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Unsure of what to do; does psychiatry have anything left to offer me?

OboroOboro __BANNED USERS regular
edited June 2008 in Help / Advice Forum
Up until five days ago, I lived in comfort in North Carolina. My basic needs were provided for there, but I had to put up with an emotionally-abusive and overly-constrained environment that drove me to -- for the second time -- drive to New Jersey knowing full-well the only thing I had in front of me was a life lived out of a car.

Prior to living in North Carolina, I lived in New York; while I lived in New York, I was committed to a mental hospital in New Jersey. I was, however, released prematurely -- I had no concrete discharge planning and every medication I had been put on was still at subtherapeutic levels. There was harassment/assaults from other patients and I phrased my complaints in the form of, "I think I could get better care outside this hospital."

So, I left the hospital, but I didn't seek the care. I impulsively bought a flight out to North Carolina, where my family lives, and tried to hold the straight-and-narrow. I got laid off. I couldn't get a job after that. The side-effects combined with the lack of results from my 'medications' led to my psychiatrist -- in New York, over the phone -- telling me to just go off them.

Living on the terms I have been in New Jersey for even just the five days has been utterly miserable. I'm too stressed to have a bowel movement, so I have terrible cramps. The only sleep I get, whether in my car or elsewhere, is so stressful and in such fucked-up situations that I'm constantly exhausted. Shit hit the breaking point last night and I resolved to leave for North Carolina again this morning:

but I couldn't make it. I drove in wide circles for two hours, hyperventilating and hitting my steering wheel and crying. I don't want to go back to North Carolina!!, and apparently I really mean that -- even given the alternative. After making slight progress (I actually got on the right highway and held on it without taking the immediate turn-off), I noticed a sign for Summit -- the town I'd previously been hospitalized in.

So, I went, and I asked for an assessment. I refused to answer questions pertaining to self-harm/thoughts of self-harm and substance abuse because I wanted to avoid compulsory committal. The woman giving the assessment wasn't able to offer me much and eventually we closed on the fact that it was my choice whether I went in or not (well, and my insurance company's, who probably wouldn't enjoy seeing a second request at the same hospital just over a month after the first). I walked away.

I figured I could see my former therapist either pro-bono or at the fee he stated -- I figured that he would be able to give me a professional opinion of whether or not a hospitalization would benefit me, or if I should just somehow force through the 600 agonizing miles back to a place so emotionally untenable that it has convinced me on multiple occasions to steal away onto the literal streets. That is preferable. Judging from my experience on the highway today, it's preferable on some channels that I can't even argue with very effectively.

I'm not medicated but previously have been diagnosed with conditions that 'necessitate' medication; this is to say, I could essentially guarantee a hospitalization on the basis of a 'medication adjustment.' What I don't know is if this would do anything for me; if the diagnoses have been correct; if my situation could at all be served by more time spent in an acute care facility. For the purposes of facilitating the discussion, those diagnoses have spanned: gen. anxiety major, gen. depressive major, bipolar 1 major recurring with psychotic elements, schizotypy, and the stuff further off Axis I like PTSD.

I don't think the details omitted -- the actual family issues -- are so relevant to be pertinent. I have a history of H/A threads which would detail them, anyway. What the question comes down to is thus:

Are my problems so suggestive that they suggest a hospitalization is a good idea? I have the leverage to get myself committed, but it's a toss-up how my paltry insurance will respond: they choose to handle hospitalizations on a case-by-case basis so far as I can tell, and there are plausible nightmare-scenarios that arise from my making the case that I need to be committed and the insurance refusing payment [on that particular hospital/treatment course].

And of course, there's the additional problem that this hospital would still be 600 miles away from where I 'live' and discharge planning would somehow have to center around that locus.

Also, I don't need you to play the, "Oh, you're so eloquent, you are obviously intelligent and 100% capable of doing everything on your own!" card. If you want to make the case that sometimes people do stupid things because of stupid circumstances, and maybe my circumstances match those, and maybe I could get through this on my own based on that, that's different. I've had H/A threads get derailed before though because I could summon proper grammar and spelling while feverishly hammering away at my laptop.

