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9:15 p.m. - 06/05/02
patient seems steady and markedly fatigued.
'nobody nowhere' reminds me in some ways of 'a child called it.' matriarchal abuse = national bestseller; it's a somewhat frightening equation. I've been reading it for a couple hours waiting for my mom to finish dreamworking a recent silk painting and hand over custody of the computer. my head is semi-foggy now; I've been a little overtired today.

last night's sleep would have been one of my weirdass, migraine-inducing comas (yes, they are still happening) but I had to rise in time for the dr. r appointment. I think this is a good thing. I also think that if I eat a little before going to bed each night I won't have this happen anymore; I have a theory it's blood-sugar related- since sugar has such crazy effects on my heads after the migraines do take hold. anyway, I've been experimenting with this idea. monday night, I ate a couple crackers before bed and was fine. last night, I didn't eat anything before sleeping, and had all the classic coma-isms except that I woke myself up in time to leave. this could all be coincidence; my life science teacher said to test everything three times- I plan to follow this pattern for a week and see what results...I'd bargain a couple crackers for no migraine any day...

that was the long-winded way of explaining why I'm a little overtired. and in need of the lowercase. lowercase letters comfort me. I think they look more like my handwriting, which is small and inhabits close-quarters.

in spite of the abuse, 'nobody nowhere' is an intriguing book. it has me back on the track that all mental illness is humanity magnified. I recognize myself in a lot of it, though certain characteristics/ survival skills the main character applies are foreign to me- (violent antagonism, antisocial tendencies, et cetera.) I've been thinking about the day that Judie and I discussed my reading habits, and she tried to explain that I was not like Deborah in I Never Promised You A Rose Garden. I am not schizophrenic (or autistic, for this entry's matter) but sometimes I wonder why. I wonder what kept me from developing other parts of my survivalist self, developing a different illness. I understand the use of a "poetic language"- the interpretation of environment through image is something I know extremely well, and this is a large part of what describes autism. and Deborah (rg) on nearly every level is a mirror-image of myself. I wonder why I was spared from those, apparently more impossible, illnesses.

hmm...surely I had something else to say. oh, yes. the appointment. dr. r. the chosen 'real world.'

maybe if I write here that whenever I seem to be notably wary of a dr. r. appointment it turns out rather well, I'll keep that in mind the next time. I think this has something to do with my tendency to be nervous about appointments *following* ones, and dr. r is not the type of person who doesn't think on what happened a week before. he may not obsess over the goings-on as I am prone to do, but he does come in with a fresh perspective on the stale events. he isn't looking for new material, rushing into the weeks' happenings and leaving the past ones undone, and he isn't drudging up those old ones without having more carefully thought out his own perspective on them.

I think relationships work well when people remember that sometimes, through no fault of either individual, they are separate beings and occasionally need to put real effort into understanding and being understood. I like the way that I can look at a recent past with him and feel like he is doing the same; I can feel safe in the idea that we are both analyzing for what went wrong, not in a blaming sense or even a negative sense (wrong is- fittingly- not the right word) but in order to determine how we can gain something from it, and how we might alter the course that neither of us enjoyed.

I like not being the only one who feels like something is wrong.

so...we talked about the meds. specifically the new med, which he prescribed last week (and which I still have not taken): concerta. he started out by telling me that he understood that he had pretty much rushed through that conversation, and that if he could do it again, he would definitely have waited at least a week to discuss the pros and cons and conclude whether this was something I wanted to do. since that sort of time-travel didn't seem an option, we talked instead about my feelings on the med (that it was unnecessary, that it was more of people trying to mold me into something "perfect"- fixing problems I didn't have) and his own meaning in offering it. he told me about some of the neurological points, explained that meds like concerta work to rectify the 'bottlenecking' of the frontal lobes, which basically control what he called executive function. since depression and anxiety generally (and especially in my case) are responses to feeling unable to control these functions, he meant the concerta as a possible solution to the original problem, rather than a late attack on the manifestations. of course, he added the disclaimer that it's all basically guesswork and we can never no for sure what a med will do until we try it, but I felt a lot better about his reasoning. I knew there had to be some small piece I hadn't heard (or hadn't been told.)

