Friday, July 15, 2011

More notes on psychosis



I started the Electro-Convulsive Therapy (ECT) in the first place because I was growing more desperate to end my life.  I went in-patient because we thought it would get the treatments started faster.  I remember being incredibly hungry because I wasn't allowed to eat or drink before my treatment, and one day they didn't get to me until 11am.  I said I would give ECT 2 weeks and if it didn't help I would kill myself.  
Since ECT induces a seizure I had to stop taking my regular gabapentin and Klonopin because they inhibit seizures.  Instead they put me on Requip to control my restless legs.  Requip is a dopamine agonist, meaning it stimulates the dopamine receptor, which probably contributed to my psychosis.  The also put me on Doxepin, which is a tricyclic antidepressant that has a sedating side effect, but it may have been activating in my case.  It makes you sleepy, and can make one delirious.
I got dehydrated from vomiting, which could have concentrated the levels of the medications in my blood and contributed to the problem.

  • I thought i was dreaming, but the dream was taking way too long.  I kept waiting to wake up, kept trying to wake myself up.  Thinking you are in a dream is a psychotic symptom. 
  • When the doctor determined I was psychotic and needed to be in the hospital I couldn't control my hands well enough to connect my pen to the paper to admit myself voluntarily, but they admitted me anway. 
  • I opened my eyes and could only see a sliver of the scene, having my focus caught between my hands in front of me and the scene beyond - I couldn't adjust the focus of my eyes for depth perception.  My family reports I had my eyes half-closed for several days. I thought it was night when it was day.
  • I was caught in a non-responsive catatonia.  "Catatonic disorders are a group of symptoms characterized by disturbances in motor (muscular movement) behavior that may have either a psychological or a physiological basis. The best-known of these symptoms is immobility, which is a rigid positioning of the body held for a considerable length of time. Patients diagnosed with a catatonic disorder may maintain their body position for hours, days, weeks or even months at a time. Alternately, catatonic symptoms may look like agitated, purposeless movements that are seemingly unrelated to the person's environment. The condition itself is called catatonia .
    A less extreme symptom of catatonic disorder is slowed-down motor activity. Often, the body position or posture of a catatonic person is unusual or inappropriate; in addition, he or she may hold a position if placed in it by someone else."
  • They gave me some medication in applesauce, from a spoon, and I became more animated.  My brother the psychiatrist says my thoughts were racing too fast to be expressed, and the medication slowed them down.   Once I started getting treatment with Klonopin (Clonazepam) I started to be able to feed myself.  When it wore off I went catatonic again.  They had to titrate the Klonopin at a higher level - 0.5mg three times a day - it was a lot.  
  •  I moved my hands quickly in circles, then clasped them to show I felt stuck.
  • Whenever Otto came I would get more alert and happy.   He played music for me on the iPod, and got me dancing and singing, even though I couldn't speak.
  • I couldn't use the restroom alone.  My  mom had pull down my pants and sit me down on the toilet.  They turned on the water to get me to pee.  
  • I emitted high-pitched giggles that were apparently quite disturbing.  
  • I held my hands stiff in front of me.    I exhibited 'waxy flexibility,' remaining in positions other people put me in.
  • I drew a maze and wrote 'what am i doing here?'
  • I couldn't pass a basic mental status exam - I couldn't keep track of where I was, the date, the season, or the time.
  • Nurses kept asking me how I was, and I couldn't answer.  I couldn't make any words come out.  I would nod yes or no but somehow it came out in reverse, like:  Jessica, do you want to go outside?  Me:  thinking yes, but shaking my head no.  
  • I kept sliding down in the chair, almost falling out, then would push myself back in, so my father put his knee in front of my knee to give me a guide.  My glasses also kept sliding down my nose.  I couldn't coordinate enough to feed myself for a few days.  I couldn't walk in a straight line either.  I remember rubbing my thighs and not having full sense of feeling in my fingers or my feet.  Standing up was a trick, as was sitting down.  I kept getting hair in my mouth.
  • I sought ways to tether myself to reality, to prove I was alive by associating with things I could recall as familiar from the real world.  Things like ordering sandwiches from the restaurant Bread and Cie, or eating sushi, or thai food - the familiarity of the food helped me orient. 
  •  I used my email and web pages to prove to myself that I was alive - I was catatonic, but was able to remember my gmail name and password!  Email ritual habit cuts through psychosis.  Then I remembered my website  (http://jessicafhirst.com/)!  I had external proof I existed!  I did research on myself - watched all my videos, looked and my postings, and 'got to know myself' again from the outside.  I wanted to wake up and get back to life because it looked like I had some interesting things to do - I got notice I was invited to a residency, and I wanted to make sure it was real.
  • Once I started to suspect I was NOT dreaming, I had to find ways to prove I was alive, in the world, that things were happening, or that I could control what was happening, in which case it would be lucid dreaming.  I thought I was in a boring version of the movie Inception - instead of explosives and folding over skylines I was trying to manipulate what kind of dessert I would get served. 
  •   The only ways I felt alive were to be in motion, to walk in cirlces, to kiss Otto, or to pee.  They had me pee in cups and funnels a lot.  They kept wanting reports on my bowel movements.  
  • I vomited at REI, perhaps from food poisoning, perhaps from a virus.  
  • There were things I thought were dreams that apparently were real.  For instance, a man with a plastic bladder and catheter coming out of his zipper, just sitting in public as it filled up.  There was a very round large young woman with short hair who was constantly yelling - I pictured her like the Queen in Alice in Wonderland.  Apparently she was real too.  Yelling about her parents being mean to her.
  • "We're going to get you good medicine.  You're safe"  my brother tried to reassure me.  He got me transferred 'against medical advice' from one hospital to another, because the doctor wasn't adequately treating my psychosis and catatonia.   



