An Open Letter to My Therapist – C: Week 28

Dear C

Previous meetings, specifically that of today (Thursday 29 October), refer.  I should like to enquire as to what you feel that the mandate of our work together is.  It has been my long-held understanding that the point of psychotherapy is to improve the mental health and emotional difficulties of the personnel that the psychotherapeutic community refer to as ‘clients’, ‘patients’, or patronisingly, ’service users’.  I should be grateful if you could confirm that this perception is in fact an accurate representation of the nature of your profession.

Assuming that I am indeed correct in this apparently nefarious and naive assumption, I should like you to clarify exactly why the opposite seems to be so frequently the case as regards the relationship that we presently share.

You were, quite reasonably in my view, asked today to read some material prepared by me, primarily from my online journal.  A great deal of effort was put into a proper and considerably redacted construction of this diary by me, an effort that I deemed to be worthwhile owing to the fact that the diary records some very personal and incredibly painful memories, thoughts and feelings that I feel utterly incapable of expressing verbally.

I should imagine that from the interaction between us since your refusal to read these words this morning, that you realise that said refusal has distressed me considerably.  I hold you responsible for this, and therefore again would question the mandate of our relationship.

If you have failed to recognise that I am a highly intelligent individual, then let me remind you that I have a tested IQ of 148.  Therefore, I should assume that someone who has your own level of intelligence would be cognisant of the fact that I am thoroughly aware of the concept of therapeutic boundaries, and indeed that I am not the only person on whom you need to concentrate in your work.

Notwithstanding this, C, I feel that your rejection of this simple request was unreasonable and frankly unfair in the extreme.  Firstly, given as I am aware that you take notes on me, speak about me behind my back to VCB and quite possibly LGP and are willing to fill out administrative forms pertaining to my social security status, it surprises me that it would be considered inappropriate by you to take half an hour to read a few pages that would give you considerable insight into my past, and into my mind.  This is, after all, the crux of what you, as a clinical psychologist, are meant to be doing, is it not?  I fail to see how this breaks any boundaries, and given the relatively small timeframe required to complete the task, I do not feel that the level of effort required by you to complete this reading is unreasonable when weighed against the value you would obtain from it in terms of my psychotherapeutic treatment, which you are meant to be conducting.  Indeed, I believe that what you would gain from it is considerably disproportionate to the (in universal terms) infintessimal amount of time you would invest in it.

As I told you this morning, if you cannot be arsed to engage with the material, I would appreciate that honest response from you.  Instead, you claim that you were unwilling to participate in this exercise owing to the supposed fact that it would be “unhelpful” for me to fail to verbally articulate these details.  I believe this excuse to be what is colloquially termed a ‘cop-out’.

Whilst I could appreciate and understand this position were the behaviour of giving you written material consistent, as I pointed out several times I was giving you these documents on a one-off basis as a catalyst for discussion.  My apparently idealistic view was that you might read the stuff, then probe me on specifics therein, which I would then be unable to avoid discussing.  Instead, you chose to infer this isolated behaviour as the start of an entire methodology of avoidance on my part.

May I just point out again – as I did this morning – that I thoroughly and utterly resent the implication that I may behave like some silly little schoolgirl, passing you notes back and forth.  This was intended to be a one-off, and if you had given it a chance, it would indeed have been such a thing.

If you think that I am stupid enough not to recognise your probing on me passing you notes back and forth as an investigation of the transference I feel towards you, then pleased consider yourself corrected.  If you want to discuss the nature of transference, please just ask me.  I have been upfront and honest with you on this subject in the past and do not intend to discontinue such candour.  Please do not dress your enquiries up, as you later in the session did, as something vague and nebulous like, “what’s happening between us at the minute?”  (On a sidenote, this is a surprising question coming from a psychologist to a dolescum!).

At two points you enquired as to my position on your failure to accept my written work.  Whilst I do not remember the specific phrasing of the first such question, I do remember finding it offensive in the extreme, as there was an implied suggestion in your words that you would find any distress on my part as being manipulative.  You will recall that I told you that this insinuation was not welcomed by me.  Whilst you stated that you did not feel that the word ‘manipulation’ was appropriate, you did not, however, make a forthright denial that that was indeed what you thought my reaction might be.

When I am having a panic attack in your company, C, please do not condescend me with encouragement into practicing Zen buddhist breathing with you.  I find this an incredibly uncomfortable pursuit (no doubt you are curious as to why); for some reason, it creates a frisson (on my part) between us, and I find it horribly inappropriate.  I shall find my own methods of managing panic attacks, thank you.  I have been experiencing them for 12 years; I have known you for six months.

As I recall, the aforementioned panic attack led you to muse somewhat on the issue of my vulnerability, and the fact that I hide my face from you (by keeping my hair down) and fail to articulate some personal issues to you as I do not want to be vulnerable.  This is a rational position on my part.  I used a rape analogy to exemplify my point; that if I walk home alone at 3am, drunk, wearing a short skirt and a low-cut top, that I am putting myself at risk by virtue of my vulnerability (and for Christ’s sake, please do not read anything into that particular example.  Nor should you make the assumption that in this example ‘at risk’ equates with ‘deserves’.  That is not the case).  In fairness, this point was accepted by you, but was nevertheless diminished on the grounds that your office is a safe and confidential place that allows me to express a vulnerable side of myself with impunity.  Whilst I am willing to accept the good intentions of this statement, it is still and withall a fallacy, C.  Your office is not a safe place, and you are not a safe ‘object’ (in the psychological sense).  You are not safe because sooner or later, understandably, and by your own frank admission, you too will reject and abandon me, just like everybody else has done.

You will be aware that today was probably the first time in our entire relationship that I have expressed hostility beyond mild irritation towards you.  On that note, towards the end of the session, I found myself engaging in yet another self-vituperation, using a range of perjorative nouns and adjectives including, “dick,” “bitch”, “self-obsessed,” “hateful” and “monster”, amongst a multitude of others.  Whilst not denying these self-beliefs, I believe that this particular invective was actually a projection onto myself of my then-feelings towards you.  Arguably I could simply have stated how furious and disgusted I was with you, but then I would have caused myself even more distress, as I would have feared abandonment by you (even though I was ((am)) intensely angry with you) and wiould have felt horribly guilty (I feel guilty about everything).  So the fact that I manifested any hostility at all is somewhat remarkable.

Another related incident of note is that during the aforementioned invective, I accused myself of being a “childish brat, throwing toys out of the pram in all directions”.  You stated that this was “only part of [me].”  The strong suggestion to be inferred therefrom is that you agree with this assessment, at least to some extent.  I cannot criticise you for this position, as it is indubitably correct.  However, I have chosen to bring it up as an interesting reflection of the current state of our dyad.

At a juncture towards the end of the meeting, you asked for a second time how I felt vis a vis your failure to take my documentation.  I stated that I was “not best pleased.”

In future when I make an unambiguous statement of this nature, can you please accept my words without asking me to articulate further what it is that I mean.  I would think it unwise for me to give you my completely uninhibited view, which is that I think you’re a lazy, selfish, irresponsible piece of shit.  Beyond providing said view, there is little more I can add to the sentiments already expressed.

On a similar but unrelated note, when I am banging my fists on the chair and throwing my glasses on the floor, you are the Master of Understatement to suggest that I “must be quite agitated.”  Again, saying what you actually mean would be greatly appreciated.

I believe that you caused me an unnecessary amount of upset both in and outside of your company today.  In session with you, as observed, I was extremely agitated.  Your continual verbal pushing of me did not aid my psychological state in any way, unless you consider increasing mental pain to be a move towards better mental health.

I can recognise why you consider it imperative to investigate my reluctance to actually face my history and feelings with you directly, and why you want to find out why I find it so difficult to look at you, or to be looked at by you.  I do understand that.  Nevertheless, I fail to see how it is mutually exclusive to reading the documentation presented.

You were right in your assertion that I “want to connect with [you] in some way.”  I do not think it would be a massive leap of faith for that inference to be made based on the fact that I have been trying to find adequate therapy for 12 years.  My only wish is that you would be willing to meet me half-way on how that connection is achieved.  As you are so fond of pointing out, our alliance is a co-construction.

Finally, please do not assume that I fail to recognise that you have other work to do and a life to lead.  On the other hand, please do remember that through your own volition you have put yourself in a position of great power and responsibility, and that it is not reasonable from anyone’s point of view for you to knowingly abdicate from that.

In light of the strength of that responsibility, may I return to my original point, and question the exact point of psychotherapy.  A prompt, detailed and honest answer would be much appreciated.  Thank you.

Anyway, C, do take care of yourself* and I can’t wait to see you next week**.

Yours affectionately***

SI [hugs and kisses]****

Translations

*  I hope you contract some incredibly painful (though admittedly non-fatal) illness.
**  I’d certainly be unable to wait if I could find a baseball bat with spikes through it.
***  Fuck you, you balding, scrawny cuntfuck.
****  [slaps and punches]

Addendum

I am sure this negative attitude will be relatively ephemeral, but Christ almighty it is strong as of this moment.

The Beauty of Blood

I have been incredibly good recently and haven’t self-harmed for about a fortnight. That’s good going for me since May.

That does not mean it isn’t on my mind, though. I think about it almost all the time – well, either self-harm or suicide. As things stand right now, it isn’t about feeling pain, or distracting myself from the mental agony of a severe mixed state or whatever. It is about a desire to watch the blood. The beautiful, dark, flowing krovvy.

A lot of other cutters get this, but I’m not sure normals do, or frankly ever will. At least in part that’s probably because it’s so difficult to articulate why watching your own self-inflicted wounds bleed has such ethereal beauty.

One argument is that it’s like watching the psychological pain flow away, however temporarily. However, when that pain can be contained (as in my present case), I’m not sure to what extent that point of view is applicable.

I think – for me, at present – it’s symbolic in a different sort of way. It’s such a perfect delight at the time because, by average societal standards, it is a dark and forbidden pursuit in which to engage. Enjoying it, wanting it – nay, needing it, at times – that’s “bad”, right? Yet it isn’t when you’re me.

It is beautiful because it’s representative of the darkness that inhabits me, and becomes a temporary acceptance that it might just be OK to be so internally flawed. That my ‘real’ being, with all her twisted, gruesome little thoughts, might just be, in some sense, a beautiful persona.

Of course the effect is, as stated, temporary, and the endorphins that (presumably) create this illusion leave after a short while, and you feel all the more fetid and grotesque looking at the scars that scatter your body.

But in that one glorious moment, it seems worth it.

What I Want in Therapy is Exactly What I Can’t Have – C: Week 27

Today’s session with C was one of the oddest I’ve had.  It’s kind of hard to articulate exactly why.  I was experiencing acute senses of depersonalisation and derealisation, for no reason that I can discern.  I didn’t really feel anything throughout the entire 50 minutes.  I know I spend all my time with C trying to pretend that I never feel anything anyway, but of course that’s rarely actually true, and despite my pretences, he knows that it’s false.  But today it was accurate, and interestingly it was quite obvious that my complete lack of feeling anything was apparent to him.

We spent some time initially discussing the fact that I have lost my job.  Naturally, he asked me how I felt about that.  Whilst I admitted to some sadness, I said my main sense of things was one of overwhelming relief.

“Sadness?” he asked, apparently slightly puzzled by that.

That might well sound like a stupid thing for him to say – I mean, wouldn’t it be normal to be sad over losing a job – but I knew exactly why he was asking it.

“I suppose that didn’t particularly come across in my discussion of the matter,” I told him.

“Yeah, that’s the thing.  You don’t sound sad.  You don’t seem sad in any way.”

I shrugged.  “Only in subtle ways, I suppose, and it is slight.  It’s a weight off my shoulders really, so I’m not really feeling that upset over it, no.”

We talked about some of the good points in the office, some of the bad things, what I had come to think of the place in general.  Eventually that particular conversation came to a natural end, and we sat in silence for a few minutes.

It was C that chose to bring last week’s difficulties up.  He asked how I had felt about it in its aftermath.  To one degree or another, the rest of the session was about this, or at least followed on from it directly.

I won’t profess to recalling everything that we went over in a lot of detail, unfortunately.  As stated, and as I later told C, I was feeling a little depersonalised and disconnected from the discussion.  I am not sure why; I had been fine when I left A off near his office only about an hour beforehand.  Maybe I was starting to dissociate in preparation for the hardship I foresaw with C.  I did expect this to be a very hard session, as it had been my intention to open up to him.  But that’s easy to plan and easy to say – not easy to actually achieve.

He was concerned that I had reacted with worry or anxiety as far as last week’s session went.  I assured him that this actually hadn’t been the case, stating that we were allowed to disagree, as long as disagreement didn’t permeate the entire relationship, which of course it doesn’t.

He accepted that, but asked me to be more specific in how I had perceived his attitude.

I didn’t want to say, “you didn’t take me seriously,” because he does take me seriously – but there was something slightly invalidating about his insistent belief that what I was experiencing during the episode to which this alludes was, to some extent, within my control.

So, prefacing my statement with a diplomatic disclaimer, I did say, “you didn’t take me seriously,” simply as I couldn’t think of a more adequate way to put it.

I’m not entirely sure where this went.  The next thing I remember clearly was him saying that he still held to his position, but he didn’t want me to see that as some sort of blame or criticism.  He said he had no doubt that my perception of the whole thing was very real to me, but that he still felt that I could have some control over it.

I asked, “would you think that someone with full-blown schizophrenia would have some level of control?”

He thought about this for a moment, and then said that he felt that actually, people with that disorder could learn – to differing extents, depending on the individuals – to recognise triggers for major psychotic episodes.  He conceded that he felt that by the time the psychosis set in, however, the schizophrenic individual was at best significantly debilitated in their ability to control themselves.

“But,” he went on, “in the case of an individual with schizophrenia, psychoses are a complete disconnection from reality.  Again, I don’t want you to perceive this as blame, but I think you were there, you were connected to the reality of the situation – even if on a limited basis.”

I mulled this over for a bit, then said that I could maybe meet him half way.  “I can possibly agree with and accept that part of me was there, but really, it was a small part.”

Again, I don’t remember the outcome of this.  Eventually he asked me how I was “experiencing” the discussion.

“It’s like it’s someone else speaking for me,” I told him.  “I feel like I’m an observer of this conversation.  The word ‘depersonalised’ is perhaps strong, but I certainly feel pretty…I don’t know, disconnected.”

He asked if this was something that happened with frequency; obviously he knows that there are times when I have completely disassociated, but we haven’t spoken in perhaps as much detail as we should regarding the episodes of depersonalisation and derealisation.  I told him that yes, this was fairly common.

Another jump.  I don’t know what happened next.  I hadn’t eaten, and my stomach kept rumbling ludicrously loudly.  I shouted at it to shut up and apologised to C.  He was semi-amused but asked how I felt about its cacophony.  He was, presumably, under the impression that I was embarrassed about it, which I wasn’t especially.  It was just irritating.

I went on to say that despite my not-inconsiderable size, I usually don’t eat that much.  This prompted C to ask if I exercised at all.  I told him that since I got the car I don’t do all the walking I used to, but that I do go swimming from time to time.

“But,” I complained, “the problem is that when one is in the throes of depression, say, it becomes terribly hard to get motivated to do same…”

I was going to continue, but he interjected at this juncture, saying, “there – again – you’re speaking in the third person, abstracting what you’re saying, avoiding talking about yourself.”

