Archive for the Mental Health Diagnoses Category

Article of the Week: Week 1

Posted in Article of the Week, Mental Health Diagnoses, psychiatry with tags , , , , , , , , , , , on Wednesday, 6 January, 2010 by Pandora

I’ve decided to undertake a new venture for a new year.  Whilst I feel very lucky that so many people enjoy this blog (why?!), I also thought it would be good if I could make it of some use too by sharing some of the most interesting psychiatry and psychology articles I come across through my travels on teh interwebs.  To that end, every Wednesday where possible, I shall put up my Article of the Week.

Article of the Week

The first is from Current Psychiatry, who have an excellent article on the differences between borderline personality disorder and bipolar disorder.

There’s an analysis of the overlapping symptoms, a look at what is different between the two illnesses, and possible reasons as to why one illness is often misdiagnosed as the other.  The article also points out that there is, genuinely, a high correlation of co-morbid BPD and bipolar disorder (especially type II), nodding at the possible biology underpinning both conditions.

A slight warning: some of this stuff is technical (well, it is for psychiatrists!), but if that doesn’t faze you, this is a very insightful article.

Borderline, Bipolar or Both?  Frame Your Diagnosis on the Patient History.

Honourable Mentions

A mention too to Kathy Broady at Discussing Dissociation, who writes a moving post on the hopelessness and despair felt by those who have been affected by psychological trauma.  She also advises on how to combat these feelings.

Hopelessness and Despair

The Canadian Globe and Mail asks whether or not psychiatrists and therapists have their own significant mental health difficulties.  The author says at one point that she has wondered if her therapist has, and I can certainly confirm that I too have made the same mental queries.

The Secret Life of Psychiatrists

Finally, Psychiatric Times posted a decent entry on how therapists and psychiatrists can end the therapeutic relationship with minimum disruption to the patient’s well-being (maybe C should read this).

Psychiatric Abandonment: Pitfalls and Prevention

Any Suggestions?

I find most of these articles via interesting links from Twitter, as well as my own explorations.  If you want to suggest an article for inclusion here, I’d be delighted.  I can be contacted in a variety of ways, or you can simply leave a comment here.

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The Latest NHS Complaint

Posted in Mental Health Diagnoses, Moods, Triggers with tags , , , , , , , , , , , , , , , on Monday, 4 January, 2010 by Pandora

The week before Christmas, I had to see a GP that I don’t normally attend, owing to the fact that LGP is so popular that I couldn’t get an appointment with him. The appointment was mainly to confirm the diagnosis of IBS, given as I had a number of blood tests to rule out other conditions. The below, addressed to the surgery’s Practice Manager, details what took place in the appointment.

Dear Sir or Madam

Re:​ Complaint

It is with regret that I am writing to you in order to make a complaint about an appointment that I had with Dr Arsehole on Friday 18 December 2009 at 8.40am. In particular, I wish to make my views known about Dr Twatbag’s dismissive and patronising approach in relation to my health issues.

The appointment was primarily scheduled to discuss a physical health problem. I had been told previously by a colleague of Dr Shithead’s that medication was available to assist in the management of this condition, a fact that Dr Wanker confirmed. However, he then refused to prescribe me anything to alleviate the severity of my symptoms, citing my age without providing any substantive reasoning. I am baffled as to the relevance of an individual’s age to their need or otherwise for medication, and was not offered an explanation. Furthermore, Dr Knobjockey chose to fixate on my weight at this juncture. I do recognise that I am overweight, but as intimated to the doctor, have recently been dieting and exercising, resulting in the loss of over three stones. Despite my attempts to make this clear, the physician continued to speak condescendingly to me about the strain on resources that the “obesity epidemic” is causing.

However, it was a discussion around my mental health that caused the most offence and which, in my view, demonstrated not only a lack of sympathy for mental illness, but in fact ignorance surrounding this group of health conditions. When I asked for medication to help combat insomnia and anxiety, Dr Bollockfist refused, in an irritable and frankly almost hostile fashion. In the past I have been refused these medications, and would certainly not issue a complaint on those grounds alone. However, I do not think it is unreasonable for me to have expected this request to have been denied respectfully and sympathetically, with an explanation of the reasoning.

Regarding my chronic sleep deprivation, Dr Cuntfeatures unhelpfully told me that a lack of sleep, no matter how long-term, “won’t kill [me]”, failing utterly to offer any practical help or advice on the matter. Perhaps this is, literally speaking, true, but this denies the extremely serious effects a lack of sleep can have on normal daily functioning. I am also fairly sure that this does not constitute professional advice nor assistance. I should not have to point out that forced sleep deprivation is used as a form of torture.

Dr Bastardface discussed insomnia that he had experienced following a personal bereavement; whilst obviously I have the greatest sympathy for his loss, I fail to see the relevance of the example, and indeed believe that the implied suggestion was that because my insomnia is not necessarily circumstantial that it is therefore somehow less real or less deserving of attention than a lack of sleep caused by a distinct traumatic event. He then, to my astonishment, point blank denied a connection between psychotic symptoms and insomnia. Might I be so bold as to suggest that Dr Dickhead researches this more fully; insomnia is, in fact, well known to cause or increase psychosis and the symptoms of psychiatric illness (source).

In discussion of the illnesses that (at least in part) contribute to the aforesaid, I was dismayed by the allegation that I was simply trying to “medicalise” my conditions. I do not believe this to be fair at all – I am presently undergoing intense psychotherapy and merely wish to try and manage my symptoms until it has reached a satisfactory conclusion (incidentally, please see the enclosed letter to Mindwise regarding the disturbing possibility of a premature cessation of this necessary process. If I cannot receive psychotherapy to sort through my illnesses psychologically, I fail to see what choice I have but to seek medical intervention). I would add, also, that even if I were ‘medicalising’ my illnesses that they are, indeed, at least partly biological. Borderline Personality Disorder is thought to exist in individuals with a biological predisposition (sources) and bipolar disorder is considered primarily a medical illness (sources). Both are, of course, considered serious mental illnesses, having disproportionate rates of psychosis, suicide and self-harm (sources).

Incidentally, I noted with interest that my file does not reflect these diagnoses, still stating that I suffer from depression and anxiety. Whilst these co-morbidities do exist, my primary diagnosis is BPD (with psychotic features) with a differential diagnosis of bipolar disorder, type II.

Overall, it was not so much what was said that upset me (though I felt that to be lacking too) as the manner and tone in which it was said. Although I felt Dr Bellend’s response to my physical complaint was inadequate, it was at least presented fairly amicably by him. His attitude to my mental illness was, however, dismissive, unsympathetic and thoroughly unhelpful – I would say it bordered on disdainful, indeed.

Whilst I appreciate the subjectivity of this judgement, I would hope that the fact I have never made a complaint about [the practice] in my life until now would indicate that I am not wont to take things out of context. Unfortunately I got the distinct impression that the physician was dubious as to the sincerity of my illnesses and that it was felt that I did not have ‘real problems’ (though should he require a list of traumatic events that have helped to contribute to my psychiatric illnesses, I should be happy to provide same). It is sad that such stigma is not only present in society, but apparently in the medical professional also. Dr Cockhead, like anyone, has a perfect entitlement to hold such a view privately, but given his chosen career should not allow it to impinge on his professional practice.

I would like to make clear that, in general, I have felt very much supported by the professionals at the practice – in particular, I would like to thank [LGP], [the Nurse Practitioner] and all the nursing staff for the support, respect and professionalism that they have shown me. I have also had the pleasure of having positive interactions with Dr Ballbag in the past, and would therefore hope that this incident merely represents a ‘blip’ in the professionalism of his practice. However, given the distress it caused me and the apparent lack of awareness that it represents, I felt that it was imperative to bring it to your attention.

Thank you for your time.

