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It’s Been a Whole Month: Birthday, Anxiety, and Ketamine

I can’t believe it’s been a month since I last posted here. I have some in-progress posts that are languishing in my drafts folder, but none of them feel complete enough to be posted. So, to try to break through the stall in my writing, this is a rambling update that will have to be good enough for me.

Look at me, fighting perfectionism one disjointed blog post at a time.

Ketamine

I haven’t written about my most recent ketamine infusions because the propofol makes it harder to find anything about them to share. I think that going into it with the expectation that I won’t remember much makes it harder to grasp whatever snippets do remain. Having the intention to write about an infusion helps me pay attention to my experience; without it, the whole appointment just disappears from my memory in the hours following an infusion.

When I began my treatment with ketamine infusions, I was fascinated by the endless imagery that each infusion created. Every appointment held new associations and interesting scenes. But lately, they all feel the same. Of course, this is okay. The dose of ketamine that I receive would probably be too intense without the propofol, and I suppose I’d rather not remember much than have a terrifying trip. Still, there was something helpful about having something of the experience to hold onto.

I have the sense that I’m more able to remember things when I’m more present in the real world – like how you remember your dreams when you awaken in the middle of them. I wonder if the degree to which you’re aware of your surroundings during a ketamine infusion impacts its efficacy, if at all. Because if it’s not at all, I’d totally ask my doctor to poke me every 15 minutes and ask me what I’m thinking about so that he can write down whatever absurd, hilarious things I say. Although, my level of zonk is usually such that I probably wouldn’t answer.

Birthday

My birthday happened this month, and it caused a lot of anxiety about the future. It’s frustrating to be hindered by my own brain. I commonly hold myself to unrealistic expectations and judge myself harshly for not meeting them. I wanted a different path than the one I’m on now, and I’m having a hard time letting go of that vision. Not that I can’t eventually end up in the same place, but I didn’t see it progressing along such a challenging path. But that’s life, right? I’ve been trying to re-frame my birthday as just another marker of survival. If I can’t get myself to be pleased with my progress in the last year, I can at least be neutral.

Anxiety

Anxiety and depression often go together, and I’ve noticed a pattern in my mental health where I alternate between the two. As I start to come out of depression, the anxiety kicks in and I feel horrified by all of the time I “wasted”. I think about how far behind my expectations I am, and then I get a frantic sense of urgency to kick it into high gear. Unfortunately, I’m also easily overwhelmed and the prospect of “catching up” to my expectations triggers an avalanche of worries and insecurities. Ultimately, whether it’s depression or anxiety that is most immediately at hand, the result is still a barrier to my forward movement.

This flexible connection between depression and anxiety is not black and white. I wouldn’t say that I move completely out of depression and into anxiety – the Venn diagram has more overlap than that. My position within it just shifts into the middle so that I’m simultaneously slow, tired, and occasionally hopeless while also filling up with anxiety saturated with heavy judgement. Fun times.

At least the anxiety pushes me to do more than I otherwise would. I would rather be motivated by the reward of doing the thing rather than the fear of not doing the thing, but I also prefer being motivated at all over not at all (if that makes sense). I’ve been trying to run again, and have been somewhat successful in the last couple of weeks. The wildfire smoke in Colorado has intermittently lifted and returned, so I don’t always get clear air, but I figure the benefit to my mental health probably outweighs the damage.

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This is kind of a rambling post, but again, I can’t seem to write anything in this context that seems worthy of posting. So, this will have to do. In other news, this is not my kitten, but look at how cute she is.

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Vertigo-Induced Panic is Terrible

We clambered into the car, half of the backseat piled with our stuff so that the dog could have the back. We’re all isolated these days, and since we were able and the infection data in the states we’d be in looked ok, we got on the interstate for a family visit (with careful precautions). Two months after the passing of my grandfather from COVID-19, the family was feeling the distance. We made it in 14 hours, a new record for the journey we’ve made dozens of times.

I’ve always gotten motion sickness in cars, so road trips can be a boring affair for me. Hour after hour, I look out the window, listen to music, and let the movement of the car lull me into a drowsy stupor. As a child on this trip, I would fall asleep for a while and wake to the car slowing down as we took an exit to a gas station or a rest stop. As an adult, I find it hard to disengage from the road; I’m always paying attention to the other cars and looking out for danger in our lane.

