"Oh, I need to ask about that insomnia! Whoops! So when do you normally get tired?" Dr. Picani looked up from writing in his notebook and smiled at him. It took Roman a moment to process that question. He felt as if his brain was broken and paused to think. He basically forgot what time was in itself until the question clicked.
"After 2 AM is when I usually start to get sleepy. I fall asleep around 3, I think. I have to wake up at 7:30 for school, so…" Roman's water bottle label strip broke again and Roman narrowed his eyes at it before starting a new thin strip as he trailed off. He was almost through with his label linguine and wanted to see how long he could make the piece. It'd probably be easier without the gloves, but Thomas wouldn't want him to remove those.
"Do ya know about sleep hygiene?" Dr. Picani asked brightly. His brain conjured up a shower spraying him while he was asleep, and he was pretty sure that wasn't right.
"I shower before bed and keep my sheets clean, if that's what you mean," Roman looked up from the water bottle to the still-writing Dr. Picani.
"That's part of it! Having a comfy environment and a proper wake-up schedule is important. I will also recommend a sleep study, because you've had them for so long. But there are other things we'll need to change, too. It's best to attack these issues from as many angles as possible, like when the Crystal Gems and the Pizzas worked together to defeat the blowfish gem monster!" Dr. Picani explained with a very strange example, stabbing his pen through his fingers, possibly to mimic the battle.
"… Right," Roman drawled, though he had to admit the idea of the Crystal Gems fighting an insomnia demon was pretty interesting. Insomnia monsters were nightmare material in his head, with a thousand eyes that watch and multiple arms that trap you in bed, so he half regretted thinking of that. "How many of those do you have?"
"I have infinity! And Beyond!" Dr. Picani posed like Buzz from Toy Story. It made sense that Patton and Thomas would pick this particular psychiatrist.
"Delightful," Roman deadpanned, ripping at his water bottle label.
"As are you! How much time do you spend in bed not sleeping?" Dr. Picani asked, tapping his pen on the top of the notebook.
"Hours," Roman shrugged, leaning back. "It takes forever to fall asleep," He signed despondently. Hell, he was tired now. He once again slept like shit last night. Largely because of dreading this stupid appointment.
"Bzz-t! Ya need t'stay outta bed unless you're about t'fall asleep," Dr. Picani pointed with his pen.
"Huh?" Roman looked up. "But I have a bedtime? I kinda don't get to pick my schedule," He raised his eyebrow disbelievingly. Jigglypuff knew he was a minor, right? Roman glanced at his arms. Yeah, nobody was mistaking him for an adult.
"Ya have a winding-down time, now. I'm happy to explain this t'your guardians if there's any push back. Ya need to do absolutely nothing in bed that isn't sleeping or being sick. That way your brain can start building the connection that the bed is for sleep so when it is time to sleep it gets the picture. This might take a tick, but if there's nothin' else stopping you, it works for lotsa people," Roman flinched slightly when he ripped his label again. God damnit. Something else preventing him from sleeping, huh?
"What about the nightmares?" Roman asked quietly, staring specifically at his water bottle still.
"Therapy will help with those. They'll be a little easier t'handle, at least. Most antidepressants also lessen nightmares if ya change your mind. Can ya tell me a bit about those dreams?" Dr. Picani inquired kindly. He had this weird way of talking about things that Roman was uncomfortable with in such a simple way that it was less menacing to face them. Though the upbeat midwestern accent talking about hard subjects was incredibly surreal either way.
"Some are being back at an old house. My dad and some foster parents pop up more than others. Some are being chased and tortured and trapped. Regular nightmare stuff," Roman shrugged as dismissively as he could manage.
"Do ya ever wake with your heart pounding, sweating, confused, or screaming?" Dr. Picani asked for clarification.
"Oh… um, sometimes. I haven't woken up shouting in a long time, but I do the others," Roman sighed, feeling defeated by admitting his dreams kicked his ass so much.
"Those count as night terrors. If you can solidify a sleep schedule and find out when those sneak up on ya, we can work from there. For tonight, just try to focus on being calm and cozy before bed. We can do other methods later, but it's best to start simple," Dr. Picani flourished his pen like a wand.