Yes, if I were having an acute breakdown I probably wouldn't be able to type so well and yes, short-term hospitalization is most often used to address acute situations. Regardless, I'm considering the possibility because, frankly, I don't know what else to do and there must be some part of me that sides with it since I went to that hospital to start with.

I've been on seven different medications to date. Some of them I went off against-medical-advice, so maybe those ones were working or could work again. I've also been hospitalized three times and seen dozens of professionals, although most just turn me away as a case 'beyond their expertise.' I don't know if there's any point left pursuing the ideas of mental ill-and-wellness.

words
Oboro on

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    TrowizillaTrowizilla Registered User regular
    edited June 2008
    If the facility you've already tried was so unhelpful, perhaps you could seek help at a different hospital. It does sound like you could use some time to stabilize and possibly get your medications straight. After that, I'd recommend you try social services, particularly disability; if you're not able to hold a job, you should be able to qualify.

    Given your previous posts here, you clearly do need help. I'm not sure you could ever really be "cured," per se, but I suspect therapy and possibly medication could get you to a point where you could deal with things better. Even getting the PTSD and anxiety, if not "under control," "better controlled" will help a great deal. I really do hope you find something that works for you.

    Trowizilla on
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    zerg rushzerg rush Registered User regular
    edited June 2008
    You're doing pretty good.
    I remember when I had failed out of college. I couldn't hold down a job, didn't have any friends, didn't do anything, and had various untreated psych conditions. Looking back on it now, those are some pretty fucking good problems to have. Your life might seem like shit to you, but it's actually pretty good. You've got a car, a laptop, and the clothes on your back. You are in the prime of your life, you earned a High School Diploma, and you live in 21st century America. You don't need to worry about dying by a lion attack, you don't need to worry that some Visigoths are going to invade and kill you, you don't need to worry about getting sent to a death-camp, and you don't even need to worry about starvation. No matter what, you get to keep on living. That means your life is pretty good.


    I'm not here to belittle your problems; they are both real and serious. However, your situation is not unique and many of us have gone through similar. The thing you need to remember is that it is up to you to choose to change your life. Fuck hospitalization, fuck medications, fuck everything else. None of that will do shit until YOU decide you want to be better.

    Psychiatry isn't a magic pill that will make you normal. If you commit yourself with the idea that it will cure you through no effort of your own, then of course it will fail. However, if you dedicate yourself to turning around your life, then psychiatry could be able to help you immensely.

    zerg rush on
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    ceresceres When the last moon is cast over the last star of morning And the future has past without even a last desperate warningRegistered User, Moderator mod
    edited June 2008
    Given that not many of us really know the full circumstances surrounding the post (although some of us may have better ideas than others), you're going to get some very varied advice here.

    Knowing what I know, I'm going to say that I think maybe you should give hospitalization another shot at a different hospital. The thing is... even if you do that, you're going to really need to work at making things better for yourself. No one else can really do that for you. Medication will help, but it still can't do all the work.

    Are you here to tell the world that you're really ready to give it a shot this time, or are you fishing for an excuse to give up on one more thing, when you go into it expecting either miracles or failure? You need to be worked up to therapeutic dosages over the course of several weeks or more; they can't just slam you into your final dosage levels your first day. Tweaking that takes time and you know it.

    Even with medication - even with many medications - the conditions that you've described just now and in the past are daily struggles for the people who suffer them, and live with them. If you don't want to keep driving yourself (in more ways than one) back and forth from North Carolina to New Jersey and in circles in some kind of horrible car-pong, you're going to have to go to a psychiatric facility and stay there until you've worked things out. Do your homework, and find one that has good things written about it and will satisfy you with a tour of the facility beforehand, and work at getting better. Work at functionality, and putting your life back together. Be honest with yourself and those around you while you're there so you can get through this, because otherwise nobody will know how to help you.

    I won't tell you not to be afraid, because it's scary, but I think it's also necessary. Make a commitment to give yourself an honest chance. Once you decide you want to get better no matter what the cost, I think you'll come out the other side and be really okay.

    ceres on
    And it seems like all is dying, and would leave the world to mourn
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    TubeTube Registered User admin
    edited June 2008
    You're never going to find psychiatry useful while you insist on trying to fuck with the therapists, in this case by "refusing to answer questions" in order to avoid compulsory commital.

