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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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.

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.

Welfare & No Therapy

Yesterday I mentioned going on welfare, and that I had been in the process of writing a blog post about it when the news of my therapist’s illness made some of that draft obsolete. Here follows the part which still is relevant:

Financial troubles have been a steady companion for a long time: I cannot work a job on top of uni, and my husband wants to work, but is currently handicapped by a lack of language skills (even though he is making a lot of progress since he started integration class). We have been living off my husband’s savings, support from family members, and once we also had to borrow money from a friend. Our life is rather frugal: 80% of what I buy is on offer or from the “reduced box” – groceries which are about to expire soon and hence reduced in price. We do not go out or buy anything that is not absolutely necessary.
A while ago, my therapist came up with the idea of me going on social welfare, which would roughly equal the salary of a student job. I could not object based on pride as I am not in the position to turn up my nose at any kind of support available. But I kept putting off visiting the department of social services because frankly I was afraid of doing so. For starters, I have a bit of bad history with administration and it is a very anxiety-laden topic for me. But also, the idea of having a place to turn to in even harder times was so comforting that it was difficult letting go the promise of relief at the expense of possible rejection. It is a pretty stupid concept and I would advise everyone to just get it over with as quickly as possibly if being told this story. Inside my own head, however, things are not always straightforward.
Fortunately, I finally managed to drag myself there, with the result that the state support my therapist suggested is not even available for me. As a student, I fall into a different category of welfare which I have to apply for at the employment agency instead, so the journey continues for a while.

To repeat from yesterday’s post, I need a statement from my therapist that I am not capable of working a job; usually, it would be the employment agency’s own doctors who have to come to this conclusion as a result of their examinations, but with mental health problems, that is hardly possible.
Going on state support was not a decision I made easily, or even voluntarily, but it’s the only practical solution left. It would be great if someone gave my husband a job instead with which he made enough so that we could exist from that income, but that’s unlikely in the current situation. All I know is, if I have to work, that is the certain end of my university career – I tried before, and the result was that I prioritized my job over classes, because “without the money I can’t stay enrolled in uni either”, and I had not enough energy for both. And I do not have it in me to make a third start from scratch, should this second attempt fail. It is all or nothing in regards to uni now.

Life goes on, with or without me. With or without therapy. No matter how unfortunate it is that my therapist got ill just now, when I would have liked to be able to write to him about the whole welfare business, I need to try without him the best I can.
My last therapy session was in early December; the one scheduled for January didn’t happen, and it was a bit of a warning sign already when it took three weeks before my therapist could tell me when he’d have the next opening – we were supposed to meet at the end of March again. He’s been chronically overworked for at least a year: last spring / summer it was pretty much the same, when I’d have a session in April, then an emergency appointment in June, and then nothing until September. My blog is full with comments on staff shortage at the hospital. What’s sad is that on the last day we emailed, he told me he was currently working in a new colleague and that he hoped that we could have “at least one session per month” from April on.

I guess this post is rather all over the place, but all of this has become one huge “cluster” to me anyway.

December News: A Short Overview

Sometimes, there are some smaller events which fit into the blog, but don’t warrant a post of their own. Or topics where I don’t want to go into a full analysis right now because that would depress me, but which I might like to come back to later. This blog entry is a collection of such “news snippets” and comments, and I am planning to make use of the feature in the future as well.

1.) Integration Class: When my husband was granted a residency permit for three years in June, it was under the requisite that he attended integration class for learning German. The first vacancy in such a class in our home town was in December: given our financially restrained situation, a different location was no option as the costs for public transportation would have bitten a serious chunk out of our budget. So we had a lot of time to bide just waiting for December to roll around.
On the morning of the big day, he left for class, only to be back home an hour later – the course had been moved to the end of January due to problems with the class rooms available. So that meant waiting for another seven weeks, and on top of that, we had not even gotten the letter informing us about this the week before. Especially my husband was deeply disappointed; he had looked forward to finally getting started after so many months of waiting.

