How Welfare Saved My Sanity

One of the biggest contributing factors towards my mental health improvement was getting on welfare. Or rather, not having to worry about how we’d be paying all those bills and the rent. There’s a lot to be said for financial stability, even if it is only the state-defined minimum. No more letters threatening to turn off the gas or electricity, no more anxiety attacks when checking the mailbox.

The public image of welfare-recipients in Germany is just as bad as it is elsewhere, but I learned long ago to tune such things out. Most of those who are judgemental don’t really know what they are talking about – and they certainly don’t know my husband or me.

And it looks like our “leeching off the system” is coming to end. My husband landed a respectable full-time job a few weeks ago which should see us completely independent of state support by the end of the year. I had paid off my old bank account within a year and thus by summer my name should get deleted off the “financial offender” list and my credit rating be ok again.

What the occupational future holds for me, I don’t know. Right now, my husband is the breadwinner, and I do all the paperwork that comes with his job. I don’t plan any further than six to nine months ahead anymore – none of the long-term plans and goals I held in the past came to fruition. I’ll deal with that topic once I actually become capable of holding down a (part-time) job.

I will forever be grateful to be living in a country where a welfare-system even exists. It wasn’t always easy – you sign away a lot of privacy and become the employment agency’s little bitch in exchange – but that is a thousand times better than what we went through before.

The relationship with my mother has gotten a lot better once it was not strained by financial dependency anymore, too. There are different factors playing into this other than money, since her hospital stay very much became a game changer that altered the way we interact, but there is no denying that money used to be a contributing factor to the tension between us.

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The Year Wasted On Venlafaxine

The venlafaxine debacle certainly deserves more attention than just the few lines I’ve allotted to it so far.

The first few days have been chronicled by this blog, but fact is that the side-effects never got significantly better. Nausea, headaches, muscle pain, and paraesthesia became my steady companions. Very often, it made me so sick that I had to lie down two or three times during the day. At every appointment I told the psychiatrist about it: he would either dismiss my complaints as “I’ve never heard about anyone having this problem with venlafaxine before”, or claim that those were not side-effects, but withdrawal symptoms because my dosage was still too low to last all day.

About fifteen months down the road, he finally cranked the dosage up – and that is where the heart problems started. Actually, I was in the early stages of serotonin syndrome, and it felt like I was on the verge of a heart attack. Before the next appointment was up, I had to lower my dosage again without even consulting him, because I just could not take it anymore. Finally he decided that maybe venlafaxine wasn’t for me and that I should try escitalopram instead.

The idea was that I would reduce venlafaxine over the course of three weeks and then start escitalopram. The withdrawal was so terrible that even though I gave myself six weeks instead, I still became bed-ridden. Other than expected, the most difficult part was not when I first started lowering the dosage, but the second to last step, which made me hallucinate.

Imagine lying in bed, sweating, your heart beating fast. Your head hurts, your teeth hurt, your back, your legs… every single muscle is in pain. Lights are too bright, sounds too loud, everything you eat makes you queasy. Your thoughts race and you cannot do anything to calm them down. And just when you think it cannot possibly get worse, you start hallucinating that the walls of your bedroom, the furniture around you, the ceiling above you are pulsating, bending in and out as if they are breathing.
I knew it was the withdrawal – that it wasn’t real – but that didn’t make it any less unpleasant. I cried like a little child: “I want it to stop! I can’t take it anymore!”

I do not want to badmouth venlafaxine, since there are many people who take it with few or no problems. I wasn’t one of them. By now, I am aware that I have problems with every drug that influences the noradrenaline (norepinephrine) cycle; that I am genetically predisposed to react that heavily to them.

However, I harbour resentments against the psychiatrist for letting me go through this for such a long time. He was friendly, but I feel like he did not take me or my complaints seriously – whatever it was, you don’t drag out a treatment that doesn’t help and causes so many problems for a year and a half. And I was too afraid that I wouldn’t get my sick note for the jobcenter if I complained too much, so I didn’t dare protesting too loudly. Even when giving the drug the benefit of the doubt, he should have stopped after six month. Instead, I wasted a whole year of my life on top of that trial period.

