Category Archives: labels

phone therapy

Three posts in as many days! I don’t know what’s come over me. 🙂

***

So, since my therapist is out of town this week we arranged to have our regular session over the phone yesterday. I was dreading the session most of the day, even more than usual actually because I don’t like talking on phones. I don’t like checking voice mail. I don’t like seeing/hearing others talk on their phones. I don’t like hearing them ring (or vibrate, in my case). I cringe when I hear other people’s phones ring. I’d get rid of mine, but that probably wouldn’t be smart for someone with social anxiety.

It must have something to do with the fact that there are no distractions over the phone. It’s me and the other caller–that’s it. There is no one else to take the spotlight off me. There are no external distractions either, like television or eating or music or a movie, etc. But there are no distractions like that in therapy anyway, so I don’t know what I was so afraid of.

Anyhow, about thirty minutes before the session started, tension, nervousness, and anxiety hit. I just wanted to get it started (or over with). My stomach hurt, and I began sweating a little under my arms. I felt like I was getting ready to go to a large social gathering or something. I think it must have been the combination of the phone and pre-therapy jitters.

I’m probably freaking out about nothing, I told myself. So I’m going to stop  indulging in my negative thoughts. Once I became aware of what was happening and told myself to stop, I felt better.

***

The session started like all our other sessions. We talked a little about how this–therapy over the phone–is new territory for us and what not. I wish we would have explored my phone-phobia a little more. I brought it up, but we quickly turned to other things.

I told him about how I was feeling anxious about Christmas, about how I’d be seeing my relatives. I told him how anxious I felt as soon as I found that out. We spoke about this for a while (mostly about how I’m afraid of interacting with my cousins’ children) before he said–

“You can push back if you want but what I think it all comes back to is self-acceptance. It’s okay to be introverted and reserved. It’s okay to be soft-spoken. But these things are not okay for you.”

He went on and on, and yet I was still stuck on his words push back. It had a negative connotation to it. To me, the words said–

Now you can push back, but if you do, you will be wrong because I am the therapist and I am right.

After he got done talking about self-acceptance, we were both silent.

“Where are you?” he asked, finally breaking the silence.

I told him the truth. I told him how I didn’t hear much of what he said because I was still stuck on him saying push back. I told him how I’m uber sensitive to his wording sometimes and how I’m afraid to stop him because I’m afraid he’ll say I’m just avoiding things (like he’s done in the past). We had a good discussion about that, and I feel a little better about it, actually. I think he understands better that when I do stop him, sometimes it’s not that I’m avoiding–it’s just that I want to say something and that should be okay. I don’t think there has to be a hidden/deeper meaning in everything.

One thing interesting that he did mention is that therapy is the one place where I can–and should–feel comfortable pushing back. A lot of times in life, I want to do that, but I just don’t have the self-esteem.

We then went on and talked more about the letter (part 1, part 2) I sent to my parents and how I can use that to start more discussions. I’m scared to talk more about it, yet I do want a closer relationship with my parents. I know my relationship with them hasn’t changed because of one letter. I have to keep moving forward, and I feel a lot of pressure to do that.

Finally, at the end of the session, I started getting flooded with anxiety, as I always do, and I checked out by browsing Facebook. When we finally said goodbye, I found myself looking at pictures of someone from high school who used to pick on me. Whenever I get on Facebook I’m unconsciously brought to the people who did me harm. I should probably bring that up in a future session, among other things. I’ll add it to the list.

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an email

When I first moved to San Francisco, I went out of my way to find a tennis partner so that I could not only get exercise but find a friend as well. I found someone right away (via the internet), and it took some time, but eventually we became friends. We started hanging out more and more outside of tennis–grabbing food or a drink, etc. I enjoyed his company. He’s gay, and since I’m sort of up in the air about whether I’m straight, gay, or both (I don’t think I’ve mentioned this), there were some awkward moments.

