What’s Up Pdoc?

It’s difficult for me to speak positively about the psychiatric profession.  In spite of my own negative experiences, I see therapists on television who seem wonderful, dynamic and caring.  Gabriel Byrne’s Dr. Weston on “In Treatment” was fascinating.  Even when he made ethically questionable decisions and recommendations to his patients, there’s a man I’d enjoy talking to.  And Vanessa Redgrave on “Black Box” has already demonstrated in one episode that she is able to unflinchingly tackle her patient’s flawed thought processes head-on, while still managing to remain kind and compassionate.

But those aren’t real people.  Real psychiatrists generally aren’t like what you see on television.  I’d like to believe that those types of practitioners exist — because it’s hard to remain hopeful if you believe an entire field of medicine is a sham — but I have yet to meet any of them.

I know I’m probably being somewhat unfair in my expectations.  One of the reasons television pdocs have the right answers is because they’re written by the same people who ask the questions.  It’s not real life.  In real life you have to think on your toes and answer off-the-cuff.

Except… not really.  Psychiatrists are supposed to be trained for this sort of thing.  It’s their job.  They have scripts and scenarios.  They are supposed to know the warning signs.  They are supposed to know what to say and what not to say.

And yet in my experience, most of them say almost nothing at all.

Getting a referral to a psychiatrist is no small feat.  If you’re lucky, you might see one within a year of a referral from your family doctor.*  At the time when I first asked my doctor for help with my mood, her only option while awaiting referral was to diagnose me with suspected depression and anxiety and to prescribe me antidepressants.  They only made me more anxious, so she increased the dose.  This induced mania and psychosis.  I still had no referral.

In a moment of clarity between psychosis and the ensuing crash, I returned to the doctor’s office and told them I thought I might do something bad.  They insisted I go to the ER, whether by ambulance or they could call my mother.  I opted for my mother.

pay attentionThey left me alone to wait for her in one of the examining rooms.

Alone.

I went through the (unlocked) drawers and cupboards.  I found a box of razor blades.

Razor blades.

I took one out.  I stared at it for a long time.  I put it in my purse.

We waited for several hours in the ER.  Eventually a doctor from psych came to talk to me.  We discussed how I was feeling and the fact that I had been suffering from insomnia for several months and that I had lost more than 20 lbs.  She confirmed that I had a referral to a psychiatrist.  She told me it would be best to wait for the referral.

I told her again that I was feeling suicidal and I asked to be admitted.

She said that wouldn’t be possible as the psych ward had no beds.  She said it would be best to wait for the referral and she could give me an emergency hotline number and a bottle of sleeping pills to help me sleep.

A bottle of sleeping pills.

I asked her if she thought giving a bottle of sleeping pills to someone who says they are suicidal was good medicine.

She said she would only give me 3 or 4 instead.

I removed the razor from my purse and put it on the table.

I was admitted to the hospital.  Because there was no room in the psych ward, I was admitted to one of the regular floors with a security guard posted to sit in the room with me for the first 24 hours.  The next morning I saw a psychiatrist.  He offered to prescribe antipsychotics and change the antidepressant I was on.  But only on the condition that they would give me one-third the dose of the narcotics I was on for pain.

Their strategy to turf me was bitterly transparent.  They would give me what I needed — the drugs for my as-yet undiagnosed bipolar — but I’d have to be willing to go through narcotic withdrawal.  The fact that I had been legally and justifiably prescribed those narcotics by my doctor didn’t make any difference.  Ultimately they knew I’d either refuse and sign myself out of my voluntary committal or I’d accept and bail after a few days of withdrawal.  I lasted about 3 days.  But at least I now had the medications I needed to bring me out of mania.

happy cartoonWhen my referral appointment finally came, I met with the psychiatrist at the Royal Ottawa Hospital.  She reviewed my history.  She reviewed my medications and asked me if I felt they were working.  (No.)  She upped the dosage.  I saw her several more times.  Every time, she asked if I felt there was an improvement.  There was no counselling.  (Unless you count “try to think positive thoughts” and “try to focus on what makes you happy”)  She just continued to make changes to the medication and say “these things take time.”  Then I got transferred to a different psychiatrist.  Same thing.  Then a third.

There was no therapy.  There were only drugs.  Antipsychotics, sleeping pills, antidepressants, anti-anxiety pills, lithium.  I stopped going.

