Chapter 4: On Distress Tolerance and Subjective Worthlessness

February 17th 2664

All I have relished

Changed in a flash

Taken by the game of life

Waves of despondency overtake me

I am left with a shadow of what I used to revere

I've been glaring at my reflection and it glares back

Mocking me for all the nights I spent howling and weeping

I'm stuck finding reasons when there are none

But maybe it's pointless trying to find one

And although I'm forced to live with a shadow

Her heavenly smile reminds me of the warmth I used to cherish

She is no longer the lady I gave my heart to

But I'm still the same man she trusted with hers

She is no longer the lady I gave my heart to

But I'm not about to ask her to return it to me

It's hers and will always be hers

- N.A.S

Dear listener, did I make you worry last night? I'm okay now. Well, as okay as someone in my shoes can be. After the phone call with Kenta, I felt a sudden urge to write a poem, so I did. It wasn't my best work, but at least it was honest and was more productive than bawling my eyes out. After writing it down, I started thinking that maybe I've been too focused on counting the days I have left with Moira and forget to just focus on enjoying the time we do have—the more I sulk like this, the shorter a year or two will be. People say time flies and I don't think I want to let it fly without me being present in the moment. Even if she can't remember who I am, I still know who she is and who she used to be. I have no idea if it makes a difference for her whether I am alive or not if she can't even remember me, but that's me questioning unanswerable things. People say that happiness is in the eyes of the beholder and I guess I need to redefine my own.

So this morning I got up before Moira did. It took everything in me to trudge my way to the kitchen and cook something that was not just microwaved frozen meal, but I was proud of what I made. I steamed some tofu together with shredded Chinese cabbage and carrot, then dumped the vegetables into beaten egg yolk to make rolled omelets. Yeah, Moira has always hated vegetables, but on the other hand she has always liked my cooking. The trick to make her eat vegetable is to chop them very finely into the tiniest morsels and hide them in something else—noodles, quesadilla, macaroni, pasta, dumplings, or tamagoyaki. Another trick is to put spices on the vegetables—she loves spices. I smiled as I put sriracha mayonnaise on the side for her.

"It's breakfast time. Hey, it's okay. It's Nardho. We live together." I said softly as I woke my wife up. She blinked in confusion and stared at me as if it was the first time she ever saw me.

"Nardho? Where have I heard that name before?" her eyes narrowed and then her lips moved upward slightly. "Oh, you are Neesa's friend who came yesterday! But why are you still here?"

"To keep you company and to cook something good when you're hungry", I tried to stay calm.

"Neesa asks you to do that for me? That's nice of her. How long are you gonna stay?"

"As long as I am welcomed." I decided to play along. Moira's doctors once informed me that it might upset dementia patients when their family members tried to remind them of what they have forgotten, but if we validate what they could remember, no matter how inaccurate and skewed, they would not be terrified of us or lash in terror. It is all about making sure the patients feel comfortable enough to let us in so that we can take care of them without them being alarmed. So I guess right now Moira simply thought I was a friend of Neesa's who somehow brought her breakfast in bed. Well, that's better than being a complete stranger or an intruder.

"Is it just you and me? Why's Neesa leaving? And how come you're not leaving with her?"

"Neesa has to work, so she trusted me to pamper you. Unfortunately, I do have somewhere I have to be today." I alluded to my counseling appointment. "Worry not, though. Do you know LJ and Naoko? They will be here in a minute and they will keep you busy until I come back."

"LJ and Naoko? Are they your friends?" Moira furrowed her eyebrows. I showed her pictures of our nephew and niece on my phone and her face lighted up in recognition. I was so relieved.

"Are those their names? I think I know them, yes. The guy is so nice but I haven't seen him lately. The woman is nice too and she is always showing me her paintings. They always make me laugh. So, they are LJ and Naoko. I sure am bad with names!" Moira giggled. God, I have missed her giggles. Moira's laughter is as rare as a rainbow eucalyptus nowadays. What, you've never seen a rainbow eucalyptus? Then I'm right, it's one of the rarest things that ever existed.

I could see Kenta's car from the window of mine and Moira's room. When the doorbell rang, Moira seemed startled but I assured her it was the people I have told her about and she went back to being smiley. Sometimes she did behave more like a child than a middle-aged person. Naoko and LJ made themselves at home while Kenta drove me to my appointment, but first we stopped by Lee's cemetery. Kenta thought it would do me good to pay my respect to our late mentor.

"Good morning, Lee-sensei. I bring your favorite flowers, freshly cut tsubaki. It's been a while." Kenta bowed his head politely and arranged some camellias on the gravestone. I put my hands together in a prayer. There were a lot of things I wish I could ask Lee. I wish I could ask him if I deserve to be the bearer of his lungs. Don't get me wrong, I am indebted that I received his lungs, but sometimes I wonder if I have rightfully carried his legacy and lived up to his name. These days I feel like an inherently bad person pretending to be good for someone else's sake.

