Monday Morning

It’s 8:32 in the morning and I send a text message to both of my boys about the Thanksgiving holiday, which is over a month away. I have to make airplane reservations and I want to check on their schedules. I expect I’ll hear from Michael; it’s three hours later where he is and he already had a class this morning. Blake I don’t expect to hear from until at least late afternoon or evening with his sleep issues. He has a 10 am class, but he’s missed attending nearly every week.

To my surprise, it’s Blake I hear back from first at 8:39 am. He confirms his schedule for me. 

Me: Whatcha doing?

Blake: Waking up.

Me: You heading out to class?

Blake: Yeah 

Me: Out of bed yet?

Blake: Showered.

Me: Wow. Just wow.

Blake: I appreciate your amazement at my basic levels of human functioning. 😛

Me: It’s a mom thing.

Blake: Are turnovers a breakfast pastry or dessert?

Me: They are whatever you like them to be. Love you.

Blake: Love you too!

It’s a brief moment in time, but it’s a victory nonetheless. Blake is awake. He got himself showered at a time that allows him to participate in the day. Whether he will leave his apartment and head to school or head back to bed is uncertain. It is just this – a moment.

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Another Bump in the Road

Friday Evening…

8:35 pm:

Text message from Blake: Hey Mom. I slept through another disability meeting. Even with only two classes, I’m completely unable to function. As much as we’ve tried with everything and even switching programs, I feel like we might need to call it quits on college. At least for this year…

Me: Hi baby. I’m right in the middle of something. Can I call you when I’m done?

Blake: Yeah

I call Blake as I drive home for the evening. He’s down on himself for missing yet another scheduled meeting with the disability office at school. He’s unhappy with life, doesn’t know what he wants, can’t find a reason to even exist. 

I try to be a good listener, but I get caught in my old trap. I sink down into the well of despair with Blake and I try to fix the situation. I point out how much better he does with more structure. Perhaps he needs a job, I suggest. At one point I even ask if he needs to be in a hospital. He hates when I do this and I hate it even as I say it. He wants to get off the phone with me and I ask him to call me tomorrow after he wakes up to check in. He agrees.

Saturday Evening

8:25 pm:

Text from me to Blake: Hello

Blake: Hi

Me: How you doin’?

Blake: Rough

Me: Can you talk for a min?

Blake: Yeah

“I want to apologize to you,” I say. “Last night when we talked I just wanted to be a good listener – and I wasn’t. When you’re in a really bad place I sometimes get caught up in wanting to help. And that’s not what you needed last night.”

“Thanks, Mom. I kind of do need help because I don’t know what to do.”

“Maybe the first thing to do is to know that this feeling will pass and when you feel clearer that’ll be the time to decide what you’re going to do.”

Then I remind him of all the ways that he IS functioning. 

“You’ve got successes, honey. You made it to your English class both days this week. You’re grocery shopping; you’re eating; you’re going to chess club; you’re taking your medication…”

“About that, Mom,” he begins, “I’m not doing so well with the medication. I’ve been waking up too late to take it so I’ve been missing it.”

My worry starts to set in. Blake is on an SRI – a serotonin reuptake inhibitor. He’s on the highest dose a doctor might recommend and has been for quite some time. I know it’s not good to miss taking it.

“Honey, how often are you missing taking it?” I ask.

“Probably 75% of the time,” is the answer.

“Blake,” I say, “you cannot not take your medication. Even if you wake up late, it should still be taken. Maybe you should switch to taking it at night since you are awake then.When is the last time you took it?”

“Maybe…Thursday?” It’s more a question than an answer. He’s really not sure when he took it last.

Abrupt cessation of SRI’s can lead to a withdrawal or discontinuation syndrome. Two of my patients in just the past week ran out of their SRI medication and missed a day or two. The effects were swift – one had a quick return of strong intrusive thoughts of harming others; the other experienced a significant uptick in her depression symptoms and found herself unable to do even the smallest exposure practice for therapy. 

I know how Blake has reacted in the past when he’s even been a few hours late to take his medication. He starts to feel like he’s having electrical shocks in his head. He starts to feel dizzy. He claims he hasn’t felt any of that, but the problem is he hasn’t been awake. He’s been sleeping very late. He slept til almost 8 pm tonight. He’s feeling very down and depressed and not sure of his path. I give him a quick rundown of SRI withdrawal and have him take his medication right away. 