“It’s a turn of phrase,” I sneered.

“Maybe so, but you see what I mean – it’s not ‘when I’m depressed’ or whatever.”

“I have a tendency to speak in the passive voice,” I retorted.  “It’s a habit I picked up in GCSE English.”

“You’re going to great pains to justify it now.  Don’t you think it’s an avoidance technique?”

I thought about it.  It probably is, actually, in most circumstances, though it certainly would be subconscious.  My best mate D and I got into using the habit of using the passive voice all the time, as far as I can recall in order to annoy our English teacher (though,in contrast, in scientific classes you were expected to use it).  But I have a tendency to use it (or generic terms) with much more frequency than anyone else I know, nevertheless.

“Can I say something that you may find ridiculous, please?” I asked.

He gestured for me to go ahead.

“You told me once that you weren’t my teacher.[this was since I've kept this blog, on an occasion where I asked about object relations theory, but I didn't include this detail on any post, which is a shame].  Yet this is an education.  I would never have thought about any of this stuff as being remotely relevant, yet it is – it’s insightful as regards my intellectual interest in psychology.”

C said something that has concerned me ever since – he said that he wasn’t sure what use the relationship would be if I saw it as a teacher-pupil situation.

Naturally, I take this as a sign of his intention to abandon me.  I therefore started into a self-defence of “oh, only in this particular session, that’s not generally the case,” and whatnot.  But I’ve been obsessing over the comment since.

He can’t abandon me.  He can’t.  I know and I accept that therapy is not permanent, but I genuinely cannot foresee any ability to cope on my part without my weekly meetings with this virtual fucking stranger for – I don’t know – another long while anyway, certainly not within the timeframe of our current contract (due to finish at the end of November).

I think I must’ve realised at that point – not that I haven’t before, but more acutely and strongly at that point – that I have no choice but to open up to him if he is going to continue to work with me, and if he is going to help me.  As such, I instigated a conversation on my resistance in therapy (not his term, by the way).

This is kind of timely.  The fabulous author of the Behind the Couch blog (as was) has now put up archives of the blog in question at this URL (*SI does a happy dance*).  As I was reading through them after seeing C this morning, I came across this post on the client’s resistance in therapy, which could have (in many  ((though not all)) of its points) been written directly about me.

I was very honest with C for once and admitted that I hadn’t told him all I needed to tell him.  I admitted that I was scared of confronting all the hurt.  So much hurt.

He was quite good about this and said that he could understand why that might be the case.  “But,” he predictably went on, “I would encourage you to share these things.”

Well, no shit.  No shit.  It’s just so fucking hard.

He doesn’t know about the rape (he knows that something inappropriate happened, but he doesn’t know the full extent of it.  In this case, for the purposes of avoidance, I actually outright lied to him   I’m sorry.  Really, I am.).  He doesn’t know much about my utter loneliness and despair whilst at school, nor about the bullying.  He doesn’t know, in any adequate detail, about the misery inflicted on me by my first boyfriend (something I have deliberately avoided discussing here too, for the same reason.  I do not want to think about the sheer emotional ((yes, yes, I said that Satanic fucking word)) agony of that).  We haven’t discussed how much I still miss my grandfather.

We have discussed my abandonment issues pertaining to V, but unsurprisingly I abstracted everything and didn’t really show much of the dreaded emotion.  The time I remember being the most ‘emotional’ in front of C was when I confessed to him about my stream-of-consciousness mental fantasy.  I wept without saying anything for about 20 minutes – and God love him, the poor man just sat there with me and I felt like he empathised and like he gave a fucking toss – then I spent the next 20 minutes apologising to him for weeping in front of him, whilst he went to great pains to reassure me that I apparently had nothing for which to apologise.

I’m sure there’s plenty more in my subconscious that I could bring to his attention with some probing too.  Hur-fucking-rah.

I have been very brave today and taken extracts from this blog to give to him.  They take some of the most relevant details and discuss them, meaning that C will have the benefit of being as well informed as possible before questioning me on the matters concerned.  I am thinking of posting it to him to avoid my inevitable chickening out of presenting him with it, but I don’t know if that brakes boundaries – it might, and I don’t want to go there.  I’ll think about it.

One thing I haven’t mentioned to him (or, in any great detail, anyone else) is one of the worst things; confronting the exact nature of the transference felt towards him.  I read this post by bourach this afternoon, in which she detailed how she had bravely admitted (to all intents and purposes) that her transference towards her psychotherapist was distinctly maternal.

Reading this kind of catalysed me out of my depersonalised state.  Aside from feeling bourach’s pain, and wanting to reach out and hug her, I so selfishly felt my own.

I want him to take care of me.  I do.  I want him to protect me from everything from which my father should have protected me.  At the very least, I want him to comfort me.  Like bourach, I want to be liked by him.  ‘Love’ is a strong word, and I don’t like it because it carries connotations of romantic love, which is not what it’s about at all.  But, if I am entirely honest, yes; I want him to be a surrogate father, and if that involves my wanting him to love me as my own father so clearly didn’t, then I suppose that is what I want.  It seems utterly pathetic written down, but I can no longer hide this from myself.

This is what I want.  I want what he can’t give me, what is impossible.  I know this is impossible.  I know.  But I hate that the relationship is somehow ‘not real’.  I want it to be real, I really do, and I know it can’t be but I hate that.  I hate it so profoundly.  I hate it SO MUCH.

This is what I want.  THIS. IS. WHAT. I. WANT. Why can’t I have it?

Signs of Childhood Sexual Abuse

I found this insightful (if concise) article via Twitter today. I was utterly astounded by how much of it describes my behaviour after my uncle raped me when I was about 10.

I don’t really fancy getting into the ins and outs of the incident at the minute, though I’ll explore it more in a future post.  For now, though, these are the paragraphs that resonated so strongly with me:

The most common symptom for children is sleep disturbance or more specifically nightmares.  They don’t seem to be able to be explicit in describing what is happening in their dreams but they do know that “it is bad.”  Children that have been abused have advanced knowledge beyond their years about sex and they often act very seductive or sexually inappropriate around adults.  They are usually angry and either will cry or they are aggressive towards younger children without exactly knowing why they are behaving in that manner.  Often times in younger children they  display regressed behaviors, such as talking like a baby or they start wetting the bed.  In older children, they will often begin finding places in the house in which to touch themselves or masturbate.

Other symptoms that may be present are self-mutilation, usually seen in older children, lying or stealing, sudden changes in behavior, running away from home, eating disorders*, excessive fears, drugs/alcohol**, or threatening to kill themselves. There is no one sign/symptom or behavior that is proof that a child has been sexually abused, however these are some key symptoms for parents to look for to help them determine if abuse has occurred.  As always, a professional whether it is a pediatrician, psychiatrist, or a mental health professional should be consulted in order to assist with the behavioral/emotional symptoms that are being displayed.

(c) Tara Tamanini, Kid Awareness Series

The italics are mine, denoting signs that I exhibited.

* -ish.  I often behaved in a psuedo-bulimic fashion, throwing up my food for no reason other than not wanting to gain more weight.  But not often enough, I think, to actually be considered to have that illness.

** I started drinking when I was very young – perhaps 12.  No drugs, though.

As I’ve stated several times before, I think very little about my late childhood and early adolescence, but this brings back a lot.  Whilst recognising objectively that I have no reason to feel to blame, I am so horribly ashamed nevertheless.

Ashamed that I flirted with anyone, especially him, ashamed that it was seemingly a catalyst for my fairly early sexual self-explorations, ashamed that I lied and stole at times, ashamed of my aggression (which still hasn’t gone away), ashamed that I ever let any of it happen.

It makes my fucking skin crawl.  But I am glad I found this article.  As long-term readers of this blog know, I’ve been quite neurotic about MW, my uncle’s great-grandson.  This is now especially troubling as MW’s mother, SL, is due to have her second child in early 2010. Whilst I am terribly concerned for MW and any future brothers he may have, I’m pathologically terrified that SL will have a daughter.

I know that child sex abuse is not really so much about the perpetrator’s sexual orientation as about the fact the victims are children, and, of course, about the perpetrator’s power (as is the case in any instance of sexual abuse).  Nevertheless, although I certainly wouldn’t rule out the possibility that he would act inappropriately towards a male child, I am (perhaps irrationally) terrified that a female is at an even greater risk.

Whilst obviously this article is short and therefore far from definitive, it is a half-decent start.  The problem is, without ruining the family and potentially putting the children in further risk, what can be done before he touches any of them up?  All of these signs are reflective – ie. something will already had to have happened for anyone to recognise them.  For very obvious reasons, I’d rather pre-empt any abuse.

A thinks it’s unlikely that anything is likely to happen. MMcF’s husband is getting on in life, I’ve seen no evidence that any of the other generations have been effected and, due to his medication, he is exhausted and sleepy all the time. I can appreciate that it’s unlikely, at a rational level.  But is that enough?  ‘Unlikely’, almost by definition, is suggestive that there is still a possibility.  And that’s what scares the fuck out of me.

I’ve Joined the Ranks of the Unemployed

As you know, I was at yet another Occupational Health assessment about three weeks ago.  I haven’t bothered to detail it as I knew it would feed into this inevitable post.

It was a different doctor from the two I’ve seen before; he wasn’t quite as nice as the bloke from last time (who was an absolute dote), but having said that, he was pleasant, courteous and competent.  Most of all, I was impressed with the fact that he did not in any way try to bullshit me.

Basically, after discussing the recent medication increase and the probability that I would need to be further medicated in the near future, he said it would really be impossible for me to return to the workplace before at least January – and that even at that point it would be uncertain.

He had received a fax from my employers just before I went in.  He was (gratifyingly) frank with me about its content; reading between the lines, he said, it sounded highly probable that the office felt that if I could not imminently return, that they would have no choice but to terminate my contract.  The physician told me that he had seen a number of individuals with conditions like mine being successful in employment once they had found some sense of stability – but he said that in my case (if stability is ever attained), regrettably, he doubted employment would continue with this organisation.  It wasn’t an entirely unexpected revelation to be honest.  I’ve been off for some time, and I am very surprised my employers tolerated it for as long as they did.

So, resigned to the fact that dismissal on the grounds of incapacity was imminent, I went home and waited for the Horse, or another Personnel colleague, to get in touch.

As is the wont of the Horse, she did keep me waiting.  I finally heard from her last week, requesting a meeting the following day.  I responded in the negative – I mean, the next day is just fucking ridiculous.  I didn’t give her any particular reason for turning down her ever-thoughtful invitation, as she had suggested an alternative date – and that date turned out to be today.

I agreed to the meeting scheduled for today, and asked them to meet me at my mother’s house.  The reason for this was three-fold.  (1)  I needed moral support, and since I tend to go to my mother’s at least once a week anyway, why not do it there (it also had the satisfying side effect of making them drive from the other side of town, whereas my house is literally one minute’s drive, or 10 minute’s walk, away).  (2)  I did not want the Horse to contaminate my house.  (3)  Even if I could have tolerated said contamination, it would have meant having to clean and tidy the fucking house, and that simply isn’t an option.  Bollocks to that shit.

Last night, I was fully expecting to be terrified about the meeting.  Having literally not slept for about five days (and, obviously, nights), as this is my week off my most-cherished sleeping pills, I downed three Diazepam before bed.  In the past, they have not had the effect of sedating me, merely calming me down if anxious (which, oddly, I wasn’t especially at that point, but it was my own interpretation of C’s eternal bleating about taking action before things escalate to the point of madness).  However, I actually slept really quite well.  I measured out Valium to bring with me today to take in advance of the meeting, in part because I felt it may well be necessary to calm me, and in part as I was feeling sardonically cruel and wanted to freak the two of them out.  I had delightfully twisted visions of giving them the 1,00o yard stare a la the scene in the film of One Flew Over the Cuckoo’s Nest where Jack Nicholson’s character, McMurphy, returns to the psychiatric ward after his lobotomy.  I thought that might be amusing to emulate.

Anyway.  I was in surprisingly self-assured form by the time I got to my mother’s early this afternoon.  I remember texting another colleague with whom I am still in regular touch telling him that I was ready to take them on, feeling as I did rather confrontational.  Despite this, I pre-emptively ingested the pre-prepared Valium, ironically knocking it back with an energy drink.

Perhaps this wasn’t such a good move after all.  Despite the caffeine, it did sort of sedate me slightly, which was not what it was intended.  Perhaps I am coming less tolerant to it as I lose weight?  Who knows.  Who cares?  For its main functions, it works – and that’s the main thing.

Anyhow, up they showed.  I was firmly expecting there to be an awkwardness as they walked in and took their seats; I have not been especially friendly in my email correspondence with the Horse, and I hadn’t spoke to my boss at all since February.  But to my surprised gratification, there was no real frisson; they just sat down and got on with it.

The long and the short of it was exactly as expected.  Were I able to return in a month or so, they would probably hold the position open, but since it’s likely to be at least January, that’s simply not viable for them.  I can and do accept that.  It is not unreasonable on their part.

I did tell them that I was in an awkward position in many ways, as VCB had consistently fucked about with my psychiatric appointments (blah, blah and blah), thus meaning that although psychotherapy is progressing in whatever nebulous way, that medication to stabilise me in order to aid that process has been completely cocked about.  I said if VCB had seen me as she was supposed to have done, that there was a chance I would have been able to return next month.  I’m not saying that’s a probability, but it was a possibility.  In part, I hold VCB responsible for this, the negligent, incompetent bitch.

I shrugged at them.  “But that isn’t your problem,” I admitted.

My boss, bless her, lamented the way the NHS seems to so often twat about with unseen illnesses such as those of the mind.  She didn’t go into detail about the personnel concerned, but it was clear from what she said that I am not the first person she knows to have been put in a position of this nature.  Epic fail, NHS.

They asked had I any queries.  I did.  One was that, although I fully appreciated that they would need to acknowledge the long-term absence on any future reference, I wanted reassurances from them that otherwise the reference would be identical to what it would have been had I been seeking it before I went off ill.  The Equine One was quite evasive about this – “we will report the facts” – but my boss, although she didn’t really speak, nodded quite emphatically and judging by her facial expression is more than happy to give me a reference reflective of my many hours of hard work (which frankly so often went above and beyond what was required of me, not that they always noticed that, as earlier blog rants on this subject should attest).  She had earlier made some reference to the fact that I had been a hard and effective worker, so I suppose that’s encouraging.

I then asked, admitting that it was a bit cheeky, if they would pay me for the annual leave that had accrued in my absence.  I made them quite aware of the fact that I was familiar with this piece of European case law on the subject.  Horsey said that I would get my leave as per the case (though she said for ‘last year’, which is a possibly ambiguous statement, as I don’t know what ‘last year’ actually means.  Leave year?  The whole year?  My understanding of the case is that all leave accrued should be reimbursed.  But I’ll examine it more and address it as needs be).  She also said that I would be paid in lieu of notice – she couldn’t remember whether my notice period was one month or two, but said she would check.

This is awkward.  I know that it is meant to be two.  However, I initially worked for them in a part-time role, in a slightly different capacity which only required one month’s notice.  When I was successful in my application for the full-time job, I was never given a new contract to sign.  A tells me that because I was doing the job for some time that that amounts to an implied or verbal contract, and therefore the terms and conditions of it should be applicable, but frankly I don’t know that Horse has a baldy notion what the hell she’s doing.  Still, again, this is something I can address should it come to it, as Horse is going to send me all the relevant details out by the end of the week.