Coincidentally, just as I made the transition from venlafaxine to escitalopram, the practice was also taken over by a new psychiatrist. The options were to either stay at the old location and get a new caregiver, or migrate to the new location and stay with the old psychiatrist. I chose the former, and have been very happy since with the lady who took over. She’s friendly, competent, seems to genuinely care about her patients, and I find it easier to talk to her than her predecessor.

Escitalopram is a walk in the park in comparison. It really helps with the anxiety, and also has reduced the depression by 80%. What was left fell into three categories:
– problems falling / staying asleep
– lack of energy
– lack of motivation.

The psychiatrist’s suggestion was to try a second antidepressant as a booster. Initially I was very hesitant to even consider this option, because I did not want to go through an ordeal like the venlafaxine-regimen again. She promised that if it didn’t work, I could stop any time, and so I started with bupropion – which is how we discovered that I cannot take any SNRIs. It basically felt like a toned-down variety of venlafaxine to me. After three weeks I stopped.

The second booster I tried is valdoxan (agomelatine), which comes with zero side-effects. It’s slower to show results than other antidepressants I’ve taken, but after five months and experimenting with the dosage there is a definite positive trend: fewer days with sleeping problems, gradually increasing productivity, more motivation. There’s still room for improvement, but I am feeling better than I have in over a decade.

This Blog Is Still Relevant

Last night, I did something I had never done before: I read my own blog. During the past weeks, I had been wondering whether it was worth keeping “Lugubrious Layara” online – after all, I had not published regular updates in almost three years, and it did not seem to serve a purpose anymore.

But as I worked backwards through my own timeline, from the most recent post to the earliest ones, I realized how important this blog was for myself. Not only as a chronicle, but especially as a measurement tool for how far I have come since.

And that is why I need to keep writing and updating. I probably will never be able to close the gaps, but at the very least, I can make a fresh start right here and now.

To Hell And Back Again

After the last post, I fell into a really dark hole. For every problem solved there appeared to arise two new ones, and between a lack of energy (which was bordering on apathy) and near-despair, I had some really horrible weeks. None of the bills due June had yet been paid, and I’d really had more than enough of those troubles over the last months: we got threatened with having the gas / electricity switched off twice and had to borrow money from a friend to pay those bills. I had my bank account terminated because I accidentally went over the credit limit and (thanks to being preoccupied with the side-effects of venlafaxine) didn’t notice immediately, so I ended up being blacklisted as a “financial offender” for the next three years – it will be as good as impossible to get any kind of loan, and I had to go begging at the bank to be granted another bank account, and on top of everything else I will have to pay off almost 1250.- Euros for the old account and in penalty fees. I tried explaining my situation on the phone, but first I had to wait three weeks for a call-back since the people holding the decision power were always busy, and when they finally did get back at me, the lady berated me for it “being all my fault”.
We just about managed to pay for my husband’s German classes and get some food on the table, even though the latter was perilously close to uncertainty at two times at least. There was one day when we had all but € 9.- between the two of us, and all that was left to eat was a bit of frozen vegetables, half a jar of jam, pasta and potatoes. No bread, fruit, rice, cheese, meat, fish, butter, milk or soy drink or whatever we usually eat. Our options were plain potatoes or plain pasta, with a bit of spinach or peas. Nothing you’d traditionally serve for breakfast – and having just asked a friend to help us out with money so we wouldn’t have the gas / electricity cut off, I didn’t want to go begging again. My mother-in-law unwittingly saved us from this by sending some money, and my friend scolded me for not telling her earlier when I related the story to her… All I can say is that there’s a difference between having to ask for help once, because you got into a tight spot, and having to do it again and again, week after week or month after month. It wears you out mentally.
I believe my husband became more worried about me and my state of mind than about the money, because even though I was not entertaining thoughts of suicide, he made me promise I wouldn’t do anything to myself. Nevertheless, even getting dressed became an almost insurmountable obstacle, and I oscillated between apathy and fits of crying. I felt like I had nothing left in me: no energy, no fight, no will. And even though I had successfully fought off the denial of the application in April, nothing appeared to move forward in that regard ever since – until the beginning of June.

