Listening to Jazz and the Power of the Present Moment

Last night I went to a jazz concert with friends. I started listening to jazz about 4 or 5 years ago, and I am grateful to have found something that fills me with such delight! The musicians almost invariably are enjoying themselves, and listening to each other, responding to each other in the present moment, a musical conversation with many turns down unexplored roads.

When I am in the middle of OCD obsessions, I am not in the room, or in my life. I am slowly building my skill at staying present enough to actually respond to what is happening, rather than catapulting myself into the past or the future. OCD resents the present moment, and would prefer to launch into a barrage of worry about "Am I staying present enough? Am I doing this right? Did I enjoy that last solo completely?" The joy of jazz for me is that it's easier to let those thoughts be there, and still find pleasure in the music.

Part 3: The Limits of Research in Making a Decision about Medication

It's 2002, and the psychiatrist who put me on his waiting list finally called to schedule an appointment. I sat in a leather chair, feeling like a willow trembling with the slightest breeze. He was a soft spoken man in his 50's, and he paused after I spoke as if to absorb what I said before responding. He concurred that I had a diagnosis of OCD, and felt medication could help me, and that perhaps after a year or so, my mind would "reset" itself and I would be able to taper off.

He proposed Celexa because it was new and not supposed to have sexual side effects. OCD thinking had seriously stunted my ability to approach anything near intimacy with my husband, and we had just started making some progress because of working my therapist, who I will call Molly. I was terrified of sexual side effects, and this was a major obstacle to my taking medication. I'd read numerous articles on the subject from the medical literature, plus enough posts on internet bulletin boards to fuel up my obsessing to the flammable point.

His assurance to me was that if I did have sexual side effects, he would put me on another drug, Wellbutrin, and this would correct the problem. As much as I liked this doctor, his solution was like something from a farce. Take one woman who is very afraid of taking medication, and tell her that a drug will solve any problems created by the first drug. . .

But I still knew that I couldn't go on the way I had been, with rituals consuming a lot of my time and energy. I told him I would need to think about it. I believe I did something actual thinking at the time. This is an important distinction. Obsessing and compulsively looking up medical articles is not the same thing as thinking about something, or problem-solving.

I'd read enough to know that some people were helped by SSRI antidepressants, and that the only way to know if they would help me was to try one. This is incredibly difficult for someone who hoards information to accept, that some things have to be experienced rather than researched, that sometimes you need to make a decision, and you will never have enough information to make a perfect decision. But I was on my way to making a decision.

Related Posts:
Part 1: OCD and Medication Decisions
Part 2: Starting Medication While Struggling
Part 4: My First Prescription for SSRI's
Part5: Feeling in the Jaw: Side effects
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Part 2: Starting Medication while Struggling with OCD and Insurance

I am fortunate to have a job with health insurance coverage, but "behavioral health" was only grudgingly included in any form, complete with a limited network of therapists, and no psychiatrists. I already had a therapist when I started considering medication, but of the sparse list of psychiatrists in my area, many didn't want to do "medication management" if they couldn't also counsel me in some way, others weren't taking new patients, or didn't return my calls. One called me back and had a 3 month waiting list, but at least was willing to put me on it.

Willingness to take medication was already tenuous for me at best, and the maneuvering required by my OCD and social anxiety was a serious challenge to following through. It's hard to cope with:

1)I really don't want to do this.
2)It's going to take quite a bit of effort to do what I don't want to do.
3)OCD is having a field day with all the uncertainty, cultural debates about overmedication, and an intense fear of trial and error.

The only other psychiatrist I'd ever seen was 7 years previously, a requirement by a previous insurance company that to get any talk therapy I had to see a psychiatrist first. He prefaced his diagnosis of generalized anxiety disorder with "You're not going to like this, but I think you need to consider taking medication." At the time, SSRI's weren't generally being used for anxiety disorders or anything else for that matter, and the drug he suggested was Buspar, which got mediocre reviews.

I felt defensive, hearing in his tone that "psych patients don't want to take their psych meds", that he knew me thoroughly after just 45 minutes, and I was a stereotype. At that point, I didn't drive, and he gave me a referral to a therapist remote from where I lived, and only accessible by car, which seemed like sending me to another country altogether.

OCD as a disorder is very adept at latching onto whatever is at hand, and waylaying you with a grain of truth, just enough truth to make itself plausible, needed, useful. It is wise to be an informed consumer, so I felt justified in compulsively reading about Buspar, to the point of exhaustion. OCD will demand an answer in advance to the question: Will this work for me? The psychiatrist was patronizing, and that sucked, and OCD was more than willing to say "Don't do anything. Just keep obsessing."

Ironically, when I was considering medication 7 years later, I was fixated on getting it from a psychiatrist because I had compulsively researched the topic, and was afraid that my family doctor wouldn't choose the right medication or dose.

Related Posts:
Part 1: OCD and Medication Decisions
Part 3: The Limits of Research in Medication Decisions
Part 4: My First Prescription for SSRI's
Part5: Feeling in the Jaw: Side effects
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Part 1: OCD and Medication Decisions: SSRI Antidepressants

I've been taking the maximum dose of an SSRI Antidepressant for the past 3 years. Before that I was on the lowest dose of an SSRI for 2 years. This was one of the most excruciating decisions I've ever made, and somehow I managed to make it in the midst of a hurricane of OCD symptoms. That is an act of grace! When my previous therapist suggested the possibility of an SSRI, obsessing went to tidal wave. I already had only a scrap of dry land to stand on in the swirling waters of my mind, which is why the therapist proposed medication. My intense revulsion and fear led her to suggest acupuncture, which was not an object of my OCD anxiety.