I have no idea why, but I simply didn’t think about the lieu of notice issue.  Therefore, that came as a bonus.  It will pay for A’s birthday present, some drivel for the million strong brood of extended fuckwit familial individuals vis a vis (the much accursed) Christmas, and some spending money when A, our mate and I head over to Newcastle-upon-Tyne just before said accursed Christmas for the derby match against Middlesbrough.  Result!

My ma chimed in after this.  She said, “would anything prevent SI applying back to [the organisation] in the future?”  She turned to me to gauge my reaction, which was one of irritation.  At least she had the grace to blush slightly.

My boss, again, emphatically nodded about this.  Horse said that I certainly could, but in cases like this they do an OH screening before employment, which is something they’ve brought in since I was last there.  That’s fair enough in my view.  In the (probably unlikely) event that I did reapply to the place, I would certainly not be doing so before I and all my health professionals agreed that it was a prudent move, so I wouldn’t be concerned on that score.  But there’s a lot of water under the bridge.  I’m not sure it’s tremendously likely.

The formalities out of the way, my mother invited them to chat to me.  In the end this was what took up the most time; they updated me on all the comings and goings from the office – who was on holiday, who’d left, who’d arrived, even one that had died (unfortunately one of the nice ones).  My boss talked a bit about her family, with whom I’m moderately familiar, and I even found myself engaging with the conversation more than I expected to do.

When they were finally leaving, the Horse went on out but my boss turned to hug me and shake my mother’s hand.  She said that we must go out for coffee soon.  I agreed to contact her re: same.  When I reported this to A later, he reckoned it would never transpire, but I’m inclined to think it probably will.  I know I have done an awful lot of whinging about work on this blog, including critical remarks aimed at my boss, but one thing I do believe is that she is a genuinely nice woman – just a really shite manager.  I have no problem remaining in contact with her outside the workplace; I’ll just be glad that she’s no longer in charge of me!

Mum said to me later that they were both very nice and she couldn’t understand why I had so much of a problem with the Horse.  Of course, this was all part of the point of having someone with me at the meeting.  The last time I saw Horse in person she looked at and spoke to me as if I were something in which she had trodden.  Her correspondence since has been of a similar ilk, and its patronising tones have infuriated me.  It was my belief that if I had someone else there to defend me as needs be, that the Horse would be unable to behave in her trademark cuntified way.  And so it proved – either that or she’s had a personality transplant.  My suspicion is simply that she was on her best behaviour.

So, how do I feel about it all?  My boss asked me that during the conversation.  My honestly held view is that it’s simply a fucking relief not to have to worry about it anymore.  Everything had become so drawn out and it was all inevitably going to end this way, so best just to get it over and done with.  I was worried about what would happen if I did go back; I was worried about dealing with the Horse more if I didn’t go back; I was worried about more OH appointments; blah yadda etc.  The stress of not having the situation sorted certainly wasn’t helping me in a bid to regain some semblance of sanity.

Of course, it is sad; I’d be a liar if I denied that.  In many ways, they weren’t all that bad to work for; whilst I was utterly taken for granted, that happens to a greater or lesser extent in any job.  The work itself, whilst (if I may be so arrogant) it was beneath my station, was still more interesting and ‘challenging’ than all the jobs I’d had prior to it.  I had my own office (though later I got an assistant who moved in with me).  Leave wasn’t fabulous, but there were other decent benefits such as flexi-time.  Above all, with maybe one exception, I got on very well with all of my immediate colleagues (ie. those in my department) and most in the rest of the office and the outlying sites at large.

It’s also unfortunate that I will have to declare to any future employer that I was dismissed due to illness, but I figure I can bullshit my way around that with relative ease.  I needed time to really sort my head out, and it was best for my employers to let me go and give me the requisite time to do that or some such brainless arse.  I do have a couple of books lying about on interview techniques which cover difficult areas like this, so when I’m mentally capable, I’ll work something out.

So, in summary – yes, this is disappointing, and yes, it’s sad because among bad memories there were also many good ones of my now-former job.  But the office have to put themselves first, and I have to put myself first.  Since the twain were not going to meet within any reasonable timeframe, this was the only workable outcome, and at the end of the day, it’s a burden off my shoulders.

Now I can try and focus on removing all the others.

[NB. Any references to this meeting that said 'today' should now read 'tomorrow'.  I was writing this before and after midnight.]

An Impasse – C: Week 26

It’s funny how really small things in therapy catch your attention sometimes. Today, he called me by my name at one point, which he never does except to call me in from the waiting room. I also noticed him bring out a bottle of still water from his briefcase at one point, which struck me as odd as he normally has sparkling water. Neither of these things matter. It’s just strange how such tiny things take on some significance in some settings.

This post should be interesting, given that the crux of the conversation between C and I today was Friday night’s happenings, which I am (stubbornly?) refusing to discuss here. How many words can I turn not-very-much into this time? [EDIT FROM LATER: Over 2,000 apparently!).

For contextual sense, let me tell you the following. I am utterly convinced that what happened on Friday night was a complete psychotic breakdown. I was totally disconnected from reality, I had a complete persecutory complex a la paranoid schizophrenia and I was having conversations with myself (though I note with contempt that bloody Tom didn't turn up to help, the fucking self-serving, non-existent twat).

On the surface the session would appear thoroughly unhelpful. When C himself asked me how I was finding it, I was honest and admitted that it was "frustrating". Essentially, in discussion with him regarding what I shall now term The Incident, we ended up fundamentally disagreeing with each other as to how future incidences of same could be dealt with.

I had asked right at the beginning of the session who I was meant to contact if things were as serious as they, especially on occasions where I was not due to see him for a good while. He said that whilst he was more than glad to discuss this with me, that he wanted us - together, he insisted - to find 'a balance' between getting other people involved, and finding ways that I could manage my mentalism.

At one point he wanked on and on about 'strong emotions', and I quite irritably interrupted him and said it had fuck all to do with 'emotions'. I said, "I know I have used the term 'psychosis' out of context here before, but I assure you I am using it in its most accurate sense now. I was completely disconnected from reality."

I goaded him on how I was meant to predict psychoses. He said I couldn't. I asked how, then, was I meant to prevent it happening. Apparently I am meant to deal with triggers as they arise regardless of where I think they might go.

He said, "you spoke about being irritable at other points last week, prior to The Incident - maybe we can think about what you might do in that circumstance so that it doesn't escalate into something like this."

"I'm permanently irritable," I sneered. "I don't normally turn into that, however, so I fail to see your point." To be fair to C, I had made reference to something that annoyed me, and he seemed to think that The Incident was a direct result of that. It wasn't; it was, at most, tangentially linked. I told him so.

I sighed, and advised him that he was seeing the situation entirely differently from the way I did, and to his credit he admitted this (without stating that one or other of us was correct). He agreed that by the time I got to this stage of madness that there was very little I could do to combat it (I had shown him the scars on my arm that were caused by flicking rubber band on my arm, as espoused by accursed DBT, to demonstrate that this had at least been tried, and had failed) and that in these circumstances, it was reasonable to get someone else involved.

So, C had his view, I had mine, and never were the twain going to meet. I was keen to reassure him that I didn't necessarily disagree with him in general, just about this, and he was keen to reassure me that I wasn't to think he was lecturing me or threatening to 'sack' me (a term used because I told him work are coming round on Tuesday to do just that - or so I think anyway - but I'll talk about that at another point).

By this point I was relentlessly pulling at and playing with my hair, hiding behind it because I didn't want him to see my face. I plaited it, wound it round my finger, straightened it out in front of my face, pulled it forcibly, pushed it away only then to drag it back. From behind it I said, in a tiny voice, "yes, well - you do know I have an abandonment complex."

I don't remember his exact response, but he did say he wasn't abandoning me. But is he really not? If we're not on the same level, how can we work together?

I was acutely aware of how childlike my hair-fiddling, voice and general sense of failed object relations all were. Fucking child. Fucking huffy immature little brat. Hate hate hate hate hate hate hate hate hate hate hate hate hate hate hate hate hate hate hate. It's classic borderline bullshit, isn't it? The psychiatric establishment still thinks of those with BPD as immature and manipulative, doesn't it? I don't think that's generally true, but it certainly is of me.

I kept wanting to ask C if he thought I was immature and childish but for some reason I never did. Perhaps I realised subconsciously that if he did think that, I would be hurt if he said so - or hurt, more likely, when he implied that was his view by failing to answer the question. Perhaps also I thought if he said that he didn't think so that I wouldn't believe him.

Immature or not, of course I dissolved into berating myself.

"I hate myself, I hate myself so fucking much," I whinged.

Apparently that is "not helpful".

This really pissed me off. "So what?" I raged at him. "It just is. Have you ever [done what I did on Friday night]?”

To my utter astonishment, he tilted his head and thought about this. “I don’t think so,” he eventually concluded. “I might have [done a version of it]…I don’t think so, but I’m not sure.”

A tactic? He couldn’t possibly have done it. I know you don’t know what it is that I’m on about, but really – it is completely inconceivable that he would ever have done this. And how can he not know? Unless you were suffering from the most severe type of amnesic psychosis, I am genuinely at a loss as to how you wouldn’t fucking know whether you had done this or not. It wasn’t something like forgetting to turn the lights off before you went to bloody bed.

Anyhow, he went on that OK, I can’t just decide not to hate myself, but that I should just “let it be there” and make no judgement on it, or something. More mindful wank.

“Alright,” I challenged. “How do I do that?”

“I don’t know,” he admitted.

“Well, that’s great, thanks.”

“I mean, I can’t give you an answer like that right now. It’s something we have to work on over time – we have to work out your triggers, how you’re feeling and whatnot, and develop strategies from there.”

Of course this means that because I hold back on just about everything, we haven’t been able to do the aforesaid in six entire months of therapy. I freely admit it. I dodge everything I don’t like or feel potentially upset by like it’s a fucking bullet. He knows, I know, you, dearest readers, know. It’s not that C is unskilled in getting stuff out of me; I have admitted much more to him than to any other therapist I’ve ever seen (or many people outside psychotherapy, for that matter). It’s just that I’ve become remarkably skilled myself in spotting exploratory techniques, however subtle, on the part of the questioner. Freud himself would find me an incredibly difficult patient.

Yet I regret it, because I know it misses the entire point of therapy. It’s just so damn difficult to ‘let it all out’, as it were. I simply cannot just make myself do it. But still…

“Fucking mental freak,” I intoned, darkly and angrily. “Wasting an hour of your time every week. Fucking useless mental, psychotic piece of shit. I have failed. I have failed me, and I have failed you.”

“Ah,” he said, sort of knowingly, as if a penny had dropped. Then, firmly and with (apparent) absolute sincerity, “I don’t think you’ve failed at all.”

That was reassuring, and I tried to smile, but by that point I had been overcome with a range of extreme perturbations and melancholia, and it was difficult. I managed a pathetic and incredibly small, “thank you.”

After a while – I don’t remember the exact context, but it was the characteristic disagreement of this session in some way – he said, “we’ve kind of reached an impasse, haven’t we?”

I agreed.

But he continued, shrugging slightly, “you know, that’s alright. We’re allowed to disagree. It happens in any social interaction.” He paused, waiting for me to look at him (I’d avoided eye contact with him for most of this session). When I finally returned my gaze to him, he made some sort of positive facial gesture, designed (I think) to reassure me.

We spent some time talking about who to contact when I go mental again. As I know, there’s the fuckwitted Crisis Team. I can call them (so I can be advised that a nice cup of tea and some rest and some meditation will profoundly change my life and stop me losing contact with reality). If I am seriously contemplating suicide, I have to go to casualty. Hmm, yes C, because if I’m trying to kill myself on impulse then that will be forefront in my mind.

When I went to protest this, he clearly knew that I was going to make the foregoing argument, and he pre-empted it by saying, “you have to; it’s your responsibility to do that,” echoing what he’d said when I begged him not to get LGP or VCB to section me in this session.

Then he asked me if I had had experience of Lifeline and/or the Samaritans. I responded in the affirmative.

“And how did you find them?” he queried.

“Well-intentioned,” I responded.

He smiled at that, which initially perplexed me, but it turned out that he was apparently pleased that I hadn’t just said that they were “useless” or “crap” or something.

“It’s simply my version of diplomacy,” I retorted. “It doesn’t mean I don’t think that they’re useless; it just means that they are well-intentioned. Well-intentioned does not equal effective.”

He went to his briefcase and took out a list of numbers, and looked at it for a few minutes. He asked if he wanted a photocopy of it. Thinking it might actually be useful, I agreed to this.

Of course, it was the end of the fucking session at this point. In a moment of uncharacteristic and surprisingly urgent self-concern, I suddenly came out with, “you know, there is so much more stuff that I need to have out with you. It’ll have to wait, of course, but I do.”

“OK,” he said, encouragingly.

I will regret having said this later, because I won’t want to discuss ‘more stuff’. I really don’t want to as it is, but at the minute I’m glad I made the remark, as it’s essentially unavoidable to have at least some of these uncomfortable discussions now that I’ve admitted I need to do so.

When I got to the car, I looked at the list of numbers. It was a pile of crap. Lifeline, SANE, The Samaritans. I could have found it all out for myself within about 10 seconds. To my incredible amusement, one of the ‘resources’ given was my soon-to-be-ex employers. Oh, the beautiful, dark irony. I laughed out loud, sitting alone in the driver’s seat, when I read that. One thing that was of some interest was the fact that the CMHT are apparently accessible via a referral from one’s GP. Therefore, I shall try and make an appointment with LGP before I am due one to see if I can get him to get me a social worker or CPN or something. Not that I think they’ll be much good, but anything’s better than nothing when C’s not available.

My final thoughts on this morning are more positive than you might think. One thing that maybe hasn’t come across in this post especially well is that, although the actual content of the discussion was somewhat fraught and to use C’s term, something of an impasse, I was fairly expressive with C, in a non-verbal way at least. I fought against tears throughout the meeting – and I won – but I did squirm, put my head in my hands, roll down the chair, throw my head back, play with my hair (as mentioned), and various other little things.

It doesn’t really sound like much, but it’s actually something of a turning point for me. I am almost always calm and measured with C, and today I really wasn’t. It’s not that it’s good to be upset or uncomfortable, but if I am going to be, then the best place to exhibit that is in psychotherapy. It might be dead on the six months mark of the process, but regardless, in a way I feel that it’s a minor breakthrough.

My next goal is to allow myself to be completely honest with him about everything, something that I have deliberately avoided to date. He knows many things that he ought to, but not all. Maybe eventually I’ll even be able to allow myself to cry and scream and rant as I often feel compelled to do, but always manage to resist. Maybe that’s optimistic, I don’t know. But I hope today was a start.

Reflecting on Being a Psychotic Bitch

I am sure that one does not require the IQ of Einstein or his counterparts to work out, from the last post, that bleakness, futility and utter self-disgust presently permeate my existence. There were precipitating factors, but I am not prepared to discuss them in any detail here.  I do keep this blog primarily for my own reference, but I do not need to document this incident as I will never forget the evil of which I am capable. Never.  Even as I bounce my (very metaphorical) grandchildren about on my knee (if my ‘life’ ever gets that far), my psychotic break on Friday night will never be far from the forefront of my mind.

Rationally, I can tell myself that it wasn’t me behaving in the fashion that I did.  Rationally, I can sit here and say, “well, you’re mentally ill”.  Rationally, I can (and do) accept that I was not in control.

