Monday, April 24, 2017
The Neverending Ending
I give up.
I am done.
Where do I get off this merry-go-round?
I am not suicidal.
Suicide would be redundant.
I am already long dead.
Or more precisely, my life story ended but I forgot to die.
God is not vengeful.
The Universe is not cruel.
They just forgot to kill me.
They forgot me completely.
All of the pain and regret and fear and disappointment are just a dull ache.
Is this done?
Can I stop writing this now?
I should not have started.
Sunday, April 2, 2017
Riding the Rollercoaster of Psychoactive Pharmaceuticals
I am so weary of this process of trying to make me, or my life, better, through drugs or any other means. I'm ready to settle for where I am and who I am, no matter how disappointing and diminished that may be. I won't be sitting comfortably, but at least I won't continue building this resume of hopes and failures. There is no room left for hope. That isn't as bad as it sounds. Hope is the great deceiver. I'm ready to be my version of real, no matter how bleak my reality may be.
For details, since the last posted update... I think I was on 150mg/day of Sertraline (Zoloft), and the same 4 1mg doses per day of Clonazepam I have been on consistently for years. When I had been on 100mg of Zoloft for a little while, I had a remarkable improvement in all aspects of my subjective mental well-being and ability to function socially (sorry if this duplicates previous posts), which lasted for about 3 months. The increase to 150mg Zoloft seemed to make no difference, except perhaps to make worse some physical side effects. The next strategy to address both effectiveness and side-effects, was a decrease of Zoloft to 100mg and the addition of 100mg of Bupropion (Wellbutrin). This was given an adequate trial period and found to have made no difference to side-effects, and a subtly perceived worsening of intended primary effects.
Now, I am less than a week into being back on 150mg Zoloft and Zero Wellbutrin. I know it is early to judge, but I feel nearly as bad as I did before starting Zoloft the first time. My Psychiatrist told me that there should be no withdrawals from dropping the Wellbutrin because it was a small dose for that drug. So if these aren't withdrawals, what the fuck is going on?
My sleep is fragmentary, my attitude and mood are slightly unstable, my anxiety, and perhaps my untreated (untreatable?) ADHD are messing with my cognition and general ability to cope. And, of course, I feel hopeless, worthless and unworthy.
I don't think I have manic episodes, but for some damned reason, I got this idea in my head that I wanted to enlist some musician friends in a project to put on at least one live performance of the full album "The Point!" by Harry Nilsson, consisting of both songs and narration with underscore. I had this idea that it was a work largely unknown to most younger generations and that it had a message, in fact several possibly useful messages, that is relevant to their lives and the current state of things.
The initial response from my primary collaborator, the one who would be writing the charts for all the other musicians as well as performing, was very enthusiastic. Then, when it came time to contact another important potential collaborator for the project, I found my self terrified by what I had set into motion. To try to reassure myself, I have tried to sing along with the record several times, and I just can't sing worth a damn. I used to sing all the time, when working or driving or just about any time. And I used to sing karaoke, first the usual kind, and then with a live band. Although I can't make myself believe that I was ever even marginally adequate at singing, I do remember getting positive responses from many people over the years.
Now it has been nearly 6 months since I have sung in public, and about 10 years since I have sung and believed that I was singing passably well.
At least it is early enough in the project that I can kill it, or at least remove myself from it, without having wasted a lot of other people's personal investment in it.
There was some other shit I was going to say, but I'm out of energy and motivation again. When will I stop writing these pointless fucking things? Soon.
Tuesday, March 14, 2017
Changes in Dosages, Initial Observations of Results, Areas of Concern
My condition going into this appointment was not terrible and not great. I found both depression and anxiety to be within tolerable control most of the time. However, the ability to comfortably engage with others socially was gone. The courage to leave the house for any non-mandatory reason was gone. I was curious if there was any way forward that could return me to some social activity, particularly going to see local bands, book readings, etc. Additionally, some common side effects which I had been tolerating for quite some time became a matter of concern for me. I wanted to determine if such problems could be mitigated, or should be accepted as permanent. Any intelligent reader can read between these lines. I was willing to compromise, trading a setback of one kind for an improvement of another, but of course it isn't that simple. The brain and body are massively complex and we're basically just throwing pharmaceutical darts at it to see what happens.
Nonetheless, based upon some presumptions based upon poorly documented past experience it was decided that I should taper back down from 150 to 100 of Sertraline, begin 100mg daily of Bupropion (generic for Wellbutrin) immediately, and keep Clonazepam as-is.
