Three-Year Migraine Anniversary

It was three years ago today that I sat down to do some reading after wrapping up a busy week of projects for my graphic design classes and 35 hours of work at the flower shop and was overwhelmed by a massive let-down migraine. That headache set off a cycle of migraine sensitivity that has remained unbroken, banishing the future that had seemed so tangible in the previous weeks, one of happiness, independence, and creative challenges, and replacing it with a life of pain, seclusion, and dependence.

Bummer, as they say.

This year has not been without positive developments, such a gradual recovery from last summer's unlucky head injury, new dog-sitting clients, my growing involvement with horses, and my recent trip across the country. But it hasn't been an easy one, either. Our long, wet, gloomy spring made me feel too sick and dull to invest effort in my photo shop (or much of anything else, either) and led me to the tearful conclusion that I couldn't bear to spend another winter in Seattle. As the wet and gloomy weather continued into summer, I was discouraged by my lingering fatigue and cognitive dullness, which made living independently impossible. It looked like moving to a sunnier clime was out of the question, at least until my parents retired, something they don't intend to do for another eight years.

Once the sun came out in August, however, I made considerable gains, maintaining energy and good spirits despite my foot injury, and it was sunshine that helped me power through the rigors of my cross-country trip and its social demands. Seeing how much better I did when the sun was shining has reopened discussion on moving me to southern California in the near(ish) future. It seems senseless to keep me in Seattle, where rain is the norm and sunshine the exception (Seattle averages 226 cloudy days per year, and rain falls on 155 of them), when I might be able to function much better and with less pain somewhere else (Los Angeles averages 35 days per year with measurable precipitation).

The trip did catch up to me, it should be noted, and I spent five days in bed last week. The dry spell that extended into October has come to a wet and blustery end, and I find my life once again dictated by the state of the weather: my activity inside is determined by what is happening outside. Thus, when the wind blows and rain falls, you can find me slumped in my armchair, listlessly watching undemanding shows (I've been viewing a lot of "How It's Made") or retiring to bed with a book and the dog. When the weather is fine, my mental functioning is restored and at least for a few hours before fatigue sets in, I can take photographs, write blogs, make decisions, and draw enjoyment from my life despite its restrictions.

Things happen slowly for me, of course, and something so drastic as a move to another state will take time. I do, however, think that is where my future ultimately lies. We've decided that at the very least that my mom and I will take a trip to southern California (my parents grew up in the Los Angeles area and much of my extended family resides in Orange County; prior to the migraines, I spent a portion of my summer vacations there every year) in February, giving me something to look forward to as the days get shorter, darker, and wetter.

Maybe one day the migraines will stop. It's not out of the question. But it's also not to be expected; it's the kind of thing I can't hope for. I must live my life as it is and that means catering to every whim of my hypersensitive system. It gets me down from time to time; a few weeks back I spent several hours sobbing out some of my keenest feelings of loss. But having acknowledged that grief, I'm back to my day-to-day acceptance. I do what I can to treat and reduce the headaches--medication, acupuncture, physical therapy and massage, diet, special glasses, sensory interventions, trigger avoidance--and otherwise seek to fill my hours with photography and animals and other things that give me pleasure. I devote much more time to feeling grateful for what I have than bemoaning what I do not.

If you'd asked me, on October 19, 2009, prior to 5:00 in the evening, what I thought my life would look like three years later, this certainly isn't what I might have imagined. But then again, I've always had an almost superstitious aversion to predicting my own future, something that has spared me the pain of not having to compare where I am to where I had hoped to be. Also, I don't have time for regrets. I can't waste any of my energy on wishing things hadn't happened the way they did. My decision to start studying graphic design was a good one, even though the intense visual, creative, and intellectual involvement it required may have been a precipitating factor. And I absolutely refuse to wish that I was born with a different brain. Yeah, its inability to properly produce and process neurotransmitters the way most brains do has resulted in my bipolar II disorder, my sensory sensitivity disorder, and my chronic migraines, but it also has a lot to do with my intelligence and creativity, my wit and wisdom, my empathy and understanding, my writing ability and artist's eye, and my unique and invaluable way of looking at the world. On the days when the weather is fine, I still have access to all of that (though not to the part of my brain that handles creative writing; most writing I do for this blog is but a faint reflection of my talent at its fullest, and I do miss my ability to write at my best) and I would rather have migraines than sacrifice what is great about my brain. Also, changing my brain is not an option, even if I wished to. Thus, this migraine choir is mine whether I want to hear it or not, so I might as well spend my time on cultivating gratitude and pleasure. It's a highly rewarding way of spending one's time and I recommend it to everyone.

So, yeah, I have a disability. But it has forced me to live in the moment, which turns out to really be the best possible place to live. It has freed me from clocks and calendars, from the artificial stresses we place upon ourselves in our society to achieve things by a certain date or time in our lives. It has reinforced the value of simple pleasures. I have a roof over my head, good medical care, a family that loves me, a dog for company, internet access to the outside world, and deeply satisfying creative work. When the wind isn't blowing, I tend to feel lucky and I often feel happy. While I wouldn't wish my life on anyone, I get by okay.

Last year I chose, on this day, to write about what I've lost, and it's all still valid. But this year, despite being forced to spend most of last week in bed and being able to detect, yesterday evening, the falling of the barometer by my rising headache even before the storm hit, I'm feeling fairly positive. Perhaps it's because I see sunshine in my future.