Best regards.

Yours etc.

Enc (of the letter to the advocacy service).

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Hearing The Voice (and Other Psychoses)

Posted in Everyday Life, Medications, Mental Health Diagnoses, Moods, psychiatry with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Thursday, 1 October, 2009 by Pandora

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.

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A (Half-)Life in Therapy: The Fabled Post of Therapists

Posted in C, Context, Medications, Mental Health Diagnoses, Moods, psychiatry, Psychotherapy with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Wednesday, 2 September, 2009 by Pandora

As any of you who have read this blog since I began it in May will know, it has long since been my intention to write about each of the different therapists of one description or another that I’ve seen over the years. The idea was inspired by the same type of post by Introspective at Conversations with my Head, so hat-tip and thanks to you my dear.

It’s now September, so you can see how successful I’ve been to date in getting around to this. But here I am, finally, with all the fascinating (!) details.

Be warned; this is very, very long. I’d suggest you don’t even bother reading it if you wish to remain awake (possibly alive). If you really want to, try it in two parts or be prepared to be sitting at your screen for a while.

I was about 12 or 13 when I began to think that I had mental health problems. With the benefit of that wonderful thing called hindsight, I can see that I might have been a bit batty even as a child – I was a complete narcissist even then, and once tried to amputate my foot. I was an insomniac and experienced nightly hallucinations. I thought it was normal at the time.

But with the onset of adolescence (though not puberty, for I experienced that mostly in its entirety a bit earlier than most), I began to feel increasingly depressed. I felt hopeless, like my life was worthless, that the future was bleak and dark, that everything was utterly futile. Even I had the sense to recognise this as a bit unusual.

The realisation that I was depressed came one day when we were visiting my grandfather in hospital. In the corridor, there was a sign detailing the diagnostic criteria for a depressive episode. I hadn’t had five of the criteria for a few weeks; I’d had them all for several months.

I remember going back and looking at the poster over and over again, in the hope that my mother would notice that there was something on it that was piquing my interest. I never succeeded in that endeavour, but sooner or later she did, somehow, realise that my marked change in behaviour was quite long term, and off she marched me to the GP. Thus commenced about 12 years, to date, of on-off psychotherapy.

The GPs

Not therapists obviously, but it was of course one of my GPs that initially made the diagnosis of clinical depression; I was aged 14 at the time. To be honest, I think they just gave me a diagnosis and medication just to get rid of me. I am still of the view that I was initially seen as an angsty adolescent that they wanted off their hands. Best to give me Prozac, then say toodle-oo. Except it wasn’t so simple. Mum had me up at the practice more times than enough and eventually they sought the involvement of…

The Counselling Bloke

In all honesty, I remember very little of this guy. I don’t remember his name, and I don’t remember the precise point at which I saw him. I remember that he was a counsellor, of course, but I can’t recall whether he felt I needed more specialist help than he could give me, or whether we just closed the meeting and mutually agreed there was no point in continuing the brief alliance. Whatever the case, I’m fairly sure that I only saw him once, and I found the meeting utterly fruitless.

I do remember what he looked like; he was a short, thin, dark haired bloke, and actually reminds me a bit of C. It’s not beyond the realms of possibility that he in fact was C; although I’m not sure of C’s age, I’m guessing he’s in his mid-thirties. That would make this meeting just on the side of possible; he could have been an undergraduate or new graduate gaining some work experience. Perhaps I am creating a phantom memory, but it doesn’t really matter either way. The meeting was still useless.

The Trainee Child Psychiatrist – Anna

I’m not sure how I ended up with Anna, but it could have been one of two ways. Either the Counselling Bloke referred me, realising I needed more help than he could give, or Mum and I went back whining to the GPs and they eventually referred me. I don’t remember, but it doesn’t matter.

According to Anna herself, so my mother says anyhow, people under the age of 18 aren’t allowed to see psychiatrists. This seems ridiculous and unlikely to me, especially given that Anna – by her own admission – was a “medical doctor” (Mum asked her one day if she had a PhD in psychology), so surely the only mental health specialism of medicine is psychiatry?

Anyway. Whatever the case, she was based at a Child and Adolescent Mental Health Unit and I saw her for quite a few months. I liked her, and despite the bizarre situation and the fact that we never really made any headway, she liked me too (more on that in a minute).

I remember few of the specifics of the psychotherapy. I do remember her giving me stupid, patronising little sheets to fill in. You had to complete the end of the sentence, eg. “I secretly…” or “I really hate…” or whatever. Though in thinking about it, this maybe only happened a couple of times.

I think she was trying some sort of cognitive behavioural approach with me, because I remember thinking at the time that whilst she was well intentioned, her methods were unintentionally condescending (even though she herself wasn’t) and I just knew they were never going to work. I did apply myself to the therapy, though, and tried to work with her, but I never let my guard down and was always very careful in what I said to her. She knew I was bright and I think she actually found me quite entertaining; I remember one incident where I had the woman doubled-over laughing (thanks to some scathing remark I’d made about someone that was intended to be amusing, but I hadn’t predicted just how funny she’d find it).

I don’t remember the exact reason that my sessions with Anna came to a close. We must have agreed to have a break, though I don’t remember that happening exactly. All I do remember is that, whilst I hadn’t seen her for a week or two, I was expecting to see her again, when a little card arrived in the post from her, explaining that she’d been offered a new job on the other side of Northern Ireland and would not be able to see me again. The letter was kind, stating that she’d enjoyed working with me and wished me all the best for the future.

I wished her well and fully understood her reasons for moving on. Our therapy hadn’t much worked anyway, but nevertheless here I was left high and dry again.

The Education and Welfare Officer – Elaine

Actually, I’m not sure whether it was Elaine or Lorraine, but I’m going to go with Elaine as it’s quicker to type.

Elaine wasn’t a traditional psychotherapist; she was actually a social worker attached to the local education board, and was involved in my situation as – owing to my mental health problems – I missed a lot of school. Nevertheless, our relationship became one that more closely resembled a therapeutic one; she was more like a counsellor than someone involved to keep tabs on me. I would meet her each week on a Thursday – it was during GCSE Maths which of course was especially gratifying 🙂

As is the wont of social workers, especially (though not limited to) those not directly trained in managing mental health issues (or so I’d imagine), Elaine’s discussions with me would centre around practical measures I could take to help myself, rather than an psychoanalytical exploration.

Although she wasn’t much like Anna in her actual therapeutic approach, she was to some extent in her reaction to me: I distinctly got the impression she recognised that I was not being deliberately awkward as some of my teachers believed, and that she believed that I was a bright, not unpleasant kid, with some genuine difficulties. She liked me. I would take her in photographs of events I’d been at the odd time and she’d always compliment me on how well I looked in them. She took me out to lunch a couple of times as well. She was the only one (other than my best friend D) to whom I would show my prolific self-inflicted injuries (which were more than just silly little cuts, but long, occasionally complex words all over my body). I don’t remember whether Anna ever asked to see them or whether I just avoided it with her, but I’m pretty sure she never saw any of it.

I don’t remember, again, the exact reason why this relationship came to a close. I don’t think Elaine left her position; I think it must’ve been something to do with me taking my GCSEs and therefore potentially leaving school, and ergo, her remit. As it happens, despite my previous intentions, in the end I elected to return to school for sixth form, but by the time I got to that stage, things were more (not entirely, but more) settled anyway.

It was during my time with Elaine that I seriously tried to kill myself (the first attempt, a gesture in retrospect, had been about a year beforehand, catalysed by a break-up with a boyfriend). On this occasion, although I decided upon doing it on a whim, it was something I had been thinking about for a long time and I really intended to die. I took a massive overdose of everything I could find in the house – paracetamol, ibroprufen, various prescription medicines of my mother’s, my Prozac etc etc – thinking it would be enough to off me (I know better now, but I genuinely believed it would kill me then).

