Help me help myself

May 8, 2006 11:45 AM

I've started to write this question a dozen times in the last year, but I always stopped before clicking the submit button because I'm afraid that the answer is that there is no answer. So, here goes nothing: How do I get therapy (or improve my situation) without money, friends, transportation, or any other useful resources?

I'm a 30 year old female. I suffer from a wide array of severe emotional problems, and I'm currently on disability and Medicare (Medicaid dropped me after a couple years because I qualified for Medicare.) I've had no case management to speak of. I've been diagnosed with, at one time or another: bipolar disorder, borderline personality disorder, generalized anxiety disorder, social phobia, panic disorder, dysthymia, major depressive disorder, complex post-traumatic stress disorder, obsessive compulsive disorder, body dysmorphic disorder, and anorexia nervosa. (I'm aware of the dangers of identifying with diagnoses; I'm just trying to illustrate the extent of the damage.) I've also got cancer (not currently life-threatening, but a financial, emotional, and physical drain.) In layman's terms, I basically hate myself so much that I don't like to go out in public, and when I do go out in public I am paralyzed by irrational fears and phobias. At home I'm extraordinarily morose. I've been increasingly suffering with these problems for 20 years now. The source of these emotional problems is probably a combination of genetic predisposition combined with certain traumatic childhood events and emotional neglect and abuse.

This is all very frustrating because I am actually very bright and have a lot of skills, but I haven't worked since 1998. I want to work and go back to school. I want to be out in the world, making friends and having some kind of a social life. All of my attempts to improve my situation so far have been stymied by a lack of resources. About half of my income (1400 bucks a month) goes to rent, and the rest is eaten up by normal bills and cancer treatment. I currently operate at a deficit of about 250 bucks a month, which I take from a modest back payment I got from the SSA. Those funds will eventually run out, and are my only meager defense against catastrophe.

I've tried going to therapy, but the (very) few therapists willing to see a Medicare patient still charged far more than Medicare covers. I had to stop going due to lack of funds. I'm unable to afford any of the medication prescribed by these doctors/psychiatrists. I get by for awhile on samples, but then I have to stop taking them because I don't have adequate prescription coverage. (The new prescription coverage from Medicare is a total scam-the deductible isn't too bad, but the gap is a complete joke. Even with that program I couldn't afford psychiatric medications-I'd be into the gap in just 4-6 months, and I can't justify spending another 35 bucks a month on top of what I already spend on my current prescription to get a few months of meds a year.) Besides, I've already taken Zyprexa, Lithium, Zoloft, Celexa, Elavil, and Prozac, among others, many before I was 15. I think enough damage has been done, neurologically speaking, though I wouldn't mind trying lithium again.

Last year, after an emotional breakdown, I went to psychiatric urgent care. After a couple hours of counseling, the caseworker admitted that she just didn't know what to tell me. She said that what I really need is case management, but couldn't offer any solutions or paths to treatment. For that advice I paid 90 bucks that Medicare didn't cover. Since then I've tried self-treating with books and carefully regimented journaling, exercise, nutrition, and sleep habits, but frankly, I'm just continuing to spiral down the drain. Recent disappointments have just sent me over the edge, and I'm cursing myself for even trying because failing is like ripping the scabs off the road rash I already have from trying to slow my slide into the abyss.

Now I just don't know what to do. I have no friends to speak of (they all live far away now) and my family isn't interested in filling the support network role, emotionally or financially. For all intents and purposes, I'm alone. I don't have the ability to get to many places on my own. The soul withering effects of being constantly rebuffed in my efforts to get help or improve my situation is really taking its toll on me. I want things to get better, but I don't know what my options are at this point, or how to find out what my options are. I'm in absolutely no danger of killing myself (I think it's rude and stupid), but I don't relish another 20 years of misery and anguish. I just want to be well, and I don't know how to get from here to there. In the last 20 years I've tried evading, ignoring, masking, pretending, self-medicating, running, self-treating, and even praying. It's just not working.

