Archive for the Context Category

A Time of Not Being Suicidal?

Posted in Context with tags , , , , , , , , , , , on Tuesday, 19 January, 2010 by Pandora

In the last post, the lovely Karita who blogs at If Narky, Feed Profusely commented that she had never felt suicidal.  This got me thinking.  Was there a time when I didn’t?

I have had a fixation with death and dying from as far back as I can remember.  My mother was disturbed when as a four year old, I told her I wanted to be a forensic pathologist when I grew up (seriously).  Although I didn’t fulfill that dream, I did academically pursue what I thought would be a related discipline, the most interesting aspects of it being those that discussed death – including, indeed, a quite in-depth exploration of suicide in a sociology class.

I cannot say whether or not I actually wanted to die myself when I was four, but I wouldn’t rule it out.

It was certainly the case in my later childhood.  I first tried to kill myself when I was about nine or 10.  I have a very vivid memory of it; I tried to strangle myself behind the closed door of my bedroom.  Clearly this was a ludicrous attempt, but an attempt it was nevertheless, and I remember the despair and frustration I felt when it became evident that my actions would fail to bring about their intended result.  I was distraught at the prospect of my life continuing.

Since then, I’ve tried walking in front of vehicles, taken two overdoses (which saw me hospitalised), tried to slit my wrists*, ankles and elbows, hanging myself and suffocation.  I think that’s it.  (* Including, of course, the incident from Friday).

I know what you’re thinking.  Anyone who’s serious about committing suicide wouldn’t have such a number of silly attempts under their belt; they plan their death, and that’s that.  Fair enough.  I can only defend myself by saying that in most of the cases, the most serious ones at least, the desire to not exist felt serious.  The most serious attempt was a massive overdose when I was about 16, which did nearly kill me.  A couple of these attempts were gestures or based on circumstantial factors, I admit – but mostly they weren’t.

When I wasn’t actually actively trying to top myself, I was probably thinking about it.  I can honestly say that I’ve almost certainly fantasised and/or ‘planned’ my suicide for every day of my adult and adolescent life, and a lot of my late childhood too.  This even includes periods of mania and contentment.

In short, this is how I perceive normality – to all intents and purposes, I have never known anything else.  I’ve been sitting here for a while trying to imagine what it’s like to not feel suididal, and it’s just beyond the bounds of my imagination.

Well, there’s more proof – as if it were needed – that I’m a headbin 😉

Tomorrow is my first appointment with NewVCB, about which I will blog as soon as I can.  I don’t know whether to be amused or incredulous by the fact that my first appointment with this woman will be in the wake of a suicide attempt.  And then I have to face C on Thursday, and that will not be fun in the least.  Alas.

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The Advocacy Saga Continues…

Posted in C, Context, Psychotherapy with tags , , , , , , , , , , , on Thursday, 14 January, 2010 by Pandora

Following on from the original letter to the advocacy charities and the inadequate response received, here is the latest. I will also be sending the original letter to my Trust’s Patient Council.

Hopefully I will not have any more two-posts-in-one-day-marathons for a while.

Dear Admin Woman Who Wrote to Me the Other Week

Re: Advocacy

Thank you for your letter dated 4 January in response to mine of 17 December. I must confess to feeling very disappointed by the surprisingly brief response of your advocate; however, I did take the advice given, and I discussed the matter with both my consultant and, again, my clinical psychologist [actually, I didn’t discuss this with the consultant, as I don’t see her until Wednesday, but they will never know. C absolutely assures me that it is not the consultant’s decision, but his].

Both advise me that the length of treatment provided by the psychologist is decided upon by the psychologist himself and not the psychiatrist as your colleague believed. My psychologist unfortunately maintains his position of ceasing psychotherapy after the period previously specified (now 22 weeks from today), despite acknowledging that my illness should really be treated through long-term therapy. This contradictory position is a clear illustration of what seems to be unwillingness on the part of the Trust to prioritise and allocate adequate resources to the treatment of mental illness.

