When I left hospital I was planning a graduated return to work after a break of a couple of weeks.  Two days before I was scheduled to return I messaged my supervisor to confirm the details of my return.  She messaged back and let me know my position had been filled while I was on medical leave and that I would not be returning.  I had not heard from her in two months, this was the first time she had informed me I did not work there anymore.
I have since worked a couple of days for a temp agencyl and spent the rest of the time at home.  When I left hospital I had the impression that my treatment would continue as an outpatient.  I figured having free time would make it easier to schedule these appointments.  Turns out it only consists of a half hour meeting once a month just to check in.  That is very dissapointing and leaves me with plenty of free time.  That free time is turning into a problem now.  It is easy for me to get down on myself when I am not doing anything productive.  When I start getting down, it is hard to motivate myself to do anything productive.  What a vicous cycle!
There are a couple of prijects I want to start.  I plan to take this weekend off and on Monday morning try to start being productive again.  I want to schedule my day and set my alarm and treat it like any other job.  I am not good at self discipline so this weekend I will physically write a schedule.  That usually helps me get things done.  
No matter how big or small the accomplishments are, my hope is that being productive will help lift my mood.  It may even help me find some purpose and regain some self confidence.  That is a lot to ask.  I would like to say I would be happy with any improvement but I know myself too well to make that claim.  Any improvement will be a benefit to me even if my perfectionist self longs for more and quicker improvements.  


Tuesday’s Good News

Going to the ER for suicidal ideation was a new experience for me that was full of surprises.  One of the most disheartining surprises was how difficult it was for doctors to see past my transition.  On my first visit that was all they could focus on.  I felt like they believed it was impossible for anything else to cause my distress and they did not believe me when I said transition was the only positive in my life.  Doctors seem to be fixated on my gender and it has really had me worried.  Not only do I feel I do not get the proper treatment at times because of it, I have also been really concerned about the effect it will have on my transition.  Maybe they will try to stop me from transitioning or suggest I go back to who I was pretending to be before.
On Tuesday when I went to see my GP those were the concerns in my mind.  I did not want to bring them up with her.  No matter how supportive she has been, I was not going to open that can of worms.  Eventually she brought up my most recent lab tests.  She went over the levels with me and asked if I wanted to increase the hormone dosage I am on.  What a huge relief! Not only does she see my transition as positive, too, my new diagnosis are having absolutely no bearing on how she is treating me.  Needless to say, I left with a new prescription and a much lighter mood.

What’s The Difference?

In January I worked a few weeks between hospital stays.  I was not in a good place but I tried my best to be productive.  
When I got in to work one morning, a friend of my boss was there.  They said the bridge was closed by the police so she could not get to her work in the city.  A quick search online told them someone was climbing the cables of the bridge.  They assumed, incorrectly, that it was a suicide attempt.  
After a quick email to my therapist so she would not worry it was me on the bridge, I went to make my morning tea.  Naturally the talk in the break room centered on the mornings event.  I eavesdropped without participating.  Given my recent state of mind, I was already very upset.  The conversation made it so much worse!
First there were questions about why the entire bridge had to be shut down during rush hour.  This was a major inconvience for commuters just because someone did not want to live anymore.  The conversation then turned to suicide in general.  It went something like: I do not understand how someone gets to that place, but if they want to why can’t they just do it without disrupting traffic for hours.
I was appalled and would have gone home at that point, except I did not really feel safe myself if I left.  I called a nurse instead and got help to ensure my own safety.
When there have been accidents on one bridge or another it is not uncommon to hear complaints about the inconvenience.  What I have never heard though, is people questioning why police and paramedics block traffic to attend to victims.  I have never heard someone suggest they just leave the victims to fend for themselves.  No one ever says, They got themselves into the accident, let them take care of it.  People are generally sympathetic to accident victims, no matter how much it ties up traffic.  
Why is it different for a mental health emergency?  It is at least equally as life threatening.  It is an action born from an illness, not just someones whim at that moment.  
Maybe it is just easier for people to relate to a physical injury?  That is why mental illness needs to be talked about though.  Maybe if it was talked about more often people would be more sympathetic and understanding.  I can say I was never callous about it, but until I became a mental health patient, I was not very educated or informed either.  Now I see the bridge closure as an attempt to save a victims life that makes the traffic disruption so worthwhile! 

