xesce: comments: my diagnoses

My Diagnoses 1981-2010

The following represent my attempt at self-diagnosis, after the fact. In many cases a diagnosis was never shared with me. In at least one case, I wouldn't have agreed with the diagnosis had it been shared with me. With my self-diagnosis, I have attempted to identify the most clear and potentially helpful diagnoses.

DSM diagnoses are often made on a multiaxial basis. Axis I represents mood disorders, Axis II personality disorders and mental retardation, Axis III physical or medical diseases or conditons which cause mental disorders, Axis IV social supports and resources, Axis V pertains to functioning, and overall outlook. Diagnoses can also be made on a nonaxial basis, listing disorders by code only, rather than separating by axis.

See also: Axis IV: Psychosocial and Environmental factors and Axis V: Global Assessment of Functioning. I think it's also significant to note that although I can't technically claim to have Axis III: Mental Disorders Due to General Medical Conditions, ichthyosis has had a psychological impact upon my life, and should be taken into account as part of the diagnosis at each stage of my life.

My diagnoses are made on a nonaxial basis, and I have omitted the GAF:

1981 (Summer)

307.50 Eating Disorder NOS**
V61.20 Parent-Child Relational Problem

I was 15 when I first asked to see a psychiatrist.*

Reason For Visit: I was staying with my mother for the summer. The previous summer while staying with my mother, I had fallen into the routine easily, my weight was stable and I did not binge, even though throughout the school year (while living with my father) my eating habits and weight had fluctuated constantly and I had felt out of control. In summer 1981, when I arrived, my mother had expressed anger/diapproval regarding my weight gain, and I had gone on a crash diet, losing about 10 lbs in a week. A backlash binge helped me to realize I had a problem, and at this point I asked to see a psychiatrist.

I could also at the time be seen as suffering dysthymia or mild depression on and off, as well as more severe depression, and generalized anxiety, both of which were having an impact on my occupational and social functioning. I think the main issues were the eating disorder and the parental issues, but I also needed help coming to terms with having ichthyosis. Increased communication with parents might have been helpful in that regard, but more may have been necessary. (See below for my suggested non-medication approach to treatment.)

For many years, I had been dealing with major moves, and fallout regarding my parents' fights, eventual separation and divorce. At age 13 I legally had the right to choose to live with my father, but my mother was very hurt/angry, and sent the police, and phoned many nights, very angry and hurt. In addition to this, I was starting high school, maturing physically and becoming sexually aware. I had a significant skin condition - ichthyosis - which a dermatologist's appointment had offered no solution regarding - and this in itself was a source of anxiety and depression. As well, I was impacted by my father's addictions and his girlfriend's disordered eating. In Grade 10, I had trouble with excessive sweating, and with extreme stomach pain. I had been taken for tests regarding my stomach, but nothing physical had been found. Throughout this time I was a top student and a basically respectful and polite adolescent.

My parents now lived at opposite ends of the province. Visits involved long, unpleasant busrides. In my case, my parents' two very different approaches to parenting, as well as their approaches to food and weight, impacted me.

My situation was already pretty complex or multi-layered at that stage. After seeing the psychiatrist a couple of times, I realized without knowing how to articulate it that my issues were not going to be addressed or even identified. I was not being secretive. I didn't know what information was relevant to offer, but the questions I was asked didn't seem to be leading us in the right directions. At the time, not much was known about eating disorders. If the patient was not emaciated or inducing vomiting, it may have been assumed that food and body issues were not serious. This may still be a relevant point at present.

After I saw the psychiatrist and realized that it wasn't going anywhere, I think it is understandable that I would experience depression. And so I spent the rest of the summer in bed. This angered my father, and probably added to the tension in the house.

*My preference would have been to see a psychologist, but only psychiatrists were covered by OHIP (Ontario Health Insurance Plan).

**(or Binge Eating Disorder, which may be added to the DSM-5). From ages 13-21, I fit the criteria for binge eating disorder.

Non-Medication Approach To Treatment

At the time, much of the following would not have been possible, but I will list what I think might have been helpful:

1) Personal counselling to address my identity crisis. Exercises to get in touch with what I liked and wanted to do, as opposed to what might please my parents but was unrealistic for me to achieve.

2) Join an internet discussion group regarding living with ichthyosis.