2.) Christmas Party: I attended the Christmas party at the library where I used to work until February 2011. Last year I chickened out of going at the last minute, blaming it on an uni test (which we really had, but it didn’t interfere with the party). This year, however, I was determined to go, and it turned out really nice.

3.) Class Reunion: Just before Christmas, there’s the annual class reunion of my school; basically consisting of having drinks at some pub and catching up with who’s doing what. The last time I attended was in 2009 for the tenth anniversary of leaving school, which proved the kickstart for an episode of major depression that led straight to the panic attacks of June 2010 and consequently to antidepressants and psychotherapy. (So there came something good out of it, eventually.) It made me feel so inferior about myself – labouring around with my university education, a really complicated love life I did not feel like explaining to anyone, and nothing else worth talking about either – while everyone else gave rundowns of their academic credentials and fancy jobs, or not so discreetly flashed chunky engagement rings… It was an experience I have not had any desire to repeat since, especially since hardly any of the people I would like to meet again attend either.
Usually, I’d just ignore the Facebook invites and pretend I hadn’t seen them. This year, however, I felt the desire to actually decline officially. I did not give any reason; I could hardly write the truth (“Most of you are a bunch of phonies and it depresses the shit out of me to see that even the stupidest and those most lacking in positive character traits managed to carve out more of a career than me”). And it’s not so much that I feel ashamed of myself rather than having no desire to share intimate details about my mental health with people I have no contact with otherwise. Maybe by the time the fifteenth anniversary rolls around I’ll give it another try, but for now, I am quite happy to stay at home.

4.) Gastritis: For the last couple of weeks, I have had stomach problems, especially in the late afternoons and evenings. The symptoms match those of gastritis, which I’ve had a couple of times already over the course of the last fifteen years. I didn’t even see a doctor for it, because the advice they give is always the same: stick to rice and apples and drink lots of tea until the symptoms go away. Antacids are not covered by the health insurance in such a case either.
It’s stress-related anyway in my case, and when it did not go away by itself, I switched to a somewhat restrictive vegetarian diet for the last couple of days: apples, bananas, rice, pasta, bread, potatoes, legumes, corn, vegetables. No meat, fish or poultry, no eggs, no coffee, no hot spices, no berries, no citric fruit, very small quantities of dairy products only (which I have to be careful about due to my latent lactose intolerance anyway). It helped a lot, but tonight I’ll try to steer off that list with small portions of the “forbidden foods”, because I start missing them.

Forcing Myself To Post

This is not the first time that I’m trying to write a blog post, even though a couple of weeks have passed since the last attempt. The biggest hindrance being my continued inability to express myself – if talking about it poses great difficulty, writig appears an almost Herculean task. So I’ll just try to give a very fragmentary overview in the hope that eventually I’ll be able to express myself more eloquently.

I don’t know how I made it through the semester, in hindsight maybe even less than at the time of living it. In the end, I was so burned out that I pushed all but one of the exams to October, because I wasn’t mentally fit for studying any more, but at least that one exam I passed with an “A minus”.

My husband’s appeal for a residency permit got granted for three years (after that, it’ll be a permanent one). We jumped through all the bureaucratic hoops and in December he can finally start the mandatory German classes, the way there being paved with many frustrations that will require a post of their own.

My old computer broke after five and a half years of faithful service. The power supply unit literally blew up (knocked out the living room’s fuse, smoke curling out of the computer’s back) and damaged not only the PSU, but also the mainboard and processors. It was only because of a financial donation from my mother-in-law that I could buy a laptop as replacement… All my personal data – photos, all my uni files, the templates for the blog charts etc. – still are on the old harddrive, but I hope I can get them back soon.