In light of the above, can I please again ask that your advocacy service looks at this case. I am very concerned that if treatment is halted prematurely that not only will I have failed to have made any significant progress, but that in fact my mental health will be seriously negatively affected. Arguably, given the number of difficult issues that therapy brings up for an individual, starting but not completing a full course of therapy is more damaging to a patient than receiving no treatment at all. I would be extremely grateful for your help, as I do not feel that I have the cognitive resources to fight this battle against what amounts to medical negligence myself.

To summarise, the decision to cut short my treatment has no proper basis in a clinical analysis of my condition. The clinical literature is very clear that borderline personality disorder requires more intensive and longer duration treatment than I am being offered. I would suggest that this is an illustration that the Trust is not appropriately prioritising the allocation of resources to the treatment of mental health difficulties. I would hope and expect that this is a matter of concern to Mindwise and look forward to hearing from you soon.

Thank you in advance.

Yours etc.

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Changing My Name

Posted in Context, Everyday Life, Moods with tags , , , , , , , , on Wednesday, 13 January, 2010 by Pandora

If you follow me on Twitter, you may have seen the other day that I had asked the Twitterverse how difficult it was to change one’s name by deed poll (it turns out that it’s actually very easy, if logistically something of a pain in the arse).

I have been thinking about changing my surname for ages – at least two years.  During that time I’ve been fairly to absolutely sure of the new name that I would adopt, and I think I have thought through all the ramifications of the whole thing properly.

Despite what many people think, there is no official or central register of name changes in the UK.  Theoretically, you can simply write a letter yourself stating your intention to use a new name, though that tends not to work much in practice when you involve banks and passport agencies and the like.  The lack of such a register means that you have to inform everyone yourself – preferably using certified copies of your deed poll – of your new name.

This includes passport agencies, driving licensing authorities, the health service (and specific services therein that you use), banks, credit and ‘store’ cards, insurance companies, utility companies, pension companies – the list goes on.  That’s not even considering your personal contacts.  It’s a profound logistical hassle.

But, for me, it is worth it.  I have long since hated the fact that I have links to my father via my name, as of course the man was a detestable piece of shit.  This was exacerbated after the whole kerfuffle over V’s will; I don’t want to share the same name as my American relatives either, after them virtually glorifying my ‘father’ and then stealing my bloody money.  I want to sever connections with that whole side of the family absolutely and completely, and this gesture is a symbolic way of doing so.

Furthermore, my surname is a completely shit one.  So much so that it was the brunt of endless verbal pestering when I was at school, which wasn’t exactly fun (not that that was what made me so inherently miserable there, but the name-calling and teasing certainly didn’t help).

I haven’t discussed changing my name with with C, although I probably should.  Perhaps this can be touched upon briefly tomorrow.  I did discuss it in some detail with Margaret, the CBT therapist I saw in 2008, and she felt that if I was prepared to go through the hassle of informing everyone, that changing my name could bring some “closure” [hate that word] on the many mental health issues I have that are attributable (at least in part) to V.  To be honest, I think that’s a very simplistic way of looking at it – changing my name is not going to change what he did to me, nor to my mother.  However, it’s one thing I can do to publicly acknowledge that I want no part in his legacy.  A token gesture, some might say, but I think it’s an important one.

I determined towards the end of last year that if I was going to do it, I was going to do it in 2010.  So yesterday (as intimated last night on Twitter) I took a deep breath, filled in the online deed poll application, and – after dithering a bit – hit ‘submit’.

The lack of a central register means that my name is not changed at all until I sign and date the deed poll (which should be with me by early next week), and in practice it remains unchanged until I send the certified copies to the aforementioned agencies and they update their systems, my cards, etc.  But I’ve taken the first step – and as I said, it’s a big step, in my view, as I have lived with this name for over 26 years.

I’m really nervous about what I am doing, but it’s a new start in a kind of symbolic way, and to that end I’m terribly excited too.

So up yours, V, and up yours, V’s family, for contributing to my being completely batshit mad.  Shortly I will have no links with you whatsoever other than my mother and genetics, and I cannot wait.

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Victories and Failures: Updates on *Those* Letters

Posted in Context, Everyday Life, Moods with tags , , , , , , , , , , , , , , , , , , on Saturday, 9 January, 2010 by Pandora

Let’s deal with these chronolgically and, coincidentally, in order of bad to good.

