I have experienced physical, emotional, and mental abuse from childhood on through my adult years. I also experienced sexual abuse at the hands of my grandfather, my earliest memory being at the age of three. I refused to go to my grandparents after I turned fourteen. I was completed rejected by my father, who remarried and had a "new" family. One of my younger brothers is a career criminal, diagnosed sociopath, and a junkie. The other has been diagnosed schizophrenic/bipolar, antisocial, and is also an alcoholic and a junkie. He also severely self-mutilates himself (cutting) to the point of near death, frequently. My mother was emotionally unavailable at best, although I could never tell if she was "crazy" or if I was. In recent years, however, she has been diagnosed with bipolar disorder and is on medication, and we have established a new, good relationship.
I had a string of abusive relationships for years; I am an enabler. I had three children out of wedlock, married the father of the third child, and had number four. I experienced severe depression, inability to maintain friendships and employment. I was often suicidal, to the point of making elaborate plans of how to do it. I finally decided to get therapy. The psychiatrist put me on 300 mg of Trazadone and 3 mg of Ativan. The therapist seemed to be helpful, and encouraged me to become active in local volunteer activities which would utilize my creative talents.
My therapist was very supportive for three years. He encouraged me to divorce my husband, which I did, and then he began insinuating himself into my personal life to the point that he would call me 6+ times a day, and would ask me to spend the night with him. I never did. He began telling me very personal things about his life, and began to give me his personal belongings. I could tell that he was depressed, asked him several times if he was considering suicide, which he denied. I was worried, but helpless. He left early Sunday morning, called me that afternoon to say that he loved me, and to remember all that he had told me. Monday afternoon I was told that he had blown his head off in his office earlier that morning.
When I divulged the information about our relationship (as he had left paperwork and belongings that I was to give to his son "should anything ever happen to him") I was told that I was lying, that it was all in my head. The mental health clinic continued to give me the meds, upping the dosage to 600 mg of Trazadone and 3 mg of Xanax. This put me into a zombie-like state for two years. Recently, all of the personnel at the clinic were fired, and a new psychiatrist and several therapists have been hired. I have seen the psychiatrist several times; he cut my Trazadone down to 200 mg, the Xanax to 1.5mg and added 150 mg of Zoloft. That seemed to even things out, and I was functional.
This last Fall I was diagnosed with hypertension, type II diabetes, and rheumatoid arthritis. So I am also taking Zestoretic, Plendil, Glucotrol, and Hydrocodone when the arthritis is really bad. December 12, I remarried my ex-husband, mostly because it was the "right thing to do" for the kids. I care about him, and he loves me. This winter my finances were such that I couldn't afford all my meds, so I wasn't taking everything every day. I thought that if I kept some of everything in my bloodstream, I would be okay. It didn't work. I did drop the Zoloft, since I had done "fine" on the Trazadone and Xanax before, but it was a bad idea, I went into a major depression, which ended with me being suicidal, but I called for help. I wasn't hospitalized, but only because I am good friends with the pastor of my church, who also happens to be a police chaplain, and is on the mental health board. He took it upon himself to take responsibility for me.
After taking the Zoloft for three weeks regularly, I was back on an even keel. However, in the last three weeks I have found out that a dear friend has pancreatic cancer and has been given less than six months, my parents are moving to a faraway state, and my best friends, the only people in my life who don't think I am "mental" are moving 1,000 miles away. In addition, I have NO libido, and when I do consent to have sex with my husband, I feel nothing. And my consent is few and far between, as my arthritis is so painful. I have been diagnosed with anxiety disorder, clinical depression, and my therapist is considering BPD.
Is it "normal" to be depressed about the diagnoses of hypertension, diabetes, and rheumatoid arthritis? How do I deal with this depression? How can I deal with the chronic pain and inability to perform my daily functions, i.e. housework, kids, etc.? Will I ever feel desire again, and if I do, will I ever again be able to achieve orgasm? This was never a problem in the past, I used to enjoy sex, and it was a frequent occurrence. Between my current depression and my physical limitations, I spend most of my time upstairs in my room.
I understand your concerns about what might be "normal" for your situation. It might be comforting to know that most persons would have a very difficult time dealing with what you've experienced throughout your life and what you are going through now. How do you feel about your current psychiatrist and/or therapist? Have you discussed completely with him or her your earlier experience in therapy, which resulted in violation, betrayal, abandonment, and loss? Does your current therapist understand completely how and why it might be difficult for you to trust him or her, or for you to trust all mental health professionals, for that matter?
It's my opinion that this issue (of trust) needs to be the focus of your treatment. Does the frequency of contact with your therapist and your psychiatrist seem adequate? At minimum, I'd recommend weekly psychotherapy sessions with med checkups by your psychiatrist every couple of weeks until effective medications and dosages have been found. The reason it's critical to establish this structure of treatment is two-fold. First, you have several complications (the organic components) to your depression, so your mental health professional(s) will need to arrive at a medication, or a combination of medications which will be effective for you. It sounds as though that footwork hasn't been completed, especially with regards to the recent extra stressors. Be persistent. Work with them and ask lots of questions. You might keep a detailed "mood" diary. Ask them about the likely side-effects of the Rx. (Change in libido is a common side-effect of medications for depression as well as of pain relievers.) Ask them, also, to explain how all of these medical factors could impact or be effected by each other. (Diabetes, for instance, can effect sexual desire. Or, hypoactive sexual desire can be a symptom of a Major Depressive Disorder.)
Secondly, if the trust issues are not dealt with (in the relationship you have with your current therapist), whatever treatment is implemented may become undermined by (unconscious) expressions of mistrust. (Your stopping the Zoloft might be interpreted as an example of this. I'm sure you realize that a medical doctor should always determine if, when, and how a prescription should be increased, decreased or stopped.)
It sounds like you have lived through a lot. You are a survivor. Summon up the strength and dignity, which are a big part of you and take charge of your emotional health and physical well being. I understand that it's extremely difficult to feel motivated to do anything when you are depressed. It might be helpful to have your therapist or some other supportive person help you create an "action plan" like a behavioral contract you can use to persevere when you feel like giving up. (You might structure your daily activities this way, too, so that your "daily functions" - housework, kids, etc. are clearly defined and delineated. (Clearly defining your tasks will help you to feel less overwhelmed and over-burdened by them. Plus you can easily acknowledge (and celebrate) the many things you do accomplish in any given day, by checking off the tasks while you do them.)
There are no easy ways to sort through emotional problems, which are exacerbated by physical conditions. Because this is always the case, you will, I think, be forced to look at the primary issues you have which will - very likely - affect your ability to trust your doctors and follow their directions for your care to the letter. If your therapist does not bring these issues up - violation, betrayal, abandonment, loss - YOU bring them up. You might show him or her this letter.
Your job is to do whatever you need to do to provide self-care, nurturing and support to you, despite constant pain and depression. It will not be easy. But, my opinion is that it will be quite possible to do, once you've talked with your therapist completely about the issues, which could hinder your ability to trust him, and to trust yourself.
Margaret "Peg" Burr , MA, MFT
This question was answered by Margaret "Peg" Burr. She is a California Licensed Marriage and Family Therapist (MFC34374) with a private practice in Santa Clarita (near Los Angeles). She performs psychodynamic psychotherapy with individual adult clients as well as couples, teens, and families. She also runs groups for adults and adolescents. Her specialty area is Object Relations Systems Theory. This branch of psychodynamic psychotherapy uses a client's interpersonal relationships as windows into his or her intrapsychic structure.For more information visit: http://www.pegburr.com/