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. 

It's gotta be me

 I haven't written in a while, and I don't know who is still around on blogger. I just can't get into journaling unless it's on here for some reason, and I guess I need something. 

So what's been going on since I think I last wrote in September:

Hospitalized in October 2020 after a really half assed suicide attempt- ended up in a decent hospital at least because they hardly cared if I read all day and skipped groups (mainly to keep my anxiety manageable)

Of course it did very little for the depression that continued to get worse over the holidays and into the new year. At some point my parents got a dog that is somehow the source of a lot of my stress and that actually was right before the attempt in October I think (I struggle with putting events in order)

I did TMS for a couple months at the end of 2020, which did absolutely nothing

I applied for disability back in November, but I am still waiting on a decision

At some point my now ex-therapist decided she thinks I have ASD.. she may or may not be right. I was supposed to get an assessment somewhere, but the place never called me back and I stopped caring

I went back to the hospital voluntarily in February 2021 because I was planning another attempt but didn't even have the energy to go through with it, so I just told my therapist. The hospital didn't really help again

In April, I got a hotel room planning another attempt.. this time I got too drunk and don't really remember much until I had to check out of the hotel and was a drunken idiot and ended up asking them to call 911. So I was hospitalized at a decent hospital (program was very DBT based) but the psychiatrist honestly tried to get my meds right, but after 2 weeks she let me go even though she said she was really worried about letting me discharge that depressed still.. but at least I planned to do IOP. 

So now I am doing IOP, and I am seeing my current psych nurse practitioner every 2 weeks. I was happy in the last hospital to be down to only a few meds (Wellbutrin, Buspar, Lamictal, and Seroquel). Now she's added Rexulti (added 2 weeks ago) and Lithium (added today). So I'm back on 6 medications, and she talked about adding more if this doesn't work. 

I am just not doing well. The IOP therapist keeps asking what coping skills I am using, and I don't wanna say that I've relapsed with bulimia and now with self harm because I just can't handle this level of depression. She seems not too bothered by my depression being a 7 out of 10 everyday. I admittedly am lying about some things to avoid being hospitalized, but the last however many hospitalizations haven't helped.. so why should I go back? I'm supposed to be listening to these lessons on self compassion and assertiveness and whatever else when what I need is survival skills because I am very close to crisis. My parent's dog is absolutely insane.. from what we can tell he has anxiety about noises and whatever else and his response involves a lot of constant barking (I don't do well with loud noise) and running around frantically and biting things and people. Like he gets into this frantic mood in the morning when my dad is on calls (still working from home unfortunately) and has bitten holes in my coffee creamer carton and then a couple days later my macadamia milk.. he also likes to bite me (not hard enough to break the skin but not playfully) randomly if I move wrong or make the wrong noise (like I can't turn my laptop to show my mom something). So I am about ready to lose it and leave and probably do something bad because I can't handle this, and they're not handling it. My mom is trying but my dad won't call to try to make an appointment with the trainers or try to get him into some kind of doggy daycare that would give us a break and probably help the dog have some fun and relax or something. 

I feel like I must be faking my depression and anxiety at this point because how could things be this bad on this much medication and with this much therapy. Admittedly, I have been told in the past by well meaning therapists that the medication only works if you want it to or work for it.. or some other bullshit that basically blames the mentally ill person for their disease because obviously the medication would work if they were trying hard enough. The IOP therapist is so cheerful and keeps encouraging me to go for walks like that will fix it all. Other patients and the therapist keep saying I need to get out of the house and asking if I could go stay with someone else, and my answer is always the same. I have no place else to go. I don't have much money (basically only what's left of the last economic relief payment), I have no job, I have no friends, I have no family around here that I could go to. I have no car. I have no way to get out of this situation, and they keep telling me to be hopeful and think about what I want in the future. I know that anything I want is not going to happen any time soon. This isn't pessimism. It's realism. I have no idea when I will hear about disability, and even the psychiatrist that did my assessment for IOP basically said not to hope for it (my reply was to chuckle and say not to worry because I haven't had hope in anything for a long time). If I do get it, it probably won't be enough to move out. The IOP therapist asked about working (I can't remember the question exactly) and I said that I am not well enough to work and it would probably end badly if I got a job right now. She questioned what I meant by something bad happened.. but I didn't know how to point out that I lost my last job because I tried to kill myself and missed work. I have attempted suicide several times since then. What about that makes it sound like I should be working? 