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Gotcha!: Celebrating Eight Years of Abbey

Last Wednesday, I sat down to begin work on a blogpost that I intended to make public on the 12th. I was only able to get the following amount of work done before I had to stop because I was finally experiencing the backlash of my exertions of my Florida trip:

***

The little whippersnapper back in 2004, two months after we brought her home.

Today is Abbey's "Gotcha! Day," her "adoptiversary." It's hard to believe it, but eight years ago on a sunny Tuesday, my mother and I showed up at the Seattle Animal Shelter before it opened to make sure we'd be first in line in order to adopt a sweet brindle stray we'd looked at over the weekend. Her shelter name was Keta; we'd already settled on calling her Abbey. We didn't bring her home until the 13th because she had to be spayed, but today's the day when she became ours. Or, more specifically, she became mine and I became hers.

She has brought us so much joy over these last eight years.

In these last few months, the first gray hairs have appeared in Abbey's eyebrows.

Since she was brought into the shelter as a stray, no one knew anything about her, including her age. The best guess that anyone could give was that she was 1.5-2 years old. That means she's somewhere in the vicinity of ten years old now and her age is beginning to show. Her eyes have acquired the bluish cast caused by lenticular sclerosis as her aging lenses densify. She's developed a couple of fatty tumors and I've found several sebaceous adenomas--benign fleshy tumors of oil glands in the skin often referred to as "old dog warts"--around her face. During her last physical, the vet noticed that she's displaying symptoms of sciatica in one of her back paws; just like her owner, she's not getting full information from her nerves in one of her feet! And that darling little Border Collie muzzle of hers has suddenly gotten quite gray. I've even spotted a few gray hairs in her eyebrows, evidence that a full "sugar face" (my favorite term for an elderly dog displaying a lot of gray/white facial hair) is on its way. She lost a tooth earlier this year and she no longer wants as long of a game. I've also had to reduce her food to not quite half of what it was in her prime because her metabolism has slowed down so much. As hard as it is to believe, my girl is getting old.

Her muzzle in 2008...

...and her muzzle in 2012.

***

My Abbey-just-planted-a-kiss face

So after writing those paragraphs, I decided to lie down and read for a while and Abbey, of course, was delighted that I was in bed because that meant we could have a nice cuddle together. Jumping up on the bed at my invitation, she came over to lick my face. That's when I smelled ammonia on her breath.

I'd noticed the day before that her breath had been unusually rank and had made a mental note that I really needed to recommit to brushing her teeth, but the ammonia odor took the concept of halitosis to a whole new level of ghastly. It also just didn't seem RIGHT. So I got out of bed again and did a Google search on "dog breath ammonia" and learned that it could be the sign of kidney trouble.

I have to say, I was rattled. I'd noticed, over the last couple of weeks, that sometimes the inside of her mouth and her tongue seemed a bit pale. Pale mucus membranes in a dog are never a very good thing, so when combined with the observation that she'd been drinking just a bit more water (I was refilling her bowl more often during the day), that her poop had looked slightly different recently, and then that awful breath, I was worried that she might be showing the first signs of some kind of serious health problem involving her organs. I wasn't able to get her into see the vet until the 12th, so Abbey spent her "Gotcha Day" being a good girl, first in the waiting room for half an hour, and then for another twenty minutes or so while the vet did a thorough exam that turned up nothing (and of course her gums were as pink as pink can be), and then while getting her blood drawn. Both of us were pretty tired by the time we got home. And then we had to wait all weekend for the lab results.

Pensive girl.

The vet called me Monday with the very good news that all of her blood work came back looking great. Her organs, her thyroid, her blood count, and everything else looked perfect. Why her gums are still occasionally pale remains a mystery, but I was very relieved to hear that her organs are all okay! The vet and I agreed to simply watch and wait. If she exhibits any other changes in health or behavior, we'll reevaluate, but as long as she is acting like her normal self, life can go back to normal.

This photo gives you a sense of Abbey's imperfect mutt proportions: long for her height and with very small head! She looks particularly silly in this picture because she's gotten distracted and forgotten to put her hind paw--the one that's exhibiting signs of sciatica--down.

This was my first major scare with Abbey. I hadn't been worried at all about the mast cell tumor that was removed from her flank last year, to the point that I was taken by surprise when it turned out to be cancerous. I've been sure to regularly remind myself over these last eight years that Abbey is mortal, that she will die, and that it's going to hurt when it happens, but it will also be okay. It's such a different thing to THINK something than to FEEL it, though, and the idea that something might be terribly wrong inside my dog was a horrible feeling. She's not my "fur baby," I don't equate her with a child or think of myself as her "mom," but I do take care of her, look after her welfare, spend most of my time with her, and love her deeply, so it was a new (and difficult) feeling to look at this vulnerable creature that I love so much and to know she might be sick. It made me realize, too, that one of the things that scares me about her death is not that it WILL happen, but I don't know HOW it will happen. I hope I'll be given enough time given enough time, when the end draws near, to see it approaching.

But the end is not yet here.

(Abbey is barking in her sleep as I write this. The sound of a dog barking in its sleep is one of the cutest sounds known to man, in my opinion!)

My mellow pup in her typical one-paw-up lounging pose.

