Psychiatric Updates

I’m still in the psychiatric hospital. Still on the closed ward, because the open one is full – so I will be moved there once there’s a bed for me. A few weeks ago, it was pretty much decided that I would stay in the hospital till we’ve found a better living solution. I’m not sure if that’s still the plan, since now everyone here seems pretty much convinced that the problem is not with my living situaiton but with my freaking out. This has its advantages, of course. For one thing, we seem to be getting a real treatment plan discussion next Thursday. I’m not sure if it will be an actual treatment plan to be discussed, or if that’s just what they call it to satisfy the insurance company. Depending on this, I may or may not get my ideas for how to make progress across. It all depends on whether whoever is in charge of such things, truly understands that I have a problem with freaking out / handling stress that is pretty seriously limiting me, besides the problem with my living situation. I hope they won’t underestimate either issue.

One of the nurses who is primarily in charge of my care, seemed to understand my issue with freaking out even before I freaked out significantly within the last two weeks. He is now helping me to write a crisis signaling plan, which is a plan in which you write how you can recognize an upcoming crisis and what you and others can do to prevent it from escalating. Some days, I like the plan, and on others, I dislike it because its current version isn’t working in 75% of instances.

The nurse also got the doctor to reconsider medication. Before last week, I was only on 20mg temazepam PRN to help with sleep, but I’ve experienced habituation for weeks so it hasn’t been working for a long time, and I’m now not using it anymore. Last week Tuesday during a major meltdown, the doctor gave me 25mg promethazine (brand name Phenergan, a low-potency neurleptic), and it worked really well: caused the overload storm in my head to decrease while making me only slightly drowsy. My opinion on neuroleptics is becoming a little more nuanced as I have more experience, but please realize that I don’t seem to have the extreme sensitivity to medications that many autistics do have. Later, another doctor prescried levomepromazine (Nosinan, which seems to be a similar agent) to help with sleep, but it absolutely isn’t working and only makes me sleepy during the day and causes me to have a hard time getting up in the morning. The -azine part makes me assume this is a neurleptic, too, and I’m well aware that prescribing neuroleptics for insomnia, is pretty stupid. Someone, I have not the slightest idea who, also prescribed me 10mg oxazepam PRN (a benzodiazepine) to use when I have a meltdown. I used it once with absolutely no effect and declined it the two other times a nurse offered it.

I spoke with the psychologist yesterday. He’d been speaking extensively with my parents and is considering speaking with my sister as well. So far, it seems I’ve not lost my diagnosis after all. He says he thinks I have Asperger’s Syndrome. The rest of the discussion – besides a pretty brief diangostic interview, which was little more than an outline of DSM-IV criteria with the question if I thought I met them and why -, consisted of him nagging about how I needed to unlearn to freak out and twirl my hair. Regarding freaking out: agreed, but not just because it’s a “social handicap” (as he worded it) but because it’s an unproductive way of handlign stress. I mean, if all it was about is that others are bothered when I freak out, I could decide to self-injure (when I’m alone and on body parts normally covered by clothing) instead of screaming or slamming doors or throwing objects. Would that be appropriate? Not quite. So the goal should be for me to learn to respond to overload/stress in an appropriate way, not to simply unlearn to scream or throw objects or slam doors. He seemed to think that I should first unlearn to freak out before anything else. Well, he’s the psychologist, but that seems strange to me: how am I going to behave during the times when I would usually freak out? But well, he liked crisis signaling plans, and my current one is basically a already more than that it simply commands me to control my impulse to freak out, even in its early stage (I started writing it less than two weeks ago), so I am slightly optimistic. And as for hair twirling: not my priority. Let me first work on the freaking out thing, and then, maybe, I might choose to work on decreasing my hair twirling habit. Of course, I understand that part of the reason why it’s not a priority for me, is that it’s mostly just other people that are bothered by this habit, and more specifically, it’s people who can see. It takes more than a little theory of mind to recognize the social problem in my hair twirling tic. However, at this moment, I’m particulalry unmotivated to work on behaviors that are only troubling because they bother others – and the “You suffer from the behavior cause of the way people react to it” strategy, even when used in reference to freaking out, has led to a stream of thoughts ending in suicidal ideation more than once within the last two weeks. Besides, on the moments when I’m not suicidal, I generally hardly care about how my meltdowns affect others, let alone something as futile as hair twirling. I might choose to work on decreasing this habit when I’m stable, not now.