I am reminded that my time with Anna and Elaine must’ve overlapped, because I now recall Anna coming to see me the next day in hospital, after I’d had my stomach pumped. When I went back to school the next week, Elaine took me out for lunch. I remember asking her why she was rewarding my behaviour; she responded that she didn’t feel that she was ‘rewarding’ it, but she was upset that I had felt so desperate that I’d seriously tried to kill myself, and she wanted to do something to cheer me up. Well, as anyone who’s been there knows, it takes more than skiving off school for lunch – but I appreciated the gesture, as well as the rest of her tenure as my EWO.

It actually pains me to write about Elaine, because it reminds me very acutely of what was probably the bleakest period to date in my life. It was only through thinking about what I was going to write about on this post that so much came flooding back to me; clearly I had compartmentalised much of it (I was whinging about this to bourach here recently). In a way, one could argue that this past year of my life (ie. 2008 – 2009) has been even worse in the sense that I have experienced a lot more than ‘just’ depression, and that would most assuredly be true. But now, at least, I have a support network, and a network that understands this whole mess is not something of my choosing. I very distinctly didn’t have such support when I was 15/16. I had a few friends, yes, but with the best will in the world it was hard for them, not having been there, to understand a disease so often (and often unfairly) solely associated with adults (I’m not even sure they’d understand it then, but anyway). Although she recognised that I was mentally ill, my mother couldn’t fully grasp the enormity of my despair either, and reacted aggressively to my illness at times, although in fairness she did champion me a lot with the GPs/counsellors etc. I was picked on by a couple of teachers too, though in fairness there were a few good ones. All in all, it was a horribly dark period in my life, and rather than discuss the specifics thereof, I think I’ll just leave it be. Maybe another day.

After doing my GCSEs I existed in a relatively sane frame of mind for a while. My dosage of Prozac had been upped, and a lot of the wankers that had made my life so miserable at school had either left or had grown up a bit. Additionally, I was only having to do subjects I liked and was good at for A Level, so things were a lot more settled for a while. Things were far from perfect; I continued to miss a lot of school, and didn’t do as well in my A Levels as I could have done – but things were certainly better in those two years than they had been in the previous five. In fact, it is only through writing the above about Elaine that I am shown how much I wear rose-tinted glasses regarding school. I tend to be quite defensive of the place should anyone slag it off, and when I think back upon my time there in an abstract sense, I am sometimes overcome with fond nostalgia – this is based almost entirely on not absolutely hating those two years of sixth form. Clearly at least part of me blocks out the unbearable misery that were the preceding five years.

But anyway, that obviously didn’t spell the end to the madness…

The First Assessment Woman

I’m not sure when this was. After sitting my GCSEs, the next time I really remember losing it big style was when I was doing my postgraduate course, but I’m fairly sure the First Assessment Woman was earlier than that. Perhaps I had been feeling low for a while in sixth form (or whilst I was an undergraduate) and had yet again been at the GPs’ ‘surgery’; given my history, they might have referred me to the Psychological Therapies people. Who knows. Whatever the case, I went to see this woman at the same hospital in which I now see C and Dr C.

I believe the meeting was intended to assess what the most appropriate psychological treatment would be for me given my history. It was, short of the Crisis Response Team (see below), the most useless and frustrating mental health-related meeting I have ever had. The woman quite openly sneered at me as I tried to relate some very difficult information to her. I think it was because I expressed everything with a distinct absence of emotion and she therefore didn’t think there was actually much wrong with me (or such was my impression, anyway).

When I related a very abstruse outline of the sexual abuse, she decided that that alone must be the entire cause of my problems and gave me the number of the local Nexus Institute. I remember protesting that I didn’t want to phone someone (so clearly the phone phobia has been ongoing for a good while then) but she dismissively said it could be in confidence “if I wished” (thus totally missing the point) or that I could see them in person, if I preferred, and that that was all, I was to run along now. I didn’t have the energy to argue with her and that was that.

I had a major breakdown whilst undertaking my postgraduate degree. I had, at this point, only the dissertation left to write and had finished the taught part of the Masters programme, so took a full-time job which looked to be like a very good opportunity, and which was, unlike my previous and subsequent jobs, directly related to my academic background.

Unfortunately, I had been in a slow, but with hindsight obvious, downward spiral, largely thanks to my own doing. I had been feeling pretty good during my postgraduate year, so cut back on my Prozac without medical approval. DO NOT EVER DO THIS!!! By the time I realised I needed to remain on the dose I’d been at, the spiral had already taken its grip and the return to the full dose didn’t make a difference.

In fairness to myself, it would probably have happened sooner or later anyway, because at no point had I seriously tackled the underlying causes of my mental health difficulties – surely a recipe for disaster. It’s one thing to be aware of what they are, but it’s different to fully face them and be aware of all the subtleties therein. To mitigate their effects, or at least begin to reverse them, in my view I need to do this. Of course it had been my choice to never get into this detail, as I’d already seen a number of different ‘therapists’ by this point and had failed to utilise the opportunities presented. On the other hand, until you’ve been there, it’s impossible to understand how difficult this is, and how skilled a therapist needs to be to get it out of someone with so many defensive walls built around them, like me.

Anyhow, as ever, I digress. The breakdown meant I lasted a sum total of one week in my new job, and eventually had to leave my course with a postgraduate diploma rather than a Masters degree.

I returned to my GP. LGP had joined the practice by this point, but I didn’t see him consistently until more recently; it’s dog eat dog in our practice, and you take who you get unless you’ve planned the appointment for weeks. So I went to another one, who simply told me to “fight against it”. Unsatisfied with this, I went to the practice’s Nurse Practitioner, who prescribed me a new anti-depressant – Mirtazapine (in part because it’s good for insomnia) – and referred me for wanky CBT. I saw ‘wanky’ now, but I was hopeful at the time.

The Second Assessment Woman

She was a CBT Nurse at the main bin in Northern Ireland, Holywell. She was certainly better than the first bint of her ilk (see above), although I disagreed with her ultimate conclusion. I remember that she asked me the one question that every single one of them has consistently asked me: “don’t you have any female friends?”

I said that I didn’t like other women, adding, remembering her gender, that I meant “no offence” to her. (To qualify this a bit, I generally don’t get on well with other women in real life, though I felt more harsh about this at the time than I now do. Online, this isn’t the case at all – most of my online friends are women. I do have one real life female friend at the minute, so maybe I’m making progress! It all goes back to a terrible case of black and white thinking; because many women express emotion, want children and dream of white weddings, stuff I hate, I behave like I think they all do. Rationally of course I don’t think that at all, but then rationality and I are not always the best of friends, regardless of my desires to the contrary).

Anyway, Assessment Woman Two listened to me and, in fairness, seemed non-judgemental and accepting of the fact that there was something wrong. She did seem puzzled by my customary lack of emotion and even apparent amusement at some stuff, but she let it pass. Her conclusion was to refer me for group CBT. I protested vehemently against this – I was terrified of the group thing. The woman said, though, that she felt it would be beneficial in two ways: (1) the waiting list was shorter for group therapy than individual therapy and (2) it would help me confront my fear of group situations face-on. I reluctantly agreed.

The Psychoanalyst – Ian

As the waiting list for even the group CBT was six months, I went back to my GP’s ‘surgery’ and asked for a recommendation for a private therapist in the meantime. The physician I saw that day suggested Ian.

Ian was a very well regarded psychologist who’d even practiced as a forensic psychologist. Without detailing my academic background too much, this appealed to me strongly at an intellectual level and although he charged £70 per hour, I was happy to ‘try’ him.

I liked Ian. In a way, he reminds of me of C, the psychologist I now see; he was qualified to PhD level in his discipline, was clearly intelligent and astute, and seemed to be able to read my mind.