The last regular therapy session was in April. I had one “on the side” in late June, which my therapist had crammed in between hospital duties one morning, but following up on this, all scheduled appointments got cancelled due to the persisting staff shortage at the hospital, and then August rolled around, which my therapist takes off every year.  I was told to get in touch via email at the beginning of September, so I guess by Wednesday (when the first dust of back-to-work-stress has settled) I will contact him.

For about three months, I have argued back and forth with German Telecom over the cancellation of my landline phone back in February: because I couldn’t pay my phone bill all at once, I had cancelled my phone and arranged for payment of the remaining bill in four rates, due in March, April, June and July.  In May, I received a letter reminding me of outstanding payments on my landline and when I called customer service to clarify the mistake, the ladies I spoke to insisted that my phone had been turned off because I didn’t pay – never mind the fact that if one calls my old number, an automated message announces that the phone number is not available at the moment. It wasn’t turned off, it was properly cancelled. On top of that, they spoke of the fee due in May, when the payment plan I’d received in the mail clearly stated that no rate was due that month, and claimed that a sum equivalent of three rates was still due when I had already paid two rates out of four.
In the end, I got so worried that I even discussed it with my therapist the one time I saw him, even though his suggestion to take a lawyer to sort this out was rather unsatisfying to me – how would I pay the lawyer? I don’t have any insurance which would cover such a case either, and so I could only hope that one of my emails or phone calls would finally sort out the matter.

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These are, in a nutshell, the most important events of the past months. This is the third day I’m “working” on this post, just to give some kind of perspective regarding the difficulty of writing. By the end of June, I was at a score of a whopping 33 points in the BDI-II, which signifies heavy depression, and right now I’m still lingering at around 15 points on good days, or higher on bad days.
The most persistent symptoms are a lack of energy and “emptiness” inside. Not only am I  devoid of any kind of esprit or verve, but sometimes it’s even hard to tell what I’m feeling. There’s… just nothing I could put into words. Which is upsetting when my husband asks me what’s wrong, because I don’t want him thinking it’s something he did. It’s just our circumstances, I guess. We’re on a very tight budget and can’t really afford to go out, much less to go on a trip for a while. So I guess part of that emptiness inside is just boredom, being stifled by the ever-same routine. And part of it is pure dread in the face of having to go back to uni in a couple of weeks. Even though I know that I should take it as a challege and one day at a time, the memory of the last semester is too fresh to actually see it this way.
Around this time last year, I thought if I went back to uni, it would take a couple of weeks and then I would get used to it. I thought that if I did not manage 100% productivity, I would reach at least 70%. Right now, it feels that anything beyond 30% is beyond my capacity, and I wonder if I will ever become “normal”, ever be able to finish uni, get a job – and hold it down. How do “normal” people manage?

Finances, Fear, Family, Frustration

I’ve been in financial trouble lately, culminating in a letter threatening to turn off my gas and electricity if I didn’t pay within the next few days. It came as a really unpleasant surprise, because I was under the impression that I had already paid all I owed last month, but apparently had been mistaken. My boyfriend was able to cover for that and so we’ll continue having warm water and heating, but it still weighs down on me. My mother barks at me that I have to quit university and get a job, my therapist tells me it’s of utmost importance that I finish university, as does my boyfriend… I’m tired of being stuck in the hamster wheel, tired of the perpetual financial strains.

And I feel guilty because I do not have the stamina for handling both a job and uni. I can’t even hold up university alone…

Last week I saw my therapist for a few minutes because he had to give me a doctor’s note so I’d get out of the second attempt of the chemistry exam. He puts a lot of emphasis on the fact that I learn to put up boundaries towards other people and learn to defend myself so I can actually do what I need to make myself feel good. Which is a lot easier said than done, especially since my brain just “empties” under stress and I become completely speechless, in the very sense of the word. It is a reaction to the cortisol surge one experiences under stress: long-term exposure to this stress hormone damages the brain cells in the hippocampus, which results in memory problems, and it also impairs retrieval of already stored information.
This morning, I was crying after receiving the letter from the energy supplier, and despite my boyfriend asking me to talk to him and say something, I just was not able to. I could not form a coherent sentence, neither in English nor in German. Even now, it is difficult to describe what is going on in me in these situations – one should assume that once the problem is taken care of, everything is alright. And my boyfriend echoed what my therapist tells me as well, that I have to stay in the present and not make this about everything that went wrong in my life, but I am not always able to do that immediately. The fear and despair can be faster than any rational thought.