"So the 'schedule' thing and the 'staying out of bed when not tired' things are required?" Roman tried to confirm, still kind of baffled by the idea of a doctor-mandated lack of bedtimes.
"That's affirmative, there, skippy! Since you've had trouble sleeping for a long time, there might be a more physical cause I want t'look into through some labs and a sleep study. We can assume that your mental health affects your rest, but I want t'be sure before I make any official diagnosis. Please still follow the guide I'm making, of course. Many of the treatments for insomnia are universal," Dr. Picani said and looked to Roman pointedly.
"Okay," Roman nodded. He looked down and saw he was at the last part of the label, tearing the final strip carefully for a long linguine of thin paper. Roman took a sip of water from the label-less bottle in satisfaction.
"So, along with therapy, and lifestyle changes, you'll have some homework to do outside of sessions. An' you can't just claim your foster dads ate it like Gumball did, ya need to actually do it," Dr. Picani said and Roman groaned loudly, flopping his head back. "Hey now, it's nothing like schoolwork, it's very reasonable. Today we're starting with a practicin' a simple tool that if I had t'guess ya struggle with. Mindfulness," He continued firmly, bobbing his pen in Roman's direction.
"I am the worst at meditation, okay? I get so bored," Roman whined, pressing just under the cap of the water bottle to make it pop in and out like a button.
"I'm just talking about plain mindfulness, not meditation. Ya have ADHD and struggle with disassociation, so being in the moment is probably very hard for you. But t'move forward ya need t'be able t'be present and stay in the moment when chatting about difficult things, so we're startin' small," Dr. Picani explained compassionately and Roman's shoulders slumped. He knew this would be hard, but forced boredom was just plain cruel.
"I'd much rather punch my dad in the face. Is that an option?" Roman dropped his head back and said bitterly to the ceiling while he clicked the plastic bottle with his thumb.
"'Fraid not, there, Buttercup," Dr. Picani shook his head. "I need ya t'breathe in through your nose and out through your mouth and really focus on the feeling for about three minutes every hour you're awake. Just breathe and be aware of yourself. The idea is to learn how to have no thoughts or assumptions about something. Ya don't hafta do the whole time at once, I just need ya t'get used to th' action," Dr. Picani explained. That didn't sound so bad. It was not great, but at least it wasn't something like 'meditate for an hour', of which Roman would rather smash his face into a cinderblock wall repeatedly than do.
"Can I listen to music or something?" Roman asked, feeling resigned to it already. Just being here was so expensive. He could try the stupid breathing thing.
"It's better if ya don't, but if ya want to for up to halfa them, that's fine. Now I know starting new things is hard, especially tryin'ta build new habits. But I need ya t'set an alert on your phone and do this. This'll take time t'build but ya gotta start somewhere. Three minutes out of sixty is a little under one percent of an hour. Very doable, right?" Dr. Picani nodded brightly, looking at Roman expectantly.
"Hopefully," Roman huffed grimly.
"Can ya show me? Do it three times and go slow," Dr. Picani requested and Roman rolled his eyes to the ceiling before sitting up straight to do it. This was dumb, but he felt like he had to try. They paid for this appointment and everything… Jigglypuff seemed like a nice enough dude and probably didn't deserve Roman's ire. Roman tried to inhale a little deeper on the second try, resulting in him flinching before coughing painfully. He took a sip of water with a gasp after he stopped coughing. "Everything hunky-dory, there?" Dr. Picani looked concerned.
"Fractured rib," Roman exhaled hard. "I think I inhaled too much," He blinked himself back to rights and took the final breath for Dr. Picani. "There. Did I fuck up?"
"No, ya did great, Roman. They're similar breathing exercises for healing your ribs, if you haven't started 'em already. More motivation is always a plus," Dr. Picani gave him a thumbs up. Roman wasn't aware that people did that anymore outside of emojis.
"Just try t'focus on the feeling of the air rushing through you and filling your lungs. Start tomorrow and do it up until our next appointment. A little buffer time can be helpful with ADHD. If ya get in some practice, then it'll be much easier. I recommend changing the noise halfway through the day. Your brain will ignore it if you give it the chance. Go ahead and make those alerts now so ya don't forget," Dr. Picani pointed to Roman's hand's with his pen. He was very thorough and thought this through.