He picked up on my feelings–and confusion–and questioned me by literally asking if I was attracted to him. At the time, I was slightly attracted to him (I guess?), but since I just started dating my girlfriend at the time, I lied to him and said I wasn’t. I think he could probably sense that I was lying, and so, long story short, we had a falling out.

The relationship sparked again after the rainy season when we started playing tennis again. We just didn’t talk about what happened. Anyway, we started hanging out again outside of tennis, and I finally told him the truth. It went something like this–

I don’t know if I’m attracted to you or not. I do think I have the capacity to love both sexes, but I am in a committed relationship, so that’s not something I want to explore at this moment. I do think, though, that I want a deeper friendship. I may be confused on what I feel on the inside, but I know I would like to be closer to you. I’ve never had a deeper friendship, outside of a sexual relationship, and so I don’t know what that’s like. I may have been confusing the feelings inside–instead of liking you more than a friend, I still wanted to be friends, I just wanted something deeper. And I still do.

I caught him off guard, he didn’t really respond–in fact I think he changed the subject altogether–and I haven’t heard from him since.

Anyway, I sent him a brief email last week–

How are you doing? I’m on break from school and heading to Kansas City next week to see the family. It was sort of sunny today, and it made me want to play tennis. Anyway, I miss hanging out.

Again, I put myself out there. I guess maybe he either had deeper, sexual feelings for me, or didn’t have any feelings at all. It just hurts that I tried to connect with someone and got shut down. Maybe I came on too strong, too fast? I’m tempted to send him an email detailing everything that’s been going on, as he doesn’t know I suffer from Social Anxiety Disorder–but I probably should just let it be. I tried, at least.

Anyhow, the point of this post is just to highlight how difficult it is for me to make deeper friendships. I’m scared to let other people in because of experiences like these.

Autobiography in Five Short Chapters

Chapter 1

I walk down the street.
There is a deep hole in the sidewalk.
I fall in.
I am lost … I am helpless.
It isn’t my fault.
It takes forever to find a way out.

Chapter 2

I walk down the street.
There is a deep hole in the sidewalk.
I pretend that I don’t see it.
I fall in again.
I can’t believe I am in this same place.
But, it isn’t my fault.
It still takes a long time to get out.

Chapter 3

I walk down the same street.
There is a deep hole in the sidewalk.
I see it is there.
I still fall in … it’s a habit … but, my eyes are open.
I know where I am.
It is my fault.
I get out immediately.

Chapter 4

I walk down the same street.
There is a deep hole in the sidewalk.
I walk around it.

Chapter 5

I walk down another street.

***

I love that poem. It’s from There’s a Hole in My Sidewalk by Portia Nelson. I feel like each chapter represents a stage of my recovery.

Chapter 1 encompasses my middle school and high school years, when social anxiety began to develop. I started avoiding social interaction by ending friendships and isolating myself; developing powerful, yet irrational beliefs and attitudes; and reinforcing those same beliefs and attitudes with my thoughts and actions–all while being unaware.

The years (early college) which make up Chapter 2 are even harder than the previous years, as I’m in denial. I know that I am an introvert and highly sensitive, yet I know there’s much more to it than that. That is, I know there’s some deeper issues. I avoided them by locking myself in sexual relationships, avoiding friendships, and abusing alcohol. I was absolutely miserable, yet I put up a happy, normal facade. I hid my problems well, and that’s the only way I knew how to cope–because I didn’t know what was wrong or where to seek help.

Chapter 3 represents my latter college years and the year I spent in New York after graduation. By that point I knew I suffered from Social Anxiety Disorder. I knew I kept people at a distance because I was afraid of what they may see inside. And I knew I needed to seek professional help, but I didn’t. Again, I coped by drinking and denying; however, those tactics began to lose their power because I knew there was a deeper issue.

