TRANSCRIPT OF AUDIO FILE:

BEGIN TRANSCRIPT:

THERAPIST: About what?

CLIENT: Serotonin Syndrome.

THERAPIST: No what's that?

CLIENT: So, it's a drug interaction between [inaudible at 00:00:14] and a painkiller.

THERAPIST: Oh.

CLIENT: Yes, and so I've been taking this painkiller, tramadol, very rarely. My doctor got just said there's an interaction with Lexapro but you take it pretty infrequently; I think it's okay. And then I ended up taking, needing to take several over a short period of time because I injured myself shoving [inaudible at 00:00:52] fracturing [inaudible] when I fell down the stairs.

THERAPIST: Fracturing what on the stairs?

CLIENT: I was dragging a coffee table up two flights of stairs. And then the next morning I slid down my front stairs. And so well serotonin syndrome I guess basically it's instead of encouraging the serotonin to hang out for a while, it's like a serotonin party in your head, yes, and potentially fatal.

THERAPIST: Oh my God.

CLIENT: Yes, and it took me a while to figure out that's what was going on because I'd also be in such altered mental states, mental confusion, problems with motor control, problems with memory.

THERAPIST: Wow.

CLIENT: Yes, so that happened and having your roommate [inaudible at 00:01:54] hospital because they said well if you start seizing or if you're driving and seizure your fever goes up more she would notice. I said yes. Then at one point they thought I was, the nurse on-call thought I was talking to a hallucination. I talked to my roommate but I didn't say one minute I'm going to go talk to my roommate, and she said I sounded really panicked. I said I'm talking to my roommate and she said oh. Oh great, I guess. [00:02:30]

So, yes, I spent I don't know a good four days feeling really crazy. Yes, it was not it's actually [inaudible at 00:02:50] the worst psychiatric medication things that I've ever had happen. And also there's been the lingering effect of all last week my eyes really hurt [inaudible at 00:03:13], it was giving me headaches. And then I was also super irritable. I talked to my psychiatrist who was super concerned that I could've died. And I said sorry, just. And she said you're probably going to feel like crap for another week or two. So -

THERAPIST: Yea.

CLIENT: Yes, so this is the fourth, fifth, sixth, seventh. I got home on my sofa with the AC because I said I just can't be around people because everyone's making me really irritable.

THERAPIST: Oh, it's horrible.

CLIENT: Yes, so the worst part of it was that for all of Friday and half of Saturday I didn't really know what was going on except for that I felt crazy. I guess for a better word -

THERAPIST: So this is -

CLIENT: During the -

THERAPIST: ten days ago?

CLIENT: Yes. So I had super racy thoughts and just feeling really panicked and then not.

THERAPIST: That must have really scared you I mean because I, we haven't talked in a while, but I know you worry about things like that.

CLIENT: Yes. Yes, it was pretty terrifying because I mean it was just terrifying because I just felt flat out crazy and I also, I don't think this is I don't know. I couldn't really think very well but I was pretty sure this might be the you-go-away-to-the-hospital-for-a-day-or-two crazy because I just felt so confused and reality felt furry and it just was I don't know. But then I also really couldn't make decisions very well for quite a while because -

THERAPIST: That was part of the whole thing?

CLIENT: Yes. And I was talking to my roommate Ashby because I called the pharmacist and the nurse said you should go to ER. I didn't want to. So I decided to call my brother who's on vacation with his wife and ask him what it was like being in a psych ward. As it turns out my mental psych ward that when I think, when I get really sort of like irrationally terrified of being forcibly institutionalized, it's basically the hospital in my head is what's being played (ph), which that when I was an undergrad with a few friends of mine who had to

THERAPIST: break [inaudible at 00:06:44].

CLIENT: [inaudible at 00:06:44]

THERAPIST: Yes.