And thus we can resume our routine of mutual pleasure. Abbey has slept in my room since my concussion last summer and for a while, due to her concern for my welfare and an unwillingness to be separated from me, managed to undo seven and a half years of perfect crate-training. I'm pleased to report with intensive training and the use of the Holy Grail of treats, peanut butter, she is back to submitting without argument to being crated while we are gone, snoozing in her downstairs crate when she's looking for a cozy retreat while I'm reading on the couch, and voluntarily sleeping in her crate at night, preferring it, in fact, to sleeping on my bed. We'd never given her many treats in the past, since she has a sensitive stomach, but she's demonstrated that she's highly food-motivated, and perhaps because she hasn't had many treats, she views individual pieces of cereal, like Cheerios, to be a powerful incentive! I've harnessed that willingness to work for paltry snacks into teaching her a new command, "Look," as well as upping the stakes on previously learned commands, like asking her to remain in a down-stay while I leave the room and walk around the house. She's a pretty smart cookie, that Abbey! The treat motivation has also worked really well in neutralizing that bad habit she'd developed of barking ferociously at people and dogs outside the car. I mention in this blogpost from a few weeks ago the intensive training session I did while we were waiting for a ferry and I'm pleased to report that it's practically cured her already! So don't listen to that old saying, "You can't teach an old dog new tricks!"

"I can has peanut butter?"

But most of our days are oriented toward leisure over labor. I invite her up on my bed in the morning for a couple of hours of snuggling and snoozing, then, when I repair to my study, she either joins me, and sleeps on her pillow, or remains on my bed and sleeps there. She takes an interest in my various comings and goings, though sometimes only by opening her eyes and wagging the tip of her tail, but always offers some kind of response when I talk to her (and I talk to her a great deal). She comes alive in the evenings when my parents come home, yodeling with joy as they arrive and thumping the kitchen cabinets with her wagging tail. After dinner she likes to play a jolly game and then it's back upstairs to snooze on the pillow in my study until it's time to go to bed.

She takes an active interest in everything I do. In this photo, she's watching me photograph crocuses by our front door. 

There's nothing more special than being greeted with a yodel! Abbey is singing out her delight in my return with a happy "woo-woo-woo!"

It's a very simple life, interrupted by occasional variations in routine such as car rides and, when I'm well enough, short walks, but the wonderful thing about living with a dog is that you learn to recognize that simple pleasures are enough. From her perspective, she gets a selection of wonderful cozy places to sleep, she gets to spend nearly all of her days with the most precious object in the world (me) and have frequent affectionate exchanges with me throughout the day, she has a larger pack that she loves that reunites each evening, she gets dinner (hurrah!), and a game, and then she can fall asleep each night in the vicinity of her beloved. Why on earth would anyone or anything want more than that?

So Abbey's a great example of living in the moment and finding tremendous pleasure in simple things, but she also makes my family laugh. We love her exuberance while playing games, the way she snuggles with her rope bones but will not not chew them, her eagerness to perform tricks in return for a measly Cheerio, her spins of delight on hearing that a car ride is in the offing, and her funny habit of hanging her tail--or her whole rear end--outside of her bed while chewing on her weekly rawhide stick.

She may not need as long of a game as she gets older, but this playful gal still loves her toys!

Abbey's "Booda Bank," her collection of rope bones that she considers too precious to chew on. "Did you grow up during the Depression, Abbey?" we tease her. "Was there a shortage of Boodas?"

Look at that silly mutt hanging her rump outside her bed while working on a stick!

And why be dignified when you can get belly rubs?

We love her expressiveness, too, the attentive way she listens, moving her eyes and ears and wagging her tail every time you speak or even look at her. It's so gratifying that we are in the habit of jokingly including her in conversations, pausing in discussions on topics such as current events, say, to ask, "So, Ab, are you running for office?" We like how she can use those eyes and ears and that tail to communicate with us, how she can clearly say, "Follow me!" by looking over her shoulder or request a tricks-for-treats session by looking meaningfully at my mother (Abbey regards my mother as the distributor of treats even though I do much of the training), perhaps poking her with her nose, and pricking her ears in a certain way. I love the way that she'll sometimes check in with me by gently bumping my leg with her nose, the way she'll lick my toes with delight when I get up in the morning, and how she'll quietly line herself up beside me as I prepare to transition to a different place, waiting for me to make my move. Our whole family loves to look at her and admire her brindle stripes ("Hey, Abbey, are you a tiger?") and her beautiful brown eyes. We like the way she lines herself up parallel to the carpet in the family room ("So, Ab, are you a mathematician? Do you study geometry?") or how she'll lie down with all her legs and her tail tucked completely out of sight beneath her. ("Hey, Ab, are you a seal?") And of course, we love to pet her, to stroke her wonderfully soft, thick, odorless fur and fondle her exquisitely velvety little ears. Without a doubt, Abbey makes our lives better.

Abbey patiently waits at my side in her "where to next?" position.

Her warm brown eyes are both beautiful and expressive.

Our beloved brindle animal on the move in our backyard jungle!

No words can properly describe the extraordinary softness of her darling ears!

