quart in session

So you know how sometimes your favourite character on TV, a character who is flawed by addiction, quits their substance of choice and you sort of get...disappointed? Like it was such a pivotal part of their character and a bit why you liked them in the first place? That's how I feel about myself. I'm not romanticising anything; my life really was more fun. Late nights out, inside jokes, fast rides on motorcycles, self and city exploration. Sure, I can do that stuff now too, but I'd only compare it to how I experienced it before, and before was just so so much better. I know I'm not being a good spokesperson for sobriety, but there you have it. And then I think to myself how good it all was, the wind in my hair and the toxins in my blood, and I think I've already lived a full and exciting life. I feel like I've already lived a lifetime. And it makes me imagine myself as a senior at a nursing home where I have my soap operas and there's always someone touching me and I think - I want to be there. Because right now, with so much of my active life remaining and nothing with boredom and despair defining it, giving the sharp edges smooth corners, I feel like such a failure at life. Before, I was an addict and an alcoholic, but at least I was those two things. I had spark, a vitality, a lust for 'anything goes', and now I am nothing. I am biding my time until that nursing home. And to top it off, I'll probably not remember any of the good times by then. 

Now, let's talk about anhedonia and its relationship to addiction. Anhedonia is the inability to derive pleasure from things you used to. Some people have depression without anhedonia; they just feel gloomy and grey but things they enjoy can pull them out a bit. Some people have a bit of anhedonia. Me, I have all anhedonia all the time. If I had any more anhedonia I could probably sell it on the black market like used panties. Anhedonia is the soul-sucking, identity-robbing part of depression. And you know what temporarily alleviates anhedonia? The only thing that does (for me, at least)? That's right- substances ('I'll use the big 'S' for all abused substances, a la Infinite Jest). Those illicit toxins create a sort of fake space for pleasure. And it's a damn good fake, I tell ya. Like, prophet-convincingly fake. I mistook it for real pleasure for almost 2 decades. And at some point I knew it wasn't real, but it was all I had. And since I still have anhedonia, it's almost impossible to resist the temptation of that false pleasure. Without it I quite literally have no pleasure at all. Such is the reason so many depressed people are addicts, and why they fall off the wagon so easily. Until there's some sort of magic cure for anhedonia, their life will continue to be a battle where pleasure, however fake, is offered - but cannot be or should not be procured.  I cannot enjoy much of anything (not even a massage or warm bath or tea) without the big S substance. I know I'm not alone in this. I've heard of lots of people, from NoFX's frontman to William S. Burroughs, who though realising they must lead a more healthy life, hates that sober life because it lacks substance (pun intended). I liked the harsh angles of addiction. The anticipation of that first hint at some alchemical change in your perception, the night- the dive bars and diners and parking lots and taxi confessionals. And even the groggy mornings, the coffee melting the confusion of the night before. All that trashiness. It made me feel alive. I was just... feeling. For once I was feeling something. It was a window into a world I was otherwise not invited to attend.

I have nothing to offer in terms of overcoming this and feel badly for anyone reading who was hoping for a more uplifting and constructive view of sobriety in the midst of a deep depression. But I got nuthin'. Nothing except, I know. I feel it too. You're not alone. I am here with you. 

