Portraits From Social Work – Part 2: Paul

Even since I lost my last job doing social work with high risk, low income adults out in the community, I have missed the clients I used to see everyday. While I’m not sure if these people ever knew it themselves, the time I spent with them was much more meaningful to me than just trying to get a paycheck. This was the first time in my life that I was really able to get to know some interesting characters and bond with people older than me, with totally different and unique life experiences. Even though I was supposed to keep a professional distance, I simply couldn’t help holding a space for each of my clients in my heart. I believe these people are interesting to learn about in general, but I am also writing about them today to ensure that I can keep them with me even if they eventually fade from my memory. (I obviously won’t use their real names for confidentiality reasons.)

Part 2: Paul

Where do I even start with describing this man? Paul was a gruff 60-year-old man (although he looked much older) with a skeletally thin frame, long peppery grey hair, a handlebar mustache, one hand and one leg. The leg he lost a long time ago in an accident when he used to ride a motorcycle. The hand, well that’s a mystery to all of us. When I first met Paul, his left hand was curled into a permanent fist. The way Paul tells it, he woke up in the middle of the night a few years ago feeling as though his forearm, wrist, and hand were on fire. He traced a ghostly, zigzagging, white scar on his skin to show me the path the “flames” took. His hand clenched shut and hasn’t opened since. We went to many doctors and specialists, but none of them had a definitive answer. Their best guest seemed to be that it has something to do with his excessive drinking, and I’m inclined to believe it. Paul, however, would never take complications from years of drinking as an answer to any of his health problems, of which he had many.

Paul was one of the most sever alcoholics I’ve even known. He was never a violent or angry drunk. He never caused any problems that I knew of except for himself. Paul’s favorite drink was vodka. And he drank about a pint of it a day, despite only receiving around $700 a month from social security. There were a few instances where he ran out of money at the end of the month and actually had to be hospitalized due to DTs or alcohol withdrawal. Once he even called me to his hospital room to ask me to bring him vodka and cigarettes. (I felt bad for him so I actually did agree to bring cigarettes, knowing he wouldn’t be able to smoke them anyway. The nurse promptly took them away.) He actually reminded me a bit of Frank Gallagher from Shameless, although Paul was a bit more irritable.

Paul was definitely a character. In addition to drinking and smoking cigarettes, he also loved to smoke weed. He even had a marijuana leaf on his wallet. As soon as medical marijuana became legal in the state he demanded a prescription from every doctor we went to. Of course he didn’t get it, even though he was eligible. The system was not yet ready to dispense actual medical cards, and there were no dispensaries even if they could have. There was no telling Paul that though. He was hard-headed to put it mildly. He was often angry and impatient, but honestly, could you blame him? His life was a constant battle with pain and poverty.

In the end, Paul’s life was evenly split between drinking in front of the TV and traveling all over the state for medical appointments. When I last saw him, I knew his time was limited. He was bleeding internally. It was clearly caused by his drinking. Still he refused to stop. I’m honestly not sure if it would have made a difference at that point anyway. As I sat down to write about him today, I decided to check the local obituaries. I held my breath, hoping I’d find nothing. Instead I discovered that Paul passed away in the summer of 2019. The obituary listed so many surviving family members, children and siblings. I new he had family, but seeing just how much and how close by they lived really broke my heart. They had all left him in the hands of the state to whither in darkness and die alone. I’m sure Paul wasn’t the best father or brother, but he certainly wasn’t deserving of that sentence. At least he got to spend his final days in the warm, sunny atmosphere of summer. That was one thing we both shared, an infatuation with summer, and a deep hatred of winter.

I wish I could have been there for him in the end. Or that I had at least gotten the chance to say goodbye, the chance to tell him that he was truly my friend, not just my client. Sure, he gave me a lot of anxiety over the years by giving this people pleaser so many unethical requests, but I am thankful for the time we spent together. Despite all his flaws, he was a good man. It saddens me deeply to know he’s gone. At least I know his pain has finally ceased. I hope he has found peace. The next time I drink vodka, I’ll pour some out for him.