So that's my pathetic attempt to update on the past several months. I will try to keep up with this again even if no one is reading. I have no other place to be honest. I admittedly have respect for my psychiatrist because she asked if I had suicidal thoughts today, and of course I said no. She later said that sometimes patients lie or don't talk about certain things because they're afraid that hospitalization will be recommended if they do.. so at least she seems to be paying attention. My IOP therapist believes me when I say that. I mean I clarified to my psychiatrist that I am not actively suicidal, but I am plagued by the thought that at any moment something could push me over the edge. It's like sitting on the edge of a cliff. You might not be planning to fall, but it only takes a small push or a strong wind and then you're falling. That's how this feels. It isn't sustainable.. but maybe the medication will help or maybe it's all my own fault anyway. 

But the only good in my life right now is these

Every picture of my daughter looks a bit goofy

I swear my son could be a model.. 

Soon to be another year

 I don't have much to day. This is mostly the obligatory entry to tell you I am still alive. After the last post, I did (I think) attempt suicide again. There was enough alcohol involved, I don't know with certainty that I took the pills. I did cause a great deal of worry because I left a suicide note for my parents and sent an email to my former residential therapist and my IOP therapist. I survived obviously. I ended up inpatient for a week and then in rehab again. I knew from the beginning that was pointless, but it's so difficult to find any sort of residential or long term treatment for mental health because insurance thinks that a few days in a psych ward should stabilize you for outpatient treatment.. yet they'll pay for several weeks treatment for substance abuse. Anyway, I spent a month at a facility I had been to before and the whole thing was a battle to get to see a psychiatrist and get the doctor to do anything with my meds. She didn't seem comfortable since I have tried so many meds before, but I am just pleading with her (over video chat) that I cannot function the way things are so she has to do something. My therapist was a jackass.. and his specialty is personality disorders. I admit that I think I have BPD, and he agreed. He just kept blaming everything I did on the BPD and blaming the depression on the BPD. He told me I make myself sad for attention. Less than a week before I discharged I had a really bad depression day and said some concerning, hopeless things to the techs.. they got worried and contacted the weekend therapist. She was sweet and talked to me and also talked a lot to me about what I want to do in the future and even did some career test with me. Anyway, my therapists response was to ask if something happened that day or did I just want some attention? Wtf? He also said I need to stop weaponizing my depression.. and that was when I was 2 weeks free from self harm, which is about the only behavior I think that could apply to. His comments basically left me afraid to tell anyone I was struggling because it would prove him right if I asked for any sort of help or attention. I would cry sitting in the very corner of my bed so no one could see me walking by. 

In the end, the depression was as bad as when I got there.. and I'm still a bit scared of what I might do. I have an assessment for an IOP monday that I hope will help.. I think there's a chance I will be sent back IP if I'm honest about the suicidal thoughts and hopelessness. On top of everything wrong with this rehab, they sent me home with totally wrong medication instructions and without some of my meds.. so I'm not able to take one of them until I can get in contact with someone there or see my outpatient psych. The other missing med I can sort of work out with what I have at home.. but seriously? What if I didn't know what I should be taking like a lot of people and actually followed the instructions? I mean I felt really rushed when she handed me the meds, so it's my fault for not reading it carefully.. but there's no excuse for the mistakes they made in the instructions. So things are not exactly going well right now, but I am alive and at home for now. I am happier to be here than suffering like that in rehab. My anxiety was so bad I only left my room for groups (sometimes) and meals that I ate in like 5 minutes. I was crying several times a day. It was a mess.. 