3) Individual counselling and group therapy related to food and body issues.

4) Family therapy to help all members of the family to see the effects of constant moving, divorce and the antagonism between parents and the overall dysfunctional communication patterns, including the extremes in approach to parenting.

a. The fact that my mother lived in northern Ontario was also an issue. The family was split up, and the distance was such, and the expense was such, that it was very difficult to have enough access to either parent. This relates to:

b. Help for parents and their SOs: Father had problems related to alcohol, smoking, food, caffeine - adjustment issues regarding his life, job, responsibilities. His girlfriend needed help with her food/body image issues, assertiveness, and needed to move back to the city. My mother had habits that were resulting in a heart condition - so even if she looked thin, she was not OK, and she was living with and dependent on a violent guy who had threatened to kill her and her kids. Some of these problems were economic, and there might not have been any realistic solution at the time.

5) I needed more family support (or I needed to become more assertive) with regards to developing my talents or abilities. If I wanted to try an exchange, if I had wanted to join a photography club at school, I would have needed to know that it was OK with them and not too much inconvenience or expense. Also, in living in the country, I was isolated and needed transportation arranged if I was to participate in extracurricular activities.

6) I think that studying ichthyosis, feminism, psychology, eating disorders (for a start) would have been helpful - basically, that having access to as much information as possible in these areas might have been a positive step. Many books I have read recently were already available (some had been for a long time) - although not necessarily in my school library.

All of the above was relevant. It makes sense to me that medication could not address these issues.

1981 (Autumn)

296.22 Major Depressive Disorder (Atypical)
307.50 Eating Disorder NOS
V61.20 Parent-Child Relational Problem

Reason For Visit: I was taken to the hospital for suspected alcohol poisoning. At this time, I had one or two sessions with another psychiatrist, received a prescription for imipramine, and for a while had ongoing counselling sessions with a counsellor.

I would think of spending two weeks in bed as a major depressive episode. This occurred during the summer, before school resumed. When I started school, I was a kind of time bomb, as my previous issues had not been addressed. When I started acting out, it tended to be pretty extreme. I think the doctors might have recognized it was about depression, which was why I received a prescription, but at the time I was told that I had a 'chemical imbalance' - which implied that I had no 'real' reasons to be depressed. The counselling was not in-depth - the woman was friendly and I liked her, but it was more of a social type chatting than about identifying my very real issues.

The antidepressants did not help at all. After a few months, I felt more distressed than before, and didn't see any place to turn. And at this point I began to save up my medication. It's not just that I didn't see the point to doing schoolwork any more - I think that also it was just too hard to concentrate.

1982 (March)

296.23 Major Depressive Disorder (Atypical)
307.50 Eating Disorder NOS
V61.20 Parent-Child Relational Problem

Reason For Visit: One day after my 16th birthday (March) I was hospitalized (for two weeks) for a suicide attempt. I had used my tricyclic antidepressants for an OD.

The reason for the attempt is significant. I had failed some exams, and just received the results that day. When I told my father, he kicked me out of the house. I had never failed exams before (and I have never failed any since). I had written all three on the same day - and I had known that my mother would be picking me up when I was done, to take me up north for March Break. I had got drunk before writing the exams, and was so drunk that the room was spinning and I could hardly focus on the paper. When my father kicked me out of the house, I had no money, and there was no one I could call - or that I wanted to call. I took the pills I had saved up because I really had no idea what else to do. I didn't know if I would die, but I was prepared for the possibility that I would.

I continue to include Parent-Child Relational problem in my various diagnoses, but it may give a misleading impression. I was not a 'normal' disrespectful child/adolescent. If anything, I had a tendency to be more calm or rational than my parents. The problem was something I wouldn't have recognized at that time, and involved their very different approaches, which resulted for me in a kind of internal war. Even when I began acting out, I was usually not disrespectful or impolite, and I was in a way mirroring my father's own out of control behaviour - since I had moved in with him, I had witnessed him regularly drinking to the point of blackout, and there had been incidents in which he had caused a lot of disappointment because of his drinking. After my binge drinking episodes, my father was just presented with the fact of my breaking curfew, or me passed out drunk. When 'caught' I never tried to fight or argue about it.

