Will I make it through?

I feel lost.

I don’t have any words written for my dissertation proposal yet.

I have to propose it this fall.

I’m so burnt out and exhausted

I’m spending 35+ hours a week on things I have to do but that are not related to my dissertation. Like practicum and teaching and managing research assistants.

 

On the weekends I’m exhausted

I cant focus to move forward

I’m scared I’m going to be kicked out of the program if I don’t so progress by getting this proposed this fall

I have to propose this fall to apply to internship

The list of internship sites is overwhelming

The idea of having to self-promote for interviews and applications is terrifying given how lousy I feel about my accomplishments in grad school

I’m not sure I can do this

My advisor is well intentioned but overloaded with managing some departmental drama and family problems.

I usually like teaching but feel so resentful of it right now for the time it takes away from my ability to work on my dissertation

These feelings are real but I think they are amplified by being on the placebo section of birth control right now

I’m still a lesbian

But I’ve been dealing with awful nausea and one sided pelvic pain for 50% of days linked with my cycle. I’m tying BC to manage it. It seems to me working and I got the green light today to not have to have periods at all anymore.

Stress is breaking my body

I hate the weight I’ve gained in grad school

Today I went from the place of just being tense anxious to looking up suicide methods.

Then I got anxious about risks of it going wrong and opted for a shower, some self harm and a klonopin instead of suicide

I have not activated the mammalian dive reflex yet but it probably is coming later tonight

My cat is useless when I am this distressed

He knows I will hug him tighter that he wants when I am this upset so he is avoiding me

I can’t die because of the cat. He needs me. He’s scared of everyone but me.

I can’t die because I have to teach Wednesday and they need me.

I can’t die because I have patients scheduled this week

When I go to therapy Wednesday I’ll probably feel completely different and have trouble talking about how I felt today.

There will be too much distance from the emotions.

For me feeling suicidal is having intrusive images of methods popping into my head over and over

I’m less impulsive than I was when I was younger.

Instead of going from thoughts to actions I’m trapped in the immobilization of imagery that I am too scared to act on.

For those misreading my intentions here I’ll be explicit and say that I am not at imminent risk of suicide.

I am just flooded with ideation

When I was a teenager the ideation was pretty much daily.

As I’ve gotten older it is less often

But sometimes I am ambushed

I don’t think I ate enough today. 3 muffins and some hummas and crackers probably isn’t enough and probably is making me feel worse

Picking something from the freezer to put in the microwave feels overwhelming

How can I dissertate if I can’t select a frozen meal?

What will I do if I get kicked out without a PhD?

I cant go there.

I need to make the stakes salient to motivate myself

But if it is too salient I am immobilized.

Can anyone recommend something light and fun on Netflix?

I plan to eat better tomorrow

I really put that above sentence there to display being future oriented so no one calls the cops on me

Telling that may have negated the purpose.

But I am future oriented.

Promise

I hate graduate school

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I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school. I hate graduate school.

 

Don’t get a PhD. But I’m 5 years in so i have to see it through.

Diagnoses

In my very first post on this blog 9 years ago I listed different diagnoses I have been given. I was thinking it might be interesting to go through those now given that I have some expertise at this point in diagnosing where I can critically evaluate them. The diagnoses below are all ones I have been given in the past.

Dysthymic Disorder: This one is hard for me. I have a really hard time judging for myself whether I have this or not. I flip flop all the time about whether I think this diagnosis describes me well. It’s really hard for me to objectively take a step back and see if I meet that persistent depressed mood criterion. I can certainly tell when I’ve dipped down into an MDD episode but it’s hard for me to self evaluate if my baseline is really depressed. I certainly have chronically low energy and sleep a lot. But I also accomplish a ton of stuff and keep really busy. But my baseline is very self critical. Jury is out on this one.

Major Depression: There is zero question that I have had many major depressive episodes.

Bipolar type 2: I absolutely do not have Bipolar type 2. People who tried to give me this diagnosis looked at the apparent conflict between my depressive symptoms and my productivity and assumed that there must be a hypomanic component but I never have anything close to elevated mood for that could meet the duration and I sleep a ton all the time. I think there’s also an element of people mistaking my fast talking for hypomania when I just always talk really fast. There’s an anxious part to my rate of speaking but I’ve also tested at 99th percentile processing speed. I think there’s an aspect of me just being able to think very fast. Also I am very socially isolated. Sometimes when I have a chance to speak after not for a long time a lot of stuff comes out because I have not talked for awhile.