What am I missing? What resource have I overlooked? Where do people go as a last resort? If needed, I can answer questions at this temporary GMail address.

posted by anonymous to health & fitness (31 comments total)

I have had anxiety and found some stuuf that really works recently - progressive relaxation, yoga and Alexander technique. I put in another forum - http://www.quarterlifecrisis.com/forums/showthread.php?t=19662. I hope this doesn't sound like a flippant answer but it is amazing for me and I hope ir can help.
posted by lunkfish at 12:00 PM on May 8, 2006

Depending on where you are (county, state, country), there may be free or low-cost help available through Social Services. I can't give you any kind of concrete info beyond that. Here in California, for example, everything seems to be handled trough the county. Sadly, it seems that the services are placed behind a wall of red tape, but they are there. Good luck to you.
posted by lekvar at 12:29 PM on May 8, 2006

Someone close to me has a situation that isn't altogether different from yours: no money, severe emotional problems, self-hate/anxiety/suicideation, limited family support, etc. She has finally gotten therapy for the first time (she's 55 years old), through a psychiatry school (in NYC). She pays $5/session and goes to three sessions a week, which is pretty damn cheap and frequent. She has just started on Effexor (after having tried several SSRIs a few years ago) which I believe she gets from Canada: she gets all of her drugs from Canada AFAIK.

Obviously the NYC part gets rid of the "no transportation" problem, and I don't know where you are, but if there's any psychiatry program accessible to you, that could be an avenue. And if you can just get the prescription for something out of patent, you can get it generic for less and/or from Canada (sorry, I don't know any pharmacies to recommend, and of course it seems like fertile ground for SEO spamming).

Hmm, but you can't justify another $35/month? That sounds a bit pennywise, if that investment would enable you to work/live/function. But I also know how lean money times can be.

Oh, and it's possible that if you found a study to participate in, they would treat you and might even pay for your transportation to/from the study site.
posted by xueexueg at 12:30 PM on May 8, 2006

I must say I'm a bit intimidated by your post: you state the severity of your problem very clearly and you pretty much rule out any solution to your problem. That makes me expect any suggestion I might make to be proved impossible by you (if you were not posting anonymously of course).

But I'll try.

I see two approaches:

1 Make more money and buy professional help. Your problems are severe and complex enough to absolutely need professional help and not some internet forum drive-by help. (yes, I know that's a self-referential statement).

2 Treat yourself for free.
2.1 Seek out situations that change you because you're in them. Work, voluntary work, social events.
2.2 do some form of meditation in a group setting. This may lessen the strength of your improductive thought patterns ('I hate myself' f.i.) and open a window of change in that respect. Some buddhist approaches ask for little or no money. There are a lot of MeFi threads with advice on meditation.
2.3 Find a support group for the social aspect. Some support groups are inexpensive or free.

I think option 2 is quite unsure; it's a bit of a band-aid actually. So I'd advise you to go for option 1.

And on a personal note: if you're down in the labyrinth it's hard to remember that open views exist. Good luck anonymous.
posted by jouke at 12:37 PM on May 8, 2006

I feel supremely incompetent to offer any but the most basic advice.

One suggestion I have regarding financing anything medical is to make a direct plea to the provider for some kind of discount or payment plan. Often they will bend over backwards to make arrangements with a sincere person, because many patients will skip out on the bill completely. But you have to ask for special arrangements.

Your county, township or other local municipality may have certain services available for free or at a discount. (In Illinois, you can get free or cheap vaccines through your county health service, as an example. I don't know if mental health issues might be offered, but you could ask.) Also, many such municipalities offer transportation services to their residents. Check into this.

You might find emotional support through an organization aimed at a specific population. I am specifically thinking of a group in Chicago called the Lesbian Community Cancer Project, although I'm sure other similar types of organizations exist elsewhere and for other populations.