Today, I’m somewhere after chapter three but before five. (I don’t want to say I am in Chapter 4 because sometimes I feel like I’m beyond it and sometimes I feel like I’m not even there yet). I am seeking professional help. I am aware of my thought processes and where they can take me. I know not everybody is a fan of CBT–or its wording and metaphors–but it has greatly helped me. I know, for instance, that certain thoughts will lead me down familiar roads, and I know at the end of those roads, there is nothing good there. I know that if I continue to take those roads, I will continue to feel a certain way. I haven’t totally changed my habits, but I am getting closer. I think Chapter 5 is in sight.

Now, for those who are at an earlier stage, there is no shame, because how you are feeling is not your fault. You are not explicitly choosing to feel anxious or depressed. We’re all at different stages, and we’re all in this together. What’s more, recovery is not linear. You don’t go from bad to good to better to best. Sometimes I’m in Chapter 4; other times I move back to Chapter 2–but, in the end, I am moving forward. More and more of my time is spent in the latter Chapters.

job hunt

I’m tired. I’ve been applying for jobs the past few days, which is very exhausting because I have to continually fight the negative thoughts.

I read a job description, and I immediately pick out everything I can’t do. These cant’s have nothing do do with me not being qualified–they are the social aspects of the job. Behind every single can’t is a negative experience, or failure on my part, from my past. For example, if one of the qualifications is that I need to be able to to work independently and as a team member, I immediately think back to my former job when I failed at this; or, more precisely, what I perceive as failures. I was fine with working independently, but I had trouble working with others, socially speaking. I never knew what to say or how to act. I questioned everything I did .. every .. little .. thing.

I also put up a difficult front. My anxiety caused me to appear stoic and unapproachable. This, coupled with shyness and introversion made it difficult to connect with people. My co-workers thought I didn’t like them, which couldn’t be further from the truth–I so desperately wanted everyone on my team to like me. (Why do I let other people’s opinions affect me so much?) But I couldn’t break through this pressure. Day in and day out, I wanted to make connections, to show that I was a valuable member of the team, and to not make any mistakes .. and everyday I failed in some way.

The more and more jobs I look at, the more and more I tell myself I can’t do something–and the more I rehash something from the past. I am just rehearsing my failures, and the more I do this, the more I believe that I am a failure, and eventually I get locked in a cycle.

Fortunately, because of CBT, I am aware of all this, and can break through the cycle; nevertheless, it’s still exhausting having to continually fight my negative thoughts. You see, each thought means much more than it should. These perceived failures are in the past. I am a different person now, and I am capable of so much. I can do anything I want. Yet, I forget this as I apply for jobs. My exhaustion has lead to a small depression, and now I’m feeling hopeless–all because of my negative thoughts, which are just based on distortions of my past (they are irrational interpretations, in other words).

What’s more, I’m applying for jobs I don’t necessarily want.

I want to work in the public library, but none are hiring because of the economy right now. I’m worried that when I do graduate (next summer) and get a degree, I’ll just have to go back to some office job. I’m trying to prepare for that now. Maybe if I get some simple part time job, I can slowly immerse myself back into the “real world.” I think if I wait and jump back into a stressful office job in the summer, it won’t go very well. I need gradual exposure in order to learn how to manage my anxiety.

So, I’m stressed, worried, and anxious about the past and the future. I’m not present. In conclusion, I’m concerned–

  1. I won’t be able to use my degree to get the job I want.
  2. I won’t be able to find a job at all (and if I do, it will be similar to what I did in the past and I’ll just be miserable again and end up quitting).
  3. Because I won’t be able to find a job or quit some other job, I won’t be able to pay rent and I’ll either have to move in with my girlfriend’s family (if they’ll take me, of course) or move back to Kansas City with my family (again, if they’ll take me).
  4. As a result, I will be a failure.

Do you see how powerful thoughts are? I have to continually remind myself that I am capable of anything. I may have struggled in the past, but I am changing. I just need to try to take it slow, gradually exposing myself to situations I’m afraid of–and, above all, stay present.