It's hard to believe, in many ways, that eight years have passed (that's enough time for a child to be born and enter the third grade!) since Abbey came to live with us. They've been incredibly tough years for me as I struggled to gain control of my bipolar disorder, went through years of terrible withdrawal thanks to a problematic medication, and then was laid low by the disabling migraines. But every step of the way, Abbey has proved to be exactly the dog I've needed. She made me feel urgently essential to her existance when I was at my sickest, which helped me conquer my fears of being overcome by suicidal thoughts and allowed me to start getting better. Becoming a better pack leader for her so she wouldn't have to be so stressed out about trying to take care of me was instrumental in helping me uncover a confident and assertive side I never knew I had. She offered quiet comfort and companionship when I felt wretchedly nauseated or in pain during the withdrawal years and was my eager sidekick on walks when I finally was able to start regaining my strength. And her presence has proved invaluable once again as I've had to retreat from the world due to the demands of my migraines. I never feel lonely because she makes an amiable companion, happy to communicate with me and partake in my pleasures while making nary a sound. She likes nothing better than cuddling up against me if I'm too sick to get out of bed and that becomes a source of happiness for me on days when otherwise it would be easy to feel down. When Abbey is around, I never feel lonely. The way her eyes light up and her tail wags when I look at her is enough to brighten my days. Her love--pure, unswerving, instinctual, and total--has carried me through eight years of hard times. I will have many dogs in my life, but I have been so fortunate to have stumbled upon, in Abbey--who was chosen largely because of the patient way she was waiting in her kennel at the shelter--exactly the dog I've needed.

I am hers and she is mine.

I love the photograph below because Abbey is gazing at me a soft look of love in her eyes. She is waiting for me to follow her up the stairs and is holding still because I've pointed my camera at her. It sums up so much of what is wonderful about the two of us together.

It's been a joy to have you at my side these past eight years, sweetie. I hope we have many, many more.

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The Best Therapist

Research indicates that the most successful scenario for treating and coping with mental illness is a combination of medication and therapy. Either one, when used alone, is not nearly as beneficial as when used together. And yet, as complicated as the medication can be (and it can be plenty complicated), it can be simple in comparison to the task of finding the right therapeutic match.

For starters, not all therapies are created equal, but there is not necessarily good information out there for patients and families to use to understand the strengths of various therapies and the differences between approaches. Furthermore, a sound therapeutic model does not guarantee that all of its practitioners are good therapists. Again, there is very little information out there to assist individuals in choosing the therapist that will be their best match, especially since someone who makes a great therapist for one person does not necessarily make a great therapist for a different individual.

And there are some bad therapists out there.

Therapists run the gamut from outstanding to good to adequate to mediocre to downright bad. A bad therapist is worse than simply ineffective; they can be detrimental to the patient's health and harm the reputation of the practice of large. Many people, once they've had a bad therapy experience, will write off therapy altogether and never go near it again: that's how damaging a bad therapist can be. It's a shame, since there are good therapists out there who could be helping those who now view therapy as worthless.

In my day, I've had two bad therapists (like the guy who told me to be kind to myself and eat some ice cream when I called to tell him--totally freaked out--that I'd woken up suicidal the day before), a few good therapists, and Andrea.

Andrea belongs in the class of exceptional therapists and for seven years she's been my invaluable guide. This week, I saw her one last time, as she is leaving the practice where she's worked all these years to explore different horizons. Although I'm sorry to see her go, she leaves me in good hands: my own. While I will take on another therapist in the practice as backup, over the years, Andrea has helped me become so skillful at managing my emotions and troubleshooting problems that I've only needed to check in with her every six months or so.

When we first met in March of 2005, it was a different story. I was in bad shape. The month before, I'd had my fourth psychiatric hospitalization in slightly more than a year's time. I was seeing a psychiatrist, but after the overdose that put me in the hospital, everyone agreed that I needed more extensive therapeutic treatment. That's how I found myself at the DBT Center of Seattle.

DBT, or Dialectical Behavior Therapy, deserves a blog post all its own to fully explain why it is, in my opinion, the best possible therapy out there. The extremely short summary is that it teaches individuals how to cope and respond to difficult emotional situations through the use of a variety of skills. It is a therapy of doing, of moving forward, of changing how you think and therefore how you feel, and it is extremely effective. I was first introduced to DBT at the psych hospital in Chicago and had seen a good therapist at the DBT Center of Seattle when I had been home for a few months between hospitalizations two and three. I was, therefore, not wholly unfamiliar with the general concept or that office in particular, but it was with Andrea that my true Dialectical Behavior Therapy education began.

As I said, I was not doing well when we first met. I remember her asking each week if I could make a contract for safety with her, meaning that I would promise not to hurt myself until I saw her next, and each week I would refuse to make that promise because I didn't want to make a promise that I wasn't sure I could keep. There are four units in DBT–Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness, and Wise Mind–and it should be no surprise that we jumped right into Distress Tolerance, the unit that focuses on surviving and coping with the most painful and extreme emotions.

The first few months were hard. I wasn't really well enough to even absorb a lot of what I was being taught, but between Andrea's gentle, kind, but firm guidance and my weekly DBT skills group, the principles started to take root. Six months into DBT, I was started on lithium, and suddenly, everything clicked. From then on, my progress accelerated tremendously.