11 best vodkas | The Independent | The Independent

Chemical Dependency

I make no secret of the fact that I take Paxil for my anxiety. For the first few years that I was taking it, I was quite outspoken about it. I never really understood why some people felt embarrassed by the fact that they were taking an SSRI or other mental health medication. Far from being embarrassed, I was advocating for the medication. I was encouraging other people struggling with anxiety to take it as well. I was telling anyone who would listen about how wonderful it was, how completely changed my life was now thanks to Paxil. And it was irrevocably changed, in a good way, at first…

Now I’m kind of glad that none of the people I pressured to get a prescription actually did. I would have felt awful if I ended up seeing them struggle in the same way I am now. Don’t get me wrong, I am still grateful for Paxil. If I could go back in time, I honestly don’t know if I would decide not to start taking it knowing what I know now. I suppose the point is, SSRIs aren’t meant to be lifelong medications. They are supposed to be temporary ways to cope with particularly difficult mental health situations while you work on targeting the issue behaviorally through therapy. If I could change anything, it would probably have been to go to a therapist and a psychiatrist before getting a psychiatric medication from my primary doctor. While they are able to prescribe these medicines, they really don’t have the depth of knowledge about them that a psychiatrist would. Perhaps a psychiatrist would have at least warned me of the side effects and potential consequences.

For a few years now, I’ve been contemplating the idea of lowering my dosage. I’ve just been too afraid to take the steps to do that though until now. I’m afraid. I’ve read that Paxil is a particularly hard drug to wean yourself off of. You have to do it extremely slowly otherwise the withdrawal effects can be overwhelming. I’m actually afraid that my doctor won’t understand that well enough to lower my dosage as slowly as it needs to be lowered. I’m also afraid that even taking small steps may result in big emotional issues.

I remember thinking how insane it was that just taking a pill could make me feel and think completely differently. I didn’t understand how it was able to target something as specific as social anxiety. Not surprisingly, I found out later that it doesn’t. No, Paxil has effected many different aspects of my life. I don’t feel as anxious around people anymore, but I do feel more generally anxious about nothing in particular. I also don’t really feel very much at all. I haven’t cried in years. Haven’t felt really happy or excited about anything in years either. We all want to avoid our lows, while keeping our highs, but unfortunately there is nothing that can make that reality happen for us, not even medication.

For years I genuinely thought I didn’t have any side effects from Paxil. It was only recently that I realized a lot of the things I was just attributing to my personality, were because of Paxil. I’ve mentioned before that it has completely obliterated my libido. I actually thought I was just asexual for awhile there. Even more disturbing than that is realizing that it might have something to do with my struggles with relationships in general. Just yesterday, I decided to google the effects of taking an SSRI on love. I wish I had made this connection years ago. There was page after page of results about taking Paxil and having a difficult time falling or even staying in love. No wonder no other love has felt the same as the love I shared with my high school boyfriend. Who I was with, coincidentally, before I began taking Paxil.

This whole time I have been torturing myself, thinking that maybe soul mates do exist, that maybe he really is the one and only person out there I’m capable of loving. I’ve been agonizing over the fact that the love I share with my new boyfriend feels different. I’ve been worried that this discrepancy of emotion was a “sign” or some other such nonsense that I don’t even really believe in. I could never understand why even when I would meet people that seemed perfect, they couldn’t hold my attention and affection for long before I would lose interest, despite desperately wanting things to work. I’ve spent years alone, thinking there was something wrong with me. It was bad enough that this medication damaged my sexual relationships, but my romantic relationships too? How could anything be worth that?

What finally pushed me over the edge and helped me make the decision to call my doctor today and start lowering my dosage was what happened yesterday. As I was refilling my weekly pill capsules, I realized that somehow I had nearly run out of Paxil. I only have enough to last me until this Friday. Immediately I was panic stricken. The withdrawal symptoms of Paxil become debilitating within a few days of not taking it. Never before had it really hit me just how dependent on this medication I actually was. I felt like a junkie who didn’t know when or how they’d be able to get their next fix. It felt so awful knowing how much I needed this little white pill. I don’t ever want to feel that I need anything in that way ever again. It’s time for a change. It’s time to uncover and rediscover who I really am and how much of me has been Paxil this whole time.

Changing Antidepressant Medication: Coping with Side-Effects | HealthyPlace

Sleepwalking

Everyday I follow the same pattern. And the more days that go buy that way, the harder it is to deviate from that pattern. I tell myself I just like doing things this way and I can stop whenever I decide to. But then there is a softer voice in my head that wonders can I? I have been sleepwalking through life for so long now, years actually. I haven’t even tried to stop. Now I’m afraid I may not be able to.