At this juncture I have completed the decrease in Sertraline and have been on Bupropion for a week. It is too early for conclusions, but a good time for noting changes thus far.
I have become more irritable, which is very disappointing because I had quite enjoyed being less reactionary and paranoid. Related or not, my cognitive function seems to be in a slow and steady decline since before the current trial. I still feel no closer to returning to social function, or to "domestic function". I realize now that I spend most of my time with passive distractions, to avoid thinking about the very things about which I am writing. Introspection is my enemy, as it always leads me to either despair, or failing the energy to be dramatic in my self pity, to the logical conclusion that I am simply done. My story, such as it was, has long been over, but I'm still here for no compelling reason. I feel obligated to remain alive to putter incompetently through the few practical tasks for which I am still useful, but grow weary of how I seem to constantly disappoint.
To complicate matters further, I have had inconsistencies in the scheduling of my dosing, and have even made errors were some doses were entirely skipped, or two doses were apparently taken much too close together in time. I use a 4 by 7 weekly pill organizer, which helps some, and is the primary source of evidence for discovering my lapses, but I think I need something more comprehensive, either an app of some kind, or a simple handwritten journal of what I take and when.
The Clonazepam had saved me from a lifetime of internal terrors I do not wish to describe, but I regret ever attempting a pharmaceutical approach to my depression.
Hey, I just ran out of motivation to keep writing this shit.
Tuesday, February 21, 2017
Preferences Regarding the Disposition of my Body, and Related Matters, upon my Death - Draft
Disclaimers
By having specific preferences, and expressing the ideas or feelings that motivate them, I do not intend in any way to criticize differing preferences ideas, feelings, traditions or beliefs of others. Yet, having said that, I recognize that I have a history of criticizing many of the practices, ideas and beliefs of those who have a similar cultural and religious history to mine, and this is likely as not to become evident here.
Before I get to my specific preferences, I acknowledge that there may be insurmountable practical barriers to carrying them out exactly as desired. At this time, I do not know the condition in which my body may be found or recovered, or if it will be physically attainable at all. It may be intact, or dismembered or mutilated in any number of ways and degrees of severity, and it may be in various stages of decay. All of these may have some affect on how it is to be disposed, and in some possible cases, it may be in the interest of public health to ignore my preferences. I acknowledge and accept all of this. After all, I will be dead, and it is unlikely that it will make any difference to me, and it is very likely that there will be no "me".
Short, Confusing and Irrelevant Paragraph
This may be a good point at which to explain, if it is not already evident, that I am often of two or more contrary minds regarding any given matter. This is particularly the case when it comes to intangibles, such as articles of faith.
Religious Background
As a person's specific relationship to matters of faith is an important guiding factor in planning and executing the disposal of remains, I shall try to explain myself in these matters as clearly as possible.
It's complicated.
I was raised until at least age 10 in the context of a very conservative rural Baptist church. This was mostly a confusing and traumatic experience for me, yet my soft brain was indelibly imprinted with a genuine fear of God, and a deep sense of unworthiness. This was compounded by being cursed with a mind just smart enough to foster doubt, and inevitable guilt over the same. As early as age 3, I would lie in bed and try to imagine God before the creation. Where was he before there was anywhere to be? If we are in his image in a literal sense, was God like a man "floating" in nothingness? I tried to imagine eternity. I tried to imagine how a universe, or a life, could have a beginning, but no end, or alternately end in eternal nothingness. I could not simply stop myself from contemplating these absurd unsolvable questions. I was, I am, equally terrified of mortality and immortality. At times I would literally beat my head against the headboard of my bed to try to break the spinning terror in my mind. I did not sleep well. As years passed, I considered my life to be a process of finding ways to distract myself from unthinkable existential terror.
After moving beyond the reach of that small town Baptist church, my parents became what I would call church-hoppers. As if in search of a new faith that fit them, we would attend a different variety of protestant church nearly every week. This was very educational, and also fostered a growing cynicism about the authority of churches and preachers. The stranger-than-fiction anecdotes are many, but fortunately slowly sinking into the dark depths of my impaired memory.
I eventually decided that I was much too clever to believe in primitive religions, yet the fear and shame are still with me, although attenuated significantly by 4mg of Clonazepam (aka Klonoptin) a day.
