(no subject)

[the_rck]

So, I survived getting my breasts squished. It was no fun, but everything's clear, and I don't have to do it again for a year. The process was more than a little frustrating as they kept sending me back to the waiting room while they checked to see if they had all the images they needed yet. (For values of 'kept sending' that equal twice but still annoying.) The whole process, from when they called me in the first time until they were done, took about an hour and a half.

I'm actually looking forward to a week of doing very little but resting, writing and trying to keep Cordelia amused. My plans in that direction may end up going nowhere, but I'm currently hoping for a quiet week.

Then again, my sister-in-law may want to get together again. Last Wednesday, she brought her two kids down, and we all went to Independence Lake. We got there late enough that all of the tables with shade that were relatively near the water were taken. The kids had a great time in the sprinkler area. Then my SIL took them into the lake. I had to pull out my glasses in order to track Cordelia, and even then I wasn't completely sure which small child she was when I couldn't see bathing suits.

I managed to get sunburned in strips on my shoulders, places where my dress shifted just enough to expose skin I'd missed with the sunscreen. I was pretty bored at the same time I was anxious. I'd brought a notebook, but there was so much sun glare that I couldn't look at it. Besides, I really needed, for my peace of mind, to try to track Cordelia. Not that I didn't trust her aunt and cousins, but....

As we were leaving, my SIL asked if I had fun. I didn't snap at her. It was a stupid question, but it was also well meant. I told her that Cordelia had a grand time but that it certainly wasn't something I'd ever do for me.

I wish I enjoyed being outside. I spent most of the three hours we were at Independence Lake wishing that I could escape and be somewhere with fewer people, less stimulation and some perception of safety. I knew (and know) that I was perfectly safe. I just didn't *feel* safe. I could help myself by closing my eyes except that then I couldn't track Cordelia which made me feel guilty.

Anxiety seems to come from my perception of variables that I can't control, limit, predict, etc. If I don't think about them, I can decrease my anxiety, but when I have to interface with variables-- using a bus trip as an example, a bus schedule, a bus driver, other passengers, the weather, traffic, finding the right stop, whatever I have to do after I get off the bus-- the anxiety spirals. The longer the process takes, the more stressed I get. If I were afraid of something specific, I could prepare for it or at least think about what to do if it happened. I'm not afraid of anything specific, though.

Some of the problem when I go out is simple over-stimulation. There's too much going on. (My psychiatrist says that over-stimulation is part of the definition of agoraphobia.) Having lots of people around is worse because each individual is another set of signals and general stimuli. They're the least predictable part of my surroundings most of the time.

Most of the time, when I'm out by myself, I simply change my filters, disconnecting a bit, so that I don't let myself see or think about most of my surroundings. I'm in more danger from anxiety then than I am from failing to see any genuine threat. It is theoretically possible that I could get mugged at noon while crossing the street between the bus station and public library or could get hit by a truck (higher odds than getting mugged) or could be at ground zero for an alien invasion or a flash flood could wash away my town or... infinite possibilities, ridiculously tiny probabilities. I'm constantly ready for some hugely unlikely disaster.

Disconnecting is exhausting and not particularly safe. The lack of safety comes from the possibility that I'll run into a real danger/difficulty and not be able to respond because I've put myself on such a large delay. The exhaustion comes from the fact that it's work to change my mental state like that. Whatever glitch there is in my brain that produces anxiety doesn't go away just because I'm pretending it's not there. It's like adjusting to a constant physical pain (I've done that, too). One can determinedly look away, but the body's set up to deliver those signals because they serve a purpose. They're supposed to keep people from hurting themselves further, from repeating actions that cause them damage. Ideally, the central nervous system learns to filter out junk signals so that one doesn't have to repeatedly note them, evaluate them and decide what to do about them.

With fibromyalgia, I have two problems. The first is that I injure very, very easily and take a long time to recover. The second is that I don't have good filters for physical junk signals. My body yells at me about things that I shouldn't even have to notice, like the texture of the cushion on the loveseat under my butt. I can't tell, sometimes, when a particular pain is something that I should pay attention to and try to do something about and when it's just normal wear and tear.

With the generalized anxiety and agoraphobia, I think that there's something similar going on. I don't tend to have specific fears. There are specific tasks that I become anxious over because I know they'll be difficult or because they require several steps spread out over time or because there are uncertainties (variables).

Most sedatives make my anxiety worse because I can perceive the way they slow my reactions and impair my functioning. My physical stress tends to ratchet up as my mind tries to make my body compensate for the sedation. Thinking about why I'm anxious and trying to answer the anxiety rationally also makes the anxiety worse. (Every time I've tried cognitive therapy or cognitive behavioral therapy, it's damned near killed me. Both actively feed the anxiety by giving it attention, lots and lots of attention.)

When I think too much or get pushed too hard on the anxiety, my brain sort of seizes up. If I'm talking to someone, I'll end up grabbing some minor point, clinging to it and arguing with everything that I've got that that point is immutable, true, fundamentally important and so on. I don't tend to sound irrational when I'm doing it. Realizing that what I'm saying is crazy requires taking a few steps back. Getting me out of it requires giving me space and not arguing with me. Engaging me in debate will simply make me cling harder to the point I've fixed on. I literally can't give it up because I feel like I'm drowning and only have that tiny bit of certainty to keep me afloat. (This doesn't tend to happen to me on LJ because of time. Being able to retreat and to wait before responding generally lets me be more rational.)

I'm still trying to find the right way to talk about anxiety. I don't fully understand my own experience. It's hard to see completely from the inside. I'm not sure it's easier to see from the outside, though. It's invisible.