Thursday, July 14, 2011

Empty


I am having a crisis of emptiness
of lack of creativity
the faucet that used to be always flowing with ideas and images has been
turned off
and I can't get it to open up again
I feel stuck inside myself
Dry
Dried out
But not like a raisin, which has become something else with flavor and character
more like an empty seed pod that can
recollect a time when it used to hold a seed
a seed that could grow in a million different ways
but now is just
empty
Earlier today Otto tried to help me get started again
He put me to work with some empty plastic bottles,
started recording my audio and taking pictures
I felt impotent
I couldn't bring myself to do anything besides
crush the bottles
Then he told me to get in the bathtub
He sprayed me with shaving cream and dumped
'clean' garbage on my head
I yelled in disgust and anger
He didn't make me want to make anything creative
He just made me mad
So now I've spent the rest of the day
depressed and stinking of shaving cream

Tuesday, July 5, 2011

Electro-Convulsive Psychotic Catatonia

Yes, you read right.
I recently resorted to ECT, or
Electro-Convulsive Therapy,
out of desperation to rid myself of the continuous desire
          to be dead.
In ECT they anesthetize you, paralyze you and then
        shock your brain.
The best I can understand is that it's similar to hitting
          CTRL-ALT-DELETE
when your computer freezes up.
It restarts your brain, sort of.
The good news - it made me feel better about being alive.
The bad news - it mixed up and erased a lot of my memories from the surrounding days,
AND
due to some combination of stopping one medication and
starting another,
being dehydrated from vomiting due to food poisoning, and
who knows what else, I became
psychotic and
catatonic
after the third treatment.
Those words get thrown around casually,
as in
"I felt catatonic the morning after that big shin-dig" but
I was psychotic and catatonic in the
        clinical sense of the terms -

detached from reality, stuck inside my head
a little help from Wikipedia:
People experiencing psychosis may report hallucinations or delusional beliefs, and may exhibit personality changes and thought disorder... this may be accompanied by unusual or bizarre behavior, as well as difficulty with social interaction and impairment in carrying out the daily life activities.


I suffered from the delusion that I was dreaming, and I kept
 trying to wake up.
I fell into a "distorted or nonexistent sense of objective reality." (Medical Dictionary)
Meaning that I forgot who I was, couldn't feed myself, and couldn't see clearly -
I had something like tunnel vision, and often felt I was seeing things 
                   in the dark even during the day.
They tell me I had my eyes closed or only half-open for a few days.
I had a roommate in the hospital named Alexa, but I couldn't comprehend that fact and thought I was both Alexa and Jessica, 
          or that nurses were getting my name wrong. 
 I just saw her as a shadow in the corner of my room, and I was afraid of her.


I wasn't sure I existed in the real world,
yet when my boyfriend sat me in front of a computer I
robotically typed my username and password
and checked my e-mail - 
so strange, that I was mostly out of this world and yet
I could check my e-mail,
an action sufficiently habitual that it 
broke through my psychosis.
I had a break-through some time later when I remembered the address of my web page,
and looked at it as though learning about a stranger - 


My brother took a video of my mother feeding me with a spoon and I have my eyes closed and am slurping like a little bird.
I was also holding my hands like claws in mid-air above my lap,
which is a part of catatonia called 'waxy flexibility'
My brother could put my arms in a position and I would stay stuck there.
I would stop halfway down to a chair 
or the toilet
and need to be pushed the rest of the way down.


