True healing

I am well. Not all well, but really well. I am still seeing my counselor. I have grieved my mother's death and dealt with much of the fallout.

I thought my brother and I were getting closer after my mother's death, but when I made an off-hand reference to one of several times my mother admitted to her part in the abuse when I was growing up, he verbally attacked me in public. When one of my very good friends stood up for me, he attacked her as well.

I struggled for months with what to do. I tried to reconcile, but I did not go to the lengths I went to with my mother--lengths that left me far more hurt than before my attempts. He clearly wanted to blame me, not reconcile. I was finally able to chalk it up to his own grief and let it go.

With a great deal of help and support, and with--I strongly believe--no small amount of spiritual intervention (I am one of those people who believes G-d is at work in the world, though maybe not in ways we'd expect, or even hope), I have a sense of who I really am, an idea of maybe who G-d wants me to be.

My counselor offered this in her interpretation of kibud av v'em--honor your father and mother: "Parenting, at its root, means helping your child become the best person s/he can be. So the best way to honor your parents is to be true to yourself, and become the person you were meant to be, the person G-d created you to be." I needed to hear that, right then. It finally clicked.

I feel like I am finally accepting who I am--who I really am--even with my flaws, my mistakes, the possibility that severe anxiety and/or depression may once again visit. And I am okay. Yes, I can do better; there's always a place for introspection, evaluation, and improvement. But my core, my essence, my Yiddishe neshama, is accepted and loved, and I am worth loving and worth acceptance. I don't have to disappear from my makom kavua because someone else is more worthy than I am. I can sit in my fixed place (where I have sat for sixteen years now) and invite others to sit with me.

This is all a huge change in perception for me. And for the last 17 days (it's that new) it has stuck. I pray it sticks forever.

In fact I have felt so accepting of myself that I have toyed with the idea of dashing my anonymity (whatever of it I have left) and coming out, so to speak. I didn't when I set up this blog because I feared what others would think, that I would lose my credibility, my job, my friends, if I owned up to what was really going on inside of me: the depression, the anxiety, the fear, the hurt, the wounded child.

Now, I don't worry so much about what others think of me because my opinion of myself is the one I have to live with (did I just say that out loud?). And for the past several decades, it's been a pretty negative one. Perhaps because it is a more positive opinion now, I am going through a sort of honeymoon period. For that reason, I will give the idea of "coming out" some time. There still may be things I don't want to admit publicly, under any name other than Rivka.

Any advice?

Threatening to burst

Tonight I am tense. I am barely able to breathe. I am dizzy. I feel like whatever is going on inside of me cannot be contained by the confines of my body. I feel a little like I am going crazy.

Today I had only three flashbacks. I could actually feel what I felt so many years ago. I had nightmares last night and woke disoriented and panicked. I have been paralyzed by my warring thoughts and emotions. Yes, this all happened/No, this couldn't possibly have happened. My dad did things he should not have done/Not my dad! He loved me! My feelings are normal/I'm just trying to get attention.

I think I should call my counselor tomorrow, or maybe even tonight, but I don't know what to say.

It is too much. I want to curl up into myself and escape. I want to not feel for a while. I crave release.

Could it really be that simple?

I am sorry I haven't been here in such a long time. I didn't intend to take a break from blogging, but apparently I needed one, and by the time I realized it, I needed to stay away enough that I couldn't even come post that I needed to take a break. I apologize for my abrupt departure. And I am not sure if I am back yet or not.

Once again, there is so much to share that it seems overwhelming but really the bottom line is that my PA (psychiatrist's assistant) changed my meds. And it worked. Really really worked.

She was concerned that even with an increase of the Prozac to 70mg/day I still wasn't getting better. In fact I started getting worse, with symptoms of Tardive Dyskinesia.

At one appointment she said, we've been treating this all along as depression with a side of anxiety. But your anxiety always comes first before the depression, so let's try treating this as an anxiety disorder with a side of depression. She has me slowly lowering the Prozac dose by 10mg/month (I'm now down to 40mg/day) which helped relieve the TD. And then she put me on Buspirone.

Buspirone is my new best friend. For the first time since I was about eleven, I can just sit and be, without needing to fix something or do something or even feel guilty about sitting and being. For the first time in a very long time, I feel calm.

I've been taking some time for myself, time to read without guilt, reconnect with friends without pressure, time to do some of the things I want to do and let go of the things I think I should do. (That's where the break from blogging came in.)

