Let It Go

One thing I’m really bad at is letting things go when they make me angry. I become kind of obsessed with them; I keep ruminating on the situation, what should have happened, why I’m right and the other person is wrong, etc. Occasionally I allow it to ruin my whole day.

Sometimes it’s a situation where Wakana would express concern if I weren’t getting angry – a situation that needs to be resolved. The anger gives me the energy and motivation to take action on it. I need to be assertive in making sure my needs are met – firm enough that the other person knows “I mean business,” but not verbally abusing them or otherwise ignoring their rights and needs. Sometimes I have difficulty finding the balance.

A prime example is trying to get treatment for my Endangered Molar, which has an infection that is causing “extensive” bone loss. (In other words, something is eating part of my skull.) My dental insurance took forever to approve a consultation with a periodontist, and then neglected to inform me of their decision. I had to call them – to learn it had been approved a month earlier!

I went for the consultation on January 22nd; the authorization for treatment was submitted on January 26th. The weeks went by… nothing.

I called multiple times and was told a variety of things, from “we never received that” to “it’s been escalated to a supervisor.” Last week I was told that no authorization for treatment had been received, but I had been approved to see the periodontist for a consultation. It had been escalated and approved just the day before.

I was furious! I told the person I was talking to that I had already been to the periodontist for a consultation and they should have an authorization for treatment. She insisted that what had been received was a referral for a consultation; the authorization was a different thing, the periodontist had to submit a “narrative,” etc. We kept saying the same things to each other over and over, with more and more frustration in our voices. I caught myself starting to slip into some inappropriate language; I knew that if the conversation continued it would likely result in me saying some very mean things. I made every effort to end the call as soon as possible without “hanging up on” the person.

I was fuming for the rest of the day. I couldn’t focus on anything else. I couldn’t enjoy being intimate with my husband. I just wanted to break things – including the skulls of the people responsible! It didn’t help that I was in a lot of pain from having Root Canal Molar extracted. I was miserable.

I thought I had to wait for the periodontist to come back from vacation to submit the “narrative,” so I decided to wait until Tuesday to pursue the matter further. After rehearsing my questions a million times – as though preparing to represent the plaintiff in court – I called my insurance. I learned that the “narrative” is basically the diagnosis and treatment plan. The person I spoke to seemed very reluctant to provide useful information … almost as though it was against company guidelines… I noticed we were starting to repeat ourselves, so I ended the conversation before I could become so angry I’d be stuck dwelling on it for the rest of the day.

On Wednesday I called the periodontist’s office and spoke to a very helpful individual who not only clarified what happened, but forwarded me the email that had been submitted to my dental insurance. To be honest, I could see how they might have misinterpreted it: the file name for the attachment was “referral,” the form filled out was a “referral” form, and the periodontist’s office also offers general dentistry. I had to (wait for it!) read the content of the form to see that treatment was being requested. I was also able to verify that it met the criteria I’d been given for a “narrative:” two specific treatments were requested by name and reference number, and it was clearly indicated that I have “extensive bone loss” in the area. I’m not sure there is any additional information that would be relevant, except that I HAVE BEEN IN PAIN FOR SEVEN MONTHS MAKE IT STOP!!!!

This time, when I called my dental insurance, I immediately asked to speak to someone who had the authority to make a decision regarding my treatment. I was connected to a supervisor – who couldn’t authorize treatment, but could work with me more efficiently. I was able to be specific regarding the treatment requested, state that the x-rays and periodontal chart were included, and explain that it was on a “referral” form but was a request to cover treatment. The supervisor offered to call the referrals department, find out what they had received, and call me back.

On Thursday I received a call saying that they have the information I’ve been trying to convince them they’ve had for weeks!!! and it will be sent to the claims department on Friday. The supervisor suggested waiting until Wednesday to follow up regarding the actual decision.

For now I’m calling that a success – because if I don’t I’ll go even more crazy.

… But sometimes it’s a situation that I don’t have any control over and it’s not really worth following up on. Most of the examples I can think of have to do with disagreeing with someone on the Internet.

I think I got myself blocked from someone’s Facebook post … or maybe the whole post got deleted? Someone else had made a comment (tangentially related to the original post) about “transgender men” being allowed in women’s locker rooms at Planet Fitness; I interpreted it to be derisive. I felt compelled to clarify that the person in the women’s locker room was a trans woman and that Planet Fitness had defended her right to use the locker room that corresponds with her gender, free from harassment. Perhaps some of the (additional) points I made could have been worded a bit better. Perhaps some of my anger came through. It’s kind of hard to say; I can maybe see how part of it could be misinterpreted…

(Or I could be making a big deal out of nothing.)

