Blake Decides to Increase His Medication

Image courtesy of Sira Anamwong at FreeDigitalPhotos.net

The big news this week is that Blake has decided to increase his SSRI (selective serotonin reuptake inhibitor) dosage. Seriously, it’s BIG news. I know. I know. For many on these medications, which tend to be the first line of defense in terms of medication for Obsessive-Compulsive Disorder (OCD), this is just a normal occurrence. Sometimes you go up in dosage. Some times you go down. That’s not the case for Blake.

Blake has been on the same dose of his SSRI since he was thirteen years old (13). He’s eighteen(18) now, in case you don’t know. That’s five years on the same dose. That’s more than two years of feeling he’d be better off dead. More than two years of people begging him to increase his dosage. His psychiatrist has begged, his pediatrician has begged him, his father and I have begged him. His therapist has encouraged him and challenged his reasoning on why he won’t increase his dosage.

“I don’t like being on medication,” says Blake. “It doesn’t help me.”

“How do you know it doesn’t help?” asks the therapist. “Maybe you’re not on a therapeutic dosage for you.”

“It doesn’t help. I don’t want to change it. It won’t help me.”

“How do you know if you haven’t tried?”

“I just don’t want to.”

Last week, the conversation came up again.

“Okay, I’ll give it a try,” he says, with little fanfare or need for cajoling.

He goes home and calls his psychiatrist and has begun a higher dose. I don’t know if it will make a difference at all in his major depression or in his OCD, but it is a big move for Blake to even try. So far, he is tolerating the increase well; however it has only been two days.

In other news, his therapist asked him this week how his week was. He’d been wondering how depressed Blake had felt in the past week.

“It’s been a good week,” remarks Blake. I haven’t heard him say that in – well, I can’t recall how long.

“So, it was a good week not to get hit by a bus?” asks his therapist.

“It was definitely a good week not to get hit by a bus.”

And Blake smiles.

 

I Just Wash More Than Other People

We pull into the parking lot and get out of the car. I notice that I’ve parked kind of crooked, so I climb back in, start the car up again, and straighten it out. Blake raises a hand to signal that I’m okay now. I notice the glove. It’s stretched out and missing the tip of the thumb where Blake has pulled a thread and the glove has begun to unravel.

As I climb out of the car and we make our way to the therapist’s office, I notice that both gloves are misshapen. The wrists sit limply against Blake’s skin, like they’ve been tugged at too many times and any elasticity is long gone.  Blake is dressed in a short sleeve t-shirt and cold weather gloves. I think he stands out in this appearance, particularly with his thumb halfway protruding from the shredded threads. I don’t say anything. I know better.

I gave these gloves to Blake a few winters ago. His hands get especially chapped and painful for a few months each year. He slathers them in petroleum jelly at night and pulls the gloves on to keep the goop from getting all over everything else. Today he’s wearing them out of the house; his hands must feel extra painful if he’s wearing the gloves during the daytime.

As we sit in the therapist’s waiting room, I am certain that The Doc is going to comment on the gloves. Anyone who has ever dealt with OCD treatment knows that embracing uncertainty is paramount, but there are few things I can feel more confidently certain about than the therapist honing in on these gloves. In a few moments, my prediction is confirmed. The Doc steps out into the waiting room and, almost immediately notices Blake’s gloved hands. He steps closer to Blake.

“What’s this?” he asks.

“Oh,” says Blake casually, “my hands get really chapped and sore this time of year.”

“Why is that?” the therapist wonders.

“I don’t know. It’s just the weather.”

“My hands don’t do that.” He holds out his own hands.

Blake removes his gloves and displays them for us. They are red and raw. It’s obvious they are painful.

“Have you been washing a lot?”

“My hands have always gotten like this in the winter.”

“How long has that been going on?” asks The Doc.

“Always,” says Blake.