When I think back to those early months (not that they are very clear), what I remember most is how helpful Andrea was in helping me confront my severely debilitating social anxiety. Together we made up a list of all the things I was scared to do and ranked them according to Subjective Units of Distress, or SUDs, which is basically, on a scale of 0 to 100, how terrified I was to do them. This list included things like asking for directions, talking on the phone, going into a store even if I didn't intend to buy something, asking a bus driver a question about stops or the route, looking at a map in public, taking the time to find the exact change when purchasing an item, making any kind of request of anyone, and dozens of other seemingly innocuous things that filled me with paralyzing anxiety. Then she had me choose one or two items off the list that I had ranked in the 20 to 30 SUDs range to do each week. It wasn't easy at first. But if I didn't do an item one week, it remained my assignment to do it the next. As items were crossed off the list, they were replaced by ones with higher rankings. Slowly this exposure therapy started to take hold, where years of cajoling and reasoning had failed. As my anxiety lessened, it became easier for me to move about the world without feeling like I was constantly being negatively judged by every single person around me. After I'd gotten the hang of challenging myself, we put the list away, but I remember when we looked at it again perhaps a year or so later. It was astonishing. Things that I had ranked as high as 70 or 80 SUDs now seemed so easy, meriting big fat zeros in terms of subjective distress in my revised view on life. The only thing that remained on the list that I agreed with was singing karaoke: sorry people, not gonna happen! It was amazing to see how far I'd come, and to this day, I still marvel at how wonderful it is to be able to do the kind of everyday things that used to fill me with terror and to be free of that sense of being constantly watched and judged. Without Andrea's advice, encouragement, and underlying firmness, I might still be obsessing over what terrible things other drivers were thinking about me because I had set my windshield wipers to "intermittent" when other drivers (and I was checking the wiper activity of every other car on the road) didn't seem to have theirs on at all. (Seriously, the thought that I might have my windshield wipers on the "wrong" setting used to preoccupy me terribly and any drive in the drizzle/rain/mist--and I live in Seattle, so there was no shortage of drizzly, rainy, misty days--was an exhausting, nerve-wracking, humiliating experience. It was a terrible way to have to live and am so thankful to be free of it.)

It could be argued that I might have done well with any DBT therapist, but I'm sure that without Andrea's attributes, I would not have come nearly as far nearly as fast. She was exactly what I needed in a therapist: friendly and positive without being superficial or exuberant; so clearly patient and kind and nonjudgmental that even I, who was so terrified of being "wrong" somehow, was able to learn to relax and trust her; clear in both her explanations and expectations; and, at the core, where it was needed, absolutely firm. I remember in one early session, during a time when I was still sorting through and dealing with suicidal thoughts, saying something somewhat glib or certainly self-centered about the benefits of suicide and her reply, that suicide really fucks up people's loved ones, shocked me tremendously. That Andrea would say "fuck" in a session was as shocking as, well, my mother saying it, or the queen. And when she said it, I believed her. That was the last time I ever indulged in fantasizing about suicide. From then on, I was wholeheartedly on board in trying to turn my thinking away from self-destruction.

And so I learned how to arrest a spiraling state of emotional intensity in its tracks; to notice when I was engaging in catastrophic thinking and how to make myself stop; how to quiet my mind when my thoughts started racing; how look for the positives in every situation instead of focusing on the negative; how to ask for what I needed and then, once I had accomplished that, how to ask for things I wanted (this was huge because my sense of self-worth was so low at the outset that I didn't believe I deserved to have needs, much less wants, and the worst possible thing would be to inconvenience anyone with something so selfish as asking for what I needed); how to separate the facts of a situation (or emotion) from the judgments and assumptions; and how to effectively respond once the facts of a situation or emotion had been established. With Andrea's helpful tutelage, I was able to leave that cringing, shrinking, petrified, miserable, out-of-control, profoundly unhappy torture chamber that was my life and enter into a positive way of being, where I believe in my worth, in my opinion, my voice, and my happiness.

It's a good thing I had DBT and Andrea at my disposal, since six months after I started taking lithium, I found myself desperately needing the skills I'd been learning. I'd started lithium because I was going off of a drug called Geodon that was causing tardive dyskinesia, or involuntary movements of the mouth and face, a condition that can become permanent if the medication causing it is not stopped. My experience with Geodon will get its own blog post one of these days, but what happened is that after six months of problem-free reductions, with me getting better and better by remarkable leaps and bounds, I slammed head-on into excruciating withdrawal. It was awful. There was agonizing pain, horrible nausea, immense fatigue, bizarre sensory hallucinations, cognitive problems, vision problems, you name it. It went on for years. And not only did the withdrawal symptoms get worse the closer I was to finishing the taper, but they continued for a full year AFTER I was off the medication. I started tapering off Geodon in 2005 and was not wholly free of its effects until 2009. And that's not counting its permanent legacy: hypoglycemia, worsened migraines, and periodic fibromyalgia. I might not have been able to cope with finishing the taper if I hadn't had DBT and Andrea to help me through one health crisis and setback after another. It really might have been unbearable. It's a good thing I was able to endure the withdrawal, though, because emotionally I am so much better completely off of Geodon!

In fact, I was able to do so well, thanks to lithium and Andrea and my year in the DBT skills group, that I was still in the Geodon withdrawal process that I started coming to my weekly therapy appointments without any problems to discuss. I'd become so skillful that I was able to tackle things by myself as they arose. It seemed silly to meet every week simply for me to report on how well I was doing, so we started meeting every other week. But even then I was managing just fine. So Andrea and I started meeting once a month. Before long, even that was excessive! In the last few years, I've been down to two or three check-in appointments a year. A lot of times, they'll just be half hour appointments to touch base. Sometimes, if I have a particular problem that I want assistance with, I'll specifically schedule an appointment to see her, but I no longer need weekly or even monthly guidance. It's hard for me to get downtown to the DBT Center's office now that I've had the chronic migraines to contend with, so we've had most of our appointments over the last two and a half years over the phone, and that's worked just fine.