When it comes to mental illness in Canada* there is a certain pattern of triage that consistently occurs.  If you suffer from depression, maybe you stand a chance.  You’ll see either a psychiatrist or a psychologist and the chances are good that eventually you’ll get talk therapy or behavioural therapy to change any faulty thought patterns that you need to go along with any drug cocktail they deem necessary to change your brain chemistry.  Someone will ask you about your trauma.  Someone will help you deal with your abuse.

But if you have bipolar disorder or schizophrenia, you become a medical patient.  Drug therapy is the only perceived solution.

And that is incredibly short-sighted.  The human mind is complex.  In the same way that my bipolar has shaped my experiences, my experiences have shaped my bipolar.  Why wouldn’t I benefit from therapy?  When the voices in my head haunt me and taunt me, why shouldn’t I be prepared with the tools to fight them?  With all the studies that show links between trauma and mental illness, it is completely irresponsible how the mental health industry fails certain categories of patients.

I acknowledge that it’s a complicated issue.  First and foremost are the restrictions placed on mental health treatment by the government.  Under OHIP, there are limits to coverage for mental healthcare as well as limits to the number of visits that are covered (which might make sense for things like situational depression or seasonal affective disorder, but not for a great majority of permanent and lifelong mental illnesses).  Compounding the problem is the unhappy marriage of the fields of Psychology and Psychiatry.  They are unwilling bedfellows at best.  Disagreement (and occasional outright disdain) between the two professions stands in the way of patients receiving possibly more effective combined therapies.

I try not to be pessimistic.  I don’t always succeed.  At a time when mental health organizations are pushing social media campaigns to remove stigma and encourage an open dialogue about mental health with things like Bell Canada’s “Let’s Talk” and ROH’s “You Know Who I Am” (and weirdly named “Friends with Benefits”), there is still a more important area of dialogue that I feel is missing.

And that is the one between mental health professionals and their patients.

You have a responsibility that extends beyond your prescription pad.

/rk

*For reference, I am in Ontario, Canada in a fairly large city.  Referral times for other locations certainly vary, but it seems to be a common theme in most places that referral times are one of the things that pose the greatest risk for patients with mental illness, especially those at risk of suicide.

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I’m Not As Think As You Sexed I Am

I once wrote my father a letter.  There must have been more of them (and there were certainly emails in later days), but interestingly I only remember this one, due in large part to his response.

In it, I shared an anecdote about a dream I’d had.  I only remembered the ending:  A man came up behind me as I was going towards my front door in the dark, grabbed me from behind with his arm pressed across my throat, and menacingly whispered “carburetor” in my ear.  It was petrifying.  I woke up in a cold sweat.  But it was also absurd.

Which is why I shared the story.  I thought he would laugh (like I did) at the absurdity of it.

Instead, he wrote back with a lengthy essay about how I was young and in bloom, and discovering my sexuality and was bound to have a lot of mixed feelings and fears about it.

I was pretty sure I hadn’t written anything about sex, so that left me mostly confused and uncomfortable.

mehThe reality of my sexual development was complicated.  Things most happened at the initiation of others.  I had played “you show me yours and I’ll show you mine” with one of my sitter’s sons (at his suggestion), and we watched each other pee.  In grade 5, a group of us at school would play kissing tag.  I ran super-fast, clearly missing that the point was to be caught, not to evade.  That progressed to other kissing games (without the running).  My kissing technique consisted of letting the boy press his lips against mine until I ran out of air.

From the outside I seemed fairly naïve and inexperienced.  And I was.  And I also was not.

Around the same time, a female friend had begun teaching me oral sex.  I had also found my mother’s Joy of Sex books, hidden away in a drawer of her desk.

But emotionally, I was barely comfortable speaking with boys.

At about 12, a friend decided I should begin dating her boyfriend’s best friend.  I barely knew him.  He got bored with me pretty quickly when he realized I wasn’t interested in much beyond a peck on the lips.

At our next visit, my father (thinking that pre-teens dating was just hilarious) smugly asked me how my boyfriend was.  When I told him we’d broken up and he wanted to know why, I told him the truth: “He got my best friend pregnant and she had an abortion.”  He was shocked.  And it satisfied me to shock (and silence) him.

