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Finally got an appointment to see my psychiatrist. It's not fair to expect her to have all the answers, but a robot can hope.
The answer here, btw, is pretty obviously 'both' - it is reasonable to be sad and angry about what's happening, and reasonable to have that affect me in various ways. At the same time, issues with my compulsive disorder and some of my perception distortions are obviously cropping up. They influence each other. Mental health doesn't take place in a vacuum!
Anyways, i'm lucky to have a doctor who's willing to work with me. Likely looking at a medication adjustment at least in the near future, so fingers crossed that goes well.