This was the first year that Pesach cleaning was not a source of panic and anxiety. I actually enjoyed getting the kitchen clean and into order. I was relaxed and a day ahead of schedule until I got sick (24 hour bug) and even then I was relaxed and catching up. It was amazing.

Life has slowed down a bit for me, though I am still dealing with the same small children and all the same volunteer activities. But now with the new meds, I can go for a walk in the morning with a cup of coffee, enjoy the sights and sounds, and even taking out this 30 minutes just for me, I am actually more productive during the rest of my day. I work a little more slowly, but I get more done. I don't entirely understand that, but I like it.

Meanwhile, I am very aware that I'm coming up on one year since my miscarriage and the delivery and burial of my daughter. I'm a little sad but I feel at peace with it. I am still hoping, baruch Hashem, to have another baby, but I also have come to terms with the possibility that it might not happen.

I am also off the Lunesta, finally. I was very sick with strep throat for a week right after Pesach and couldn't take any medication at all. By the time I was better, I decided I wanted to try sleeping naturally. Sleep is still elusive; last night I slept from 2-3:30 a.m. and 5-7 a.m. That's it. If I need to, I'll go back on the Lunesta, but I'm still hoping to do this one thing med free.

For now, as long as I have my Buspirone I'm happy. Finally.

Lost

I don't want to jump to conclusions but I am scared.

I have been so tired for so long. The upgrade to 5mg Lunesta has helped me sleep through the night most nights but I still spend a larger percentage of my daytime looking forward to sleep than I do looking forward to anything else.

Erev shabbos I went to bed early, feeling dizzy and unable to stand up any longer. I planned to be at shul in the morning. I woke at 3:37pm Shabbos afternoon. My husband says I am exhausted and needed the sleep. I am not sure what I am doing that is so exhausting.

I dozed on and off until my regular bedtime and then took the Lunesta. I slept through the night again and am sure I dreamed something important, though I cannot remember what it was. I woke this morning feeling a little better. More awake but not more energized.

As today wore on, it was as if my nerve endings were getting increasingly frayed. Being around even just a couple of people felt like I was suffocating in a crowd. Every noise was loud and grating. Every voice too shrill. Every touch painful.

I want to shrink into myself, curl up and hide away somewhere. I can sense tears, though I wouldn't call it sadness. Maybe just lost. There are projects I want to do but no energy to do them. Everything is a strain, a chore. Everything wears me out. My body cannot decide if it is too hot or too cold; it only knows it is not comfortable. Clothing is too scratchy, too warm, too something.

I really thought I felt okay late last week but now my husband says he's seen me headed this way for the past week. I am scared, concerned that this is my bad time of year, this is the treacherous path through the calendar, but this recent feeling seems to have come on too quickly, too sudden and without warning.

Due to scheduling conflicts, I will not see my counselor for three weeks. I will not see the psychiatrist's assistant for another two months. This doesn't seem like something to take to my rabbi. I don't even know if this is something I should do something about or something to wait and see or something not to worry about.

Is it just exhaustion? Or side effects of either of my medications? Or have I already crossed the anxiety bridge, missed the red flags again, and started my stay on Depression Island? I can't tell anymore. I only know I want to be quiet and alone and to sleep.

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?

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.

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.

My new anti-anxiety kit

It is amazing that after years of therapy, I am still learning things about myself. What I've learned recently, now that I am recognizing the signs of anxiety and the OCD features, is that I am a very tactile person. Touch is a primary way that I can ease the anxiety.

I learned that when my counselor suggested aromatherapy, to find a scent that would relax me, and all the scents I tried didn't do anything for me other than make me sneeze. But she got me thinking about what I do when I'm sitting and anxious.

I pick at things: skin, hair, scabs, cuticles, fuzz. I pull hair out, which I discovered is a diagnosis all by itself and part of the OCD spectrum called trichotillomania or TTM for short.

I'm attracted by textures. In fact sometimes I wish I could wear a tallit katan just so I could finger the knots in the tzitzit (fringes). A friend suggested worry beads but my first reaction was that it would be mistaken for a rosary!