When I explain to the Hubby what I’ve learned, he is concerned. Could it be that our 19-year-old son is not able to take care of himself on his own? How could he not have realized that it was not okay to miss his medication? Why didn’t he say anything until now if it’s been going on for a while? I tell him that we need to wait and see if he makes the correction and if it sinks in.

In the meantime, Blake has now taken his medication two days in a row and I’ve been checking in with him regularly to make sure there haven’t been issues with that. Since he didn’t wake up until nearly 8 pm last night, he’s been up for over twenty-four hours. It’s a familiar cycle for him – one I’ve lectured him on many times before, but resist doing now. He’s still down today, but he’s been in better spirits, texting me funny photos and fun facts about goofy things. Another episode in this journey…

Off to College

It’s been a month and a half since I last posted. It’s been a busy seven weeks.  There was the annual OCD conference in Washington, DC, and a family vacation – and then there was getting Blake ready for college and moving him in. Yes, you read that right, Blake has gone off to college.

In my last post, I shared how Blake had begun to take steps on his own initiative to leave the house and do activities: a trip to the game store, an outing for coffee. It was surprising to us, and he continued to do it. The hubby, Michael, and I were all proud of him, though we tried not to make a big deal out of it. Making a big deal of things with Blake tends to backfire.

Last week, the hubby and I flew with Blake to the Pacific Northwest and helped him settle into an off campus apartment with three other young men. It was an emotional experience for us all – each for different reasons. For the hubby, it was about watching his youngest leave home; for me, it was a mixture of sadness at seeing Blake leave home, happiness that he loved his newfound independence, and fear that I will receive endless texts about how unhappy my son is or, worse, no texts because he just doesn’t get out of bed and is only awake in the wee hours. Blake felt a calm satisfaction at having his own space and making his own hours with no one looking over his shoulder, yet the specter of school weighed heavy on him as he hung his head sadly and declared, “I’ve never ever liked school. This is going to be the shortest college career in family history.”

The apartment before the young men arrive

Returning home was a strange affair. Our house feels incredibly empty. Blake was ever present on the family room couch. The hubby and I have new routines to establish, as well as the process of getting to know one another again with no offspring in the home.

How things will go for Blake is a big question mark. He’s texted once since we left him three days ago (well, actually twice – the first time being to tell us he got out of bed and went to orientation). He wanted to say “Hi” and tell us that all was well. I’m trying to give him a little space to make his own way. His therapist advised him to be aware that OCD symptoms can creep up on one when going through a new transition; depression symptoms can, as well. Blake prefers not to think about that. My guess is that this has to be exciting and scary at once for him. Let’s see what happens. I’ll keep you posted.

His Own Initiative

Our oldest, Michael, left the country one week ago today with excitement over studying and living in another country and a passion to become more fluent in another language. The hubby cried as he hugged our son goodbye, then cried more as we drove home, and once again as he searched birthday card after birthday card in pursuit of a suitable one for our younger son, Blake’s, nineteenth birthday. The hubby’s tears reflected many things: the sadness at watching Michael leave after several weeks in which they spent many close moments together, the bittersweet realization that we will be empty-nesters in a few short weeks, the juxtaposition of the personalities of our two young men – one who craves new experiences in the world and one for whom his bed and our sofa seem experience enough.

Michael’s parting recommendation to his brother had been that he begin to venture out into the world, that he practice the skills he will need when he moves to college in another state next month. He’d worried lovingly about his brother and whether he’d have the skills to live in his new environment. He’d proposed a plan to his brother in which Blake would go out of the house, perhaps a couple of times each week, so that he might gain experience and confidence, and perhaps a little momentum. Blake initially embraced the idea, but it quickly seemed to fall flat as I wrote about in my previous post (“A Plan That Lost Steam“). Depression and anxiety seemed to win out.

A Flash of Hope

I had resigned myself that Blake was not going to follow the plan he and his brother had plotted out. I expected to see him step back from life even more. The hubby and I were true to what we had promised and did not bring the plan back up. To be honest, I even stepped back on our therapy-planned morning routine of waking Blake up. Sure, I still saw that he got up and out of his room, but with much less rigidity and urgency. I felt deflated and spent time searching my mind as to how I would live as meaningfully as possible regardless of what would come with either of my sons in the months ahead.

Still, there were things to be done before Blake can leave for college. There were apartment supplies to be ordered and bank accounts to be transferred (Blake still only had a custodial account in my name). So, I continued to go through the motions of preparing for the move. On Monday morning, Blake and I prepared to go to the bank to get things in order so that he might obtain the all-important debit card.