1982 (Summer-Autumn)

309.81 Posttraumatic Stress Disorder
307.50 Eating Disorder NOS
296.22 Major Depressive Disorder (Atypical)
300.7 Body Dysmorphic Disorder
300.22 Agoraphobia
300.23 Social Anxiety
V61.20 Parent-Child Relational Problem
Also on Axis 4: Extreme lack of social support/resources

I did not seek treatment at this time, but after a series of traumatic events, my diagnosis would have been as listed above. The final event which triggered the Posttraumatic Stress consisted of a night during which I woke up in a field 90 miles from where I was living, with vague memories of sex and abuse involving several males. After I woke up, I walked for many hours in the dark completely terrified. I quit school immediately, and didn't leave the house much for more than half a year.

A few months prior to this: My mother died suddenly of a burst aneurism. About two days before this occurrence, I had discovered that I was pregnant. I had an abortion after the funeral. There was a major move, not just for my brothers, but also for my sister and I, from country to suburbs. Then my father almost died due to a fractured skull. And there was much additional stress, I ran away from home (still 16 years old) and that itself resulted in a major traumatic incident for me. When I returned to the family home, I think I was suffering Posttraumatic Stress. I was left to my own devices, and I think this progressed into a combination of Body Dysmorphic Disorder/Agoraphobia, with the emphasis on the BDD as the more significant of the two, of which Agoraphobia was a symptom, rather than main diagnosis. Social Anxiety at this time began to become an issue. I was cut off from all ties and resources, and even family get-togethers became difficult. It was mainly because I had so many experiences at this point to be 'embarrassed' about, but it was also because I was not in school/developing my potential, and my sense of identity was eroded.

I had nightmares for a year, or was afraid to go to sleep for a little longer than a year. The Posttraumatic Stress in my case might have triggered the Body Dysmorphic Disorder. It may not have been only one incident which resulted in PTS, but a series of traumatic incidents which occurred within a short period of time. My symptoms/reactions seemed like they might have been related to a combination of events, and when I reached a 'limit', a PTS reaction was triggered.

In 1983/4, I managed to get myself together and attend school and find a part-time job, but I lived in what could be described as a constant state of distress. A school guidance counsellor during this time was helpful, but ultimately, when further family upheaval was experienced, I did not rally. From late 1984 until 1989, aside from a few exceptions, I spent the vast majority of time in the family home, cut off from all contacts with the outside world.

1989 (May)

296.22 Major Depressive Disorder (Atypical)
307.51 Bulimia Nervosa (purging type)
300.7 Body Dysmorphic Disorder
300.22 Agoraphobia
300.23 Social Anxiety
V61.20 Parent-Child Relational Problem
Also on Axis 4: Extreme lack of social support/resources

Reason For Visit: At age 23, I was committed to a psych ward. My father had the police take me away. No discussion first. I had even offered previously to go willingly - but he wouldn't talk about it, and on the day I was given 5 minutes' notice that the police were coming.

Since age 16, I had a pattern of not going outside. At age 17-18 I had gone back to school for a year and had a part-time job, and at age 21 I had managed to live away from home for 6 months, but other than that, for the most part, I didn't leave the family home. During this time, there were again various moves for all of us, and breakups for my father. After his second wife left him, he was on his own, and didn't know what to do with me. He was disillusioned with his job, and resigned. He was about to move into a place on his own, and didn't know what to do with me.

At this hospital, I was misdiagnosed (or at least I was never allowed to know or discuss the diagnosis), and it was a major effort to get myself out of that place. Since I had no place to go, I had to accept welfare as a condition of release. I had been given an ultimatum: I either had to accept 'treatment' - which consisted of medication I was not allowed to know the name, effects or intent of - or sign up for welfare, such that they were not just releasing me onto the street.

At this point, I was Bulimic. This part of my diagnosis was correct, but I had offered it myself - I had not been withholding info about it.

At this point, and during my next hospitalization, I think Agoraphobia and Social Anxiety would not have been diagnosed, because I exhibited no signs of anxiety related to being out of the house. But, it also points to those issues as not being the 'real' diagnoses for me. The real problems were related to my self-image. Body Dysmorphic Disorder would not have been diagnosed because the doctor did not talk to me long enough to earn my trust. In an emergency situation, I could conceal these issues, which did not mean they did not exist, but it did take a lot of energy to appear 'normal' - and I think I did this as a kind of survival instinct. At this time, without asking me, the doctor may have assumed that I did not go outside or have social contacts because 'I didn't want them' - he completely missed my depression and loneliness, my feelings about my appearance, and my lack of resources and social opportunities - probably because I was so 'positive', but mainly because he wouldn't talk to me long enough, or take a detailed enough history, even though I told him I thought he needed to talk to me more in order to make an accurate diagnosis.