he said that from my e-mail, he thought I was interpreting it as someone trying to fix what wasn't wrong, trying to change me. I told him that in general I understood meds to be about helping me be who I *am* (not changing me) but based on the quick explanation I'd received last week, I'd felt some of that. he'd told me the concerta would help with 'boredom' and aid in 'focusing' me, minutes after I told him that I didn't struggle with boredom, and I don't feel I have trouble focusing. I explained that although I do feel bored occasionally, and that my depression and anxiety do hinge on feelings of powerlessness like he'd suggested, I didn't look at my times of boredom as an overwhelming force of detriment to my life. they didn't strike me the way the anxiety or depression do- as major hindrances. he listened to this with admirable attention, and we talked for awhile about where the feelings of powerlessness come in in my life.

I told him about having friends who are struggling and being unable to help, about doing everything I can to make the collegiate cut, and still having no say in whether or not I'm given an acceptance letter, scholarship, et cetera.

I told him those areas did breed considerable, and occasionally unrelenting, depression or anxiety, to which boredom wasn't comparable. I explained that generally, if something bored me I could finish it (if necessary) and move on. when doing so, I moved on from the feelings as well; they didn't linger to further irritate me. just tonight, I felt boredom when my mom began using the computer just as I meant to, and for awhile I wandered between rooms, restless. then I fell into my book, and when she called up to let me know she'd finished her task, it took me minutes to mark the page and return downstairs.

because I was feeling so safe and heard, I told him that my resistence to this med right now didn't mean I'd never be interested. who knew where I'd be in the fall, with seven classes to juggle and the possible variable of act testing? I might need help focusing, help drudging through the busywork, help curbing my inevitable boredom in the more time-consuming or less challenging classes. but as my life stands now, I didn't feel it was necessary. as my life stands now, I feel more compelled to find non-chemical solutions to my problems. they are small versions of the problems; they are decent testing ground.

he understood this. I'm not on the med. he told me I made sense and my perception was legitimate. I told him I occasionally make sense, and he said, "about 99% of the time." it struck me that I could be right that often and he could be right that often and we could disagree. because sometimes we're both right in what we're thinking, and it's our communication that's skewed. anyway, I'm free to start taking the little cylindrical pills if I want to, but I have no duty there. he's such a sweetie when he agrees with me.

it's getting near bedtime. I have to remember what else we talked about...hmm.

the eight week mark came next, I think, and if not it will in my retelling. I reiterated that my bringing it up had not been evidence that I was keeping rigid track of the time, but I really had just become curious and felt compelled to check my journal for a ballpark figure. as it turned out, we'd reached eight weeks, and so I'd mentioned. and yes, I told him, I had been a little thrown and hurt at his surprise. I worried that the plan had changed without my input.

he explained (before I even began talking about it) that he had honestly just lost track of the time, and so I'd thrown him with my comment. and that, seeming so innocent in the busy-ness of his day, comforted me.

I told him I didn't know what eight weeks meant to me. I told him that I so pros for staying and for leaving- and the same with cons. I told him I hate decisions and I didn't know. he asked what it would mean if we didn't have to decide, if we could just take a few weeks to evaluate, and I told him I would have trouble not feeling like I still had to figure it out. "if I'm going to have to decided in three weeks time, I had better start determining now." (similar to: "if I'm going to have to talk about this in a week, there's no way I can just stop thinking about it until then.") planning, planning, planning...

he said that either model (him as my therapist, my parents' therapist, and tammy as my dietician -or- someone else as my therapist, him as my parents' therapist, and tammy as my dietician) could work and be positive; I whined about my indecisiveness. he asked, amusedly skeptical, if it would help to have someone else make the decision; I laughed and shook my head, knowing my control/ powerlessness issues would just start roaring at the slightest semblance of exclusion. I explained that even though I still wanted to be as far away from my parents as possible, I wasn't comforted by the idea of having to give another family history, having to 'start all over' again. we talked pros and cons of parental involvement. I told him that I had pretty much reveled in how cut off Harriet kept them, although it did make it difficult when she went to them about a safety issue, or when she made an overly frank comment about them. I explained that even though she had taken it to a more negative extreme, that sort of autonomy was something I've always preferred. even the very general (siskel-ebert-type) updates Tammy gives them tend to gnaw at me a bit. I want my therapy to be as much "mine" as possible, and even though I understand their need for information, it does grate at me a bit.