One of the things I’ve always been grateful for is my ability to kick addictions. I’ve stopped smoking cigarettes for years at a time quite easily, cold turkey. I’ve abruptly been able to halt a rapid descent into alcoholism. No desire to drink lingering for even a moment. No hesitation. I’m one of the few able to successfully and easily become vegan. It’s been nearly a decade without animal products now. I have been able to stop smoking weed at times when I felt it was no longer serving me. No hassle at all.

I don’t know how other people end addictions, but for me I just start to get sick of it. I guess it’s like hitting rock bottom. The fear of continuing on this way becomes greater than the fear of changing. I’ve also heard that some people are just genetically predisposed to struggle more with addiction. I’m not sure how true that is scientifically, but it does seem to be a lot harder for some people, impossible even.

But maybe it’s not the chemicals or substances that I can’t let go of. Maybe it is harder for me to sacrifice my routine. If I am able to replace a component, whether it be an addictive substance or not, I am easily able to carry on. I’m less confident about being able to change my routine in general. To break away from even having a rigid routine. I am getting tired of it though. Being a prisoner of my own habits. I’m tired of sleepwalking through my days. Not thinking, mindlessly going through the motions, mimicking the day before. Even when it wasn’t a good day.

I can hardly remember what it was like to be a kid, waking up to endless possibilities, no structure, perfect summer days, doing exactly as I pleased. I’ve all but forgotten how to exist in that way. I don’t know how to listen to my own desires anymore. I’ve boxed myself in. And I’ve become afraid to leave that box. But I want to learn how to be mindful in each moment again. To really live again. Or at least try to. And even though here I am again, just planning to make plans, I still have faith in myself. At least it’s something.

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Self Sabotage (Anxiety Edition)

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Have you ever only started to notice something after it’s pointed out to you? At my last social work job, one of the therapists advised a client with an anxiety disorder to stop smoking. This client was a mess and also coincidentally a chain smoker. The therapist told her that smoking cigarettes increases anxiety despite her insistence that they calmed her down. At this point in my life I was not smoking, but I had in the past. I tried to think back to the way I felt after having a cigarette. I couldn’t particularly remember them making me feel anxious. But it made sense, and I wondered why this client would continue smoking if it did indeed make her feel worse.

Fast forward a few years to the present day, and here I am, smoking again, more anxious than ever. Except this time, I do notice the connection. Even before I’m done with the cigarette, I can feel my anxiety going through the roof. I spend the minutes before I light up looking forward to smoking, then spend the time during and after asking myself why on earth I am doing/just did that to myself. It is perplexing to say the least.

Addiction is a fascinating beast. The way it can make you want something even when it makes you feel bad immediately. Somehow your body still craves it. It’s not just cigarettes of course. I also have this problem with coffee. Although I don’t worry about that one as much. As far as I know coffee won’t give me and those around me cancer. However, the caffeine does make me feel like I’m jumping out of my skin. It doesn’t really give me energy the way it used to. Maybe the first cup or two does a little, but I generally drink at least a pot a day when I’m at work.

The craziest part about these destructive habits is that I am using them as coping mechanisms, as a crutch. I don’t really know how that can be. I’ll feel anxious, so I smoke a cigarette. That only makes me 10x as anxious! I feel anxious because I’ve been drinking coffee all day long. So what do I want to do to treat myself and relax? Have some coffee of course! It never ceases to amaze me what a mystery my own mind is.

Now rather than looking at my client in confusion, I find myself looking at my own reflection instead. Even though I have big plans to stop smoking again next month and probably switch to decaf or tea too, I know it’s easier to make plans than to follow through with them when the time comes. Nothing is preventing me from stopping today, but yet here I sit, looking forward to another cigarette, another delicious cup of coffee.

I don’t know why I sabotage myself in these ways. But I’m sure they aren’t the only ways I do so. Perhaps at the very least I can learn something from this realization. Maybe I can start to recognize other manners of self-sabotage. Maybe a therapist can help me discover the reason I am making things so hard for myself while simultaneously pretending I’m giving myself a treat. For now, I’ll just keep reminding myself where to place my focus. I am not changing these behaviors because they are “bad” or because I am “bad” or “stupid.” I am changing these behaviors because I love myself. I want happiness and tranquility for myself. This is not a punishment or a reprimand. It is a tender act of love. And that feeling of warmth and compassion, that is what I need to truly change for the better.

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