Why does feeling like dying make me think that I've been living?

I couldn't think what to call this post, so I'm going to steal a line from a Town Pants song. Honestly, I'm staring at the computer not sure what to even say. I think everyone around me has a different idea of how I am doing. They are all pretty much convinced that I am doing better than I am because I am choosing not to mention certain behaviors. I think maybe in some ways I am better than I was. My mood is not 100% depressed now. However, I am wondering if maybe my mood is better because my behavior is worse. 

The main behaviors that I am choosing not to tell my therapists (IOP or individual) are the purging and the cutting/burning. My psychiatrist knows some about the self harm but not the bulimia. In my mind, neither is that bad. I am usually only purging once a day and the self harm isn't everyday and isn't that severe compared to what I've done in the past. I'm afraid to mention the bulimia because I don't want my new therapist to insist I need to see someone who specializes in eating disorders.. some people get weird about that. I haven't mentioned the self harm because she already seems concerned about the suicidal thoughts. I am trying to convince her that those aren't new or that severe. She seemed particularly worried when I mentioned the trip in 3 months and how it was overwhelming to think of being alive that long. I couldn't come up with an explanation for that which made sense. 

The behavior that I certainly have not told anyone about is a new form of self harm (well not new.. just not one I have done recently). I might have gotten incredibly triggered last week by something in the book on borderline personality disorder that I was reading. Towards the end of the book there is basically a rating system for suicide attempts.. it ranks them from least severe to most severe with details like type and number or pills and location of cuts. Several other methods are included. I knew I shouldn't read it, but I did. It didn't increase my suicidal thoughts. It did sort of justify the self harm because on the rating scale it would be probably a zero. I started with taking 8 tylenol PM at bedtime.. which felt really bizarre. I spent a couple hours debating if I really needed to go to the restroom and debating if I would be able to walk because I was dizzy when I stood up. The second night I took 4 tylenol and 8 tylenol PM. The goal of this (which I can't really explain) is to see if I can damage my liver between now and when I have my annual physical next week. I wanted something that would show up on the blood tests because that would be proof that I actually did damage. I really don't know why this is so appealing. I am afraid if I tell anyone that they will decide I need to go inpatient. Maybe I need to go inpatient, but for the past year it's been very difficult to justify going without some attempt or a drinking binge or just something to prove I need to be there. The problem is that I think this will escalate. 

So everyone thinks I am doing okay. I do not think I am doing okay. I just have no idea how to communicate this because I don't really want to go inpatient, but I kind of want to be sick enough that I have to. I don't like others telling me I seem better when they have no idea what's going on in my head or in my life. 

I don't know what the point of this was, but I wanted to get it out. 

September

 I am probably writing way more often that I should be, but it helps me. I don't even know who is reading this anymore. 

Today's topic is what should have been a neat conversation with my parents about a trip they're planning, but in reality it has some pretty overwhelming implications. I actually already kind of knew about it because I'm observant. I knew my dad was buying tickets for a Cubs game, and then I noticed that the game was at Wrigley. We live in Texas, so obviously this meant some kind of trip would be planned. I did not see when the tickets were for, and I had no idea if the plan was to take me too. 

I am not a baseball fan. I find it at best boring and these days it would probably be very anxiety provoking since I don't handle crowds or noise well. I just didn't know until today if the plan was for me to go to Chicago with them and just not go to the game. They brought it up at lunch, and I kind of wanted to interrupt them and say I knew about the tickets because my dad was taking forever to get to the point, but I decided to be polite and listen. We ended up talking about if there was anything else to do in Chicago that I would enjoy since the game is only interesting to them and my brother. That was all fine, and we discussed the art institute and if there were any plays. I mentioned finding nice places to eat, but it seems pretty obvious that the omnivores are probably picking the restaurants because I sent them 2 cool vegan restaurants that they have no interest in. I also sent my mom a link for an italian beef restaurant (one of the foods they want to eat) that has a vegan beef sandwich. She said she would see if it was where we were going. (This is a tangent but I'm annoyed) I feel like I should get some say in where we eat because I already get stuck eating a lot of veggie burgers because we go to restaurants with no other options for vegetarians. They could at least pick one restaurant for me. That's not the point of this.. 