As far as the title of the entry.. my birthday is this month. I really don't feel good about that either. I have had 4 suicide attempts this year. I have been in 3 rehabs, 3 inpatient stays, 2 IOPs, 3 medical hospitals/ERs. This has not been a good year, and things aren't exactly looking up. 

Apathy

I am still stuck in this pattern of considering actions that will help make it easier if I decide to go through with the plan (to go get a bunch of pills and alcohol and a hotel room). I haven't booked the hotel. I mostly keep debating what day I would leave. Today I decided I should change a few passwords because I think my parents could log on to my computer if I didn't. I'm not sure if they have caught on to the fact that I used one password for a lot of accounts. I was trying to decide if they'd be able to get onto my bank website and see where I used my card and how to avoid that.

I am still wavering between apathy and depression. Also there's a bit of general frustration and irritation with my parents and their usually bickering. The rest of the time I am pretty numb. The things I currently look forward to are.. the hotel room.. alcohol.. some kind of food. I honestly have decided that I am unlikely to order food delivered because I never end up with much appetite. I'm leaning toward picking up some basic snacks at the pharmacy when I get pills or the liquor store (it's surprising the interesting snacks this particular store has). It will depend on how much energy and anxiety I have. I have officially finished notes/emails to 1.my current case manager 2. my case manager from residential 3. the therapist from the previous rehab and obviously 4. my family.

But I'm not that depressed? I also did an assignment for IOP. I did an online Refuge Recovery meeting. I read a recovery related book and highlighted some interesting things. I read the nice notes people wrote for me before leaving rehab. I took all my medications today. I don't know what the fuck is going on with me. I think I long to self destruct because I want to feel something. There is no desperation or deep emotional pain. I'm just tired, and I just don't care anymore. I don't know what will make me care or give me any hope or goals for a future. I don't think there is going to be a very long future, so why try? I am just surviving, but I am surviving.

Mismatched

**Trigger Warning**

I am bothered tonight and choosing to write about the amazing differences between my thoughts and my actions or my thoughts and my words.. or for that matter my actions and my words. Pretty much, the inconsistencies are growing by the day, and I am unsure how concerned I should be (I'm guessing greatly disturbed).

I saw my new therapist from IOP for an individual session today. The things she said and the way she was sitting there made me feel like I was being studied. I'm not sure how to explain this. Most of the time therapists just look like their listening to you like a relatively normal human being. There is a different way people look at you when you're acting unusual or unique in some way. She mainly seemed fascinated by how calmly and unemotionally I was able to discuss my suicidal thoughts and the last 3 suicide attempts. I guess most people would get emotional? For me it's all matter of fact.. it happened, it didn't work, and it seems pretty likely to happen again eventually. She actually asked some very intelligent questions and make some very reasonable observations. She understood when I talked about calling 911 that I didn't suddenly come to the realization that I wanted to live. It was more like I realized it wasn't happening quickly or like I wanted (or I didn't think it was going to work) or the 2nd time that I didn't feel like wandering the streets of Dallas at night with no phone and no money hoping to die. It was more like that attempt wasn't going right, and I needed to stop and try again. We talked about why my method has always been the same because I hope I will just fall asleep and if the powers that be (God or other humans) intervene I will wake up and if that's not meant to happen I won't.

I was not entirely honest about what's going on though.. I mean she asked me to rate on a scale of 1 to 10 the likelihood of me acting on the thoughts today. I said 3 because today it was very unlikely to happen. I neglected to explain the amount of thought I have been putting into the plan and some things I have done that might be concerning. Mainly I have two files on my computer.. 1 is a suicide note of sorts and 1 is a list of hotels/addresses/pharmacy etc that might be needed if I decide to do it. I didn't mention that during IOP I have trouble focusing, so I sit and look up the hotels and the prices and what sort of restaurants deliver food there. She seemed to find it interesting that I plan out the food because I think she thought I was planning to binge, but it's just like how prisoners on death row get to choose their last meal. That also includes planning my last drinks.