As for religions other than variants of Christianity, I am honestly mostly ignorant, but curious. From what little I have read, it seems that Judaism, Christianity, and Islam have portions of their sacred texts in common, all worship essentially the same monotheistic God, and differ primarily on who their favorite Prophet or Savior is. That hardly seems enough difference over which to be having centuries of war, but what do I know? Hinduism, as seen from a distance, seems like a fascinating polytheistic acid trip. Buddhism seems the most benign, and the only one that doesn't have, as far as I know, the concept of a God. Are there other major religions? I can't think of any right now, but I'm sure there are many.
Enough preamble. On to some specifics:
Organ, Body, or Tissue Donation
I understand that it is unspeakably selfish of me to withhold a body I will no-longer inhabit from the re-use of organs, or donation in whole or in part to medical education or research. Nonetheless, I am unspeakably selfish in this matter. My only reasonable excuse for refusing organ donation is that I don't believe I have any organs that would be particularly preferable, or perhaps even usable. I was born broken in several known ways, and probably in other ways not identified, and I have not exactly worshiped at the temple of this body. It has malfunctioned numerous times in numerous ways, and continues to do so. My more unreasonable excuses have to do with some religious superstitions which have deep roots in my broken brain, mutated by my own psychoses, and cannot be fully weeded out.
Preparation and Burial of the Body
Important: while what I describe is essentially a "natural burial", please do not allow anyone to construe my meaning to be what is commonly called an "ecological burial", a process which involves a disintegration of the body far more thorough than cremation. I do not wish to be frozen in nitrogen and shaken to bits. Yes, I know it isn't really me, just my physical remains, but I'm just weird about this. People, often are weird about stuff like this, each in their own way.
I would prefer to be prepared and buried by methods similar to what I have heard referred to as "natural burial", and I believe is also similar to other traditions. I do not wish to be embalmed, nor even to have my blood removed. I do not wish my organs to be removed. I have no problem with temporary refrigeration or freezing of my remains until the most convenient time for preparation and burial.
I would prefer that my body, or recoverable portions thereof, be stripped of clothing, cleaned, wrapped in some manner of biodegradable cloth, and placed in a biodegradable casket. I would prefer a woven casket, preferably of willow, as I have had a love of willows throughout my life, but whatever material seems prudent will do. I definitely do not want my casket placed in a buried vault, or surface mausoleum, but rather placed directly in the earth. I do not mind the inevitability that the casket will be likely crushed in the course of re-filling the hole. If my casket is to be on display for any kind of memorial service, but there is a risk of an unpleasant odor, any means which will not be damaging to the local ecosystem may be employed to mitigate the odor. At this writing, I have done no research into such things. Under no circumstances is there to be a public viewing of my remains. My remains should only be seen by those who transport it to a place for preparation, those who are involved in preparing it for burial, and any forensic examiner if such is required.
I do not wish to be cremated, if it can be avoided. I find the practical process of cremation to be horrifying, even though I wouldn't actually experience it. But if it cannot be avoided, then at least I would prefer not to become a gruesome household decoration nobody really wants, but would rather join the silt of the Willamette river, if possible. To be released somewhere beyond the bounds of the Earth would be ideal, but an expensive indulgence for a person who earned no such grandiose disposal in life and, as I seem to keep saying, is dead anyway.
Funeral, Wake, Whatever
Obviously, funerals, graveside services, and other such memorial gatherings, are to meet the needs of the living, as the dead have no more needs. Nonetheless, I cannot resist a final posthumous opportunity to coerce people into hearing music that I love. If there is to be an extended period of time during any gathering during which background music would be appropriate, I wish that music to be the album "A Blessing of Tears" by Robert Fripp, or really anything by Arvo Part. Additionally, to open and close any formal ceremony, I wish for the song "Here Comes The Flood" by Peter Gabriel to serve as opening, not the overproduced bombastic version from his first album, but rather the simpler arrangements that can be found on Robert Fripp's album "Exposure" or Peter Gabriel's first best-of collection "16 Golden Greats" (terrible title). For a closing song, the brief instrumental closing theme to Mystery Science Theater 3000, either in it's original form, or preferably, transcribed for and played on or recorded from a sizeable church organ. I have a work in progress version of my own cover of "Here Comes The Flood", which, if finished before my death, may be preferable. Similarly, I have not yet begun the process of transcribing and re-recording the closing theme to MST3K, but if that is completed before my death, it would be preferred.
I may or may not write my own elegy, as that seems to be the pinnacle of egotism and cruelty to anyone who might actually have cared about me. I would inevitably write something glib and insensitive.
