I had a therapy session today to discuss whether to continue therapy. My therapist says that she was recommending ending therapy less because I made ‘wrong’ decision, more because she felt therapy was not helping me and I was moving backwards into a child state that she thought I had moved away from. I agreed that I’m not sure if therapy is really helping, although with psychodynamic psychotherapy it’s notoriously difficult to measure any kind of improvement. I had been wondering whether to try a new therapist with a different approach (although I don’t know what) or a frum (religious) Jewish therapist who might be better placed to help me navigate the Orthodox Jewish community.
Contrary to what my therapist said, I do feel that I am still trying to push outwards, albeit that it is often two steps forwards and one back because, as I’ve said before, the harder I push at the world, the harder the world pushes back at me. My therapist did at least feel that I’m a lot better than I was when I started seeing her six years ago, which is true.
We decided to leave things for a bit. We were breaking for a month or so anyway because of my holiday and then her holiday, so we decided to meet again after the break either to discuss how to continue or to do a proper end of therapy meeting.
That was fairly positive. More problematic was what happened when I tried to get a repeat prescription of my medication. My antidepressant, clomipramine, was not available in the dosage I take at four different pharmacists, due to undisclosed supply problems (the supplier says there is a problem, but not what it is). I take 75mg in the morning and the same in the evening, as a 25mg tablet with a 50mg one. Neither 25mg or 50mg tablets are currently available. 10mg tablets are available, but you can’t take 75mg with 10mg tablets. In theory I could split it 70 : 80, if the doctor prescribed it, but that would involve taking fifteen tablets a day even before my other tablets (four psychiatric medications, one hay fever tablet and four vitamin supplements). I don’t really want to have to take twenty-four tablets a day and I certainly don’t want to have to take all of those to America.
Whatever happens, I have to get a new prescription from the doctor. My GP’s practice seem to arrange their appointment system to prevent people from seeing the doctor (seriously, I think they told one of my parents that they deliberately make it almost impossible for you to get a quick appointment so that you will have to book one in two or three weeks, by which time you may not need it any more and cancel), but I have a note on my record to say I can book an emergency appointment within twenty-four hours if I need to (in case I’m suicidal). I thought it was legitimate to use that here, as I need to sort this ASAP as I’m running out of meds and am away from Sunday, but it turns out the note is not on my file any more. I guess it gets taken off automatically after a while. Which is problematic as I was getting suicidal last week and nearly needed to use it. Anyway, the receptionist booked me an appointment for tomorrow morning, but I did feel a bit like a liar, or that I was stuck in an Orwellian world where I was suddenly an unperson.
I suspect the clomipramine may be out of production, as I believe it’s rarely prescribed these days (it’s an old generation of drug), which is a problem for me, as it’s about the only antidepressant that has ever done much for me. Plus now I may have to go cold turkey over my holiday, which will not be fun. Maybe it’s just as well that it looks like most of the people I wanted to see while I’m in New York aren’t able to see me.
My OCD is still a bit worse, although not as bad as it was eighteen months ago. I think I’ve got it under control, but it’s frightening that it can come out of nowhere, both the kosher food OCD and the pure O (obsession) OCD. I’m trying to remember the CBT coping strategies that I learnt for dealing with the OCD. I think can control it reasonably well these days (better than the depression or the social anxiety, anyway), but it is worrying whenever it returns, especially as some pure O thoughts never really go away completely. It just makes me feel that I’ll be messed up forever.
I know the OCD comes partly from stress and upheaval, but partly from anxiety and guilt about my sexuality. That I feel I have to completely suppress my sexual feelings, which is not easy and probably not healthy. I guess that probably feels into the depression too. Unlike some religions, Judaism is strongly opposed to celibacy, but has no answers for what to do about sexuality outside of marriage other than “Get married young (or remarry quickly if you find yourself divorced or widowed).” It has no answers for someone like me, who is a weirdo freak who no one will marry and who in any case (as I said yesterday) has no contacts in the frum (religious) community to set me up on dates and no confidence for online dating or singles events and certainly not for meeting women casually and asking them out. I’m just an communal outlier no one really cares about.
I’ve been feeling more lonely. I feel that things are never going to work out romantically with E., but I can’t see them working with anyone else either. I find it hard to believe anyone could be as understanding and gentle with me as E. was and even if someone was, I can’t imagine she would be more forgiving of my quirks, flaws and mental health issues (and consequent financial straits) than E. This post I saw today spoke about the power of love to heal mental health issues, but it’s not really something I have experienced much of, or feel likely to in the future. E. was supportive, but ultimately couldn’t cope with my issues (for legitimate reasons); my only other relationship ended partly because my girlfriend expected me to deal with her (undiagnosed) issues, but ignored me when my depression was bad.
It’s hard to know what I want from a relationship. I can’t really imagine what it’s like to be in a stable, loving long-term relationship with someone or to live with someone other than my immediate family, as neither of my relationships reached that point (one lasted eight months or nine months, but was interrupted a couple of times by my girlfriend saying she wasn’t sure she really liked me and could I leave her life for a few weeks while she decided what she felt; my relationship with E. only lasted two months, long-distance the whole time). Being a virgin, I can’t really imagine what a physical relationship would be like either, though it is perhaps a little easier to try to imagine, though what I imagine may bear no relation to what it would be like. I suppose what I can imagine is little things, gentle touch, support, shared jokes, feeling comfortable together. It’s hard to imagine that happening again though and certainly not long-term, as both times it began to happen in the past, the relationship broke down because my partner either got scared or took advantage of the situation.
I feel I’m not coping with living with my parents again either. It’s partly that their behaviour can trigger the OCD, but also just their habits and interactions can be difficult for me to deal with, partly from depression or autism, but partly from just different personalities. It’s mostly trivial things that I shouldn’t really complain about (I guess a lot of people develop annoying quirks as they get older), but (a) it’s hard to live with people who have annoying habits when I didn’t choose to live with them and (b) it makes me feel a bad son/person/Jew who would never be able to live with a wife and kids. Though sometimes I wonder if I am justified in getting annoyed about some of these things. It is hard to know, or to know what I can actually do about them. I know I can’t change them, but at the moment, I’m pushing myself to my maximum and I don’t feel I can change myself to be more patient either.
I guess that struggle to imagine things getting better is how I feel about a lot of things right now. I try to put a brave face on things and for a while I can even genuinely be positive, as I was with my therapist earlier. But sooner or later, the pessimistic voices start again. “Do you know how few people with treatment-resistant depression achieve sustained recovery?” (fewer than half, apparently). “Do you really think you can fit in to any workplace with all your issues?” “How could anyone ever care for a freak like you – and if she did, how would you actually meet her and talk to her in the first place?” As I’ve said before, CBT didn’t work for me because it tries to get the depressed person to find evidence against their negative perceptions of themselves and the world, but the evidence seems to indicate that my perceptions of the world are all actually true (my self-perceptions perhaps less so).