"Do you want to talk to him? It's okay if you don't, but I figure it might help." Kenta put his hand on my shoulder sympathetically. I nodded and closed my eyes, imagining Lee as I knew him. My Catholic faith forbids me to believe that the dead could hear the grievances of the living, but it permits me to conjure a memory in veneration of a dearly departed advisor.

"Senpai, do you think Lee would chastise me if he knows I'm struggling with suicidal thoughts? I have tried to curb those impulses but they always come back when I'm lonely. It feels as if someone has shot me and leave me to die but I'm alive although I'm bleeding through the bullet hole. I don't know how to explain it to you, but I do want to stop being hostile to myself and master my own mind once more, it's just that suicide is always something I think of."

Kenta pulled into an embrace and then looked me square in the eyes. "Lee was the kindest person I've ever known, Nardho, apart from your brother Johan. I don't think he's gonna be judgmental if he could see the state you are in now. He's gonna be concerned, yes, but I imagine he would advise you to hold on to hope. Life is valuable and it is up to you to find that value."

We sat in silence for another minute or two before we hopped back into the car. I spent the drive to the psychologist's clinic watching the clouds. Moira and I used to find shapes in the clouds. Sometimes she would say things like "I see a sheep! Very fluffy!" while I pretended to see what she saw. I suppose clouds do look like a little lamb at times—white, woolly, fuzzy, and lovely.

The receptionist at the clinic instructed me to fill up an intake form at the waiting room. About twenty or thirty minutes later, a woman greeted me and introduced herself as Amanda Torres.

"I've read your intake form," Dr. Torres began once we were alone in her office, "from what I gather it seems like one of your goals in this counseling session is to learn how to manage your emotions. I've also noticed that you checked the box that said you are feeling unlovable. Would you care to elaborate more? Actually, before we start, could you tell me what you already know about DBT sessions?"

"All I know is that I want to become functional again, Dr. Torres. I'm tired of forcing myself to wake up, eat, get enough sleep, and do basic everyday stuff. I want to be able to genuinely smile instead of putting on a forced smile. As for feeling unloved, well, it's hard to feel loved when my wife forgets who I am. I seek your help because I've heard that DBT is where someone like me could learn balancing radical acceptance with a change from within, whatever than means."

"I hear you. What have you done so far to control your emotions? Do those work to soothe you?"

"I keep a voice recording. No one is listening, I know, but I can pretend."

"Whatever works for you is a positive coping mechanism. Some people light up incense sticks because certain scents can be relaxing, some people meditate, so it's good that you have found a routine that grounds you. Keeping a voice recording can help you track down your emotions. If you want, you can even rate your emotions on a scale of one to ten."

"Today I'm feeling more like a four and a half. Fatigued and yet not completely downtrodden."

"That's great that you're aware of your emotions", Dr. Torres noted, "Next we shall talk about what I expect you to do in this therapy session to help yourself. I want you to work with me and that means you need to allow yourself time for self-healing. While the healing process is ongoing, I want you to refrain from any self-harming behavior. If you have any compulsion to hurt yourself, call me or the crisis helpline. Therapy is a two-way street. Think of it like rowing a boat—you wouldn't drill a hole on the boat or do anything to make it sink. In the same way, you shouldn't do anything to sabotage yourself on the road to recovery. Am I understood?"

I answered in affirmative and Dr. Torres continued to explain that dialectical behavior therapy is a rehabilitation treatment in which clients learn to set their own personal goals and address underlying challenges in their lives, all the while also developing skills that can be used to reinforce and reward positive thoughts like I am worthy of life, I a worthy of happiness. She then asked me if I am familiar with the metaphor of depression as an optical illusion. When I said no, she showed me a card with a picture of a white cup. After a while, I realized it was also a picture of two black faces. The contrast between the light and the dark has created the trickery.

"You see, Mr. Sitohang, depression is like the cup vs faces fallacy. In reality, it does not have to be either or—it can be both a cup AND two faces. The cup and the two faces are not opposites, just like your desire to die and your willingness to fight for the right to be alive don't have to be at odds. You want to die but simultaneously you are clinging to your life because the truth is somewhere in the middle. You don't have to figure out which is which, you just have to step back and look at the entire picture. I invite you to think about this."

I played with the card in my hand and then it dawned on me—it is not death that I desperately seek, it is liberation from the unhappiness of feeling like I do not matter in Moira's life anymore.

"I just want to end the agony but I do not know how to unburden myself," I admitted.

"It might take a while to get there, sir, but we will work together to get you there. But I'm afraid our session for today is almost over. If you want, we can schedule another one and if it suits your needs I can teach you some distraction methods to keep your mind off of negative thoughts. DBT is all about regulating your emotions and using healthy coping mechanism to make horrendous moments more bearable. From what we've discussed today, you are on the right track."

I thanked Dr. Torres and, like she recommended, scheduled more appointments to further discuss my problems. In the meantime, I will keep trying to realize that being in pain does not negate the fact that there is still some value in living my life, no matter how difficult it is for me to see that.

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