he mentioned that last week's multitasking (my dad's meds were tested while we met in a different room- an occasional reality of our meetings) probably did not help with that, and this was a practice he wanted to discontinue. he thought (rightly) that it would be better for our meetings to be just our meetings, and to consistently take place in the same room. he asked if there was anything else I thought could be done to further make the sessions "mine" so I mentioned that I felt better when my parents dropped me off, but so often they have questions to ask/ answer, appointments to make, et cetera that they need to come in. he brushed aside my justification and said it was still something that could be worked on. I could only think of one more.

I told him that sometimes I felt like we discussed me in the context of my parents. he tends to ask about how I'm doing with what's going on with my mom or with my dad, how I'm feeling in the environment at home. while that's a definite part of my life, it's only a part, and it excludes the other people I'm in contact with, the other events that happen in my life, and the other goings-on that are more intrinsically *me.* as important as it is to talk about the pain around my parents, I do have a life outside of it, and I sometimes feel that isn't addressed. just because I see so few other people doesn't mean I only have contact with my parents. and not having those bases covered means that when I do face a major struggle in a "separate" area of my life, I don't feel capable of covering all of the background necessary to explain. perhaps more often, I just feel like I'm in separate family therapy. I'm being treated as a cog in the family workings, instead of as the 'individual' that a more removed therapist would see.

I think he understood this instantly, before I had finished the first sentence. I think that, in spite of how brilliant he is, his focus on the family had kept him from catching it, and as soon as I mentioned it, he set the course for change. with my agreement, he seemed eager to explore the other areas of my life. "you're right," he said. "it's an odd assumption that just because you spend your day at home, it revolves around your family. I don't know what you do with your day. and we've never talked about other people in your life, other than what your friends were like in Neverland- in the past. not currently." he mentioned a specific incidence that's fallen under the radar, and I laughed a bit sheepishly and explained that we didn't need to talk about *that* (no! I didn't mean the crappy stuff!)...but I felt understood.

I think the course we'd been taken made me feel like my only really important problem was life with my parents and any other struggle was secondary. I don't think he meant me to think that.

so...we're supposed to "think together" about whether or not I want to see someone else. the truth is, I don't think I do. I know myself, and I know that I need there to be a real option that I can live, something we check back on occasionally, so this maintains its "controlled" status, (I don't sit in rooms without visible doors) but I think the "change" I felt was coming may not have been so drastic as a therapist-switch (even though, having been planned eight weeks in advance, that didn't feel drastic.) I think it just meant making our work more all-inclusive and discussing some things that we hadn't.

so basically, I'm only left wondering why he wanted me to see The Therapist Who Makes The Dalai Lama Pay Homage instead of him. I'm guessing it was because of my own stated needs, which makes me wonder why he isn't still working on that. I guess I'm not quite ready to admit if my needs have changed.

my needs might have changed...in a lot of ways, I just feel like I have a better chance of being ready for college in a year if I work with someone from the point of my relationship right-now with dr. r than from the point of a beginning with someone else.

not to mention that he is a really decent person/ therapist. I knew I'd believe that again eventually.

I feel like I'm forgetting something, but if I am, it isn't coming back to me with my increasing tiredness. lisa loeb is lulling me to sleep (mistrandy's gift card gave me "cake and pie"- borders of course refused to house the crabs) ... it's a really lovely cd, even if it isn't positively wonderful. I think her voice is just one of my most gentle noises, and I need gentle right now.

so god bless the difference a week makes, and despite the abruptness of this, I'm off to bed. my own little medical charting is done for the night.

chord

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