So I went on a scavenger hunt around home and started collecting things in an old small sewing box:

• satin binding from a childhood blanket
• set of four 1-inch ball bearings, to manipulate in my hand
• palm-sized smooth stone
• pair of strong magnets to play with
• hand-held bathing brush with bristles on one side and pumice stone on the other
• Koosh ball
• Rubik's Cube
• and to top it off, hand lotion in a Eucalyptus/Spearmint scent that I can massage my hands with

Then for Chanuka my husband gave me a home manicure set from Israel, with Dead Sea minerals (or so it says). I tried it on one nail and it's smooth and shiny like I polished it and lately I've been rubbing it instead of picking at hair.

My counselor thinks it is great that my answers to anxiety are things that are self-care. I fear becoming vain or superficial, yet at the same time these things are allowing some of my hair to grow back.

While I don't usually like labels because I think they often are unhelpful, having a diagnosis to help me understand why I do what I do--when I'm not thinking about what I'm doing--has been very helpful. Finally I can stop fearing the manic episode that has never come and work on finding ways to deal with and tame my anxiety before it turns into depression.

Gathering strength and information: why is contacting the rabbi so scary?

I saw my regular counselor today and I told her of my dream and what my PA said yesterday. I also told her what I posted yesterday and what readers had commented and specifically Rabbi WAC's suggestions. She really liked the team approach.

The team approach is basically this. The biggest responsibility is mine. I have to speak up about what is going on in my head, my heart, my soul. I have to tell appropriate people about when things are good, when I'm concerned, side effects, thought patterns that don't seem right. I have to ask for reality checks and be as accurate as possible in my descriptions of how I'm doing. To not downplay what's going on. I have to be diligent about taking my meds, exercising daily, getting enough sleep, pursuing stress reduction as needed.

The next one in line is my husband. He sees me every day and might notice something I'm missing. He might catch inconsistencies between my words and behavior, or sense that something is just off. He will ask me about it, and using his discretion, may or may not make sure someone else on the team knows about it, too.

My psychiatrist's assistant (PA)/counselor will handle the medication aspect. Do we need to adjust meds, add something, scale it back, try something different, all this is her area of expertise.

My regular counselor will handle most of my other issues: ongoing relationship with my mom, parenting my children, anxieties, negative self-talk, coping with depression, social anxiety, high self-expectations, and so on.

The last ring is the one I'm uncertain of. That's my rabbi. I would like very much for him to be part of the team. I want very much not to be afraid of that, too. I want him to be available to handle my religious and spiritual concerns, issues around and in shul. He sees me most every Shabbat. We have a history together, for over a dozen years. He has played a very important role in my life. I'd like that to continue. I'd like to have someone to take my religious and spiritual concerns to, because right now no one is there to offer Jewish answers.

Many years ago, a psychiatrist told me I needed to focus on both aspects of my life in order to get better: physical and emotional.

Not two, I told him. Not both aspects. There are five: physical, emotional, intellectual, social, spiritual. All five need attention. I was under his care when I began my formal conversion studies. Shortly after my conversion and just before he left the clinic, he began researching and then publishing articles in psychiatric journals on the importance of spirituality to psychiatric healing. It would be nice to think maybe I helped a bit with that, though I'm not sure.

At any rate, only four of the five are getting attention now. I need to follow my own advice and see to that fifth.

One concern my counselor raised was that my rabbi might not be the right person for this. She suggested that I ask him outright, after explaining what I need from him, is this something you can provide? If not, that's okay, just please refer me to someone--perhaps another rabbi--who can.

She is concerned that he might be stretched too thin, too distracted, focused on too many other areas. She was certain that my falling through the cracks is not intentional on his part (I am certain of this, too), but that there is the possibility I am looking for support in the wrong place.

I'm not ready to say that, yet. I haven't ever before asked him for regular, ongoing support. I want to give him that chance.

She said I should have a full year of regular support from him before I bring up past issues. My relationship with my rabbi is not broken but it is wounded. It needs time to heal, she said. I can do that.

She also said that she is concerned that the sometimes lack of follow-through issue is sort of like intermittent positive reinforcement. That is, sometimes I get the reward of a meeting with him. It is the type of reinforcement of slot machines and it is dangerous for me because it keeps me hanging onto a relationship that may or may not be healthy for me.

But she is optimistic that it might work. I did, at any rate, promise her I would contact my rabbi and ask to schedule a meeting with him. I would do my part to see this happen. Then it is up to him.

The power of prayer: is it time to come clean with the rabbi?

I wrote recently,

I had a dream the other night about having a meeting with my counselor and my rabbi and my husband and me. Sort of like a team approach to helping me cope when things are bad, and even when things are okay, or dare I say, good. But then I am back to what is appropriate to ask for.