I didn’t have another boyfriend until I was 18.  And in the heteronormative sense at least, I was still a virgin.  He was 21 and in university.  I was still on the fence about when (and if) I even wanted to have sex.  But once again, my father assumed he knew all about my sexuality and took it upon himself to call my mother, to tell her it was time to “get her on birth control.”

And so it was decided.  I would get on birth control.

And so I decided I should probably have sex.

I honestly don’t know to this day if I might have waited longer if they hadn’t unwittingly given me their tacit permission.  Somehow by doing so, there didn’t seem to be any reason any longer not to do it.

/rk

To Dream, Perchance to Sleep

Nighttime is when I live my other lives.

It’s not a time of rest — at least not mentally.  I’ve always been a bit mystified by people who wake up fresh and new in the morning.  The first time I encountered someone who said they hardly ever dream, I was astonished.  I do nothing but dream all night.  I wake up exhausted.  And that’s when I sleep at all.

Most nights it takes an hour or two to fall asleep.  My mind turns over conversations I’ve had during the day.  I re-examine every interaction, turning them over in my mind.  I question my choices.  I see myself through other people’s eyes in those interactions and paranoia sets in.  And the only way to calm the anxiety that builds is to continue to play those moments over and over in my head.

clownswilleatmeOf course there are nights when sleep doesn’t come at all.  It’s not an unpleasant experience, necessarily; since my mind is abuzz with ideas and sensations and for the most part I don’t feel tired at all.  I have grandiose ideas.  I write long novels and poems and play movies in my head.  I look back on these times with regret that I didn’t get up and write them down and preserve them, but I doubt very much that I would be able to transcribe them effectively.  The visions flow faster than speech or thought and I don’t want to get up in the middle of the experience lest I disturb that feeling and lose my place.

It’s very tempting to stay in that place.  Around 6 years ago, when in the midst of a very serious manic phase, this is how I spent most of my nights.  An anti-depressant I’d been prescribed combined with a walloping 30 mg a day of hydromorphone (Dilaudid) for pain (and a diet that consisted most of coffee) left me sleepless and occasionally even hallucinatory.  I felt brilliant and sleep was largely a waste of time.

But I know the ensuing crash is inevitable, so when I get those days now, I know it’s a warning sign.  I take note.  If I get more than one or two of those days in a row, I know I will need to take steps and tell someone.  And so far, I don’t seem to get to that point.  Within 24-48 hours, I do sleep, even if it’s not terribly restful.  And so I figure at least I’m probably staying on this side of danger.

My dream life is just a variation on consciousness.  I know that it holds far too great a position of status in my perception of reality.  I know this because I get them confused sometimes.  Much in the same way that I hold odd beliefs that combine both reality and delusion, events that occur in my dreams spill over into my waking life.  Arguments that I have in that world cause resentment, anger and hurt to build within me towards loved ones because of slights they have committed towards me.  Because even if I can rationalize that the events weren’t real, I am still left with the feelings and emotions that they have elicited in me.  Those are harder to dismiss.  To dismiss them, I have to at first acknowledge them.  Then I have to search within myself to determine what insecurity seeded the thought that sprouted into the dream.  It’s possible to do, certainly, but it requires a lot of mental work and introspection.  Multiply that by several dreams a night and combine it with all the other mental work I need to do every day just to keep an even keel and it’s exhausting.

While other people believe in God and heaven because they fear the black nothingness of death, there has always been that part of me that finds that kind of finality reassuring and comforting.  It’s not healthy, I know.  But when you live a life haunted by unwanted thoughts and memories, the absence of thought and the end of being is alluring.

I can count on one hand the number of times in my life where I have slept without dreaming.  While undergoing surgery, for example.  It is a strange sensation and I’m not sure how to relate to people who experience this type restful sleep on a regular basis.  Waking up feeling rested and energized is fantastic.  But without the dreams, there is no sensation of the passage of time.  I find that odd.  But maybe that is why I feel so old and worn so much of the time.

I am living a thousand lives.  It wears on the mind and body.

/rk

Unfinished Business

Since it is apparently a day for not finishing things, it would seem the only proactive solution would be to write a post about not finishing things.

I had the opportunity today watch the first episode of “Black Box,” a new tv show about a neuroscientist with bipolar disorder.  As a new show it shows promise, with great actresses (Kelly Reilly, Vanessa Redgrave), a fairly good premise and interesting cases.  But the characterization of the lead actress’ manic episodes reflected that common cliché — that mania is all elation and magical feelings.