FAIL

On 17 December, I wrote to two mental health advocacy groups (Mindwise and the Northern Ireland Association for Mental Health) regarding the whole ‘you can only have 24 more sessions’ bullshit with C.  Both have now responded, and both have represented something of an epic fail.

Mindwise simply told me to discuss the matter with my consultant psychiatrist, as “they would be the ones making the decision”.  Well, I will, when I see my (new!) consultant on 20 January (over a month late, might I add).  However, as regular readers will know, Psychiatry have been one of the problems I’ve been having with the NHS during this most recent breakdown (though to be fair, this was not outlined in the letter).

Talk about passing the fucking buck.  It was simply a case of pushing responsibility onto someone else, and not wanting to tackle my case themselves.  Is it because I is borderline?  Everyone hates a borderline, innit.

Should the meeting with the psychiatrist not yield results, though, I am going to write pompously back to these tossers and demand their assistance.  Either that or the media will be learning of their incompetence and unwillingness to help a mentally ill individual, which is exactly what they exist for.

I heard from NIAMH yesterday.  Apparently, their advocacy service does not operate in my Trust area.

Forgive me, but is it not the NORTHERN FUCKING IRELAND Association for Mental Health?!  At no point does the name of the charity remotely infer that it is not operational across the entire country.  How, then, can they not operate in my Trust area?  Is it because I is borderline?  Everyone hates a borderline, innit.

In fairness, at least they did suggest some sort of action I could take.  They said I should try the Trust’s Patient Council service, who apparently deal with matters like this.

I will heed their advice, especially given that a Twitter friend had some results via the Patient Council in his area, but not until I have heard back from the Trust, who were copied in on the original letter.

POSSIBLE WIN

As you know, the advocacy letter was copied to the Chief Executive of the Trust.  Not wanting to be arsed himself, the individual in question passed my letter to the Director of Mental Health services.

This bloke wrote back to me a few weeks ago, telling me that he had requested more information and that he would be in touch once he had received same.  I have not heard more from him yet, but am hopeful that the mere act of kicking up a fuss like this and threatening to contact the politicians and the media might be enough to get some action from him.

I won’t hold my breath, of course, but I will cross my fingers.

WIN

HAHAHAHAHAHAHA!  Asshole GP has backed down!

Apparently, Dr Bellend/Twatbag/Arsehole/whatever-else-I-called-him “would like to apologise” and accepts that his attitude fell short of “desirable [surely ‘necessary’?] professional standards”.  Ha!  Muah-ha-ha-ha-ha-ha!

The letter went so far as to offer me the opportunity to meet the Practice Manager and Dr Knobjockey to further discuss the matter.  I will not accept the invitation, but I suppose it was good of them to offer it.

As I have generally been well supported by the practice (recently, at least), I won’t be a dick over this.  I’ll write back and accept Dr Fuckwit’s apology, and just hope that I won’t have to see him again.

MEH

And that, folks, is the latest news on that front.  I feel smugly satisfied about the GP letter result, but of course am rather disappointed that the advocacy charities are not actually doing anything that remotely resembles advocacy.  But we shall see how this continues to play out over the next few weeks.

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Christmas…Revisited

Posted in Context, Everyday Life, Moods, Triggers with tags , , , , , , , , , , , , , , , , , , , , , on Wednesday, 30 December, 2009 by Pandora

I feel I should say a few more words in addition to the last post.  Firstly, thank you all for your concern – to those that commented here, contacted me through Twitter or indeed those that contacted me directly.  I am OK, and all the better for your concern, for which I am extremely grateful.

Despite what I said on Boxing Night, I don’t think a hospital admission is necessary or desirable just at the minute (well, not that it would ever be desirable, but you know what I mean).  It is my belief that the delusions and the severity of the hallucinations the previous day were induced by severe stress, and are hopefully ‘just’ transient.  ‘They’ are usually there these days, even to the extent where they are stealing my thoughts (schizophrenic-esque thought-blocking?) but fortunately their desire to cause harm in the same way as the day they first arrived has not been present since I’ve been taking Olanzapine.