It took me a year to choose to take medication. A year of compulsive research, and increasingly time-consuming mental rituals of trying to figure out whether I should take them, which one would work, and battling my fear of making phone calls in order to find a psychiatrist who would be able to prescribe them for me. So let's recap:

1)I have health anxiety, so I was petrified by the possibility of side effects
2)I was prone to existential OCD, and ruminated on whether I would no longer be myself if I took medication. I wanted to know how I would feel without a constant barrage of OCD, but I couldn't actually replicate it in my mind, which totally freaked me out.
3)I I wanted absolute certainty, in advance, that I would get on the right medicine, at the right dose, and that I wasn't crazy to consider taking SSRI's.
4)I had severe OCD issues with making decisions, and the decision points kept branching off infinitely--should I take the med? Who should I get the med from? Which med? Which dose?
5)I felt that my therapist was overwhelmed by my obsessing, and after my initial panic when she suggested meds, she didn't know how to help me make a decision.

Here was the bedrock:
Obsessing about medication was leaving me little time to do anything else with my life.

I had the revelation that it was possible that taking medication would stop the obsessing about medication.

I was full of fury about this. I hated this. I felt trapped. I couldn't go on as I was. I was exhausted. But what if taking medication meant I was unredeemable? That I was wrong? I had intense dread, as if taking medication was the equivalent to choosing to go to hell. I don't mean this in any specific theological way, but rather sheer terror.

It's hard to think back to this time. I found the courage to take a chance on medication, which calmed the constant feedback loop of OCD enough to give me some breathing room, and then later, to do Exposure and Response Prevention Therapy. I'll write more about this experience. It's more than fits in one post. But if you are struggling with a decision about medication, know that my heart goes out to you.

Related Posts:
Part 2: Starting Medication While Struggling
Part 3:The Limits of Research in Making a Decision
Part 4: My First Prescription for SSRI's
Part5: Feeling in the Jaw: Side effects
Part 6: Being on Medication & OCD Weeping
Part 7: Wanting to Get off my Medication
Part 7.5: Built on Sinking Sand: OCD and Health Anxiety

Letting the Thoughts and Feelings Be There

I got to the grocery store this morning and started feeling overheated in my winter coat, and very tired, and running behind schedule, and felt a rising panic. I practiced letting the feelings and sensations be there without judging them.

I hate the whole concept, because I judge the feelings very harshly, and I want them gone. It's only because the escalation of panic due to my incessant judging is so painful that I even consider following my therapist's advice.

I'm fortunate that Leonard has worked with me in session to focus on sensations without judgement, asking me to describe to him the heat in my cheeks, or the tightness in my chest, or the pressure in my jaw, and letting them be there without getting into a wrestling match. Then he'll ask me if I can tolerate the feelings, as they are.

Tolerating is different than liking. It's often uncomfortable, unpleasant or painful, but without the interference of my OCD interpretations of "I'm going to die. I can't stand this. What if I am seriously ill? What if I lose it?" toleration is possible. It takes all the strength within me to admit this. But I've seen what happens when I battle the thoughts and feelings. I've seen it consume me, and intensify the sensations, and truly cause me to lose it, and this creates just enough willingness in me to consider there are alternatives.

Indecision at the Library

I loved going to the library as a girl. My father was willing to take me since he was always reading, and needed his own fix. I'd get 10 or 12 books and line them up along the side of my bed, a wall against anxiety, fear and parents who could barely take care of themselves let alone me and my sister. OCD latched onto this love when I was in my 20's and still reappears, like today, when dh and I went to the library. I'd already started the day with intrusive thought #1, "You've ruined your day by websearching for 1/2 hr while eating breakfast." I'm savvy enough to recognize that this is a thought, not necessarily reality(though it could be, who knows), but still scared enough to want to do a thorough autopsy and determine if I have indeed ruined my day.

At the library I started strong, but then moved to the fiction section and couldn't find the right book. I started the "searching without cause" dance of indecision. Look at every book on a section of the stacks. Pull multiple books off the shelf and flip through them trying to decide if they will be disappointing. Pull some of the same books off again. Scan the titles slowly, in case I missed something. I believe if you mapped out my footprints like do with dance instruction, the ground would become obliterated with all the repetition and retracing. It seemed an eternity, but according to my dh it was about 10 minutes.

He came over and asked me if I was done, and I took my out, and said yes. I was on the verge of saying, "No. I wasted 10 minutes and didn't find anything, so I need to rescue those 10 minutes by searching for another 1/2 hr." I think this is referred to do as "sunk costs" and you can't get that back, although OCD would like me to think it is entirely possible and I am defective in giving up.

Trips to the library work best when I go in ready to flip a coin if I am stuck on a decision, and to randomly pick a few books without knowing for sure that they are "right" and generally taking my chances. OCD takes a lot of energy. I was ready for a nap when I got home, and had some OCD backwash about my imperfections, but I'm on to the idea that I can spin straw into gold by looking at the same books over and over.

Trying to figure out how to comment on my own blog!

Thank you to those who have commented on my blog! That means more than you can know! I am still trying to figure out why blogger appears to eat my comments. Hopefully I'll have an answer soon, or perhaps someone is familiar with this problem.