I don’t deny that there are moments like that.  But it’s a bit like any drug — that type of high is fleeting.  You can spend much of your time chasing that high — and maybe you’ll even achieve it from time to time — but you’ll spend a heck of a lot more time on the cusp and frustrated.  The reality for most people tends to be a lot closer to what you’ll see on “Homeland” with Clare Danes’ character.  Sleeplessness, disordered thinking, angry outbursts, erratic behaviour…

Today is one of those days.  Well, not one of those days — I am medicated against such an occurrence.  Instead of elation, I am stuck in limbo.  It’s not that I can’t write — I’ve already started two other posts besides this one, and I have about five more in my head trying to fight each other for supremacy.  I just can’t stay focused on one of them long enough to finish before I lose interest and start another.  Ideas for writing flood my mind, but so do thoughts of a million other things all at once.  I am acutely aware of the clothing against my skin, my heart beating and the air filling my lungs.  I am hyper-sensitive.

If you’ve ever surpassed your coffee threshold or taken stimulants of any kind and reached that point where you feel sort of sick and spinny and irritated, it’s like that, but worse.  Because coffee and stimulants wear off fairly quickly.

Like most people with bipolar, I’ve developed tactics for dealing with these episodes.  I used to find a glass of wine effective in taking the edge off.  It’s not just me that I worry about, it’s the people around me and my relationships with them.  Because when I feel like this, I pick fights.  I get angry for no reason.  I quit things.  This is where my bipolar tends to look like a lot of other different mental illnesses combined:  ADHD, generalized anxiety disorder and borderline personality disorder with a little PTSD thrown in for good measure.  Unfortunately, as solutions go, self-medicating with alcohol is a poor decision as it tends to sling-shot me backwards into depression.

There are actually several different kinds of bipolar, and I am blessed with what is considered the most severe form:  mixed bipolar with rapid cycling.  Personally I think each form presents with its own unique and special type of hell, but it cannot be denied that the treatment of mixed bipolar is the most challenging and the prognosis is poor.

I’m not certain of the value in writing when I’m in this state.  The end product (should there be an end product) is bound to be scattered and incoherent.  I find myself routinely cutting and pasting pieces of sentences into google to make sure they even make sense grammatically or if I’m just making up words or expressions.

I do think writing is better than not writing.  Not all writing is about creating perfection.  How I write is maybe as important as what I say.  My writing is about more than just relaying the ideas within the words.  It is also about showing the person and experience behind the words.

And sometimes that person and their experience is messy, disjointed and unfinished.

/rk

 

The Guilty Mother’s Lament

badmommyDearest children of good mothers:  One day, your otherwise loving and attentive mother will almost kill you.

I am not speaking of overt neglect or abuse, or even intentional harm.  But somewhere in the process of parenting you, your darling mother will make a poor decision or be distracted for a split second and you will be irreparably harmed.

Or at least that is how you will tell the tale, and in spite of her attempts to play down the course of events, your mother will secretly and guiltily agree with you.

~~~~~~~~~~~~~~~~~~~

For instance, I’m sure my son will share the story of when, at the age of 2, he stepped off the pier we were standing on at our cottage and plunged underwater while I stared at him FOR A FULL 3 SECONDS trying to figure out if I could retrieve him by reaching my arm out rather than getting fully soaked.  I did ultimately jump in after him and yank him to the surface, but I am sure for those three seconds his poor little mind questioned all he knew about the universe and it is a miracle that he survived and has not been warped for life by my hesitation.

~~~~~~~~~~~~~~~~~~~

My own sad story dates to my 19th year, when I was fully and pathetically in the throes of a chest cold.  Insistent that I was unable to go to school, I spent a week consisting of days on the couch in front of the television and nights where I would literally crawl on the floor to my bedroom at night.  I was dying.  Clearly I was dying.  How could she not tell I was dying?

My mother said I was not dying.  She felt I was being overly dramatic and told me to knock it off.  When I remained steadfast, she ultimately relented and took me to the doctor, if only to call my bluff.  The doctor took out his stethoscope, listened to my back, declared it to be viral pneumonia and prescribed a month of bed rest.  I tossed the diagnosis at my mother like an accusation.  It was met with silence.

~~~~~~~~~~~~~~~~~~~

My mother’s own near-brush with tragedy came around the age of 12, I think?  Maybe younger.  Feeling deathly ill and weak one morning, my grandmother pushed her out the door nonetheless, and forced her to walk to school.  Based the version of the story told me by my mother, I pictured a 20-mile walk across countryside in dire weather.  (My mother grew up in suburban Ottawa and the school was down the street.)  She was sent home when she developed a rash.  It turned out my mother had scarlet fever.  She did, however, live.