I cannot stop thinking about this idea of a team approach. At the same time I know it cannot be done as I dreamt it, for logistical reasons. I began thinking about how I could achieve the same effect without us all in the same room.

Today I saw the psychiatrist's assistant for my monthly check-in. My meds continue to work at 30 mg/day. My anxiety is minimal and related to actual stressors. There is still no hint of mania, reinforcing their decision to scrap the bipolar diagnosis. My only problem is sleep disturbance. I continue to wake for 1-2 hours in the middle of the night. Lunesta is not working to keep me asleep and I risk morning panic attacks. She prescribed Ambien for me to see if it will help. I have been managing on about 5 hours of sleep a night for the past month.

I decided to ask her what she thought would be appropriate to ask the rabbi for. When he asks, what can we do, how should I answer? Especially knowing that October and the next major depression cycle is looming.

Ah, she said, pastoral care can be very important. She approved that I was asking now, before things got bad. She did say that the worse October/January depressions were almost certainly Seasonal Affective Disorder. She said exercise and being outside, getting even a little sunlight, would be extremely important for me. We might need to increase my meds during the winter, she said. I might have to wait until spring to try and get pregnant again, since she believes the increase in meds carries an increased risk of miscarriage.

She said what I should tell the rabbi is that I need his support. That I need him to understand what I'm going through, that the depression and anxiety may be lessened by medication but would likely never go away completely. That I may have to deal with this for the rest of my life. She said I should ask him for healing prayers, that I should not underestimate the power of prayer. I had to smile at that. She does not know about this blog.

I asked her if there were tangible, specific things I should ask him for and she said yes. Because shul is so important to me, because my depression and anxiety attack my Jewish identity, I should ask to meet with him regularly a few times a year, preferably before the anticipated depressive cycles. Just to check in. Just to see how things are going, how I am coping in shul, if there are things I feel I need while I am there.

Her answer helped but it scared me too. It scared me because it means I would have to be more honest with him. I'd have to be more open with him.

I might have to tell him about this blog.

I'd have to tell him that explaining my depression by using a 2000-year-old Talmudic theological world view makes more sense to me than any modern medical or psychiatric description.

I'd have to tell him that I have difficulty trusting him.

I'd have to tell him about the hurt that continues to accumulate.

I'd have to tell him about periodically feeling Unseen.

I'd have to tell him about how my illness affects my perceptions and social interactions with others at shul.

I'd have to tell him that I see quite plainly others' demands on his time, his energy, his attention. I'd have to tell him how my problems seem insignificant in comparison to others who need him, and how that leads me to not even ask in the first place. How I don't want to add to the demand.

I'd have to tell him that even telling him all this is risky because there is a precedent for lack of support within our shul, that even he does not always follow through.

I'd have to tell him that when we do meet and talk, it means the world to me, but it also raises my hopes and I can't always afford to do that.

I don't know if I can do it, tell him all that.

I'm afraid of hurting him. I'm afraid of criticizing him. I'm afraid of destroying whatever relationship we currently have.

I'm afraid of his reaction, that he'd be angry with me, whether it was for keeping all this from him all this time or for feeling it in the first place.

I'm afraid of being so vulnerable when I'm half-expecting that any meeting with him will result in my getting hurt, if the meeting even happens in the first place.

I don't know if I would be opening the door to more pain or opening the door to a more complete healing.

...for the sin which we have committed before Thee in speech; ...and for the sin which we have committed before Thee in presumption or in error...

Good news better news best news

I am so tired tonight but I wanted to write about the good things that have happened or are happening here. It is a wonderful feeling to know that good things are going on, even as there are pockets of sadness and grief around me.

My neighbor's 16-year-old Akita, one of the gentlest dogs I've ever met, died today. We are sad for their family and ours--we'll miss him too--yet for the first time, I don't feel my own happiness over recent good tidings diminished.

The first bit of very good news is that we did receive the financial aid we asked for. This is an incredible relief. We try to make ends meet on one salary and my husband is certainly not a highly paid doctor or lawyer or similar professional. But I am so pleased that we can still provide a Jewish education for our children. It is so important to me that they have this strong start, this confident identity as they begin their school careers.

The second bit of good news is that I am gaining some perspective on the rabbi issue. I have not seen him in weeks and this is okay with me. I think that perhaps I need to be very, very, very direct with him. I think perhaps I was expecting him to have a greater sensitivity or a more perceptive sense of people than perhaps he really has.