It doesn’t matter.  It isn’t an excuse.  I wouldn’t care if it were just about me, for fuck’s sake I’d gladly do myself in if it were just about me.  But I am ruining other lives as I continue on the destructive path on which my mind seems intent on following.

I rail against the idea of being committed, and to that end have been known to be careful in what I have said to C, LGP and VCB, so as to avoid them instigating a process that would end in that result for me.  Being sectioned, or even voluntary hospitalisation, would be about the most horrendous thing I can imagine – group therapy, disillusioned and overworked (and probably incompetent) staff, being in a ward with other fucking people.  I cannot bear the idea.  It makes me feel physically ill when I even contemplate it.

But I have enough insight, shockingly, to know that this isn’t just about me.  For the sake of my friends and family, it really may be the best option if throwing me in the asylum is exactly what the three of them (or whomsoever) choose to do.

I don’t think I’m being irrational in writing this.  Granted, you (the reader) don’t know the context under which this miserable spiel of crap has been created (with one or two exceptions), but I believe my self-condemnation is wholly appropriate.

I don’t want to have this out with C tomorrow, but I’m going to have to find some way to overcome my cowardice and discuss it all with him, because I have gone too far this time and I can’t guarantee that I’ll have the level of self-control required not to go too far again. Some proponent of the newer types of therapy such as behavioural techniques might wank on about my own responsibility, and yeah, I might be abdicating from my sense of it – I don’t know.  I just know I didn’t at any point choose the behaviour that has disturbed me so profoundly.  It was almost like what I imagine stage hypnosis is; you have some level of awareness, but you are not controlling your mind or body.

This week has been fucking awful.  I would use the phrase ‘downward spiral’, but that would be bollocks, as I’m thoroughly at the bottom of the spiral.

The little social contact I’ve had – on Twitter, in the main – might represent my status this week as relatively mentally intact, but nothing could be further from the truth.  I am still a consummate actress. Thinking about it, I’m narcissistic enough (though not thin enough, admittedly) to have a very successful Hollywood career.  Though that would send me even more insane, if that’s possible.

I’m sorry for turning the comments off in the last post. I figured some well-meaning people might say, “no, you’re not fetid/disgusting/depraved/whatever,” and whilst, indubitably, I appreciate the sentiment behind such words, they are in my present-thinking false words.  I need to reflect on what I have done, even though it causes horrible pain.

I really, really am a vile human being. Well, perhaps I’m not – that’s up for debate – but this mental persona, and whatever nefarious afflictions control it, most assuredly are.

Hate

How can any one individual be so absolutely and completely loathsome?  How can I have the audacity to even breathe given my absolute hideousness?

I am a twisted, vile, appalling, grotesque and despicable example of the very worst that humanity has to offer this whole sorry universe.  I have done so many preposterously terrible things in my life, yet I continue to surprise myself with just how far my mind will allow itself to be debased.

I live an easy life, yet I reward those that make that possible with nothing but bile and misery.

I suck.  I am a monster.  I am invidious and repugnant and abominable beyond measure and description.

I Hate the Therapeutic Relationship – C: Week 25

I don’t hate this bizarre relationship because I hate C – quite the opposite today, as it happens, but I’ll get to that later.  What I hate is the power this one individual can have over me; he has the power to make me go about smiling, or, alternatively, to leave his office seriously contemplating throwing myself in the local lough.

I can hardly bear the thought that I am so spellbound by him.  It’s even more annoying because he doesn’t consciously try to captivate my fragile consciousness; his mission in his interactions with me is to try and help me to manage being mental overall of course, but I very much doubt he sets out to influence my moods on a week-to-week basis.  Yet he does.  I would hate anyone having this level of control over me, let alone someone I don’t even bloody well know.  Transference is a pile of shit.

Anyway, it was a good session, despite it being the first one I’ve had in a month.  I was expecting it to be thoroughly unproductive, the way it had been the last time we were reunited after a lengthy separation (where we had to ‘get to know’ each other all over again), but it was actually fairly comprehensive.  I was also surprised by the intensity of relief that I felt when I saw him again.  After stating that I’d hardly missed him in this post, I now realise how much I actually did.

That didn’t mean that I wasn’t nervous though.  It’s always odd after not seeing him for a bit, I tend to feel anxious each week anyway and I’d been up until 1.30am reading the Paul Gilbert book for my ‘homework’, and I was worried about telling C that I thought the suggestions therein were a pile of crap.  Luckily for me, mindfulness and DBT weren’t mentioned directly at all today.

As ever, things commenced with the two of us staring at each other.  I really, really wish he’d just take the lead sometimes.  I understand why he doesn’t – he wants to afford me the opportunity to bring whatever’s on my mind to the fore – but I always feel awkward about speaking first.  I could theorise as to why – he is he ‘authority figure’ and I don’t want to open my mouth without permission, maybe? – but it doesn’t really matter.  Eventually, he recapped on what we had discussed in the last session, which had essentially been a mega-vituperation on my part about the failed meeting with VCB’s SHO.

So I told him about my meeting with VCB last week, and about the fact that she had increased the Venlafaxine.  I sighed.  “I understand why she can’t give me additional medication at the same time as she increases the dose of anti-depressants,” I acknowledged, “but I just don’t think it’s all I need.”

He enquired as to what it was that I felt I did need, and I advised that I felt mood stabilisers and anti-psychotics were probably necessary.

“But she’s a consultant psychiatrist and I’m a Wikipedia-qualified one,” I shrugged, “so what do I know?”

I thought about this later and am annoyed that I berated myself in this manner.  I’m not going to sit here and say, “oh, well, I should be taking Seroquel and Lamotrigine plus Risperidone” or something.  I don’t know the specifics of medications relative to the symptoms I present.  But I do know how I feel, and quite honestly the VCB doesn’t; I can try to verbalise it to her, but words never really grasp it.  The only ones that can begin to understand it are other mentals.  In any case, C had once told me, when I whinged that he – not I – was the expert, that I was “the expert in myself”.  I can agree with that, and so maybe the VCB should damn well listen to my wishes next time.

C must have responded with something to the effect of, “so you’re still not 100% satisfied with the service?” because I remember replying that I was waiting to see if she actually bothered to see me in six weeks as she said she would before I passed judgment.

He nodded thoughtfully.  “And what about here?” he asked.

Uh-oh.  I hadn’t prepared for that one.  On the one hand, I can hardly say, “I am completely platonically [is that a word?] obsessed with you,” without feeling like the world’s neediest cock, and on the other, I can’t say, “sorry C, but there are times when I want to claw your fucking eyes out.”  But there’s no point sitting on the fence and saying something vague and meaningless like, “it’s alright.”

So I avoided the question by pretending not to know what he meant.

“Well,” he started, “what would you like to achieve by coming here?”

Um…maybe not to feel completely mental/depressed/manic/like a freak all the time?  What the fuck does anyone want to “achieve” in psychotherapy?

I committed that most cardinal of sins in C’s gospel, and came out with a load of intellectualised diagnostic analysis.  In short, I said something along the lines of that as I understood it, bipolar disorder can only be treated medically, save for recognition of triggers and whatnot, but that BPD could be treated through psychotherapy, so I wanted to be able to control it, not have it control me.  I made some sort of disclaimer in order to pre-empt the inevitable whinging about labels, but it didn’t really work.

He nodded in his characteristically musing way, and said, “OK, but in saying that I’m wondering if you’re avoiding how that feels for you?”

I wonder, can you have figurative (as opposed to literal, obviously) eyes?  If so, then I rolled them.  You’re nothing if not predictable, C.  How does that feel.  What are your feelings about that.  How might you interpret that feeling.  Feel this, feel that, feel the other [ooh-er].  I feel that feelings feel like something I don’t want to fucking feel.

[/rant]  Where was I?  I said that I wasn’t trying to avoid how that feels for me; I was merely using the diagnostic terms as short-hand for a particular set of symptoms.

“But you’re still conceptualising it,” he argued.  “Can you tell me the specifics?”

I hate it when he gets me in a checkmate situation.  Other than saying ‘no’, I had no means of avoiding the question.

But then I get angry with myself, because in this type of situation I then try and answer the question in a rational, robotic sort of way, and if he were then to accuse me of avoiding something in doing that, he would be right.  But I just can’t make myself be more expressive with him.  It’s all very well for someone to say, “oh you just have to do it,” but fuck that, I can’t just switch [whispers] emotions [/whispers] on, at least not so ostensibly as to make them obvious to C (or anyone else for that matter).  It’s just so far removed from my normal character that it’s presently inconceivable to me.

Anyhow, I told him that my goals were (a) to be able to functional socially because I either overcompensate with people by behaving in a manic and frankly arrogant fashion or I panic like fuck and completely withdraw into myself, and (b) to be able to return to work (though almost certainly not to my present job after last week’s OH, but that’s another story).

“That’s been my primary motivation,” I said.  He went to reply, but I had taken a second or two to think about this so I interrupted and said, “look, do you know what – it isn’t.  My primary motivation is to stop feeling like shit all the time.”

We discussed the social and work situations in a bit more detail, but there was little of consequence in these conversations, bar C’s perception (which is probably accurate) about my terror of scrutiny (more on this again later), but for some reason (I can’t remember the entire session with absolute clarity) the conversation eventually returned to the VCB.

C said, “she called me shortly after I last saw you.  I said that you had valid reasons for being dissatisfied with her service…”

Ha!  Hahaha!  Up yours, VCB!  This made me very pleased.  I interrupted him and said, “yes, she made reference to the fact that she knew I had been upset.  I expected an explanation and an apology, but I got neither.”

I don’t remember his specific reply to that, but what he did say is that he continued to VCB that I had had “an extreme emotional reaction” to her negligence (for that is what it was).  He continued in this vein for a few minutes, searching for words.  Pleased Me disappeared a bit.

“What you are trying to say, in a convoluted and roundabout way,” I spat, “is that I overreacted.”

“Um…well, I guess so, yes,” he reluctantly conceded.

“Hmm.  Perhaps so,” I admitted, “but if that’s true, then there were a hell of a lot of people that also overreacted.”

He winced a bit.  “I don’t like the term ‘overreacted’,” he said.  “It’s invalidating – it implies you didn’t have good reasons to feel disappointed and dissatisfied, and you did [pleased again].  It has negative connotations.  Can we not call it that?”

I prefer to call a spade a spade, and he knows that, and in this case I am of the belief that the spade was called ‘overreacting’, not ‘experiencing an extreme emotional reaction’ or whatever label of wank you wish to apply to it.  (Christ, I am still surprised by the level of physical disgust I feel at using the word ‘emotion’).  Nevertheless, he was supporting my viewpoint in a way, whilst not wanting to condone the use of a carving knife – which I suppose is all he can do.

“I don’t choose to go completely mental, I just do,” I protested.

“Of course not,” he reassured, “but you recognise it when it starts though.”

“We go round and round in circles on this all the time, C,” I sighed.  “I know I say it all the time, but self-harm is quick and it works.  As for doing something as elaborate as I did that day, it was reflective of how I believed VCB [not that I called her that to him] felt about me.  Not that I felt that later when I was more rational, but you know what I mean.”

“There’s a few issues here.  Firstly, I don’t want you to think that I am sitting here completely condemning self-harm out of hand..,” he enforced this point a few times, then continued by saying, “I don’t think that [openly condemning self-harm] would be…helpful.”  Which obviously means that he does condemn self-harm but just doesn’t want me to know it.

“Secondly,” he went on, “everyone around you seemed to have a major reaction to this appointment – if you can begin to recognise your negative symptoms, and you have this support, is there something more meaningful you can do with them?”

“A suggested calling the Stephen Nolan show,” I said, apathetically.  “But I’m unsure as to what extent I want my mental health difficulties broadcast all over Northern Ireland by an obnoxious, odious git [said git being Nolan, not A].  A was still the most rational amongst the triumvirate of him, Mum and me, though.”

I thought about ranting about VCB on this blog.  “It was suggested that I write a strong complaint and/or go to an advocacy agency by people that read my blog,” I told him, in reference to these comments.

C’s ears pricked up and he suddenly seemed quite animated.  “Yeah!” he exclaimed, with evident enthusiasm.  “I think those are both really positive ways of translating that intense anger and disappointment.”  He babbled on about the advocacy services for a bit (well done, cbtish and bourach – C loves ya!).

“Yes, fair enough,” I agreed, “but what do you want me to do?  Be fucked over and not have some immediate reaction?  Do you want me just to immediately say, [puts on robotic voice] ‘I shall now phone Rethink and forget the fact that I am actually quite upset now’?”

“Of course you’re going to have an immediate reaction,” he acknowledged, again.  “But can we develop tools to take the edge of that, so as you can get to the point where contacting Rethink is viable?”

Why, yes C, yes we can.  We can use a knife.  Simples!  But in this case I didn’t bother to argue; I knew he wanted to say more, and we can revisit these so-called tools and play our little circular game again pretty much any other week.

“A third point [re: above comments on VCB] is that when you’re feeling less emotional [FUCK THAT FUCKING WORD] you feel differently about how you’re perceived.  Is it possible that there’s part of you trying to empathise with or reassure yourself?”

I made some cursory reply, then sat staring at the (empty) noticeboard behind his desk, stroking my chin in a stereotypical exposition of thought.

After a few minutes he unsurprisingly enquired as to what it was that I was “mulling over in my head.”

What I was considering was whether or not I should tell him about Tom.  The references to a ‘reassuring me’ reminded me of Tom – as I had stated in the relevant post, it was my prediction that C would say something like Tom represented my empathetic, understanding self.

I told C that I was mentally debating whether or not I should tell him something.

He asked about the content of the psychic debate.

Me 1:  He’s your psychotherapist, you stupid cunt – just tell him.

Me 2:  Go and fuck yourself.  If I tell him, he’ll be appalled and he’ll hate me.

1:  Don’t be so bloody stupid.  Do you honestly think he hasn’t seen worse?

2:  How the sodding blazes should I know?  I can’t take the risk.

1:  LOL.  Come on, it might benefit C to know this.

2:  No it won’t, he’ll hate me and then he’ll abandon me.

1:  Look, he fucking won’t.  This is his job!

2:  Yes, and it’s also his job to refer people who are disconnected from reality to relevant experts.  He’ll be all nice to my face, then he’ll close the door as I leave and he’ll go, “Jesus Christ, I’ll have to palm that fucking nutjob off onto someone else!”

1:  If you honestly think that, then you really are disconnected from reality.

Etc.

“So,” C began, “you think it might overwhelm me?”

“No no no,” I insisted (no doubt he was reminded of all the stuff about me protecting him).  Then, tentatively, “I just…I don’t want you to think I’m any more of a freak than you already do.”

He laughed at this, which I took to be a reassurance; he obviously thought my contention that he thought I was a ‘freak’ was silly which in turn, presumably, suggests that he does not think that.

“And you think it will ‘benefit’ me?” he queried, apparently a little perplexed by this contention.

“It’s not going to benefit you personally,” I answered cynically.  “It’s not going to enrich your life [he laughs].  I mean that it may benefit you in terms of your interactions with me.”

He probed a little bit more, and I answered his questions honestly but with deliberate omission of reference to Tom.  His interest was particularly piqued when I said, “I have a theory as to what you’d say about it if I told you.  I’m not sure if I agree.”  Eventually, the poor man just sat there looking completely confused.