Bipolar type 3: An inpatient doc tried to give me this diagnosis once because I had a bad reaction to Ritalin. This diagnosis does not exist so I clearly don’t have it.

Social Anxiety: I have anxiety about a lot of things. Sometimes some of it is about social things but I don’t believe I have ever really had social anxiety. It’s more than some of my generalized anxiety bleeds into social domains. But the symptoms are better accounted for by my Generalized Anxiety Disorder.

Generalized Anxiety Disorder: Hell yes. This is my main underlying problem. Everything stems from my GAD. When I am depressed it’s usually because I ran myself into the ground from being super anxious. Sometimes I have a few good days where I think maybe I don’t have GAD anymore and then some speedbump happens and I realize I clearly still have GAD.

Panic Disorder: I have had panic attacks but I have never had panic disorder. Panic disorder requires fear about having panic attacks. For me it was always that I was anxious about something else and happened to have a panic attack.

OCD: I have a tendency to by obsessional but I think it is really stretching to say I’ve ever had OCD. That obsession compulsion loop does not describe me well generally and when it does it is better explained by other disorders.

Trichotillomania: I absolutely met for this in the past but no longer meet criteria for it. I still pull but the severity is so low that it’s not causing any problems for me. When i get stressed my pulling can increase but I’m not in the clinically significant category anymore.

Tourettes: Yes I meet criteria but I do feel like my symptom presentation is a bit odd since it developed more in adolescence than childhood. Ive had this tendency to get caught on repeating phrases though as a self soothing thing for my whole life so I think that I had an element of this going on as a kid but my parents perhaps didn’t realize that the verbal loops I was getting in were not under my control. I’d say things like “I like my cat” a bunch of times and my parents would respond “Yes we get it you like your cat”. But I wasn’t really trying to communicate things. It was more of a loop I was caught in. I still have tics and they get worse when I’m stressed. It’s only certain kinds of stress though. Social rumination is a major trigger for my tics. I feel nervous wearing headphones in public because I worry I will have verbal tics and not realize I am doing it.

ADHD (inattentive type): I have a pretty well documented pile of neuropsychological testing that says I have ADHD. I think perhaps though I actually have the combined type no the predominantly inattentive type. I’ve gone through all my records from childhood and they all talk about impulsivity symptoms. My most recent assessment found that I did terribly on measures of impulsivity on the Conners CPT.  Right now impulsivity symptoms are the most impairing part of my ADHD. For example I have an extraordinarily hard time inhibiting urged to blurt things out when a thought comes to mind which make some people REALLY mad when it means I interrupt them. I try so hard to manage that but I basically have two modes either fully suppressing any talking or talking where I’m likely to end up unintentionally interrupting.

Sensory integration Disorder: This is more an OT diagnosis and is not in the DSM so I don’t feel qualified to comment.

Auditory Processing Disorder: This is more an audiologist diagnosis so again don’t feel qualified.

Borderline Personality Disorder: Here’s the thing. I can see why people applied a borderline diagnosis to me. I still really don’t think I have ever 100% met criteria for it. I think you always had to stretch some of the criteria in strange ways to make me meet. As of right now I think it’s even clearer that at this  point in time I don’t meet criteria. Borderline PD is often conceptualized as being on this emotional rollercoaster. Certainly I was like that in the past. Now I’m more stably anxious. Under extreme stress I will start to look “borderline” ish because I become very emotionally reactive, am prone to impulsive self destruction, get very distrustful of others, etc. But the thing is I don’t look like that on a typical day or even in the typical week. In the past I had a lot more daily mood instability but I am less reactive now. Every now and then I get ambushed with periods of being on an emotional yoyo but it’s far from being my baseline. Even at my worst people were most likely to give me a borderline diagnosis when I was in acute distress. I don’t think that’s a good way to diagnose personality disorders. Do I have a personality disorder? Probably, but I think I’m more in the cluster A and C camps than B.