I guess I could always fall back on something like this if I can’t find a job.

in a safe place

For longer posts, dealing more with theory, I usually start writing them three or four days, sometimes weeks, before I post them. I have an idea in mind, and I like to watch it grow, like a piece of art. As of late, though, my moods have been fluctuating so much that I often times abandon my original idea altogether or change it so much that it barely resembles its original form–which is the case for this post (the latter issue, that is).

***

Put simply, I had to give two class presentations this past week. One on Thursday, and the other on Sunday. I haven’t had to do any sort of public speaking in over a year, so I clearly was very nervous/anxious going into it. I decided to try to get some of my thoughts out to help not only understand the anxiety (and where it’s coming from), but alleviate it as well. What you’ll soon find out is that the presentations went well. Sure, I was nervous, but I did fine, probably better than most people, in fact.

Anyway, here are some highlights–

Anticipatory anxiety hit me on Wednesday: I feel like shit. My stomach is tense and wound up in a knot. I’m having trouble swallowing. I’m sweating. I feel like I should take an Ativan or something, but I sort of feel like I’m becoming dependent on them. But none of my relaxation strategies are working. I’m sick (with a cold), so I can’t go running. I don’t know what to do.

Honestly, I’m mostly worried about the questions after the presentation. What if I won’t be able to answer them because I’m flooded with anxiety? What if I sound nervous? What if I fail?

I eventually calmed down, but anticipatory anxiety returned before my presentation (no surprise there): My presentation is in less than 3 hours. I’m in denial (sort of). I just ate, took an Ativan (1mg) and a Propranolol (10mg), and went over my presentation again. My stomach is tense. I’m sweating pretty bad, especially under my arms, and I feel an impending doom. I know the negative thoughts are hidden under this doom, but I’m scared to see what’s under there. I wish I had therapy tonight–and I wish even more that I hadn’t skipped therapy on Tuesday (because I was/am sick).

Again, the presentation went fine: It’s over. It didn’t go bad at all. I got hung up on one question, but overall, it went really well. I feel stupid for making a big deal out of nothing. About five minutes before the presentation started, I chatted with the professor and the other students. I then stood up, shook my body all over, and then went to the mirror and smiled (to make sure I still could). This helped to calm me down. I can now strip off my sweat-stained undershirt and move on.

Anticipatory anxiety started again on Sunday, about seven hours before my next presentation. I’m starting to feel a bit nervous. I feel that impending doom again. It’s scary because I don’t know what lies beneath. It’s unknown. Thoughts, on the other hand, are tangible, while this feeling is not. I can hold thoughts. I can touch them. They are real. But I’m too scared to find those thoughts.

Then two hours before the presentation depression hit: I’m depressed, and I DON’T GIVE A SHIT ABOUT THE PRESENTATION. I don’t know where these feelings came from or why I’m having them. Maybe they’re connecting with this doom feeling?

The depression wore off for the presentation, leaving me with anxiety, but it came back immediately after: Well, the anxiety  pushed the depression into the background. I took an Ativan (1mg) before the presentation. Again, the presentation went well, and, again, the anticipatory anxiety was much worse than the actual presentation. I feel good about the week, but depression is hitting me again. I’m scared.

***

By the end of the night I was really low. I binged on food, drank a big beer, and had a cigarette (the first one since the wedding)–nothing helped. I woke up feeling even lower. What’s going on? I asked myself. I had a fairly good week. I mean, I not only got through the presentations, I did really well. I should be feeling good. I should be feeling great. As always, though, there’s much more going on than what meets the eye.

Actually, depressions usually hit me after successful social situations because that part of me that wants to be messed up–that part that likes having social anxiety, that part that I know, that part of me I think is me–flexes his muscle and brings me down. He, my anxiety, wants to maintain control. Does that makes sense? However, I still think there’s more there.

I’ve been triggered by quite a few things this week, namely this post and this post and this post and the movie Black Swan.

For the sake of length, I’ll try to not go into too much detail.

As some of you know, I’ve been dealing with this question as of late–Without social anxiety, who am I? The answer is a resounding I DON’T KNOW!, which is exactly why I’m so scared to find out, which is exactly why I sometimes like my anxiety–and even fuel it. My illness is warm and fuzzy; it’s familiar; in some ways, it’s all I know about myself.