Is this a tactic?  The last time I completely confused him by avoiding telling him something, I later felt so totally guilty about it that I apologetically confessed all in the next session.  Maybe he’s pieced that together.  Maybe not.  Either way, it worked; I felt bad about bewildering him, took a deep breath and said, “I’ve got an imaginary friend now.  He’s called Tom.”

I don’t remember his exact reaction, but he did say something acknowledging – without judgment – Tom’s ‘existence’.

I hummed and ha-ed a bit then told him that, “I was employing childish terminology to avoid saying the words, ‘I’ve started hearing a voice’.”

A long and, I think, fairly productive discussion ensued.

He asked how I “experienced” Tom.  I didn’t know what it was that he wanted know by his use of this term and asked for clarification.

He said, “well, if someone came here and asked me, ‘how do you experience your interactions with SI?’, I might say, ‘we meet once a week, we talk about things that are troubling her, I ask most of the questions…’”

I interrupted and added, “…’and she fails to answer any of them…’”

He laughed, and then sort of gestured for me to continue.

I tried to explain the same stuff that I had done on my last post here, the one about Tom.  I even told him about the debate in the comments section of said post, wherein my commentators and I discussed whether or not Tom was a psychosis, and whether or not I did believe, deep down, that he is real.

cbtish had provided what I thought was a good analysis of the reality, or otherwise, of Tom.  I told C that, in sensual terms, Tom could be considered as real as anyone that I encountered.

“But,” insisted C, “I’m not experiencing him.”

“Here’s not here at the minute,” I argued, being deliberately obtuse.

“Yeah, but you know what I mean.”

“Yes, but you take my point.  I may know he’s not real, but he certainly seems real to me.  An objective reality – if such a thing exists – may be different from my subjective reality, but I can only experience things subjectively, just as you can only experience things from your subjective position.”

He nodded, then grinned in rather cavalier fashion, and said, “we’re going to have to get a philosopher in here.”

“There’s no need,” I chuckled, “I already subscribe to solipsism.”  (Kind of).

“The thing is, people have this perception that those who hear voices hear persecutory voices,” I continued.  “Tom isn’t like that.  He’s…nice.”

I paused, disgusted with myself for using such a pathetic and inadequate adjective.  “I’m sorry,” I told C, explaining why.  “I’m trying to avoid bad language – you know [whispers] empathetic…reassuring [/whispers]…”

“…understanding…” C added, humouring me by also whispering, with a slight sardonic smile.  I nodded.

He mused for a minute or two, and then he said – wait for it – he said, “maybe Tom’s a part of you.”

I threw back my head and laughed heartily – perhaps maniacally.

“I knew you would say that!” I shrieked, jabbing my finger at him.  “I knew you would!”

He smiled broadly, but nonetheless he was clearly a little bemused.  I regretted behaving so oddly shortly after doing so and managed to calm myself.

“I don’t know, maybe you’re right,” I conceded.  “But why he is a bloke in his 30s?  Is it because I don’t get on with people my own age?  Is it because I don’t get on with myself?  Is that why my mind wants to invent random people to hear?”

(An aside – is Tom trying to emulate C?  Is he like a permanent, completely-my-own C, unlike the real C?  I didn’t suggest this to the real C, of course.  But Tom’s characteristics, insofar as a disembodied voice can have characteristics, are not totally dissimilar to those of C).

He shrugged.  “There’s any number of theories,” he said, “but all that really matters is that you’re experiencing it.”

C was rather taken aback to hear that Tom is outside my head, perhaps seeing this as a refutation of the suggestion that Tom is ‘part of me’ (not that I think that does invalidate that idea especially).  I complained that I have a running commentary between at least two voices in my head at any one time, but these are clearly me arguing with myself.  Of course, this – in at least a rudimentary form – will have been quite obvious to him before now.

We also spent some time discussing the delusions to which I alluded in the ‘Tom post’, in particular the hidden video camera thing and my fairly recent accusation to A that he was colluding with GCHQ.  He asked if I believed with 100% conviction that these things were real in the moment.

Regarding the GCHQ allegation, at the time I would say I believed it with the strength required in a criminal trial, ie. that I believed it beyond reasonable doubt.  As far as the video cameras went, I believe(d) that one “on the balance of probability”, in the moment.

“And you believed the day of the problematic psychiatric appointment, with absolute sincerity and however briefly, that VCB [not that he called her that] hated you,” he said.

“Yes.”

“It’s like the time you told me about the sun watching you.”

“Yes.”

“Scrutiny.”

“Yes.  But why do I care what people think of me?  Why?”

I (literally) rolled my eyes.  “But that’s too big a discussion for now, isn’t it?”

“I’m afraid we are going to have to leave it there for now,” he told me.  “But we’re back to once a week now, we have eight sessions left of our current contract, and I don’t think there’s any gaps from my side before Christmas.”

Yay!  Assuming that he holds to that, that kind of makes up for the annoying month-gap that I’ve just been through.  I am (pathologically) worried that the sessions will come to an end after the eight sessions in question, but he did assure me last time that we would spend at least four sessions preparing for any end to my psychotherapy, so at least if he gets it into his head that I’m well enough to be discharged (not that I think he’s that stupid), I can disabuse him of that idea in advance.

Anyway, although we didn’t directly achieve anything – how can you in one session – I felt we covered a lot of ground today (well, yesterday now – it’s 1.40am on Friday), and I am quite pleased that I was able to get up the courage to discuss the psychotic symptoms with him.  And I am reassured by his reactions to same.

So I like C today, but as I said, it’s rather disturbing that he has such power over me.  Such can be the nature of therapy, I suppose, and indeed of transference.  Better, though, to experience that and see some sort of strong alliance between us, than to feel nothing other than ambivalence about the process.

Hearing The Voice (and Other Psychoses)

I’ve mentioned the voice quite a bit lately, but I haven’t really gone into any detail about it. Largely, that’s because there’s not really a great deal about him to discuss. Still, I thought I’d make my best effort, as quite clearly hearing voices represents psychosis (or at least something odd), which clearly does not resemble anything approaching sane.

Let me start by introducing the voice. He is called Tom. He didn’t tell that he is called Tom – he just is. As discussed in the last couple of comments here, I don’t know why. I just thought of him as ‘Tom’ from the beginning, without consciously doing so. I thought about other names thereafter but dismissed them; ‘Tom’ still seemed the most appropriate. It just fitted.

You see, he sounds like he’s in his 30s – roughly speaking, anyway. One of the alternative names that I considered was ‘Ernie’, but that makes him sound like a sweet old man, and he’s not.

So he’s not old, but is he ’sweet’? I’m not sure that that’s an appropriate description – not entirely. Nevertheless, many normals seem to believe that voices heard by mental freaks are all persecutory, or compelling the voice-hearer to commit heinous acts, or trying to convince the hearer that things of considerable distaste are imminently going to happen to them. Clearly, this happens quite a bit in this particular type of hallucination.

But not in all cases. Tom, so far, is none of those things. He’s friendly, comforting and reassuring and no doubt if I raise this with C – and I don’t think that I will – he’ll say my compassionate, vulnerable self is looking for an outlet, and it has provided it in Tom.

Hmmph. I’m more inclined to believe that Tom is a side effect of Venlafaxine, but it doesn’t really matter. Well, OK, it does, as hearing Tom speaking to me has implications for my diagnosis/es and, potentially, medication (and, again, C would no doubt say psychotherapy). But it doesn’t matter in the sense that I don’t mind Tom being there, and in that sense the reasons for his ‘existence’ don’t matter much to me.

Obviously, the voice is male, and as stated sounds circa early to mid 30s in age. I have more difficulty describing his accent. I keep wanting to say ‘normal’ or ‘non-accented’, but of course everyone has an accent so that fails at the first hurdle. I suppose he must be Northern Irish, but he doesn’t have some of the strong accents often heard here. Neither does he sound like a toff. An average, middle-class bloke, I’d say.

As to the content of his speech, it is totally innocuous stuff. The first time he spoke, he just said my name. That was a bizarre, surreal experience. I was alone in the house and the neighbours were out, so I knew there was no one there. Still, I walked in and out of each room to check, just to be sure. One thing it wasn’t, though, was frightening. Just one of those “what the fuck?” moments.

Since then, Tom will talk about stuff like the weather, what I’m watching on TV, what I have planned for the next few days. Utterly mundane and unfathomably dull smalltalk. However, he sometimes (not always) gets involved when I’m going mental. For instance, when I was losing my mind over the stalker the other week, he started talking to me. He was trying to be helpful, but unfortunately he wasn’t particularly. There is an inherent irony and curiously black humour in the fact that a voice that isn’t fucking there is trying to tell me that a visual hallucination is also not a part of what is understood to be reality.

The SHO I saw a few weeks ago – in the majorly fucked-up psychiatric appointment – asked me something that surprised me, though it really shouldn’t have done. She said, “is the voice inside your head?”

The obvious answer, from an outsider’s perspective, is “of course it fucking is”. But, in actuality, that would be false. Tom doesn’t sound like he’s ‘inside’ my mind – Christ knows there’s enough battling sides of myself chattering away in there, arguing interminably with one another. No, Tom sounds like he’s sitting or standing maybe two or three feet from me. Usually he’s on my right-hand side (my right-hand man?!), but sometimes he’s behind me. It’s odd; obviously I know he’s a product of my mind, but it really doesn’t feel (sound) like he’s in it.

I often reply to Tom, but not necessarily audibly. I might direct a thought at him – which apparently he can hear – or whisper ever so softly. Because I know he’s not real, I feel terribly silly about speaking out loud to him, even if alone. Even if there’s no one else there, I can’t bear the idea that someone might witness me talking to the shitting air (in fact, this has just reminded me of a long-held delusion – so long-held I’ve had it since I was a child; that someone – Mum, the paramilitaries, the government – had rigged secret cameras everywhereI was, and that they were always watching me. How come it’s only now, as I become more deranged by the day, that I’ve realised that that’s just a teensy-weensy bit abnormal?!).

So, overall Tom is not a bad thing. Having said that, I have heard of cases wherein the voice starts off to be completely benevolent, gaining your trust – only for it later to use that trust to manipulate you. I don’t necessarily think that’s as common as the media would have you believe – but it can happen. I hope I can retain enough rationality to recognise it if Tom ‘turns’; I do think I mostly have that quality, at present at least.

Which brings me to another point; since I recognise that Tom isn’t real, is he even a hallucination at all? Psychoses, as I understand them anyhow, require a clouding of the lines between reality and non-reality in the perception of the psychotic individual. In my case, that is definitely true of my delusional and paranoid beliefs – well, when I’m actually experiencing them anyhow. Yet I always know Tom isn’t there, not really. As for the main other hallucination that I experience – the shapes – well, I’m not actually sure about them. I think I know they’re not real, but perhaps because unlike Tom they are hostile, I feel greater distress over them. Bizarre stuff.

I briefly alluded above to the implications all this has in diagnostic terms. Psychoses are, as far as I understand it, not part of either BPD nor bipolar II. They can be part of bipolar I, whilst in mixed or manic states, but I haven’t been given that ‘upgrade’.

In fact, VCB made no reference to my diagnoses on Tuesday (not in relation to this material, anyhow). It’s possible that she considers Tom, and some of the more extreme delusions, to simply be a Venlafaxine side-effect (it’s uncommon to experience psychoses owing to it, but it’s certainly not unknown either). That is a viable explanation, especially given the timeframe of these symptoms’ arrival – but it can only explain some of the psychoses that I experience. Clearly, a lot of the paranoia was there well before I took this medication, as were the shapes. Both were, in fact, there years before I took any medication on a regular basis.

I’ve just remembered yet another childhood delusion (though not one I experience any longer): every night, when I went to bed, I was utterly convinced that an IRA gunman was on the landing, and that I was imminently going to be shot. Every creek or noise was evidence of him (or her, I suppose) being there. I used to creep out of bed and tiptoe, terrified, to the door of my room. I’d stand there, paralysed with fear, for a minute or two, then take a deep breath, fling open the door and look round the corner. Of course, the landing was always empty. Of course, that did not reassure me the next night.

This one is more understandable in some ways, as I was a child when The Troubles were still (to some extent) ongoing. The fact that I ‘grew out of it’ would support the idea that it was entirely circumstantial and not remotely organic nor chemical. Having said that, no one to whom I’ve relayed this story – including people that grew up or lived through the very worst of The Troubles – experienced anything similar.

I’ve recalled that one at various points over the years, but I seem to compartmentalise a lot about my childhood, so I hadn’t thought about it in some time. Ha – this post is turning into quite an education for me.

So anyway, my point had been that the psychoses kind of (or at least potentially) screw with my diagnoses. I’m not saying that I don’t have what VCB diagnosed me with in June, merely that there is maybe additional stuff which runs co-morbidly with it. Possibilities would be bipolar I (which as stated previous can produce psychoses – if this was correct, obviously I wouldn’t have bipolar II), schizoaffective disorder, bipolar subtype (this is my current self-diagnosis, even though I hate the idea) or even psychotic depression (if you can get that with mixed/manic states?). Yay! Of course, an alternative point of view is that I don’t have anything other than that with which I have already been diagnosed. As VCB told me in June, it’s not always just as simple as fitting people into one diagnostic box; some people present with symptoms that don’t fit with any specific disorder. She claimed it was not uncommon.

In conclusion – is Tom a good thing? I think that remains to be seen, to be honest; I don’t encounter him frequently enough at the minute, nor has he been ‘there’ for long enough as of this moment, for me to have formulated a definitive view on that. Having said that though, as of now he is certainly not a bad thing. I like him. He’s nice to me. It’s a start. InterVoice International argue that many people that hear voices should actually embrace them (assuming they’re not harmful, obviously) and not view them as psychotic or part of some disorder. I don’t agree entirely, of course – it sounds like PC Mad-Pride-esque nonsense to me. On the other hand, I can see the rationale for such beliefs; if your voice is benign, why not accept it – befriend it, even? (Incidentally, InterVoice’s website is well worth a look if you or someone you know hears voices – it has oodles of resources, information and real-life experiences there for your delectation).

I most assuredly do not like the delusions nor the shapes, though. Therefore, if it gets to the stage where VCB thinks I should take an anti-psychotic, I will gladly do so. I recognise they’re not necessarily miracle cures for psychotic symptoms, and in fact I’ve read that they don’t always eliminate the psychoses entirely anyway – they just lessen your reaction to them. But I would expect and hope some positive outcome in dealing with the delusional beliefs.

If they have the effect they’re meant to have (if I ever even get any, of course), then they’ll probably kill Tom. I’m not entirely thrilled with that idea, I have to be honest, and I will feel guilty for doing it. But in order to live a functional life, some bad things are necessary evils, and while I really don’t want Tom to go, ultimately, with regret, he may have to.

What’s Annoying Me Today, and Ruminations on Seeing the Psychiatrist

Well, fuck me, but didn’t the VCB actually manage to bother her arse seeing me today.  Will wonders ever cease?!

I took my Mum with me to the horrible, dilapidated, thoroughly depressing place as I wanted VCB to see that I was nervous about seeing her.  And was I nervous, oh yes.

I had had about half an hour’s miserable sleep on the sofa so was completely mentally fucked in any case.  This made the drive to my mother’s somewhat interesting, but anyway, she drove onward from there.