I was discussing with C at the last session (which I have yet to blog about – hopefully by early next week) about how I hadn’t been (consciously) bothered about my history with Paedo until fairly recently.  As this was towards the end of the session, we didn’t have time to explore the possible reasons for that, but no doubt it was lying in my unconscious, unprocessed, the whole time, subtly and insidiously contributing to my chronic depression and severe breakdowns.

Anyway, for whatever reason, it bothers me now, and the feeling of horror and dread about it and about him was very acute on Christmas Day.  The McFs were going out for Christmas Dinner (good, because it meant slightly less claustrophobia), but it started out badly when it was decided (after an unnecessarily protracted debate) that A and I would travel to the restaurant alone with Paedo and MMcF.  It was an utterly vile 20 minutes trying to make smalltalk with the two of them and when MMcF surreptitiously handed me £10 to buy A and myself a drink, she said, “I hope you have a very happy Christmas,” causing me to laugh incredulously in her face.

By the time we arrived at the restaurant I was highly agitated, and upon sitting down (trying and failing to not be close to Paedo) downed two Valium.  It was not just him.  It really was not just him.  There were about 16 or 17 people around the table, and I just cannot tolerate that.  Groups make me endlessly nervous, especially when they are all talking loudly and demandingly at once, and especially when (despite knowing them all my life) I am deeply nervous around and have nothing in common whatsoever with the personnel concerned.  My history with Paedo just exacerbated something that would have already been there.

The Valium helped, and I relaxed a bit, but it was still bloody awful.  The meal was nice enough, but I threw half of it up and my IBS was out of control.  A and I forced our way through it, but the worst was yet to come.  Rather than go back to MMcF’s house after dinner, it had been decided to go to SL’s.  I have nothing against SL and her husband, but for some reason the dynamic in their house is always different from elsewhere; everyone congregates in the same room on top of each other, whereas back at MMcF’s, at least people break into factions, making the group more manageable.

SL’s was tortuous.  The overbearing crowd, the inanity of the stilted conversation, the obsessive fixation with MW (whose nose will be put out of joint when his sibling is born in March), my mind recalling my history with Paedo and my Mum’s disbelief when I told her about it – it all got on top of me, and indeed of poor A.

‘They’ had been telling me all day what a horrid, fetid slag I am, but I’ve learnt to…not ignore them, and not push them to the back of my head, because that’s where they reside anyway.  I don’t know; I’ve learnt how to not respond to them, I suppose, when they are wittering on like this, which is a lot of the time.  However, it’s pretty much not possible to fight them when they turn into the all-powerful screaming cacophony that they were the first day I encountered them.

Well, didn’t they start it again, just as we had managed to escape the worst bit of sitting about in the living room, joining as we did ScumFan and DMcF, who were playing the X-Box in the kitchen.  ‘They’ started screaming at me that I was evil for keeping my mouth shut about the rape and the molestation, that I had put all the other generations at risk and that it would therefore be a mercy for me to “eliminate” MW, given that he could expect “nothing but” the same fate from his great-grandfather.  I tried to ignore them, really I tried, but the more I fought them, the more and more effort they put into their critical wailing.  I was ordered to go to where MW was sleeping and smother him.

Of course, the last thing in the world I want to do is kill someone, especially not an innocent kid, so by this point I was hiding behind A and covering my ears and muttering a poem (as well as some ‘shut ups’) in order to try and distract myself.  The next thing I remember was being in the utility room in tears banging my head against the washing machine (!).  I tried to get past A, who was standing their blocking my exit, but he wouldn’t let me past for fear that ‘They’ might have successfully compelled me to go to MW’s room.  I think I slid down the wall in defeated resignation then; I was convinced ‘They’ had finally taken complete control of my mind.  The fight was over.

Well, luckily ‘They’ hadn’t managed to take control, and the fight wasn’t over.  I honestly don’t recall how this all finished, but the next thing of which I do have a clear recollection was having a discussion about something or other with SL, MW’s mother, in a calm, almost seemingly jolly fashion.  Yet all the time I was thinking, “the voices in my head just now wanted me to murder your baby son, you know.”  Thank God people generally can’t read my mind.