the importance of being.... habitual

I understand the healing powers of routine. Really, I get it. I know for a fact I thrive better with a set routine. Because of this, when I was young I wanted to either be in the cadets or be a nun. Not because of any alignment to any sort of believe or value system, but just because I'd know when to wake up and what to expect. No alarms and no surprises. When someone asks me to imagine a safe place, I imagine a hospital bed. Horrific, right? But not to me. There's always someone awake, around me. Human touch is always available in abundance- hell, I don't even have to ask for it. Even the cold shock of a stethoscope feels like a massage if there is a warm body tending to me behind it. Plus nobody can sneak up behind me in a hospital bed. If I were to imagine myself, as often people do, on some sort of sandy beach I'd become so anxious I'd feel paralyzed rather than relaxed. A sandy beach??? You mean, out in the open like that? Nobody else is around? But what if...Oh, hell no I can't close my eyes! Relax? That's just inviting surprise.
At any rate, I do understand the importance of habit. But when I open my eyes in the morning (okay, the afternoon), even though D so sweetly has coffee ready and the dog already walked, I cannot move. I just. cannot. move. The dreams I had, so lucid I can't separate them from memories most of the time, were so sweet (even if nightmares) because I am never depressed in my dreams. It's never really about me in my dreams. And then when I wake up it's only about me. This self-obsession I cannot escape. I know it. I see it. I recognize it. Yet I am powerless to control it. People tell me, you gotta force yourself, Just get up and do something. The same thing every day. Run, walk, read, whatever. It's difficult to explain why this is an impossibility in the depressed mind. I once explained it to someone like this: Imagine the most horrible thing, the most heinous thing, you can do to a person or animal. Now go do that thing. What do you mean you won't? There's nothing physical stopping you. Is it just because you know that it's wrong, someone told you that you'll go to jail? No? What is it then? What is that deep, instinctual, so-very-YOU force that's stopping you? That strength of impotence, the revulsion, the inertia, that is what is keeping me in bed. Not that I think it's a heinous act like in my example, but the STRENGTH of that revulsion to that act is very, very similar. It's almost a physical impossibility, like someone has to drag me out. The only thing that has ever worked to get me out of bed at a specific time is the fear of getting into trouble, of being ridiculed as punishment, that deep-seated fear of chastisement, of castigation, of being scolded and called a disappointment. That is the only thing stronger than my revulsion to leave the warmth of my bed. One time I signed up for morning yoga classes (expensive ones, thinking that would get me out of bed) but they were so all namaste there I knew I wouldn't get into trouble for not going so I didn't go. Yeah.
In an effort to at least pretend I'm going to introduce routine into my schedule, there are some things. Money is tight right now so though I'd like to get a membership at the YMCA nearby, it may have to wait. I used to go to an Agnostic AA meeting once a week. There's that. I could do that again (I probably won't but shhhh you're ruining the exercise). I meet my therapist Friday at 3pm every week so there's that too. For some reason I stay faithful to that even thought I know I wouldn't get in trouble for not going. So that's interesting, what's keeping me at it. I'd like to get back into my snow globes (so, I make these snow globes right? But there's no warm fuzzy scene in them. They're usually scenes from horror movies or just random sad things like a graveyard scene with mourners, or men carrying a body in a carpet, that sort of thing). Aaaanyway, getting back into that would also be great but it's fucking expensive to do. Train miniatures are like little nuggets of gold to surly veterans*. Plus I swear they up the price for me because they know what I'm going to manipulate them into. And, there's no set time so I'd have to make my own schedule which again isn't going to work. I could go back to work but I tried that already and fell most spectacularly. I thought I was ready but the electro-shock stole a lot of my memories so I had to ask about the most basic duties of my job which just caused panic attack after panic attack. I think most of my memory is back but how do you know what you can't remember? How do you know if you're forgetting something if you've forgotten it? The only way to know is to go back to work but....fuck....those panic attack were just too much. I need to be sure I'm ready.
So this post ended up being pretty boring so I apologize to anyone (if anyone) is reading but if this blog is just as much for me as it is for others, shit's gonna get boring and whiny and all the wonderful characteristics of the melancholic mind.

*I love and respect all veterans but it's a fact the ones with miniature trains are often surly. Hey I don't make the rules.

full circle. and then some.

Re-reading that last post, over a YEAR ago, is mind-blowing to me. I'm no further ahead, and that's not just a subjective critical me talking. Really. I'm no further ahead. Except for the fact that my brain has been surgically shocked and magnetized and medicated up the wha-zoo, nothing has changed. I may have read a new book or two. Oh, I learned how to make a pie they stopped selling at my local market. I moved into a new apartment. All surface-y stuff. Nothing in here in HERE has changed. Over the past year, there's been way too many low points to count. I'm still off of work. I don't shower often. I've shat myself in a hospital bed with the icky feeling of being electrically charged. And I had been. 7 times. The TMS - transcranial magnetic stimulation - was not as invasive. But still nothing. Then we went off-label, tried ketamine and different combos of antipsychotics and mood stabilizers. Lithium made my hair lighten and my face puff out. No joke I looked completely different. Plus I could FEEL it coursing through my blood. Hard to explain but there you have it. And my doctors have all but given up on me. I figure I'm just too... needy. And I don't respond to treatment so they get frustrated. Here's some examples of emails I've sent them, intending to be honest and articulate but ending up sounding like a verbose, pompous head-case:

October 20th, 2014

Hello Dr. _____

                As you know, I am one of the participants in the rTMS study that you are currently running. This week will see me undergoing treatments 15 through 20. The following is something I've wanted to discuss with you in person, but, as I’m not terribly articulate or cohesive when I attempt to express complicated things verbally these days, I thought that it would be more effective if I conveyed my thoughts to you in writing here.
          The reason for this letter is not actually to discuss my progress within the rTMS study, but rather my ongoing care and possible medication regime upon completion of the rTMS treatments. Specifically, I am very interested in the Ketamine study you are involved in, and have brought it up with my Psychiatrist, Dr. ____, who is also very interested and supportive of the research. In fact, I am very keen to explore whether I would be a suitable candidate for taking part in the Ketamine study. I do believe that the rTMS is helping (really helping) a certain aspect of my specific case (namely, the part of my brain that allows me to focus, have clarity, and have ambition), but the portion of my case that generally gets addressed with medication (the part that finds life dull, grey, and meaningless) is the portion I’m afraid will still be left wanting after treatment is complete.
                At this point, after two decades of fighting the disease, I truly believe that there are two different types of (or components to) depression: one which I call noise depression is the aspect of my depression that the rTMS is definitely helping me with. It gives me clarity and focus and I am able to concentrate and persevere without having intrusive thoughts and self-criticism disrupt my activities. The other, which I call grey depression, is the feeling of anhedonic hopelessness and emptiness that appears to exist within me at a level that is deeper than my outlook or day-to-day thought patterns, down in my core mood or ‘being’. I think some people are afflicted by one of the two types of depression, and some people have both, and I believe that I fall into the latter category. My grey depression does seem to improve with medication or anything else that raises serotonin/neurotransmitter levels, but only for a short time and only at the highest dose. I've tried them all except MAOIs. I feel (and am terrified of this feeling) that after the rTMS is done I will have a very clear, focussed brain that is able to live in the moment, for the moment (without the noise of intrusive thoughts and ideas) but that this moment, this focussed being, will still feel grey and hopeless.
                At any rate, as it is clear that I will still have to sort out my medication after rTMS treatment, and as I have very high hopes that participating in the Ketamine trial might be a promisingly effective route for me to take, I would very much like to know your thoughts on my suitability for the trial. I've been following the research into Ketamine for treating depression with great interest, and would really love the opportunity to be part of a study to prove its efficacy. Also, I’m not even sure that TWH study participants are allowed to be part of more than one study, so any information you could provide would be more than appreciated.

Thank you for taking the time to consider this request for your advice, and thanks also for all that you do,

-Nicole 

November 18th, 2014
Hi again Dr. ______,

Firstly, forgive me if this email comes across as a platform or sounding board of sorts; I truly am curious to see if this thought aligned with the rTMS's study's basis and/or findings...

It was such a basic and obvious fact that I had this morning, one that had been staring me in the face all this time but I had never been able to fully articulate- and that is the fact that, very early in my childhood, my brain learned that focussing on one singular thing or idea was self-destructive and would essentially (and not even hyberbolically) be the death of me, simply because every time I focussed on a single thing or thought about a single idea it was always very dark and dismal. So my brain taught itself a new pathway, and that was to not focus on a singular defined idea, but to think about all sorts of little things all at once - to fragment and subvert, interrupt and divide, explode and implode - whatever it took in order to preserve itself (for which I would like to commend my former little self's brain with a Jurassic Park's 'clever girl' sentiment here). And now, today, this is the very reason I cannot concentrate enough to read the very books that I align my sense of identity with so fervently, and why I cannot decide on what to do about a very simple problem or decision, or why I cannot quiet my mind enough at night to just focus on the idea of getting some much needed sleep. This neural pathway, this Kafkaesque corridor of perpetually redirecting doors, has been so ingrained and so rewarded (by the very fact of being allowed to continue to live) for doing what is has been doing, that it has ensured this pathway be very deeply rooted, essentially assuring it be (and perhaps even irreversibly so) buried, indeed.

And so now, what I fear is happening, is that the dark and deep sadness that my brain taught itself not to focus on when I was little, is becoming terrifyingly close to being able to be concentrated on. rTMS has given me clarity of mind, and this pathway has been rerouted somewhat to allow for a singular line of focus to be actualized, but my brain (recognizing that this line of focus will be very dark indeed) is again trying to forge a different path, another spatial rearrangement of thoughts, so as to not self-destruct once again. And this spatial rearrangement that manifests itself into a noisy and unfocussed mind, again relapses into that familiar pattern of depression. A mental ouroboros, of sorts.

What I need is to somehow convince my brain that that clarity and focus that rTMS can offer does not necessarily mean that it will be a dark lucidity, but at the same time I struggle with this: if indeed the thing that my brain will be allowed to focus on (even if I can teach it to not fear focussing on one particular thing) is really that dark and desperate, how ever can I convince my brain not to reforge this new-found focus into something that essentially metamorphosizes into a confused and noisy redirection of thoughts? What is that dark area, how can I reach it, and how can I make it go away so that my brain does not recognize it as something to avoid?

These were my thoughts this morning, and thoughts that I was hoping you could give me some feedback on, in terms of how the rTMS thesis or subsequent analysis, has imagined or navigated these potential waters.

Thank you once again,

-Nicole

Seriously though. WTF. I have no idea how I would answer such emails. Probably with a variation on "fuck off you nut job". At any rate, I am back here, blogging, to use this forum as a adjunct to other therapy in hopes something finally gives. I'm (carefully) tapering my medication, going to once a week talk therapy, and writing. After all, I'm out of other options. This is the only combo I haven't tried yet. After 20 years of struggling with this with no respite, you'd think I'd finally give up. My therapist calls me stubborn for it. I like that. I'm not sure what this blog will become, since blogging is so different from journaling. There are, of course, things I would never write on here for the public eye. So in terms of how honest, how helpful it can be to me, that still remains to be seen. But for now, let's just do what doesn't kill us.