CLIENT: So, I actually never visited the [Walter Reed] (ph) but that's basically what I imagine. That sort of look. And it was good; I managed to hold up easy. I thought it was really scary that if I checked in they wouldn't let me leave. And it would be forcible psych hold or something just I was scared that I wouldn't leave. And also I fear weekends, like that's not fun, Saturday night wasn't any fun, and I didn't want to bleed. Also the process of waiting for hours and then being in a hospital room and just also I'm going to get bored and I was just thinking this. My thought with this was I think I'm going to be more freaked out and anxious if I go in than if I stay home and my other treatment is thallium, which I have, so [00:08:14]

THERAPIST: Which is for -

CLIENT: [inaudible] surgery on [inaudible at 00:08:15].

THERAPIST: Which by that point you need a hat or?

CLIENT: Yes, I figured out. I figured that out by Saturday afternoon.

THERAPIST: So you're concerned about having to go to a psych ward for the serotonin syndrome?

CLIENT: Yes because, well two reasons. A, I'd essentially be alone. And B, I said I'm not seeing right now so I don't know how I would it probably is in a way. I don't know, I don't know. Like basically her existing in the apartment made staying in my apartment a little less or slightly more of the thing that seems reasonable on the grounds that I said well she would notice if I got worse and would call 911.

THERAPIST: Are you feeling that I thought you should have gone in or something?

CLIENT: No.

THERAPIST: Okay.

CLIENT: No, no, no. I was, I -

THERAPIST: You were really unsure of what to do -

CLIENT: I didn't know what to do.

THERAPIST: and probably were confused.

CLIENT: Yes.

THERAPIST: And also unsure where to, who to ask.

CLIENT: Yes. It was also one of those things where I said well I picked nurse hotline so I had to call said you might want to go to the ER or call the pharmacy.

THERAPIST: Could you call I mean, you could have called me although once we got out what it was I probably wouldn't been that, I mean I could've Googled it too but I wouldn't have known other than that any more than you. I guess could you have called Izzy (ph)?

CLIENT: I could have; I didn't think of it until Sunday.

THERAPIST: Why?

CLIENT: Because I didn't want to go in.

THERAPIST: To see her you mean? [00:10:15]

CLIENT: I didn't want I just didn't want to go to the hospital.

THERAPIST: No but I guess -

CLIENT: I wasn't thinking very well.

THERAPIST: Okay. I got that. Your thought was that if you called her she would tell you to go in.

CLIENT: And then I would feel like I had to go in.

THERAPIST: And you had to go in. Well I get the part about how by not calling her you can avoid feeling like you have to go in. It's just all the time you were trying to figure out what to do.

CLIENT: Yes.

THERAPIST: Okay. It was just muddled.

CLIENT: Yes, and -

THERAPIST: You didn't want to go in.

CLIENT: I said I don't want to go but the problem was that some of the symptoms were that's just every day. Are you nauseous, are you sweaty, are you...? So what? I'm nauseous half the week, I'm always sweaty, I don't know where to -

THERAPIST: Right.

CLIENT: Yes.

THERAPIST: And now you're [inaudible at 00:11:17] and I assume you didn't call your PCP's office for the same reason you didn't call Izzy (ph).

CLIENT: I did call them and they said well when did you last take the tramadol, which I wasn't entirely sure because I couldn't remember.

THERAPIST: And this is the doctor calling you back?

CLIENT: Yes. And [inaudible at 00:11:40] calls back well it should be out of your system. TSL review okay, take your temperature. If you start running a fever or have a seizure call 911. Okay, I'll do that. But I think I still, I don't know. When I was talking to my brother about the times that he's been in psych wards I realized that I never visited him ever. Yes, we were talking about it and when he was I think we were in Finland when I was just 19, he was I must have been 16, he was 18 or 19 my parents wouldn't let me, they told me they would not let me go because it would be too scary and disturbing. And [00:12:51]

THERAPIST: I was in another country.

CLIENT: So -

THERAPIST: That part hasn't -

CLIENT: Yes, and it was, it was very -

THERAPIST: Difficult?