“Do you want to go grab a coffee afterward?” I asked him just before we left.

“Oh, I was planning to go there myself as a way to get out today. You know, like we talked about with Michael. Is that okay?”

I was a bit startled, a little excited, but tried not to show it.

“Of course,” I said. “Do you want to take separate cars and meet me at the mall, then? We can walk over to the bank, then grab a coffee, and I then I can leave so you can have your time.”

So, we did. Blake navigated his way to the mall parking lot and we met up and walked to the bank and completed the business of transferring his account into his name. Then we walked back to the coffee shop, where I grabbed an iced coffee and quickly made myself scarce. Blake set up his computer at a table.

“I wish I’d brought a chess board,” he noted. “I’d ask someone here to play with me.”

When I got home, I dashed off an email to the hubby at work: “Thought you’d want to know…

And Then Another

On Thursday, he did it again.

“Mom, since we need to go out on another college planning errand today, can I use it as a way to launch into going out on my own again? It kind of helps ease me into it. I mean, since we are going out already, I can just go off on my own when we’re done. I’d like to go to the board game store.”

“Sure, honey. Let’s meet up at the store. We’ll pick out supplies and then you can head on your way,” I’d suggested.

About a half hour later, Blake showed up to meet me.

“Twenty-five minutes to find my way here!” Blake shook his head.

“Hey, you found it and you did it safely,” I replied.

Then we proceeded to giggle our way through the store, Blake being more frugal than I, me reasoning that the slow cooker he was choosing was going to be too small. As we finished, I bid him fun on his adventure. A couple of hours later, he was back home. He’d completed his mission, and had even observed a group at the store playing a Dungeons and Dragons game.

“I tried to join in,” he said, “but they were already too far in. They have a board game night there every other Thursday.”

Whether Blake will continue his missions out into the world we shall see. This week, my son, the one who prefers his bed and the family room couch, went out twice – for no reason other than to practice doing it. No one cajoled him or made suggestions. He just did it himself. While we cannot show great excitement because we know, from experience, that this will just send him back into hiding, this weekend the hubby and I are doing happy dances when no one is looking.

A Plan That Lost Steam

Michael, our 21-year-old, is getting ready to leave to study abroad for the remainder of this summer. He sat the hubby and I down the other day and told us he was worried about Blake’s emotional state and his upcoming move out of state to begin college.

“He’s really not ready to go,” Michael observed. “He feels like a disappointment to you guys, especially when it seems that everything is based on whether he gets up in the morning or not. And he doesn’t respond well to tough love. It just makes him shut down more.”

“So what are you thinking?” I asked him, as the three of us sat on our back patio.

“I think he needs a mission, a purpose. You know, little tasks to get him out of the house. Things he needs to practice to live away from home. He can go buy his groceries so you can get an idea now what he’ll need to spend on them and so that he’ll get used to buying what he needs. And he can go to the library or the coffee shop and set up his computer and practice writing from there. You could give him a small stipend each week so he could practice. I think it would make him feel accomplished. But,” Michael continued, “I don’t think it should come from you guys.”

“What do you propose?” asked the hubby.

“I’ll talk with him tonight,” Michael noted. “I’ll see what he thinks and help him to make it his. If it’s his idea, he might be willing.”

So, we parted leaving this between the boys.

Michael Makes Inroads

The next morning, Blake stopped me early.

“Mom,” he said, “Michael and I were talking last night about ways for me to get ready to leave for school. Can we talk with you and Dad tonight about it? I think it’s a good plan.”

“Sure,” I answered. I tried to sound calmly enthusiastic, but inside I was kind of excited. Was my son who regularly chooses bed and the sofa to leaving the home actually wanting to launch a little bit?

The four of us met last night and Michael and Blake led the talk. Michael shared how doing these kinds of things would have helped him make the transition a little easier when he left for college. He thought it would give Blake more confidence to live in the world

And Then I Watched it Happen…

Blake went from mildly enthusiastic to questioning to looking downright terrified. He started finding reasons it wasn’t a good idea. He started worrying he’d be judged and held to this standard. He worried he’d fail. It didn’t matter what anyone said. The hubby and I noted we wouldn’t hold him to anything. It was his plan, and if he followed it, we would cheer him on. If he did not, we wouldn’t comment. Michael stayed positive and light and shared how beneficial it could be. I was proud of how he held his own and supported his brother. In the end, we left it that Blake could decide whether he did it or not.

And then, as I got ready for bed, he called me into his room.