Floating in Fog

I can not help thinking that this has been a bad week.  The evidence may suggest otherwise but there is a disconnect somewhere between logic and feelings.  
I worked on Monday and it went well.  On Monday afternoon I enjoyed a quick impromptu visit with friends.  I had a great visit to my GP on Tuesday.  She seems to always manage to give me hope.  Wedesnday was the first trivia night I have been to in close to a year.  It was nice to see everyone on my team again.  
The only real negative I can see in the week was a dissapointing meeting with my outpatient team.  My dissapointment is probably even out of proportion to what it should be.  The news they gave me was not necessarily bad or earth shattering.  This one meeting has coloured my world though.  It has turned a decent week into a horrible one and sent my mood into the fog of depression once again.
This is the first really bad depression I have had since the medications have built up in my system enough to work.  This is the first chance I have really had to see the effects of these medications.  Even though I am in the darkness the fog brings, I am not as deep as I would have been before.  It is like the drugs have suspended me.  Instead of hitting the bottom, I am floating somewhere in between.  It is not a great place but it is better than where I could be.  The medications seem to be keeping me from crises mode right now.  
This is the first time in my life I have been on antidepressants.  Until now I was not even positive they were doing anything.  I know they probably affect everyone differently, but it would be great to hear if you have had similar experiences with them or just how they affect your mood. 

Subtle Discrimination

I started another post this morning about a similar topic but from a more positive perspective.  I will finish writing that one and post it soon, but I really needed to write about my experience earlier today and my thoughts on navigating the mental health system as a transgender woman.

I just met with my case manager and psychiatrist.  They are both very nice people with the best intentions. I left the meeting feeling discouraged and down though.  It has taken the rest of the afternoon for me to sort out what was bothering me about it and put it into a somewhat comprehensible post.  I wish I could have come up with the words during the meeting.  I did not want it to come across as anger though and I think I often do come across that way when my emotions get the better of me.  I guess I can thank BPD and anxiety for that.
In this meeting I told both of them that I thought I needed more support in the form of mental health groups or a community peer support worker, which I was told I would have access to even before I left hospital.  They told me that there are no transgender support workers available.  Now I wish I would have told them that while maybe that would have been idea, any support would be better than what I have now.  As for groups, again their focus was on groups for the LGBT community.  The honest truth is that I have that covered myself and probably know more about that than they do.  My needs from them are mental health supports.
I have seen the statistics that I am sure they are familiar with about the increased risk for suicide among transgender individuals.  What I do not see in those statistics are the reasons for suicide.  Sure, I tried my best to kill myself and I happen to be a transgender woman, but one was not directly related to the other.  I remember seeing a statistic somewhere about females suffering more from depression than males.  Sorry if that is not correct, but my point is, I do not think a doctor would assume someone is depressed solely because they are female.  Gender would not be the main focus of the caregivers.  
To me, it has seemed that the health care providers in our hospital system cannot get past the label of transgender woman.  They assume all of my problems are because of that.  If they would look deeper they would see that I do not let that label stop me from socializing, working or living my life.  In fact, it has not been an issue in my day to day life except when I interact with the health system.  They seem to make it a bigger deal than it is.  I do not want my identity to rest solely on the diagnosis I have been given or on the fact that I am a transgender woman.  I am me.
I have given a lot of thought to how my mental illness and gender may be related.  I am no doctor but all I can see is that maybe hiding my true identity for so long contributed to my lack of self identity.  I stress the word contribute and acknowledge that it is by far not the only contributing factor.
My feeling is that the health system needs more education.  Transgender people are just people, like anyone else.  If gender is a problem for someone, please help them.  If a transgender person commits or attempts suicide, please do not assume the only reason possible is gender, though.  I feel that focusing so intently on my gender is a subtle form of discrimination.  Treat me like you would treat anyone else.  If I say gender is not an issue for me, focus on what the real issues are.  If a transgender person is not available as a peer support worker, give me a choice of someone else.  
One more vent from today, then I am done.  The highly functioning thing is rearing its head again.  It seems that unless I am in full crises mode, they think I am doing good.  I am unsure of how to get through to them that I am not as good as it must seem.
Does anyone else have experiences with doctors not recognizing the real problems or only fixating on one issue?  I would love to hear your comments.