I think it should be apparent by now that I am not doing so well with the depression (and now the borderline). I still have a lot of suicidal thoughts. I'm just simultaneously thinking of what I want to do and questioning what other people will think my motives are. The book on borderline I am reading talks about how borderline patients are viewed as manipulative, but that that isn't the motive of the self harm or suicidal behavior. In my case, I am really quite miserable a lot of the time. My life is nothing I want it to be, and I have no real control over any of it. I feel trapped living with my parents. I have no car. I have very little money. I truly believe I am not well enough to get a job. Any amount of job stress would probably push me right over the edge. Still, waiting to find out about disability is taking forever, and I've had people question if I should even be waiting for it. Like the psychiatrist who did my assessment for IOP basically told me I shouldn't hope to get disability and shouldn't be waiting and how no one ever gets it and I should look for a job. I wanted to punch the man because it was a really tactless way to approach something that is none of his fucking business. So anyway, it's not about being manipulative, but I know it gets seen that way. 

Well, now I have this plan for a trip in September, and going would require me to be 1) alive and 2) not in the hospital. That's a really big commitment. Now I'm going back and forth in my head about how it would be better to have a suicide attempt now because I'd for sure be out of the hospital by September. It's not a really good place for my thoughts to be. I know that I could either approach this as motivation to get better or as a reason to just say fuck it because being alive 3 more months is overwhelming. I want to cry writing this. 

Things at home aren't good, but I think people (mainly my IOP therapist) think what's going on is no big deal. I complain a lot about my parent's dog, but pretty much everyday I deal with the dog deciding I am not allowed to fucking move. He doesn't bite hard, but he tries to jump on me and bite me if I'm typing (he's asleep at the moment, thank god), if I am just sitting reading, if I try to reach for my glass of water.. my very existence seems to be a problem, and I can't live like this. Then there's my parents arguing and my mom snapping at me for no apparent reason except I guess I said the wrong thing. She snapped at me twice yesterday because I was asking if she needed help making dinner (but she'll also be upset if no one helps her), and I've cried at least the past 2 days over how she snaps at me. This is the house I am stuck in for the foreseeable future. I mean other times my parents are loving, which is why no one seems to understand how bad it can be. Today after lunch, I went shopping with them, and my mom bought me 2 tops. If I bring up the financial problems or not having transportation in IOP, the therapist has questioned why I feel it would be a bad idea to work. I mean if nothing else it would look bad on my resume to lose another job because I tried to kill myself. That's how I lost my last job. So there's no way to really talk about everything and not then have to explain why it's not possible to get out of this situation any time soon. 

Three months is a long time. Oh and i start with a new therapist tomorrow. My mind has been going back and forth between wondering if maybe this person will be better and assuming it will be the same bullshit I have dealt with before. Will she immediately suggest IP? Will she also question why I can't work? Will she immediately want to do a family session as though that will help? 

I don't know. I legitimately have to stop typing because the dog is now awake and staring at me. Not even kidding. 

Making matters worse **TW**

 Just FYI this is probably going to be triggering, but for my own sake I need to get some things out

So I made the brilliant decision after getting my new diagnosis to buy Marsha Linehan's (creator of DBT) Cognitive-Behavioral Treatment of Borderline Personality Disorder. It is very enlightening, but it may be making matters worse at the same time. The book is intended for professionals and not so much for patients. It has a much more detailed and complex description of borderline personality disorder, and she also talks a lot about the tendency with borderline or suicidal patients to blame the victim or view them as manipulative. What she says about that has reminded me of therapists and doctors that I have had in the past. I assumed they were right in that either I wasn't working hard enough at therapy or simply that therapy would never work for me. I like this part

" Even if therapists believe that a particular treatment will be effective in the long run, because it has worked with other patients, helplessness in the face of the borderlines' intense suffering —suffering that causes the therapists reciprocal pain—is the repeated, day-to-day experience of working with these individuals. In the face of this helplessness the therapists may redouble their efforts. When the patients still do not improve, the therapists may begin to say that they are causing their own distress. The patients don't want to improve or change. They are resisting therapy (After all, it works with almost everyone else.) They are playing games. They are too needy."

I wish I could see all this as hopeful.. that maybe I just need to find the right therapist who can handle borderline. Really, it's making me feel hopeless because the likelihood of that is rather limited. I might get into a DBT program, which is terrifying in its own way, or I might not for whatever reason. I am dependent on insurance, transportation, and the fact that if I am honest about how I am doing there is always the risk of just being told I need to be inpatient. There's the risk that if I admit to purging daily, they will insist I need eating disorder treatment first.. and getting insurance to cover that is another nightmare.. and I honestly don't care about stopping right now. If I don't get a good therapist, I am just reminded of all the times therapy has failed in the past. 