When A and I went to bed, and I don’t remember saying any of this, apparently I was convinced that A was not A but in fact his sister.  I also apparently believed that ScumFan – surely the most innocent and naive of young men – was involved in a serious way with drugs.  Needless to say, these ridiculous delusions disturbed A considerably.  And then, thanks to Zopiclone…nothing.

Boxing Day was better than Christmas Day, but still awful.  In the morning, I completely defied ‘They’ by playing with MW as I normally would (obviously in others’ company).  ‘They’ mumbled and whined a little like they usually do, but mercifully it was nothing with which I could not deal, and at no point did they try to persuade me to harm the baby.  Shortly after midday, A and I headed off to his father’s house.

Normally, it’s just A, his father, step-mother and me for Boxing Day, but on this occasion his aunt and her husband turned up.  I just wanted to sit and vegetate, as is the norm on our visits to A’s Dad’s, but the aunt would not shut up for more than three seconds.  Nice enough woman, but she began to grate on me not just through her constant demands for conversation, but also as she made underhand insults directed at A, inferring (and not at all subtly) that he was less intelligent than her children (which is not true, but since they have degrees from Oxford she feels that it is so, apparently).  A told me later that she had been intensely jealous of his parents when it was realised that he was a smart kid, and she always wanted to better them.  What a poor, sad cow.  How pathetic and meaningless must one’s life be to be so utterly fixated on bringing up intelligent children simply to compete with others?

One thing I’ll say in her defence was that despite her laughable level of inebriation she didn’t at any point attempt to embarrass me by quizzing me on the reasons for my present lack of employment, presumably having been warned in advance by A’s step-mother not to do so.  It’s not that I’m ashamed of being mental, but it’s hard to convince people of the sincerity of the conditions sometimes, especially (I’d imagine) when they’re as plastered as she was.

Eventually A and I escaped to his mother and step-father’s house, which is always fairly relaxed.  Upon getting in, knowing I wouldn’t have to drive again, I opened a bottle of red and downed it in literally about five minutes.

And now it is over.  It is over.  There surely is a God!  We are keeping out of everyone’s way on New Year’s Eve, having booked into a hotel for the night.  We’re not attending any function – we’re just going to sit in either a quiet corner of the bar, or in our room with a bottle of wine.  Alone.  All a-fucking-amazingly-lone.  Then, on Sunday 3 January, we’re going to another hotel, this time for two nights, thus using a Christmas present from A’s mother.  Both hotels are fairly plush, with pools, nice restaurants and bars, beautiful settings and privacy.  AI hope these will prove just what is needed as a tonic to the horrors of the past week.

I had strongly considered killing myself on Boxing Morning, but I need to remain alive for the duration of these sojourns, as I hope they will serve to relax me and hopefully mentally prepare me in some small way for the year ahead.

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Christmas…

Posted in Context, Everyday Life, Moods with tags , , , , , , , , , , , , , , , , , , , , on Saturday, 26 December, 2009 by Pandora

…has been fucking awful. I had a complete psychotic break on Christmas Night after the stress of engaging with the MMcFs (and in particular Paedo) all day and heard ‘They’ telling me to kill MW. Obvioulsly I didn’t. I also told A, apparently believing completely, that ScumFan was a drug-dealer (he’s not) and that A was actually his sister in disguise (!).

Boxing Day has been a fucking nightmare too, though on a lesser scale. But the psychoses of last night are what matters. It is time to be hospitalised.

‘They’ told me that smothering MW would be “a mercy”. Maybe or maybe not, the very thought of harming him is beyond contempt.

Enough is enough.


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The Advocacy Letter

Posted in C, Context, Everyday Life, psychiatry, Psychotherapy with tags , , , , , , , , , , , , , , , on Thursday, 17 December, 2009 by Pandora

Dear Sir or Madam

Re: Advocacy in Accessing Mental Health Services

I am writing to enquire as to my rights and to what extent you can assist me in accessing the services to which I am entitled.  I am diagnosed with borderline personality disorder with psychotic features with a possible co-morbidity of bipolar disorder, type II.  I take anti-depressant and anti-psychotic medication, and although I only received the diagnoses in June 2009, I have been utilising mental health services both on the NHS and  in the private sector since 1998 (having originally been diagnosed with clinical depression and social anxiety).  The care that the NHS has provided has always been wholly inadequate; until recently, any therapy I have been offered has either not come to fruition, has ended abruptly or, in one incident, has seen me being regarded with outright hostility.