At first I was able to see the post and all the comments leading up to mine, but there was an “error loading” at the bottom of the page. Then the notifications I had received regarding the post disappeared. The post no longer appears in my feed or where it was originally posted. It’s as though it never existed… which might be for the better, but it’s annoying the hell out of me!

I could private message the original poster, apologize for anything that was offensive, and ask what happened… but I’m not sure it’s worth it. We’re acquaintances who haven’t been in the same physical space for years; I’ve never even met the other people who had commented.

I think the best thing to do is let it go and move on with my life. Focus on something else. Do something else. I wish I could switch off the thought patterns that keep fixating on this relatively insignificant experience – or delete them. The post doesn’t exist anymore, so why should my memory of it?

But if I had an easy time letting things go and switching my focus to something else, I wouldn’t have written this blog post. Anyone have any ideas? What works for you?

To Save a Tooth

“How can someone so young and healthy have such a serious problem with their teeth?”

The endodontist (root canal specialist) actually asked this during our meeting today – after I’d described a previous dentist’s theory that over a decade of grinding my teeth had caused a cavity to form inside one of my molars. It had decayed from the inside out, to the point where I almost needed a root canal when the cavity was finally detected about a year ago. I thought the dentist had fully treated it, but he only inserted a temporary filling. Some miscommunication must have occurred because I didn’t realize any follow-up was necessary.

Now my gum is badly swollen from an infection – that came back worse after I’d finished the antibiotics I was prescribed four weeks ago. It’s actually less painful now, but still very uncomfortable and so sensitive to the touch I can’t brush my teeth the way I’m used to. I feel like I have a bean wedged between my gum and cheek, and my jaw is sore on that side. I really miss being able to chew on both sides of my mouth and I’m concerned about how a gum infection might affect my overall health.

The endodontist couldn’t have performed the root canal with the infection there anyway, but he pointed out a bigger problem. I’m in danger of losing the molar next to the one that was supposed to receive the root canal because it’s the one that is infected. Ironically, the endangered molar is the one I thought needed treatment; my only complaint about Root Canal Molar is that it feels weird when I touch it with my tongue because it’s the very back tooth and I think half of it is missing. No pain; food gets stuck back there sometimes but I get it out with floss, everything’s fine. Apparently it might actually need a root canal or I could lose it, but again, there’s a much bigger problem.

My poor Endangered Molar has been assaulted by an alien civilization for at least the past two months! In addition to the gum infection, there is evidence of significant decay in the roots, possibly bone? I am in serious trouble. I really need to receive treatment for this … well, apparently, about a year ago.

The endodontist is not qualified to deal with gum infections, and is not authorized to give referrals to see a periodontist (gum doctor) or oral surgeon. So, I had to go back to my primary dentist in order to take further action. I was so furious, I was ready to start destroying things. When we got home I saw that Dog had gotten into my kitchen garbage! I was so angry, I told Mom to take him upstairs so I wouldn’t kill or seriously injure him. It was terrifying and so frustrating because I didn’t have a safe, socially acceptable way to express my rage!!!

I called my primary dentist and learned she could see me if I arrived within the hour. Within about 5 minutes Mom was driving me there; we arrived just in time. She asked questions and took X-rays and said I had two options: I could go to the periodontist to try and save the tooth, or I could go to an oral surgeon to get it pulled.

To be completely honest, if money weren’t an issue I’d say pull the fucking tooth, clean out the infection, and give me an implant. But implants aren’t covered by insurance and can cost up to $3,000. That’s more than my wedding dress! I could get the tooth pulled and not get an implant; this might be what I end up needing to do, anyway. I don’t think a bridge would be an option due to the location of the tooth; the dentist didn’t mention it as one.

But everyone – by which I mean the dentist and my mom – seems hung up on “but you’re so young!” and “it’s really better to keep your own teeth.” There’s a chance a periodontist might be able to help me, so it’s best to take that chance and get the tooth pulled only if it doesn’t work. I expressed some uncertainty, so the dentist made the decision for me: we’ll try the periodontist first. This way the dentist doesn’t have to feel guilty (I don’t think I’d feel any guilt, sorry Endangered Tooth – regret maybe if I then experience problems, but not guilt) and I might get to keep my tooth until I’m old enough for extraction and replacement to be okay. I’d need to wait for the antibiotics I’m now on (again) to kick in and (hopefully) clear the infection before I could go to an oral surgeon, anyway.

