Here I am

I'm back. Still have tough stuff on my plate, but I have at least gathered the information I need so that I feel like my thinking is ok and I can go forward with handling it.

My problem is that I reached a weird point with my therapist. I discussed that a bit a few weeks ago. Last week we talked about it a lot more, and he brought up things indicating that he thinks I may not be progressing much, that he questions the benefit, etc. I talked to him about how it seems he always thinks I'm being negative when that's not how I'm necessarily really thinking, or how I am even when that's how I'm acting.

Then we had a discussion that was difficult for me because I was telling him I thought he wasn't understanding some of what I was going through. That went immediately into well of course he couldn't but he did respect my situation, etc. However, that's not what I meant.

I've lived with bipolar quite some time and so I am well past grieving its presence in my life. I have known from day one that my situation was complex and that I would not have good stability; adequate was the goal. In time I learned that adequate stability meant a lot of stretching on my part, but it was liveable and I was finding good things in life again. Until I got so very, very sick in January 2006. I consider that the bad period really began more like late October of 2005, but it was more typical of my cycling then; bad and annoying but causing the constant threat of disability.

Over the last 11 months since I returned to work I have had to face so many new realities. It was almost like being diagnosed again as I struggled to learn to live with the new limitations. Oh, let's be honest, to even admit I had limitations was a struggle that was about 6 months of therapy. And now I'm having to admit that I will need to leave this job path that I love so much soon.

I never did exactly well, even for a bipolar patient and I was always considered quite unstable. My first few years were the ones with most of my horrible med reactions, so that did not help. But those first years I did have two or three month sequences where I would be ok or better. I went for periods of time without med adjustments. I was ok between monthly visits with the psychiatrist most of the time.

Everything changed when the bad episode started. Since then I have had only 2 (today being one of them) psychiatrist visits when meds weren't changed. Even though we usually follow a one at a time process thanks to my reactions there have been a number of times I've needed multiple changes at once. Besides that there has been frequent email contact with my psychiatrist. I've had 2 problems severe enough to require my family doctor call the psychiatrist. I'm very, very unstable all the time. I no longer get to ignore my disability, ever. And the impact on my life went from being pretty bad to being horrible.

On top of that I realized I've burned through so many medication options. I've retried anything that I thought I had been wimpy about taking, but most of the reactions I've stopped for were dangerous. I have known for quite a while that I was probably going to face a point when the meds weren't there like I would need. I never thought it would be so soon.

One of my personality traits is a desire to be prepared for things. I do much better with emotionally difficult situations if everything is explained in advance. I need to cope with the fear and anger and whatever before I'm also coping with emotions. This makes sense when you consider my already out of control emotions; it reduces the response later.

So in the last months I have been through a process of grieving and being angry about my illness progressing. I've had to accept that my days of pretending for one minute that this isn't going on seem to be pretty well over. Further I've had to accept that the losses are going to continue. And I've had to accept that it is very likely I'm going to face some ugly treatment decisions soon, decisions I never wanted to make. Decisions that make starting lithium look easy, and I thought that was pretty monumental.

My therapist came into my life when I was already very ill last year. He's never seen me at the level of functioning I still want to think of as "typical" for me, even though I'm beginning to know I need to live in the now and define typical as the way I'm living. I don't think he understands how hard the adjustment in thinking has been, partly because he has no way of seeing how much I have changed. I don't particularly like myself now either, but I just woke up from a long time of being too ill to care. I'm working on it, but I don't know who I am in the strange new land. I don't know if anyone but me could see a difference, but I think it is there from my early posts to the ones 4 months later and beyond. My therapist sees only the person he has known during this time I have not been well and to him that is the real me, when to me the real me is now unknown. I'm trying hard to quit thinking of myself as the way I was, but it's hard to not remember.

I think I left my therapist out of my coping with these things. I talked about it, but I don't think I did well problem solving through it, nor letting him help. I am sure I didn't say a lot to him about relevant parts. Maybe it feels too private, and surely there are certain things I get to find to be too private, or maybe I was embarrassed, or maybe it was something else, but I think he's listened to months of my talking about the parts I was upset about but not moving on, while in reality I was doing so, in my own way. I'm there now. The day I became certain it was time to move on in my career and had good reasons and a plan for how to do it, a plan that probably involves the dreaded hospital, I'm good. I just don't think that is very clear to my therapist.

I'm really worried. There is a lot more to discuss because this just didn't get concluded last week, but I think he's giving up on me. I understand in ways, but in other ways I'm hurt and angry and confused and many other things. I have done a lot wrong, but I think there are ways he just simply isn't getting what I'm talking about because even when I try to explain Just Me 2005 edition and Just Me 2007 edition and why 07 is still trying to turn back into 05 with some improvements he can't seem to picture 05. He's not been there for the worst med reactions, nor has he ever seen what has happened to me on all antipsychotics. There are 3 more to go. The thing is that we can be pretty sure at least one will do something really bad. So far no antipsychotics have worked. Well, they work but they do bad things to my body. I felt good on one of them, good enough I think it might have made a major difference in my life, but it had dangerous side effects (scary blood pressure). I have good reason to be wary of these meds.

Today I talked to my psychiatrist a bit about whether my feelings about having changed abilities, etc is valid based on the 2 years ago comparison. I also explained my theory. She was supportive and I believe is going to try to talk to him to touch base. That in turn makes me feel squeamish because it's hard for me to think of people talking about me, especially when I know perfectly well one isn't so thrilled with me.

I'm dreading weeks of trying to work this out. I feel like I'm failing therapy, something I didn't really use to think was possible. I guess it's good I'm well enough to take this on because I've been aware for a long time something was wrong I didn't want to face, but still, this involves doing many things I hate, all at once.