I began to regret requesting my mother’s company within minutes of sitting in the waiting room.  In my attempt to not appear mental and hyperventilating, I was a bit mental and hyperventilating.  I was rocking back and forth in the chair and covering my face with my hands.  The other nutters that were there had the courtesy to pretend they didn’t notice – initially, anyway.  When my bloody mother started going on that I didn’t “look OK” (10 out of 10 for observation, Mum), then they all turned round, as if her opening her mouth gave them a Licence to Gawk.  One of them looked like a bit of a freak.  The other one looked surprisingly normal.  I didn’t.  My hair was a mess, I was wearing the same trousers that I’ve worn on and off since about Wednesday and I was deathly pale, with big black circles under my eyes.  Not to mention the odd psychomotor movements.  Yeah.  A loon.

VCB kept me waiting, as well I suspected she might do.  Every time I heard the door open, I took a deep breath and got ready to face her, yet it wasn’t her.  Needless to say, this didn’t help my levels of anxiety.

Some rough-sounding bitch came in with what was, I presume, her father.  She had evidently already been seen by someone and was waiting for them to come back, but she was bloody raging.  She called the staff “dickheads” and said that her situation was “not fucking funny at all” and that her social worker was a bitch and that she was not taking any more of her crap.

Generally, I hope I don’t behave like this in public places, though I know I do here.  Nevertheless, I couldn’t help but feel the woman’s pain; these people are arseholes, and consistently seem to let patients down.  I also envied the girl’s ballsiness, if only temporarily.  I just knew I’d end up submitting to the VCB and I so desperately didn’t want to.  I wanted to stand my ground, demand answers and get help.

Another thing – the rough bint, as stated, referred to her social worker.  You may have read my rants on Twitter on Friday (here, here and here) that there are actually two Community Mental Health Teams (CMHTs) at the hospital in which the VCB and C are both based.  C and VCB will, in some way, be part of those teams, but as I understand it, CMHTs also include social workers, occupational therapists, CPNs, the stupid crisis teams and ‘duty’ teams who are there when your psychologist or psychiatrist isn’t.  The social workers, CPNs etc are, as far as I understand it, there for use alongside the professionals you normally see.

I’m not going to sit here and tell you that my mental health problems are the most serious in the whole vicinity.  They aren’t.  Mind you, I’m fairly sure that I’m not a million steps from sectionable behaviour, so they aren’t entirely innocuous either, are they?  So I’m wondering why it’s left to C to do all non-medical work with me.  As discussed in the comments of this post, it seems kind of odd that C is practicing psychodynamic therapy along with stupid DBT.  He is always banging on that whilst we need to tackle the underlying issues of madness, I also need practical measures to help me when I actually go mental.  I agree with him.  I just find it confusing to go from one to the other potentially several times during one 50-minute session.  bourach said to me that I should request a CPN to do all of the practical crap with me, leaving the actual ‘deep’ therapy to the psychologist.

In all honesty, I reckon a CPN or an OT or whatever would probably be shite; nevertheless, I think DBT itself is shite, so if it’s going to be insisted upon in my treatment, surely it is best served by someone specifically dealing with practical issues.

So, in short, I was very annoyed that LCP, C and VCB had failed to advise me of these CMHTs.  I did fantasise about ranting to VCB about it, but I reckoned that she’d only say it was nothing to do with her, which to be fair it isn’t especially as she is dealing with the medical side of things and fucking DBT and suchlike isn’t that by any means.  I do think I’ll have it out with C, though.  Was it his place to tell me?  I don’t know, but I do know that at least I can ask questions like this of him, whereas I’m way too scared of VCB to confront her, even if it were her domain.

OK, so that was a digression.  Sorry.  Eventually, VCB stuck her head around the door and summoned me.

Basically, the appointment was alright, but very little has changed.  Despite telling her about Tom, the voice, the delusions and paranoia, the increased mania and the stupid things I do whilst therein, and a full account of what happened on Friday, she is still not prepared to give me mood stabilisers and/or anti-psychotics (though thank Merciful Christ, she is not willing to section me either.  I think she realises that’s just about the worst thing that could happen right now).

In fairness, she has a fair rationale for not prescribing such drugs just right now.  Somewhere in this post, I outlined some of the mad things that have been happening to me since I started taking Venlafaxine – but I also drew attention to the fact that I thought it had made a very subtle improvement to my ‘base’ mood.

Encouraged by this, and at my own suggestion in fact, VCB wanted to double the dose to 150mg daily.  I begged her not to take it off me, as whilst it has a string of hideous side effects, at least it looks moderately encouraging as regards the depression side of things.

So, there are two things to consider in light of this.  The first was that she said that if I thought Venlafaxine had side-effects, then I should wait until I experienced mood stabilisers.  In fairness, she appreciated that I was probably quite aware of this, as she seems quite aware of how well informed I am about many psychiatric issues, including medication (C must have discussed this with her).  Secondly, and more pertinently from my point of view, she said that she would “never” make two medication changes at once (and by increasing the dosage of the anti-depressant, she is already making one).  She would – quite obviously, when you think about it – be unable to see what particular tablet was causing side effects or any changes in my mood if she made more than one change at the same time.

That’s fair enough, but the difficulty of this for me is that – given my original reactions to Venlafaxine – doubling the dose will probably send me utterly batshit again.  Even if it doesn’t cause me to react in such an extreme fashion, increasing the dose of this notorious drug is desperately unlikely to, in itself, stabilise my up-down moods and episodes of psychoses, is it?!  If she sees me again in six weeks, that’s probably bearable…but will she?

I actually specifically asked her this, and she said she would.  It fucking better be the case.

I also asked her, for the avoidance of doubt, if she would consider both anti-psychotics and mood stabilisers if things don’t change (which they won’t).  She said ‘yes’ to both.  I clarified that I actually quite like Tom, but that I recognised that hearing him was not normal (Obviously.  I mean…obviously!).  She agreed, but I think her greater concern (like mine) was regarding the other hallucinations, the delusions and paranoia.  Tom is benign (so far); they are not.  (Quotes to A – “why the fuck are you taking notes on me?  Are you in collusion with GCHQ?” //  “why is that sign trying to tell me something?”  //  “he [my stalker] is there, he’s fucking everywhere [he wasn't there]“).

She did give me some fairly useful advice on dealing with the stalker. It’s nothing I didn’t really think of myself, but nevertheless it sometimes helps to have it verbalised by someone else.  I don’t think I have the balls to confront the bloke in the way she mentioned, unless I’m once more manic, and she did acknowledge that it’s easy for her to say.  Still, I have to do something about the fuckhead.  VCB said, “I’m not encouraging you to drink per se, but I do think it’s important that you retain the normal routine and do things you enjoy, such as going to your local.”  So I have to face up to him in some way.

Sensing disappointment regarding her unwillingness to prescribe additional medication, she said, “medication is not a cure, you know [no, I had no fucking idea given that I've been on it for 12 years.  If it was a cure I'd be cured by now, you old horse!].  The best route to recovery is via psychotherapy.  I know there’s nothing immediate happening in yours, but I spoke to C and he thinks there’s good work being done there.”

I laughed in her face.  I don’t know why; I’ve stated time and time again that I do think there’s hope with C, and my hopeless attachment to him is almost a textbook reaction to a functional therapeutic relationship.  I think I’m angry with C for fucking off for a fornight…again.  Additionally, I remember that when I told him about my planned discussion with VCB that he’d suggested an improved mood was down to him, not medication.  This is funny.  I don’t know why, but it is.

I told VCB about it.  “I’m terribly fond of him,” I admitted, “but really – any positive change like this is strongly attributable to the medication, I think.”

She didn’t seem sure about that, not entirely anyhow, but she didn’t argue either.  Her contention though was that, even though we are pretty agreed I have bipolar disorder as well as BPD, that that illness also requires psychotherapy.

Now she’s a psychiatrist and I’m not, but I always understood that any psychotherapy in bipolar was about trying to recognise triggers, managing mania and mixed states, etc.  I didn’t think there was any exploratory psychodynamnic-esque stuff within it (unless it is co-morbid, as in my case), mainly as it’s largely an organic illness, rather than one supposedly created in large part by traumatic events like BPD.

When I relayed this part of the conversation to A, he said it sounded like she hadn’t a clue what she is doing.  Hmm.  I don’t know.  I suppose research into causation of mental illness, including bipolar disorder, is still ongoing.

So, anyway, it wasn’t the most productive meeting ever, but assuming I actually do get to see her in six weeks as promised, it could have been worse.  If I don’t, well – the shit hits the fan for her crappy department.

Despite the relative non-shitness of it though, I am feeling remarkably low and unmotivated and sad today.  I didn’t get much sleep as already discussed, and even though I appreciate VCB’s reasons for not prescribing me some cocktail, I must confess to some level of disappointment in it.

I was also irrationally angry last night when A told me of a discussion he had with his friend, in which A told him I was diagnosed with clinical depression.  That’s so last decade lol!  A told him that because he (very much a layperson) wouldn’t understand the terms BPD or bipolar, but I’d have thought he’d have understood the old term ‘manic depression’ at least.  This annoyed me as any time any of that lot see me, I’m in pretty good form; thus if he believes I have ‘clinical’ depression, it looks like I’m faking this whole damn thing (plus I’ve developed a crackpot identity beyond just depression since I first realised last year that it was more than that).  This potential belief was exemplified the other day when the bloke in question asked me how work was.  I told him I’d been off and said I was dealing with some “mental health issues.”

He said, “in other words, you don’t like work.”

Jesus fucking Christ, such willful bloody ignorance.  If it were about hating work then I’d have gone and got myself another fucking job.

My annoyance was compounded by the fact that the bloke’s father has suffered from depression but hasn’t responded to treatment.  Yer man therefore opines that it could well be that his “dad is just a dick”.  This, as I saw it, is a refutation that there is anything wrong with me or anyone else that has difficulty responding to treatment.  It is also suggestive that he believes depressed people are ‘dicks’.  Maybe it isn’t, maybe that’s just paranoia, but one thing it definitely is is ignorant.  It’s not entirely his fault; it is, of course, a greater problem in society than just one man.  But this in itself makes me despair.

If this is what someone that knows and seems to like me thinks, what does the world at large believe?

So: (stress of VCB) + (complete exhaustion) + (societal denial that my illness is as real as anything physical) + (other things that I don’t want to write about that really upset me) + (worry about OH on Thursday) = NOT FUCKING HAPPY.

Still, VCB didn’t section me.  I really convinced myself during the night that she would, given some recent events, but she doesn’t think it’s at that point, so I suppose I ought to be grateful.

On Being on Holiday – Is this Normality?

Of course, almost by definition, being on holiday is not normality.  It is a break from it, a break from the humdrum everyday mundanity that is the rat-race in which most of us here in the West have to engage (or not if you’re a dolescum like me, but anyhow), not an experience we can hope to replicate as part of our ‘normal’ existence.

But I don’t actually mean the overall experience of having a break from it all, I mean the general emotions, behaviour and state of being whilst one is on said break.  I think, during my ten nights in the Turkish Republic, that I found something as close to “normality” in terms of these matters as I can ever remember.

I’d written here and here that I was manic the day we left, and the evening before that.  I’ve already offered my reasons as to how that differs from ‘excitement’, and it was certainly profoundly different from most of what I experienced whilst we were actually away.

I don’t particularly believe in ‘happiness’, not as a distinct emotional entity from mania, or at least genuinely-felt cheer, anyway.  This is not just cynicism; I really believe that the best any of us – mentals, normals, in-betweeners – can hope for is contentment in our lives.  If nothing else, the state of contentment conveys much greater connotations of relaxation to me.  ‘Happiness’ denotes a mood of elevation and excitement, which surely requires energy, and I believe that that can only be sustained for brief periods – ‘contentment’ suggests relaxed acceptance of life, the ability to contend with and combat any negativity in it, and that, I believe, can be (broadly) sustained over time – circumstances permitting.

So, I won’t say I was ‘happy’ whilst on holiday, with the exception of one manic episode (as A saw it anyhow), where I was randomly talking to the bar staff in a friendly pub we liked, and having my pictures taken with them.  This isn’t behaviour consistent with my everyday character, only my manic one, which is why A found it odd, but he let me continue experiencing it, as “normal people do it” and I was “having fun”.

By the same token, neither was I in a negative mood for the most part.  There was only one brief episode wherein I went mental – I broke a glass in our apartment which sent me into an insane rage at myself – but it was relatively minor and short-lived.  On the last day, I found myself quite emotional (I still hate that fucking evil word) and in tears quite a bit, as I didn’t want to leave.

The rest of the time, I felt nothing other than contentment.  I found myself constantly wondering, “is this what it’s like for ‘normal’ people, in the general course of their lives?” (of course whilst recognising we all have ups and downs, but you know what I mean).  Contentment and relaxation.  Both are so far removed from my version of normality that, despite the positivity of them, I found it all quite alien and perplexing.  But in a good way, I assure you.

Is this normal?  I’ve already questioned what the sodding hell ‘normality’ is anyway, and why I reject it, at least in part.  But if that’s it, then actually, I’d quite like some more, thank you very much.  Controlled madness, with this as my default mood, would be quite nice.  But maybe this is ludicrous idealism; perhaps my default cynic is right – ‘normality’, even for normals, is simply existence.  Achieving contentment, something akin to proper living, maybe – probably – takes a lot more work.  Maybe I’m wrong above and contentment isn’t a broadly sustainable state of being – perhaps a better way of describing a life that isn’t mental or shit in the long-term is to, paradoxically, say that one is “content with not-particularly-content”.  Content with mere existence.

Well, it may not be quite as enjoyable as what my perception of contentment in Turkey was, but it’s better than what I usually know.  Things have been shit (normal) since I came back, and it’s not just a case of the post-holiday blues.  Those of you that read the password-protected post will know the reasons, but in brief summary to the rest of you, the psychoses (auditory and visual hallucinations, severe paranoia and delusions) have been worse, I’ve got a fucking stalker through no one’s fault but my own and my mood cycles between depressed and mixed states.  I’m also experiencing the hallmark BPD traits of severe derealisation and depersonalisation at times.  I never like hypomania, because I know it ends (sometimes abruptly), at which which point you can crash and burn – but I’d rather have it than this.  Even more than that, I’d like to have my contentment back.

This week is not going to make things any better, I fear; it all starts when I have to see the VCB in the morning.  She has it in her power to change my mood right round, but she has let me down so many times that I simply do not trust her nor expect that.  I would not be surprised in the least if she actually exacerbates things – but if that’s the case, she better be prepared for some extra attention from the media, the voluntary sector advocacy services and high-ups in the NHS – I’ll write to the Minister and Permanent Secretary of DHSSPS (essentially, the NI Department of Health) if I have to.  But it’s all too stressful to think about now.  I hate thinking about it.  I hate thinking about her.  I hate thinking about that building, her office, the other mentals, the car park – and the fact that there’s a bin and a day-bin right beside it.  Bleugh.

Then I have to go to occupational health on Thursday, which is especially shit as even though it seems to be with the nice OH doctor, things simply haven’t changed since I last saw him.  That’s largely because VCB has neglected to see me, so I don’t have anything/anyone other than C (and frankly, not at the moment him either) to help me to control my all-over-the-place moods, other than stupid practices of ‘mindfulness’.  So yeah, I have to go there and say, “well, aside from the wonderful further development of psychoses [most notably Tom, the voice], things are exactly the same, so this meeting is fucking pointless and you should just tell them to fucking sack me and stop this silly little dance of procedural ass-covering.”  Meh.