It could have been he had other patients with ADHD? He probably did. He wasn't happy about most of his diagnosis. Roman used to like to pretend his real dad was Hermes, and that's why he was good at running, so his inner eleven-year-old was kind of stoked at the idea. He figured there were doubtlessly lots of not-so-fun things about it the books didn't cover. But the idea that Roman has monster-fighting senses was cool to think about. He made the alerts on his phone for tomorrow and picked a pleasant chime noise.
"They're set," Roman lifted the phone to show the screen.
"Thank ya kindly, Roman," Dr. Picani smiled brightly. "So what's something ya wanna get outta therapy?" He said emphatically, and Roman paused.
"Uh, they're forcing me to go. No offense, but I don't want to be here. I don't like thinking about this stuff," Roman muttered quietly.
"That's normal with PTSD, Roman. You've been willing to try so far, and that's step one! But you've gotta find a reason for yourself to want this or you'll have a lot of trouble moving forward, don'tcha think?" Dr. Picani explained with lots of emphases when he referred to Roman.
"Is this one of those times where I can take a minute?" Roman asked and took a sip of water nervously.
"I'd be offended if ya didn't!" Dr. Picani grinned brightly and looked down to his notebook to keep writing.
What the fuck did Roman want out of this? Making Patton and Thomas happy was kind of a reason, but it wasn't really for himself. What does he want for himself in general? He needed his brother back, and that was certainly for himself, but he wasn't even sure what he wanted out of life. He'd just been focused on the one thing for so long he hadn't stopped to consider it.
Oh, fuck, he'd have to consider it soon. They make you decide your whole fucking life at 17. His school counselors were always pushing college agendas, but the state only covered tuition and some books at a community college, not housing and food and stuff. He assumed he'd never get to go and die in a gutter somewhere. Fuck. He probably had to come up with a plan for that, too. Did he want anything out of his life at all? Was his life worth even wanting things out of? Did he even deserve good things?
"Roman, how about that breathing technique?" Dr. Picani alerted him softly and Roman nodded, focusing on his breath for a moment. He didn't feel like he was going to have a panic attack, but he sure didn't like where that train of thought was going. "Did that give ya a bit of an existential crisis?" He asked as Roman took a sip of water and leaned back on the couch.
"That's a fucking understatement," Roman rubbed his face angrily, the gloves tugging at his skin.
"Be careful, there, don't press so hard," Dr. Picani reminded him and Roman dropped his hands.
"Sorry," Roman sighed and gripped at the pillow in his lap instead.
"It's okay t'be frustrated, Roman. Another skill we'll work on learning is how t'step back and prepare yourself before things get too intense," Dr. Picani said gently, looking compassionate. Ugh.
"That sounds fan-fucking-tastic," Roman replied sardonically, unable to stop himself. Jesus. Okay, maybe he was kind of overwhelmed and a massive asshole.
"Big picture things can be overpowering, so let's look at the small picture and short-term goals for now. Is there something that your mental illnesses might prevent you from doing that you'd like t'be able to do again?" Dr. Picani suggested congenially, motioning with his pen again.
"I don't fucking know. Who can even tell? I don't know what's me and what's my issues, and I haven't for a long time," Roman grunted and tried to drop some tension from his shoulders but rolling them.
"Would you like a quick run-down of the conditions and how it might show up? I'd like it if you'd research some things from verified sources on your own time, but I can give the basics," Dr. Picani offered.
"The floor is yours," Roman motioned with his arm.
"Of course it is, Roman, I own the office!" Dr. Picani beamed the dopiest dad smile Roman had ever seen. "Depression is a cyclical mood disorder. You'll go through feeling okay and then periods of sadness as the bulk of the symptoms, other than struggling to push past motivation barriers," Dr. Picani motioned with his pen from left to right. "Anxiety is similar. As you know, anxiety's symptoms are mostly fear-related, and you'll tend to avoid things. Ya might overthink things and work up things in your head from anxiety, too."
"Okay," Roman nodded. They sort of covered that previously, but the reminder didn't hurt. He had lots of practice at forcing himself to do actions he didn't want to, so it wasn't a big issue for Roman at the moment.
