Therapy: Depressive Schizoaffective Disorder

Brave maybe, but exhausting

I sat there the silence deafening staring blankly at AnneMarie, my therapist for the past year and a half. I trusted her completely, trusted her with my life. I knew I’d be dead without her. Times had been rough after my liver transplant in 2011. When I should be putting my life back together filled with hope, mine was crashing around me. Today I was numb.  I’d been numb for weeks, feeling nothing. Failure, you’re fucking worthless.  The depths of clinical depression, of schizoaffective disorder is horrible, but the numbness is worse, much worse. No highs, no lows, not feeling anything at all, just the unceasing voices screaming at me from inside my head. I can’t imagine anything worse than fighting your own brain everyday, every night, every morning when you wake up.

“Mark,” she repeats no impatience in her voice only concern, “let’s see your arms.”  I roll up my left sleeve. The cuts aren’t deep, but repeated. Parallel line after line up the length of my arm where I had dragged the razor blade over my tender skin. It was pink, inflamed, not infected but obviously sore.  Cut deeper you failure, the screaming continued.  I’ve been cutting myself off and on since I was sixteen.  It slows the racing thoughts, quiets the voices, allows me to feel something, anything. “How many times did you cut yourself since I last saw you?”

“Maybe a hundred,” I reply calmly without a sense of regret.  It had been less than a week. “It’s better than the numbness.”

“You don’t deserve this,” I shrug my shoulders.  “As I said earlier, I’m leaving it up to you, River Point Behavioral Health or Wekiva Springs for an evaluation. I’ll give you through tomorrow.”

“I won’t go inpatient,” I stammer, “not here, not in Florida.”  Florida is 49th in mental health funding.  I’ve flatly refused to go inpatient here in the past even though I’ll admit I probably needed it. There are two hospitals I’m willing to go to: Johns Hopkins in Baltimore and McLean outside Boston.  Both are long shots at best, perhaps that is the idea.

“You’re critical Mark.  I never said inpatient just an evaluation and possibly a partial hospitalization or intensive outpatient (IOP).  If you don’t I’ll have to baker act you.”  I know she doesn’t say this lightly. Just imagining the police taking me involuntarily is frightening.  The threat of Involuntary commitment rings in my ears.  It’s not the first time she’s threatened commitment, nor will it be the last. She knows it will get me to do what is in my best interest.

“Fine,” I shrug. I know it’s for the best, but that doesn’t mean I’m happy about it. “I’ll go this afternoon.”

“Are you okay to drive.”

“I think so, yes.”

“Have you been having anymore visual hallucinations?”  I shake my head the pit of depression opening up again swallowing me whole as I’m resigned to my course.  You’re fucking pathetic, tell her no, the voice snaps.  At best I’ll be spending weeks at the mental hospital. I just went through IOP a few months ago and returning is not what I had envisioned for me.  “How are the voices?”

“Constant,” I say matter of factly.

“What are the saying?”

“That I’m worthless.  I’d be better off dead.  They’re laughing at me.  To cut myself.  The usual.”

“You’re listening to them then?”

“Sometimes,” I concede.

“Are you suicidal, having suicidal thoughts?”

“Thoughts yes.  No plans though.”  She nods understanding that I do not intend to kill myself.  In the past when I’ve been suicidal I’ve had very intricate plans: listen to particular music, a last meal, the exact outfit I plan to wear, etc.   “I fantasized about swimming out into the ocean until I didn’t have the strength to go any further.”

“Is that your plan?”

“No I’d throw myself in front of a train,” I confess, “It’s quick and a sure thing.”

“When did you come to that decision?”

“Recently,” I admit. “I can’t though. I owe it to my donor’s family to survive.”

“Yes you do.  How’s your sleep?”

“Terrible. I’m getting only three hours a night or less.”


“The same as always. Jerked awake in a cold sweat, my heart racing.  Always the same dream.  I relive it every night. Every night since I was sixteen.”

“Are you meditating?”

“Every evening before bed.”

“I think you should try meditation in the morning as well. Keep meditating at night as well as the rest of your evening routine. We have to get you more sleep.  Are you taking your trazadone?”

“No.  It makes me loopy all the next morning.”

“I understand, but you need some sleep.  You need to focus on how far you’ve come the past couple of years. You are healthy physically after your transplant.  You are sober.  Those are major accomplishments.”

“I try.”  There are currently 120,000 people on the organ waiting list, 17,000 people on the liver transplant waiting list. Only 6,000 receive a liver annually. The guilt that I didn’t deserve one is consuming me.  The fact that I lied my way through the Mayo Clinic psych evaluation haunts my memory. Am I sorry for that?  No, it was the only way to get a transplant. I’d have been listed as potentially noncompliant.  Did I deserve the organ?  I don’t think so.  Add it to the list of my issues.

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