The money came in about three weeks ago, and despite the fact that we didn’t get approved for March (when I was still officially a university student and not available for welfare), we got monthly allowances retroactively from April 1st on. We could pay our bills, and get rid of the debts with the health insurance and the energy provider. I made a payment plan with the collection agency to pay off my old bank account in rates, paid off my sister since she had covered the contents insurance of our worldly possessions earlier this year, and gave two months’ worth of rent to my mother, as a thank you for supporting us when my parents were on a budget themselves.
Having this existential problem lifted off our shoulders has done more for my mental health than any other measure taken during the last months. For the first time in years, I go to bed without being afraid of what the next day is going to bring: even though I still get a fright when one of those “official-looking” letters comes in, I can immediately remind myself that we have the money to take care of whatever is heading our way.
The German welfare system is far from perfect and much criticized, but compared to our situation during the last year – and especially the last couple of months – we are doing peachy right now. Of course, we are not eating steak and lobster, but I can buy everything we need and some more, whereas before I would have to prioritize and calculate whether I had enough money to buy some yoghurt, for example, or whether it had to wait until the next time since it was not strictly necessary.
There was one day when I went to the neighbouring town for shopping, since the local supermarket had some offers which justified spending money on a tram ticket as we would still save compared to buying the same products in our hometown – and I made a mistake when calculating the expense. It was just a minor figure I was off, about 50 cents, but I ended up those 50 cents short for buying the tram ticket back home. I did not dare taking the tram without a valid ticket because of the € 60.- fine if I got caught, so I had no choice but walking home. It was a relatively warm day and I was dragging / carrying about 30 kg (roughly 65 pounds) of bottles and groceries in my shopping trolley and two bags. I had called my husband to meet me halfway, but by the time we got home, I was completely exhausted.
That is only one story out of many about how destitute we were. I walked around in jeans ripped from wear and tear for over a month, because I could not find a pair cheap enough in my size. When I finally found one, it had a bad, unflattering cut and I didn’t like the colour, but at least the prize was very low and the fabric not torn, so I bought it anyway. After just a few short weeks, the pull tab of the zipper broke – cheap material, I guess – so I had to put a safety-pin through the eye of the slider for using the zipper: the result was that every time I went to the toilet or got (un-)dressed, the safety-pin popped open and stung me in the finger. At that point, I made such a pitiful figure that my mother and sister gave me a part of my birthday present, two pairs of jeans, about ten days early.

Maybe that gives a little insight into why I have not been blogging. At some point, I just got too exhausted – all my mental energy went into making sure we would get on state support. And I wanted to escape from the daily struggles, not reflect on them.

Follow-Up With The Psychiatrist

This morning I saw the psychiatrist again. We discussed the side-effects and agreed that I would continue taking venlafaxine / effexor, as it appears to have some mildly mood-stabilizing effects on me by now, and that I’m going to stay on this dosage until my next appointment at the end of May. Since it’s been only two weeks on 75 mg so far, it might take more time to make the side-effects go away completely: my main complaint was that I felt even more tired than before, but since citalopram had that same effect, switching to another drug does not seem worth it as chances are that I react this way to all antidepressants.

The psychiatrist asked me how I felt on a scale of 1 – 10, with 10 being absolutely awesome, and I rated myself a 3, even though I had to think about it quite a bit. That rating was more influenced by my physical complaints, and by feeling exhausted and stressed out about the welfare process; otherwise I would have given myself a 4. The goal for now is to make me reach 5 – 6 on this scale, and he asked me what had to change for me to feel that way, which I answered with: “I’d need more energy to actually manage my daily responsibilities sufficiently to feel that way.”