But what's really bothering me now is this part in the book where she talks about how the primary goal in DBT is to decrease suicidal behaviors. It gets really triggering there.. 

"The desire to be dead among borderline individuals is often reasonable, in that it is based on lives that are currently unbearable. A basic tenet of DBT is that the problem is rarely one of distorting positive situations into negative situations. Instead, the problem is usually that a patient simply has too many life crises, environmental stressors, problematic interpersonal relationships, difficult employment situations, and/or physical problems to enjoy life or find meaning in it. In addition, the patient's habitual dysfunctional behavior patterns both create their own stress and interfere with any chance of improving the quality of life. In sum, borderline individuals usually have good reasons for wanting to be dead. "

and then

"Whatever the reason, I have at times been convinced by patients that they are right. Not only did I believe that their lives were unlivable, but I myself saw no way out for them. I felt hopeless myself [...]I believe that individuals at times make informed and rational decisions to commit suicide."

I am obviously taking a few parts out of a larger discussion (basically that the therapist must take a non-negotiable position against suicide), but you can see how it might be upsetting. So I really probably should stop reading this book, but it's kind of addictive because it's all so accurate. I have to take occasional breaks to not get totally sucked in since my mind was not in a great place to start with.

So I don't know why I am writing this.. but I just needed to get it out

Borderline

 So when I made the last post, I was still kind of annoyed. You have to understand that the first time borderline personality disorder was brought up by a psychiatrist was around 14 years ago. My first time inpatient my psychiatrist printed out a bunch of stuff on borderline and gave it to me, but then we kind of never discussed it again. At the time, I honestly didn't see it, but now I think certain BPD traits were more obvious then than now. My moods were all over the place and I was discovering a bunch of anger that I had avoided for years, and it was coming out sideways at the therapists and psychiatrist of the eating disorder program I was in. Then I finished the program, and borderline wasn't discussed again for years. 

I can't remember when it came up next. I may have been reading about it on my own by then or maybe my therapist and I had been discussing it.. but that was probably the same therapist who was convinced that OCD is the root of all my problems. I did try to find a DBT group at the time, and the therapist for one I looked at told me I didn't have enough life experience to fit in with the group. I'm assuming the statement was based 100% on my age because he hadn't talked to me long enough to know my life. The next time I really remember borderline coming up was when I was inpatient for either drinking or depression. The psychiatrist basically said to me "you have a personality disorder, so medication isn't going to work." I know there is some validity to that statement, but it really seems like he just wanted an excuse not to deal with me anymore. Also, he didn't diagnose me with BPD. No one had diagnosed me with it. 

Fast forward to 2020 and the million times in treatment. While I was in residential over the summer, I actually brought it up with the therapist because I had found a really good book on borderline that I was reading. She didn't want me reading it because I guess she wanted me focused on her theory that my problems are all due to some repressed trauma. I continued to read the book because by this point, I fit the criteria better than I had back in 2007 because I'd had several suicide attempts and drinking in addition to the self harm and bulimia. Then I went to another rehab later and had the horrible therapist who supposedly specializes in personality disorders. Maybe he does and it's just overshadowed by him being a horrible, little, hateful man.. anyways.. He talked about separating myself from the borderline, which is something I had been working on. He also accused me of doing everything for attention.. not just the self harm but any time staff found me crying and got concerned he said it was for attention. This led to me being afraid to talk to anyone when I was upset because of what he would say about it. If I asked for help, it was for attention, but if I bottled it up and self harmed then that was also for attention. There was no way to win. As far as offering any solutions, he would just say he didn't have enough time to work on it with me... how if he had longer then he could have helped me. He did make the point that I probably wasn't diagnosed because insurance doesn't want to pay for treatment for borderline. 

So I think my current psychiatrist thought that she was suggesting something new. I think it was supposed to be a revelation that made my life make sense. It was not something new, and it was not something I'd had really good experiences with before. It had been thrown around by psychiatrists who didn't know what to do with me. I had been told not to think about it. I had been told that insurance doesn't cover it and had it used to say that I made myself sad for attention. I had twice tried to get into DBT groups and once been told I didn't have the life experience, and the second time admittedly it was my drinking that made them turn me down for the group (different group/therapist and I don't blame them for that decision). What upset me when my psychiatrist brought it up was not that she said I had borderline, it was the way she made it sound like knowing that I had it would make everything make sense. She made it sound like it would make everything easy. I just have to separate the borderline pain from the depression and figure out which is which.. like that's an easy thing to do. Yes, sometime I can tell when it's the borderline. There's a sort of mental pain that is almost impossible to stand that is clearly different from the depression. There's also the impulse to do something self destructive when anything goes wrong or any feeling is too much that I know is the borderline. Knowing that can be helpful, but it clearly hasn't fixed things. 

