Medical Service Appointment

The worst part is over now that the appointment with the medical service is behind me. It went by no means great, but at least I did not cry afterwards like last time.

The physician took a little more time to ask questions, about 15 minutes, which was the one positive aspect of the appointment. On the negative side weighs in that she tried putting phrases in my mouth that I didn’t mean to say, kept interrupting me, and generally had a brash demeanour.

I wasn’t feeling my best to begin with: slept badly the night before because of anxiety about the appointment; kept confusing words; couldn’t remember which dosage of escitalopram I take, etc. And the doctor’s behaviour made everything even worse.

For example, I had tried to explain why I had not gone back to psychotherapy – that I want(ed) to, but for reasons already discussed on this blog haven’t. She tried to twist it into me saying that because I’d had such a positive experience with my first therapy, I was resisting seeing someone else now and idealising the first treatment. Absolutely not true. If health insurance wouldn’t limit the number of sessions I could have, I’d be way more willing to try things out. And even if, ultimately it was my psychiatrist who suggested to wait with that – and she knows me a helluva lot better than someone who judges me based on a 15-minute-meeting.

The doctor also had never heard of CBASP and when I said that the general consensus is that chronic depression is largely treatment-resistant with standard behavioural therapy, she called bullshit. Whatever, I don’t really care. It’s what the scientific papers say, not my personal opinion. Not trying to convert anyone, least of all her.

Also, she said I was “talking in diagnoses”, not how I felt. Well, last time I tried that with her colleague, he wouldn’t even let me finish. Also, it’s really hard for me to open up to strangers about such personal stuff. There’s a reason why my therapy sessions worked out so well, and that is that he took the time to make me comfortable. I realise the medical service was never meant for that kind of in-depth, trust-gaining discussion, but I had told her half a minute earlier that I suffered from social anxiety, and how at uni I would devote 75% of my energy to not freaking out and 25% to following lectures. It’s kind of a low blow to hold “talking diagnoses” against me after I just divulged that strangers freak me out.

Seven hours since I got out of there, and the knot of anxiety in my stomach only slowly starts dissolving.

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Jobcenter Updates

The jobcenter sent us two forms as part of a „hearing“ regarding why they paid us too much money. Two separately mailed letters containing the exact same forms and the exact same letters, except that one was addressing my husband with “you earned income” and my letter read “Mr. Layara earned income”. So I explained for the fourth and fifth time respectively in those forms that the jobcenter pays in advance, but my husband’s salary only comes in about six weeks later since he gets paid retroactively the following month. I also asked for our monthly allowance to be reduced, to avoid having to transfer back hundreds of euros later on. We’ll see how that goes.

Tomorrow, I have an appointment with the medical service to assess my mental health. Last time was pretty bad; my one comfort is that with just a few more months to, the result of tomorrow’s appointment will only matter short-term. I was supposed to bring ALL my files from various doctors, but they gave too short notice of the appointment to get anything from the psychiatrist, and anything from the clinic / therapy is not available as it is part of a medical study and thus confidential. For the latter I still have a statement written by my therapist from the last time I had to see the medical service.
Also, I need to bring all the medication I take. Not sure why – to prove that I’m not making anything up? Shouldn’t they already have my medical records on that from the psychiatrist? And how would showing them a bunch of blisters prove I am actually taking that stuff? Seems rather stupid to me.

On Tuesday I have an appointment with my caseworker at the jobcenter. I am not sure whether I mentioned that before, but we got a new caseworker a year ago. She is nice enough, but I miss the old one. She was bipolar, so actually understood how mental health problems can influence your everyday life. Also, she would get in contact before setting the actual appointment. They don’t have to do any of that, but it was a courtesy she extended to me that made me feel as if they took me into account as a human being, not just a file that needs to be processed.

To say that I am afraid of the appointments would be overstating it, but they make me terribly nervous. I feel pressured, and “faulty” to boot. I understand that the state needs to check who they give money to, but this arrangement is not contributing to my recovery.

Misfortunes Never Come Singly

Over the past few days, I’ve had to deal with a number of frustrations and disappointments.

The aquafit class got cancelled after local authorities closed the pool and adjoining gym. Apparently there’s fault with the ventilation system, and fixing it will be so extensive that it won’t re-open before summer 2017. A number of schools and seven different sports clubs have now suddenly lost their training locations.
As for the group I was part of, any vacancies at aquafit classes held at different pools are first going to those who joined as part of their physical rehab. Anything that’s still available afterwards will be offered to the “prevention group”, or you can simply get your money back.
Financially it’s no loss, but I was so happy with everything concerning this: the group, the instructor, the time slot, the uncomplicated drive… On Friday I’ll find out if I can at least finish the last four weeks before the summer break.

Then, we are having jobcenter problems. My husband has a fixed salary per hour, but there are additional boni for night shift, Saturday or Sunday work. So he never gets paid the same and the difference can be several hundred euros in extreme cases.
As I mentioned before, welfare is slowly phasing out; we are still approved until the end of September and only get substituted right now to make up the difference between the threshold-income and his actual income. We have to hand in a copy of his payslip every month to prove how much he made.
Well, the first month, when my husband’s actual income after taxes was still lower than what we got from the jobcenter, they paid us too little and the missing rest came three weeks later. The second and third month, they paid us too much (way too much this month) – which wouldn’t be such a big problem if we wouldn’t get into trouble for that down the road. We basically have money sitting in the bank that isn’t ours, that we can’t touch because they might ask it back at any given time, and all attempts to contact them have been fruitless so far. They don’t react to emails, phone calls end in the holding line…

On top of all of this, the jobcenter ordered me in Friday morning to discuss my medical report. It makes me nervous as hell, because I don’t know the result and what they want to do with me. Worst case scenario, we would have the means to terminate welfare support on the spot. Last month we were just 60€ below the threshold and this month we’ll be over it, so the jobcenter would have (or should, at least) stopped giving us money anyway – we only wanted to stay until September because we could have used the “mobile pass” still, which gives you percentages off public transport fares, and as a security net until my husband’s probational period at the new job ends at the beginning of September. Last but not least, terminating now would be a nightmare of bureaucracy, whereas just waiting until it runs out does not require anything other than NOT requesting a renewal.

Logically, I am aware that no matter what they are going to say on Friday, they can’t do anything to me. I could just walk out saying “So long, suckers!” if shit hit the fan. But being the unconfrontational person that I am, it already stresses me out.

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.

Two Years

Two years since my last blog post. Two years since my mother suffered a sepsis due to necrosis in the foot, caused by undiagnosed diabetes type 1. We didn’t know whether she would live or die – she lived, minus an amputated foot. I could not write about it back then and don’t know whether I want to now, as it was a very saddening and stressful experience and it took this long to come to the conclusion that I might have digested it properly enough to move on. Maybe I will go into more detail one day, maybe I won’t. For now, the above must suffice.

A lot has remained the same since then: I am still married. I am still on welfare. I still haven’t been back to therapy.
Some things changed: I am off venlafaxine now and on escitalopram. Venlafaxine didn’t do me much good and a lot of bad, and the side-effects of quitting it were horrible. Escitalopram works really well for me, though. I also have a new psychiatrist who I am more pleased with than the previous one.

So that was my life in a nutshell these past two years, as far as it is relevant to this blog. I hope to write more regularly again – I missed it, but the mental hurdles were just too difficult to take at the time.

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.