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<title>Zk | 2013-10-28-medication-and-analogies</title>
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<h1>Zk | 2013-10-28-medication-and-analogies</h1>
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<p>type: post
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slug: medication-and-analogies
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date: 2013-10-28
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title: Medication and Analogies</p>
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<p>My doctor laughs at me for the sheer number of analogies I use to try and
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describe anxiety, panic, and depression.</p>
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<p>During our last session, I think I used three in quick succession. “It’s like
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reading under a blanket at night when you’re a kid and all of the world is
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whatever you’re inventing in your head and everything ends beyond the
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flashlight-lit underside of the covers” - describing derealization and paranoia;
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“I feel like I’m on the other side of a chain-link fence from anxiety: about
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twenty feet away, but then, as the effects start to wear off, whatever’s beyond
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the fence starts to attract my attention and draw me near; panic would be the
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point where I hop the fence to go see.” And, the one that got the laugh,
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“Stress is what sets the boulder rolling down the hill, anxiety is when it
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starts to break up, and panic is when it starts the avalanche, and I guess I
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feel like it’s more likely to be just a single rock rolling down the hill these
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days than an avalanche.”</p>
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<p>I may be a little over the top.</p>
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<p>I like the analogies, though, because this isn’t something that lends itself
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well to direct description. The words that would result from me doing so are
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either clinical or cliché, and I don’t feel as though they accurately get the
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point across of what exactly is involved with anxiety and depression. For
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instance, restating my three earlier analogies would simply be “derealization to
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the point of fugue state”, “anxiolytic effects of medication”, and “breakthrough
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panic”. They’re accurate, to be sure, but none of them, by necessity, cover the
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full experience of what’s happening.</p>
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<p>Needless to say, things are better. Not fixed, but better. The medication
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(switched now from 10mg daily fluoxetine and 0.5mg daily lorazepam to 20mg daily
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fluoxetine and 0.75mg daily alprazolam, spaced evenly) had done quite a bit to
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lift me out of such a state of constant anxiety as to be nearly non-functional,
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to a low level of worry that I imagine is relatively normal, for whatever that
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means. The breakthrough panic has also been helped quite a bit, and I’m finding
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that both the severity and frequency of panic attacks has shifted: the amount of
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breakthrough panic is, overall, less, though, which is good. I’m still at about
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one attack every 36 hours or so, which is better than the once or twice a day I
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was experiencing before, and what I would call the average attack is more along
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the lines of what I was experiencing about a year ago: pounding heart, tunnel
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vision, ticcing in hands and neck, feelings of terror, feeling like I’m going
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crazy, and suicidal rumination.</p>
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<p>A few times a week, though, I’ll have something more major. These come in two
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loose varieties that I guess I’d call functional and non-functional. Functional
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major panic usually involves intense derealization or depersonalization,
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paranoia, and auditory aberrations. I disconnect from the world around me and
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from myself and wind up, as I said, in some state similar to reading a book by
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flashlight under the covers. The world ends at that boundary of the blanket,
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and none of the characters I can perceive are actually real. The hearing things
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bit has settled down from something like an announcer-type voice instructing me
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to hang myself heard just over my shoulder to a TV left on in the next room
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which just happens to be showing an instructional video on how to hang oneself.
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An improvement, as I said, but not a fix. After all, this was <em>every</em> panic
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attack a month or so ago.</p>
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<p>Much more rarely are the ones where I stop being able to function in the world
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around me. It’s like one of the functional major panic attacks kicked up to the
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point where things stop working. Language stops making sense and becomes a
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series of sounds; vision becomes a bas relief of colors strung together rather
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than a comprehensible picture of the world around me, and so on. Becoming
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incoherent on top of becoming illucid is hardly pleasant, so the most I can do
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is just go lie down or whatever. It’s hard to tell what exactly goes on since
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it feels as though so little of me is left, so I don’t know what it looks like
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from the outside. Every part of me is replaced with panic, though at that
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point, it ceases to feel like just panic, and more like I’m slipping out of
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existence.</p>
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<p>I spent last week as a sort of half work-trip, half vacation in the bay area,
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working on a planning-sprint with coworkers and visiting my partner and some
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friends in the area while I was out there. Over the course of the trip, I had
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about three functional and one non-functional panic attacks, which I guess is
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kind of a lot, but for the fact that I was travelling, and travel makes me crazy
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enough as it is. If you’ll pardon the additional analogy, it’s as though all
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senses became a TV screen tuned to a dead channel, moods like the skies over
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Chiba. All I wanted to get by was just a plain, fine-grained static that I
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could still see through, still comprehend everything beyond, but every now and
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then, pictures, shapes, sounds, and colors would start to form within that
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static and assert themselves over the rest of my perception, mood, anxiety
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levels, and so on. It’s embarrassing - particularly so when it happens in front
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of my boss or partner or friends. Mortifying.</p>
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<p>This led to some other interesting observations. Or, well, it boils down to one
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interesting observation, made in a few different contexts. There are three
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stages of working with a problem (well, at least three that are pertinent here)
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like this: acknowledgement by self, acknowledgement by others, and integration.
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It took me probably a year to a year and a half before I was able to acknowledge
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to myself that things were going poorly enough that I probably ought to see a
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doctor, and about that long after to really integrate the stuff that I learned
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into life.</p>
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<p>Similarly, it’s all well and good for me to talk to my partners and my friends
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about anxiety and panic, and to write here about symptoms after I’ve
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acknowledged them with myself. It’s important that I have the ability to share,
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of course, but I also feel as though it is respectful of me to be honest with
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those that I’m close to. It’s another thing entirely, as I found out (again)
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this week, to actually integrate that knowledge through actual experience.
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Having a panic attack around friends and partners is the experiential side of
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the knowledge I’ve spent cultivating within myself and between myself and
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others. It’s uncomfortable, painful even, but I think that I’m better for it,
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because it helps me to comprehend not only things from an outside point of view,
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but also the effects that me <em>freaking out</em> has on those around me. After all,
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all of this is my responsibility, whether or not those around me help (and I’m
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certainly thankful for those that do!). It’s not something I have to deal with
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by myself, of course, but it’s my responsibility.</p>
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<p>Anyway, I know this was all rambling, but I figured it worth it to kind of pull
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together some ideas from my record-keeping (which I usually do during or
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immediately after on <a href="http://twitter.com/foxproblems">twitter</a>) so that I can be
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a little more prepared for tomorrow’s appointment. Who knows, maybe I can even
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get by with fewer analogies!</p>
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