On my last post I talked about my work struggles during my blogging hiatus. Here I will talk about what’s been happening with the treatment of my mental illness this past year. I was going to a local mental health center for therapy and medication management. The psychiatrist there listed as my diagnoses: recurring major depressive disorder, generalized anxiety disorder (GAD), and obsessive-compulsive personality disorder (OCPD). I saw the therapist about every two weeks, which was okay because I got to discuss what was on my mind, but I didn’t feel like it was doing a lot. I was concurrently doing Dialectical Behavior Therapy there weekly. That, I felt, had some very useful coping strategies, but I didn’t feel like it addressed the root of my problem. Not to mention there was a lot of homework each week and I wasn’t in enough public situations or motivated enough to practice doing everything assigned in class. And, there was a whole lot to remember. I still managed to stick it out until the end. However, I had a problem with appointments with the psychiatrist there. Sometimes the psychiatrist would be out on the day of our appointment and have to reschedule. That would be fine if they rescheduled me for the following week or something. That’s not the way they chose to do it. Instead, after going almost two months between appointments, I was sent to the back of the line and had to go another two months without seeing the psychiatrist. I realized if I was ever going to get control of my anxiety before old age, I’d have to get help elsewhere.
I heard from patients of another place who had nothing but great things to say about it. You could get in to see someone there quickly and the clinicians were said to be very good, so I started going there. It was difficult having to catch up new clinicians about what’s wrong with me, but I managed. Perhaps I should write down a summary of the issues I deal with, so when I see a new clinician for the first time I can just read the summary, instead of trying to think about what I’ve been going through and put it into words in a way that makes some sort of sense and doesn’t give them a faulty picture of what’s really going on. The psychiatric nurse practitioner (NP) sent me for formal psychological testing to help guide my treatment. It took a few months to get in and complete it, but I now have the results of that testing. Unfortunately, some of the testing only addressed symptoms I’ve experienced over the last six months. I hadn’t had a major depressive episode in over a year, so the diagnoses the test administrator arrived at did not include major depressive disorder, which I clearly have. Not leaving one’s home for months on end, not taking care of oneself, and sleeping most of the day are not things someone with a mood in the normal range does. However, I do think the examiner was right on what she did diagnose me with: Autism Spectrum Disorder (Asperger’s Syndrome) and unspecified Anxiety Disorder. The testing showed no intellectual development problems, but definite psychosocial and emotional problems. I’m actually heartened by this because I have confirmation of what was suspected and am now in a position to seek out the help that will be the most beneficial to me.
My psychiatric NP suggested I get in touch with this organization that helps people specifically on the autism spectrum find and maintain employment. I told her I don’t know if there is a job out there I can do, except maybe one where I can work from home on my computer. She said there are jobs like that. I just hope I’m qualified for them. She told me something at a previous appointment that made me think. She said that the solution to some people with a mental illness is going to be something like 80 percent medication and 20 percent therapy. Others, she said, will be more like 20 percent medication and 80 percent therapy. Based on the fact that I’ve been on so many different medications in the last 18 years and have seen only mild improvement at best from them, I probably fall into the latter category. The issue I’m having is finding the best therapy regimen for me. There is a place my former clinician suggested to me that specializes in therapy for people with anxiety disorders and OCD, but when I checked with that place, they said they do not take insurance. If I had $100,000 stashed away then maybe I could go to them, but alas, it’s not meant to be.
My psychiatric NP mentioned desensitization, where the patient is exposed at less intense levels to the thing that causes them unreasonable fear. When they become comfortable with that, they are introduced to the thing at gradually higher intensities until they are no longer afraid of it. That sounds like it might be something that might help me, but I’m not sure how that would work given the things I have excessive anxiety about. The counselor I’m going to for regular therapy is nice. However, I’m not sure how he would implement desensitization in the clinical setting in which we meet or if he even does it. It seems like talk therapy is his primary method of treatment. My psychiatric NP seems very reluctant to try me on a benzodiazepine. I completely understand it because of the dependence that many people experience on it, but it’s the only drug class for anxiety left that hasn’t really been tried with me. For the time being, I’m not going to push for it. When we finally figure out a strategy that will help me lessen my anxiety to a manageable level and socialize with people better, I will let you know. In the meantime, I will keep bringing it to God in prayer.