Tonight we can add to the list of concerning behaviors printing some reading material on DNR orders because on 2 of the last attempts at least I was intubated, and I'm wondering if I can prevent that.. although the form I printed has a place for a doctor to sign that I was competent when I signed the form but have shown evidence of being incompetent later.. and I don't know if a suicide attempt would automatically indicate you are not mentally competent to make such decisions. I haven't done anything with the form. I just want to look into it.

So yeah.. I am not all that depressed tonight. I am kind of numb and sometimes almost a bit happy. I've had casual conversations about random things with my parents. Everyone at IOP said I seemed more upbeat than last time. I had to carefully choose words to explain that I was less depressed but in all honesty, I am not well. I didn't want to explain the searches and obsessive things I was researching while listening to everyone else check in. I didn't want to say earlier that I was entirely unlikely to act on anything tonight, but it isn't a good sign when I tackle some obstacle standing between me and the actual act. There was another thing I did but it isn't a definite indication of intention to act because I reason that it can be undone if I change my mind later. I wrote all this and thought of another thing I did that I haven't told her... actually it has to do with a semi-lie I told the other day when she was asking questions after group trying to gauge how suicidal I was.

The more and more I try to explain this, the more removed I feel from my feelings. Does that make sense? I suppose tomorrow I may email my therapist if I am still concerned. I think I should sleep on it and see how I feel tomorrow.

Small talk

I started IOP last night. It's through the same center I did residential at, although it's online right now because of covid. I am struggling with it. We did a check in last night and I said I was depressed. I otherwise basically summarized my current situation (that I just got out of residential over the weekend) but didn't go into the whole mess that led up to me being in rehab this time. That's a bit heavy to bring up so soon, and I need to know people a bit better before I talk about anything involving suicidal thoughts. I guess it was an ok group.. I couldn't focus. My head was off in the worst kind of obsession. I was looking up hotels for if I run away again.. I looked at prices and pictures to see if the rooms would have a fridge and a microwave. I made sure they'd have wi-fi. Then I looked up what sorts of restaurants deliver food there. I already had figured out some hotels within walking distance of a liquor store.. and close enough to a pharmacy and other stores for other necessary supplies. I was looking at all this with IOP open in the background. I was listening, but I was in my head.

Well, today I tried to listen to IOP.. but it was not helpful. Somehow during check ins they got off on discussing one of the women needing to get her hair done and her telling a story of a time she spent a ridiculous amount of money getting her hair done. This went on for probably 15 minutes. Meanwhile, I am sitting there fighting back tears. I am sitting there with the depression closing in and the ever present suicidal thoughts, and they're just chatting. I had to leave and get a tissue. At the end of the group, the therapist was asking about what people like about the group and what they'd find helpful. Several people talked about how they like the small talk because they get to know each other better. Someone talked about wanting people to be more open. It got around to me.. and I basically said I didn't know what to say. I said that I have realized in the past couple days how unready I was to leave residential. I said so much hadn't gotten better, so I am very pessimistic about treatment. At this point, I was crying.. and everyone was supportive. They said they hadn't realized I was struggling. I don't know.. I said something about just not wanting to end up back in the hospital.

So of course, the therapist was concerned. I had to convince her I wasn't actively suicidal (which is a lie) and was safe tonight (which is true). I tried to explain that I just don't know what to do.. and how my next psych appointment is late in August. She asked if I was out of my meds, I said no.. they just aren't helping. So I think this will all get brought up in treatment team, and I am honestly just hoping I don't get sent to a psych ward. Residential was helpful, but the psych ward wasn't. I just don't know how to sit there in IOP like it helps to chat cheerfully with everyone when I am sinking. I can't explain that I can put on a brave face and act fine but then continue with actions that clearly indicate something is wrong (writing notes, doing research, etc). But I'm ok tonight. I just don't know what will happen if this doesn't get better. Tonight I just want to go to sleep. I see the therapist individually on Thursday, so at least I'll have a chance to talk more then. I just don't like putting anything so heavy on the other patients, so I hope that I can be honest with the therapist at least.

3 months

I am considering using my blog again now after all that's happened the past several months. I will start with a summary of this year.