"You already got the breakdown of the C-PTSD symptoms. It can express itself in a variety of ways, and we'll deal with that as they come up. Flashbacks an' nightmares are pretty standard, but any avoidance behaviours from fear can also be PTSD, but you can usually track the reactions to a trigger rather than a phobia. It takes a long time to address, so we may also need to turn to medication in the meantime. That would require working through your stigma against them," Dr. Picani certainly didn't hold back with that one.
"I—" Roman started and cut himself off immediately. "Fine," He gripped the water bottle and chewed on his tongue. The issue wasn't that he hated medications. It was that it was more work for foster parents and more 'special needs' notes on his file.
"Well, that brings me to an important point I need to hit! Ya have four conditions with irritability as a symptom," Dr. Picani held up his pen and bobbed it at Roman. "Ya seem to do well on controlling outbursts already, and I'm very impressed," He smiled a wide grin and winked again.
"It's safer that way," Roman looked away and crunched at the bottle in his hands.
"Ah, well, that's not so nice. But ya need to give yourself credit where credit is due, Roman. I've seen lots of little signs here and there that you've got anger issues, and ya still stopped yourself from snapping at me about something you seem to be sensitive about. That's something to take pride in," Dr. Picani pointed with his pen again.
"Shit, is it that obvious?" Roman hissed in disdain.
"I'm a trained professional who looks for things like that, Roman. If you think you've been managing so far, I have no reason to believe you haven't," Dr. Picani smiled and Roman froze, staring at Dr. Jigglypuff. Shit. "Okay, well, now I have a reason to," He said pointedly, raising an eyebrow at Roman.
"God damnit," Roman dropped his head. "Can we, just, not with that today? Can you tell me more about ADHD than Percy Jackson covered?" He asked, realizing how desperate he sounded.
"If that's what you need right now, that's no problem for me. Though, I won't let ya back out all the time. If it's a big issue, we don't have time t'look into that today, anyway," Dr. Picani's smile was tinged with a little sadness.
"Right," Roman said irritably. Great. Whatever. At least it wasn't right now.
"So, ADHD! The inability t'regulate attention is what they named the disorder after, but it's much more than that. It has high comorbidity with a variety of disorders. Your thoughts on the outside may look like they are going from point A to point G quickly, but in your head, your brain is simply making rapid-fire associations, and that's because your brain's default setting is go Speed Racer go!" Picani cheered at the end when he brought up Speed Racer.
"Uh," Roman blinked a few times, but Dr. Jigglypuff was not deterred from his explanation.
"Ya might have a tendency to ramble or speak too loud. Ya might not have a talking filter. Your brain might get stuck on something and not want to catch up. Ya might hyper-fixate on a subject and be in uninterested in anything else. Ya may experience maladaptive daydreaming. There's lots of variety with ADHD's symptoms and how they present. There're even more t'list, but we'd be here all day if I did. Does any of that hit home with ya?" Dr. Picani rambled off in quick succession.
"I think… most of it does? I mean, I'm not sure what some terms mean, but it all sounds kind of familiar in context," Roman replied, surprised at everything going on.
"Good! I'll give you a link to look more into symptoms at home. It's okay if you can't answer my question about goals today. We can consider it a little more homework," Dr. Picani said pointedly.
"You said it was reasonable homework, and I need to be a spelling master to google half of these terms," Roman huffed, interrupting him.
"Ya don't have to research it all right away, and I can send you with some packets t'help find something ya'd like t'change. You might not even get to it due to executive dysfunction. Have you ever just sat there doing something, needing to get up an' do something else, but no matter how hard ya try and yell at yourself to get up and go, ya just don't move?" Dr. Picani proposed.
"I, uh, yeah," Roman nodded. He didn't realize that was also ADHD. He sort of thought that was laziness.
"That's executive dysfunction. Your brain can't get interested enough in doing the things it knows it should do, so it just won't. That also might look like procrastination, uncontrollably switching what you're doing, or struggling with scheduling among a buncha other stuff. When considering goals with ADHD, we'll have to look at what's realistic. Would help with school be something you're interested in?"
"… Maybe?" Roman responded meekly. Did Jigglypuff know he was bad in school? Was that also an ADHD thing?