There’s also my perfectionism, my need to always be perfect. I can’t make mistakes. I can’t have any flaws. I have to anticipate every move. I have to always be on the guard. And yet, perfectionism, is about mistakes, because a perfect human is flawed. Thus, by not allowing myself to make mistakes, I prevent myself from not only being perfect, but knowing what it means to be truly human. There is a part of me that does want to let go, but I’m still wrestling with the question of what exactly that means–and how to go about doing it when all I know is rigidity and repetition and compulsion.

But maybe I got a glimpse of what it was like to not be hindered so much by anxiety or my perfectionism this week? I engaged with people and was able to give two presentations without feeling too much anxiety. I also let go (somewhat) during them. I allowed myself to fail a bit on the question and answer section afterward. I could of been more thorough. I could have answered them better. But, frankly, I didn’t give a shit. I also have a huge, 15-page paper–30% of my grade–due on Thursday that I haven’t even started–and, again, I don’t give a shit.

I’m wondering, am I feeling depressed because I’ve seen a glimpse of myself in a new light–without so much anxiety and perfection–and not liked what I saw? Or is my ego (my anxiety) just flexing it’s muscle, wanting to maintain control?

***

Finally, without my anxiety, I’ll have to deal with deeper issues–

I really hate this system I’m living in. As reminded here, we’re just living a joke (capitalism) and our lives are the punch lines.

Here, I’m left with the difficult question of how do I fill this void inside of me? I’m continually looking to the future for happiness. That is, my next goal, my next achievement, my next cure, etc. What happens when there is nothing left to cure? What happens when I actually have to start living, and what if I really don’t believe there is any point to living besides not dying?

Finally, here I’m reminded that these feelings I’m having are temporary. In fact, I’m feeling much better now–but even that is temporary.

How did I know that someday–at college, in Europe, somewhere, anywhere–the bell jar, with its stifling distortions, wouldn’t descend again?  ~Sylvia Plath, The Bell Jar

is social anxiety real?

Please note: I wrote this post for the first ever Blog Carnival of Mental Health. The topic is diagnosis.

***

So, as many of you know, WordPress allows me to see what people search for to find this blog. As of late, I’ve had some alarming searches, namely–“is social anxiety real” and “is cyclothymia real.”

I guess it’s good that people are questioning their inner experiences, but I’d like to know to what end? Labels are dangerous. It’s very dangerous to define yourself by a set of labels (or diagnoses) because you limit yourself. For example, if you say, “I have social anxiety, so I should be acting a certain way,” you can literally limit yourself to those courses of action. I also believe that the pharmaceutical companies profit greatly on these labels. If they can make us believe we have something wrong with us (i.e., a particular diagnosis), when in fact there’s not, then they can profit at our expense.

I think it’s easy to forget that there is a big difference between experiencing some anxiety during social experiences and having Social Anxiety Disorder (more on this here).

However, diagnoses can also be good, namely because they allow you to get the treatment you need. If you don’t understand your inner experiences, it’s hard to get treatment. When I finally sought out professional help, I felt greatly empowered. I took back some control from my anxiety, but I also had to take responsibility for my well-being. In other words, I had to do the work inside of therapy and out, to learn strategies on how to manage my social anxiety.

In a sense, the people who conducted those searchers are right–labels aren’t real. They’re only the tip of the iceberg. When we label things (without looking deeper), we ignore the essence. We ignore what’s really going on. I think it’s good to question your labels and diagnoses, as long as you are still addressing your inner experiences–because those are real, without a doubt.

If you deny the way you feel, you only strengthen the negative emotions, in my opinion. You must learn to accept.