It was he who first suggested to me that my narcissism was an elaborate defence mechanism, built up over the years to disguise inherent and strong self-dislike. I remember arguing, “but I genuinely do think I’m better than some people,” and him responding by saying, “you genuinely think that you think you do, yes.”

We did discuss some of the stuff that effected me as a youngster, but although this was closer to psychoanalysis than any other therapeutic situation in which I’ve been, he was still primarily interested in here-and-now of my psychology. I believe that this was not because he wasn’t intending to explore everything else in more depth, but because if he had an understanding of what was now the case, it would allow him to work backwards. C did something similar, but has a more structured approach.

Again, though, my whole ‘lack of emotion’ thing was pronounced and perhaps he therefore didn’t realise how serious the situation was, or at least was becoming. Furthermore, if I am entirely honest the whole thing was kind of like an extended intellectual discussion between two parties interested in the way people’s minds work. To this end, I don’t feel that it was necessarily a particularly helpful relationship, even if it was an interesting one.

I think Ian could perhaps have helped me had I allowed him to break down more barriers, but then again, just because we liked each other at an intellectual level doesn’t mean that we ‘clicked’ especially; I don’t think we did, and there is increasing evidence suggesting that the dynamic of the therapeutic relationship is what allows the most useful and effective type of work to be done (see here or here, for example).

I went maybe five or six times, approximately every fortnight, though it became progressively less frequent as time went on. Aware that I wasn’t working, Ian suggested that I do some reading and practical things, and suggested I came back in a couple of months to save myself some money. In fairness, he did genuinely seem to want to provide me with a value for money service.

I didn’t go back, but not because I just gave up.

The Hypnotherapist – Edith

Having heard that I was paying out £70 per hour, the McF dynasty decided to get involved, recommending a hypnotherapist that S and her daughter SL had both gone to, finding her effective and more reasonably priced than Ian at £70 for two hours. I must confess that I was cynical, but my mother offered to pay for the treatment so I thought, “what the hell?” My intention was to have it compliment the work with Ian, rather than replace it, and for a short while nearing the end of my contact with Ian, the two did overlap.

Edith was the sweetest, most gentle woman you’re ever likely to meet. She oozed empathy and sympathy and absolutely tried her level best.

For my part, I did open up to her, but still in a pretty detached sort of way. For instance, I remember one discussion in which I was supposedly hypnotised where she was “regressing” me to my childhood. She asked if I could see the little SI in my mind’s eye, and I said that I could. There was a conversation about the kid’s actions, behaviours – I don’t remember it fully, but in any case, despite outward appearances, it became apparent that Child Me was probably not very happy. Big SI was very bad and said that she didn’t care that her mini-me was somehow unhappy. Edith said, “doesn’t she need to play? Shouldn’t she be enjoying these years of her life?”

I can’t remember my exact response, but it was certainly a definitive no. She kept pressing the issue – “but can’t you empathise with that little girl, that innocent child” blah blah blah – but no matter what way she tweaked it, or however she phrased it, I didn’t like Child Me and did not empathise with her. Edith kept trying and trying to instill empathy in my unconscious, but it never worked.

I’ve always wondered if I was completely hypnotised anyway. Whilst I obviously recognise that hypnosis is generally not like you see on the Paul McKenna show or whatever, but that it is rather just a heightened state of relaxation, my experience in Edith’s was distinctly different to both that of S and SL. S in particular had found that her body took on the characteristics of her abusive ex-husband – she spoke in his voice, she lashed out a couple of times and emulated his stature. SL hadn’t quite such an intense experience, but more so than I had, and neither remember much of it, whereas I remember a lot of it quite clearly (and anything I don’t recall is more to do with the passing of time rather than the hypnosis bit, I think).

I’m not faulting Edith; if I wasn’t hypnotised, then it is probably because I resisted it. I don’t know about the accuracy of the claim that some people can’t be hypnotised – maybe that’s part of it? But still, once more, I wasn’t fully willing to confront everything in detail. Again, yes, this is arguably stupid, but I still utterly despised the notion of expressing emotions (I still do) and was incredibly defensive.

One issue of difficulty was that I had to point blank lie about McMF-paedo-fuck to Edith. This is because she lives close to the McFs, and of course she treated MMcF’s husband’s daughter and granddaughter. Although I have more than one uncle that is still alive (and did then too), it would just have been too awkward to admit that it was an uncle. She did directly ask me who was responsible, so had I said, “my uncle,” there was nothing to stop her from asking which one. I therefore had to lie and say it was the husband of a friend of my Mum’s. This meant having to remain on guard about this issue a lot, which no doubt didn’t help the hypnotherapuetic process.

Having said all that, Edith must have done me some good. One thing she did do was set anchors, though as far as I know this is as much about neurolinguistic programming (NLP) as hypnosis. Occasionally I’ll still grab my wrist in a certain way to try and calm myself – that was one of the anchors.

Whether it was partly this, or partly expunging myself each week to her in general, even if still in a detached way, something must have helped in some way, because it was after seeing Edith for a few months that I started looking for work again.

(For the record – when I got a job, thinking I was back on track, I didn’t return to Ian. I did eventually receive a notification to attend a CBT session back at Holywell, but it was in the mornings, and that clashed with work, though as I was part-time back then, afternoons were ‘do-able’. I let Holywell know this, but was told that the group sessions only took place in the mornings and that therefore I’d have to wait another while for individual therapy. I never heard from them again).

A initially advised me against going to the four interviews I got at this point, as I would totally lose it each morning before the interview of that day. But I somehow forced myself to go to them all, and in the end was offered two of the four positions (I had temped briefly at the full-time one, and had other experience in the area, so no doubt that helped). Ultimately, I took the part-time one, because (a) I felt really encouraged by the staff I’d met at my interview, (b) it was in part working with animals and (c) I felt that a part-time position would be a better way to ease myself back into work.

Unfortunately, it didn’t entirely work out well, as despite appearances some of the staff weren’t quite so nice – but that’s another story. I did keep in touch with two of my colleagues from there (AC and DL), and thus am still grateful for the experience. Anyhow, I applied for another part-time job, got it, then a few months later got promoted to a more senior and full-time job. This is my ‘current’ job.

Things were fine for about a year, though the year had many stresses – V’s death and the will fiasco, a change of manager, a lot of stresses in the job itself that really shouldn’t have happened. Eventually, I was becoming increasingly agitated and depressed, and even dreading going to meetings as I knew I would only have a pile of extra work laid at my door, when it wasn’t possible to do any more. I was becoming increasingly neurotic and disillusioned with life in general, and one day I cracked and rang my mother in tears, begging her to put an appointment on with the bloody GPs the next day.

This she did, and that was the last day I was in work.

The Crisis Response Team (CRT)

I initially saw the Nurse Practitioner that day but when she heard I wanted to die and I couldn’t see a future for myself (amongst other things), she said, “you know, you’re really ill,” and decided to involve one of the partners in the practice.

He, in turn, decided that I needed to urgently see specialist mental health professionals and arranged for someone to come out to my house that day.

I am not sure that I have enough pejorative terms for the two women that turned up. Whilst the first one was friendly enough, when the other (apparently the more senior) one took over, she was incredibly passive and didn’t stand up for me, so I hold her as well as her colleague culpable for my annoyance.

Despite outlining how unbearably bad I felt, despite trying to tell them why, despite all the efforts I made to convey the longevity and seriousness of my condition to them, the more senior woman said I should “perhaps try meditation”. I actually laughed, thinking this was some sort of twisted piss-take, but her facial expression conveyed the information adequately that she was not joking. For the record, I have no problem with meditation, but don’t believe it’s a substitute for proven medical intervention.

