Identifying The Problem

In my last post I vented my frustration at the process that lies before me. I was already coming around in my view of the situation, but I still needed an outlet for my disappointment. Now it is time to get to work. My plan is  to make sense of this by writing out the problem on paper, and I will post the results of that writing here. Be patient as these posts may ramble a bit.There is no obvious path ahead of me and the problem is a large and complex web of interrelated fears. There is only one way to deal with large complicated problems, and that is too break them down into smaller manageable pieces. The actual problem needs a clear and specific definition. The first question that needs to be answered is simply what it the problem? The problem is clearly emetophobia, but that is not specific enough for this purpose. Emetophobia references fear of vomit and/or vomiting that my actually mean a variety of different things depending upon the individual. So what specifically am I afraid off? Continue reading

The Extinction Curve And Making A Plan

This past Friday I had the second appointment with the CBT guy who is supposed to help me work through this emetophobia. The appointment included a required background questionnaire that frustrated us both as we plowed through a bunch of extraneous crap that wasted a lot of what could have been otherwise useful time. Eventually the conversation did turn to the topic at hand, and I was able to fill in some cracks in his understanding of my circumstances that became apparent to me after I had time to process our last appointment. I also detailed a somewhat new realization that pretty much every time I have found something that gives me some joy in life it is eventually sabotaged by these fears. Continue reading

Getting it on Paper

Off and on over the years I have day dreamed of getting paid to write. I enjoy writing though I often lack inspiration. Back in my darkest days I wrote a little bit. It was all as dark as my mood and I never shared it with anyone until I found it by accident one day and posted it here and here. I played around with short fiction stories recently, but as a father, husband, and middle class worker bee there is little time for following my own pursuits. Truthfully the stuff I wrote wasn’t all that good anyway. My stuff always lacks the descriptive details, the things that convey the setting and mood in a way that actually puts the reader into the story. It is all mechanical and matter of fact, no real pizazz. I was once employed as a technical writer and I was good at that. I actually redesigned the entire menu of written reports my company provided its customers. They were concise, to the point, easily navigated, and well received. That remains my biggest accomplishment in writing.

This summer while on the water working with my father I was struck with a rare lightning bolt of inspiration for a magazine article. I had an idea but as is the norm, particularly in the summer, I had no time until today. Today I was off. It is the last day of my vacation and by accident became a day I had all to myself. I finally sat down and wrote. The topic and whatnot isn’t important, but what is is that I got the ideas all on paper. I had taken the time to outline the project a couple weeks ago and I have been thinking about it since late in the spring so it was pretty much written in my head which made actually giving a physical form much easier. Two hours, 1200 words, and draft one is complete. It’s a ways from actually being done, but the ideas are all out on paper. I have no idea the submission guidelines to the publications I have in mind so I will go search those out next and modify the content if required. I am somewhat concerned that it may be a little long for what they would use it for, but I think I can shave it down if I have to.

I think this is a really good idea. I really think it will sell in the market I have in mind, and I am pretty excited to have actually started down the path. It was nice to write with purpose. To actually have an idea and put something together that could be useful to others. I know I am a long way for done, but it has been a good day.

Back

I was blessed to grow up in a place that is probably the closest thing to paradise on the east coast of the United States. We had everything; mountains, oceans, forests, and an idyllic small town where everybody knew your name. I grew up in a place with a sense of community that cared for its people. I knew it then, but I really know it now.

I Still live very close to that place and even have cause to go there from time to time, but a few days ago I was passing through and I saw it clearly for the first time in years. It has changed. The geography is the same, but the town feels different. I can only hope those pillars of citizenship and community are still there somewhere.

I recently heard this song and it reminded of my childhood and this place from the past.When I listen to the lines below I swear the song could have been written about me:

“My Daddy’s getting older now, but son he’s still as tough as ever

Him and my little boy are best friends now wish it could last forever

My Mommas still the one I talk to when I need advice

She never ever let me down, god what will I do when she’s not around.”

Peeling Back The Cover

Last Friday when I went to my appointment I expressed my concerns about the depression versus anxiety diagnosis and laid out the degree to which this fear of vomiting has impacted my life. I was surprisingly nervous going into the appointment and wasn’t realty sure I was going to do it until I started talking. I find it a little strange that after six plus years of seeing this guy I still have trouble expressing myself, but talking about this is still something I have some trouble with particularly with male doctors. For some reason I am more comfortable verbalizing my fears and insecurities to a woman. He listened politely to the entire story; I laid it out from the beginning and asked that he be patient with it as I explained seemingly unrelated parts of the puzzle and brought everything together in the end. I had had the conversation in my head a number of times in the days leading up to the appointment so once I got talking the ideas flowed pretty easily despite my apprehension.