***

As for me, I’ve been suffering with social anxiety since high school. It took me a long time to figure out though what was going on. I just thought I wasn’t trying hard enough and needed a stronger will to get through social situations. I’ve since found out that only makes the anxiety worse. Anyway, I was officially diagnosed with Social Anxiety Disorder in the Fall of 2008, and I was just diagnosed with Cyclothymia this past August. In both instances, I felt relieved, because I could finally explain what was going on inside of me–and start getting the treatment I needed.

EDIT: All the posts on the Blog Carnival can be found here

perfectionism or punishment?

Why are pdocs always late? I’m always having to wait at least fifteen minutes after our scheduled appointment time. It’s not fair. Because of I was late like that, I would probably get a lecture on the importance of being on time. It throws my day and all my structure off. On days I have to see him, I can never plan for anything after. Anyway this time I decided to say something–

“Right on time, as usual,” I said, quite passively. His non-response indicated that he didn’t appreciate my sarcasm.

I had high hopes for the session. I wanted to drop the other medications I’m on–Lamictal and Klonopin–and start taking Nardil, as a friend of mine with social anxiety has found Nardil quite helpful. The problem was/is that my pdoc hasn’t prescribed Nardil in over twenty years as he had a patient almost die while on it. You see, there are some dangerous food interactions, particularly alcohol, cheese, aging fruits and vegetables, some meats, soy, and so on. It’s quite alarming. You could eat the wrong kind of cheese and end up in a hypertensive state and have a heart attack.

But if the ends justify the means, I think I can live with the reduced diet–and the risks. My pdoc, however, wants to exhaust all other options first. So, he increased my dose of Klonopin and added Xanax into the cocktail (both of which, I might add, I’m having trouble filling due to insurance restrictions–so frustrating). Anyway, I came out of my appointment disappointed.

Oh, and I also got lectured.

My perfectionism came up. I told him I’m frustrated because I don’t have many friends, and outside of my relationship, I pretty much only hang out with my girlfriend’s family. And since she has a large family, I pretty much bounce from one large group social gathering to the next. I don’t believe that type of exposure works. I need gradual exposure. I need to see small successes and build from there. I won’t get any better if I continue going to huge social gatherings. But I don’t feel like I can opt out of them, either. Otherwise, I would just sit around the apartment, isolated.

“It’s okay to avoid things,” he said. “In fact you need to take back control from your anxiety and start saying ‘NO!’ every now and then.”

“But then I’ll be completely isolated,” I said.

“You’re going to school, you’re starting an internship, you have a girlfriend–you don’t sound isolated to me.”

“I’m going to school online,” I countered, “which isn’t helping my anxiety. I’m scared to death of the internship. I’m too dependent on my girlfriend.” We sat in silence for some time. “I can’t help but think this way. I know my perfectionism is fueling my anxiety but I can’t control it.”

“Mike, it’s not perfectionism. It’s punishment. You’re punishing yourself for not being perfect, and by doing so, you’re giving control to your pain. You still have control, though, but you don’t feel like you have it anymore, because these beliefs of yours are so ingrained. I don’t think you’re challenging your beliefs enough.”

I’ve been in therapy for over a year–is that not enough? But he’s right. I do not feel like I have control. I feel like I am my anxiety. I am my beliefs. I am who I say and think I am. How does change occur, though? It’s easy to intellectualize this process, but that can only take me so far. Change is deeper, in areas that I don’t like to touch. In areas I don’t know how to touch. When I do touch them, I shut down, I get flooded, and I push away.

He also brought up the issue of learned helplessness. I’ve failed so many times in the past, I do not believe I can succeed. I’ve taught myself how to fail. I’ve let my anticipatory anxiety get the best of me. I think I’ll fail, therefore I will fail. But maybe–just maybe–being conscious of this will help me change? I hope so.

***

Later on in therapy that night, my therapist asked, “What does it mean to be perfect? What does perfectionism mean to you.”

“It means I avoid being judged negatively,” I said.

There’s more but I don’t feel like typing it out. It was a tough session, to say the least. He pushed right up against my beliefs, and I pushed right back, shutting down in the process. I feel like we’ve been at a standstill for some time now. Why does change have to happen so slowly?