Lithium, in combination with several other medications, is essential to managing my bipolar II disorder. But if I hadn't had Andrea's gentle but insistent instruction to help me cope during the seven months between the fourth hospitalization and when I started taking lithium, it's probable I would have continued ping-ponging in and out of the psych hospital, almost certain that I would have embarked too far down a road of self-destruction to easily turn back, and possible that I might have ended my life altogether. At the time we met, after years of just barely clinging to a facade of normalcy, I had become unmoored. I knew the frightening thoughts and urges that were flooding my mind were the result of brain chemistry out of balance, but I also didn't know how to stop them, and their warped seductiveness was becoming harder to resist. I was so terrified and also so appalled that I could think such things that it was hard for me to talk about them, but I trusted Andrea, and even before I was able to effectively implement the DBT skills I was learning from her and my group therapy, it gave me hope that I might someday regain control of my mind. It's not a coincidence that I have never needed another psychiatric hospitalization since I started DBT!

And so with Andrea's invaluable help, I was able to grow from a fragile, damaged, terrified husk of a human being into a confident, balanced, happy woman. I went from being so emotionally raw that the slightest thing could send me into a tailspin and so fearful that the mere thought of ordering a pizza over the phone could send me into a panic to the point where I was able, on my days off, to get all dressed up, experiment with a little dramatic makeup, go downtown, take myself out to lunch at a nice restaurant, go to a matinee of a play all by myself, stroll around downtown while enjoying the admiring looks of passersby, check out the latest fashions even if I wasn't planning on buying anything, make a purchase at a drugstore and chat with the cashier while taking the time to find the exact change despite someone waiting behind me in line, and generally have a wonderful time. Even more remarkably, when the onset of the chronic migraines brought an end to those fabulous afternoons and left me unable to work, socialize, or even leave the house because of pain and tremendous light- and noise-sensitivity, I've still been okay. When I am happy, and I frequently am, it is a happiness as legitimate and whole as what I felt on those delightful, confident days spent enjoying the dining, shopping, and entertainment offerings of the city. I owe it all to DBT. Had I not learned how to stop myself from fixating on the negatives and instead see and capitalize on the positives during my climb out of the depths of depression, I would not have handled this disability with nearly so much aplomb!

While I have no doubts about my ability to continue to not only manage my emotions but to thrive, it has been a bit of an emotional process to say goodbye to Andrea. Walking past the Louis Vuitton store on the way to my final appointment yesterday, I recalled how it was one of my earliest assignments in my quest to conquer my social phobia to go in the store and look around for several minutes despite my belief that I was not "good enough" to be in there. It took several weeks for me to work up the courage to open the door and endure the judgmental (I was sure) stares of the security guard and sales associates as I nervously made myself look at every bag and every shoe. It's simply phenomenal how far I've come and while I remain grateful and proud of myself every time I make a phone call or go into a new situation without panicking or ask for help or any other scenario that would have been nearly impossible for me in my anxious days, it's been very moving to really remember down to the visceral level how I used to feel in those wretched days and compare it to how I feel now. I have not seen the last of Andrea; while our professional relationship has ended, DBT guidelines allow for ongoing contact between former therapists and clients if such a thing is agreeable to both parties, and we agree that it would be really nice to get to touch base now and then! I was very glad, though, when we parted, that I was able to tell her that she has made a tremendous difference in this world: she changed--and perhaps even saved--at least one life for the better. She always credits my hard work for my success, but without her approach and personality and patient coaching, I would never have been able to form the bond with her that has, over time, enabled me to succeed.

So thank you, Andrea, from the very bottom of my heart. I love the person who I am now, am no longer afraid of the world and its opinions, and I no longer need to be afraid of myself, three things that, when we met, seven years ago, I never could have even dreamed would be possible. I have been so fortunate to have known you and worked with you and thrived because you. The vastness of my gratitude matches the scope of my former unhappiness, which is, to say, immense. Thank you! Thank you! Thank you!

The Flip Side

Note: I wrote this draft last week and then haven't felt well enough to come back to it, but upon rereading it today, decided to leave it as is (with the reference to being at Mr. Gorgeous' house in the present tense) because it says what I want it to say and will save me the energy of having to rewrite it.

I haven't been feeling well lately, so I was going to follow up my earlier post with the acknowledgement that my self-knowledge and acceptance comes at a cost, which is suffering. I am keenly aware of the duality of things, that suffering is the other side of joy, that love is not wholly complete without loss, that you don't fully understand happiness until you have experienced sorrow, or know peace unless you have faced terror and chaos and pain. I know how rock-bottom feels and up until today, that was going to be the subject of my post, that it must be recognized how tragic it is that I survived the worst of my bipolar disorder and then years of awful medication withdrawal only to be brought down by migraines. It is truly terrible and unfair that I must find happiness in little things because otherwise there might be no happiness at all.

Happiness is as simple as this.

