only major change I've made is eating better. Plus, I like how it feels and that buoys my mood too.

I am not a couch potato but I could do better about getting aerobic exercise. Cleaning house and chasing after children helps but is not quite the same as a workout. If only I had the room and the money to blog on a treadmill. Our health insurance now offers us a reduced membership at the local Jewish Community Center if I exercise some number of days each month. Time will tell if it is incentive enough for me.

And then there is sleep. Or no sleep. Like last night when I finally fell asleep at 5am and woke at 7am.

The Prozac, even when taken in the morning, will disrupt my sleep. It makes my already light sleep practically non-existent. My doctor tried me out with Lunesta, Ambien CR, and Rozerem, and only the Lunesta had positive results. Over the past few months, I've very gradually needed to increase my dose of Lunesta from 1mg/night to 4mg/night. Until recently, it has helped me get to sleep within less than an hour and sleep through the night, waking if I need to without feeling drugged or drowsy. It has brought dreams back into my nighttime, something that has been missing for over a year.

But within the past few weeks it has not been working as well. It's taken me longer to get to sleep and then I wake at 3am or some other middle of the night time and cannot get back to sleep. So I thought last night I would try going without it. Unfortunately, that meant going without sleep, too.

I know that Lunesta, like many sleep aids, does have a risk of dependency so that going without it may cause a few nights of interrupted sleep before the body's own sleep cycle takes over again. That appears to be the case with me. I don't see my doctor for another week, so I'm not quite sure what to do. What I know for certain is that I need my sleep. I need that REM sleep. I need more than 2 hours a night.

I'm doing pretty well on the 50mg/day of Prozac and there's no indication at this time that last year will repeat itself, despite my worries to the contrary. But staying out of the depression by using medication is resulting in less sleep, which increases my risk of depression, which might cause another meds increase, which will result in less sleep, which increases the risk....

It is enough of a challenge to live with the depression and anxiety/OCD, knowing there is no cure, only management. Why does treatment have to be so challenging too?

It maks me really wonder what G-d wants me to learn from this.

Haveil Havalim at YID With LID

Thank you to Yid With Lid for posting this week's Haveil Havalim and including my blog.

Musaf as therapy

I think there is a lot to be said for sacrifice.

Let me explain that. I'm not saying it's time to fire up the altar, and I don't want to go anywhere near the political ramifications of rebuilding the Temple. I'm not even saying that sacrifice has to involve death. Not like it used to.

Rabbinic Judaism has replaced the Temple offerings with our tefillot, our prayers, which require an investment of time and effort, and if you count synagogue membership and other annual contributions, also money. Musaf is the additional prayer service that represents the additional Temple offering on Shabbat and holidays.

I think about this and I am not certain it is enough. Because nearly everything in life today requires an investment of time and effort and money. What makes our offering to G-d any different than our offering to a political cause or a social cause or a few hours of Internet shopping?

To me, it should be different. It should be special. And so when I reach Musaf and I'm contemplating the role of the Temple in our collective history, I take a moment to reflect on a different sort of sacrifice, my own "addition."

What do I personally need to sacrifice that is standing in the way of my connection with G-d?

What obsolete defenses, inaccurate fears, faulty assumptions have cluttered my life and made it harder to reach my potential? Which of those need to "die" and make room for new life?

Lately I've worked on my fear of loss, my tenuous trust in the universe, my fear of not belonging, not deserving, not having the right to be.

It isn't easy. It isn't painless. Sometimes this blog is part of that sacrifice because there's safety, it seems, in silence, in never bringing these things to light.

Speaking up means I have to think about it, put words to it, talk about it. Hear others' opinions and ideas. Learn from it. Change it. Allow myself to be changed for the better.

It seems to me that is at the heart of Judaism itself.

Sorry this seat is taken

I started blogging 50 weeks ago. Almost a year. Due to the depression, I have only hazy memories of last January, so I went to see what I'd blogged about then.

Much to my surprise, very early on there's a post about being told, sorry this seat is taken, again and again at a shul-sponsored brunch.

Interesting. How much has stayed the same and yet how much has changed.

You don't need OCD to need a fixed place in shul

I hadn't spoken with my friend D in a while, until yesterday, when D called with new year's wishes and to check in. D reads this blog regularly and occasionally calls to talk with me about something I've written. (D was the one who got me to start this blog in the first place, since I was horrible about keeping a written diary.)

My last post about being embarrassed to admit that I was afraid of losing my seat in shul caught D's attention.

Why are you embarrassed to say you want to sit in the same seat at shul?

Because in comparison to everything else, it seems so mundane. So insignificant.

And yet you write--without embarrassment I presume--that having a seat at a table with others for a meal at shul is quite significant. How are they different?

(I hate it when D points out my inconsistencies.)

They are. Let me see if I can explain. Knowing that you have a place to sit, to daven, to be in shul without worrying about taking someone else's seat or breaking some protocol is something I consider important. So important, that I'm always thinking of people who come in after me, and what if they don't have a seat? I find myself wanting to make myself smaller or sometimes even to disappear so they can have my seat and won't have to go through the discomfort I've felt. But at meals, which are far less frequent than once a week to begin with, usually everyone else is already seated, so I'm not as worried about people coming in after me.

Rivka, I've lost count of the number of assumptions you've made in that explanation. It sounds to me like you value having a regular, fixed place to daven, a makom kavua, and you value having a place to sit at a meal where you're valued as a person and not just a mother. Yet you seem to be saying that you don't deserve the first and you do deserve the second. I'm curious why you don't feel you deserve a place in shul?

I don't know. It just seems like others are more deserving.

Based on what? Do you think G-d wants you to disappear so someone else can have your seat? Do you think the congregation wants that? The rabbi?

No.

I don't think so either. In fact, I think they all want you to take your seat and inspire others to sit with you.

I don't know how to do that.

I know my feelings of "deservedness" are related to my history and my depression, not to mention my self-esteem. But even when my head understands that it's okay to need a fixed place, my heart doesn't accept that I'm worthy enough.