Yesterday I had written J a very short email that I had something to ask him, something I kept forgetting to ask him, and would he remind me to ask when I came to our session today. So when I got to the office today I noticed some changes. First of all, he hadn’t shaved in a while. The last time he was unshaven was when he was getting ready to be a pirate for Halloween last year. Since Halloween already happened, I assume he is not shaving for some other reason, but I didn’t ask. Also the chair to the right of the loveseat was only a couple inches away, as opposed to a foot or two away which is where it usually is. I made a comment about that, and he said he steam cleaned the carpet over the weekend.

So J said, after he Purelled (he hasn’t used the Purell since July when I asked him why he was using Purell every time I walked in. I did feel badly that he stopped his Purell routine for me, so I was happy to see him use the Purell today), he asked me what I wanted to ask him. I said I actually wanted to ask him two things. But first I gave him an envelope with some more ideas for the box. These were things that I consider unresolved, or things that were too scary for me to bring up. He asked if he could read them, and I said he definitely could, but he didn’t read them while I was there. He just set them down next to my box.

The first thing I asked him was for another voice mail. I had asked him to leave me a voice mail in April when I was in Mississippi and I needed some reassurance. I’ve been listening to that one for six months, and I wanted another one. He said that is no problem, he wrote himself a little post-it, and he asked me what I wanted him to say. I told him that was up to him.

The second thing I asked him was if there was a test for depression. Not like a blood test, but maybe some kind of objective written test? He asked me why I wanted a test. I told him that my pdocs have said I am depressed, and J said I am not, but he’s not really a doctor, and they are, but J knows me better than they do because I see him every week. He asked if a diagnosis or a label would affect my choice of going on medications and I said it would not. But I was concerned that maybe I am in denial and I said that how can I fix a problem if I don’t know what the problem is.

So J got his DSM off the shelf to read me the criteria for depression and dysthymia. His DSM looked well worn – it was actually in three pieces. I think he needs a new one. Maybe Santa will bring him one for Christmas.

I told him that I could diagnose myself with anything in the DSM. And I have. I have diagnosed myself with lots of things – Borderline Personality Disorder, Narcissitic Personality Disorder, Schizophrenia, etc. He said that is common, when he was in pharmacy school everyone had that problem – thinking they had every disease in the book.

So after hearing the criteria, I think I might be depressed. Things are worse than he thinks, I think. He said what jumps out at him is more along the dysthymia realm – low self esteem and feelings of guilt. What jumped out at me were these:

depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).

recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

I don’t think he knows how often I think about dying, or how often I cry (every day, multiple times per day).

For dysthymia the criteria that are appropriate to me are:

insomnia
low self-esteem
poor concentration or difficulty making decisions (I’m not sure this is me, but J says I seem to have trouble with decisions)
feelings of hopelessness

and you have to have had these symptoms for 2 years, and must not have gone for more than 2 months without symptoms. Two months? I would love to be free of these symptoms for two months.

I told J that I don’t really understand what depression is, and the DSM doesn’t explain it. How could one of the criteria for depression be:

depressed mood most of the day, nearly every day, as indicated by either subjective report

I asked him what is a depressed mood? I asked him if it means hating yourself, feeling you are never good enough, or is it being sad about something? No one in my life has died, I have not been traumatized, so how could I be depressed?

J said he doesn’t like labels, or diagnoses, but for some disorders, those that require medication in particular, it can be important. He told me about tests for alcoholism, questions include things like “Does drinking cause problems in your life?” I said, “If you have to take a test to see if you are an alcoholic, then you probably are.” Same with depression I think.

So maybe I am depressed? I wonder what it would do for me if I were to admit this to myself.

I told him that I am totally functional; even he said I am “very competent.” I picture depressed people as being unable to work, having to stay home or in bed, eating ice cream out of the original container. Depressed people don’t lay in bed eating apples and grapes, do they? Here I am, supposedly trained for a crisis hotline, stigmatizing depression. Ugh. I said that I go to work every day, I do my chores at home, I feed my son and my dog, I run, eat healthy (well, that is an obsession, I didn’t mention that.)