February- 1st suicide attempt of the year. This is the one that I took pills while black out drunk and woke up in the hospital. I was in the medical hospital for a week followed by 5 days inpatient and a few weeks IOP. (days in hospital 12)

April- toward the end of March I got kicked out of IOP for relapsing with alcohol. They recommended I go to rehab before I could come back, so off to rehab I went. (days in 28)

May- I spent 28 days in rehab, and I was continuously telling them my depression was getting worse and so were the suicidal thoughts. I had a plan in my head, and I only couldn't do it because if I left they said they'd call the cops (because I was suicidal). Well, they started talking about transferring me to a psych facility, but my therapist was terrible about communicating what was going on. I got angry with him for leaving 2 days in a row after I agreed to transfer somewhere without telling me what was going on with the transfer. I asked to leave AMA, and various people at the facility panicked even though I never even got so far as to sign the AMA form. I once again agreed to be transferred, but they went ahead and called the cops anyway instead of doing what we had agreed on. I end up having a cop show up for a welfare check and then went to a psych hospital for an evaluation. I lied about how I was doing, and I had hoped I could go back to rehab. Well, that didn't happen. They called my parents to come get me and said the facility wasn't appropriate for me.

So I was home for 1 night and then was supposed to go to a psych hospital. I convinced my parents to drop me off and went in for my evaluation. I changed my mind during the seemingly endless waiting and dealing with some very rude people at this hospital. I told them I didn't want to go in, and I was safe to leave. I left and got a hotel room. I drank for a night or two.. it's a bit blurry. I changed hotels because I somehow lost track of what day it was and when I was supposed to check out. I got to the 2nd hotel and took a lot of pills.. both prescription and Tylenol PM. I sat around waiting for them to do something, and I panicked. I called 911.. I remember the ambulance coming (and the paramedics were really cute). I kept trying to explain what I took and answer questions and them saying I wasn't making sense. I was taken to the ER, and I don't really remember much of the couple days I was in the hospital. I guess I was intubated at some point, and my liver was in really bad shape. Somehow when I was conscious again I convinced them to let me leave AMA. I went to Walmart planning to buy more pills. I managed to leave my phone in the Lyft and didn't know where my debit card was. I end up shoplifting a bottle of tylenol PM and wandering around the area taking them and trying to decide what to do. I was somewhere in Dallas with no real clue how to get anywhere and no phone. I finally borrow a phone from someone in the parking lot of a gas station (after actually asking a cop for help and being told he was too busy to even call for an ambulance) and get taken by ambulance to the same hospital I left earlier that day. I repeat the process of drinking charcoal and being given all sorts of meds.. and that's all a blur. I agree to go to a psych hospital once my liver is back to being ok. (days in hospital 5)

May/June- I spend 18 days in a psych hospital where they try to sort out my meds. I am crying daily and suicidal. I get talked into going to a residential facility because clearly I need more help. They only agree to let me leave if I go straight there. I actually planned to agree to be picked up by the facility staff and then say I changed my mind and go kill myself, but I somehow got talked into actually going to the next rehab. (days in hospital 18)

June/July- I went to a residential facility that does dual diagnosis (alcohol and mental health) and actually also eating disorders. I had been sober 3 weeks when I got there, but my depression was still out of control. I spent the first 3 days crying pretty much constantly. I eventually started going to groups and doing assignments, and I really tried despite the depression being bad. My therapist kept trying to argue there's something in my childhood I need to deal with that's causing the depression, and I kept arguing that there might be but the pressing issue is that I was suicidal and self harming daily (and purging but didn't mention that). So I managed to spend over 45 days there and the depression is still bad, but insurance says no more residential. I have mixed feelings about leaving. I don't think I'm ready, but I also feel like it wasn't getting better anyway so I was wasting time. At least here at home, I have my cats and my parents. I have been home just that one day since I first went to rehab in April. Total days in hospital/inpatient/residential 63 so far this year.. and I start IOP again on Monday. I am pretty burnt out