I think I need to decide if I'm going to continue to fall through the cracks or not, and if not, then I have to make myself visible and heard. If he offers to give me a referral list of Jewish counselors, then I need to ask him exactly when he might have that for me. I think I need to pin him down, metaphorically speaking. I think I need to think in terms of tasks and deadlines with him.

I also think I need to figure out exactly what I need from him, from shul, from my shul community. October is coming fast and I need to prepare for the inevitable downturn that will accompany it. There is the possibility that it won't be so bad this year, but in 22 years it has been hard, so I expect the worst and hope for the best.

Meanwhile my painting art therapy is going well and almost complete. I will have a whole new room within a week or two. I love to go out there now and just enjoy the colors and looking out the windows. I think when it is finished, it would be a nice place to daven.

So this is maybe my homework. My rabbi often invites people to come see him before he is too overwhelmed preparing for the High Holy Days, to talk about the past year or what they envision for the coming one. If I can figure out exactly what I need from him and from the shul, what do I need when I walk into the building on Shabbat or a holiday or whenever, then I can meet with him and tell him. I might even take relevant parts of What would I want my rabbi to know Part I and bring them with me.

I see my counselor this week. Maybe this is a good thing to work on. And yes, my high expectations. Those aren't going away any time soon I don't think, so they will be there to talk about. Ayelet is right that those often come from not being or feeling good enough. I know that feeling well. I grew up with it.

B'ezrat Hashem, I will have more good news on my other anxieties soon.

I don't even know where to start (good post)

I would never in a million years have guessed what has happened over the past two months.

Yes, I am still pregnant, baruch Hashem! Four and a half months and counting. Baby seems to be doing well and I should start feeling movements any time now. I have developed gestational diabetes for the third time in as many pregnancies, and while I have to inject insulin twice a day so far, and test my blood sugar four times a day, I'm doing okay with that. I don't enjoy the needle pricks, but I do like knowing that I'm taking care of myself and my baby by doing so.

That isn't the zinger though. The event that blew my mind is this:

Apparently, I am not bipolar and have been living with the wrong diagnosis for 13 years.

Here is the background. Remember when I was really depressed in January? I was referred to a psychiatrist and a psychiatric physician's assistant back then, but didn't get an appointment until April. I guess a lot of people need psychiatric help. I had an in-depth intake and several long appointments. They reviewed my psychiatric history over the past 17 years and had one question: how did I get the bipolar diagnosis?

I remember that part well. It was 1994. I was hospitalized for the second time in six months and my doctors convinced me to begin medication. To determine what meds I should be on, I had to answer a ton of questions about my moods.

Did my depression last for more than two weeks? Yes.
Did it interfere with my ability to live life? Yes.
Did I ever feel like I had a lot of energy? Yes.
What did I do with that energy? Clean, organize, shop.
Did I find it hard to sleep when I had this extra energy? Yes.
Did this extra energy alternate with the depression? Sort of. I never had the extra energy during my deepest depressions.
And so on.

There was no question about episodic depression, and one doctor suspected bipolar. So I was put on an anti-psychotic, a mood stabilizer. I was told that if this stabilized my moods, I was bipolar. If I didn't react to it, then I wasn't.

It stabilized my moods. Sort of. I wasn't sad but I wasn't happy either. I was just mildly depressed all the time. I lived life like a zombie. I did this for two years and finally couldn't stand feeling like I was just taking up space. I weaned off the meds and found that exercise, avoiding sugar, and a strong spiritual/religious life kept me pretty grounded most of the time. My depressive episodes slowed to two bad times per year--October and January--and two more mild episodes in April and July. My psychiatrist at the time told me to keep doing what I was doing, and eventually ended treatment.

Fast forward to April 2007. I was asked more detailed questions about these energy surges.

Did I ever feel invincible? No.
Did I ever take risks that put me or others in harm's way? No.
Was this excess energy goal-directed or generalized to everything? It was always goal-directed. That's why I couldn't sleep. I was so excited about my grand plans for whatever I was about to do (as in finding that perfect clock radio), that I couldn't wait until morning.

Then they asked other things:

Do I ever feel anxious in social situations? Yes. Always.
Do I ever worry about something that may or may not happen in the future? Constantly.
Do I ever have physical symptoms from my worrying? Yes--lack of sleep, headaches, stomachaches, sore muscles.
What do I do when I feel anxious? Clean, organize, shop.