Comments

[anderyn.livejournal.com]

Man, you sure are more aware of things going on in your brain than I am (ie, in my own brain). I just get anxious. I haven't dissected it like that. I'm not sure if I envy you this self-knowledge or not.

[the_rck]

I'm not sure how helpful the self-knowledge is. It's very hard to tell. Sometimes, it can help to explain my perceptions to other people so that they know how not to set me off, but there's an awful lot of navel-gazing involved.

[cherydactyl.livejournal.com]

You know, obviously not being a psychiatrist, this is just idle speculation. If sedation makes things worse, what about stimulation? The treatment for ADD/ADHD is to give stimulants (usually amphetamine or similar things) because, for people with these conditions, they actually have a sedative effect. I don't know how accurate this is to how it acts, but my picture is that the stimulant causes the bodily systems that regulate energy and focus levels to have to activate to bring the system down a notch, and it actually manages to bring it down farther than the original level, so to speak. (This is a mental model I have built after reading lots about ADD, so I'm not sure if it's my synthesis, or how one of those sources painted it.) It just makes me wonder what effect stimulants would have on your anxiety, and specifically if you would compensate and get to a "more normal" level like ADD suffers do with their inattentive behaviours.

[the_rck]

I don't know what stimulants might do. The general wisdom in psychiatry seems to be (based on my impressions) that stimulants increase anxiety by increasing arousal. So far, what I've tried has been SSRIs (evil, evil, evil) and sedatives (also evil).

One psychiatrist actually suggested anti-psychotics. He said that I obviously wasn't psychotic/delusional but that whatever was going on didn't seem to be responding to the usual chemical prodding for anxiety which made him think that trying from other directions might be worth trying. That was the last session before he finished his fellowship, so it never went anywhere. I was dubious.

For what it's worth, provigil, the medication the current psychiatrist wants me to try for fatigue appears to be a stimulant. I suppose we'll see what it does.

[cherydactyl.livejournal.com]

I find the topic of psychiatry and its relatives completely fascinating...I guess I'm just saying that to tell you I'm interested in your experiences and what they might say about how brains in general and/or your brain in particular operates, as well as being interested in you in general. :)

And...dumb question, but do you use a multivitamin? I have some recent reason to hypothesize that a good supplement can be very helpful.

[the_rck]

I take women's one-a-day. I took magnesium for a few months recently and used to take calcium/vitamin D (probably will again when I get around to buying more). I haven't noticed that any of these supplements make a difference, but I also haven't stopped taking the multivitamin for more than a day or two in several years. The biggest gap was when we were trying to find an over the counter version that wouldn't make me sick after I stopped taking prescription pre-natal vitamins.

[adrian-turtle.livejournal.com]

My psychiatrist prescribes amphetamines (the same kind they use to treat ADD) to counter my Eeyore-Depression. That's the kind of depression which makes EVERY initiative roll a critical miss, when it gets bad. When I take a low dose of stimulant* in the morning, it improves my ability to cope with pain and depression**. If I take too much, or take it too close to bedtime, it interferes with my sleep and is counterproductive. The psychiatrist keeps encouraging me to take more, and to take it later in the day, but better sleep at night is more important to me than being more functional in the afternoon.

*What works for me is 5mg of amphetamine, or 500mg of caffeine. The amphetamine has fewer side effects. Have you tried large doses of caffeine, or do all the usual caffeine-delivery mechanisms upset your stomach too badly?

**I notice the improved ability to cope mostly for the depression. My anxiety problems are secondary (tertiary? quaternary?), while yours seem to be your most challenging problem. The thing you describe about not being able to respond, and being scared because of a potential need to respond to *something*, just not knowing what...is very familiar. Mine gets a lot worse when I'm exhausted. The incipient meltdown feels remarkably similar, whether I'm exhausted from pain, sleep shortage, extended hypervigilance, physical exertion, or something else entirely. Stimulants can give me 6-12 hours of not feeling exhausted.

[the_rck]

I haven't noticed caffeine having an impact on my anxiety, but up until the last few years, I rarely drank anything caffeinated because of the diuretic effect. My bladder fills fast enough on its own. I thought for a long time that caffeine had no effect on my alertness/wakefulness. I've discovered in the last few years that that was wrong. It will make sleeping harder even if it doesn't make me feel more awake (and not just because I keep having to get up to empty my bladder).

Sugar seems to buffer me against reflux from caffeine, but the effectiveness depends on the amount of sugar relative to the amount of caffeine and on what else is in the mix. I can't, for example, add enough sugar or honey to black tea to keep it from making me sick. Adding dairy can help a little bit but not enough for me to add it for anything but helping mask the flavor.

I think that sugar has been my stimulant of choice most of my life. It works and doesn't make me (immediately) sick. I like hard candies, jellybeans, sugared gum and other things that come in small pieces that can be stuck in my pocket and doled out gradually. Candy bars tend to be too much. I like to keep some in the freezer for when I'm desperate, but they're really too big. (Of course, small doses of sugar have the drawback that I lose track of how many I've had and just don't stop.)

[odosgirl.livejournal.com]

Congratulations on the clean mammogram. Take it from a breast cancer survivor, getting squished once a year can save your life. :-)

[the_rck]

That's why I didn't get cranky at the woman doing the mammogram. She was careful to explain what was going on. It hurt quite a bit, but it wasn't unnecessary. She did keep asking me if I was 'all right' at points when I simply wanted her to move a little faster to get things over with.

Of course, it did occur to me that, if I were a masochist, I might seek out that sort of thing. ::laughs::