CLIENT: I wanted to but I think the way -

THERAPIST: What things you think makes it scary, the other people or your brother?

CLIENT: My brother. They were worried, they felt that -

THERAPIST: He was psychotic?

CLIENT: Yes. Even though we I already had because we were trying, myself, I think my dad and I, were trying to talk to Seth because he wasn't okay it was clear clear, and he was really sad and rambling and then open (ph) for a while. So I already knew that he wasn't okay but they would not let me go but they visited every day. And then I guess my [inaudible at 00:14:17] at Dartmouth basically a student, whatever [00:14:18]

THERAPIST: Stolen.

CLIENT: Yes, basically. And it was something like [he used to] (ph) come on the bus and it wouldn't have been hard but I didn't and my parents were actually saying no, no, no you don't need to go; he's fine, don't need to go. And then he's been more than one, what's that word, what's that word in program, whatever. Yes, and they and Barry said you shouldn't come, there's no point, he's I don't know it was just dismissive like there's no point in -

THERAPIST: That's unusual.

CLIENT: Yes, it was really somebody said that is fucked up midway through. And it's like they were we both said yes that is because one of the hospitals he was in, and he was in it for a couple weeks, I could walk to from my parents' house. It's a [low-ball] (ph) place you go to, and actually in the hospital they ran there from his high school, the [inaudible] society. So, I feel really weird that I never -

THERAPIST: [inaudible at 00:16:03]?

CLIENT: Yes, yes I mean it's nothing but yes, actually as we were talking about it and I never visited him, I felt very uncomfortable about it that I haven't. [00:16:22]

THERAPIST: Yes, I wonder if you are afraid it would make you crazy.

CLIENT: I don't know. I don't, I don't know. Yes, it's I guess I'm prone to that. My parents were both very dismissive of it and said it would be too upsetting for me to handle, which [is fair] (ph). So I guess in that sense yes, I felt like well it's that bad and they go then what if, I don't know, I lose my entire mind and then what happens next?

THERAPIST: It [inaudible at 00:17:28] around you I guess.

CLIENT: Yes. And -

THERAPIST: That's all part of it. Well it sounds like your parents, I mean in that I'm sure it really disturbed them for their son to be having that kind of trouble.

CLIENT: Especially the first time. [00:18:03]

THERAPIST: Yes. And I would imagine they didn't talk a lot about that or probably from what I know of them, what you said, acknowledge a whole lot how insane it was for them. They just put all of that disturbance into you. In other words, yes it's upsetting and it's very difficult and everything but it was basically something really thrown into a loop that you got to not go anywhere near that place because that was a squeaky route. Do you know what I mean?

CLIENT: Yes, and I was also thinking I get to, I also worked for the [inaudible at 00:18:48] ward, both times I visited Fred in the hospital because I know him. It was rhetorical theoretically disturbing. And oops, sorry, it's still weird. And so my brother actually we talked and it was kind of like, well his main comment was the thing about being in the psych ward is that they try to make you feel better. So that's really nice. I said yes, that does sound very nice. I actually said all right I'm going to do this. And then the on-call doctor said no, stay home. All this emotional work to feel okay about it and now you just want me to stay home. And I was also being neurotic about Ashby asked do you want me to go with you? I said no, yes, maybe.

THERAPIST: Where were you going to go? [00:20:03]

CLIENT: That was the thing, the reason why I called, the one reason I called which was do I say, do I go to Sinai or do I go to [inaudible at 00:20:20], where do I go? And the answer was, ended up being to stay home. That was part of my fear I don't know where I'm going. And from when I was in school and right after, it always if you were going to Walter Reed (ph) or somewhere you kind of were okay, it's usually like oh, okay they have a thing, [an installment] (ph) for a day or two, and then they came home. But Walter Reed always seemed like this mysterious and suddenly they're gone and you don't see this person for a week. And you're alone and it just felt that it was all very scary and weird because you weren't [inaudible at 00:21:20] and it was something new for college me it was difficult to get to and I was just like what the fuck. And it was always unclear -

THERAPIST: Man, it was associated with big stress and memory L, which I mean which is early HDL or which is especially created with some great fears.