Highly Functioning

On my next to last Friday in the hospital I received a new diagnosis from the doctor.  She asked if I knew what Borderline Personality Disorder is, then read the criteria to me.  It seemed to fit and I was more than a little impressed that she had actually been paying attention to what I was saying for the last month.  She had sifted through all the conversations and came up with a diagnosis that seemed to fit better than any I had received so far.  That was the only positive I could immediately see from this.
Accurate or not, this seemed like something bad.  A mood disorder is something I can understand.  Everyone has a bad mood every now and then, mine just lasts longer.  A personality disorder seemed more personal.  It seemed like something inherently wrong with me.  
I have since educated myself and know better. (I already knew a mood disorder is not the same as a brief bad mood but my internal talk will not always acknowledge that). I now see that having an accurate diagnosis just helps me get the proper treatment.  I would have preferred not to get the diagnosis on a Friday though.  I would not see her again until Monday, so I had all weekend to live with questions and worries having free reign in my mind with no good answers.
On Monday durung our discussion, the doctor told me that I had been highly functioning for a BPD sufferer.  I guess it appears that way outwardly.  A trip through my mind would resemble Indiana Jones going through the Temple of Doom, though.  Maybe I should have been an actor.  Apparently that is what highly functioning means.  I can appear calm, collected and normal while inside the poison darts are flying, rocks are tumbling on me and parts of my mind are booby trapped and intent on my destruction.  These are not exagerations either, there is so much going on up there and I can never escape it.  It follows me everywhere. 
Now that I understand more about BPD I can see it is not necessarily a life sentence.  There are ways to treat it and minimize the symptoms.  It is important to me to remember to drop the masks I have been wearing for years though.  It is not easy but it is necessary if I want the most effective treatments.  If I convince everyone I am ok and highly functioning, I will always have to fight my battle alone.  In public I will continue to wear the masks that have served me so well, but my doctors should get a leather jacket and bullwhip, because I have to let them into the temple.

My Note From March 21

When the lessons and tasks are all ended,

And the school for the day is dismissed,

And the little ones gather around me,

To bid me good-night and be kissed.

-Charles M. Dickinson, “The Children”

This is not a note from the psych ward technically.  I was discjarged yesterday and I am back home.
December 28 was my first visit to the emergency room.  From December 28 to today I have been to the ER four times at two different hospitals.  I have been admitted to three different hospitals.  I have spent more nights in hospital this year than at home.  I have talked to at least fifteen doctors and been prescribed at least ten different medications.  I have been apprehended and handcuffed by the police twice.
I am happy to say that I am now able to laugh again

  I have learned some important skills to help me.  The last month and a half was more helpful than the other two hospitals combined.  I am mot cured by any stretch of the imagination.  I compare leaving the psych ward to graduating from elementary school.  I have some of the basic skills I need to survive, but I have tons more to learn.  Now I at least have a more accurate diagnosis.  That will allow me to work on what will help the most.
Hopefully there will be no more notes from the psych ward from me.  I do plan to continue to write about mental health.  Tomorrow I will meet with my outpatient team to see where I go from here.  After that I am going shopping for spring clothes!!!