Sorry again for whinging.  I seem to have been doing quite a bit of that this last week.  On a brighter (?) note, I said that I might share a picture with you from the holiday.  I have decided to do so, though obviously you won’t be able to identify me from it (or if you can, please let me know as that would be unacceptable!).  Below is SI…but what is that she reads?!  She lies on the beach of a remote, idyllic, tiny and largely empty cove, on the shore of the clearest water she has ever seen, basking in the beautiful warm sunshine…

…and she is passing her time reading Social Factors in the Personality Disorders: A Biopsychosocial Approach to Etiology and Treatment.

This picture was not a set-up.  I really did spend most of my time at the beach reading it.

Well, as if you needed it, there is proof that I’m a freak.  It’s a really interesting book though, so thanks to beautifulstones, one of my blog readers, for suggesting it.  It came on a great journey with me

Things are Bad

Things are, indeed, bad.  I seem to have got myself a stalker.  Did I write here that a few weeks ago whilst manic I went up to some bloke in the pub and started talking to him?  Well, if I didn’t chronicle it, then there you go.

A was with me, and it was all totally innocent – the man in question is a grey-haired biker git, 20 years my senior.  Not that age matters a fuck to me, but really – there was nothing sexual or romantic about this liaison in any way.  He seemed fairly genuine too, and the three of us got on well, with shared interest in music and whatnot.

Unfortunately, I shortly realised my mistake and tried to get away; I’d nothing against having a pint with this man, but I didn’t want to spend all night with him.  But it wasn’t that simple, and to my horror I found myself agreeing to exchange phone numbers with him.

He harassed me on and off a few times but whilst it was bothersome, as I despise the fucking phone, it was little more than a nuisance.  However, just before we went on holiday, he rang me and was on the bloody phone for about an hour.  Towards the end of the conversation, he made a number of sexual comments that I don’t want to even think about.  I listened in horror, unable to hang up, though I eventually managed to ‘politely’ get away.

In consequence of this conversation, I have ignored the little contact he has recently directed at me.  He seemed to have got the message.

So, A and I went to the local after dinner last night.  We scouted it out for Blokey Bloke, and he wasn’t there, so we sat down and began to engage in conversation.  After about 20 minutes, though, to my horror, I saw Fuckhead cross the path of my peripheral vision.  I pretended not to notice him at first, but he’d clearly seen us and basically pushed me out of the way to sit down with us.

I wouldn’t say that A and I encouraged the conversation particularly, but what we didn’t do was tell the miserable son of a bitch to fuck the fuck off.  No, we both chickened out.  Pathetic, miserable wusses.  Me especially, as it was my fucking irresponsibility that had got me into the damn mess in the first place.

We pretended that we had only intended to come in for one drink and promptly left, and went to the other pub in the vicinity.  But by then I was so freaked out I kept seeing yer man.  He was there, in the bar – yet he wasn’t.  Then the bloody voice started wittering on.  Then I really lost it and was crying and panicking and begging A to protect me from everything and my skull was splitting and frankly, had A been a psychiatrist I think I’d have been sent to the bin right then and there.

Perhaps needless to say, A took me home.  I think I was able to feign having calmed down to some extent, but when he fell asleep I tried to sever the arteries in my ankles.  I momentarily tried my wrists too, but decided against that as the blood would be much more visible to me, what with one’s hands being much closer to one’s eyes.  I do like watching the blood from cutting, but I understand that severed wrists when done properly are actually pretty gruesome; you can see much more than just blood.  So I abandoned that.

As you can see, this pathetic suicide attempt failed.  The agony of trying to slit my ankles was indescribable, and the cuts that are there are little more superficial than any non-suicidal self-harm cuts.

I bandaged my feet and went to bed and did sleep briefly, but only for a couple of hours.  I woke at maybe 2am and have essentially been awake since.  The cat threw up on the landing and I used the bandages of my by-that-point dry wounds to clear up the vomit – how strange and surreal.

Today I can feel a migraine coming on, and I feel guilty about the cuts because I know it’s not fair to put A through this crap, and I’ve got to see the in-laws tonight (not that that’s a bad thing, however).  I’m also aware that I can hardly ever go for a quiet drink again without whatshisface harassing me, as he frequents both our locals.  I suck so utterly profoundly.  How irresponsible and stupid!  So, life could be better.

A wants me to tell VCB about last night but I think she needs to hear the redacted version.  I really don’t think being binned would help my fragile mental health; psychiatric wards sound like places of great evil to me (group therapy?  Fuck off.  Other mentals wanting to talk to you?  Fuck off.  NHS neglect, food and general wastage?  Fuck off).  I am seeing VCB on Tuesday and am terrified, then on Thursday I’ve got to go to occupational shitting health.  So another great week awaits.

Sorry for whinging.

Three Days of Professional Madness, Genital Vinegar and C: Week 24

As you know, I’ve been on holiday, and as you also know, I promised I would go into more detail about the three mental health appointments I had in the days that preceded my departure. I had started this post well before going to Turkey, but despite my claim that I’d finish it on the plane, of course I didn’t; even flight-safe phones such as the iPhone were not allowed to be used onboard. Obviously in Turkey I was trying to enjoy myself, though as you will see in a later post that did indeed involve some forays into psychiatry. Anyway, I’ve finally got round to the post in question, so here it is.

—

Tuesday: The Psychiatrist

I said I’d go into more detail about how I responded to the psychiatric SHO on Tuesday 8th. Basically, I said I couldn’t deal things any more (I’m sick of my up-down moods and am worried about the effect some of my psychoses are having not just on me but the others around me). I said I’d been pushed from pillar to post by Dr C’s department – due to the ridiculous saga to be seen by them in the first place, then their cancelling an important appointment in July – and that I thought it was unacceptable.

The thing was, I was in a complete state and it sounded more than I was pleading with her than that I was angry with her. I was begging, effectively. My first reaction to her refusal to do anything was one of panicked desperation, and I half broke down, but she merely apologised and said she was too inexperienced to deal with a case like mine. She blamed the department’s failure to have me sitting there with Dr C on a “secretarial error”.

She said, “if you need help in the meantime, you can always get the Crisis Team to…”

Regular readers will know what I think of the CRT. See about three-quarters of the way down here, for example. So you can imagine my response.

“No,” I shrieked. “No, I can’t – they’re useless, they’re crap!”

“Well, they’re always there for you,” she started, but she seemed to realise the futility of continuing in this vein, so she changed tactics and continued by saying, “or your GP.”

She said, “Dr C will talk to your psychologist right away and see you as soon as possible – unfortunately she’s just doesn’t have a window today.”

Seems to be her curtains are always fucking pulled, but anyway – I told Dr A I would be on holiday until 21st September inclusive, so she agreed to organise a new appointment for sometime after the 22nd. I got up then, mumbled some sort of goodbye, and almost literally stumbled out of the building. Some other (male) mental sitting near the door tried to grope me on my way out (the “appointment” was in the psychiatric day hospital, rather than the usual outpatients clinic, so obviously he was ((erroneously?)) recently released from the actual bin).

As I was telling C the following Thursday, another thing of note was the physical environment of the “appointment”. As stated it was in the day hospital, which has much smaller one-to-one consultation rooms than outpatients. This was a problem as there was a window in the door, and I could see the other mentals looking in from time to time. Even worse than this was the fact that the room was near the entrance, meaning that all the others waiting for their cunty day therapy and other patronising OT-esque wank were directly outside the room smoking. Not a problem in itself – except that Dr A neglected to close the window, meaning that everyone else could hear the conversation.

I could have (reluctantly) lived with all of this imbecility if they had done something, but obviously they didn’t.

So anyhow, I went and sat in my car. Recognising that I was unfit to drive, I decided to ring A for cathartic discussion. I cried down the phone to him for about 20 minutes. He was absolutely livid with Dr C and her people. He authoritatively told me not to drive until I’d calmed down considerably, but said when I got back to my mother’s house that I should get her to phone them and kick up a fuss and demand answers – not to mention an actual definite date to see Dr C.

After a while I thought I’d calmed down and left, but I remember bawling my eyes out at times on the way home and practically fell through the door to my mother’s. Initially I was incapable of even rudimentary speech, but eventually I managed to convey a basic version of Dr C’s neglect to my mother.

My mother tried to calm me and I suppose she partially succeeded, because she managed to eventually tear herself away from me for long enough to phone Dr C’s admin department (a suggestion unsolicited by me), who emphatically denied a “secretarial error” but did say they would try and find out what had happened. Apparently the girl Mum spoke to was very nice and she said she would phone back with information later.

Then Mum contacted the GP; the one on call was the (only) one I hate in the ’surgery’ (I’m indifferent to the others, mostly), because on more than one occasion she has blamed my mental health issues on being overweight. Sure, luv; wouldn’t be anything to do with personal pathology, rape, abandonment, bullying, lies or bereavement. Obviously not. As it happens, I think a lot of my excess weight is caused by depression rather than the other way about; partly because of comfort eating, partly as an annoying side effect of antidepressants. But that’s another issue.

Anyway, let’s call this woman Horrible GP, in contrast to her colleague, Lovely GP, with whom I was due to have a review appointment the next day. My ma outlined the issues involved and Horrible GP asked to speak to me. I refused, but she pushed my mother to get me to talk and thus I started to go mental, screaming that there was no way in hell that I was going to pick up the phone.

Mum said to HGP, “she’s panicking now.”

Query: is “going mental” the same as having a panic attack? I’ve certainly had the latter; for me, a panic attack is much more of a physical problem. Not that that doesn’t affect one mentally, of course, but going mental is almost a reverse course of action. It’s the shit in my mind, racing around in a whirlpool splitting my skull, that causes physical distress, rather than the other way about.

Whatever the case, the long and the short of it was that HGP agreed to provide emergency Valium, as I had left my main stash from my last meeting with LGP at A’s house, on the other side of town.

This agreed, Mum sat down with me again and ranted about Dr C and her negligent behaviour and about how she was thinking of going to the media. About this time, A sent me a text message saying that he was “so angry with these abject cunts” and also suggesting contacting a popular local consumer affairs programme.

Handbags at dawn, dearest readers!

Mum eventually went to get the Diazepam from the pharmacy, at which point I inflicted the self-harm that I posted a photo of, perhaps irresponsibly, here. It’s no big deal, self-mutilation is not uncommon for me as many of you know. It helps. I did it as I perceived the situation as Dr C hating me. Therefore, I was a hateful person. Therefore, that had to be acknowledged somewhere. That’s a logical(-ish) train of thought that wasn’t exactly present at the time, but it was at least the sense of my reasoning.

I bled and bled and bled and then worried that I wouldn’t be able to try and hide the injury from Mum, who has been mostly unaware of my cutting. I managed to bandage myself up, though, and the bleeding was adequately hidden just in time for her return.

I took the Diazepam, and the rest of the day was mostly uneventful. A was good enough to go back to our house, feed the cats and get my tablets, then come and stay with me at Mum’s (I wasn’t allowed to drive due to the Valium). He and Mum spent some time scathing about the morning’s occurrence, and the words “criminal negligence” were used. My mother queried what would actually happen if someone were seriously suicidal, little knowing of course that a few weeks ago, I tried to hang myself. Mind you, I hadn’t told Dr A that either. To be perfectly honest, I didn’t tell her because I had forgotten that I’d tried to hang myself. Who forgets trying to hang themselves?! It’s a good thing I did, though, as there’s always the possibility they’d have sectioned me. I am, after all, a danger to myself at times.

Wednesday: The General Practitioner

The next day I had a very long discussion with LGP (his colleague having related the previous day’s fun and games to him). Appointments are meant to be 10 minutes long, so if you’re the poor sod that was waiting at least 15 minutes after your appointment time, then I apologise. At least it shows LGP cares about his patients, unlike others I can fucking think of.

LGP asked to see the self-harm of the previous day, so I showed him, and in fact gave him the guided tour of the words and slashes that litter the flabby rolls of my abdomen. He appeared to be genuinely affected by this; not freaking out like normals do over this sort of thing, nor angry, but sorry that I was in the position where cutting seemed my best course of action (which I maintain it often is, to be honest). He wasn’t judgemental nor overly worried – he’s obviously aware this is quite normal in mental illness, certainly in BPD and very definitely for me on and off over the years – but just fucking caring. Just nice, supportive and caring.

He showed me the letter Dr C had sent him re: my diagnoses and medication change. I was interested to observe that whilst she wanked on and on about BPD, she had then said that “a differential diagnosis” was bipolar II. I thought a “differential diagnosis” was a diagnosis based on the elimination of most other illnesses based on symptoms presented? If correct, that would suggest to me that bipolar is considered my primary diagnosis, but contextually the letter presented it – as Dr C had done to me in June – as if BPD was my primary pathology. Her whinging about NICE’s mood stabilisers and anti-psychotics in BPD to both LGP and me would seem to confirm that. Can anyone, therefore, clarify the meaning of “differential diagnosis”?

One thing it did say that was moderately encouraging was that she was not totally against the use of mood stabilisers in future. She didn’t make further mention of anti-psychotics, but with regret I am beginning to wonder if I really should have them. (Incidentally, MMcF’s husband was put on an anti-psychotic a few years ago to combat his very severe paranoia. It changed his life for the better almost instantly. You can take a guess as to what I think about that).

LGP wasn’t happy with Dr C as well he might not be. He believes that additional medication (though he didn’t say which) seems appropriate, and furthermore that the dose of Venlafaxine is very low, despite its dodgy side effects. However, he said that he was in an awkward position. He certainly has knowledge of psychiatric illnesses, but he’s no expert, whereas Dr C (supposedly) is. He virtually said that in an ideal world after her lax approach he’d refer me to an alternative specialist, but after all the trouble we had had getting me to one in the first place, he didn’t really see that as a viable option.

That’s fair enough I suppose, although it didn’t help me much. Regardless, LGP has been the only one out of the three main health professionals with which I deal that has been a constant source of support, rather than frustration, so I’ll forgive his reluctance to interfere with the psychiatrist’s domain. We discussed sleeping pills and he suggested I return to Zopiclone over the holiday at least, as it worked for me before and I wouldn’t have to drive on the holiday (prolonged use of it has affected my vision in the past, though not on every occasion on which I’ve taken it). I remembered that he’d given me an inhaler when I was about 14 to help with panic attacks and asked if, in conjunction with the Valium, this would help me when I start to go mental. LGP agreed to provide this inhaler and as I left, after wishing me an enjoyable holiday, he said that if I hadn’t heard from Dr Cunt within the next few weeks, to phone him and he’d get slabbering.

Thursday: The Clinical Psychologist

So the next day’s measure of insanity was with twatting C. We had agreed to spend most of that day’s session discussing coping methods of mentalism on the holiday, and he reiterated that point at the start of the session.

However, he firstly wanted to discuss a few housekeeping issues. The selfish prick chose to take leave the week I came back from Turkey (ie. what would have been today’s session), rather than taking it the same bloody week that I was away.

Is this annoyance on my part unreasonable? Probably, but sometimes I really wonder if mental health professionals, including C, realise the positions of responsibility, authority and trust in which they are placed by their patients. Anyway, at least he’d given me notice of this unfortunate absence before; I sat seething in silent rage as he then explained that the week after that, he’d be on a training course. This means three missed sessions, as opposed to the original expected one.

