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Saturday, December 29, 2007

DBT is *hard*

This was originally a reply to the excessively chippy commentary/addendum/rebuttal? left by a Buddhist-Scientologist on MDMA (i.e. "wattsian") after a review of Skills Training Manual for Treating Borderline Personality Disorder. As usual, I said too much and rambled too long. And since little in life sucks with greater force than that of amazon bandwidth published by those who've never laid eyes on the product, I did the usual. . .

I agree w/ gutenberg. I've just started trying to look at a couple of the skills with a therapist I'm fortunate enough to see2X a week, and I can scarcely comprehend a fraction of what we manage to go over together, let alone retain and apply it.

It's all well and good to use active verbs like "to encourage" "to choose" and "to learn", I suppose, when you're not struggling to effectively (conjugate) "be" through the cognitive dulling of a sick brain. Idealist- I certainly agree with you that there's a pandemic of the "worried well" in the US, and it's pretty scary that even some MDs no longer pretend to differentiate between commercial materials and clinical matter. I can bite my tongue when they crack the PDR or the DSM in conversation with me- I'm sure that's a sign of respect in the MD world. The patient feels "ownership" of the diagnosis and complies triumphantly with the prescribed treatment- the full color picture in the PDR and accompanying multipage infotorial agree, no need to disclose that pFarmkobub crafted the entry for Euphidexine and paid a nice sum for the article, with a premium for the indexing. It's hardly a secret that the manufacturer makes a wild claim in order to distinguish its drug from the 5 or 10 novelty-knockoff competitors in its therapeutic class. God forbid, Cymbalta is not an analgesic. Zyprexa is not an anti-depressant. And shyness is not a mental illness. Thank God that little cartoon showed up with a detailed explanation of a simple personality trait can uncover 8 painful symptoms of crippling neurosis, talk with your doctor about Paxil for social anxiety if you checked any of the above. . .

These are the ridiculous diagnosis, those based upon a photocopied 10 pt T-F quiz, with a logo imprinted across the top. The transparency of each new attempt to reword the question "do you have psychotic manic episodes?" is insulting. "No, Abilify-no. I do not fit the template you're marketing to today." I don't know whether the copier had broken in a fit of rebellion against Beck-Inventories, or he was out of sponsored disorders to seek for his samples, but he seemed very certain that denial of mania on the basis of that quiz, cemented major depressive disorder. With nary a glance at my records, where he'd certainly have found some food for thought. (Vanilla misdiagnosed my eating disorder, as well.)

At any rate. . .yes. Treating mental illness is tricky- particularly when there's so very much money to be made on rewriting the diagnostics to include everyone insane and patenting new uses, prodrugs, every imaginable method of administration. What remains is this: serious mental illnesses cannot be willfully righted by those in their grips. True- the brain can change. We surface or reach terra firma, as the case may be, over time or quickly, naturally. It's called cycling- and it's inevitable as ignoring bedtime, and likewise benign for a few. Unfortunately in the trough (and the peak, I'm imagining) there's no mind present to give word form to feeling. There is no thought at all- no joy (but not despair, either), no interest, no attention span, concentration, or indulgence in sanitation/hygiene. Diminishment of all the senses. No hope- it's only at this point (a fairly high point in the cycle) that I experience things I can describe as a feelings (disappointment, disgust, despair, hopelessness, loneliness, boredom, fear, paranoia, frustration, regret, embarrassment) and begin to have some relatively coherent- if uninteresting/repetitive- thoughts. While I'm ruminating on the details of my latest low, I try to shovel a path through the crap that I let accumulate, the junkmail dropped anywhere in the kitchen, laundry strewn around the house, empty wrappers, bottles, vials, bags, cotton balls, receipts, charge slips, appointment cards, sundry toiletries, office supplies, and condiments carpet the bedroom floor. Books. Everywhere. Ignore, for a moment, disasters yet to be recovered from the last emergence. Oh, forget that I haven't finished *unpacking*. There's clean, crumpled laundry in the car. And a can in the kitchen begging for the dumpster. But enough of the filth, what did I *ruin* when I was in this state?

Well, Christmas. This is not the person you want at your holiday table in any event, but devoid of all thought, emotion, and energy, I wasn't even a civil laundry leech.

And. . .my career. Or rather, confirmed its demise through my inability to produce a paper suitable for presentation before an academic audience in time to present it. Or ask someone with the dosh to rent a room at the conference to read it for me. Because I was without thought, interest, or energy. Nevermind attention span and concentration.

Yes, the brain can change. Mine has lost mileage (by almost an entire variable of IQ, if that means anything to you.) I know what I've lost, and I hate that the most.

3 comments:

  1. Not doing them yet, my therapist is skipping around as she's really trying to just introduce me to the concepts/skills that I might be able to use right now. Since it's informal, 1-on-1 setting we can do that.

    But I've seen the DCs before, with an asshat T tried to force me to fill them out without giving me ANY background. . . then berated me for coming back with incomplete cards (because I had no idea what the shit meant.) I know I will not "like" them. And, truth be told, I know I'm not going to be honest on them, either.

    There is stuff that simply not going to be commited to paper or admitted to anyone, period. Last thing on earth I need is someone keeping an eye on my, uh, "out-of-mind-field-trip" habit.

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  2. interesting commentary. i'm anxious to see how useful you find dbt.

    i'm starting a group in a week. wish i could do it 1:1, honestly, but way more cost-effective to do the group. we'll see, i guess?

    re: cymbalta--

    especially not an analgesic that should be prescribed alongside ultram (which actually is an analgesic, but also acts on serotonin). the combo had me knocked out cold for about 18 hours. i pretty much hate doctors.

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