Speaking from experience with my mother, ask around. You may have to swallow your pride and reveal your needs to strangers, which can be scary, but you never know who knows somebody willing to help you until you put yourself out there. We found a surgeon willing to operate on my mom for a much-reduced rate because a friend of a friend who was a nurse heard about her situation and happened to know a doctor who was a nice guy and was willing to help. Another acquaintance pointed us toward the free and reduced-rate services available through our county, because she had once worked at the free county clinic and knew that such things were available.

Good luck to you.
posted by SuperSquirrel at 12:41 PM on May 8, 2006

The anonymous poster is located in New York State.
posted by unknowncommand at 12:52 PM on May 8, 2006

emailed you.
posted by vanoakenfold at 12:55 PM on May 8, 2006

I emailed to ask about the transportation issue (and location, but unknowncommand beat me to it) and so, for the record, poster says:

Transportation is hard because I'm afraid to drive and am limited as to where I feel comfortable driving. Public transportation is available and I've used it, but it's pretty limited in terms of scope. I can occasionally prevail on people to get me to places, but it's like pulling teeth.
posted by xueexueg at 1:15 PM on May 8, 2006

The suggestions about contacting social services are good: Even if they can't do anything for you themselves, the caseworkers should be able to refer you to other agencies that are free or very inexpensive. They can recommend specific programs, some that help with finances, others that help with medical needs, etc.

Also, if you live in an area with a large research hospital, such as Cornell, you may be able to find a clinic that meets your needs. The downside to these clinics is that they are usually staffed by residents who switch off every year, creating a certain instability. But it is definitely better than nothing.

There are non-profit organizations in most communities that provide mental health services on a sliding scale. They don't always get a ton of publicity, so in a lot of communities people don't even know about them until they're referred by social services.

As for prescriptions, if you end up seeing a psychiatrist, ask about low-income programs run by the pharmaceutical companies. Most of these are for people with no prescription drug coverage, but some encompass those who are under-insured. With some prescriptions, you may be able to get a never-ending supply of samples from the doctor. When your doctor is prescribing the medication, discuss cost along with all the other factors. Zoloft, for instance, goes off patent next month, so generic varieties will be available later in the year.

Transportation makes everything difficult, of course. If you don't have a reliable transit system, or you don't have the energy to walk to the bus, wait for the bus, board the bus, transfer to another and so forth, there are still other ways of getting to your appointments. Some social service departments have "homemaker services" in which aides help people with exactly this sort of thing, as well as other needs you may have.

Another transportation possibility is that you could post to a community bulletin board. If you have some sort of skill, which you almost certainly do, whether it's a facility with words, cooking or computers, you can try to trade services. Offer a computer lesson in exchange for being picked up and dropped off at an appointment. Tutor a high schooler for her SATs -- she'll likely get school credit for community service for agreeing to drive you where you need to go.

Another possibility: As someone who qualifies for Medicare, you may also qualify for services usually reserved for senior citizens, including transportation to and from doctor's visits. In some towns, the local Red Cross will pick up and drop off people who don't have another way of getting around.

In Greenwich, Conn., there is a program called Community Answers that has info on everything from getting a job to finding transportation. If your town has a similar program, you can probably get a comprehensive list of social and mental health service agencies that way.

In New York state, most social services are provided at the county level. Check out your county website for more info.

Usually, when we are in situations we see no way out of, someone else can see something we can't. Trite though this may sound -- although if it helps, it comes from someone who has struggled with severe depression for years -- there is always a bend in the road.
posted by brina at 1:19 PM on May 8, 2006

I'll just say this: there were some sections in your message that spoke to me of an optimism within you that you may not even realize is there. Do you realize, for example, that being able to acknowledge that you are bright, that you have a lot of skills -- your own words, there -- these are extremely positive signs in and of themselves? And your desire to work, to be out of the house, to have a social life, to go back to school -- these are good desires! It means that part of you sees a possibility of a better life for yourself, and desires that. That was a very big bright sun shining out to me in the midst of all of your commentary. I was really extremely encouraged to see those words standing out amidst the rest of your post.