CLIENT: Yes, and it also always felt like maybe they don't want the [inaudible at 00:21:55] because or maybe I shouldn't go because I don't visit my brother so maybe I shouldn't so yes, it was [inaudible at 00:22:23]. It's definitely been a not good two weeks, this whole time, really -

THERAPIST: I imagine it's been kind of disturbing for you. I mean this is like, I don't know, really teaches you how it was like to be a little psychotic, something that's been terrifying you for a long time. And it's got nothing whatsoever to do with mental health in a way program (ph) action but I guess it was a relief [inaudible] didn't know that. And even afterwards, like later kind of matters in a way but in other ways kind of done.

CLIENT: Yes, I was well the first thing I was considering once I was, once I said serotonin syndrome, okay this is happening, okay, wait I can process what that means. I said why did Lauren tell me this is the worst thing in the world because [inaudible at 00:23:41] oh, I'm stressing, it's just [inaudible at 00:23:46]. It didn't even happened very much, I felt like people have described it I said oh, so you feel really depressed or panicky or gross or whatever for a day or two. I did not think it would be like I don't feel sane for several days. And yes I guess I feel like yes, this is probably a tiny taste of something [Jim recycled] (ph) in his head and that was really also super scary and that it was so horrible. I also thought really well that I never [inaudible at 00:24:53] myself or others because I really want it to stop and really just wondered -

THERAPIST: Because you want to know what was actually going on?

CLIENT: My point is I don't remember half of it.

THERAPIST: I mean being psychotic is you usually find it really awful and horrible. It can be terrifying, it can be very confusing, very disturbing. Unless it's mania, hypomanias can feel pretty nice for a while. But other than that it's awful, awful, awful, awful.

CLIENT: Yes, but one of the things that I found funny and horrible was, was all those the nurse. And she said I'm just want to ask you a series of questions, [something we're going to cover] (ph). I said yes, great, determining coverage. I think I am, whatever. And so she's asking the standard do you feel like killing yourself [when you walk] (ph) into your house, do you want to harm other people, blah, blah, blah, and also asking me other questions. And I always want to say I know you're going to ask the standard-type questions. The answer is I'm not going to kill myself, I'm not going to hurt someone else, I'm not listening to [inaudible at 00:26:39]. But I'm pretty sure that's not actually going to be helpful if I've just said that but I always want to. I just kind of [inaudible at 00:26:55] because she was trying to be very casual about it in feeling and I was just can we get to the part where you tell me what I should be doing? And she asked if any of your part of your body not work and I just didn't, I said I don't know what you're asking me. And she just repeated it verbatim and that's when I went to my roommate's room and asked her do you think any part of my body isn't working and the nurse thought I was talking to myself. [00:27:28]

The other thing about being yes, yes, I know what you're asking, is to think wow, I guess I have been spending a lot of time. I've made that phone call or had that interaction a lot which I don't know. I guess I always find it a little frustrating because I guess my answers are pretty much boys and things. I don't want to hurt myself, I don't want to harm others, I'm not hearing voices, I'm not hallucinating anything. And so I don't know, for some reason why the fact that I always say get a hold of that makes me feel like oh obviously not that. I'm not mentally involved because I said no to those questions and I do every time. And then I think yes, but that's not that's more of the do you need to leave your space right now, sort of question. [00:29:16]

THERAPIST: Right it's more like sort of the immediacy, kind of how to what extent are you immediately in danger kind of question.

CLIENT: Right and do you feel safe in your home question. But as of [inaudible at 00:29:48] I said yes, I spend a lot of time dealing with all the issues. I guess that it feels in a certain way old hand like I know what you're going to ask me. I know she can find my pill bottles, et cetera.

