Should vs Could

This week I had appointments with both my GP and mental health nurse.

My GP told me she'd spoken to the psychiatrist last week. She wanted to give the psych a good picture of my situation, so they went back through all the letters on my file, back to my first psychiatrist at the age of 12, the bullying throughout my school years, the abuse, trauma, old inpatient psych admissions, a massive overdose at 13; she listed them off one after another, and each one hit like a bullet in the chest.

But the psychiatrist is happy with my current meds, and doesn't want to change my antidepressants because mirtazapine's "the best I'll get". I told her I didn't understand what's changed between them recommending I try the last two antidepressants and now. It's not like I've tried that many either - maybe five total because I refused to take them from age 13-18. I think it made sense to her though, because she said she'd ask the psychiatrist next month if anything can be added to the mirtazapine, because no one seems to want to take me off that. I'm not trying to be a pain. I just want something to make everything slightly less unbearable, so that each day isn't so hard to get through.

On the upside, the psychiatrist agreed DBT would be helpful for me one day, but not at the moment, and definitely not in a group setting, so that's that settled for now.

The GP stressed that we're going to go about things very slowly, because she knows from reading through my history that previous doctors etc., especially ED psychs, have all come bowling in way too hard and fast, which obviously doesn't work for me, so that's not the plan here. I'm just relieved to finally have a team who are willing to work with me instead of against me, and recognize my previous teams may've been wrong in their approach.

At some point she wants me to see a psych, which is fair enough, but still scares the shit out of me. She gave me the name of a psychologist, but said it'd be good if I could work towards seeing the psychiatrist one day. She said she hopes I can get there at some point early next year, and I'd never be pushed to talk about anything or things from the past until I felt ready to. It all seems way too fast but we'll see what the next six months bring.

Then I saw the mental health nurse, and it actually went pretty well.

She asked if I'd been doing any sewing or tapestry or anything, but I haven't really. I told her I feel so overwhelmed all the time, it's paralyzing, and there are so many things I should be doing but I can't do any of them but I can't stop stressing about them either.

She stopped me there. She said 'should' is one of the worst words, a double negative. People with depression and anxiety tend to use it a lot, but it only makes you feel worse. She said there's nothing I 'should' be doing, and I need to learn to say 'could' instead - and I'm not allowed to beat myself up while doing it.
"I could be doing X, and when I feel up to it, I will."
Not "I could/should be doing X, but I'm not because I'm a lazy fat piece of shit."

She asked if I thought I was fat, which seems like a bit of a no-brainer to me. She went on to lecture about body dysmorphia, but I really don't think I'm dysmorphic at the moment. I was at one point, but I think I see myself as I am now, and that is far too much.

She asked if I thought I needed help from the ED services team, and I just said hell no, that they're worse than useless. I told her that when I was diagnosed with AN by their head psychiatrist, it was my first time asking for help with it. In one appointment, he diagnosed me, told me I could "keel over and die at any moment" (no blood tests or obs anything, so I'm pretty sure he was overreacting), and sectioned me. Then when I was finally discharged, I had to keep seeing them until I reached BMI 18, never receiving any actual psych help along the way because they say your brain can't absorb it. When I stopped seeing them as soon as I reached the goal weight, I was told there would be 'conditions' if I ever wanted help from them again, which put me off ever going back. I'd only been sick for about six months at the time, and tl;dr, the whole experience was horrific and I don't plan on seeing them again.

And I had another silly problem with the mindfulness stuff. I'd downloaded the Mindfulness Skills CD, but still hadn't listened to it yet because I didn't know when to listen to it or how to 'use' it. I must sound like a total idiot when it comes to all this mindfulness stuff. So she wants me to listen to all five tracks a few times, pick the one I like the best, and try to listen to it at least once a day... why didn't I think of that?

Those who read all of that, you're a champ and deserve a calorie-free cookie.


xxBella