    You should absolutely be in the hospital. Absolutely. I will brook no debate on this because no one in possession of even a modicum of the facts should be able to deny this in good conscience.

    Tube on
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    poshnialloposhniallo Registered User regular
    edited June 2008
    I agree with CT. I've hardly ever talked to you, Oboro, but I've seen the way you post, and I am fairly familiar with mental health issues (family problems and professions), and you seem to be denying your medical needs.

    You clearly don't trust doctors enough to be honest with them. I've never known a doctor who sectioned (that's what we call it in the UK) someone without being very careful and without good reason. You are messing up your treatment options by, frankly, making poor decisions due to having mental health problems.

    poshniallo on
    I figure I could take a bear.
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    The CatThe Cat Registered User, ClubPA regular
    edited June 2008
    You may not like the hospital environment, obo, and fair enough because its full of sick people, but even with the negatives that are an inevitable part of the modern mental health institution, its still the best place to get help. No-one outside is really equipped to give you what you need. You just need to ask for it, knowing that the good will outweigh the bad. That means no more bullshitting the staff - they can't read your mind, they don't know how to help you properly unless you tell them exactly what's going on.

    You've tried everything else, and lets face it, this absolutely can't be worse than what you've already been through.

    The Cat on
    tmsig.jpg
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    AldoAldo Hippo Hooray Registered User regular
    edited June 2008
    Yes, you need hospitalization, Oboro.

    Stop lying to the professionals being paid to help you, no one will be able to help you unless you allow them to try their best.

    That is pretty much all I can say, we all know that you have practically zero good luck in life, but there is no way you can turn the tables if you don't put your everything into it.

    Aldo on
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    RocketSauceRocketSauce Registered User regular
    edited June 2008
    Oboro wrote: »
    For the purposes of facilitating the discussion, those diagnoses have spanned: gen. anxiety major, gen. depressive major, bipolar 1 major recurring with psychotic elements, schizotypy, and the stuff further off Axis I like PTSD.

    I work as a Case Manager at my local mental health center, and work with clients who have one, or more of those diagnosis. If you're bipolar with psychotic elements, I don't understand why you're not on your medication. I'm assuming you're an adult, and it's your choice, but I think that might be part of the problem.

    If your medication isn't helping, go in for a med eval and see if you can't get it changed around. Also, if you've been diagnosed with PTSD, and depression, why aren't you seeing a therapist regularly? Was it not working? I'm sure at this point you're aware that you can request a change of provider, and hopefully find one that will fit. I work with a lot of therapists, and I know it can be hard to find a really good one.

    RocketSauce on
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    Regina FongRegina Fong Allons-y, Alonso Registered User regular
    edited June 2008
    Just to echo what some others above ahve already said Oboro, you know you need help, but you continue to try to manipulate the healthcare folks who you deal with in an attempt to retain control of your situation. That won't work out in the end. You're not going to receive satisfactory mental health care while refusing to let anyone in your head (who can actually help you or do anything).

    Regina Fong on
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    OboroOboro __BANNED USERS regular
    edited June 2008
    I used to see a therapist regularly, when I was ... 16-17? That's almost four years ago, now. He and I had a good working relationship but I think deciding to go off my meds (Depakote, Risperdal, Lexapro then) combined with an ill-fated attempt at family therapy together drove a wedge between things. Once I graduated high school I began the cycle of constant needless travel that's dominated my life since.

    "I'm not stable enough," is both a really poor and a really good excuse for not having a regular therapist. The combination of elements in play has made it almost impossible to find one even while living somewhere that isn't a car: I've spent upwards of six weeks trapped in unending referral loops. A lot of therapists are uncomfortable taking on a patient with a history of 1) mental illness severe enough to have required multiple hospitalizations, 2) a history rife with trauma, 3) substance abuse issues, and 4) transsexuality. Despite that 4) is in the DSM-IV, and the provisions that I and other transpeople abide by for care is in part dictated by that, there's a shitload of therapists and psychiatrists out there who at best feel unqualified -- I've had no short of ones that didn't even know what it was. Forget the ones who just think I'm describing a fetish.