Mood Disorder NOS: This is not longer in the DSM but was basically a catchall for weird mood stuff that didn’t fit elsewhere. I actually think a lot of that weirdness can be explained by PMDD

PMDD: I fought this for a long time but I think I’ve come around to it.  The way I see it, PMDD is an amplifier of my existing symptoms. It explains a lot about why I often have short lived depressive episodes that are intense but don’t hit the 2 week criteria needed for MDD. It’s hard to really get across how giant of a mood shift I can have from this. Even when I know that PMDD is at fault because I can look at my period tracker it does little to help in the moment because the emotions feel like just as important signals as they do at other times. It is a source of endless frustration that there is so little research on treating PMDD.

Things I wish I knew before I decided to do a Ph.D. in Clinical Psychology

  • Going in this field makes it harder to get mental health treatment for yourself. You can’t get treatment at the place you work and you need to avoid getting treatment at places you might want to work in the future.
    • When you get treatment it can add a weird dynamic that not all therapists are equipped to handle. It’s hard for my therapist to get the right balance of pointing out a way to apply a useful skill to my situation and irritating me from telling me something I know well from my own clinical work.
    • Graduate school was the worst thing I could have done for my mental health.
  • The stakes are so high for me to not get to the point of needing a psych hospitalization. In those situations so many different people are involved in you care and that means losing control over who has my information.
  • Most people are doing “me-search” but within field stigma against mental illness among people in the field is extremely high. Frankly I think there is more pressure to hide mental illness in this field than in almost any other career.
    • Some mild anxiety or depression is okay. But things like my self-injury would turn some serious heads.
    • There are some high profile people who “come out” about their personal mental health struggles but until you are a top tier famous researcher you have to hide mental illness or risk being discriminated against.
  • Some supervisors  conduct clinical supervision in ways that is dangerously close to therapy. Avoid Avoid Avoid.
  • A PhD takes a looooong time. I know so many people in other careers who have paid off the student loans while mine are still sitting in deferment. I am over this situation of not being in a “real” job. I want to settle down but there are years of additional tasks ahead of me before that.
  • So much of your fate is in your advisors hands and they have zero consequences when they let you down
  • Graduate school is not like school. At the beginning yes you take classes but later it becomes an apprenticeship.
  • In late graduate school you’re functionally holding a job but you don’t get the rights that you would have in a normal job. In fact your university probably will block you from getting the employee benefits they give to their staff.
    • In a normal job if you are treated poorly you can quit and probably find something in the same field. In graduate school transferring is very rare. I am unhappy with my program but my choices are to leave and abandon this field or stick it out.
    • My program feels they even have the right to control our ability to volunteer in activities unrelated to our professional work
  • The longer I am in this program the less of an idea I have about what I want to do with my life

 

I am lost and floundering. I don’t know how I will present my accomplishments positively for internship applications when I am so angry over the ways my program let me down in both my clinical and research training. Reality did not match the advertising.

 

I just so desperately want a job that does not have a time limit on it. Every year my funding is assigned for the year. Every year a new practicum to learn the ropes of. Whenever I get my footing the year is over and I start over. It’s a endless cycle of CV updates and new computer logins.

I have to do internship and a postdoc.  And even after postdoc I’m not guaranteed job stability if I go an academic route.

I could be 40 by the time I have security in the position I hold.

I want a real job

I do not recommend getting a Ph.D.

 

Healthy by graduate school standards

I’ve been in a strange position where people have repeatedly described me as calm, handling things well, good with stress. Not ways I am typically described.

I’m in the midst of some objectively bad circumstances. What makes this situation unusual is that other people are going through it with me. I’m so used to the majority of my suffering coming from mental illness. That’s an isolating struggles. It is bizarre to have a struggle that with social support embedded in it.

People around me in this mess are experiencing their first run ins with clinically significant anxiety and depression. I’m in strange situation where years of dealing with internal stressors that felt worst; somehow have me coping more effectively in the face of an actual objective undeniably shitty situation. I guess of coping with buckets of anxiety and depression that were disproportionate to the situation got me some benefit for handling my present difficulties. I’m still secretly cutting of course, but that is my baseline level of functioning.

Don’t get me wrong. I am miserable. But within normal range and at most adjustment disorder miserable. Not trying to find the fastest way to kill myself miserable.

I’m so aware of my past propensity to quickly escalate to suicide attempts that even being many steps removed I panicked asked my psychiatrist for seroquel prn just in case I need to knock myself out to keep myself safe. I’ve lost some major protective factors in my life. I’m in this strange place of having built so much insight into what makes me suicidal, that losing protective factors makes me anxious even if I am not having suicidal ideation.