But then the sun came out today. I needed that sun very badly. I'm house-sitting for Mr. Gorgeous, which I enjoy, but it's exhausting, especially when the weather is abysmal and saps whatever strength I have. It's also just plain miserable to walk a dog when it's 42 and raining. My moods are most definitely impacted by the seasons: my hypomanic phases always came in the spring or summer. So the sun came out and suddenly I was glad. And not only was I glad, but I found myself feeling deeply grateful that my life has been and still remains, in many ways, hard enough that the mere appearance of sunshine can send my mood soaring. The hillside above Mr. Gorgeous' house looked so beautiful in the sunlight that I stepped outside with my camera to take a picture of it and that's when I discovered that it was snowing! Yesterday evening's walk was undertaken in sun-lit rain, a chilly experience whose novelty, despite the rainbow, quickly vanished, but sunshine and snow was a magical delight. Now I am happy. And furthermore, I feel lucky. It's a tricky thing, this kind of luck, but today, if you were to give me the option of being able to erase my migraines and the years of struggling to bring my rampant depression under control, I'd turn that offer down, and take, instead, the wisdom and the joy that those agonies have granted me.

www.ccreativity.etsy.com - www.silvermouse.etsy.com

www.facebook.com/ccreativityphotography

Something Just a Little Bit Wonderful

Today I finally got around to photographing the pomegranate that I've had since before Thanksgiving.

I love what I do.


(Both of these images are now for sale at www.ccreativity.etsy.com!)

Gratitude

Unfavorable extremes

We've had terrible weather around here as of late, at least from my perspective. Three days of wind and rain and generally stormy weather left me so sick that I was only just barely well enough to attend my family's Thanksgiving dinner and certainly not up to writing a post on gratitude as I had hoped. Then the barometer swung dramatically the other way, which made me feel just as awful, and I was forced to delay finishing this post once again. This essay has been pieced together over four different days, but the delays caused by these unavoidable bouts of terrible, weather-related fatigue are one of the realities of my illness and are exactly why I work so hard to find reasons to be happy in a world where I have so little control over how I physically feel. Also, in a way I'm glad this post was delayed because it's almost more appropriate to write about gratitude on a day other than Thanksgiving when part of my strategy for coping with the migraines is finding things to be grateful about every single day. While this may cover things that I mentioned in my 30th birthday post, I feel it's a theme that can't be repeated often enough.

People often wonder how I'm able to cope with being disabled at this age and living with pain on the daily basis. My strategy involves being grateful for what I have rather than being unhappy about what I lack. Happiness, I've found, is easiest to discover when you want what you have. There are, of course, situations that people can find themselves in that are truly awful, but if many of your needs are being met, you may find that it's possible to realize happiness within your limitations, whatever they may be.

Better living through chemistry

First of all, let me make something clear: I wasn't born this way. In fact, you might say I was physically incapable of truly feeling happiness for the first twenty-five years of my life because of screwy brain chemistry. Back when I was so depressed, it would just make me feel worse a lot of the time to tally up what I had to be grateful for because I'd think, "What is wrong with me, why can't I feel glad when I have all these positive things in my life? I must be a terrible, flawed person." It took the introduction of lithium into my system for my brain to be capable of feeling happiness. Within two weeks of starting lithium, it was like the sun had come out. I'm grateful for Lamictal and Effexor, too, but without lithium my life would be so much harder.

It wasn't lithium alone that made me capable of seeing the world in a way that focuses on what I have to be grateful for. I went through some excellent and intensive therapy that trained my brain to recognize these things. (Of course, lithium was essential in making me able to absorb and embrace the therapy. I know this because I started the therapy before I started lithium and there was a marked before-and-after difference!) One of the central tenants of Dialectical Behavior Therapy is that it is possible to hold two opposing beliefs in your mind at the same time, namely, "My situation is hard, unfair, miserable, disappointing, etc." AND "I am capable of feeling happiness, joy, pleasure, satisfaction, etc." This way of thinking can free you. Feeling happy in no way invalidates the reality that you are suffering. But suffering in no way prevents you from finding happiness. To find happiness involves learning to see it, to find it, to will it, to make it. This doesn't come naturally or easily. But if you become skillful enough, it becomes unthinkable to live any other way.

Cases in point:

I still clean up alright

A few days ago, for example, I wasn't feeling well because of the weather, but I had the thought that even though my life isn't what I wish it could be, at least I like what I see when the mirror. There are plenty of people out there who don't, but I do. And so, in that way, I am lucky. The next day, I was grateful for my mother. I had a sudden resurgence of a tough emotional issue that made me seek her out just before she was going to bed and I dumped all this trouble onto her lap and she listened to me, held me, and reassured me, and I'm so grateful to have her there to do all those things. On Thanksgiving Day, I had initially been feeling poorly enough that I was not sure I would be able to appear at dinner at all. However, when the time came, I was at the table, fully dressed (including makeup!), and while I only made it through dinner and not any of the festivities before or after, I was present for the meal and ate well. The other day I was grateful for the company of my dog on a rainy afternoon when the barometric pressure had left me fit for nothing but dozing in bed. The dog, of course, thought this was the best possible thing that could ever happen

and she nestled up against me and tucked her head against my chest as I slowly stroked her velvety fur and listened to the sound of the falling rain. It was a very peaceful and I felt lucky that I was able to let go of the notion that I should be trying to get stuff done and accept that I was unable to do more than snuggle the dog and, furthermore, to appreciate how wonderfully warm and soft and soothing my bed was on that stormy afternoon.

Other things I am routinely grateful for include having a warm, safe place to live; caring, respectful, medically-literate parents who are able to afford the health care I need; the love and friendship of my wonderful sister; the excellent doctors and other care providers I have on my team; my art and ability to create; and the internet, which allows me to keep in touch with many people, share and sell my art, and even watch TV. In fact, I've become so accustomed to seeing the world through the eyes of someone who's grateful that is almost difficult for me to see myself as someone who is unlucky or in a bad situation. Yeah, yeah, I have the daily migraines and all of the complications that go with that, and sometimes I do get frustrated by how little I can do, but often it doesn't seem worth complaining, not when I have so much I'm grateful for.