A little more help from the online medical dictionary:
"In catatonic stupor, motor activity may be reduced to zero. Individuals avoid bathing and grooming, make little or no eye contact with others, may be mute and rigid, and initiate no social behaviors. In catatonic excitement the individual is extremely hyperactive although the activity seems to have no purpose."


I must have had aspects of stupor and of excitement, because I kept 
running my hands over my thighs, and moving as though I were
 putting on and
 taking off pants 
from a seated position.
I didn't bathe for several days and my mother finally put me in the shower to rinse me off because I stank.  At least that's what she told me -
I can't remember.
I don't remember most of what happened in the days surrounding the ECT, or my psychosis.
I thought the dream was lasting much too long and I
couldn't wake up.


I thought I had imagined the existence of the doctor who performed the ECT - 
I couldn't recall having met him, I thought he was part of my dream.
I couldn't speak - couldn't form words and say them out loud.
This doctor didn't get it, he really didn't 
get it.
"Jessica, you have to talk or I can't help you,"
he said, as though my silence was voluntary
and deliberate.

Monday, April 11, 2011

I haven't been able to write lately I've
not really been able to think
the pills have plugged the holes in my head that
let in the gremlins of self-destruction
but those same holes seem to have been the ones that let in
air

so my creativity is suffocated
wilted
I'm used to having more ideas and flights of inspiration than I can usefully develop
and now there's a roaring silence and overwhelming
emptiness
a flatness

I don't feel like myself and I certainly don't feel like an
artist
I am trying to appreciate the absence of the urges to
hurt myself,
 the fading of the wish to be dead
but I'm caught up in anxiety about not having the wish
to do
or create
anything

Saturday, March 12, 2011

this tide


every afternoon lately it 
rises within me this
tide
(can I compare it to that?  is it an adequate metaphor?)
of despair.
it sounds melodramatic but
it's true
i'm having daily ebbing of my will to live
i can't tell if it's
 a pain soaking me
 or
all that is good and alive getting
squeezed out
i just know I'm left
desolate, rough, cratered

while passing through these extremes
I want to die,
or truthfully, I just want to be dead
the dying sounds too painful 
I am trying so hard to remember how good it felt to
eat breakfast this morning or how
simply delightful it will be to
slide under the covers tonight
I am trying so hard to remember that
 the tide changes direction,
goes from unbearable to
merely painful to
sometimes lovely

Monday, March 7, 2011

more thoughts on being the sea



I feel buffeted by forces more within me than without
I know I am immensely fortunate not to have my life or bodily integrity threatened on a daily basis
nevertheless I indulge myself in feeling cursed by all the things that bite, beat and infect me from the inside

the sun is an external force acting on the sea
moving in its independent cycle
 indifferent to whether it passes over crashing waves, swells, flatness or storm
unmoved by how its reflection is affected

there is a small tidal pool in front of me
it appears so contained, so full of itself yet
i know it will empty come low tide, and overflow
the current  borders come high
what I see now is only a moment in its existence
in reality it is always in flux

Yet it would be another mistake to view it as I do myself,
cycling between low and high, empty and full

Somewhere else on the planet is a corresponding tidal pool that
fills as this one empties, and empties as this one fills
could the same be true of me?  that I could find my counterbalance?
that even when I feel depleted, lost, there
could be another place inside me still full?






Tuesday, March 1, 2011

on being water - more of Palmer Fishman's nature metaphors

I've never had an easy time meditating.
or sitting still
the two together have been disastrous

once I was with a good friend
 watching water falling off some rocks and into a river.
When I concentrated, I became The Waterfall, Itself -
that particular space through which the water was falling.

The Waterfall, Itself isn't any particular molecule of water, or bubble, or twig
No, it's the water-filled path between the edge
and the pool below
So the water molecules or bubbles that I could follow with my eyes are like my thoughts -
 just falling through -
and similar in their ability to distract me from
 my integrity, my wholeness, from the Waterfall, itself.

More recently I have been trying meditation anew
my therapist sometimes talks about 'surfing' various emotions.
I was walking my dog along a beach favored by surfers, and I saw them sometimes catch a wave, take a ride, and sometimes just get pounded.
Either way they always ended the ride sinking back into the water.

I thought I'd rather think of myself as the ocean itself than as the surfer -
whatever storm would, like the twigs in the waterfall, just be passing through, and even
during the fiercest storms some other part of me would be calm.

That is what I need right now, the presence of mind to keep some part of me whole and calm,
even when other parts
of me are getting rocked by a hurricane.
Whatever wave is an energy passing through me,
 but it is not me,
as I'm trying to learn
 even when I have thoughts of ending my life, these are only thoughts,
they are not me, and certainly
not all of me.
They are a fierce turbulence that will pass.