1990 (April)

296.23 Major Depressive Disorder (Atypical)
307.51 Bulimia Nervosa (purging type)
300.7 Body Dysmorphic Disorder
300.22 Agoraphobia
300.23 Social Anxiety
V61.20 Parent-Child Relational Problem
Also on Axis 4: Extreme lack of social support/resources

Reason For Visit: At age 24, I was signed myself into a psych ward. I had to tell them I was imminently suicidal in order to be accepted. The reason I signed myself in: I was 'taking responsibility' as best I could by signing myself in. I was a burden to my family, and to my father in particular. After my father and stepmother had left Winnipeg, I had no contacts in Winnipeg. I eventually decided to take an old friend of my mother's up on her offer to let me stay with her, and I came back to Toronto. However, when I arrived, her husband was sick, and I couldn't stay with them. I ended up staying with my sister in the room she rented from my father. This was an incredibly tense situation, and after a month, I voluntarily went to the hospital.

At this time, I received a general diagnosis of Depression, Anxiety and Bulimia. Antidepressants, antianxieties and antipsychotics were all prescribed for me. (I did not take any of them.) Also prescribed were therapy at an eating disorder clinic, and Family Therapy. I think they were on the right track here, but the main issue was that I had a profound lack of personal stability which would make attending therapy on a regular basis possible, but also that I lacked belief in anything and was completely directionless. I had spent too many years cut off from all resources that I did not know how to utilize them when some became available. My 'disability' was complex and psychological in this regard.

This hospital had a policy which reflected that the were aware of the stigmatizing influence of psychiatric labels. The diagnosis I was given seemed pretty good. So what was the problem?

One issue was that I was prescribed antipsychotics, and when I asked what they were supposed to do, I was told only that they would 'clear up' my thinking.

I think that one of the problems was a communication problem. Once a psychiatrist had diagnosed me, he had no further contact with me. From there, there was a team of others, and it seems unlikely to me that each and every member of this team would have an overview of the situation - and I did not receive in-depth contact with any one person. In addition, since I was a candidate for family therapy, another big issue was communication and information that everyone could understand. Basically, not everyone was on the same page. Even years later, family members still participated in triangulated conversations, and their speech and actions demonstrated that they believed depression was about weakness, whininess, and giving up. The psychiatrist I worked with afterward (not the diagnosing psychiatrist)did not articulate much to me. And, unfortunately, I had trouble understanding him - I felt bad about the fact that I could not understand his accent, and often had to ask him to repeat things - which made for stilted conversation. In addition, he asked me the same questions I had been asked before, but took notes while I spoke, usually asking me to repeat very slowly, sometimes even very painful details. (Freud did not take notes while a patient spoke - he thought this was not only distracting, but also bad for the patient.)

I had been without support or resources for a very long time. I needed some kind of acknowledgement regarding what I had been through, but even my suicidal feelings were dismissed in family therapy without much comment, and my understanding was that my family were embarrassed by what a quitter I was, but also that they resented me being so emotionally manipulative as to bring it up. No one acted as if they believed my feelings were real, or worth considering. My daily reality was dismissed, invalidated.

If I try to zero and in and make the situation clear, I think the issue was that we all needed a lot of education, and there was no way that that could have occurred overnight.

I couldn't ask for the emotional support I would need, because I didn't know how. I had spent years with unmet needs, believing it was about personal defects, and it seemed like something you just couldn't do in my family - say that you needed handholding or whatever. And, there was an awareness that although on the surface we could appear quite a close family, and that we all had a sense of humour, there was a profound reluctance on everyone's part to have to become overly involved in the lives of the others. It's about strong underlying beliefs: each individual is responsible for his or her own life, and it is too much imposition to ask for help with unreasonable problems. 'I wouldn't ask for that kind of help, so I can't respect anyone else asking for such help.' Not realizing that family therapy is based upon the idea that the unit as a whole is sick, with one member often presenting as a kind of scapegoat. Every member needs to be educated regarding the communication and behaviour patterns within the family, and how each member contributes and impacts upon the lives of all the others.