I told him about the recent problems with the job centre and the energy provider, and he was so nice to give me the medication I need until my next appointment out of the stock at his practice, so that I would be relieved from the self-pay contribution necessary at the pharmacy. (One of the benefits of welfare is that it eliminates the self-pay contribution for medication, but right now that obviously doesn’t apply yet.)
He also gave me an incapacity certificate valid until the end of May for the job centre, and I will see him again right before this one runs out. That is important both for proving that I am actually unable to work, and so the job centre can’t put me into an apprenticeship programme – if you cannot prove you are incapacitated, they can take away your benefits if you don’t comply with their orders, or they won’t even let you get on welfare in the first place.

At War With The Job Centre

Dear Mrs […],

hereby I lodge an objection to your refusal of my application for welfare.

On Tuesday, April 2nd, 2013 at 3.51 PM, I received a phone call by a job center staff member (phone number: […]), informing me that the appointment for Friday, April 5th, at 9 AM, had to be cancelled because you had become sick. When I asked when my alternative appointment would be, he informed me that you would get in contact as soon as you recovered and returned to your work place. This did not happen.
My husband, Mr Layara, and I had two appointments at 8 respectively 8.30 AM for that very same Friday with the employment agency in the same building, which we attended; there was absolutely no reason we would have missed the appointment at 9 AM with you had we been informed that it was on again. During the entire time, you could have reached me via mobile phone and mail.

The incoming phone call from April 2nd, 2013, is being archived in my mobile phone for the duration of one month and can thus be proven.

Kind regards,
Layara

On Tuesday I got a letter from the job centre, informing me that I had missed my appointment, when it clearly had been cancelled, and as a result – because I neglected my cooperation duties despite having been lectured about the legal consequences, and because I “refused cooperation” and made it “excessively difficult” (WTF?) to come to a resolution of the case – my application for welfare would be refused. I would have one month to hand in written protest.
Since the job centre is closed to the public on Wednesdays, I went there this morning and left the letter which I have translated above; trying to call the lady in question remained fruitless as she didn’t pick up the phone either on Tuesday or Wednesday.

After receiving the letter, I got initially so mad that I wanted to punch someone in the face. I had not done anything wrong, but merely acted according to what I had been told by representatives of the job centre, and yet I was the one who had the hassle of proving my innocence even though the error was clearly on the side of the staff – due to poor internal communication at best, or simple incompetence on their side. As if I did not struggle enough with fulfilling my daily tasks already…

Depression Symptoms & Antidepressant Side-Effects Assessed

It’s becoming very clear that despite taking twice as high a dosage of venlafaxine / effexor now, the timed-release capsules work much better for me. The nausea and vertigo vanished completely, and in the mornings I don’t go through withdrawals anymore either. I do feel quite drained from the experiences of the last three weeks, though, very tired and listless. I lost 6 kg (13.2 lbs) – 4 kg over the first weekend and another 2 kg since – and even though I would welcome further weight loss very much, it goes without saying that vomiting, diarrhea and skipping meals due to nausea is not exactly a healthy way to drop the kilos and at least partially responsible for the feelings of weakness. On top of that, venlafaxine also suppresses my appetite for a good part of the day, until it returns in the evening and I suddenly start scouring the kitchen for all the stuff I did not buy when shopping…
There has been no improvements of the symptoms I primarily started taking venlafaxine for yet, the cognitive impairments and lack of energy, but I do feel more emotionally stable recently. Next Friday I have a follow-up with the psychiatrist, when I’ll find out whether I’ll increase the dosage further or stay on it for the time being.