I'm not sure I have much else to contribute, other than to suggest that you remember that caseworkers and psychologists and psychiatrists most definitely do not always know their stuff. The fact that you've been diagnosed with eleven different mental disorders and been prescribed six different mood-altering medications doesn't suggest -- to me, at least -- that you actually HAVE eleven different mental disorders, it suggests to me that you've gotten some major boneheads as therapists, including the one who outright told you she didn't know what to say to you. If I were a therapist in that situation, I'd never actually say that to a patient. If your job is to give guidance, if you don't know how to guide the person in front of you, you don't give up on them, you get some advice yourself from higher up your food chain on what to do. That caseworker should not have responded in the way she did.

I will say that if I read your mathematics correctly, it sounds as if you've got $950 per month in non-rent expenditures, including cancer treatment. ($1,400 in income + $250 monthly deficit = $1,650 total expenditures - "half of $1,400" in rent = $950.) I have no idea how much cancer treatment runs, and of course, that is untouchable. But $950 sounds like an large amount to me. are there areas that you can trim in your budget to assist you with freeing up funds for other items? I speak not as to your cancer medications, and it would be useful to know how much your cancer medications costs when contemplating this. But let's say that half of that $950 figure is cancer-related expenditures. Is the $450 due to credit card debts? If so, have you considered, unpleasant a thought as it may be, filing bankruptcy? I ask this not to be invasive, but you are asking us to help, and one aspect of the problem that you are presenting to us is that you cannot afford therapy or mood-altering medication; it's that angle that I'm trying to address via this question.

Finally, a somewhat radical question: is moving entirely out of the question for you? I'm just thinking that if you are in area where you do not have access to transportation, your life might be made considerably more easier if you were in a location where (a) more delivery services were available; (b) there is extensive public transportation available to you; and (c) the health-oriented support structures of city, county, and religious services were conveniently accessible. These seem to me to suggest that a city might be a good location for you to be in, given your unique set of problems. Is it something at all contemplatable?

I'll leave you with my favorite paragraph from an essay called "Hack Yourself":

"We're excellent pattern-matchers. That's what the human mind does -- it's a pattern-matching engine. So we look at ourselves, at our history, at our behaviors, and we draw straight lines between the points -- we assume that just because we've done things a certain way in the past, we'll always do them that way in the future. If we've failed before, we'll always fail.

"Screw that."
posted by WCityMike at 1:21 PM on May 8, 2006

Many church organizations offer counseling, some faith-based and some not. Some churches also offer transportation by volunteers for those folks who don't have the ability to get around on their own. Have you tried investigating local religious groups? The Catholic church in Chicago offers counseling (separately) that has very, very little to do with God.

OP I see you are in New York state. Here is a link to Catholic Charities in New York (you'll have to find your own area). The New York Times offers the Neediest Cases fund - they may be able to provide you with the money you need to make ends meet each month. There are a ton of results if you type in "depression counseling religious new york". Perhaps you can find something there.

Finally, maybe you can find help from one of the 60,000 charities listed on NYCharities.org.
posted by MeetMegan at 1:26 PM on May 8, 2006

Also, I'm not trying to push the Catholic church; they're just the organization I'm most familiar with.
posted by MeetMegan at 1:28 PM on May 8, 2006

I've very little useful to add, except one of my favorite pieces of mindset advice from a quote that I don't recall the provenance of:

"Do you know what the difference is between an engineer and a politician? It's this: an engineer takes a large insoluble problem, and breaks it down into many small problems, each of which can be solved. A politican takes many small problems and combines them all into one large problem that no one can solve."