THERAPIST: When have you had to answer those questions? I mean I don't think you have since I've known you, maybe yes. [00:30:30]

CLIENT: When, let's see, [inaudible at 00:30:36] that recently. Every time I see a new therapist, yes. When I when I call in [inaudible] Ashley or whatever [inaudible at 00:30:49] purpose -

THERAPIST: Oh they ask you that?

CLIENT: They ask you that and then a couple places also asked me that if it's an emergency and I say no, I just want to see a therapist.

THERAPIST: That's kind of different. I mean I'm not saying how they've had to deal with mental health issues but [inaudible at 00:31:12] you've got to frame it as though you have sort of often had to deal with mental health issues that are serious enough that it really makes sense for people to be asking those questions.

CLIENT: What, so I guess part of it is I don't think I also get asked those questions when someone says is anyone in your immediate family have mental health problems? And then I say yes [I'm going deaf] (ph), my father and brother are [inaudible at 00:31:41] and psychotic. And they say whoa, I'll ask you some questions. And seeing who's a scrubber, I don't know, I just been asked it a lot.

THERAPIST: Okay.

CLIENT: Also if you [inaudible] and care on every 10 days I think [inaudible at 00:32:06]. I think it's primarily an item that my brother, my brother [inaudible at 00:32:17] father.

THERAPIST: I mean you're not even close to any of those things except for this incident really as I understand it. [00:32:31]

CLIENT: Yes.

THERAPIST: If it refers to the anxiousness that's all in the past but I mean it was horrible, I'm not trying to minimize that but it's different.

CLIENT: Yes, I guess that's part of why I'm always blocking the discussion because that's not my mental health problem and I don't know, or but it's I kind of wonder could we just cut to the chase of whatever I want to do?

THERAPIST: I see. Like with the nurse on the phone just skip it and get to the part where [inaudible at 00:33:18].

CLIENT: And I understand why they're asking. I get all of that. I guess part of the frustration is I get really frustrated when they try to pretend that they're not asking these questions and it's like just ask; it's easier. I guess I feel like in this weird way I may have to justify myself, which is what's happening. I don't know I guess part of why I [live with this] (ph) is one of the reasons why I didn't want to go to the hospital is I'm well I'm not going to die in the next hour probably. So I don't know, it felt like I was calling urgent care for an infected hangnail or something. [00:34:40]

THERAPIST: It sounds to me like you have a sense that somebody is going to find you to be crazier than you are. [inaudible at 00:34:56] for the wrong idea, or they're asking these questions because maybe that's really what's going on or they'll think so. And you're going to wind up in the hospital and they'll keep you for longer than [they do there] (ph) because they're going to think too, -

CLIENT: Yes, I don't, I guess I don't fully trust that whatever doctor I'm seeing is going to listen to me or listen to me, believe what I have to say and I have found that and also let me know what's going on or let me make some kind of decision on my own.

THERAPIST: Like the [inaudible at 00:36:11]? Like the judgment about that and what should be done? [inaudible at 00:36:21]. It's tricky. I know that happens. I mean the I think you mean to be hospitalized you don't want to be [inaudible at 00:36:43] haven't that much anymore. If anything people, at least what I'm hearing more often is that people not getting admitted or being released too early.

CLIENT: Yes. My brother's comment was there's no way they were keeping me more than 48 hours.

THERAPIST: Yes, if they would have admitted you.

CLIENT: Yes, he says even if worse they would admit you, you would be out in two days. I said yes.

THERAPIST: I mean the only thing that would happen is if there was some study done by grad student, traffic (ph) grad students when they said they told us that they were hearing voices but endorse no other symptoms and the person who told them to do this was in ethical studies.

CLIENT: Excellent group [inaudible at 00:37:41], where no room ever -

THERAPIST: I don't think they do that anymore. They'd be kept for three weeks. Nowadays they wouldn't be admitted. Maybe not because this was so much more insightful but because the vibe was -

CLIENT: [inaudible at 00:38:02]?