She continued by asking me to analyse a scenario. Bloke A is in the park with his six brats running around screaming and doing my head in. What’s my reaction? “That Bloke A should die.”

“Alright,” she said, “now assume you approach Bloke A and tell him to shut his children up, and he apologises to you and says it’s just that his wife died that morning. What’s your reaction now?”

“My reaction is that while I am sorry for his loss, Bloke A should die.”

She looked puzzled and said, “but don’t you see that there are different ways of looking at things?”

“Yes,” I said, “I’m not stupid. What is your point?”

Apparently I was not recognising that there was an alternative viewpoint to the behaviour of Bloke A’s children and his inability (or unwillingness) to discipline them.

“That is incorrect,” I protested. “I do accept that there’s an alternative viewpoint. I still think he should die as his grief isn’t my problem. In fact, I’m offended on behalf of his wife. Shouldn’t he be taking his kids to see her parents or something? Or, in an alternative viewpoint, let’s assume the wife’s parents are dead – surely she has some family? Shouldn’t he be engaging with them and sharing grief? Or if he needed to be alone, why isn’t he alone? I appreciate that it’s possible that neither he nor his wife have any friends, family nor colleagues, but I think even you’d agree that that’s unlikely.”

But apparently I still missed the point.

After a long and protracted argument, about the above scenario, meditation and other issues, I admitted defeat and told the two of them that I was disgusted that my national insurance went towards their salaries.

This comment was ignored and they agreed to refer me to a…take a guess…wow-ee, a CBT therapist! Deja vu, anyone?

As they left, they told me it was “lovely” to have met me (so they’re liars as well as morons). Perhaps needless to say, I didn’t return the ‘compliment’.

The Cognitive Behavioural Therapist – Margaret

Given my previous experience of CBT therapists twatting about, I knew if the dumb bints from the CRT even did refer me (which it turned out they hadn’t), that I’d be waiting a while for it, so back I went to one of the GPs, and again asked for advice on a private therapist, though this time I specified that I wanted to try CBT rather than psychoanalysis.

Enter Margaret, at £90 an hour.

Although I liked her as a person, it was Margaret that gave me my intensely negative view of CBT. Initially, I was cautiously optimistic, but it didn’t last. As is apparently typical in CBT, now that I’ve read about the process more in-depth, she would have me analyse the likelihood of a perceived negative event. As a very rudimentary example, someone I know walks past me in the street without speaking to me. I can (a) assume (s)he hates me or (b) rationalise it – maybe (s)he didn’t have her glasses on, maybe (s)he was on his/her mobile, maybe they’re depressed.

Um…so? I know there are a million other explanations and I know that it is almost certainly not about me unless there has been a very clear reason for that, such as an argument. I already fucking know all that, I don’t need anyone to patronise me about it. The question is how does one really believe it? When I asked Margaret that, she said you just have to have an evidential base for the belief, which tallies with the literature on the subject, but that’s bullshit in my view as it’s already been recognised as utterly irrational by me; I already see and recognise that evidential base, but it’s doesn’t stop me from believing that the worst case scenario is the case, even if I don’t rationally believe it. If that makes any sense.

Another technique would be to directly face that which is most feared. As an example of this, I told her that I was freaking out about an interview for a job for which I’d applied, and she said I must go, as exposure to the event would be helpful.

I ended up in LGP’s office having gone totally batshit, and he gave me Diazepam for the first time.

In fact, I actually did go to this interview, and of course it didn’t go badly (in the sense that the panel weren’t Satan Incarnate; it did go badly in the sense that they were looking for someone much more qualified than me). But I already knew it would never be as bad as my panic was making it out to be. This happened another few times – I would utterly and completely lose it, even though I knew it could almost certainly not be as bad as my losing it would suggest. It doesn’t matter than I’m rationally aware of probable realities. It doesn’t matter that I know the worst that can happen is that the interview panel don’t like me or that I don’t get the job, and it doesn’t matter that neither of these things are likely to matter in the grand scheme of things.

I still fucking go mental when I’m under stress, or sometimes (mostly, actually) ‘just because’. Furthermore, in the case of the latter, I am not losing it because of any specific reason – as such, how can I rationalise what I fear? I mean, I don’t (consciously) know what the fear is in those moments. Even if I did, I already know anything a CBT-like approach could teach me.

Although I liked Margaret, I became increasingly disillusioned with the CBT approach, not to mention the fact that I was beginning to get into horrific debt – meaning that her employer’s ludicrously high charges were too much for me to pay. So that was the end of that.

My mother happened to be seeing the Nurse Practitioner at the GPs’ ‘surgery’ on an unrelated matter. The Nurse asked how I was getting on, and my mother said that things were not good. Upon a brief glance at my records, the Nurse saw that no referral had been made for me by the CRT for psychotherapy (I knew they were incompetent).

The Nurse therefore took it upon herself to make a referral. Fortunately for me, though, she cocked it up and didn’t make it specifically for CBT, like it was meant to have been when the bitches from CRT decided upon it.

I was really struggling during this period, and at my behest, had my medication changed to 40mg of Citalopram daily, which is the highest dose they were prepared to give me. It was at this juncture that the GP I saw decided to refer me to a psychiatrist, on top of the Nurse Practitioner’s referal to a psychologist. I finally saw her about five months later, despite the fact the waiting list was less than three months at the time. Contextual links follow later.

It was somewhere after my CBT with Margaret than I began to believe I probably had more than ‘just’ clinical depression and anxiety. I didn’t really investigate anything further at the time, but I recognised that for a while I’d been experiencing a wider set of symptoms. I assumed, rightly as it turned out, that seeing a psychiatrist would shed some light on this.

A relatively short period after my mother’s appointment with the Nurse Practitioner, I received a questionnaire through the post asking me to outline my psychological difficulties to help cut waiting times for a psychologist. I was prompt and, I hope, thorough in my completion of this document.

Some weeks later, I received a letter from the same hospital in which I’d seen the first assessment woman, asking me to attend an assessment with Dr C J, a clinical psychologist. Mum and I were both raging, as we wondered how many more fucking assessments it would take before they actually offered treatment? In both of my previous assessments, I then was simply moved to a waiting list for whatever the treatment deemed appropriate was. Still, I went along, because one has to do things the way the NHS wants.

The Multi-Disciplinary Psychologist – C

I’m not giving his first name. I’ve already told him I’ll keep all references to him here anonymous, and even though his first name wouldn’t give away his identity exactly, there’s always the chance that someone who doesn’t already know may find out who I am and work it out from there.

The ‘assessment’ session with C ended up turning into three assessment sessions, because he actually took the fucking time to discuss each of the points raised in the aforementioned questionnaire in detail with me. Surely he must have been breaking NHS protocol by actually taking his time over it?

I didn’t know what to make of him at first. His intellect was obvious, and I respected that, but there was something indefinable about him that I found quite irritating. Nonetheless, when I told him I thought CBT was a load of crap, even though I wasn’t a psychological expert, he accepted that and said that I was certainly the expert in myself, and that if that didn’t work for me, then it didn’t.

By the end of the three sessions, whatever it was that irritated me about the man was beginning to abate, and when he said that he would continue to treat me, rather than someone else, I was glad. We initially agreed to six weeks (his optimistic suggestion), shockingly commencing the following week! Progress at last. He did warn that although it might be mutually attractive, we couldn’t let our sessions become some sort of intellectual endeavour (as had been the case with Ian, though C is not entirely familiar with all that). I did stress that I couldn’t abide being talked down to, nor could I bear to not communicate comfortably because I had to ‘dumb down’ what I was saying. C accepted that and stated that he would be glad to have an intelligent dialogue with me, but it wasn’t to become a discussion of my issues as a psychological abstract; it still had to be directly about me. Given my narcissism, I was happy enough to acquiesce to this.