Since 29 February 2009 I have been seeing a clinical psychologist on a weekly basis for psychotherapy broadly of a psychodynamic nature (though the  approach is integrative).  As of today’s date, we have had 35 sessions in total. It has taken me some time to fully open up to and to trust this psychotherapist, but now that I have, I feel that progress is being made, albeit slowly.  I believe that further progress can be made through this relationship.

Unfortunately, my psychologist has informed me that he can only continue to offer me therapy for 24 further weeks (starting from the next session).  This would, of course, equal 59 total weeks of therapy (including three assessment sessions at the start, and four sessions to end the therapy).

As you will be aware, all published research on borderline personality disorder strongly recommends long-term therapy for the condition. Indeed, NHS and NICE guidelines on this illness and on personality disorders in general completely contradict the view that one year’s worth of psychotherapy is remotely adequate treatment.  I believe that the New Horizons consultation recently undertaken by the health service would not support this situation either.  I strongly believe that not only is long-term treatment advisable, it is in fact necessary to deal effectively with my condition and therefore I feel that it is my entitlement.

Whilst I appreciate that resources are limited, I am frankly disgusted by the postcode lottery that seems to be in operation.  For example, I am aware that there is a specific self-harm team within the <other NI area> Trust – whilst self-harm is not, of course, by any means the only symptom of BPD, I am sure that this team would work frequently with individuals with this diagnosis and would thus understand it well.  Furthermore, I am familiar with several other individuals that have this (and other) disorders – in most cases less severe than mine – that have received guarantees of treatment lasting at least two years (in some cases) and three years (in one).  I have yet to encounter a single other individual who has received only a year’s guaranteed treatment.  My psychologist himself admits that ideally BPD should be treated twice a week for a minimum of 18 months.

I believe that if therapy comes to an end as proposed that I will in fact undergo a significant regression, and probably end up utilising yet more NHS resources.  I am unable to work, and am in the regrettable position of being dependant on state benefits – a situation that I abhor.  Any saving of government resources in cutting short my treatment is, therefore, a false economy.  I also feel that the worry of treatment coming to a close will overshadow my relationship with my therapist thus preventing us from tackling more substantive issues together in the relatively short period we have remaining.

Additionally, I understand from the various guidelines from the health service that multi-disciplinary approaches are considered desirable and indeed necessary for personality disorders.  To that end, I am surprised that I have never been offered access to the CMHT’s social workers, CPNs or occupational therapists, despite presenting symptoms perhaps best dealt with by such individuals in conjunction with my psychologist.  Although I have had one experience of the Crisis Response Team (which, I might add, was an utterly appalling meeting), I have never been advised on how to contact them again in an emergency, of which I have had several in the past year.

I am not prepared for the NHS to once again treat me as a second class service user and am prepared to contact MLAs, MPs, the relevant Minister and Permanent Secretary, and indeed the media in order to obtain the treatment to which I am entitled.  I would therefore be strongly grateful for your advice and assistance on (a) ensuring that I obtain a guarantee of continued psychotherapy, in line with NHS guidelines on the longevity of same; (b) ensuring that said psychotherapy can preferably continue with the therapist I presently see, as of course issues of trust and abandonment are a big part of this illness; and (c) ensuring that I can have access to the full range of services from the CMHT and the Crisis Team in an emergency.

As you know, borderline personality disorder, especially when psychosis is involved, is a severe mental illness and in this case has not been taken seriously.  I feel that this matter is urgent and desperate, and to that end would be very grateful for your help and advice.  Should you require further details, or if you would simply prefer to correspond via another medium, please do not hesitate to contact me via email on <my email address>.  I look forward to hearing from you.

Thank you in advance.

Yours etc.

Copy to: Chief Executive of my Trust

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