27 March 2016

Medication, or the lack thereof.

I've been off of psych meds-- completely-- for a while now. I made the decision for a lot of reasons, but one of the major reasons was that even though I was taking a handful of pills twice a day I still ended up homeless. The PTSD didn't go away. The romantic and social sides of my life didn't get any better. The meds didn't make college any easier or less frustrating. Were they a complete waste? I don't know if I'd say that. It's impossible to tell if I'd never started on the meds again in 2010, what life would be like now. I'm not even very interested in guessing.

"Self-medication" is a term you hear a lot when people talk about PTSD-- alcohol, drugs, driving fast, whatever. Way back in the day, when I was still married, alcohol was my thing. I arranged my life around drinking, so that out of seven nights a week five of them I was either out for darts, softball, or bowling. Dinner almost always involved a couple of beers, or a couple of pitchers of beer. Some days, lunch did too-- there was a bar in Milwaukee that had happy hour all day with $.25 tap beer. Even with all of that we bought beer by the case at home, not by the six pack, and a case lasted only a few days. (My ex-wife drank a lot, even more than I did.)

When my marriage ended-- when we actually split up-- I stopped drinking. Not completely, but almost. The bowling league ended not long after, so that stopped. When that season's darts league ended, I was done with that. The next spring I didn't play an inning of softball. My "social life" ended, because all of the "friends" I'd thrown darts with, played softball with, and bowled with turned out to not be friends at all. They were just people who liked to go out and drink with other people, and it didn't matter who the other people really were.

I still have a beer or two now and then, but it's pretty rare. I like and appreciate beer-- I certainly have my favorite brands, and I know enough about beer to know the difference between a lager and an IPA. I also have a taste for Irish whiskey, and there's a small bottle of Jameson's in my kitchen cupboard. Every once in a great while, usually if I'm down with a cold, I'll have a shot. The bottle is 2+ years old now and still half full. It's even rarer that I'm ever close to drunk-- the last time was getting close to ten years ago.

When the VA asks, and they always do ask, how much I drink I respond that I really don't. They have to have a number; how many drinks a week? A month? It honestly averages out to less than one a month, so I say none, and they look at me like I'm lying, or sometimes they'll come right out and say it. "None? Really? I'll enter one." No, you won't. The answer is zero.  I'm not kidding.

It's in that light that I've been thinking about psych meds, especially since I stopped taking mine. At one time I was on venlafaxine, trazodone, bupropion, prazosin, and one other thing I can't remember that made me sleep for 16 hours at a time. I'd also previously been on sertraline and citalopram. I was essentially on downers to counteract the PTSD and anxiety, and uppers to counteract the depression. It reminds me of the times in grade school when they tried to warn us about the dangers of drug abuse (this was before D.A.R.E) by talking about people who used one drug to get high and then another to come back down.

It should be noted here, I'm neither a psychiatrist nor a pharmacist. Your mileage will most certainly vary, so don't mess with your meds just because I write or something. Talk to your psychiatrist or pharmacist or *somebody*.  If you'd like to find out more about medication for PTSD, this is a good place to start.

I fight PTSD on my own now.

I work nights, and I stay up late, so morning for me is actually late afternoon for most of the world. Work starts at 1700, so I'm usually up around 1400.  Let' say that my day starts when I wake up, in that transition period from being asleep to being awake, when one moment I'm in some dream/nightmare and the next I'm lying in my bed wondering why the room is wobbly. It's really hard to describe-- the way movies and TV depict "waking up" isn't really accurate. I'm not in a cold sweat, I'm not screaming. It's not usually sudden. I'm probably more confused than anything until I look around the room for a minute.

First thing, I look at my phone-- this tells me what day it is, what day of the week it is, and what time it is. Did I oversleep? Did I undersleep? Do I have an alarm set for any time in the next few minutes that will go off and scare the bejeezus out of me?  Usually I'll tell Siri to turn off all of my alarms once I'm actually awake. If I woke up too early I'll make sure my alarms are set. If I woke up late I'll try to decide if I need to call work, and fortunately that doesn't happen very often (coincidentally, it hasn't happened since I stopped taking the meds). Then I'll check the weather, see if there's anything I need to worry about-- rain, snow, cold, heat, swarms of locusts, whatever.  By the time all of that is done, I have to pee and so I get out of bed.

It takes me a while to wake up. The amount of time it takes depends on a few things, one of the most important being how disturbing my dreams were. Sometimes I remember them very well, other times not so much. Sometimes it takes me a little while to fully realize that the dream has ended and that I'm awake. I'll peek through the blinds on my windows to see what it's like outside, see that outside is actually still there, that the houses and cars and trees are where they're supposed to be. Somewhere in all of this I'll look at my phone's list of notifications, see if anyone's been trying to reach me or if anything's happening in one of the Slack channels I'm in, since this will likely have an impact on what happens in the next few hours.