But I’m not suicidal. I’m grieving in a way. Not from death, but due to an unexpected and uncontrollable major life change.

When I first started graduate school I viewed the negative comments and despair represented in phd comics as something of hyperbole. I’m deep enough in that that comic is my truth now. I started of thinking grad school was just a matter of systematically plugging way at things and that I would make it through. Now I’m treading water and have a vague idea of where land is. I am working towards finding land but I don’t know if it is the right way or if I will make it. I think I will, but these doubts about finishing are new. I didn’t view failing to get the phd as a possible risk before.

Somehow I have landed in a space where my misery is within the realm of normative graduate school emotions.  I find myself wondering if I still meet criteria for GAD at times. Then I’ll be ambushed by something stressful and decide yep, still there.  But at least in how I am outwardly presenting to others somehow it appears I have my shit together. I guess years of mental health difficulties have actually boosted my coping skills. At least making me look normal compared to a bunch of neurotic graduate students undergoing a major stressor.

Updated thoughts on DBT

It appears my post about getting DBT notes has gotten some attention recently. This made me realize I’m long overdue for updating here about my current thoughts on DBT.

Here’s a link to an earlier post about my thoughts on DBT: Do I need to rethink my feelings about DBT?

There is a part of me that feels I was robbed of a “true” DBT experience. I know now that strict adherence to DBT protocols would not have allowed for me to do individual therapy for DBT while waiting for an opening in the skills group.  I never got to join the group before being kicked out.  From what I’ve learned in coursework about DBT I think I would have really benefited from the interpersonal effectiveness modules at that time in my life.

I think that the therapist I was working with could have done a lot more to work with me regarding my anxiety around phone calls. I do still feel that it seems backwards to kick me out for self-injuring and being too anxious to make coaching calls.  I don’t believe that low severity NSSI should be classified as “therapy interfering behavior”. I still find this rule to be very backwards. However, I do think that it could have been possible to sell me on this part of the treatment if it had been explained the right way. The way I experienced it, I was just ambushed one day with an ultimatum to do the calls or quit. I think if the role the calls play in the model of treatment had been explained to me clearly  I might have been able to buy into them more.

My non-DBT therapist at that time was doing a lot to unintentionally reinforce my self harm. When I didn’t self harm  after feeling upset she would ask in excruciating detail why I had not self harmed. This led me to self harm more since I never had a good answer for why I hadn’t done it. If I self harmed when upset I didn’t have to generate a reason why I didn’t do it. I didn’t have the language at that time to articulate this. But I think a lot of problems around the coaching calls besides the phone anxiety related me to at some level understanding that in many cases talking about my self harm in therapy was making it occur more often.

The “DBT” I encountered in hospital and partial hospital settings was DBT in it’s worst form. It was done in a way that didn’t strictly adhere to the protocol (It was just handouts) and was run by people with minimal training in the therapy. This didn’t help my opinion of DBT. I think my DBT experiences drive home how much damage can be done when people deviate from a manualized brand name treatment but still label it with the brand name. It was a long time before I realized that I didn’t ever get DBT in the way Linehan intended. If I had realized this maybe I might have made different choices about trying DBT again.

I still object to the way DBT can be pushed aggressively and I think the rules around NSSI and coaching calls are too strict. But I have warmed up to the benefits a lot of the skills can offer.

I’ve warmed up to Linehan as a person. I love watching her call out people on bullshit at conferences. She is a wonderful public speaker. I love her presentations about the iatrogenic impacts of hospitalization. Despite her data against hospitalization being being correlational, I think she makes a really good point in this area about the lack of evidence in favor of hospitalization.  That said, I’ve not warmed up to her so much that I’d ever want to work closely with her in a professional context.

I don’t think I’ve warmed up to DBT enough to do DBT as a clinician. I certainly use some DBT handouts with clients, but that’s different from doing DBT and I don’t represent what I do as DBT. I don’t think I could buy into all the parts of the treatment sincerely enough to do it. I also think that with DBT if I were to strictly follow the protocol it would be wrong for me to continue my own self harm while treating it as a “therapy interfering behavior” for my clients. I believe I could stop self harming if I were in this situation. But I’m not sure I want to. For me, the benefits of self-harm still feel greater than the negative consequences.

My feelings towards DBT are more positive than they were in the past, but I maintain some criticisms of the treatment design.