THERAPIST: Yes. But any way, that is all true but yes I get aware how much [inaudible at 00:38:10] too you're being treated that way a lot through your mom and that contributes to fear of joining. It's not just the kind of perception that happened, you have, but you had. But that she doesn't listen to you about what your symptoms actually are and what's going on and has this diagnosis, determination about your mental health.

CLIENT: Yes, I mean that's the big private I mean the other two things are for a while the CS, the pharmacist would argue with me about getting prescribed both valium and Ativan and then [inaudible at 00:39:06] my psychiatrist go away. And we argued, I think we argued at one point three different times.

THERAPIST: Oh my God.

CLIENT: Yes. I said the doctor prescribed them. You're not telling me that I'm having a drug interaction, so and I've never seen her do that with anyone else except when one time someone wanted, did not want the [inaudible 00:39:34] package the generic version and the pharmacist said no it's the same. And the woman said I don't want the generic [inaudible at 00:39:44] specifically on the directions [inaudible]. So that experience is super stressful. And yes, the thing my mom's saying of being I know what's really going on with you. The other thing that I run into I was talking, I talked to Ashby about it, my roommate Ashby, [inaudible at 00:40:29], how in this weird way that I guess that every morning I get dressed and feed myself and go to work and feed myself and shower and whatever. But and leave by myself and do, function, but I'm not always taken very seriously. I'll talk to friends and they say well but you know. And I still believe never -

THERAPIST: You get out of bed every morning.

CLIENT: Yes, yes, they say but you get out of bed every morning. I say well yes but that sometimes takes an hour. I think part of it is that well [inaudible at 00:41:36] suicidal, I said I don't know what to tell you. I haven't but it's very broken. And it's usually people who haven't had mental psych inter mental problems or very focused on whatever theirs is. And so one of my friends was saying how she gets really angry sometimes and frustrated; she feels like some people, every place was they sit down like they have their own problems and at some point they're just like they don't get [in the bed with it] (ph), they're just and she says I feel I can never do that. [00:42:31]

And I do feel like I have a [inaudible at 00:42:38] in this weird way sometimes I feel like if I actually did that, couldn't get other opportunities or whatever, that would somehow make people take me more seriously.

THERAPIST: I see.

CLIENT: But I don't actually want to do that. And it's just I guess it's like when I told Ashby, I said Ashby I'm kind of having a nervous breakdown, she said yes, yes. I said no, no, I'm feeling woozy right now and she said oh, okay. And I also said that to Molly. And I guess in a way they do, in a weird way, kind of envy Josie just being I'm going to fuck off from all responsibilities for two or three years. She felt horrible but I would also like to fuck off for two years or whatever. [00:44:25]

I guess I had a little I guess I would like to I guess the other thing is I tell someone so the deal is I'm feeling very depressed right now and their response is well everyone has rough times. I say no, I'm really depressed right now and I would like you to pretend that I'm recovering from major surgery. And it just gets so frustrating that sort of, I'm trying to communicate we're not doing very well and [inaudible at 00:45:29]. I say nope, nope seriously, and there's no real just pick them up. That's not what I mean but it's just not my game. I just know -

THERAPIST: Graduation (ph) or?

CLIENT: Yes, I guess I feel like, sometimes I feel like well I don't think I can get this person to get what I need and then you let yourself go and you do that [inaudible at 00:46:09] you don't want to [inaudible at 00:46:09].

THERAPIST: Right, you're feeling however you're feeling [inaudible at 00:46:15] contemplating?

CLIENT: Yes.

THERAPIST: We can stop for now but I'm so sorry to hear about what happened.

CLIENT: Thank you. Yes, I -

THERAPIST: Awful. [00:46:25]

CLIENT: Yes, I'm also I never I never want to I asked my doctor for a new painkiller. I said do you [inaudible at 00:46:40]? I'm the most important thing to me is that it not interactive with anything. I don't care if it makes me drowsy or fall on my face. I just never want to do this again. So, [inaudible at 00:46:51] and I will see you tomorrow.

THERAPIST: See you tomorrow, yes. [00:46:58]

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