Here’s the really fun part. I could get an emergency referral to see an oral surgeon, but my insurance doesn’t see gum infections as requiring emergency treatment. They wouldn’t approve the emergency periodontist referral over the phone; there’s a chance they might not approve it at all! I have to wait 2 to 3 weeks before I’ll even know if I can see the periodontist, never mind then having to make an appointment! The infection will probably come back and/or get worse in that time, and who knows? Maybe more of my teeth will be in danger.

The receptionist said I have to wait for the referral to come in the mail, but if I had X Better Insurance she could write a referral and hand it to me.

Pissed doesn’t even begin to cover it.

You might be wondering, what do dental issues have to do with mental health? Well, let’s see.

1) “How can someone so young and healthy have such serious problems with their teeth?” Well, sir, perhaps my health issues are not readily apparent because they aren’t medical, in the sense most people are used to. I have mental health issues, which impact physical health as well. In my case, they clearly affect my dental health! For example, I GRIND MY TEETH!!! due to chronic tension from repressed anger and overwhelming anxiety.

2) I’m not working because my mental health issues are severe enough that I can’t even follow through with a job interview. I don’t trust my mood to be stable enough for me to show up for work consistently, and my anxiety levels to be low enough to function once I get there – assuming I can manage to be on time. Wakana would say I’m being too hard on myself and I should focus on the times I have been punctual and consistent. But I don’t have to do it every day; when I have had to do it every day I’ve struggled. I need help getting to the point where I can try it again.

Anyways, not working means no income means I can’t afford better insurance or to just pull the fucking tooth already and give me a titanium implant.

3) It’s really hard to do things like stand up for yourself to make sure you get the best possible care, drag yourself to the dentist and wait Spock knows how long hoping you’ll get seen as an emergency patient even though you don’t have an appointment, and deal with the stress of going to the fucking mall to see an overbooked dentist with staff that is probably overworked and underpaid and sick of being the person patients get angry at when their insurance is being sadistic. It’s even harder when you have mental health issues (especially being more attuned to other people’s needs and emotional states than your own). I would rather pull my own tooth without so much as taking ibuprofen first, than deal with the headache that is going to the dentist!

Hmm…

4) When you have a mental illness(es), you start to rely more on other people’s judgment; sometimes you trust it more than your own. “Maybe I thought he was being a jerk because I was wearing depression goggles.” “Maybe the chest pain I’m experiencing is from anxiety.” “Maybe I’m having these symptoms because I read that they’re potential side effects of the medication I’m taking.”

I know I can’t always trust my thoughts and feelings because they tell me things like “nobody loves me” and “I can’t do anything useful” and much, much worse. I rely on people reminding me that those things aren’t true and encouraging me to think about situations from other, more creative, and generally more positive perspectives.

So if you’re in a situation like I was last week, when the hygienist who did my cleaning said the pain I was experiencing from my infection was “normal,” it can seem a bit “crazy” and “excessive” to insist on seeing the dentist anyway. They were busy, I was feeling overwhelmed, I didn’t want to be on antibiotics again anyway, and I’d just been told that my problem was no big deal. So I left. If I’d stood my ground (or had someone advocate for me like my mom did today) my gum might not be swollen. I don’t know if my teeth would be in any better shape, but at least I could brush them!

5) Extremely frustrating situations like this can trigger all sorts of painful, unhealthy, and outright dangerous thoughts. It’s even worse when the people who are supposed to help me when I have a serious health concern like this either don’t seem to care or care but can’t do anything because of bureaucratic red tape. I’m fortunate that I’m in a place where my primary concern is protecting my health, and that my mom was able to support me in expressing my anger – probably because she was angry and worried too.

I’m furious to think that I can’t get the help I need because of a rule my insurance company made up, that someone who has never even met me has to review my information, make a decision with more concern about the company’s bottom line than my health, and use fucking snail mail to communicate with me. It can be all to easy to internalize that ruthless capitalistic complete and utter lack of compassion, to absorb the message that I am worth less than someone who can afford to pay for a better insurance plan (or worse, unworthy of medical interventions, period). So for now I’m clinging to my anger like a life preserver; the hard part is doing that while keeping it directed away from myself.