"You'll have to work with your school to make a 504 plan, but I'll get the paperwork on my end ready. Normally, you'll get extra time for assignments and testing and also a copy of notes in class. In theory, teachers could adapt a curriculum to be more directly engaging, but that is a lot to ask for the poor overworked teachers of the US school system, so the ways you can get help are restricted," Dr. Picani seemed a little peeved at that.
"The notes and time thing would be magical, though. I space out and miss lectures and run out of time for tests constantly," Roman was hopeful at the prospect.
"We can check for other learning disabilities right now if you like, they're Quick-Draw McGraw," Dr. Picani offered, writing something down in his notebook.
"Uh, sure," Roman nodded.
"Do words or letters seem to jump around the page? Or perhaps your eyes can't follow a line to read easily?" Dr. Picani asked, making his pen jump in the air from point to point randomly.
"Oh, that's dyslexia! That's another one from Percy Jackson. I think I have that. If I can focus enough on a book, it's not always a big deal other than accidentally skipping stuff, but if I can't it's a fucking nightmare. Shame I can't read ancient Greek, though," Roman declared passionately, popping his water bottle again. Dr. Picani smiled brightly at Roman, and he felt weirdly proud of himself.
"That's exactly right, Roman! Well then, do you mix up numbers in your head easily? Perhaps two and four are indistinguishable in your memory?" Dr. Picani inquired about another one right away.
"Um, yeah?" Roman furrowed his eyebrows. He hadn't heard of this one.
"That's dyscalculia. The last one is dysgraphia. How are your fine motor skills?" Dr. Picani asked, writing in the air with his pen.
"Oh, they're good. I can crochet and knit and I draw often," Roman shrugged. He'd never heard of that, either.
"Great! So that's just dyslexia and dyscalculia. There's a test to confirm online, but they're so common with ADHD that I'll include it in your diagnosis paperwork for the school, anyway. With those learning disabilities, you basically get more time to read or permission to use calculators on tests," Dr. Picani announced cheerily, and it was a little infectious.
"Sweet," Roman nodded, fighting the urge to lean forward. He shifted and popped his water bottle again with a plastic crackling noise. "Wait, you're just going to take my word for it?" He tilted his head at Picani in confusion.
"Why wouldn't I?" Dr. Picani responded guilelessly. Huh. "So, there's another thing with ADHD that is more of a coping mechanism that I have seen you do non-stop today," Dr. Picani seemed amused, crossing his legs in his lap.
"What's that?" Roman asked curiously and took a sip of water.
"That's the finest label spaghetti I have ever seen in all my years as a psychiatrist," Dr. Picani pointed to the pile of label shreds on Roman's lap.
"Uh, thank you?" Roman felt confused all over again. He sounded genuine, but Roman literally just made a papery mess on an impulse.
"You weren't kidding about those fine motor skills. I can't believe you pulled that off wearing gloves. You're very, very fidgety, Roman. You seem to need something occupying your hands at all times. Some fidget toys or jewellery might help with your schoolwork," Dr. Picani spun his pen in his hand almost as an example. Roman wanted to learn how to do that. "Do ya have cold hands? Most of the ones you can get away with in class are feeling textures. Ya won't be able t'feel things easily with those gloves on," Dr. Picani pointed to Roman's hands.
"No, um, Thomas asked me to wear them to stop me from unconsciously digging my nails into stuff. They said I'm supposed to wear them when I'm nervous until I have… uh, better tools to deal with things," Roman explained sheepishly while he popped at the water bottle.
"You rub at your face with a bit more pressure than recommended as well, which can be bad for your eyes," Dr. Picani pointed out, tapping his pen in the air in Roman's direction.
"Thanks," Roman replied sarcastically as he rolled his eyes, shooting the Puff a dirty look.
"Anytime!" Picani said brightly, sitting up straight. "I treat teenagers for PTSD, I'm afraid I'm immune to sarcasm," He beamed sincerely, absolutely glowing at Roman. He felt a little miffed at first, but loosened up and chuckled automatically. It was dumb to be mad at Jigglypuff for not getting upset when Roman was a jerk. Roman still wasn't excited to be here, but it was a lot less terrifying than he thought it would be.