Here I am, yet again, taking a deep breath before I write this. I had one of my "famous talks" with Thomas yesterday where I find a way in the back door to his mind and learn what is really going on inside his head. I kind of don't know what to do with this information but I suppose I will start with letting his therapist know.
Therapy yesterday was a bit frustrating for both myself and Thomas' therapist. Thomas is such an enigma and trying to figure out the "why's" of his behavior takes serious detective work that more often than not goes down in flames. I felt like I was the observer in a rather intense game of 20 questions--only it was more like 100 questions.
What we are trying to figure out is the source of Thomas' ever-changing emotions about work. For so long he was anxious. We all knew that was because of his paranoia and delusions. Then he became "stable" and he was pretty ok with work. That lasted probably a week. Then 2 weeks ago he began burning bright with anger about work. It came out of nowhere and was impossible to find tools to help him cope with it. Then came the crippling depression about work. Before and while at work he would maintain a level 5 out of 10 on the scale rating his depression's intensity and even went as high as a 7 at times. I used everything in my toolbox to try to help him and failed. That is where we are today. Puzzled about this ever-changing mood state of Thomas's, his therapist likened it to a kaleidoscope. He said,
"You know how you look into one and you see a design and then "click!!" you turn it and you get a different design and then "click!!" you turn it again and find still yet another design? That is how your fluctuating mood states feel to me, Thomas."
I thought that was a perfect analogy. I filed that away inside and sat there listening to the 100 question game going on and tried, on my own based on the path his therapist would go down, to figure out for myself what is going on with Thomas. It wasn't until we got in the car that some thoughts about this began to take shape in my mind.
I went back to a conversation that Thomas and I had had a year ago. He had told me that he "didn't want to get rid of the paranoia because he didn't know what he would put in its place." At the time I was frustrated because I figured if he wasn't going to let go of it then how was he going to get healthy? Then I went back even further to the conversation I had with Thomas' doctors when he was hospitalized and diagnosed with paranoid schizophrenia. They told me that Thomas' mind was like a huge sphere twisting and turning to accommodate incoming information about his experience in the world. This sphere was a mass of delusions and if I (for example) were to pull something out of it in an attempt to help him then he would "quickly work to fill it in with something new." They told me that he would never be well because he had been working on this sphere for years before we caught it and the chances of fixing it were slim.
I thought about what they said and what Thomas said and I realized something. Thomas is more stable now. He no longer has paranoia and his anxiety is just about gone so in effect that leaves holes in his mind that need to be filled. He told us yesterday that he is depressed before and for a while into work and then it dissipates because he has to focus on his work but then he comes to some sort of awareness and essentially reminds himself that he's depressed. I thought at first this was a fully cognizant choice on his part but after talking to him I realized this was an automatic function of his brain and that sphere. What I realized, is that in the absence of his constant hypervigilance about the preoccupation with paranoid thoughts he was filling the proverbial holes in his sphere with the only thing he has left. Feelings!! He has to do this! It's what his mind does. If it's like what the doctors told me, right now his sphere is twisting and turning and since we pulled paranoia out of it we have left open doors and gates to holes that need to be filled.
So, I sat with Thomas and talked to him about all of what I have written above. He mulled over what I was saying and he agreed with my line of thinking. I couldn't believe it! We had our answer! This was a moment to celebrate a little bit.
Now, though, this morning I feel a sense of foreboding. The doctors were right two years ago. He's doing exactly what they said he would do and he is replacing one thing with another all in an attempt to right his inner world. Now what do I do? What do I do with this information? If this is an automatic function of Thomas' mind then how do I make it stop? Clearly this is something that is untouched by the meds and I'm not sure it can be touched. I can see that the meds' function is to eliminate paranoia, delusional thoughts, anxiety, classic depression etc. but what on earth is going to stop the sphere as a whole?