Traveling during a pandemic made us uneasy. We stopped as little as possible, only getting off the highway for gas and careful bathroom breaks. Few people wore masks, and we got odd looks and a wide berth on our way through the doors to the little convenience store in Nebraska. In Iowa, we took a side door past families eating at outdoor picnic tables, used the facilities, and beelined it back to the car. Illinois was busier, and by then we were exhausted. Despite spending the entire time sitting, long road trips are remarkably draining.

We left home at 5 A.M. and arrived at our destination at 8 P.M. After unloading the car, supervising Stella’s obligatory investigation of all smells contained in the house, and eating some real food, we each turned in for the night.

Coming from semi-arid Colorado, I’m unaccustomed to the humidity. I was instantly too hot under the blankets. After I threw off the covers, I tried to relax and put my sweaty discomfort out of my mind. When I closed my eyes, I felt the world moving beneath me — gently but unpredictably. I’ve had mild vertigo before. Boats, amusement park rides, and treadmills all produce a similiar feeling of unsteadiness for me. This, however, did not subside as my previous spells have tended to do. Instead, it only became more intense. I sat up and tried to take deep breaths through the rising nausea. The room was jostling around me, and I felt very high up on my bed. I slid to the floor and started to panic; it was only getting worse, and at this point, I didn’t think I could get up without falling over. Realizing there was no trash can in my room, I decided that I might have to throw up in the dog bowl. (Thankfully, that was avoided.)

In an attempt to convince my brain that my body was stationary, I lay flat on the floor, pressing my palms and heels against the hard surface. Truly panicking now, I took gasping breaths and tried to keep my gaze locked on something still. It was not working. I crawled to the wall and sat with my back pressed against it, crying, shaking, and trying to get my breathing under control. I felt like I was in a rickety wagon, speeding along a track while bumping and swaying dramatically. Even when sitting completely still and looking only at one point, the world around me continued to move.

I don’t know how long it took — I’m sure it felt like longer than it was — but the panic subsided and I eventually felt capable of making it downstairs to the kitchen. I sat at the table and looked at a spot on the tablecloth for over an hour. Slowly, the vertigo improved. Moving my head as little as possible, I got up to get a snack, hoping it would settle my stomach. I shuffled two small steps forward, then stopped to wait for things to slow down, then repeated as I moved through the kitchen and back to the table with some crackers.

Part of the anxiety came from the overwhelming disorientation, which then produced more anxiety because I instantly thought “how will I get home?” Sitting in a car for 14 hours created horrific vertigo and a subsequent panic attack, so the thought of doing the same thing a week later worried me.

Thankfully, our trip home was uneventful. I took Dramamine and we made more lengthy stops. I also hogged the front seat for part of the drive. The vertigo I noticed upon getting home was much less intense and didn’t stop me from swiftly falling asleep. Human beings are not well-suited to spending an entire day in a moving vehicle, but it was more than worth it to see family. Even with the masks, the social distance, and the little Lysol wipes wrapped around the serving utensils, we managed to fully enjoy our time together.

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COVID-19 and Anxiety: Caution vs Compulsion

Yesterday, my city declared a local disaster emergency. A growing number of presumptive cases of COVID-19 in my county have led officials to close all city facilities. This has given me pause when it comes to the complexities of COVID-19 and anxiety.

I was diagnosed with obsessive-compulsive disorder when I was about 11, and I dealt with many different obsessions over the years. Perhaps the longest-lasting obsession I had revolved around contamination and germs. For the last several years, I’ve been blessedly free of OCD, and when an old obsession pokes its head out, I’m fairly quick to oppose it by doing an exposure. Since the start of the media coverage of COVID-19 in Wuhan, I actively tried not to let it worry me too much. I could feel the pull of anxiety, coaxing me into watching the news coverage and letting it take over my life. Of course, I stayed informed but did my best to not obsess.

Now, my own city is seeing dramatic effects of the virus, both in increasing cases and in the social results of widespread, repetitive media coverage. Many of our city facilities were closed several days ago, and our city council has decided today to close them all. This afternoon, I finally made the trip to my pharmacy, located in a grocery store, to pick up my medications. The sight of so many empty shelves was unnerving. The only fresh vegetable remaining was lettuce. The bread aisle was sparsely populated with hamburger buns and a few loaves of whole wheat. A man asked the pharmacist where the thermometers were and was told there were none left.

I bought my items and went home, then washed my hands several times between unloading groceries, putting them away, and cleaning the counter they sat on. I’ve been cleaning my phone case, our door handles, and even my sunglasses after touching them while out. Am I simply being cautious, or have I crossed the line into compulsions?