My family and I attended Family Therapy once a month for almost a year. My father drove me to each session, which might have had something to do with my ability to attend - that act in itself was perhaps an example of 'practical and emotional support' which was necessary to me.

Once disability insurance was granted to me, everyone stopped attending therapy. I was never queried by my family regarding ongoing treatment for myself, or what would happen (would disability be discontinued) if I did not seek treatment. This is an example of family philosophy. They had already gone out of their way to participate, and from now on it was up to me. But nothing was articulated, there was no communication.

2000 (May-June)

296.23 Major Depressive Disorder (Atypical)
307.51 Bulimia Nervosa (purging type)
300.7 Body Dysmorphic Disorder
300.22 Agoraphobia
300.23 Social Anxiety
Axis 4: Extreme lack of social support/resources

Reason For Visit: At age 34, I attempted to apply for disability when my long-term relationship broke up. For the first 3 years we had lived together, I continued to receive benefits, but after 3 years we were considered to be a commonlaw couple, and he was 'legally' responsible for me. There was no way he could have afforded to help me live on my own - it was necessary for me to apply for disability.

I wasn't able to go through with the process. I went to a two-part assessment, where I was given a prognosis of 'Poor'. In order to continue with the process, I had to go to therapy twice per week, which I wasn't up to. After a few months of extreme stress and insecurity about my situation, I took GK up on his offer to live with him in Australia.

Since then, the only contact with those in the field of mental health has occurred when I was applying for a permanent resident visa. At first, I wanted to be completely open about my situation, but soon found out that whatever they say about acceptance, the reality is something different, and I very accutely became aware that 'people like me' were not desirable candidates for visas. So I got myself together as best I could, and I lied my way in to Australia. However, the reality of the situation - that as I was, I was not really wanted, that I was considered of no value to Australia, had some effects on my self-esteem.

2005-2008

296.24 Major Depressive Disorder (Atypical with Psychotic Features - nonbizarre delusions)
300.7 Body Dysmorphic Disorder
305.00 Alcohol Abuse
307.51 Bulimia Nervosa (purging type)
300.22 Agoraphobia
300.23 Social Anxiety
Axis 4: Extreme lack of social support/resources

The longer my problems continued without some kind of acknowledgement or resolution, the more likely I was to acquire further complications, such as the nonbizarred delusions and alcohol abuse which came to be significant starting in 2005 or so. Alcohol abuse is now more of a focus than bulimia.

BDD is very much an issue, and has become worse with age. It is not so much about having an unrealistic idea about my appearance as it is about not being able to accept not being attractive 'enough'. But it is true that some of my issues are truly hideous, and have a great deal of bearing on my inability to commit suicide. Part of it relates to the ability to face the outside world, but part of it relates to the embarrassment of people being able to examine my dead body.

I have made steps through the years towards trying to create my own alternative solutions, but it remains that I am not able to connect well enough with others or with life itself.

2010

296.23 Major Depressive Disorder (Atypical)
300.7 Body Dysmorphic Disorder
305.00 Alcohol Abuse
307.51 Bulimia Nervosa (purging type)
300.22 Agoraphobia
300.23 Social Anxiety
Axis 4: Extreme lack of social support/resources

I think my current (2010) diagnosis would have to be about a kind of psychological depression mainly. Alcohol and food/bulimia are still issues of (in the case of alcohol - growing) concern, but the focus is on a wish to die. I still have major Axis IV issues, and they are now probably irresolvable. My psychological depression is based on accurate assessment of my life, my age, my potentials. I am still overly preoccupied with my appearance, and probably do have BDD.

I am currently without a passport (mine expired in November 2009) because I don't feel I can deal with getting a photo taken, which I think is a BDD-related issue. Lack of a passport makes it difficult for me to have independence.

Additional Notes Regarding Diagnoses

I am much more likely to be able to go out if I am 'acceptably' thin and fit. So, it is like the 'agoraphobia' is conditional, which means that it is probably not the primary diagnosis.

In case it's not clear, it looks like there is something of a pattern when it comes to my Reason For Visit: the initial one at age 15 was about an internal struggle, an inability to please my parents or be what they wanted, which was expressed through a loss of control with food, whereas all the others from age 16 on were about a lack of personal stability and resources - not having a 'home' or place to stay.

