Wednesday, November 26, 2014

Down A Dark Hole

Thomas had therapy yesterday. It's usually on Thursday's but since this Thursday is Thanksgiving I moved the appointment to yesterday. My original intent for doing that was to talk about this "demon" delusion of Thomas's and his "urge to harm". We covered that in the first part, set up safeguards for him and for me when things get really bad and Dr. K. and I tried and succeeded to get Thomas to commit to the new plan. Using a traffic light as a gauge we decided the yellow light meant that he was getting angry and needed to do some relaxation techniques and back away from stressful things and a red light, which was set up for me mostly, was to indicate that Thomas had gone over the edge where relaxation would no longer work but straight up removing himself from the situation was the only answer. I was instructed by Dr. K. to point out the red light times to Thomas and he asked me if I felt comfortable doing it. I don't know why I said I would, though I was hesitant in my answer, because I truly am scared of Thomas in those times, though they are rare. I grew up in a household where red light anger happened a lot and I can't imagine a time when I could have ever said "hey, you're a red light" without some kind of unpleasant consequence. I think that's why I'm not comfortable doing it now with Thomas. I'm afraid of anger. I'm afraid of anger, I'm afraid of it's destruction and I'm afraid for my safety. I learned throughout my life that if I could run the other way from it then by all means, DO IT. Now I'm still not sure I would stay in the situation now with Thomas especially after Dr. K. asked Thomas how he would feel if I told him a he was a red light and Thomas's answer was "I don't know." Good God. NOT what I want to hear when I'm thinking about diffusing a situation. I don't want an "I don't know what I'd do" to turn into my safety being at stake. Needless to say, this red light thing is something I am just going to have to practice in my head enough and remind myself that I'll come through the situation okay if I choose to do it.

Then, in the hours before session I thought a lot about how Thomas did that weird "coming into focus on me" thing that he did on Monday night. I have to say, not in a traditional way, but in some way I can't put words to, it scared me. Having Thomas appear to be able to see into the center of my soul scared me. Please don't misinterpret the use of the word scared because it wasn't like I fear for my life or something. Not in the least. It was just the fact that he went from being completely gone to appearing to be right here, right now, in the moment. So, before therapy I wrote an emergency email to Dr. K. asking him if he thought Thomas might be dissociating. For those of you who don't know about or understand it totally, it is defined as a separation of normally related mental processes, resulting in one group functioning independently from the rest. In it's most extreme form it leads to multiple personality disorder but THAT IS NOT WHAT I'M TALKING ABOUT WITH THOMAS. I DO NOT BELIEVE HE HAS MULTIPLE PERSONALITIES. I am fully aware that the general public thinks that schizophrenia is multiple personality disorder and I don't want to feed that misconception. What I am talking about with Thomas is something called "depersonalization or derealization" which means a state in which one's thoughts and feelings seem unreal or not to belong to oneself. After listening to Thomas talk about what he feels, Dr. K. thought Thomas might be dealing with that.

What precipitated the thought that might be happening to Thomas were my experiences with him lately, especially Monday night but also a couple of other times this month. Then with some gentle questioning Dr. K. and I learned that Thomas (like on Monday night) began to feel like he was in slow motion, like his actions (of putting things on the shelf for example) were slowing down. Then he said he was in a kind of fog. It was that fog that I found Thomas in and it was that fog from which I retrieved him Monday night. With further questioning I learned that he feels, when he's in that foggy, slowed down state of mind, that he feels like he's standing outside of himself watching himself do something and also that he's falling down a dark tunnel. Clearly, and if you know dissociation or have seen it in your loved ones, it is a disconcerting experience as an observer. I asked Thomas if he felt like he was falling down that tunnel, could I talk to him and get him out of it so he could continue to stay at work? He said it wouldn't work and that he'd want to come home.

Here is what is at issue for me with this whole dissociation thing right now. Monday night wasn't the first night that this has happened this month. At his birthday dinner he was kind of out of it and then at one point I looked across the table at him and he was doing that "staring into my soul" thing. I really really wish I could better explain this experience to you. My only word for it is that it is disconcerting.

I have vast experience with the most severe form of dissociation, that being multiple personality disorder (or as it is now known as Dissociative Identity Disorder), because a family member of mine has it and I have had many many experiences of watching this person switch from one "personality" to another and into these derealization, depersonalization states of being. One could say I should be used to it by now but seeing it in my son is a whole different thing. I worry deeply about him and I hate seeing him disappear and be lost to me, not to mention how it feels for me when he returns to me.

I don't want this for Thomas. It appears that it's a function of his intense anxiety. When his mind can no longer handle the anxiety or stress for that matter, he starts to disappear inside of himself to avoid feeling the anxiety. It's a fairly common coping mechanism (think: when you're driving and suddenly you don't realize how you got to the store--that's called highway hypnosis but is also dissociation in a milder form). My biggest concern is that I've seen it happen a lot in the last month and I'm unsure of where it's going. As his mind "learns" that it can do this to escape intense situations then it begins to become an automatic coping mechanism and one that is ultimately maladaptive.

It really makes me wonder if his reported 4 out of 10 level anxiety is really a 4. To find yourself in a dissociative state you have to be under an immense amount of stress. Perhaps his 4 is an 8 and coupled with the stress of working too many days in a row and now having to work tomorrow on pre Black Friday and then again on the actual Black Friday, he may disappear again to a place I'll have a more difficult time of retrieving him from. At this point all I can do is wait and see. He has today off so he can rest but the next 3 days are going to be intense for him. I suggested to him that he should cut back his hours to which he argued that he was fine but when I mentioned it to Dr. K., Dr. K. seemed to agree with me on that and we all agreed that Thomas could work the next few days but if things got worse Dr. K. was going to write a letter to Thomas's manager and ask that his schedule be cut back to just 3 days a week. That was the original plan all along but retail being retail and especially in a big corporation, they lost sight of Thomas and his illness and began working him far more hours than he can handle.

And so we wait and we watch. We'll see what the next few days bring for Thomas.

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