Aha.

There is nothing here, the psychiatrist said while patting my very fat psychiatric file, to indicate mania. Episodic depression, yes. Anxiety, yes. And a high likelihood of Seasonal Affective Disorder. Even indications of Obsessive Compulsive Disorder--a type of anxiety disorder. But not mania. Every episode I had where I had to clean my kitchen until it sparkled, or shop for the perfect clock radio, or reorganize all the bookshelves? Anxiety attacks.

After a month of appointments, they are about to toss the bipolar diagnosis. My new diagnosis is Major Depression, General Anxiety Disorder with Obsessive Compulsive Features, and Seasonal Affective Disorder. And the reason for the recurring depressive episodes--roughly every three months? Most likely a hormonal imbalance.

As it turns out, the Prozac I'm on is what they'd first recommend for the depression and anxiety. And I don't have to worry about triggering a manic episode. Come September, we will develop a plan for when the baby is born, since I have a documented track record for severe postpartum depression. After that, probably after the baby weans, we'll look at other options, and both have said that I will be a full participant in deciding which option to try in what order. But medication may be some combination of an antidepressant and hormones.

This has completely changed my identity. Here I have worried, sometimes excessively, about triggering a manic episode, and the worry itself is part of what's wrong.

And yet it's a relief. It feels more right than the "atypical bipolar II" ever felt. I don't have to explain how my manic episodes aren't like everyone else's manic episodes. Now when I get the urge to clean (and it's not just prior to Pesach), I ask myself if I'm anxious about anything. So far, I always am. I try to deal with what I'm anxious about instead and that helps a lot.

The best part is, I feel like I can finally get the help I need for what's really going on with me, and that, I believe, will better my life not only for me but also my entire family.

At loose ends

I had a horrible night. I hurt so much from yesterday and the uncertainty of this next week.

Hospitalization was looking more attractive, more necessary, until I checked our health insurance coverage and saw that we would need first to give the insurance company a 5 day advance notice for inpatient care unless it were a life or death emergency. And second insurance only covers 80%.

In 1995 the average daily cost in the United States for inpatient care at a behavioral health unit ran about $500 a day. Figure an increase of at least 20% over ten years (maybe much, much more) and we're talking about out of pocket expenses of at least $120 a day. If they change my meds rather than just the dosage, it takes 2-3 weeks to reach a therapeutic level, and they'd want me stabilized before I left. That means taking on a debt of at least $2000.

I can't do that to our family. Plus there are other issues, child care chief among them. I know the argument is that my life is worth more than $2000 but I can't justify the stress my family would be under to pay the bills, either. I'm hoping there is some other option. Or maybe the increase in my meds since Thursday will help before it gets to that point.

To the hospital???

I didn't want to bore anyone with continuing tales of woe, but the fact is, despite the various things that have happened over the past two weeks or so, the depression that made its severity known here has not gone away. It's questionable whether or not it's gotten worse.

I just saw my counselor today and my husband went with me. Between the two of them, they think this is serious enough that they are of the opinion that I should be hospitalized. I managed to talk them into 48 hours until we make that decision, so I have until Sunday. I really don't want to go. It's been fifteen years since I was last hospitalized for this.

In the past hour I've managed to gather most of my emotions and seal them away. It may not be particularly healthy but it allows me to function for now. Otherwise I'd be terrified of going to the hospital and equally terrified of not getting any help.

I think I will maybe be meeting with my rabbi tomorrow, though I have no idea what I would say. I'm not even sure what I need.

Update (evening): I kept busy this afternoon by cleaning and reading and was able to keep the depression at bay but it keeps all my feelings at bay as a result. It's also tiring; six hours of this and I'm dizzy and stumbling around from exhaustion. I don't really know what that will get me except buy me some time. Please G-d, may tomorrow be better.

Depression as adversary

It seems clear from the last several posts that I need a tool to help me make sense of when my thinking is from the depression and when it's not. I've also written several things about my depression that follow a kind of theme:

• it breaks me down and consumes me and spits out what's left, and
• I have this black cloud over my head or in my head and I can't see (both from here)
• [it] takes that and twists it all around, that I don't deserve success, that my faults are too many, that I'm simply not good enough (from here)
• I'm ... under the influence of my unstable emotions (from here)
• It left me questioning my contribution to my marriage, my contribution to anyone, my value to the world (from here)
• It's that I just feel less. Less everything that is meaningful to me, and
• It diminishes everything important. It corrodes what makes my life meaningful and powerful and profound. It eats away at what makes me me (both from here)

And then over Shabbat I had a weird spark of an idea. Too often I see my depression as me, as the same thing as me. What if I thought of it as something else? My words above follow a theme of something taking over, blinding my reason and destroying what's important to me, who I am. What if I solidified that concept?