Indeed, I don’t think Blake can remember a winter where his hands weren’t painful, raw, or bleeding. His hand washing at age six was my first big sign that he had OCD. It was something I’d hoped would go away. Despite education and treatment, it is still here, twelve years later. Blake knows nothing but painful winter hands.

“Maybe you’re washing too much,” suggests the therapist.

“It’s not that,” Blake says. “I just wash more than other people, that’s all, but that’s not why. The weather just does this to my hands.”

“You know,” suggests the therapist, thoughtfully, “you could try an experiment. You could decrease or stop washing and see what happens. Then you’d know if it’s the weather or the washing.”

“I don’t want to. That’s disgusting.”

To Purchase New Gloves or Not

After therapy, as we drive home, I note to Blake that his gloves have seen better days. It’s time to toss this pair out.

“But they’re the only pair I have,” he laments. “Do they really look that bad?”

“Yes, they do.”

Blake reluctantly tosses his gloves in a trash can later that day and sadly wonders what he will do to protect his hands. I ponder whether I should buy him a new pair. My inclination is to purchase them (mind you, we live somewhere where the daytime weather rarely gets below the 50’s Fahrenheit), but I wonder whether I’m accommodating his hand washing behavior if I do. He hasn’t asked for new gloves, nor has he said anything about going to purchase them himself. For now, I’m waiting.

I Matter, Too

Image courtesy of digidreamgrafix at FreeDigitalPhotos.net

“More importantly, how are you doing?”

This question from Blake’s therapist takes me by surprise and throws me off balance for a moment. Blake has just walked out of the room, shutting the door behind him. Nature calling. I’m just finishing paying for the session, thinking I’m about to walk out the door, too. The therapist isn’t quite done yet.

“What do you think?” he asks, and then he points out, “He’s talking about serious stuff now.”

He’s correct. Blake only started coming to therapy when he wanted to take some control of the interventions his therapist, his dad, and I were implementing. He was angry. He came to bargain. In recent sessions, he’s talked about depression, his dislike for himself – just the mere concept of “Blake,” about his disconnection from the world. Today was no exception and, as has begun to be our routine, I sat like a fly on the wall watching the interaction between Blake and The Doc, wondering what I was doing in there. Although the therapist in me is fascinated by observing what’s going on.

It’s Not About Me, Right?

We’ve been seeing this therapist in hopes that our 18-year-old can overcome his OCD and severe depression and ready himself to live in the world.  So I just didn’t expect it when the therapist asked about me.

“I have good days and not so good days,” I answer.

“Well that’s a pretty non-specific answer,” the therapist says with a smile.

“I worry about him,” I say, “but I’m learning patience.”

The truth is, I’m kind of disconnected about how I am. I’ve been so mesmerized by the therapy session, I lost myself a bit. It’s only later in the day, as I ponder the question, “More importantly, how are you doing?” that I think over my frustration at watching my son climb back into bed multiple times each morning. It’s later that I recall the heartbreak at hearing my son talk about how life isn’t worth the good moments when he considers how awful the bad moments are. It’s later that I remember part of me sinking inside as I watch my son wash his hands immediately after handling money or tiptoeing around areas that the dogs might have contaminated.

At the same time, I’m touched by The Doc’s inquiry. As much as my son is suffering, family members are, themselves, affected when their loved one has OCD, depression, or other mental illnesses. If we aren’t directly involved in rituals, or trying to get them out of bed, we are worrying about them. So I’m appreciative of this simple act of kindness and caring. It resonates in me. It reminds me that we family members have to remember to care for ourselves in the face of our loved ones’ struggles. We have to be mindful of our own well-being. If we aren’t, we can become impatient, bitter, angry – basically of little use in this war called mental illness.

So, thank you, kind therapist, for reminding me that I matter, too. It opened something up inside of me and I feel just a little more alive and grounded. I feel less stuck in the mess with my son, and more like myself. And this morning, when I allowed myself to take a long hike in the nearby mountains, I was just a little more open to taking in the scenery and appreciating it, instead of having the specter of depression and OCD hanging over me. Yes, I matter, too.