During those first six weeks, I began to grow from being pretty indifferent to him, to becoming really rather fond of him. He seemed to have got the mix right between employing intelligence and empathy in his approach – this is a position I still maintain about him. At the end of those first six weeks, I burst into tears in his office and begged him not to abandon me, as he was the first therapist to really ‘get’ me out of the many I’ve seen. We agreed to another 10 weeks at that stage, and when those came to an end, another 12 (of which we have presently had two sessions, with the third tomorrow). I see him once a week, first thing on Thursday mornings.

Perhaps because of his balance between intellect and empathy, rather than just one of them being in evidence, I have opened up considerably to him and have even shown the dreaded emotion, though I still curb it to some extent a lot of the time. I’ve told him stuff I’ve told no other living being.

In essence the therapy is mainly psychodynamic, though he has tried – usually to my annoyance – to bring stuff like DBT into the mix. His rationale is fair; psychodynamnic exploration is important, but when I lose it I need practical help too. I’m still dubious about DBT, but at least it has an ancient philosophical background which CBT doesn’t.

The main thing I’d say about my relationship with C is that there is a bond between us now. I am horribly attached to him, and whilst I won’t delude myself into pretending that he returns that attachment, I do think he likes and gives a damn about me. He is the first of all of these people that I have actually experienced transference towards, which is demonstrative of the fact that my psychotherapy with him just might be the vehicle I need to a recovery of sorts, as of course the phenomenon is generally expected to manifest if the therapy is to have any hope. Transference does cause me to get annoyed with him over very little at times. He causes me to get annoyed with him at times; the way he’ll avoid a question infuriates me, but this is him trying to avoid getting into a intellectual discourse with me, for the most part.

But all this transference, bonding etc is not to say that the process is fun; quite the opposite. It’s intense, overwhelmingly so at times. It often (ironically) depresses or angers me, saddens me, has made me lose it a couple of times. Even though I’ve opened up to him on many issues, I am still incredibly defensive and tend to (figuratively) run away if he hits a nerve. Yet somehow he manages to get most of it out of me eventually, showing his subtle but evident skill. I always crack up though. But then I always expected that things would get worse before they got better, because I have not faced any of my ‘baggage’ in any real depth before.

Overall, it’s possibly the most difficult sustained experience I have ever been through, but nonetheless, I think the relationship is a very good one, and despite the regression in my condition since I met him, in conjunction with his colleagues in Psychiatry, I have a glimmer of hope that, over time, C may be able to help me get some control back over my life.

The Psychiatrist – Dr C

Again, no names. In this case I don’t even know their first names anyway.

Obviously she’s not a psychotherapist and exists mainly to monitor my illnesses from a medical point of view. But I want to hat-tip her anyway, for providing my diagnoses back in June. Dr C also changed my medication to Venlafaxine on that occasion, but was open to the possibility of adding further medication to the cocktail should it prove necessary.

Unfortunately it took a hell of a lot of trouble to finally get to see her (it was only in discussing self-harm and suicide ideation with C that I was ever seen by them) and now that I have met her, it apparently takes a lot to continue to be seen on a regular basis. Basically, I feel fucked over by her, just like I have been by the NHS on several occasions, but meh. I ought to be used to it.

At least, though, when she does bother to show up, she seems to be willing to tackle my case in a straight-up fashion and to do something that might actually have something like a positive effect, so in conjunction with C, I have my fingers cautiously crossed.

So there you have it. The life of the Serial Insomniac through therapy. I realise that I have whinged an awful lot in the early part of this post that people kept attributing my madness to teenage angst. For what it’s worth, I do understand why this was thought to be the case, for the laypeople anyway, and I am working towards letting go of my anger in that regard, though it’s not easy.

It is only now, about 14 years after first really feeling that there was something psychologically wrong with me and about 13 after seeing someone about it, that I feel I might actually be finally moving in the right direction.

I expect it to be a slow process, but I’d rather have that than have no hope of regaining control at all.

Apparently BPD has a decent prognosis in the right circumstances, though I certainly won’t hold my breath. Bipolar disorder has no known cure. Either way, I’m not asking for ‘cures’. I accepted years ago that I will probably be on medication for the rest of my life; I am fine with that, and I am not against some sort of semi-regular ‘top-up’ psychotherapy after completing my main course, if that is what is required. Cures are not what I seek, as discussed in more detail here and here.

But I do want to be able to at least be functional, and I do hope that with C’s help, maybe – just maybe – I might be able to regain enough control to achieve that. I don’t know. The journey will continue to play out on this blog.

Lucky you, dear reader. If you’re still reading this post, then I’m amazed and don’t understand how you’ve not passed out or even died of boredom. Even by my verbose standards, this is fucking long. So, until ‘C: Week 23’, so long.

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I Hate Psychiatrists

Posted in Everyday Life, Mental Health Diagnoses, Moods, psychiatry, Triggers with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Monday, 20 July, 2009 by Pandora

So, after my grovelling apology and new-found respect for Dr C back in June, the current behaviour of her and her team has reinforced to me why I thought they were shit in the first place.

I was supposed to be seeing Dr C next Tuesday, so as she could review how the change to Venlafaxine was affecting me.  Regular readers will know that I’ve gone completely fucking mental since I changed to them, as demonstrated in just about all my posts in the last few weeks, but especially here and here.  Dr C, or perhaps more accurately her bint secretary, had already changed my appointment time several times.  This was irritating, but meh; as long as they were to see me, I could live with it.

Well, a letter arrived on Friday from their office stating that whilst they “apologised for the inconvenience”, the outpatient clinic had been cancelled and that an appointment had been rearranged for 8 September.  September.  What the fucking fuck?

I went to ring them but instead of being able to type their number into my phone I just ended up panicking and ultimately throwing it across the room.  Eventually I got my mother to phone the bint secretary for me.

The bint told her that the clinic wouldn’t have even been with Dr C in the first place.  My mother didn’t get the name, but it sounded like it was Dr N, the SHO I met the first time I went to psychiatric outpatients.  That wouldn’t have been ideal, but I could have lived with it.  But anyway, Dr N has cancelled her clinic.  Just like that, apparently, and no more reason was given.

Alright, my ma went on.  But SI is climbing the walls and would really need to speak to Dr C.

But that isn’t possible, apparently, since Dr C is on holiday.  For “quite a while”.

And in the meantime?

September is literally the first appointment available, so that’s too bad really, oh how regrettable, but that’s the way it is.  If there are any cancellations, they’ll apparently phone me.  Yeah, right.


Go fuck yourselves, one and all in psychiatry on the NHS.  Fucking bastarding cuntflapped bollockheads.

No wonder I don’t want to be hospitalised, if this is the standard of care one can expect.  Mental health professionals don’t care about mentals, clearly.

I got off the phone with my ma and threw my head at the wall with such force that I literally fell backwards, and very nearly knocked myself out.  I sat down again, got back up, sat down, got up, paced, sat down, paced some more and eventually ended up in the kitchen looking for the knife.  I then went and re-carved the word ‘HATE’ across my tummy, about which I wrote here.

That action having been completed, I sat on the sofa with the knife for a while wailing and sobbing in utter desolation.  (For what it’s worth, after a fairly short while I felt a lot better, proving that self-harm does indeed work).

It’s like the conversation I had with C on Thursday.  I don’t think I’m being taken seriously by the NHS.  I really don’t.  I would love to have the nerve to make a suicidal gesture and that would fucking show them.  Even better, I’d love to actually be successful in catching the bus and then the cunts would face a potential lawsuit and be forced to apologise to my family and friends and shit.  But as of right now, obviously, I don’t have the nerve.

Everyone is commenting that these tablets don’t seem to be good for me.  As I detailed here, if they are creating mixed episodes (which they are), then the apparent way of treating this is to add mood stabilisers to the medication cocktail.