Not like a multiple personality thing. I don't need that on top of everything else. But it feels like an internal battle when I'm dealing with the depression, a fight to stay in the moment, a fight that sometimes requires sacrifices and casualties. What if it really is?

What if my depression is my own personal adversary?

R. Shimon b. Lakish stated: "A person’s evil inclination gathers strength against him every day and seeks to kill him" (Sukkah 52b).

The yetser hara, evil inclination, and adversary were often considered the same thing in Talmudic times. I don't hear a lot about it today, but the idea holds a certain amount of promise the way I think. I'm not saying that the depression, or more specifically the bipolar II (depression/hypomania) major depression/generalized anxiety disorder with OCD features/seasonal affective disorder (as of April 2007), isn't real, or that it doesn't need medical treatment. Medication and therapy are a given. It's more about perspective.

If I change my perspective, start thinking of the terrible, self-demeaning things I think about myself as coming from the depression/adversary then I have a way to fight it, resist it. I can picture the adversary/yetser hara/depression/black cloud trying to break me down, trying to get me to do harm to myself, trying to kill my spirit at least. I can see the real me differently. I can find answers in Torah, and Tehillim of course. I can ask G-d for help.

In my current flawed perspective it seems to give more legitimacy to my asking others for support.

Please don't misunderstand. I have never believed in a source of evil except perhaps for human choices, and I don't intend to start now. This isn't some demon from the dark side wrestling for possession of my soul. It is brain-based and comes from within me. But the perspective of seeing it as the manifestation of my yetser hara, my adversary, allows me to see the real me as something different, something better.

Something worth saving.

Inconsistent

I know I said here that I wanted a break, wanted to withdraw. That's true.

Then here I asked you to say hi and sit for a while. That's true too.

And the inconsistency is bothering me. I can't quite figure out why it's inconsistent or why it bothers me, but it seems to be and it does.

I had a hugely painful night last night. I touched a nerve somewhere about giving and taking and selfishness and the ability to accept help. It left me questioning my contribution to my marriage, my contribution to anyone, my value to the world. It was all very much in doubt, and I think it's because I finally put my finger on a topic so central to healing. I cried hard enough to rupture blood vessels around my eyes.

I'd been worried about someplace I had to be today but my youngest woke in the middle of the night with a fever and sore throat. It hurts to see him sick, yet at the same time I couldn't help but think that, with the timing, G-d "works in mysterious ways."

I won't have to leave home until tonight when I'm attending, G-d willing, a lecture on a Jewish topic dear to me. I can't elaborate, but I'm looking forward to going. And I think it will be quite well attended and I can hide in the crowds. It's easy to be alone in a large group of people.

Going through the motions

I'm still exhausted and numb from this past week.

Yesterday's counseling session went well. My counselor said in all the time I've been seeing her (a few years), she's never seen me cry in a session, until yesterday. I thought I had one other time, but still, if it's twice in a few years, that says something. I guess I have strong defenses.

Today I have no motivation, no energy, no anticipation for Shabbat. I yearn for the times when the rituals are meaningful and powerful. Today I'm afraid I'll just be going through the motions.

I'm a little anxious about going to shul tomorrow. I'm not sure if I really want to be seen right now or not. If I am, I'm not sure how I'll handle it. If I'm not, will it be a disappointment or a relief? I don't know.

A good Shabbos to all.

I see we're about out of time

I see my counselor tomorrow. I've printed out most of my posts, especially from It's here and more recent, for her to read.

I don't want to go. I want to stay at home and not go anywhere. But she needs to know what's going on.

The hardest part is I have to find a way to drive there competently, pay for my session, wait in a room of strangers (it's a clinic), make all the niceties on the way to her office, then drop my defenses, bare my soul, and pick it all back up within 50 minutes so I can drive competently home.

Right. And I wonder why it's so hard to feel in these sessions instead of just thinking.

P.S. I know there are some comments I haven't yet responded to. I will. I'm just trying to get through right now. Thanks for bearing with me.

P.P.S. Responses to comments are now up. A few have gone instead into a FAQ I posted here.