I do the normal stuff like showering and getting dressed. As I'm doing this I'm talking to myself, going over whatever's going on-- some days it's a pep talk, some days it's a sitrep, most days it's both. I complain, I wonder, I suggest, I rant. I think and talk about whatever I need to get accomplished at work or on my own projects. Sometimes I go in circles for a little while until I can arrange it all into something that makes sense. It takes some time, sometimes.

Once I'm dressed I check the stove, to make sure all the burners are off. I make sure the George Foreman Grill is unplugged. I make sure the window is closed and locked. I make sure the bathroom light is on, because I keep it on when I leave so there's a light on when I get home. I check the weather again to make sure I'm wearing the right number of layers. Maybe I'll look outside again for someone walking by, to see what they're wearing. 

Then it's shoes/boots/sandals on, coat/jacket/whatever on (or not), and checking pockets. Left front pocket: pocket knife and Desert Storm challenge coin. Right front pocket: foam earplugs, pair, one each and LED flashlight. Back right pocket: wallet. Back left pocket: empty. Left shirt pocket: phone and earbuds (unless wearing a coat, in which case phone in right coat pocket). Keyring attached to clip attached to belt. U. S. Air Force ring on right hand. Pebble Smartwatch on left wrist. If I'm going to be coding at work that night I'll make sure my headphones are in my backpack. Chances are almost certain that whatever I need to do homework/projects/work is already in my backpack from the night before.

This is all known as the pocket dance, and it's quite hilarious to watch.

Somewhere in all of this my iPhone beeps to tell me when I need to leave in order to get where I'm going on time by foot. That's what keeps the pocket dance from being self-perpetuating.

Then it's earbuds in, something to listen to selected, cord arranged under field jacket snaps to keep it out of the way (or not depending on weather and wearing of said field jacket), into the hallway, door locked, door lock checked, and out into the world.

I have to cross streets six times to get to work. On average, I almost get hit by a car or bike at least once every time I walk to work/campus. Therefore I try to minimize the number of streets I have to cross, especially at intersections that don't have stoplights. It's a little out of the way, but I take a bike path that cuts my number of street crossings in half. On the bike path, people on bikes come closer to hitting me than the cars on the street do, so I have to be extra careful there.

Coding happens, or help desk happens, or studying happens.

When work is done: it's the middle of the night, so there's a lot less traffic and it's much safer to take the street (the bike path seems to attract some really strange and dangerous people late at night). I'm usually walking home at or shortly after bar time, so I often have to avoid drunk people. By this time I'm tired, generally a little cranky, and triggered all to hell because of the number of nights I spent sleeping on or near the exact streets I take on my walk home. I see the spots where I hid, where I slept, where I took shelter from the rain, and even one or two spots where I had to pee in desperation while I was homeless. Walking home feels like running a gauntlet, or an obstacle course, although instead of a physical challenge it's a mental one. I'll cross the street to avoid other people. My heart is usually beating pretty fast. I'm really, really hyper aware.

And then I'm home. Something to eat, maybe watch a movie or read a while, and then back to bed to do battle with the dreams.

While all of this goes on, the normal (and admittedly boring) things that happen every day, I'm trying to map the future out. It's the end of March now, and I'm leaving Madison for good when the middle of August arrives. I'm haunted by the memories of being on the streets here, and I want to put that behind me both in terms of time and in physical distance. I'm trying to figure out just what the hell is going to happen when I leave-- buying a plane ticket is easy, getting on the plane is easy, but what the fuck happens when I actually land at SFO or LAX? Still workin' on that. Stay tuned.

I know correlation doesn't equal causation; but I believe it took being off the meds for a little while, then completely, for me to realize that I need to be somewhere else. The past few months I've done a lot of reading, and a lot of thinking, about what's happened the past few years. Maybe the meds didn't cause a lot of things, but the meds didn't prevent them either. How many different meds does a person have to be on? Which ones work? Which ones don't? I don't know. The VA doesn't know. Self-medication, when it's in terms of drinking too much, is looked at as a bad thing-- by self-medicating you're avoiding the problem (or you're making things worse because the alcohol impairs you). At a certain point, when it comes down to taking a handful-- literally, a handful-- of pills twice a day and still not getting anywhere, what's the difference between drinking too much beer and taking too many pills?

All of which is completely unscientific. I know. I get it-- but once you find the right cocktail of pills and find balance, that doesn't keep the world around you from changing. The pills do the same thing that any other medication does-- they dull the pain, lessen the effect, make things "tolerable". There's a point where you need to feel some of the pain. You need to look around you and realize that the things you're fighting to stay close to don't really give a shit about you in return.

I've found an equilibrium that works for now. It's not happiness. It gets me up and dressed, it gets me fed, it keeps me busy enough to keep most of the PTSD in check. It's a battle, every day. As it gets closer to the time when I'll move away from here, the number of thing I need to figure out and get done increases, and so does the associated stress. I'm going to have to start over somewhere else-- not completely, as I'll still be able to use a lot of the things I've been learning over the past few years-- but social life and work and friends and places to get good burritos late at night. That's the kind of change that needs to happen, but it's not the kind of change that will happen if your brain is all clouded up with chemicals that don't belong there.

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