How the fuck am I meant to get these if the psychiatrist refuses to fucking see me for months?  My GP can, theoretically, prescribe them, but of course he’s not the expert that Dr C supposedly is.  She would know if the mixed episodes are caused directly by the Venlafaxine, or whether it’s something else.  She would know whether she should change me to another anti-depressant, or whether adding mood stabilisers on top of Venlafaxine would be the best answer.  I am not sure that Lovely GP has this in-depth knowledge.  As CVM (a registered nurse) said to me, he went to university for five years and then trained as a GP thereafter, so he damn well should be able to know – but, simply, he doesn’t have the same knowledge and specialist experience than Dr C and her ilk are reputed to have.  Still, I may go and see him anyway.

I am convinced that C could get them to take notice (it turned out that it was him rather than Lovely GP that did in the first place), but of course there is no C this week 😦  I will have to rant about it to him next week before he then goes away for two weeks 😦 😦

Additional worries:

  • GA is on this landmass.  In fact, she is – until her departure next week – never more than about 40 miles away.  I feel violated.  I wonder, despite my request for her not to, how much back-chat she has engaged in about me?
  • Fucking occupational health tomorrow 😦  Panic panic panic panic panic panic
  • Because of the shrinks wanking about, it is almost certain that I will lose my job now.  If they’d see me as planned next week then I might have been able to get a solution to my present situation fairly quickly.  Given that I am now likely to continue feeling this fucked up until at least September, about the time work are expecting me back, I really cannot see how the situation can be resolved.  I didn’t realistically think it could have been anyway, but it was possible, and now the chances of not getting dismissed are low to infinitesimal.
  • The effects of my mentalism on poor A (I went mental again on Saturday, though it was remarkably less severe than the previous couple of weeks).
  • The fact that some people are still unwilling to try and understand that this is not something that I can help, that I could end being mental by “changing my thoughts” (ha!), and decide to tell me what I should and shouldn’t do about it and how I should count my blessings.  Never thought of that or anything, thanks.

I’m not totally losing it today, but things do seem pointless and bleak.  Nevertheless, that’s a fairly default position for me, so I suppose it’s progress from going totally off my head.

Well, I will report back on the occupational health tomorrow.  Can’t wait…!

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Angry Therapy – C: Week 16

Posted in C, Mental Health Diagnoses, Moods, Psychotherapy with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Friday, 26 June, 2009 by Pandora

Yesterday was the first time I lost it with C.  I have been wry with him, played mindgames with him, slagged him off to others – but never yet have I actually exhibited annoyance directly at him.

Anger is the wrong word, really.  It wasn’t as strong as that, but it was certainly the first time I’ve raised my voice to him and openly displayed annoyance directly at him.

The session started in the usual stupid way of both of us sitting looking at each other.  I wish he would just take the lead sometimes, but he always wants to know where my mind’s at.  Eventually he gave up staring at me and asked how I was feeling.  I stated that I had felt better, but had felt worse.

“But how do you feel here, right now and in this moment?” he probed.

I didn’t want to convey how anxious I was about the meeting after last week’s disaster, but eventually I said, “I’m wondering what mental pain you’re going to put me through this week.”

C seemed a bit surprised by this statement, but maybe that’s my imagination.  I said that I sometimes found therapy very difficult.  (Yeah, cos it’s meant to be fucking easy, right?).

In this particular instance, given the timing, it would not take a genius to work out why therapy was hard, so he himself brought up last week’s altercation about this blog.  I admitted that I still thought he was angry with me and that he would abandon me and leave me in a (metaphorical) gutter (that’s a metaphor I’ve used too many times, but I can’t think of anything else).

For once there is not a lot to say about the session in terms of specifics, because basically the same thing was discussed throughout.  But there are a few moments worthy of mention.

I defiantly told him that I had blogged about last week’s session, to see how he would react.  He responded by asking me what I had written.

I said I had written, in part, an analysis of what he was doing by probing me about the blog.  Of course C wanted to know what form that analysis had taken.

I said, in a challenging fashion, “I believe that you were trying to explore the transference I experience in this room.  Would that be a fair comment?”

I felt quite smug in observing his reaction.  He screwed up his face in thought for a few moments and was, in my estimation anyway, taken aback by my candour.  Eventually he said, “yes, I suppose so.”

He reiterated that he didn’t have a problem with me blogging about our “work” but that he did want to reinforce the idea to me that “there had to be some boundaries.”  I asked him what boundaries, specifically, did he mean.  Was he simply referring to the fact that the blog had to be anonymous?

He said that he was and there were no additional boundaries.

“I’m not stupid!” I raged at him.  “How patronising!  Do you think I go and write, ‘hello, my name is <my full name here> and I am in psychotherapy with a clinical psychologist called Dr <his full name here> who is based at <name of hospital here>?’  Do you actually think I do that?!  Who does that?!!  I have an IQ of 148, what do you take me for?!”

It was a compulsive outburst, which was perhaps unsurprisingly then followed up by a, “that wasn’t fair.  I’m sorry,” at which point I bowed my head in submission.

Then I asked, more diplomatically this time, “why do you feel that you need to continually reiterate this position?  You know I know this, so what is your reasoning?”

He yet again screwed up his face in thought, but this time he appeared more uncomfortable.  I realised that I was reversing the roles a bit, and guess what?  I apologised yet again, hurray!  “I’m playing mindgames with you,” I admitted.  “I’m sorry.”

C said that after my previously feeling that he was seeking justification from me, that I was now seeking justification from him.  He didn’t say this exactly, but I felt his view was that after believing he was punishing me, I now wanted to punish him.  Of course this was followed up by more ‘sorry’s.

Although the ensuing discussion was wide-ranging in the sense that I discussed others with whom I experience outbursts, it all came back to the same thing.  I get angry (or at least irritated) then revert to submission (not with others in general, though I do tend to curb my rage with them much more than they realise, which in some ways amounts to the same thing).  It was exemplified a couple more times in the session, but I don’t remember exactly what I’d said that required apologies.  But apologise I did, and indeed at one point he pulled me up on it.

I apologised for apologising, then apologised for apologising for apologising, until C started trying (and failing) not to laugh.  I waved my hand about and said, “you know what I mean.”  I proceeded to enquire as to whether or not I spent half my time apologising to him.

“Well, not half the time,” he began, at which point I interjected with a mildly irritated, “that was a deliberate hyperbole.  You know what I mean.”

C half-smiled at this, then proffered the view that yes, I certainly spent “some time” apologising to him.

It all went back to the same thing.  Defiant and challenging and annoyed versus submissive and scared that he will abandon me and I will have to kill myself.  He wants to know from whence this dichotomous position comes, but feels it needs more exploration.  Then there was the usual bullshit about how much I protect him and that therefore, how much I avoid confronting stuff (not that I don’t have other ways and means of doing this, however).

We went on and on and on about these things, so again didn’t get talking much about DBT and the fact that I had sought extensive philosophical arguments for it.  At one point I did contend that my anger related to radical acceptance.

C asked why, and I opined that I still opined as exemplified by still becoming annoyed and that thus I hadn’t radically accepted anything and that I had therefore failed.

C laughed in my face (in a nice way) and said, “you have failed because you haven’t implemented the suggestions in one basic handout?!”

“Sorry,” I said.  What else?!

A lot of the session was also spent in silence.  We would look at each other for what seemed like ages without speaking, or we would just simply stare at the floor.  Guess how I reacted to this?  “I wasting your time by not speaking here.  I’m sorry.”  Bet you’d never have guessed that.

In any case, at this juncture there are no real answers.  I am scared to tell him that my rational, intellectual view is that my transference is about V.  I am not sure what I think ’emotionally’ anymore.  I don’t know if I do think emotionally.  I still abstract so much of myself even in front of him and I really do believe coming to grips with everything is going to take time.