The most daunting forest is made up of individual trees, basically. It's something I like to keep in mind for my own minor bouts of melancholy. Good luck to you.
posted by Drastic at 1:30 PM on May 8, 2006 [1 favorite]

700 USD / month for rent is a fair bit of money. You say your family is not interested in providing financial or emotional support, but might they be willing to house you for a while? Alternately, can you move somewhere where rent is significantly cheaper? It doesn't sound like you're tethered to anything locale-specific.
posted by ori at 1:31 PM on May 8, 2006

In New York State, there is the Office of Mental Health; here's a directory of their facilities. I've emailed you with further info.
posted by scody at 1:31 PM on May 8, 2006

One more thought about rent, to add on to what ori said: Are you paying full market rent? Given your disability status, you may well qualify for Section 8 housing vouchers, or some other kind of housing assistance.

Beyond that, I have little to add to what other people have posted, except to echo the information that most communities do offer some form of free or reduced cost therapeutic services. In New York State, I believe many of these services are offered at the county level, and that most of the providers are licenced clinical social workers. There may be a cost, but assuming they can help you, the investment will be worth it.
posted by j-dawg at 2:11 PM on May 8, 2006

You might try shopping around for therapist who will let you pay what you can as you go along. I lucked out once and had a therapist who charged me a reduced rate (about 20% off the regular rate) and I only paid what I could each week. Sometimes as little as $10 or not at all. I owe the full amount now but she still accepts whatever I can afford monthly. I really appreciate what she did and it gave me the opportunity to deal with some really serious problems.
posted by vionnett at 2:22 PM on May 8, 2006

emailed you.
posted by sgt.serenity at 3:22 PM on May 8, 2006

Investigate zen Buddhism... find a koan that you like, fast until the answer comes to you.

I know it sounds silly, but sometimes you have to learn to make up silly answers just to stop asking painful questions.
posted by Laugh_track at 3:48 PM on May 8, 2006

Do look into local churches...some may offer counseling that isn't especially religously oriented. I know our church (in Washington state, sorry) offers subsidized, sliding-scale counseling without regard to religious affiliation, by professional, certified counselors who happen to be Christians but who do not push "religous" solutions. They don't prescribe, but that doesn't mean a church in your area doesn't have an MD available.
posted by lhauser at 5:05 PM on May 8, 2006

You're obviously very intelligent and you write very well How about starting out with some sort of online work, maybe editing. That might begin to approach the financial issue..
posted by mert at 5:41 PM on May 8, 2006

If you are religious, try going to church (or whatnot) more often. It's a place that expects new people to get involved and people generally care enough to be able to support people through hard times -- such as helping connect you to the health care you need.

I don't know of another type of community that is so easy to join, but please do find something else that is has an active community to be involved in. It will help the problems be a little smaller to have friends.
posted by Margalo Epps at 5:52 PM on May 8, 2006

I'm not sure how large of a town or city you're in, but does your area have its own United Way? You can check at http://national.unitedway.org/myuw/index.cfm. The organization does have its problems, but they can sometimes act as a clearinghouse to direct you to appropriate resources. The local one here does something like that.

For medications, there are some programs to fund meds for low-income people. The first few Google results might be worth checking out. Some doctors keep lists of these, so if you can find a doctor , they may also have a program they work with regularly. They're often funded by the drug manufacturers.
posted by dilettante at 6:07 PM on May 8, 2006

I have suffered from serious depression myself, and in my case the only thing that really helped me was finding that one good friend. I am also on Wellbutrin (or a generic version thereof), which, unlike several other medications I tried, does really help without any noticeable side effects. It is probably too expensive for you, but if your finances should improve I would recomment trying it.
posted by blue shadows at 6:22 PM on May 8, 2006

Trader Joes, Walmart, uniion supermarkets, banks and libraries are all places that offer reasonable health care benefits for part time workers. Is that an option for you? If you're afraid of losing the beneftis how about working under the table somewhere or from home.