As for the welfare process and related paperwork, the main appointment at the job centre had been cancelled on Tuesday already because the lady had become sick, and the one who works on our case at the employment agency was replaced with a colleague due to illness as well. While being very friendly as well, this colleague could do little more than collect the forms we had filled out at home and the documentation we had brought. Other than that, we will have to wait for them to get back to us. I handed in the questionnaire on my medical complaints today; the question was: “Do you have medical conditions which influence your current job or have done so in the past? Please give a short description of your illness respectively your symptoms and tell us which kinds of occupation would be influenced by these.” The space left blank was less than a quarter or a page, so I could not go into much detail:

“Diagnosis: chronic recurrent depression with comorbid panic disorder.
– permanent / daily symptoms: muscle pain in legs and arms; social anxiety; slowed-down thinking; word finding problems; problems falling asleep (at least 2 hours / night); severe lack of energy; hypersomnia; decreased libido
– frequent symptoms (at least 3 days per week): stomach pains; digestive problems (diarrhea); back pain; memory problems; concentration problems; depressive emotions (sadness, emotional emptiness, hopelessness); headaches
– periodically appearing symptoms: insomnia
– under stress also anxiety attacks
– currently (since mid-March 2013) additionally vertigo, nausea and vomiting due to starting an antidepressant regime (venlafaxine)

Because of the diverse symptoms, I am physically, intellectually and emotionally affected with any kind of occupation.”

That is as accurate an assessment as I could give of my daily problems in such a small space, and each of my healthcare providers should be able to confirm them. I learned today that the medical service will first contact my general physician for information, which is a bit of a problem since at least 80% of my depression treatment has been done by my therapist; the general physician does get reports from my psychiatrist, but except for the fact that I have participated in the medical study he does not know anything about the psychotherapeutic treatment. I do hope they’ll get in contact with him as well – if our regular case worker had been present today, I would have asked her, but her colleague was not familiar with the protocol in such cases.

The End Of An Era

Yesterday, I exmatriculated from university. Thirteen and a half years of fighting, and then it took all of 58 seconds to leave – there is a form you print out, fill in your name, address and student-ID number, give the reason for exmatriculation (I checked “illness”), and hand it over to the student secretary. She double-checked with my student-ID, stamped the form, gave me a formal statement that I had left uni, said goodbye, and that was it. My niece, who had accompanied me, timed the procedure.

That was in the afternoon, however. The morning my husband and I spent at the job centre, where we had an official appointment to start the welfare process, and saw someone from the employment agency afterwards. She might help my husband find a job, and I had to see her to work out the procedure regarding the “impaired working-ability” label. We got a total of about 50 form sheets we have to fill out: the actual application, and different questionnaires on just about every aspect of our existence, from the flat we live in (size, number of bedrooms / bathrooms / kitchens, how much rent we pay, what kind of heating it has, how much we pay for water and electricity, etc.) over our respective job résumés and occupational histories to a questionnaire on my depression history. We have to bring bank account activity statements for the last three months, and attestations of my health insurance, my husband’s integration class, the exmatriculation from university, a copy of my rental contract, yadda yadda yadda. And all of that has to be ready by Friday next week, because then we have the next appointment.
The procedure regarding my medical status will be that I formally release my general physician, therapist and psychiatrist from their obligation to secrecy, so that the job centre’s medical experts can inquire about my depression history, the treatments and my current status. They will then write a formal assessment, based on these facts, and I will get an invitation for discussing the results. If the results are clear and nobody objects, I will not have to undergo any further examinations through a medical officer.
The lady from the employment agency was very nice and sympathetic; she even inferred that she had personal experience with it – I just could not tell whether she meant depression, panic attacks or both. Regardless of what was the case, I felt treated with respect and in a non-judgemental way, which certainly is a first in my dealings with bureaucracy outside of the mental health sector. She’ll also remain our contact person for the rest of the process, so I’m doubly glad about this.

We were at the job centre for over two and a half hours, with over an hour of waiting in chairs in between. I had not taken the venlafaxine that morning, because I didn’t want to go into a side-effects frenzy during the appointment, but halfway through the withdrawal set in and my brain started buzzing like a mobile phone. I hope that for our appointment next week the timed-release capsules will prevent that scenario.

Venlafaxine: Doubling The Dosage

It was time to go from 37.5 mg to 70 mg of venlafaxine per day, and also to switch from the regular tablets to timed-release capsules. Today is a public holiday in Germany, and with the long Easter weekend ahead, I would have a few days in a row for adjusting to the new dosage. I was prepared for the worst – more nausea, maybe even vomiting, but in the end it turned out relatively harmless. There was a bit of vertigo and some tingling in my limbs, but generally the transition was rather smooth. I can definitely tell a difference between timed and regular release, because as a capsule, the side-effects do not (sometimes violently) spike within the first 120 minutes after consumption, but create a gentler wave rather that carries you into the afternoon.