In relation to that, he reminded me that our ten contracted sessions are due to come to an end in the next few weeks and we would need to discuss the way forward.  I do not recall how it was he phrased it, but after saying all the usual cack like he would need to seek my views, see how I dealt with our sessions when they were over blah blah blah, he did say something about seeing if we were going to continue our bizarre, asymmetric relationship in “the long-term”.  It wasn’t a promise, but whatever way it was phrased it did suggest to me that he was willing to do this.  This, obviously, is most reassuring because my fear of him rejecting me overwhelms me at times, which is why I think I spend so much of my time apologising to him.

We ended the session with a brief discussion about last week’s meeting with Dr C, my friendly neighbourhood psychiatrist.  Apparently C hasn’t heard from her (more NHS efficiency, then) so I was forced to tell him what my shiny new diagnoses are.  Bizarrely, I found it difficult to confess this information to C, despite the fact I’ve been almost bragging about it online and to (some of) my ‘real life’ acquaintances, family members, friends etc.  Perhaps it is because C as a psychological professional is bound be fully cognisant of the nature of BPD, and the fact that it is traditionally hard to keep clients in therapy.  I don’t want him to think I hate him but don’t want him to abandon me; I don’t hate him and dont want him to abandon me.

But anyway, I eventually managed to tell him about both the BPD and the bipolar II as diagnosed by Dr C, and about how she’d changed my medication and would be willing, if necessary, to add mood stabilisers to the equation.

C asked how I felt about having these ‘labels’.  I said, that as my own self-diagnosis had been largely correct, I partly felt vindicated and affirmed, though (to his surprise) I said that I sure had all the cluster B and C personality disorders (it was partly a joke, but as I said to him, I do have features of most of them).  Moreover, though, I said that I felt that being mental would at least be easier to confront in some ways now that I know the specific form of the mentalness.  It doesn’t make being mental any easier to cope with, but at least I know what I’m dealing with, and isn’t knowledge supposed to be power?  I concluded by saying that I thought my meeting with Dr C had been helpful, which as readers of this blog will know was indubitably the case.

So that was that, and next week it will all be back again for more fun and games.  I remember saying to bourach, who regularly comments here, that I wanted to start a fight with C, but she said quite rightly that I’d only feel bad.  I didn’t particularly start a fight, but I did expect to be annoyed with myself for even raising my voice to him at all.  The thing is, I’m amazed to report that I’m not especially.  Had it been right at the end of the discussion, or had we parted on bad terms, I certainly would have done and would probably have done something that the normals tend to call ‘stupid’.  However, I felt the discussion was useful – if a bit samey – and I think C is beginning to learn where he stands with me, as I hope I am with him.  We shall see.

I had much more to write about the rest of yesterday but I will have to leave it here for now.  I have to meet the fucking SSA medical people this afternoon to discuss my ESA – basically I need to prove to them that I am actually mental.  I am really worried because, for various reasons, I have to go alone.  Time for a little Valium, methinks.  I also heard yesterday from the office of significant evil and malevolence, but all this and more will have to wait for its write-up.  It’ll probably be Tuesday, because I am going to Dublin with A to see AC/DC this weekend.  A trip away will hopefully do me good, but unfortunately I don’t even like Dublin, because it’s so fucking busy all the time, which when you fear crowds is Not A Good Thing.  Still, a change of scenery and a good blasting of rock will hopefully cheer me up a little.

(Forgive any errors in this post but I really don’t have time to proof-read it.  I will do so later and make any necessary corrections).

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I Love Psychiatry!

Posted in Mental Health Diagnoses, Moods, Psychotherapy with tags , , , , , , , , , , , , , , , , , , , , , , , , , on Friday, 19 June, 2009 by Pandora

A bit of a turn up for the books, this is.  After the misery of C yesterday, and my intense dislike for Dr C the last time I saw her, I am very happy with how this morning’s meeting with the latter went.

There is not a great deal of point in detailing the entire conversation I had with her, as a lot of it was her clarifying points I’d made previously and on matters she had discussed with C.  I would be repeating a lot of this if I went into details.  Suffice to say, I discussed the points she raised with me in detail, brought some of my own to her attention, and let her proceed.

I was interested by a number of things.  Firstly, it was just Dr C I saw today, thankfully.  Not that I have anything against Dr N, but having to speak to both of them felt like I was being interrogated by a panel of interviewers.  Secondly, Dr C did not seem to be nastily questioning me in the way she had been before; I did not get the impression this morning that she felt I was a bullshitter, yet I previously had done so.  I suppose she needs to take that stance to weed out those that are bullshitters.  Thirdly, and perhaps most importantly, she spoke to me in absolutely non-patronising terms.  She assumed I had previous knowledge of most matters, she spoke in academic and erudite terms and she didn’t come off with off with any airy-fairy arse biscuits whatsoever.  It would be fair to say that I was impressed.  I was surprised that I was impressed, as – as you know, dearest readers – I had not liked her at all when I first met her.  But really, this was a positive change.

The crux of the meeting was that Dr C says my diagnosis is tricky.  She says that I do not clearly fit the diagnostic criteria for any one mental problem, but I do have strong elements of some.  Apparently it is not at all uncommon for crackpots like myself to not neatly fit into one diagnostic category.

The disorder that she feels is most strong in me is Borderline Personality Disorder.  Perhaps unsurprisingly given this, I feel completely vindicated by this assessment. In fact, she actually asked me how I felt about this diagnosis; I told her it was one of the conclusions I had come to myself in my endless foray into self-analysis.

She was glad that I was not distressed by this but nevertheless went on to say that it is not just BPD.  She said there are also clear signs of Bipolar II, a type of bipolar disorder in which the depressive elements are the prevailing symptom, but in which mania and hypomania are certainly present at times.

Of course, I still have clinical depression on top of all this.  As a friend on Twitter said, I should win a prize for multiple diagnoses.

Dr C said that she believes the BPD to be stronger than the the bipolar disorder.  She said the mainstay of treatment for BPD is psychotherapy combined with anti-depressants.  Obviously it’s clear that Citalopram are not working in the least and as such she has now prescribed me Venlafaxine.  According to her, NICE have recently issued guidelines advising strongly against the use of mood stabilisers and anti-psychotics in the treatment of BPD, apparently due to the fact that there is no evidence that such drugs help the illness.

Dr C had the decency to ask me what I thought of this.  I said that I was no expert, evidently, but that based on the little I do know of mood stabilisers, I thought that they could potentially be helpful in my case.  She considered this, and said that although she certainly thought they could have benefit in treating the bipolar elements of my mentalism,  that she thought the BPD was the stronger illness and as such she was reluctant to try the mood stabilisers for now.  To be fair, she says she is not at all ruling out prescribing them; if the Venlafaxine doesn’t work, or only works in some ways, she is willing to try other stuff.

She explained that as Venlafaxine is an SNRI rather than an SSRI, which is all I have taken hitherto, I may find it more useful than my previous medications.  I’m still relatively cynical about its potential for success I suppose, but it’s reassuring to know that she is not ruling out other options in future if they are needed.  As she said, we are both new to each other and it may or may not take some experimentation to get it all right.

All in all, I’m very pleased.  Someone finally has the decency to tell me what is going on.  I am grateful for all C does, of course, but it was important for me to get a name (or rather, names) for this fucking thing (or these fucking things), and now I have that (those).

I don’t think this is a solution – in fact, I know with absolute certainty that it isn’t.  Nothing ever will be, and psychotherapy is going to continue to be incredibly difficult, I fear.  Nonetheless, I am encouraged, and feel I it’s a step in the right direction.

Even though she almost certainly doesn’t know about, never mind read, this blog, I think I owe Dr C an apology for my previous rant against her.  So sorry, Dr C – and thank you.

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