Money is not the only source of stress – there also are the uni exams, of course, family situations, and the fact that the bureaucratic process for our marriage is very frustrating. I had to hand in a statement from my parents that they supported me financially, which got “lost” – even though I handed it in, it never arrived at its destination. Then I brought a second copy of the statement, only to be told that I had to re-write it. It is almost ridiculous that my boyfriend’s American documents are all fine, but my German documents create all kinds of problems…

You Better Watch Out, You Better Not Cry…

Christmas usually is an especially difficult time of the year when it comes to family relationships. The stress prior to the actual holidays brings out the extremes in our behaviour. My mother regularly explodes on December 23rd because she has problems delegating tasks, but gets overwhelmed by the load and vents her frustration and stress violently…

Thursday, December 22nd

Twelve minutes into Christmas break on the way home from university, I slipped on the escalator leading down to the tram station and twisted my right leg, while simultaneously tearing my left arm (which was still grasping the handrail). I could still walk, but only with a heavy limp, and had to have my sister pick me up from the tram station in my home town so she could carry my bag.
Over the course of the evening, I got rather upset because while my mother was rather worried, it was over the fact whether I would be able to drive her and my grandmother to the supermarket the next morning, and she didn’t express any concern regarding the pain I might feel. Functionality trumps pain – her problem with my depression was that I didn’t function anymore, too. Now that I appear functional again, my feelings become secondary once more.

Friday, December 23rd

At 9.30 in the morning, I found myself at an overcrowded supermarket. Finding empty space in the parking lot had already been a challenge, especially since my grandmother uses a rollator walking aid and wants to park as close to the entrance door as possible. The situation inside was worse rather than better.
With the need to pull myself together for uni temporarily suspended, my mood had started tumbling down quickly, and the longer we were inside the grocery store, the worse I felt. My swollen foot pulsated with pain and the constant bickering between my mother and grandmother – who were both affected by the general atmosphere as well – grated on my nerves.
After about half an hour, it took a really insignificant event only to push me over the edge: I was waiting for my grandmother to finish her business in the butcher’s section and just biding my time, when suddenly I felt the gaze of a middle-aged man on me. As he noticed that I caught him looking at me, he winked at me. No idea why it upset me, but it did. I wanted to yell at him to stop looking or winking at me.
I hid in the only empty aisle I could find and actually started crying. Because of the limping, I was always behind my mother and grandmother anyway, so nobody missed me, but in order to not rouse suspicion, I couldn’t stay there for long. Managing to pull myself together until it was time to queue at the check out, where people were standing in long lines already, I excused myself and went to wait in the car: officially to rest my foot, but really for calming down. I switched the radio on and concentrated on the music, so that by the time my mother and grandmother had finished their shopping, I had regained my composure.
In the late afternoon, I got once again into my mother’s crossfire when she repeated her threat that I had to move out if I didn’t get a student loan, which caused me lots of anxiety again.