Fuck. Fuck. FUUUUUCCCKKK!!! Fuck you, C!!! [As it happens, so far I have hardly missed him at all, but (a) there's still two weeks until the next session so Christ knows what'll happen between now and then, (b) I'm trying to replicate my frustrations from then rather than my feelings now and (c) whether or not I miss him is not the point. The fact that I am essentially entirely devoid of mental health support for nearly an entire month is the fucking point].

So anyway, C asked was there anything I wanted to bring to the table before we discussed preventing and coping with madness whilst on holiday. I decided to refrain from coming right out and asking him directly if he had spoken to Dr C, and instead enigmatically replied, “has anyone spoken to you about me?”

He furrowed his brow a little and said, “not since I spoke to your psychiatrist, Dr…Dr..,” he searched for her name.

I reminded him, and asked when the conversation to which he was referring took place. It was clear he couldn’t remember exactly, and he eventually replied with something vague like, “a few months ago.”

Great work, Dr C. You and your SHO claim you want to speak to C and see me as soon as possible thereafter. Clearly it was right the fuck up there in your list of priorities.

I nodded at C, feigning casual indifference, eventually cracking under the pressure of his piercing stare of curiosity a few minutes later.

“You won’t be aware of the events of Tuesday, then?”

“It was Tuesday you saw her, wasn’t it?” he asked in all sincerity.

I laughed bitterly and made some vicious snipe about how useful “seeing” her was.

I went on to detail the circumstances in full. Those have all already been reported here so I can omit that part of the discussion from this summary of the meeting. Basically, two issues arose.

Firstly and of foremost interest was that C seemed utterly perplexed by the fact that I had cut myself in the wake of his colleague’s fuck up. Well, aside from the fact that’s a fucking hallmark trait of my illness, you twat, I was going totally up the walls and self-harm – as I have told about 496,960 times – is a quick, simple and effective tool to suppress such spiralling insanity.

OK, SI. Why the need for something so elaborate, then. Perception at time: Dr C hates me. I am hateful. That needs to be acknowledged.

Entirely predictably, C droned on for about 40 years on methods of “distraction” and “grounding myself in the moment”, all this bollocks we visit in a circular motion time and time again. I don’t remember my response to him. I just remember my metaphorical eye-rolling and desire that he’d move the fuck on from this DBT nonsense, because in its simplest form anyway, it doesn’t fucking work.

Anyhow, the second issue arising from the Dr C conversation was what he thought of the treatment meted out to me by Psychiatry. He seemed surprised by the strength of the reactions of A, Mum and (obviously) me, and his expressions and body language suggested, to me, something akin to nonchalance about the situation. Well – maybe ‘nonchalance’ is an unfair word. But I certainly did not get a vibe of overt concern like I had from LGP.

So, I set him a challenge. “If I ask you a straight question,” I began, “will you please give me a straight answer?”

This, of course, garnered a slight non-verbal reaction, because it was a strong inference that he often doesn’t answer straight questions. Well, he doesn’t. If he doesn’t like my directness about that on this occasion, that’s just too bloody bad.

“If I can,” he responded.

Ha! What you mean, C, is if you’re willing. Do you think I’m stupid? Can’t you even plan the answer in a straight fashion?!

I asked him if he thought I was being unreasonable in expecting better from the Health Service. I reminded him that I had been fucked about by Psychiatry from January to May, then fucked about again in July after a serious medication change to a seemingly effective but nonetheless insidious, potentially mind-altering, drug, then fucked about again in September. Was that fair? Was it fair, also, that such carelessness was exhibited vis a vis my privacy in my meeting with Dr A? Whilst acknowledging that to some extent the NHS is ‘free’ to use, was it fair that I had worked since I was 16 (insofar as my illnesses permitted) and will hopefully return to and continue to work until my 60s, thus facilitating the salaries of Dr C and her team via national insurance – only to be treated in this fashion? Was any of that actually fair? Was I being unreasonable?

When he didn’t immediately respond, I pointed out that my enquiry was serious. I genuinely wanted to know if something about my fury, and that of Mum and A, was somehow unjustified.

He eventually started wittering on about it being fair to expect certain standards from a service, regardless of what that service is, and certain frustrations were bound to be evident were those standards – or, more accurately, the expectations of standards (my distinction, based however on what I inferred from what he said) – were not met.

Exasperated, I said, “yes or no – do you think my anger is unreasonable?”

He sort of sighed, then said, “you talked about your main GP as being a good doctor, but the on-call one on Tuesday as being someone you strongly dislike. Dr C is, presently, in your mind, a second ‘bad’ doctor. If I answer ‘no’, I am just another ‘good’ doctor, affirming your present mindset. If I say ‘yes’, then I become a ‘bad’ doctor.”

He was obviously accusing me of black and white thinking, which is generally not a particularly unreasonable view for him to take, but nonetheless I resented every syllable of this fuck. Is what he said not profoundly black and white? Can’t he understand that if he can coherently and reasonably defend his position on the matter that I might have some insight, that if he disagrees with me that I might be able to derive some perspective from that? Oh no. Even in someone with an IQ of 148, it’s apparently as simple as a childlike concept of good v bad, with no room for relativism at all. I might have BPD, but I’m not completely colour-blind to shades of grey.

Rather than lose it with him, I tried to rationally explain my reasoning for my views on the GPs, the subject of his comments that had especially irritated me. My views on both have been developed over years. I first met LGP over 12 years ago. I first met HGP maybe six or seven years ago. I just didn’t meet either of them once or twice and form a view of them. My views on them, and on all other GPs and health professionals I’ve met, are based over time. They can change dramatically or quickly, I’ll admit, but not without very good reason.

In general, that is.

He conceded that perhaps there was more to it than good-doctor-bad-doctor, but pressed, “why self-harm though?”

This was irritating, as I’d already outlined my reasons. I sighed and said something like I wasn’t sure we’d ever see eye to eye on this.

He said, “I wouldn’t be sitting here with you if I didn’t believe you had other coping methods.”

Seeing my eyebrows raise, he added, “…or at least if I didn’t believe that you could develop them. What would be the point in that?”

I don’t recall my thinking now, but I looked him straight in the eye with what I think was some sort of oddly demanding expression and asked in a dark monotone, “are you going to leave me then? You’re going to abandon me?”

Poor C. The man was genuinely stunned. Reflecting on it now, so am I. Talk about adding two and two and getting half a million. There was absolutely no tangible link between expressing that he had hope for me and a suggestion he was going to desist from seeing me. None.

“Where did that come from?!” he exclaimed, mystified.

I honestly don’t remember my answer; I am writing this a fortnight later. I must have said one of two things; either I tried to justify my ridiculous belief that C had suggested he was going to ‘dump’ me, or I immediately apologised and submitted to him. Either way, we ended up in the submissive position, with me predictably following my Attack-Defend-Submit pattern. I said that my comments were clearly bullshit, that I was being daft and he should forget it.

“But it’s obviously something you’re bringing to this room,” C pointed out. “Why is that?”

As can be my won’t at times, I began playing psychologist. Interesting that I refuted any suggestion above that I was childlike, because I remember telling C that that’s exactly what I was. When he asked me why I thought this, I sardonically replied that I wasn’t allowed to intellectualise matters so I couldn’t answer his question.

He laughed and said, with a kind of amused defeatism, “go on then.”

Of course, I couldn’t. This was a PhD qualified clinical psychologist I was talking to. I’m a Wikipedia qualified psychologist. (Actually, I’m underselling myself, as I do have some knowledge of the subject, but it is from some time ago and was not even half as in-depth as a full undergraduate degree, nevermind a doctoral one). For the record, I was thinking of attachment and object relations theories and their roles in transference.

Anyway, my paranoid whining led to a monologue from C about ending therapy. Obviously I’m aware it’s not indefinite, it’s not a permanent fixture in neither his nor my life, aren’t I? But he’d like to assure me – again – that it will never just abruptly end. He envisions a minimum of four sessions of preparation before discharge, probably more, blah de blah.

I just sat there and looked at the floor, struggling to not burst into tears like a bloody newborn, struggling not to get down on my knees and beg him not to leave me to try and make some sense of insanity, my past, my future – my entire damn life – alone. I know I sit here and spout bile about the man and slag him off and call him names – but I do like him despite it all, and I need him and see hope with him and I can’t do it without him – not yet anyhow.

I was utterly overwhelmed by how much I don’t want him to abandon me and how inadequate and feeble I felt because of that. How sad and ridiculous that an intelligent woman of 26 wants a man she doesn’t even know to take the place of her missing father, grandfather and, frankly, friends, given that she only has a few close ones. How pathetic that she is vulnerable like a girl 20+ years her junior, and that she wants this unknown figure to scoop her up and take care of her. It’s so wretched that it’s almost kind of darkly amusing.

He interrupted this self-indulgent and piteous stream of consciousness by asking, “how are you feeling now, in this moment?”

I can return to ranting now. I swear to fucking God that I am sick to death of that phrase. He must surely use it as his meditation mantra. Is there some cadence in it that I’ve missed that makes it an attractive thing to say all the time?

I cleared my throat and said I was fine. He looked at my cynically, but decided against pressing the issue, presumably as there was very little time remaining in the session.

“When Dr C contacts me,” he began, “I can tell her nothing if you want. What we discuss here is confidential. Some people might not be at all comfortable with the idea of a discussion about them behind their back. Others may find it helpful. What’s your take on that? What do you want me to tell her?”

“It is weird to think of the two of you discussing me whilst I’m in absentia,” I admitted. “However, I don’t think that makes it unhelpful.”

I shrugged. “Use your discretion, I suppose. Answer her questions, give her any information you feel is relevant.”

He nodded, and I saw him look at the clock, which to my annoyance he’s moved to behind ‘my’ chair so (I presume) that it’s less obvious to the patient when he checks the time. Which it’s not as you can see his eyes shift above your head. And in any case it was pointless to hide it on this occasion, as he said, “we’ve left very little time to talk about your holiday.”

Oh really, I had no idea, I thought we had six hours. To be honest, I was glad. The preceding minutes had been pretty intense for me and I was tired.

We did conduct a quick and fairly basic discussion on coping if I were to go mental in Turkey, but beyond talking about getting A involved in the techniques, there was nothing new in what was discussed. I did talk about the inhaler from LGP and the Valium, but C kept whinging that these were external sources (oh really? I thought I had them sewn into my oesophagus) and that I needed to develop internal responses. To be honest, I just sat there and nodded, not really agreeing, not really even thinking about what he said, because I just wanted to leave. Not a good thing probably, but there you have it.

As I left, he said, “I hope the holiday goes OK.”

I ranted to A about this later. OK? You hope it is OK?! No “have a nice break” or “I hope you have a great time”?

To my surprise, A defended C. A contends that C had to be careful; had he said he hoped it was “great” or whatever, I would have been too cynical to really believe that he meant it, or that I expected it was possible that the trip could be great. I actually don’t agree that that would have been my view, but in fairness I can see why C might have thought that. So I can forgive his lack of enthusiasm to some extent. I suppose.

Friday: The Flight

OK, the title says ‘three’ days and this is a fourth day, but it doesn’t involve professionals attending to my madness, and in any case I’m not going into too much detail. You can probably tell from the style of writing here and here that I was (hypo)manic on Thursday night. This carried on right into Friday.

I suppose there is an argument that I could simply have been excited about going on holiday, but I don’t think that is the case. Forms of mania are, to me (and as far as I know to diagnostic manuals), different from contentment or excitement, in subtle ways at least. I understand that bipolar II in particular often goes undiagnosed because the hypomania therein often presents simply as an especially good mood. Maybe I seemed in an especially good mood on the Friday of that week, and I probably was, but I was also behaving oddly and saying really stupid shit.

I don’t have the best recollection of it, I’ll admit. I do remember sitting at the departure gate at the airport, delayed, babbling incoherently and in a racing fashion to A. I remember dropping my bag and having some sort of hysterical fit of laughter and more racing speech about this ludicrously uninteresting event. People around me were looking at me as if I was mad (which clearly I was). A found it amusing, and I can understand why it might have been to some – but it is also not ‘normal’; certainly, it was not appropriate behaviour for a public place.

And it very certainly, profoundly and completely wasn’t appropriate for a plane, and luckily I had enough cognisance to realise this. So, for the first and to my credit (?) only time from then to now, I took Valium to space me out and slow me down. It worked, to A’s self-proclaimed disappointment, but obviously it is not a long-term solution to episodes of mania.

Thus began our holiday. I will write in more detail about that shortly; it’s a separate issue from most of this post’s material. However, don’t worry; I’m not going to bore you to death by telling you what we did, what we ate etc etc etc – even if you actually know who I am, such things become dull very quickly. Of course, I keep this diary primarily for my own reasons – but more in relation to my mental health, not ‘normal’ stuff, if there even is any of that presently in my life. No, I want to think about how I felt on the holiday, how I behaved – whether there was an overt exhibition of madness thereon, or whether I actually managed to acquit myself well. I hope to write this tomorrow, but if not hopefully early next week.

Meh

When A and I were waiting for the plane, I received a message from my mother stating that a letter had arrived from Psychiatry offering an appointment on Tuesday 15th. LOLOLOLOL. Can’t they get anything right? I clearly told Dr A I would be away until the 21st. Mum rang them for me and whinged some more, pointing out they had not explained the situation as promised to her on the phone on Tuesday. They promptly and without question rearranged the meeting for Tuesday 29th. I am now terrified of it. It’s not great timing either as I have another bloody OH appointment on Thursday 1st October as well, but there’s not much I can do.

So, finally, you’re probably wondering what the reference to ‘genital vinegar’ in the title of this post relates to. It relates to Dr C. In ranting on Twitter, someone responded to me that Dr C was a “vinegar cunted bitch” – or so I thought. It turned out he was actually referring to some bint spreading more “Obama is a Nazi” bollocks in the US, but never mind – the title as one for my psychiatrist stuck.

Obviously there are a lot of ‘C’s in my life anyway. The actual C, CVM, Dr C…I’m sure there are more. Therefore, to avoid confusion and to reflect my current position on Dr C, I shall henceforth refer to her as the Vinegar Cunted Bitch, or VCB. I know I have a terrible penchant for acronyms, and when combined with usage of terms such as ‘BPD’ etc it is bound to get confusing – but I’m not going to start calling C ‘John’ or VCB ‘Dr Alfonso-Smythe-Hetherington VI’ just to anonymise them, so you’ll just have to bear with me. I have to bear with myself, after all.

How to be a Serial Insomniac: Lesson One

Come to Turkey, and drink some of this:

I was totally manic yesterday, and no doubt this Turkish coffee will induce more of the same, but it’s just so good. A asked me at the airport yesterday if I was on drugs, such was my mania. Then he laughed at me. People around us were looking at me as if I was a freak. Which to be fair I was (am).

A said I should blog about it, but I was way too restless to do that. I’m in a good mood today (!) but not manic, so it’s hard to describe. Anyway, I’m sitting in a Turkish coffee shop writing this on my phone, so it’s not the ideal medium to communicate it anyway. I will try to do so at another juncture, though.

I didn’t get publishing the draft post about Lovely GP and C and the aftermath of the psychiatric disaster of Tuesday, because even plane safe phones weren’t allowed to be switched on during the flight (what the fuck?). But I’ll get there.

For now, though, I’m going to concentrate on trying to enjoy my holiday. A and I are both in relaxed and good moods, which is a ridiculously unusual occurrence (we estimate the last time this happened was when we were in Lanzarote in May 2008). So we had better take advantage of it.