Location
Obviously, I need to be buried somewhere that allows the kind of "natural" burial I would prefer. I have a fondness for Lone Fir Cemetery in Portland, but I'm not even on the waiting list yet, and I don't know if they allow the natural thing. If it were all about me, I would like to be secretly and illegally buried somewhere deep in a national forest, preferably in the coastal mountains of Oregon, but this isn't all about me, nor should I burden anyone with an obligation for lawbreaking and considerable inconvenience. Other than these, I have no strong preference, and the choice of location should be catered to the convenience of anyone living who may wish or feel obligated to visit the grave site. If such is possible, a location where there is minimal or no grave site maintenance is appealing. After a reasonable period of time to allow for natural decay, and the passing of those who knew me, I have no problem with the burial site becoming anonymous and re-used for any purpose.
Marker
I do allow myself the conceit of wanting a semi-durable marker, with the usual information, at my burial site. Any natural material is acceptable, and something that will degrade over time is fine. I am thinking of perhaps something made of baked clay, which should last as long as anyone has any interest, yet politely degrade into anonymity afterwards. I have an absurd fondness for the idea of a Haniwa, a kind of traditional ancient Japanese terracotta grave marker, but more specifically, one which resembles the "Gyroids" that can be found in the various versions of Nintendo's "Animal Crossing". I can provide images, and further, may actually make one myself sometime before I die.
The Longest and Most Unnecessary Paragraph
[Editorial Note 2017.02.27: I regret the judgemental and punitive statements I make below. It is common for people to have comforting beliefs that are contrary to the theology to which they profess to adhere. There is no real harm in this, so I should not be so critical, especially considering that I won't hear it, or if I do, the joke's on me. My discomfort with this sort of theological dissonance is rooted in my own negative experiences with, and knowledge of, less benign contradictions.]
I do not want any preacher of any kind, unless in the interim I have truly befriended and specified one, using the event of my death as an opportunity to do their standard stump speech. The only exception to this is if my wife, Patricia, who I fully expect to outlive me, insists on a traditional Catholic service, and even then I hope they can limit themselves to some kind of standard generic script. I have been to a few different kinds of funerals and memorial services, and what I want to avoid is some stranger pretending to know anything about me, or any bullshit talk about "God's will" or fantasy talk about me "watching over" anyone after death, or worse, ignorant claims of me being an "angel" after death. These things are commonly spoken by ignorant Christians who don't even know the founding documents of their religion. I have no idea what happens to me after I die. I do know that by strict Christian orthodoxy as described in the Bible, my body will lie in the ground until the second coming of Christ, at which time it will be resurrected, and a bunch of other crazy shit happens, including a war between Heaven and Hell. What fun! It's a long road to the pearly gates. So between my death and the second coming, I won't be doing any looking down benevolently on anyone, nor will I be in Heaven hobnobbing with my dead relatives, which sounds more like Hell anyway. Also, according to Christian orthodoxy, nobody dies and becomes an angel, no matter what Clarence says in "It's A Wonderful Life". Angels are terrifying powerful creatures who may superficially resemble humans but are an entirely different kind of being, as depicted in some of the better horror movies and the delightful Fox series Lucifer. Again, I don't know if any of this is true. The logical fragment of my mind finds it all to be extremely unlikely, but my frightened little boy brain has been cruelly conditioned to believe it. This is the real reason for objecting to cremation, and even modern embalming. It just seems like saying to God, "You're so all-powerful, let's see if you can resurrect this bag of ashes and bone meal!"
What the Hell? I'm dead, and never was an expert on anything, so let anyone say whatever shit they want. You can probably see now why I should not be writing my own elegy.
This first draft is more-or-less done, as I can't think of anything more to add, relevant or irrelevant. Once this is reviewed by an actual Funeral Director, it is bound to be significantly revised.
Tuesday, November 22, 2016
Dosages and Desperation
It is a little complex because different symptoms are taking different paths. Part of what comes with my depression and/or anxiety is irritability and paranoia, basically taking everything that is said or done in the worst way and over-reacting. Thankfully, this cluster of symptoms has consistently been disappearing over the course of my treatment with Zoloft. As of now, bouts of reactionary jackassery are very infrequent, usually extremely brief, and I usually figure out what is going on (or more to the point not going on) and make amends in time to salvage what remains of the interaction. As a result, my illness is perceived as improved by others because I am getting along better with others. There is an internal component to this, of course. I'm simply more philosophical about how I perceive, contemplate, and respond to stimuli. I find it easier to put things in a perspective that make them smaller rather than bigger.