Abbey celebrates the simple
pleasure of peanut butter

My dog also helps. Canine critics have been known to sniff at the way dogs are so goofy and happy about everything, but really, what's so bad about that? Abbey's favorite time of day is when my parents have come home from work and we're all standing around in the kitchen together. Food is being prepared, she knows she will be fed in just a few minutes, and in the meantime she will drum out her happiness on the cabinet doors with her tail and bask in the heat of the oven whenever the door is opened. This scenario happens almost every night and yet her delight in it never lessens. And why should it? It is wonderful to have the whole family together and to know that dinner is imminent. Why on earth do we take that for granted? She teaches me this lesson in a dozen different ways every day and it keeps me focused on the good things I have right now, right in front of me.

It took a nice camera to take this picture, but all it took to find it was keeping my eyes open.
I found this rain-drenched hydrangea just around the corner from my house.

Besides always looking for reasons to be grateful, one of the biggest and most important factors in my ability to experience happiness on a regular basis despite my situation is that I actively cultivate a sense of wonder. I'm highly visual, so it's very easy for me to look around at the world in a way that sees all that is marvelous, but I think anyone who is willing to break away from passively looking at the world and start seeing the world can learn to do this, too. My focus on the macro in my photography is one result of this sense of wonder. One of the reasons why I love taking photos is because it enables me to show other people the world as I see it. There's so much amazing detail in even the most ordinary objects that fill our lives. I'm always on the lookout for textures or patterns, inspecting objects down to their most minute details and watching how they change in appearance depending on how the light strikes them. And, of course, there's plenty of amazing things to be seen outside in the natural world. I look for wonderful things on all possible scales, from big beautiful clouds painted pink and orange by the setting sun to the smallest streak of color on the very edge of the petal of a flower. Again, I look for textures, for details, for colors. There are so many unexpectedly beautiful things all around us if you look with your eyes truly open!

Beautiful color, evocative odor

I'm highly visual, but we experience the world through all our senses. Truly paying attention to music or the taste of favorite foods or scents that invoke nostalgia are all great ways to awaken your sense of wonder. There were a few days last week when the vine maple leaves on the trees in the backyard had turned yellow and that's when I smelled it, the scent that for me defines and encompasses the essence of all things autumn, the slightly spicy smell that maple leaves give off when they've turned color and are starting to fall. It's a smell I remember from childhood autumns and the giant maple tree that grew by my elementary school's portable classrooms, an aroma I carried in my heart and longed for during four long autumns in Florida, a scent of emotional importance that ranks up there with the smell of the Noble firs that we gets every year as Christmas trees and the memory of my grandmother's perfume. If you're awake, if you're paying attention, the world is littered with wonderful sounds and aromas and flavors!

Laugh all you want, but I think the
centuries of innovation and all the
tiny gears that make this watch tick
are pretty amazing.

An active sense of wonder doesn't just have to be about sensory things. My friends teased me a little while back when I mentioned, in a status update, that clocks were pretty darn cool, but think about it! It took millenniums of innovation for clocks as we know them to come into being. They are such a basic background part of our lives now that we don't spend much time thinking about how amazing it is that all those little gears can work together, evenly dividing the passage of time in three different ways. Of course, digital clocks are very cool in their own way, but it's so satisfying for me to think about the development of clocks, from primitive machines that showed only the hours, eventually evolving to show quarter hours and minutes, becoming more complex and accurate until they could to be shrunk down and carried on the person. Each innovation built upon the last over many centuries and now we absolutely take it for granted that we can accurately determine the time by looking at watches on our wrists or clocks on our walls.

Petrified wood

Another cool thing that we also take for granted is the ability of blood to clot. It's fundamental. The survival of living things depends on it. But unless you happen to be a hemophiliac, you probably don't spend much time thinking about how cool it is that when you bleed, you clot, and that your blood doesn't clot (except under specific medical circumstances) when it's circulating around your body. Talk about an awesome evolutionary adaptation! Or how about this: take a look at that rock in the photo on the right. Once upon a time, this rock was a tree--back in the days of Pangea! We're talking about something that is somewhere in the neighborhood of 250 million years old. 250 million years! And now you can see it sitting on the ground in Arizona. Isn't that incredible?

Science is cool. Ideas are cool. There's a lot amazing technology out there. Our bodies, even when being difficult, are absolutely fascinating. There are so many engrossing sights and stories and sounds to be absorbed. So much of the world is beautiful.

One of my favorite Mouse photos makes
something beautiful out of poisoned grass

It's also true that there is much that is hard and horrible and ugly and unfair about the world. It used to be that that was the only way I was capable of seeing it. I remember how, in the early fall of 2004, when I was really, really sick, I saw dead trees everywhere. There were a lot of dead trees around. Most of the dead ones were young and had recently planted, so there must have been a combination of a cold winter and a dry summer or something like that that killed them. But to me, those small, dead trees seemed like the saddest possible thing and, furthermore, a representation of the world at large. I could still see a world full of dead trees, so to speak, if I wanted to. But I choose not to. I choose to protect myself from a certain part of what happens in the world, not because I wish to deny it, but because I can't afford to make myself miserable over things that are beyond my control. I can't prevent hunger or war or greed. I can't change the weather or transform my brain or wish away my migraines. However, I can choose how I feel.

I choose to be happy. I choose to be grateful.