When it was all said and done he agreed that the fear of vomiting thing was a significant issue that needed further exploration. He strongly suggested I seek out psychotherapy and suggested a guy he knew he has a special interest in dealing with phobias. I was not thrilled at first for a couple reasons. First this guy’s office is in a very busy area in the center of one of my work routes. I drive a company vehicle that may as well be a billboard on wheels. I take my privacy concerning this stuff very seriously and I was concerned that I would be too conspicuous. Second as I mentioned in the first paragraph I am not thrilled about talking with men, and this was going to be some difficult work. I just didn’t know. I was further discouraged when the office ladies indicated that there was a waiting list to see the guy and the wait would probably be several weeks. In the end I decided that the wait would give me time to decide if I really wanted to peel back the cover these issues at the moment. One could imagine my surprise when later that afternoon the office called me back to arrange and appointment for the following Wednesday. I am off this week so traveling to the appointment in a company vehicle wasn’t an obstacle so I decided to give it a go.

As I write this I am several hours removed from that first appointment and have had some time to reflect on the conversation. My first thought is why the hell these doctors don’t talk to each other. I spilled my guts about this just a few days ago. It was hard, and I didn’t relish doing it again, but I figured these guys are in the same practice so the talking doc should have at least seen the notes from the visit that led up to this. Nope. We started from scratch. The guys first question was “what are you looking to accomplish by being here?”. This is certainly a fair questions and even a good starting point unless the patient, me, thought you were already going to have the answer to that. Shit. He followed up with “Why don’t you tell me about what has been happening”. I am out of practice with this stuff. I didn’t have the first clue where to start. It’s not like I am talking about some bump or bruise that just happened the other day. This guy is looking for a what? A summary of thirty years of anxiety? Does he really want me to sum up something that has affected every part of my life for this amount of time in a sound bite? It has become such a large complex issue that I am not sure it is even possible. This isn’t MSNBC or Fox News it’s the actual truth that matters here not just the words.

After something of a shaky start I was able to get out the general idea of how these fears have impacted my life and how the overriding sense of general anxiety sits on top of it all like a dark cloud. He asked interesting questions, though I could tell by some of them that his understanding of my turmoil is far from complete. It is going to take more than one 55 minute appointment to get all that across I suppose. I did like that he seemed goal oriented. My first several experiences with talk therapy were all open ended affairs. One of these therapists was fantastic and I really felt like I gained something with each visit, but even she didn’t really have a goal for our work that she articulated to me. These therapists created a safe place for me to work through some difficult times, but I came to rely on them as sounding boards which made it difficult to move on. This guy and a woman I spoke with a couple years back have both taken more of a no nonsense approach to what we are trying to accomplish. There are already actual outcomes’ being discussed which is refreshing.

There wasn’t much time today for anything more than outlining the problem and discussing a couple rough ideas for approaching them which all boil down to systematic desensitization.  I am cautiously optimistic at this point. He was easy to talk to and once we got going I felt as comfortable as I have in any other therapy office. There is a lot going on here, and I am not sure we can just tease one piece out and make it go away. This one fear has been part of my life for so long that it has imbedded itself throughout my psyche. It’s like a tumor with tentacles weaving its way into places I am probably not even aware of. Is it possible to untangle this? I guess were going to find out.

Time For A Fresh Look

This coming Friday I have an appointment with the doc to go over my medication. The Wellbutrin has helped a great deal. For the first couple weeks I felt brain dead. It was hard to concentrate and I sometimes felt a little disoriented, but all that has passed, and while not 100% I feel much better than before. This short lived foray into a drug free life has raised some questions. I think my official diagnosis is Severe Depressive Disorder without Psychotic Tendencies, or something like that. I remember the first time I heard it I thought the word “severe” was stretching things a bit, but he was the doc so I let it slide. Over the past couple months as things started to come apart a depressed mood was not the problem. Everything started with, and was centered on, anxiety. I was having these crazy thoughts about the purpose of life and what happens at the end of life, and even then I wasn’t sad about those things as much as I was scared of them. I could tell that if I allowed things to continue a depressed mood was going to be the result, but the problem was anxiety. I mentioned this in passing at my last appointment and was told that early onset of depression in men takes the form of agitation and anxiety and that he didn’t think a new diagnosis was warranted.