I’m Going To Quit University

Instead, I will enroll at the only state-maintained German distance teaching extramural university, starting next autumn. The idea was actually proposed to me by my mother and sister, because my sister is considering doing the same, and they thought it might make studying easier for me. I also discussed this with my husband, and slept over it, so while this was a relatively sudden decision, it’s not a rash one.

Arguments in favour of the change:

• You study online and out of books. Apart from the written tests, there are only two weekends during the entire Bachelor’s programme where you have to attend a seminar in person – and one of the study centres where you can do so is easily accessible to me, even without a car. Since I waste about 75 % of my energy in class on fighting off depression and only the remaining 25 % on taking notes or studying, I believe I will actually be able to study more effectively that way. You receive the materials and literature lists via mail, and you send in your homework and term papers online. There also are video streams of lectures and special software programmes for learning. At any time, you can contact qualified docents if you need additional help, and should you need to see someone face to face, you can also visit the study centres.
• It’s cheaper than a regular uni. Money is always a factor for me. And you pay for the classes you take only, not a fixed sum regardless of whether you actually take any classes at all. So, if shit hits the fan and I have to take a sabbatical (which I hope never happens, but we are talking eventualities here) again, I don’t have to pay just for staying enrolled in the programme.
• It’s more time flexible. I can adjust the learning to my personal schedule, because nobody cares whether I study something on Tuesday morning or Thursday afternoon or Sunday night, as long as I send in my homework punctually.
• Academically, it’s worth just as much as a degree from a regular uni.

Arguments against the change:

• I’ll not have a semester ticket for public transportation anymore. But: With the money I’m saving every semester on fees, I can buy a good number of tram tickets if needed…
• It sets me back to square one. But: I only took 6 hours per week last semester, and the next one would have been the same – I might actually be able to take more classes than that and thus eventually make up for “lost” time.
• They have a limited offer of subjects you can study only. And geosciences is not one of them. That is, in the end, the only heavy argument against it, in my opinion – and the reason why I never thought about making this step before. It would mean changing my major again. But: You can study psychology with them, and that is something I would be really interested in.

In the end, I believe the scale tips in favour of going ahead and doing this, because there are also arguments which fall outside of the pro-and-con-scheme listed above. The days of fantasizing about becoming a world-famous archaeologist are long over, and I don’t see myself crawling through the Andes or Alps, looking for rare minerals, either. What I want above everything else is to finally have some kind of degree and become employable; I’ll happily work as a secretary or a boring office job afterwards. The pipe dreams of glory are firmly buried.

And there are some obstacles in my current university course which did not occur to me when I had to make a quick decision in August 2011, and which I pushed into a remote corner of my mind afterwards: field trips abroad. I can’t do them – it would be ok if I got my own private hotel room at the end of the day, but going abroad and sharing a cabin with people who are essentially strangers for two weeks horrifies me to no end. I have worked really hard on my social phobia, but that is a problem I don’t think can be “treated out of my system”. On top of that, you also have to pay for those trips and all the equipment needed for it in addition to the semester fee, which runs up sums of several hundreds of euros every time, and I just cannot afford that.
Finally, seeing how the current semester ends on Sunday, I could actually apply for welfare myself instead of hoping some cryptic system where I take over from my husband works out – I haven’t been able to pay for the next semester yet, so all it needs is a phone call that I won’t be returning and I’m out.

Maybe it makes me look fickle in the eyes of some, but over the course of the last three semesters I realized that most of my problems with uni stem from the system itself, and I genuinely believe that my mental health would profit both from taking a break until October and even more so from getting out of that system. I love learning and writing papers and all of that, and I want to focus on this instead of how to effectively hold back tears in a classroom.