The inability to resolve this issue is likely behind my continued wish for death. I do not have the internal resources or stability to believe that I can solve this, and to me it seems like the only answer is to kill myself. It could be that because this issue was not recognized or identified before the age of 16 that I was never able to resolve it. My difficulty in acquiring employment may relate to the fact that I had my first full-time job during the summer at that age, in the midst of a series of crises and major upheavals, and that I have never come to terms with that period in my life - such that I either wasn't able to develop normally, or all attempts to seek employment trigger a remembrance of that highly stressful period.

My father's unresolved problems also impacted me. He also sought help and was not helped. His problems were extreme, and part of them included highly ambivalent feelings about being a parent. I probably did pick up that he wished I'd die so that he would not have to deal with me any more, and it may also be true that he would rather others believe I was a nutcase than own up to his own bad behaviour.

Agoraphobia is likely a symptom of Body Dysmorphic Disorder, which itself might have roots in my family drama/unresolved issues with my mother. BDD may have been triggered by a series of traumatic events which included her death.

Social Anxiety to me seems likely to relate to the 'embarrassing' nature of my 'self-destructive' acts, and long-term chronic understimulation of my environment, combined with demoralization, all of which has made it difficult to hold onto an 'identity' that is strong enough to hold up in social situations. But here the problem is not that I need meds to help me face social situations or in order to help me 'face' my problems - it's partly that I lack any social outlets whatsoever, and mainly that for many years I have not travelled a path in life that would result in catchwords and validity that would act as passports in social settings. I can't actually see any social situations in which I want to be - when I think of conversation, in any I can imagine, it seems like I will never have a 'basis' from which to express ideas which will seem valid to others.

It is not the symptoms of anxiety or embarrassment that I consciously fear - it is the depression that comes with the inability to truly connect with others. It is also related to a feeling of being overburdened - for anyone, it might be stressful to keep up with the pace of normal life outside the home. For me, it takes a lot of energy to face the reality of the competitiveness and judgmentalness out in the world. My identity is not strong enough to do this easily or seamlessly, and when I do it, I do seem to need at least the possibility of a 'reward' - for me this is about the possibility of connection. Otherwise, it seems pointless, or like it takes too much energy. Most people in the world accept that to protect oneself it is necessary to keep some stuff to oneself and to put on a kind of mask in public - for me this takes a lot of energy.

I think that suicide is a valid option considering my circumstances and the extreme unlikelihood that I will become involved enough in life or content enough to want to live. However, I will list what I think might be appropriate as far as treatment if I decided not to take the option of suicide.

Cosmetic surgery is a valid option to explore. I have heard it said that this is a bad idea for those with BDD, as very often the problem persists after, or an addiction to procedures occurs. However, the issue may be that results aren't completely predictable - in my case, I understand very well that just fixing one or two features would not 'solve' the problem. It's difficult to keep tweaking the results, say the way I would the appearance of a new website, when it comes to the body. Just because this is not practical at present, doesn't mean that for the future it would not be - I mean regarding future patients with BDD.

Mainly, it would be about trying to force myself to initiate contact in the outside world. To join support groups for things like ichthyosis and hsv2, also for body image issues. To go to a psychologist just to talk, to have someone to talk to about things that most people don't want to hear about, and to try to achieve a kind of 'acknowledgement' that the psychologist can see what I am trying to say, to work at identifying interests - even if that is possums and movies - and just jump into groups that discuss these things or exchange photos or put up a possum blog myself rather than wait for GK to do it. Join dating sites, meet a few people after exchanging correspondence. Try out chat rooms. Make a serious effort to reconnect with family. Go to book sites and discuss my take on books I have read. Find out if there are places I can volunteer. If I am interested in homelessness or GLBT rights, there must be groups to join, etc. Start my own groups. That is off the top of my head, I will get back to it later, when I think about it more.

I would not be going into it with the idea that any of these solutions is ideal - I would be going into it for the stimulation of new activities and interaction, using some of my recognizable issues or interests as starting points, hoping that somewhere along the way, either through one of these activities, or something that comes up as a result of increased participation, that I would have interactions that felt 'real' as opposed to things I am trying to endure in order to be proactive and positive.

But the main problem might be that I lack the 'spark' of genuine interest in actually living my life.