Some of you may remember that at my last physical my doctor suggested I get back into therapy and see a psychiatrist. I am back in therapy, making progress, and this past Monday I finally met with a psychiatrist.
I've been both eager and anxious about going. I was eager to feel better and had hopes that she could help me. And I was very anxious about the medicinal roller coaster of trying new meds until we find something that works or give up in failure. But I trust my doctor and had a good recommendation for this psychiatrist. So, off I went.
It was kind of like going to therapy with a doctor. Lots of psychological and medical questions. She took an extensive history and asked follow up questions about my life and behaviors. The history part took about forty-five minutes. I'm telling you, she asked questions I've never been asked. And considering my therapeutic and medical history, that's saying something. Some of these questions sparked thoughts I hadn't had before. They changed my perception.
She asked about my sleeping habits. I don't sleep well. I haven't for years. I gave a description of my typical bedtime, rising, and nap habits. She asked me to quantify it. In a twenty-four hour period, how many hours do you sleep? I'd never quantified it before. I knew my habits were bad. I knew I should be getting more sleep. But until she had me add it up I had no idea that I was sleeping only 4-6 hours on a regular basis, including naps.
She asked about my eating habits. Ugh! I hate this topic. I described my general aversion to food and my typical eating patterns. I knew I didn't eat well. I had no idea how bad until she asked me to quantify it. Do you eat enough to sustain life? Calorically, probably. Nutritionally, not even close.
Having someone ask that and having to admit how badly I was failing was eye opening. But not as much as her next statement. Earlier in the interview, we'd discussed my history with self-harm. I'd explained that I hadn't purposely hurt myself for over a year, except for once after a particularly difficult therapy session.
She said that sleep deprivation and starvation are forms of self-injury (common with a history like mine).
Now, I don't know if that hit you hard, but it hit me hard. I had never thought of those behaviors as self-harm. But after considering it for a few moments I realized that she was absolutely right. It didn't mean I was converted and ready to change in that instant, but it made an impact.
She also said that sleeping during the day is a self-soothing strategy. An unhealthy one.
Again, not something I'd thought of. (After thinking of that and the other bomb shell I spent a lot of time over the next few days wondering why I am self-injuring and self-soothing my way through my life. I guess I still have lots of work to do.)
She said she wouldn't think of trying meds until I start sleeping. So many of my symptoms could be sleep related. Also, she'd like to build on success rather than failure. In other words, let's try something we know will help instead of working our way through things that might not. Once we fix the sleep problems we can see if we still have things to work on.
Of course, she doesn't simply want to work on the sleep problem. That's just the beginning. Basically, my life is in complete overhaul. She wants me to change several of my behavior patterns. She was very direct and specific. She said I am well on my way to an eating disorder (something I'd actually considered before). And then she gave me the following goals.
* I am to eat three meals and three snacks a day, on schedule.
* I am to sleep 7-8 hours a night, going to bed and getting up at the same time each day -- zero naps! (Melatonin is allowed)
* I am to drink 96 oz. of water a day.
* I am to walk at least 20 minutes a day 4-5 times a week.
* No soda after 3:00pm, as the carbonation interferes with sleep.
Having her spell it out so definitively is helpful. No thinking on my part, just follow through. She set standards. It's my job to do my best to meet them. It was also helpful when she told me that changing patterns like this can take 3-6 weeks. You see, I've done it for a month at a time before and seen no change. It helped to have a time frame.
I agreed to do my best. I will go back and see her in two months. She also ordered a sleep study; I meet with that doctor next week.
She works in the same office as my therapist. I saw him a couple of days later. I am not exaggerating to say that he was tickled pink with how well it went and that I was taking it seriously. He said only about 30% of patients follow through with a plan like this. They both also agreed that whether these changes take away all my symptoms or not, they will help my therapy to be more successful. I know that's true. Therapy always goes better when I feel better, especially when I have the energy needed to maintain boundaries.
I expected sleep to be the toughest one. It's not. Not by a long shot.
Walking is tough because I have a bit of a social phobia thing happening right now. The idea of going out and walking through my neighborhood makes me anxious. It doesn't mean I won't do it, but it's tough.
The water has been relatively easy. A lemon Propel Zero packet in my water bottle and I'm good to go. It's also cut way down on my Diet Coke consumption. I am making a lot of trips to the bathroom, but that is supposed to level out over time.
The biggest difficulty for me has been food. I really had no idea it could possibly be so hard to eat. I eat every two and a half hours now. Meal, snack, meal, snack, meal, snack. I have to set an alarm on my phone to keep myself on schedule. I try to make healthy choices, but I'm not working super hard on balance throughout the day yet. Right now the goal is to teach myself to be hungry and respond to it.
I did okay for the first few days. I ate on schedule. I made healthy choices. But it got harder yesterday.
It was time to eat lunch. I went to the kitchen and tried to find something that looked good. Nothing. So then I looked for something that would meet the basic needs of a meal. I ended up choosing a peanut butter on wheat sandwich and yogurt. As I took my first bite I started crying. I desperately didn't want to eat this food. It didn't taste bad, I just didn't want to eat it. I forced my way through. It was hard just to open my mouth and put the food in. I sometimes gagged as I swallowed. And I cried the whole time, but I did it. Then I was super nauseous afterward. For several hours.
The high and determination I felt those first few days seems to be gone. Now it's just a chore. It's so hard to find food that I like. It always has been. I prefer somewhat bland food with few ingredients. Today, as I make up the grocery list, I find myself struggling to think of things to put on it that I will eat.
It sucks. It seems like I spend my whole day thinking about food. What am I going to eat next? With all these changes I'm working on, I'm struggling to even think about anything else. I'm not taking on anything new or making any other plans for a while. I just don't have the time and mental energy to do one more thing.
But I am doing my best. I have always been one to do my homework. I just hope it's worth it.
To see how it was all going a year later read this.