Initially I accepted that, but as the weeks have passed I am not so sure. I don’t remember exactly what my original diagnosis was, but I do know that I wasn’t sure what was happening to me, and I waited a long time to get help. When the picture began to clear I knew that use of medication would end the career I had just spent a great deal of money and effort to attain. As a result I went to talk therapy, but I held off for nearly a year taking any medications. I was initially hit with symptoms in early May, and did not take any medications until mid-March of the following year. By then I was surely depressed by a number of things including living with the elevated level of anxiety and the loss of a career path I truly enjoyed. Given the amount of time that passed from the start of the problem to the effective treatment I am no longer convinced that depression was the problem so much as a symptom. My recent discovery concerning emetophobia also sheds some light how long I was actually living with these high anxiety levels and really didn’t even know it.

I think that on Friday I am going to present this line of thought to the doctor and see if he is open to revaluating what is happening with me. This particular doc never knew me before I was on Klonopin either. He always said it was a mood depressant. I have had problems with depressed mood over the years there is no doubt about that, but could I have been more susceptible because of the Klonopin? Again this makes the depression more a symptom than the core problem. If he is not open to a revaluation I am going to consider switching docs. I really think there may be something to this.

It Has A Name

Emetophobia – an intense, irrational fear or anxiety pertaining to vomiting. This specific phobia can also include subcategories of what causes the anxiety, including a fear of vomiting in public, a fear of seeing vomit, a fear of watching the action of vomiting or fear of being nauseated.

In one of my very first posts on this blog I spent a lot of time describing my experience with anxiety. In that post I mentioned a deep seeded fear of vomiting that I attributed to two traumatic experiences I had as a child. I alluded to this fear entering my everyday decision making process, but I didn’t elaborate a great deal. Some of the impacts of this fear I have barely admitted to myself let alone put into print or said aloud. Here is a partial list of the things I have or haven’t done as a result of this fear:

  • When in High School I used to tell my girlfriend that I wanted to get take-out and go eat down by the river rather than eat inside a restaurant. I used the river as “romantic” alternative to eating in a dining room, when the truth was I was afraid of getting sick in the restaurant.
  • I avoid places with large crowds because bathrooms are either hard to get to or filthy dirty should one have to hang their head over a toilet. When I do go to a concert or show I want to sit on the aisles so I can make a quick and subtle exit if I have to.
  • The biggest reason I don’t drink alcohol is fearing of being made sick
  • When I enter a new building I am sure to identify the locations of the restrooms and any trash cans in case I need a quick place to puke.
  • I adhere strictly to expiration or use by dates on food.  l also will not eat leftovers or cold cuts that have been in my refrigerator for more than a few days.
  • I never burp. I can’t distinguish between the sensation of burping and nausea. It all feels the same to me. Of course the inability to expel the gas from my body adds to and prolongs my discomfort. I have memories as a kid of leaning over the toilet thinking I was going to be sick. I could feel it coming and when I opened my mouth nothing came out except the noise and gas.
  • Periodically I will awake from a deep sleep and leap to my feet convinced I am about to vomit and rush to the bathroom. I will often fall back asleep on the bathroom floor or if I return to bed I will put an empty trash can near my bed.
  • My wife is a school teacher and when she has sick students in her class I am in full on freak out mode at home. Likewise with my 3 year old son I am paranoid of being around him when he is sick. We have been lucky thus far that he has not had a real stomach virus, but I know the days is coming and I dread it.
  • Feelings of nausea will often leave me sweating and shaking. Sometimes my mouth with salivate heavily as if the act were about to happen though it never does.
  • It has without question directly affected my professional life. I really don’t want to get into details here as it is the most painful truth, but I have worked on airplanes and boats so it shouldn’t take much imagination to see the magnitude of that problem.

Much of this list has been spoken to therapists and various shrinks, but I have never presented the entire list together. In my last experience with talk therapy a couple years ago it was brought up in the more detail than ever before, but still this word, emetophobia, was never mentioned. For years, decades actually, I have been suffering with this, living with coping mechanisms in place and I didn’t even know it had a name. I always thought it was just a personal oddness. There was no way a significant number of other people had a similar problem. If I had a nickel for every time somebody looked at me trying to be helpful, but sounding condescending, and said “Nobody likes to get sick” I would be a wealthy man.

The discovery of this word, emetophobia, came as a result of some recent personal realizations about the level of anxiety in my life, and wondering at the source of my true problems. Am I depressed which causes anxiety or am I anxious which makes me feel depressed. It feels like the classic chicken or egg scenario, but having spent some time with little to no medication in my system, and being benzo free for seven full months I am beginning to wonder if there may actually be an answer. Maybe the docs have just never asked to right questions. I want to write more about this, but it feels like a different post. For now I am just going to consider what it means to have a name for nearly thirty years of torment. Emetophobia. There is power in a name.