My internal life is not going as well as that. Part of how I deescalate perceived negative stimuli is through a kind of fatalism, realizing that things will be as they are and I am powerless to change them, so why bother getting upset? I also internalize a lot of perceived negative stimuli through a belief that I deserve it, that I brought it on myself, so once again, what point is there in reacting in a way that can only make it worse? Finally, and most importantly, I realize that most of the negative stimuli that I perceive is simply manufactured in my own malfunctioning mind.
So while I am being less of an overt asshole, I am still being passively upsetting to others by simply not performing the few simple duties I have in life well, consistently, or in some cases, at all. I do a lot of sleeping, or trying and failing to sleep, and other forms of doing nothing but letting time pass.
So, that is how I am doing, or not doing, in terms of my effect on the lives of others, but what about selfish me? How am I doing? Very not well is the short answer, and getting worse rapidly.
Shortly after starting Zoloft, I found myself able to resume in-person public interaction with old friends and acquaintances, and through those connections accumulated a few new associations. I was meeting with a group of people at "Karaoke From Hell", a recurring show at Dante's, once or twice a month. Singing has always been important to me, and I once again was able to convince myself that I could sing well enough at least to enjoy it, even if I couldn't perform as well as I believed had been able to about 10 years ago.
Abruptly, the last two monthly attempts started well enough, but I found myself feeling out-of-place, foolish, and painfully aware of my vocal shortcomings, well before the evening was over. I went home both times feeling depressed and convinced that not only could I no longer sing well, but that the belief that I had once been a moderately good singer was a delusion. I was also acutely aware of the age difference between myself and most of the other people present, and could not imagine that my presence could be as welcome as they pretended it to be. They were being kind to a pitiful and foolish old man.
Most of my time since my life sort of collapsed, first in 2000, and further in 2003, has been spent on a myriad of pointless digital projects, mostly playing around with reworking other people's existing music and films. Now I am finding that I am performing poorly at even these indulgent diversions. It takes me longer and longer to make progress. I context switch between projects too often, and don't document my process so I often am at a loss as to where I left off when I return to a project. I do a lot of tossing out untold hours of work and starting over. And remember, this is stuff I am doing purely for my own interest, contributing nothing to the lives of others. Self-indulgent obsessions which rob time from my household duties. I can't even live up to my own standards of goofing off.
My cognitive function seems very inconsistent and degrading. A vague but heavy malaise drags me down and saps my energy. I am overwhelmed with thoughts of many things I was sure I was going to do someday, many of which have been started and lay unfinished, will never be done. I don't know how much time life has left for me, and everything I do is going slower and not well. Even relatively trivial goals I now realize are beyond what is left of me.
I am rapidly approaching the state of mind I was in when I started Zoloft, a feeling best described with the single word "done".
I'm at 150mg of Zoloft. The clinical limit is 200mg. I'm trying to hold out and delay asking for that final increase for as long as possible because after that, there is literally nowhere to go. If it doesn't work, or if it works and then gradually starts failing, I have nowhere else to go. True hopelessness. As for anxiety, a lot of old symptoms are coming back, but I am not quite in the hell hole I was in before I started Clonazepam. But I know I will be back there at some point, I feel myself descending towards it, and there is nowhere to go there. The 4mg daily dosage I am on already would be considered by many clinicians to be absurdly high.
Before I once again declare myself "done"of my own volition, it seems likely that life and medicine will have decided for me. I'm sorry to be so absorbed in self pity in a world full of people enduring real suffering beyond my imagining. I have cheated death so many times in so many ways, but it seems that the world, evolution, the universe and God all agree that I was not meant to live. If I had been born very few years earlier, many of the medications and surgeries that have saved my life would not have existed. Television and other media are filled with heartwarming and inspiring stories of people living meaningful, purposeful lives bravely overcoming illnesses and injuries far worse that my poorly wired brain and poorly plumbed circulatory system. There will never be such a story about me because I am a selfish, self-pitying, self-loathing weakling who will continue whining and complaining until my bitter end.
Thursday, October 13, 2016
The mix is better for now
My previous post was too early in the process of dosage increase. I also complicated matters by being impatient and going from the intermediate dose of 125 to the new dose of 150 after only 5 days.
Again not any sort of manic happiness, just a more balanced perspective behind how I feel about things. I am once again fairly consistently capable of gratitude, yet not completely crushed by shame over having been an ungrateful ass. The process of making amends where I feel it is needed is often difficult because I have conditioned people to take a defensive and suspicious stance when interacting with me.
My biggest concern is that once again my condition will degrade over the course of very few months, and another 50mg increase puts me at the maximum of 200, and if that doesn't work or last, there is nowhere to go but things like ECT.