For people with anxiety disorders, dealing with COVID-19 and anxiety during the pandemic puts them in a confusing position. People are being encouraged to be extra careful about handwashing and touching potentially dirty items. Events have been canceled and gatherings are recommended to be limited, making it easy to justify complete isolation due to anxiety. So when the behaviors that normally indicate a disorder are socially sanctioned, what do you do?

I can tell that going to the pharmacy triggered something, and where before I was simply careful, I’m now afraid of things in my own house because they came from outside, and I haven’t cleaned them. This alarms me because it’s exactly how I used to feel in the grips of contamination OCD. It’s overwhelming to suddenly feel like nothing around you is safe to touch.

This coronavirus could live on surfaces for two to three days, so maybe constant cleaning and disinfecting are completely warranted. I imagine many people are feeling this despite never experiencing feelings like it before. Nobody really knows how much is too much, and this is exactly why OCD is so tricky. In non-pandemic times, contamination-focused OCD is fed by a seed of doubt (indeed, every kind of OCD is fed by doubt). It can feel shameful because you know that your compulsions are irrational. Now, it’s unclear what rises to the level of irrationality. Maybe the compulsions I usually try to avoid are precisely what I should be doing.

There is no blueprint for handling COVID-19 and anxiety. I think it’s reasonable to increase your awareness of surfaces you might normally touch and to wash your hands more frequently. However, I know that for me, allowing myself to engage in my old compulsions is a slippery slope. It might be acceptable to do right now, but it will be harder to stop the longer I let it go on. It’s a balancing act, and I have to decide how much my anxiety is serving a purpose now versus how detrimental it is and could be in the future.

I’m certainly not going to tell anyone how to keep themselves safe. I am, however, going to tell myself to be cautious about being too cautious. As long as I can leave the compulsions behind again when life approaches normal, I’ll be okay.

Stay safe,

Genevieve

How Perfectionism Can Block Creativity

Over the years, I’ve made deliberate efforts to reduce my perfectionism surrounding my artwork. I think I’ve made some good progress. When I’m in the groove of regular artwork production, I can sit down with a blank page and some materials and just… start. With minimal agonizing, I can just start to put lines or colors on the page and see where it goes. But, when I stop making art for a while, the barrier of perfectionism returns. It always leaves me overthinking and judging myself harshly for my attempts to get started again. I haven’t been making anything in the last couple of months, and it took me some serious intention to pull out my watercolors and paint this.

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Rationally, I know that it doesn’t matter if I make something and rip it up, or if I make something and let people see it even if I’m not proud of it. But the perfectionist in me thinks I need to have a piece planned out and executed perfectly. I do think that there is some value in this trait. It can give you the patience to get something “just right,” or to sketch your concept with different angles or color schemes and figure out what you like the best. But then again, art never turns out exactly how you imagine it, and there’s rarely a point where you know for sure that it’s done. While perfectionism can help you get closer to your mental vision, it can also keep you from getting started at all– and that’s paralyzing.

In my experience, perfectionism and creative block go hand in hand. You can’t figure out what to make because none of your ideas are good enough; your attempts don’t look like you imagined them, so you scrap the whole thing; the longer you go without making something you like, the higher your expectations and the harder it is to get started. My approach to getting through this is to pick something that I like looking at and just start drawing/painting it. I don’t try to come up with a completely original idea yet- just pick a reference and get started. Sometimes this is enough to jumpstart my inspiration, and at the very least, it usually gets me excited about creating more things– whether from imagination or reference.

That painting I showed earlier– I don’t like it much. It’s based on a photo of Stella that I absolutely love, and my painting doesn’t come close to giving me that feeling. So, I don’t like it much, but I like that I made it. I like the feeling of seeing something coming together, even if it doesn’t match my expectations. I’ve been trying for weeks to get over the funk of creative block, and I think this painting may have helped.

Fighting perfectionism takes practice, and for me, it seems to take deliberate consistency. Letting my practice collect dust makes it harder to pick back up later. But no matter how long it’s been, I know that the more willing I am to make mistakes and to take risks, the more satisfied I am with the results.

As a bonus, here’s my attempt at depicting the fish wedding from one of my ketamine infusions (part 8). It looked pretty much like this:

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Yup. Pretty weird.

 

Tracking My Anxiety

The anxiety began when I was eating lunch and scrolling through youtube, trying to find something interesting to watch. I scrolled faster, considering each thumbnail more and more briefly as the tightness in my chest increased. “Hold up,” I thought. “I’m supposed to be tracking my anxiety for my appointment next week. Let me write this down.”