“It’s just so hard to get out of bed,” he said, staring off into space. “Bed is the only place that feels good. It’s like having a hug and having to leave it. Nothing in the day feels good and I just distract myself with YouTube or games all day. And then it’s even hard to go back to bed knowing I’ll have to do the same thing again tomorrow. Living is hard and I’m too scared to die – so I’m just in that in between space.”

And there was little more I knew to do for my son than listen, acknowledge, and snuggle him with a tight squeeze until he dismissed me with a, “Good night, Mom.” For all my professional training and experience, I do not know how to move my own son from here to there. And right now, I don’t know that there is anyone else who knows how to either.

Which Way From Here?

Sometimes treatment moves along at a snail’s pace – or even seems to go backward

When I began writing this blog five years ago, my son, Blake, was 14 years old and had recently refused treatment for his Obsessive-Compulsive Disorder (OCD). He’d had a relapse over the previous school year and, despite access to terrific treatment from specialists in Exposure and Response Prevention (ERP), he ultimately wanted to do it his way.  I started writing as a way to express what was going on in my head, to document what was happening, and to sprinkle in stories of being an OCD specialist while living at home with OCD.

As time passed, my writing shifted. In many recent posts, I’ve focused on the depression that settled in over Blake, causing my hubby and I to make the decision to ask him to defer enrollment in college so that he might take care of himself and gain some skills. We entered therapy as a family. First, Blake refused to participate, and he launched into 18-year-old sized tantrums – turning over the belongings in his room, slamming doors and shutters – each time we introduced a new expectation that was meant to move him toward improved functioning. Finally, he came to treatment as a participant and even started meeting with the therapist without us. I’ve documented his struggles, our struggles, and his progress.

Now, Blake Turns 19…

In about a week, Blake will turn 19-years-old. I haven’t talked much about his OCD lately because we’ve mostly been dealing with depression. Blake’s sleep schedule became greatly dysregulated at the end of tenth grade. He sometimes slept until 10 at night; he was up until 3, 4, or 5 in the morning. Over this past year, he’s been awake all day most days. This has mostly been due to my waking him each morning if he doesn’t get up with his alarm. It’s something we agreed on with his therapist: no sleeping all day in this house; if you don’t get up on your own, we will wake you up. But that last hurdle, getting up on his own and staying awake, has been a challenge. Sometimes he does it. Sometimes he does not. In recent weeks, there’s been a slide backwards. He hasn’t gotten up on his own, and he falls back to sleep all over the house for great chunks of the day.

In our most recent therapy session, I joined Blake and the therapist and we focused on where things are at. Blake was dug deep into his position that “nothing” will work and, yet, he was unwilling to try anything new. Top that off with an essential element: Blake does not really want to accept that anyone else might know better than him and what his head is telling him. His brain tells him he’s a worthless screw-up and that it’ll never get better – and he listens to it. I will vouch that this young man is not worthless in any sense, but many steps forward that he has taken have been with pressure from others. I cannot recall a moment where he has honestly said, “I need help and I’m willing to allow others to walk me through this.”

Pivotal Moments

I watched as Blake’s therapist, a longtime specialist and pioneer in OCD treatment, dug in himself. I could see the struggle in him as he could see the road my son is headed down. He pointed out the direction Blake might be going in his quest to continue to do it Blake’s way.

“Blake, my sister’s mental health issue was destroying her life. We begged her to get treatment, to do it another way. But she continued to choose to do it her way…and it killed her.” I could sense the anguish in the therapist’s voice as he shared his personal story of losing a family member to refusing to get proper help. It’s kind of amazing when you reflect that the professional in front of you is a human being.

He continued, “It’s clear that coming to therapy once a week isn’t getting you to where you’d like to be. It might be time to think of doing something more. It might be time to think about residential treatment for OCD.”

“How would that help?” Blake asked. “They’d just be doing it for me.”

“It would help to have therapists and counselors and staff around 24 hours a day to help you learn to live differently.”

“It wouldn’t work. They’d just be forcing me.”

“You’re right. It wouldn’t work if you went into it with the same attitude you have. It wouldn’t work if you continued to see it as something others were pushing you to do. It might work if you were to recognize that doing it your way isn’t working and if you surrendered yourself to something new. You’d have to see yourself as worth it.”

“I’d feel like a freak,” Blake said quietly. “If I was so desperate as to go live in a hospital, I’d feel like a freak.”