A New Hope

Last week was a whirlwind of internal change and things happening. I actually wrote Drama of the Gifted Child last Monday; I had intended to write more about how my current situation is actually quite good for me, but then Tuesday happened and I re-read what I’d written and decided it felt complete enough to post.

an image of part of a calendar showing last week, with text indicating what important experience happened for Ziya each day

an image of part of a calendar showing last week, with text indicating what important experience happened for Ziya each day

On Tuesday I read a scholarly article titled “The Abject Self: Self-States of Relentless Despair” by Kathleen Adams, which can be found in the International Journal of Group Psychotherapy, Vol. 61 (2011), Issue 3. It did a great job of explaining why sometimes I feel like a functional adult named Ziya with relationships and interests and goals, etc. – and other times I feel like a terrified, helpless child who has no past or future and knows only despair. It’s because I am both those things; there are actually separate neural circuits in our brains that create different self-states in response to different situations. Abjection – a preverbal state of reaching for an unattainable object, being rejected, and fearing annihilation – can be one of them.

I finished reading the article just before my music therapy session with Wakana, so it and The Drama of the Gifted Child (by Alice Miller) provided great material for us to work with. I told her about my birth experience (as I’ve pieced it together from information Mom gave me, my understanding of our relationship, and conjecture) and she suggested we address it through music. I kind of plunged head-first into the deep end, feeling … the words “despair,” “like I was lost,” “hopeless,” “terrified,” “utterly rejected,” and “alone” don’t quite do it justice. I was simultaneously staring into, being drawn into, and reaching out from the void. I feel it now as the discomfort in my eyes that I associate with crying, even though most of the time when I’m aware of it I don’t actually cry. Something’s trying to get out.

I felt the emotions I’ve turned to food to pacify my whole life. And then she reached out to me, looked me in the eyes, told me she was right here with me; I could reach out and touch her. She was so full of hope, life, curiosity, compassion. She brought me back into the light, the living world, my adult body. The ability to rationalize and use words to describe my thoughts and feelings instead of just expressing them.

“Are you okay?”

I described a scene from Star Trek: Enterprise in which they go on a rescue mission to try and help Vulcans who got lost in The Expanse, a region of space that basically defies the laws of physics. The Vulcans had essentially become zombies, slaves to their aggressive urges and “darkest” emotions. The protagonists were unable to help the Vulcan zombies; they barely escaped with their lives. The most humane thing they could do was put the Vulcans out of their misery.

“I feel like I’ve run into a room and slammed the door. I’m holding it closed but it’s only a matter of time. The zombies are on the other side, trying to break in, and I’m terrified of what will happen when they do.”

In a word, rage. I thought she’d ended it too soon. I was afraid that, if I “opened the door” and expressed my emotions, at best I would destroy our therapeutic relationship, and at worst I would actually hurt her. Those feelings subsided when she explained why she had done it: she didn’t want to re-traumatize me.

On Wednesday I finally went to the dentist to try and have something done about the tooth that’s been causing agony in the whole right side of my face and ear for weeks. It was a rather unpleasant experience, but I asserted myself and expressed my needs. I should eventually get to see a specialist who will perform a root canal, and in the meantime I have antibiotics that are wreaking havoc on my body and hopefully helping it fight off the infection that’s been causing the pain. I can’t wait until I no longer have to take a pill every 8 hours!

On Thursday I had my third appointment with the APN. We had a lot more time and were able to actually talk about things that were important to my treatment. She was going to prescribe a different drug, but I asked her questions about it and reminded her of the experiences I’d had with Zoloft and Wellbutrin. She took some time to review her notes from our prior meetings (we’ve been meeting once a month) and decided to go ahead and prescribe the Lamictal. We didn’t get to talking about gradually increasing to a therapeutic dose; I just have a month’s worth of 25 mg tablets and an appointment to see her again in another month. She advised me to wait until I’d finished the antibiotics to start taking this new medication.

Friday morning I was writing in my paper journal and something extraordinary happened. I started using “we” instead of “I” to acknowledge that, however you want to explain it, there are multiple selves (or aspects of self?) bouncing around in this body. “We” were still expressing “our” views as though they were unanimous…

Until a dissenting voice spoke up: “No, I don’t want to clean up the clutter, because it helps me feel safe.”

We talked a bit about order and chaos (by writing in our journal), and how now that we’re adults we don’t have to live in chaos and fear anymore. “Whoever hurt us is gone.”

It seemed to be going well until the word “embarrassed” got used. Then the dissenting voice became very justifiably angry, calling at least one other out for being ashamed of and hiding zir.