    The recent salvo of medications (Lithium, Lamictal, Zyprexa, Trazodone) was littered with side effects and didn't leave me feeling any better. Like I said, my New York psychiatrist told me to just go off everything [bar the Trazodone, which I need for nightmares and related panic] in that group so I don't know.

    I've looked at hospitals different than the ones I've been to before and I'm inclined to believe my Provider Directory is wrong since it lists New Jersey state hospitals as not accepting federal New Jersey insurance. Granted, it's not Medicaid, but if all they take is that, I've been told I'm eligible. I don't know.

    This is already becoming one of the things I attempt to do where the only 'checks and balances' are you guys, some friends on an Internet forum. There's a lot of rigmarole and information and missing information here and I have no idea what to do with it. Phone calls are scary, but I'll get around to one or two today. I'll take it at the necessary pace, since, well, I'm the only involved party and the only one who can do anything at all.

    So. I'm working at what we think is necessary. I'm looking at the hospitals, I've got phone numbers and addresses, I just need to write down answers to the inevitable questions so I don't choke up and hang up on people.

    re: the manipulating the system comments, I don't have a good excuse for this. I just get really worried when things start to slip out of my control, so if that starts happening I'll start reframing things so that my rights aren't compromised. I don't trust the psychiatric system nor do I trust most of the people that I meet through it. A fifteen-minute assessment isn't enough to assess their trustworthiness. :|

    EDIT: To clarify, I don't mean the paragraph about therapists and I not working out previously as a way of brushing off that avenue of approach. Just ... one thing at a time. v_v

    Oboro on
    words
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    RocketSauceRocketSauce Registered User regular
    edited June 2008
    Oboro wrote: »
    So. I'm working at what we think is necessary. I'm looking at the hospitals, I've got phone numbers and addresses, I just need to write down answers to the inevitable questions so I don't choke up and hang up on people.

    re: the manipulating the system comments, I don't have a good excuse for this. I just get really worried when things start to slip out of my control, so if that starts happening I'll start reframing things so that my rights aren't compromised. I don't trust the psychiatric system nor do I trust most of the people that I meet through it. A fifteen-minute assessment isn't enough to assess their trustworthiness. :|

    Look at it this way, if you're a danger to yourself or others, you won't have a choice to be hospitalized or put on medications. You've got a lot of choices at this stage, and the decision is up to you. If you had a broken arm, would you go to the hospital to get it fixed, and take medication? Of course. Mental health is the same thing, you just can't see it.

    I don't know how your state or county is set up, but they probably have an adult program where you could get set up with a Case Manager, who could help out with getting a steady job, a place to live, managing your anxiety, etc.

    RocketSauce on
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    ceresceres When the last moon is cast over the last star of morning And the future has past without even a last desperate warningRegistered User, Moderator mod
    edited June 2008
    Oboro wrote: »
    re: the manipulating the system comments, I don't have a good excuse for this. I just get really worried when things start to slip out of my control, so if that starts happening I'll start reframing things so that my rights aren't compromised. I don't trust the psychiatric system nor do I trust most of the people that I meet through it. A fifteen-minute assessment isn't enough to assess their trustworthiness. :|
    It's good that you can admit this, but I also think it's important to note, and important for you to see, that you are not in control right now. The things we're talking about, like finding a hospital, are steps you can take to get it back. I've been watching your life roller-coaster and spiral for 2 years now. I still want to see you on a healthy track.

    ceres on
    And it seems like all is dying, and would leave the world to mourn
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    LewishamLewisham Registered User regular
    edited June 2008
    ceres wrote: »
    Oboro wrote: »
    re: the manipulating the system comments, I don't have a good excuse for this. I just get really worried when things start to slip out of my control, so if that starts happening I'll start reframing things so that my rights aren't compromised. I don't trust the psychiatric system nor do I trust most of the people that I meet through it. A fifteen-minute assessment isn't enough to assess their trustworthiness. :|
    It's good that you can admit this, but I also think it's important to note, and important for you to see, that you are not in control right now. The things we're talking about, like finding a hospital, are steps you can take to get it back. I've been watching your life roller-coaster and spiral for 2 years now. I still want to see you on a healthy track.