Here’s how to overthink your anxiety record: First, I spent several minutes considering the medium I should use to document my anxiety; paper and pen seemed reasonable, but what kind of format? List? Table? Stream of consciousness essay? I also considered the kind of paper I’d use, be it sticky notes, that half-used legal pad in my bookcase, small notebook–ugh. Too many choices. Let’s go digital. Thank goodness the Notes app is pretty minimal, or I’d still be waffling on what kind of font to use. (Speaking of “stream of consciousness”, I just realized that I could totally make a PowerPoint presentation, complete with awesome clip art and slide transitions. That would really prove my therapist right when she said I’d probably find a way to make it complicated because I’m an overachiever. Challenge accepted.)

So far, I have written down everyday things like realizing I wasn’t sure if someone introduced themselves as Janice or Janet and imagining the obviously catastrophic embarrassment when I inevitably pick the wrong one. I also have bigger things like my unknown life plans, noticing that Stella had put her sneaky paws on the counter and eaten chunks of chocolate cookies out of the pan (she’s fine), and also seemingly random anxiety with no discernable cause. Some of the “random” anxiety is probably due to sensory processing disorder and my tendency to steamroll over discomfort rather than make adjustments for my nervous system. It’s a work in progress.

I think I’ve spent a long time telling myself that anxiety isn’t an issue for me, which makes it a challenge to be mindful of it. After the OCD mostly disappeared, I guess I went “Well, that’s done. I don’t have anxiety anymore.” If only it worked like that. I keep having to reassess my understanding of what’s a normal amount of anxiety and in what contexts it’s normal. Seriously, I have no idea at this point. Do other people feel anxious when they have to walk by the check-out lanes on their way to somewhere else in the grocery store because they can feel people looking at them? No? What kind of lie have I been living?! I guess I knew that some of my anxiety was unreasonable, but convinced myself that it was minor enough that it didn’t need to be addressed. Now I’m just not sure what should be on my list of concerns. Time to go put “worrying about the amount I worry” on my list.

In case my therapist reads this: don’t worry, I will not be showing up with a PowerPoint detailing my anxiety, although that would be hilarious and probably a new one for you.

 

Anxiety and Doing New Things

In an attempt to fill my time with things that will keep me from slipping back into severe depression, I’ve started doing New Things. One is volunteering and the other is taking a neighbor/friend up on her offer to teach me how to ride horses.

I really want to quit and crawl back into my hermit cave. I am way outside of my comfort zone, which, for me, always leads to near-constant worrying and ruminating. I can’t help but laugh because when my new therapist asked if anxiety was also a problem for me in addition to depression, I said “hmm, no, not really.” She later disagreed, and the more I think about it, the more I realize that yes, yes it definitely is. Now that my depression is easing, I think that anxiety is coming to the surface. (Additionally, when I tell people about this anxiety realization, they look at me like “you…didn’t know that?” So, that’s cool. Everyone knows about this but me.)

When I’m really depressed, I’m so numb and slowed down that I don’t even worry about saying “yes” to new things; the answer is automatically “no”. But when the depression lifts, my natural tendency to overthink everything and fall face-first into crippling indecision has room to become obvious. Because I feel capable of doing more than I did while depressed, I feel like I should say “yes” to new opportunities, even if I’m on the fence.

Rather than deciding to just get out there and demolish the boundaries of my comfort zone, I get…stuck. Really stuck. I want to do new things in general, but when an opportunity comes along, my worry and fear keep me from making a confident decision. It’s tough for me to decipher whether I don’t want to do something because I’m feeling overwhelming New Thing-anxiety or because I won’t like it. And, since I know that this is a problem for me, if I think there’s a chance I might like it eventually, I tend to make myself push through and do it no matter what. Of course, I do that while also continuing to worry about whether or not that’s the right thing to do.

An additional layer of this terrible cake is that I do not like quitting, even if I really want to bail. And even if this hypothetical New Thing has very natural exits where I can decide it’s not for me and stop, it still feeeeels like quitting. This makes me even more indecisive because not only do I need to know if my anxiety is coming from a dislike of the Thing or not, but I also need to know if I can be committed to the entire Thing. No quitting. Approaching opportunities like this is not fun, and I do not recommend it. 0/10.

I imagine the goal is to take each new opportunity and be able to decide, quickly and simply, whether I want to do it or not. I just don’t know how to do that without taking all of the stuff above into account and getting hopelessly tangled up. I guess step one is to remind myself that I can say “no”, changing my mind is ok, and that in many cases, it’s not that big of a deal.