Saturday, December 24th

Christmas Eve is the main event of the festivities in Germany, with big family dinners and the exchange of presents in the evening, and it started even worse than the previous day for me. I was already crying in the shower, with no clue how I was supposed to get through the day, and poured it all into an email to my boyfriend, which I felt guilty for later – waking up to your girlfriend’s hysterics doesn’t make for the most relaxed Christmas either. (He was utterly lovely about it, though.) Somehow I managed to dry my tears and leave, though, so I could help my mother with the preparations for dinner, but what happened then took me by surprise:
The conversation turned to my 10-years-old niece, who had exhibited rather ill-spirited moods that morning too. I remarked that I’d occasionally wondered if she didn’t suffer from the same condition as I do, but had never said anything because that was a hunch rather than something I could back up with solid facts. And that’s the truth – there are certain gazes or the way she holds her head or looks at people that feel utterly familiar to me, like the seed of all that avoidant behaviour, but I cannot present any evidence.
My mother nodded, then asked: “Where does this come from? Is it me?” (My mother looks after my niece when she isn’t in school.) I was completely flabbergasted and utterly at a loss. There are basically three reasons which cause chronic depression: 1.) genetic predisposition – which I certainly have from both sides of the family; 2.) neglect in infancy and childhood – which I can exclude for myself; 3.) repeated experiences of helplessness over long periods of time, concerning “significant others” like parents or other very close family members – which is very much the case with me. I had never told her what caused my chronic depression, because that’s simply too damn difficult a task – I don’t want to hurt my parents, because I know they had to endure a lot worse from their parents and never had a chance to not become slightly messed up either, but I could name dozens of situations that led to me becoming depressed and developing patterns of avoidance. My mother probably noticed that I was looking for the right words a little too long, and when I finally answered, it was just the three points mentioned above without connecting them to any personal experiences.
This was the worst time possible for this conversational topic to come up; on a different day, I might actually have welcomed the chance for broadening this point with her, but NOT ON CHRISTMAS EVE…
Myself, I started feeling better in the afternoon and got through the evening ok. We had all agreed to not buy any presents for each other because money is tight, so the big emotional climax was missing, but at least nobody fussed about it and I wasn’t reminded to get a job either…

Sunday, December 25th

I slept like a stone, until noon almost. The day was quiet, but pleasant. In the afternoon we went to see my grandmother and aunt, and in the evening I met one of my school friends who is home for Christmas. I didn’t feel like crying.

Monday, December 26th

Boxing Day is a national holiday too in Germany and at least in my family entirely dedicated to laziness. This year was in so far unusual as the family had a bowling tournament with Wii Sports – my mother isn’t much of a computer user and doesn’t even have an email address, while the rare behaviour for my father was to actually come out of his office for a family activity. So it was rather strange to see them playing a console game, but I really enjoyed the whole enterprise!

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So that was my Christmas, in a nutshell. In a little while I’m leaving for meeting another friend; I’m trying to fill the days with pleasant and diverse activities, so that my depression index goes down again and I will be fit for the last month of uni and exams once Christmas break is over, because if I learned one ting in therapy, it is that you must “fake it until you make it”.

Last Session Of The Year

Last therapy session of the year; the next one is on Friday the 13th (January 2012), to which my mum will accompany me. Apparently, my regular therapy is also coming to a close – I’ve had 31 sessions so far and if I recall correctly, that means only 4 more in the normal rhythm before drawing them out. Not sure about the time periods between them, but I do know that session 40 is definitely my last one. I’ll part with a laughing and a crying eye: laughing because my life improved so vastly, crying because I will be sorry to say goodbye to my therapist for good. The whole purpose of our relationship was that it would end again eventually, but I’ve grown fond of him… but, I guess that’s a bridge I’ll cross when I get to it.

We took a look at my uni schedule today, trying to find out what I can eliminate – all contact hours, homework and commuting time added up, I had a 50-hour-week and a BDI-II score of 20, with a tendency for the worse. Friday was crossed off the list completely and I’m supposed to figure out what I can do without until I reach a point where the work load does not push me into a depression anymore.
“We are pulling the emergency brake now,” my therapist said. “And if it gets too much,” he smiled, “just scratch another class off the list and go to the cinema instead.”
Eliminating classes wasn’t the problem, I didn’t need help for that. The huge difference is that if my therapist “allows” me to take it easier, I feel like I’m actually doing something pro-active and taking care of myself, whereas without discussing it in therapy, I’d have suffered from a bad conscience and felt like I was only procrastinating. That’s clearly something I still need to learn during our remaining time together: that I have a right to take care of myself and that I’m allowed to set limits.
A job is only possible in summer, because I’m going to have exams and an “en bloc” course and an excursion (probably followed by another protocol) during the upcoming semester break, and during the second semester my situation will hardly be any different…