I mentioned how my moods can change so quickly. I can be in a good mood, and something can happen which will lead to a bad mood instantaneously. He asked me what puts me in a good mood to begin with, and I said that I do not know, sometimes I just wake up that way. He asked if there is anything I can do when I get put into a bad mood to reverse it, like mindfulness (argh!!). He said I have a roof over my head, food to eat, a job, good kids. Does that help? Well, actually that just makes me feel guilty for feeling in a bad mood, but I didn’t say that. He asked if he could give me a personal example.

He told me that two weeks ago today his dog had surgery because she had cancer in her jaw. I kind of freaked at that. Two weeks ago when I was in his office talking about some stupid crap, he was thinking about his poor dog having surgery, not knowing if she could die! But she had a successful surgery and it turns out that the doctors got all of the cancer. Last Monday J felt down in the morning when he left for work. He didn’t know why, he just was in a bad mood. Maybe it was because it was Monday, or it was the first day of the new month, or it was one of the first cold days we had. But he had a talk with himself and told himself that the Monday before last Monday was a terrible day, wondering whether his dog would live much longer, and on this Monday he was sure she would be fine, so he should be in a better mood. He said his mood didn’t immediately improve, but over the next couple of hours he felt better, and he even went home after work and told his wife that he was in funk that morning, and she said she was too, but then he felt better.

OK. That was a nice story.

I told J about the situation with my son’s pdoc, and how it put me in a bad mood. We talked about that for a while. He did agree with me that making us wait 55 minutes was way over the line, and that only seeing my son for 8 minutes seemed a little short. I told him about my anger and my hurt. He asked me how long we have been seeing pdoc (4 years or so) and if past experiences with pdoc can temper this bad experience. I saw his point. Pdoc has been very nice to my son. He helped me when the psychologist gave him a wrong diagnosis after a full neuropsych evaluation. I told him that I wrote pdoc a letter this morning saying how disappointed I was with the service we received. He asked why I wrote it, and I said that I guess I wanted to be somewhat assertive and just let him know how I felt.

He thought that was good. I said that I agreed with his opinion that our past relationship with pdoc can be more important than this one incident. He seemed surprised. He said, “You really feel that way? You don’t feel guilty now, like you shouldn’t have felt hurt, and you didn’t have any right to write that letter?” I said, “I was going to say that, but I know you wouldn’t have liked it.” He said, “But do you really feel that way?” And to be honest, I can see his point. A year ago I would have felt invalidated and minimized if he had asked me this. But I seem to have changed. I really do see now, that it’s ok that I felt hurt, but it’s also ok that I can overlook this based on our previous experiences with pdoc. This is pretty amazing to me. And I think to J too.

I told J about how my boss bought me tickets to a show that I wanted to see, and it was nice, but I was waiting for the bad to happen. That the bad always outweighs the good. Good stuff happens and I expect bad, and then when bad happens I think, “Well, there you go, you knew something bad would happen.”

Then I told him about the whole situation with boss and the ex-wife and the emails and how I told my boss that I couldn’t deal with this situation anymore. I got kind of choked up when I was telling the story. And then I couldn’t remember the point of why I was telling him. But later I remembered, and it all came together for me, but I will write about that tomorrow.

I noticed time was almost up, so I put my boots on. But J kept us talking, and I was doing most of the talking for a change! But time was definitely up, so I reached for my coat. He usually says “We have to stop in a minute” and gets up to go to his desk, but he didn’t. When he saw me reach for my coat he turned around to look at the clock behind his head. I turned around to look at the clock behind my head, and saw that it had stopped at 11:35am. I said, “Your clock stopped.” He said he was wondering why I was getting ready to leave. I guess he doesn’t have an internal clock. He was asking me how I felt when I was with my boss, and I said I am actually rarely with him, but occasionally we are together in the house and we have gone out for drinks together, and it’s nice to be with him. He asked if I felt good about myself when I am with my boss and I said that I generally do.

It seemed like a disjointed session, but after I left I realized how it all fit together perfectly. J hasn’t left me a voice mail yet. I’m wondering if he read the little slips of paper that I left for him to put in my box. I wonder if he is offended by some of them, for example “J searching my blog for ‘sex’ and then lying about it” or “J answering in a flip manner when I try to express a feeling, like ‘my problems don’t all happen on Tuesday at 11am’ and J answering ‘Do you want me to follow you around?’” I really wanted to get everything out, and I guess in a way I did want him to read these papers, to know what I have been thinking about and what I consider is still unresolved.

More tomorrow….