Is This As Good As It's Going to Get?

I had my appointment with my med-shrink this afternoon. I try to have some idea of what I'm going to tell him before I get there so I was thinking about this as I drove to the appointment. I realized how much better I am doing than I have for a long time in the past.

I am not actively suicidal. The self-harm BS is down to non-scarring, minor issues. I am not in bed all the time. I am getting the kids where they need to go when they need to be there and taking care of them emotionally and making sure they have everything physically. I am even managing to participate in their activities to some degree. Dissociation is under control. I'm not at either extreme end of the eating spectrum. My sense of self-worth has increased a little. My adamant adherence to paralyzing levels of guilt and shame has lessened a little.

This is good! These are significant improvements. I've been working very hard to get here too. I've been taking my medications as prescribed. I've been working in therapy. I've been trying to change my thoughts. I've been pushing myself to improve behaviors. It is completely exhausting. But it's paying off. Things are better than they have been in about 2 years.

But... things still aren't good. I was thinking about where I'm at on the spectrum of various symptoms. Things are so much better but taken without the comparison of how they were, they are still pretty ugly.

I am tired all of the time yet can't stay asleep. I cry at the drop of a hat. I just don't care if things get done and indeed, a great many things are not getting done. I'm not even writing fiction anymore! Since March the only fiction I've written is a blurb for a round robin we're doing in the writing group I moderate and the only reason I managed to squeeze it out is because of all the people I would have let down if I hadn't. I am having concentration and memory problems. I do not have enough energy/motivation to make some of the lifestyle changes necessary for better health. Almost nothing is fun any more - the best I seem to do is degrees of bearable and is only done to keep from letting people down.

In fact, the only reason I'm not looking for a way out of this "life" is because I read about the irreversible damage it does to the kids left behind. My kids are literally the only thing keeping me going.

But things are so much better than they were. So I kept thinking that maybe this is the best I can hope for. Maybe it won't get any better than this and I should accept it and adapt. It could be that I should just be grateful for the amount of improvement I've done so far.

This was my thinking as I went in to talk to the med-shrink. It had a hefty undercurrent of Has he given up on me? and guilt over whether or not I should just be thankful for the improvement I've gotten and not badger him to work impossible miracles.

I considered chickening out and not bringing it up but when he commented how good I look, that I look the best he's seen me in years, I launched into my prepared speech. I told him that I am doing better now than I have been in years. I told him a few of the specifics (not all as he gets jumpy at the mention of some of them) and I told him that I've maintained this improvement for the past two months since I saw him. Then I paused and we looked at each other for a second. And I blurted it out.

"Is this as good as I'm going to get? Is this it? I've made so much progress but I'm still having problems. So... I guess I just want to know if this is the best I can expect to get. If it isn't, I just need to know."

Doc squirmed. When he squirms like that it means he doesn't like the question. Not necessarily that I won't like the answer or that he doesn't like the answer, more like he doesn't know how to answer or what I'm really asking. He leaned back and crossed his arms.

"I don't know how to answer a question like that because the answer isn't inside me it's inside you."

Great. He can't do anything - work harder in therapy. Let me guess - I'll only keep getting better if I really want to, meaning of course, that I'm not trying hard enough.

"All I can do is turn the question back around and reflect it to you. If, on a scale of 1 to 10 with 10 being life is perfect and 1 is it isn't worth living, you rate yourself at a 7, I'm happy with that. If you put it at a 3 we still have work to do."

Not long ago I was indeed at that level 1 rating. But things really have improved. I would put things at a 4 right now. I told him that. I don't remember exactly what he said, only that I'm pretty sure it was a poor substitute for "damn" based on his body language and the look on his face. "You answered your own question then." And he started digging through my chart, reviewing the millions of things we have already tried. "Let's see if we can get you up to a 9."

He tried to reassure me a bit that he hadn't given up and that we just had work to do. But he's not too good at the reassurance thing. He's a great psychiatrist but his bedside manner leaves a little to be desired. Still, he sent me home with some Lexapro to add to my other meds and a lot more hope.

Please, God - let this work!