Our roleplaying exercises were a little different today: not the usual dialogues acted out, but instead my therapist challenged me to defend my position. After I told him that I preferred learning at home over learning at the library, for example, he said: “Convince me! Why should I believe you are learning more effectively at home?” So I listed my reasons – that I felt more relaxed at home and could concentrate better because I wasn’t constantly aware of the people around me, that I didn’t have to watch my stuff if I walked out of sight of the desk, that I had more freedom on when I wanted to learn…
Later he made me stand up while he remained seated (a position I hate, because it causes me to feel vastly overweight – even though he doesn’t get that impression and it exists in my head only) and voice the effects the depression has on me as if talking to my mother: “I have troubles falling asleep and wake up in the night; the muscles in my arms and legs hurt, my joints too. I have headaches and backaches and stomachaches. My eyes are inflamed and hurt and I can’t always see properly because of that. I can’t concentrate very well either and doing my homework gets really difficult because of that. There are cognitive problems which make me forget words and sometimes I don’t even understand my homework anymore because of this.”
Only when looking back I realize I listed exclusively physical symptoms, but didn’t mention the sadness, crying and despair descending upon me. Had I spoken to my therapist directly instead of him acting as a proxy for my mother, I would probably have mentioned this, but since we hardly ever discuss intimate feelings in my family, I didn’t speak about this in therapy either.

One aspect I forgot about and which my therapist highlighted today was exercise. There is no room in my current schedule for any kind of physical activity. He described a scientific experiment to me, in which hamsters had been exposed to stress over a long time, leading to the hamsters becoming depressed. The source of stress was removed then and the hamsters got divided in three groups: group A had a nice cage, plenty of food and social contacts; group B a nice cage and plenty of food; group C a nice cage, plenty of food and an ergometer. Everyone suspected group A to show the fastest recovery rates, but in fact it was group C which was the most successful within the given time frame…
Exercise is supposed to be light and fun – no pressure to achieve any results, but regular periods of physical movement. I certainly remember how beneficial my Tae Bo classes were, even though I have nowhere near the energy for that now. But I’ll try to reserve a fixed time for swimming or cycling or something like that.

Depression Revisited

Those last few days my situation has been really bad; as mentioned before, I depend on financial support from my parents, and my mother has been urging me to get a job, even though I hardly have the time and capacities for taking a job on top of my studies. I tried handling the situation on my own, but when she threatened I had to move out of my flat (which would equal moving in with my parents again), I panicked and wrote to my therapist about the situation. He replied:
“My medical opinion is that a place of your own is very important. Moving out or getting a job at this time would put your health in extreme danger and further increase the risk of chronification. That’s a specialist’s opinion. Please stay calm and tell your mother that you are in close contact with me and asked for my medical opinion. I’d be happy explaining it to her personally in the new year.”
I am going to take him up on this, because I believe that he’ll be able to speak with much more authority to my mother than I could ever have. If I say anything, it might look like I’m unwilling to get a job, when in reality, that’s not the case at all. I wish I had the energy to handle both…

I don’t actually think my mother was going to kick me out – it’s more like a really inappropriate kind of hyperbole to steer me in the direction she wants me to take. But at that time, the idea really freaked me out: I do love my parents, but living with them permanently would drive me over the edge quickly.

I’ve had so much stress lately that the muscles in my limbs turned stiff and hurt so much that I can’t fall asleep until 4 in the morning. My eyes are inflamed again too. Those are symptoms I can handle, though. What unnerves me is how much my cognitive abilities are influenced by this: it’s harder to concentrate and doing my homework becomes more difficult. It started about two weeks ago already, but has increased since.