“Blake,” I broke in, “if J were to check into a residential program for what he’s going through, would you think he was a desperate freak, or would you be proud of him for getting the treatment you know he needs?” I asked this in reference to someone close to us Blake worries about.

Without a pause Blake noted that he would be proud – and he made the connections.

“I guess I have some thinking to do,” Blake acknowledged.

An OCD Program?

You may have noticed above that Blake’s therapist did not suggest Blake consider going into a residential program for depression. He suggested a residential program for OCD. He suggested it at least twice (I didn’t include all the dialog). Why an OCD program? We never got to talk about it, but I think I know why. I believe the therapist thinks that much of what is going on with Blake can be traced to his OCD. Blake has an extremely low tolerance for uncertainty or discomfort of any kind. He actually shuts down and becomes unmovable when faced with an anxious moment. He prefers to live in a comfort zone according to rules he has determined are acceptable to live by (but that are actually dictated by OCD). He’s been living a life of religious rules for over six years that has been driven mostly by fear rather than joy and meaning.

Blake has something to think about. How much thinking he is doing, I do not know. I know he got himself out of bed for four days in a row – and he felt proud. And then he sunk into three days running of not getting up on his own and falling asleep for large chunks of time. He is mere weeks from leaving our home to finally beginning college in another state and living in an apartment with three roommates he will not know. If he elects to go to a residential treatment program, what would become of that?  For now, I don’t know. I don’t know what happens if he goes to college, can’t get out of bed to go to school, and returns home. I don’t know what happens if he falls backward enough not to be able to leave home. Like all things that are in the future, I am waiting to see. I’m hoping for the best, but not deceiving myself in acknowledging that this just might not go well.

 

Sharing – About Me

Recently, a patient came to session struggling more than usual. Depression had settled in on top of her Obsessive-Compulsive Disorder (OCD), which is not at all uncommon. It just happened on the heels of the deaths by suicide of Kate Spade and Anthony Bourdain, and it sparked her to act.

“I can understand how someone could do it,” she told me. “I can understand what it’s like to have it seem like it just doesn’t matter if you are here anymore.”

She went on to talk about what she felt like at the present time, and then it happened. Maybe I nodded with too much agreement. Maybe I empathized in such a way that sparked the recognition.

“You, too?” she asked.

“I once spent two weeks in bed. Only got out to do the essentials.”

It just seemed to spill out of me, my admission that I, too, have struggled at times with major depression. I didn’t share it for her sympathy or to make me feel better. It just seemed like the right moment to say, “Hey, you’re not alone, and this beast can be bested.”

“I’m sorry,” she said.

“It was before I knew much about how to deal with depression. I’ve learned a lot since then.” And then we had an in depth conversation about how to deal with her depression.

Sharing Personal Information

There’s a bit of a rule in the world of mental health professionals that we don’t share much about ourselves. The treatment session is for our patients, not the place for us to get our needs met. We have therapy and our own relationships outside of the therapy room for that. I actually came from a training experience that encouraged us to be “blank slates” to our patients. We were to answer questions about ourselves with, “How will the answer to that help your situation?” or “What makes you ask that question now?” It always felt strange to me to answer that way, but I did it figuring that I’d get used to it. I didn’t.

When I began treating individuals with OCD, it was already out there in the world that I was a parent of a child with OCD. I’d written articles about it and I shared about it with most of my patients if it seemed appropriate. Working with other parents, it seemed to give credence to what I was asking them to do. To many, it made it seem that I understood, on a deep level, what they were going through. For me, it felt more genuine.

I don’t know if it was the right thing to do, letting my patient know I’d experienced depression myself. I’m not going to try to justify it, and I’m going to have to continue to look at why, when, and how I share personal information with my patients. I do know that being more real feels like a better approach than being a mystery or a “blank slate.” I do things in session like share about the panic attack I had at forty feet below the surface of the ocean while scuba diving. I share about the intense fear I had of public speaking when I was younger – so great that it nearly prevented me from pursuing a career as a psychologist (we had to take an oral exam). And I share how I learned not to have these things rule my experience.

On the day my patient came in struggling with depression, I took the session outside. It’s not something a lot of therapists do, but it’s not so unusual. I took it outside because we uncovered the fact that my patient had stopped her daily walking routine a few months ago, and because we talked about the importance of exercise as one component in dealing with depression. And so we walked. She in her athletic shoes and me in my dress sandals. Together we sought out slight inclines in the neighborhood and we climbed them. I got blisters…and a note from her the next morning showing the miles she’d walked and describing how the fog was beginning to lift.