Maybe you could save on rent by getting a roomate. Having someone around can be a huge mental boost too. A roomate who has pets is even better, imho.
posted by fshgrl at 7:47 PM on May 8, 2006

To expand or Margalo Epps' suggestion, my church had counselors that I could talk to. And the church was able to help me pay for therapy.
posted by CrazyJoel at 8:01 PM on May 8, 2006

County sliding-scale services are the best help I've seen for situations like this. They will also often help with medication samples, and should assign you a caseworker who'll help with getting you into some low-cost prescription programs (Googling the phrase turns up some help finding some of them).
posted by Cricket at 8:29 PM on May 8, 2006

Contact your county health department. In most counties in the country there are long waiting lists for the income-based mental health care that these places offer, but at least that's something. If the person who answers the phone is not helpful when you call the health department, ask to talk to someone else. Keep trying until you find someone who knows their shit. There are a lot of incompetent bureaucrats out there, and you shouldn't give them the power to keep you from getting the help you need.
posted by croutonsupafreak at 9:25 PM on May 8, 2006

I strongly agree with whoever suggested getting a pet. Pets are constant companions, give you their love unconditionally, reduce stress and, depending on the kind, can cost very little money. It's a trite thing to say in the face of all your problems, but if I'm feeling down, nothing makes me feel better than a long heart-to-heart with my dog. Plus, the responsibility for another life can be very grounding and therapeutic. If you're worried about the cost of keeping a pet, a little extra cash made from home might help you cover it. Amazon Mechanical Turk seems to be a possible opportunity to make a bit of supplementary income from home.

I might also recommend NYC Helpline, a contact phone service for anyone in need of someone else to talk to. Not only do they offer a nonjudgmental listening service (vent away), if you tell them your difficulties-- particularly financially-- they may be able to refer you to other services that can help you out (that's the way my local one works, anyway.)

Lastly, and, I know this may not be the popular advice, but it might help, if you're having this much trouble getting medications and so on, perhaps medications aren't for you. There are other ways of healing yourself besides physically. Have you looked into meditation? Does the spiritual type of healing interest you at all? I'm not thinking "Make peace with your God" here, at all, more something along the lines of Buddhist tradition. It could be something as simple as reading from the Tao Te Ching once in a while, or as complex as undertaking a complete study of A Course in Miracles. There are plenty of authors out there who might help: Marianne Williamson, Ken Wilbur, Gary Renard, Alan Watts, and Eckhart Tolle, to name a few. If your local library has The Disappearance of the Universe, I'd recommend starting with that, if you're interested. It sounds utterly flaky, but I know many of my severely depressed friends have found these extremely helpful coping tools. It's possible, as well, that if you look around, there may be a Buddhist organization or monastery that would be happy to have you meditate and learn with them.

It sound silly, but, as laugh_track put it, sometimes you have to make up silly answers just to stop yourself asking the stupid questions.

I hope that helps.
posted by WidgetAlley at 10:40 PM on May 8, 2006

This is a really minor thing, but exercise boosts my mood without fail. Going to the gym is more of a pain in the ass than the actual work out itself, but it gets that adrenaline pumping and really makes a difference in my overall state of happiness.

The gym isn't really my thing either, so to minimize the amount of time (and money) I have to spend there, I joined an all-women roller derby league. There's women from all ages, all races and all walks of life that are there for support as well as to skate. It seems a little silly, but it's really quite enriching.
posted by commasplice at 10:23 AM on May 11, 2006

It sounds like you're between a rock and a hard place. I really hope things are getting better.

I have three suggestions.

1. I support the idea of getting a pet. My cat gives me a lot of love and comfort when I'm down.

2. Call your local hospital and ask for the Free Care Department. Most hospitals have such an office. The paperwork can be massive and takes a few months, but even people with jobs can qualify for free, yes FREE, care if they meet the income requirements.

3. It's very hard to get motivated to do it, especially when you're down, but if you can force yourself to get aerobic exercise it is almost guaranteed to boost your mood and decrease anxiety. Running is best! (Now, if only I could follow my own advice on this one.)

Good luck to you.
posted by mintchip at 9:11 PM on September 29, 2006