    Yep. By lying to others, you're lying to yourself about how things are going for you right now. And things are not not going great. Definitely investigate your options, find something that works for you.

    People can't help you if you try and stop them. Doctors ask good questions for good reasons, they're not tricks. The sort of questions that are going to get you involuntarily committed are there because they think it would be a really good idea if you were in there getting help. Let's face it, it's more work for them if you are in there, and no-one wants more work :)

    Honesty is going to be the best policy.

    Lewisham on
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    FeralFeral MEMETICHARIZARD interior crocodile alligator ⇔ ǝɹʇɐǝɥʇ ǝᴉʌoɯ ʇǝloɹʌǝɥɔ ɐ ǝʌᴉɹp ᴉRegistered User regular
    edited June 2008
    Therapy is like going to the gym. You get out of it proportionally what you put in.

    That applies to therapists, psychologists, psychiatrists, hospitals, or any other mental health professional.

    Feral on
    every person who doesn't like an acquired taste always seems to think everyone who likes it is faking it. it should be an official fallacy.

    the "no true scotch man" fallacy.
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    JohnnyCacheJohnnyCache Starting Defense Place at the tableRegistered User regular
    edited June 2008
    You don't have to chose between Jersey and North Carolina. If you're an adult, go someplace else. You only have to make enough money to fill your tank, and you can avoid any hot water for "vagrancy" or any of that crap by parking at walmarts or paying the small fees to car-camp at state parks or KOAs.

    You do not have to choose between two environments you hate. You need to consider the degree to which that artificial constraint is part of your pathology.

    And just remember, all the time, that you're young and you're alive and there are things out there worth being alive to see. One moment of love or transcendence can redeem a long stretch of misery.

    I understand why you don't want to be committed. I don't blame you at all for that. You need help, somewhere. Maybe from some people who've been through what you're going through...at least they could recommend a doctor that doesn't think you have "a fetish"

    JohnnyCache on
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    RamiusRamius Joined: July 19, 2000 Administrator, ClubPA admin
    edited June 2008
    I guess it is convenient that we have a professional Case Worker on hand, and I guess somebody here has family members in the medical health profession and someone else might work in healthcare in general, but goddamit oboro, this is a Webcomic Forum. Just because you have found our community to be accepting or understanding is no excuse to be turning to us for advice in what seems to be a critical juncture in your life. You need professional help. I'm not trying to make the obvious point that our advice here shouldn't be seen as a substitute for professional help, I'm saying that our advice should not even be sought as a supplement to professional help. You are making a bad decision by turning to us for help. We cannot help you in any meaninful way. We can continue to be accepting and understanding, but those things will not get you well.


    Now, apparently you are having a hard time finding a professional who has a successful track record in treating your particular set of issues, and I'm sorry to hear that. But I don't think anyone here can recommend you that particular therapist that you need. Maybe there are some other places on the internet that you could look. Maybe you need to start with a phone book and some support groups and some case workers. I don't know. But I know this: You need help that we cannot provide you. Please go and get it. We will still be here afterwords, and we look forward to hearing from you when you are well. Every minute you spend at these forums is a minute wasted that you could be spending in a more productive search for the persons or institutions which will be able to successfully bring your life to a state of normalcy.

    Ramius on
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    poshnialloposhniallo Registered User regular
    edited June 2008
    I feel that what Ramius wrote almost shouldn't be touched. Perhaps he should lock the thread? (if Admins can).

    However, what JonnyCache said reminded me of something I thought, which is that you'll probably never be happy with the attitudes of psychiatrists towards your transgenderism. I think you're using that as another excuse to avoid doctors. If your feelings towards your own TG-ness were stable and healthy, it wouldn't be a factor in your problems. As you say that it is part of your problems (and mention the DSMIV) I would say that your feelings on it are complex/mixed/unhealthy enough that you'll never find a therapist who perfectly mirrors your attitudes.

    poshniallo on
    I figure I could take a bear.
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