She also brought up DBT, and I don't know if she realizes that DBT therapists are not easy to find. There's not a lot of them, and I have no idea how many take my insurance.. Also I don't have a car, so I have to rely on my parents to get me to therapy.. and that's a whole big guilt issue. So this isn't going to be I suddenly know my problem and just have to find one of the magic therapists to fix it. I have to find a therapist that is close enough, that takes my insurance, that is accepting new patients, and will work with me and not just hear how I'm doing and insist I need to go inpatient (which puts the whole process on hold). I have to keep myself alive long enough to do the work, and that's not an easy task. The suicidal thoughts have been increasing. It's probably bad that I'm purging at least once a day now. I have been self harming. Honestly if I tell my psychiatrist about the bulimia and the self harm, I am betting even she would start suggesting inpatient even though she's said we're trying to avoid it. 

Oh and she said she was interested in the borderline criteria regarding intense/unstable personal relationships and how that applied. Now I'm trying to figure out why.. because I think my mind is assuming she is asking because of something I said about a particular relationship. My response was that it used to be an issue, but that now it isn't so much and issue since I have no friends. She said that that will get better, and I will have friends. I'm now wondering if she thinks I have that sort of unhealthy relationship with someone currently in my life. While I have a history of idealizing therapists and doctors (mainly determining my whole self worth based on what they say and their opinion of me), I'm not doing that right now? My relationship with her is.. I tolerate her because she's making an effort to treat me which is more than my last nurse practitioner, but I also resent her cheerfulness and the increasing number of meds I'm on. Nothing about that is intense because I really just don't care. My IOP therapist.. I care very little about anything she says and am not even remotely honest about my life. And my parents.. well that's probably not healthy, but I don't idealize them or devalue them.. they are just my parents who I have to live with right now. So I am paranoid about why relationships was the diagnostic criteria she seemed concerned with. Although she also brought up the recurrent suicidal threats/gestures as being part of why she thinks I have it, and I agree about that.

Wow, that was a much longer post than I expected.. and not very organized. I just needed to get some of that rant out because it's been in my head since wednesday. 

Diagnosis

 Not a lot to say on this at the moment. My doctor tried to make BPD sound really hopeful because now I just have to figure out what's depression and what's BPD and isn't it so great to know more about myself? And I don't even know what the fuck else she said because I know enough about borderline to know it isn't an easy thing to treat. I've read enough about it to know it fits, but no one has wanted to put it on paper.. 

So anyway, I'll just put this here and say something about it later when I'm less pissed off (not so much about this but about the ever increasing number of medications she prescribes)

Do I actually care?

 I've managed not to be hospitalized yet. This is probably because I am lying or minimizing or generally omitting the truth when I am talking in group. I'm a little more honest with my psychiatrist, but even then I am choosing not to bring up the relapse with bulimia or with self harm. In IOP, I am just acting like I'm fine (still reporting my depression as 7/10, so how fine can I be?) and saying I have no suicidal thoughts. In truth, I am not having that many because I have reached the point where I don't even have the energy to plan anything. That means soon I will probably reach the point where I have no energy to purge or self harm, so maybe that's no big deal. 

I am ambivalent and hopeless and yet part of me is trying to think of solutions. Mainly, I spent most of my time in IOP today listening (it's on Zoom) but with Chrome open and looking for treatment facilities. I am searching for something that doesn't exist. Several times professionals have recommended I look for a residential/ longer term inpatient facility that specializes in mental health rather than just substance abuse. A few of such places exist, but they are never covered by my insurance.. some don't take insurance at all. Insurance treats depression as a quick fix. They will cover inpatient for a week or at most 2, which is like a bandaid on a bullet wound. They will cover outpatient treatment, but the only time they cover a 30 day program or more is for substance abuse. I've been to several rehabs that claim to treat dual diagnosis, but they were useless at handling depression. I pretty much continually got worse with the depression, and they either blamed me for not going to all the groups (sorry I was sobbing in bed) or just acted like it was fine. So there's probably no options, and I probably wouldn't want to go anyway. I guess this is me preparing for when I inevitably end up inpatient again and the subject gets brought up of what to do with me after discharge. I think sooner or later it's going to happen. I know this level of depression isn't sustainable.