~~~~~~~~~~~~~~~~~~~

There are stories in the news every day of parents who abuse and neglect their children.  Horrific stories.  These are not them.

If this is your reality — if you have just one story that you bring out of storage with which to tease and shame your mother — a moment characterized by a split-second moment of weakness or error of judgement where you ultimately turned out ok, you probably have a pretty decent parent.

Because it’s the part we leave out of the stories that is important.

Grandma took my mother to the doctor, got her the antibiotics and took care of her.  My mother took me to the doctor, took care of me, and even collected my homework from the school (uh… thanks I guess).  And although I will replay that hesitation in my mind over and over and over, I did jump in the water to save my son.  I remind myself that it didn’t happen because I wasn’t paying attention or being neglectful.  I was there, standing beside him.  And he tripped and fell in.  And I did exactly what I was supposed to do.  I got him out.

We do a lot of things with our children as mothers which we convince ourselves will scar them for life.  And kids can be scarred, emotionally and physically.  But these aren’t those stories.  These are the stories of halfway decent, doing-their-best, pretty good mothers.

rk/

The Apartment

After my father’s book sold, he suddenly had money.  A lot of money.  According to him he was a millionaire, and while I suspect that this was likely an exaggeration, the book did make it to #10 on MacLean’s Magazine‘s national bestseller list.  He spent money like it was in endless supply.  He rented a large office (with a shower!) to work on his next book (a spy novel, which he never finished), and from which to work out various investment deals.  He only carried 20s or 50s in his wallet and dished them out liberally.  He bought a half-million dollar house to live in with his wife and new baby (my half-sister).  And he rented an apartment.

We never discussed why he needed an apartment, but he told me not to tell my step-mother about it.

He also started drinking heavily and using cocaine.

I first found out about the cocaine during a conversation in his car, where I expressed some concern that my brother was smoking (cigarettes).  My father started to grill me:

cocaine“What about drugs?  Is he doing drugs?”
“I – I don’t know.  Maybe?”
“What do they look like?”
“Dad, I said I don’t know if –”
“Do they look like this?!!
And he pulled out a bag of cocaine.
“What?  Dad, no.”
“You can tell me.  You can come to me.  I’d rather you come to me than get it off the street.”

I’m a little fuzzy on the rest of the conversation*.  I think I just changed the subject.

~~~~~~~~~~~~~~~~~~~~~~

During one of my visits to him in Toronto, my father took my best friend and I out to a nightclub.  This was clearly designed to impress us:  he made a point of telling us that it was a member’s only club.  He bought our drinks (we were underage) and we got very, very drunk.  Afterwards, he offered us his apartment to sleep at.  But on the way there, he wanted to stop by his office to grab the keys.

When we got there, he showed us around.  He then proceeded to pour out lines of cocaine on his desk and snort them in front of us.  I think he offered us some (again, my mind gets a little fuzzy here*), but we both declined.  He then dropped us off and we spent the night sharing the apartment futon, where I don’t think I got much sleep between the room spinning, and my low-level anger and resentment stewing in my mind.

~~~~~~~~~~~~~~~~~~~~~~

In the summer after my first year of university I needed a place to live.  My father invited me to stay at his house in Toronto.  There wasn’t technically space for me (It was a two-bedroom), but since my dad was sleeping on the couch, my toddler sister shared the bed with her mother and I slept in my sister’s bed on the floor in her room.  This was intended to be a temporary stop-over to my living for the summer at his apartment (which I still wasn’t supposed to mention to my step-mother).  But my dad kept putting me off.  For one reason or another, I couldn’t move to the apartment yet, until he sorted some things out.

In the meantime, I was looking for temporary work.  After a short stint in telemarketing (ugh) I found a fairly well-paid (but gruelling) job at a meat-packing plant, but they wanted me to start on Monday.  Something I couldn’t do without a pair of steel-toed rubber boots.  They weren’t expensive (about $25) but I was strapped for cash.