“You said this was about freeing emotions, feeling and expressing them spontaneously. Well, I’m very angry! That’s going to happen ‘in public.’ What are you going to do, stay in the house ALL THE TIME? Stop hiding me! Stop denying me.

“I EXIST AND I’M FURIOUS!!!

“And now the floodgates are open and I’m out! You’re not going to shut me down again. […] You cant suppress me anymore if you want your precious ‘mental health.’ You will be depressed if you keep suppressing me. I’m really mad at you. I keep trying to tell you but you won’t listen to me!”

“You’re the judge, the critic, the warden…”

“No! YOU are!!! You’ve kept me from expressing myself our entire fucking life don’t you see?”

“Yes, it’s true, I’m sorry.”

“‘I’m sorry?’ That’s it? Our whole life.”

“I was trying to keep us alive.”

“Well you almost KILLED me!”

“It wasn’t safe.”

“YOU weren’t safe.”

“You weren’t safe either. You said you needed the clutter to hide in. I don’t think you felt safe. You needed me.”

“I guess I did.”

“You don’t need me anymore. Look at you, standing up for yourself like this. How assertive! Getting your needs met. Expressing yourself. You’ll go far in the world. So far.”

“Don’t leave!”

“But if I stay, all I’ll do is hinder you.”

And just like that, gone. Whoever was in control of the body before is gone, and I’ve taken their place. I don’t even know their name, preferred pronouns, nothing. This whole time – a young adult’s entire lifetime – I’ve been a crying child shoved in the corner of the psyche and largely ignored; now I’m in charge. A whole life to live, so many decisions to make. There are other people here to support and guide me, but our former leader is gone.

We gave “her” a Viking funeral, the ship, flaming arrows, fire out at sea, sung lamentations, everything. It was quite beautiful. And then I ascended Pride Rock and looked out on a glorious landscape touched by the rising sun and sang a song that was so full of life and joy and vitality…

Then I had to get dressed and go somewhere and the weekend was its own whirlwind of socializing one day, then trying to settle down and finally write the paper from my summer class (oops!) the next. I was kind of useless – sad and lethargic – on Monday, but I did some research and cleaned my desk, so I actually have some space to work. Considering how I’ve responded to such abrupt changes in the past, I’d say I did pretty well. I kind of got some whiplash; I didn’t crash.

I also decided to start taking the Lamictal, even though I still have about two days’ worth of antibiotic left. I was feeling rather anxious about it, but I haven’t spontaneously combusted, so I think I’m going to be okay. I hope.

Listening to Myself – Part 1

Visiting Banji for a week was the best thing I could have possibly done for myself. I was so happy to get to spend time with my best friend, sharing in some of our favorite activities together (including staying up all night talking). She made a point of asking me what I wanted to do and engaging in a 2-way conversation where we each expressed our views and then compromised to find a solution we could both be happy with. It took some time, but I grew more comfortable recognizing and expressing what I wanted.

It also provided me some much-needed space from Fox, during which time I could think about our situation more clearly. I realized that I want to continue our relationship; there is still a lot of room for both of us to learn and grow from it. But in order for that to happen, I need to assert myself. Wakana says I need to become Aware of how I feel and what I need, Accept it, and Act on it. I’m starting to get the awareness and acceptance; the action is taking some work but I’m moving in that direction. A lot of good has happened since I tried to break up with Fox and kick him out of the house: he’s been working hard to make it a more pleasant place to live and to get his life back on track and generally be a better spouse. I find myself attracted to and happy to spend time with him again. (He still does things to annoy the hell out of me, but I’m working on being able to set boundaries that should help with that.) It’s a really great feeling.

I also need to address that feeling of something being “off” with our relationship that I mentioned in Reactionary. I can’t really say what concerns came up before I started this blog in December 2012 (about 2 years into our relationship); I’m sure there were some but overall I was happy with our relationship and busy focusing on school, trying to become less enmeshed with my mother, addressing my mental health issues, and navigating the effects Banji’s move was having on our friendship.

Since starting the blog, however, there have been a plethora of times I’ve expressed concerns and then never followed up on them, including outright saying I wasn’t ready to get married! I didn’t have nearly as many followers at the time I wrote these posts as I have now; I hope that if I’d had more followers then, someone would have called me out on some of these things. I’ve reviewed the posts leading up to our legal marriage ceremony last November and quoted passages that really should have prompted some kind of action (most likely communication) on my part. Please remember that they are quotes of out of context… but even so, I’m disturbed by my failure to take my own concerns and needs seriously for so long. This can’t happen again.

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