Much easier said than done.

 

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An Encounter with Contamination OCD

I haven’t been consumed by OCD in several years, something I’m immensely grateful for. That particular kind of mental torture is truly awful and not something I would wish on anyone. One of the subsets of OCD that I had was contamination OCD. My body and belongings had to be whatever my disorder deemed to be “clean,” or else some unnamed disaster would occur. There were often no actual illnesses I was afraid I might contract – I was just terrified of potential contamination by unknown germs/viruses/entities.

The Endless Compulsions

Beyond the fear, maybe the worst part of contamination OCD was how time-consuming it was. If something was “dirty” and it touched something “clean,” or if I touched the dirty item and then the clean item, they were both dirty. I spent a lot of time planning out sequences of actions that would combine touching dirty items because otherwise, I would spend half the time washing my hands raw so as to not contaminate anything else. My hands were always painful. I scrubbed them under hot water until I’d stripped them of any moisture barrier. Any movement cracked and split the skin open, which, ironically, made my bleeding hands perfect entry points for bacteria and viruses. But, OCD is not swayed by reason and rationality. It creates doubt that can’t be rooted out with reassuring facts.

Contamination OCD After Recovery

For the most part, I don’t deal with OCD anymore, contamination OCD or otherwise. My day-to-day life is not consumed by it like it was before, but every once in a while, I encounter something that stirs those obsessions up. My perfectionism around self-harm is one, and tapeworms appear to be another.

Unexpected OCD Triggers

I’m not squeamish, despite what you might think after learning of my past with contamination OCD. Again, OCD is not rational. Parasites are fascinating and don’t bother me from afar, but when I found a tapeworm segment in my dog’s stool, I felt the familiar stomach twisting of contamination OCD.

Once the initial shock passed, I found myself thinking about all of the things I would have to clean. First and foremost, the hand that held the poo bag. I must not touch anything between there and home, not even to put my hand in my pocket. The bed in her crate would need to be washed, and all of my sheets and blankets because she often snoozes on my bed. Should I wash her leash and harness? Perhaps I should stop petting her– would that be going too far? On second thought, that would be impossible. I’ll just wash my hands every time I touch her. So, like, 80 billion times per day.

OCD is Irrational

Keep in mind that the most common species of tapeworm is passed to humans only when you ingest a flea that carries the tapeworm eggs. Not likely. There is also a species of tapeworm that can be passed from dog to human through ingested feces on unwashed hands, but it’s not common in the U.S., and I’m a frequent hand-washer as it is. In other words, it’s very unlikely that I would get tapeworms from Stella.

I Fell into Old Patterns

That night, I lay in bed, Stella at my feet, and tried to control my rising panic. The vet was closed for the holidays, so I had left a message. Having no idea when they would return my call, I did what any smartphone-wielding person would do; I looked it up. Unfortunately, Google played the role of the reassuring-but-clueless friend who says something terrifying right at the very end of the conversation.

“Oh, it’s very uncommon for people to get them? OH, you might not show signs until years after ingestion?!”

Not gonna lie, my concern for Stella was overshadowed by my selfish, irrational fear for myself. The thought of something living inside me usually doesn’t bother me. After all, we are made up of more bacterial cells than human cells. Maybe it’s an evolutionary adaptation to be totally wigged out at the thought of parasites taking up room in your gut.

Facing Contamination OCD with Exposures

The good news is, I realized that I was obsessing about this right before I returned to the scariest thought of them all: “What if I already have tapeworms?” This is good news because it really kicked me into the best way to face OCD thoughts, which is to say, “Yeah, and?”

In the dark in more ways than one, with my tapeworm-host dog not three feet from me, I had to say, “Maybe I do have tapeworms. What am I gonna do about it right now?” Just sitting with the uncertainty brings you to the stunning realization that there is absolutely nothing productive about rumination. So, with a little more deliberate relaxation, my hypothetical tapeworms and I went to sleep. Well, maybe not the tapeworms. Do tapeworms sleep?

Living with Uncertainty

I still don’t know if I have tapeworms, and it’s honestly probably something that I’ll worry about off and on for a while. I do know that I’m much better at squashing obsessions than I used to be, maybe because I know it’s something I’m prone to and can catch it early on. Stella is on a deworming medicine and continues to behave like a dog. That is to say, eats anything and everything with gusto and drinks water out of the Christmas tree stand when nobody’s looking.