In my wallet, I carried with me an American Express card that my father had given me for birthdays and emergencies.  For birthdays he would tell me how much I could charge and I’d shop for myself.  For emergencies… well, there hadn’t been any emergencies.  Except this.  This felt like an emergency.  I needed the job and it was a small amount.  I knew I’d be able to pay it back to him.

I tried to contact him, but he didn’t answer.

So I charged the card.

When I finally got through to my father he exploded.  His American Express account was in arrears.  He wasn’t supposed to be using it.   We screamed back and forth at each other over the phone.  I knew I shouldn’t have charged the card, but any feelings of remorse in that moment were superseded by a sense of fury at my father for overreacting and not being straight with me in the first place.  He was in dire straits financially, but he had pretended to me and everyone that everything was fine.  He just kept screaming and blaming me for the situation as if my $25 credit card charge was solely responsible for his world falling apart.

I told him to go fuck himself and hung up the phone.

We didn’t speak for a long while after that.  He declared bankruptcy and had to sell everything.

Needless to say, I didn’t get the apartment.

/rk

*I’m not trying to obfuscate here:  Under moments of great stress, I sometimes retreat into my head as a safety mechanism.  Because of this it’s sometimes easier to remember feelings and thoughts rather than tangible memories of actual events. 

Was, Not Was

Reality is both subjective and fluid to a person with bipolar disorder.  I’ve touched upon my issues with delusion in previous posts.  It’s a difficult thing to explain to someone who is not mentally ill, that there is nuance with delusion and psychosis.  I think people can wrap their heads around crazy; they can picture the person who hears voices, who sees things and who is detached from reality.  What is trickier to understand is that this same person might appear normal.  That they might function.  That someone might experience these things and still walk through life, paying bills and making friends and acting like they’re not living what most people would consider a nightmare, is a bit hard to relate to.

It’s not hard to know that the voices in your head or the unsolicited thoughts are lies.  I do live in the real world, after all, and I’m capable of rational thought.  But in times of stress, they become insistent.  Relentless.  Ignoring them becomes less practical than compartmentalizing.

Flickr: Cross-stitch ninja

Flickr: Cross-stitch ninja

I live in two realities.

Or rather, my experiences are divergent.  Bubbles occur in my stream of reality when I am, quite literally, of two minds about something or someone.  I had a moment like this recently on my birthday while on a visit to the Biodome in Montreal.  At the Antarctic exhibit, there were puffins.  I was overwhelmed by feelings of wonder and surprise and burst into tears.  It’s not like I’d never seen photographs of puffins before, but somehow, somewhere along the way (in spite of evidence to the contrary), I had compartmentalized a belief that they were mythical creatures.

There is no particular pattern to my delusions, except for the commonality that they persist in spite of the fact that I know they are not factual.  I’ve touched on a few of these in previous posts:

        • I have supernatural powers, including but not limited to invisibility, telekinesis and flight.
        • My father and stepmother, besides being themselves, were also John Lennon and Yoko Ono.
        • I am an atheist and do not believe in an afterlife but my dead grandfather is watching me and I used to have conversations with him in my head.
        • I don’t expect to wake up tomorrow.  This one has made it very difficult to follow through on school, long-term commitments and to plan for the future.
        • Stuffed animals come alive at night.
        • People can read my thoughts.
        • Animals can read my thoughts.
        • I have a baby that I am forgetting about.
        • Dreams are real life and real life is a dream.
        • I have imagined my husband and one day I will wake up and he will have disappeared.
        • I have imagined my son and one day I will wake up and he will have disappeared.

Combatting these delusions is exhausting.  How strong and persistent they are waxes and wanes depending on my mental state.  But what is even more exhausting is hiding the crazy.  Trying to appear normal while all of these things are going through my head only feeds into the notion that other people can sense what is different about me.

Because of that, there is a certain liberation in outing myself.  In writing, I lay myself bare.  I think that more than anything, fear is what keeps people from healing.  To avoid facing their fears, people will lie and avoid and build a wall around themselves.  The fear of being ‘found out’ for who we are and having our private selves revealed can be paralyzing.

Surprisingly, there is nothing that has given me a greater feeling of control over my life than baring my inadequacies.  I am the captain of my ship.  There is satisfaction in knowing that the decisions people make about my worth (good or bad) are based on truths they know about me, rather than from some perceived reality.

/rk