Archive for the Psychotherapy Category

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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Protected: Pointlessly Stupid Navel-Gazing Repetitive Nonsense – C: Week 37

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

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Vulnerability and Self-Disgust with C – Week 36

Posted in C, Moods, Psychotherapy, Triggers with tags , , , , , , , , , , , , , , , , , , , , , , , , on Tuesday, 12 January, 2010 by Pandora

Thursday was the first day back to therapy after C’s Christmas break.  It was a successful session in a long-term sort of way, but was nevertheless very traumatic for me, tackling as it did a lot of hurt and vulnerabilities that I don’t want to face nor admit to.  There was nothing specific that was so stressful about it, but as I said to C towards the end, I felt very “battered and bruised”.

I was glad to see C again, having missed him and craved his protection over the three weeks since I last saw him.  However, he has committed a cardinal sin.  He has grown a beard.  Not like the goatee, Derren Brown-esque beard he had when we first met, but a full-on, proper beard.  I’ve nothing especially against beards, but honestly – he looks like something out of a children’s illustrated Bible.  When he came to the waiting room to get me, I was aghast to be greeted by Jesus (or Judas if you prefer, he could be either).  It took me a quite a while to stop fixating on this newly arrived hirsute feature.

As has been the case since C has been back in VCB’s stomping ground (as there is building work going on in his office), we opened by taking a few moments to compose ourselves.  The waiting room in the place is usually full of people, unlike that for C’s proper office which is always empty.  The people unsettle me, and C has realised now that he has to give me a few minutes for this anthropophobic anxiety to abate somewhat.

Of course, I had C anxiety as well.  I always feel nervous before I see him, and it was especially strong on Thursday given that I had not seen him for three weeks.  To that end, initially I was stubbornly refusing to speak in anything other than one word answers to questions.

Eventually, he asked me how Christmas had been.

“I’m not going to discuss that,” I brattishly declared.  I knew, of course, that he would follow that up with a question as to why I was not going to discuss that, so before he got the chance to do so, I changed the subject and told him about the latest troubles with the health service.

The first thing was the whole bullshit about the GP talking down to me, just after I’d last seen C.  I told him all about it, going so far as to re-enact some of the mannerisms that Dr Arsehole had employed during his irritable rant towards me.  This was before the reply to my complaint had arrived.

“How dare someone earning as much as a GP does behave in that fashion?” I raged.  “How dare the jumped-up twat speak to me like that?”

“How were you in the room with him?” asked C.

“Pathetic,” I admitted.  “I just sat there and took it.  I did try to argue with him at one point, but he just kept on and on, and I backed down.  As I was leaving, I even thanked him!  A reckons I need to discuss my remarkable ability to be so horribly passive with you.”

The second NHS issue, which I’ve only mentioned in passing here, is that apparently VCB is no longer my consultant psychiatrist.  When I last saw her in November, she said she’d see me again in a month, which she didn’t (surprise surprise).  Then, when I finally did get a letter inviting me for an appointment with Psychiatry, it merely said that I had an appointment on 20 January with Dr M, not VCB.  It made no reference as to the change of individual whatsoever.

C said, “as far as I know there’s been a shake-up in Psychiatry in terms of geographical location.  They’ve changed the boundaries that each consultant operates in.  Is that what happened?”

“No one told me anything, so I wouldn’t know,” I spat, disgusted.

“I’m not going to lie to you,” I continued, “I’m not VCB’s biggest fan.  But at least I had some sort of relationship with her – I knew her, and she was at least in some ways familiar with my case, so this is incredibly frustrating.  It strikes me that Psychiatry is possibly the worst branch of medicine in which such nonchalance and disruption should be in evidence, what with issues of trust and attachment being so much a part of certain illnesses.

“But what do I know,” I added bitterly.  “I’m just the mental that sits opposite you people.”

“Is that how you see yourself?” C jumped in.

The truthful answer to this is that I don’t know.  The comment had been intended as a slight on the Psychiatric “service” and indeed on mental health services on the NHS in general, but of course I exist in a perpetual state of self-loathing and self-disgust, whether im- or explicit, so yes, it probably is – to some extent – how I see myself.

I told him so, adding that I have no right to be mental because what has happened to me is so considerably less serious than that to which many others have been subjected.  This came up a couple of times in the session – basically I feel guilty for being a mental when other people who’ve endured worse aren’t or, if they are, then they have more right to be than I.

C mulled it over for a minute or two, then said, “one thing about you is that you’re defined by contradictions.  You mentioned earlier about being passive – there is that side, yet there’s another side that can be extremely assertive in the right circumstances.  It’s the same with your belief that you are somehow not entitled to be a mentalist [interesting use of that word, I thought].  You hate yourself for being this way, you think you have no right – yet you will fight to the death to get the treatment to which you feel you are entitled.”

“It’s hardly rocket science, though,” I responded.  “In some ways, whether or not I’m entitled to be mad is irrelevant; the fact is, I am.  Regardless of the reasons for that, I should be entitled to treatment, under the foundations on which this health service was based.  If I kicked that wall over there and broke my toe, the stupid manner in which I broke my toe would be irrelvant to those treating me; I would still be entitled to their medical attention.  I don’t see why it should be different for one’s mental health.”

“It shouldn’t,” he agreed.

Oh really?  OK then, why are you cutting short my fucking therapy?  Not that I brought up that issue specifically, because I didn’t want to engage in the pointless navel-gazing that had been the previous session.  If our time is limited, it must be used effectively.

Anyhow, I don’t remember how he phrased it, but basically he said that a person’s history and indeed how they respond to it is completely relative.  He said that we can only develop from our own experiences and, essentially, that I really shouldn’t beat myself up for being mental.  Later on in the session, he almost went so far as to say that I have every right to be, but I’ll come to that later.

Of course, I can rationally accept a lot of this, and indeed I know that certain mental illnesses with which I have been diagnosed are thought to exist in individuals who are biologically predisposed to having them, the symptoms manifesting after some sort of psychosocial trigger.  So of course I am not to be blamed for being mental…says Rational Me.  In-Control-Irrational-and-Ironically-Mental Me does not agree.

We also discussed how the anger I feel is sometimes misplaced.  I contend absolutely that my anger towards the health service is completely just, so that’s not one such example, but I will fly into a genuinely murderous rage at either myself or, say, my mother (particularly my mother) for something ridiculously stupid like dropping a pen – yet I am not angry at my uncle.  I am angry at my father, but that miserable sod had the audacity to die, so I’m hardly likely to be able to direct that towards him.

Of course, mention of my uncle in the context of anger was A Very Bad Move.  C said, “so, are you going to tell me what happened at Christmas?”

I glared at him.  “Did I not already say that I don’t want to talk about that?” I sneered, eventually.

“You did, yes.”  He looked at me enigmatically.

Oh, but you can read my mind, can’t you C?  Saying that I didn’t want to talk about it is some sort of conspiratorial Newspeak for, “I want to discuss that with you in intimate and excruciating detail”, isn’t it?!

“You don’t want to tell me about your Christmas, do you?  No – you don’t.  So why should I tell you about mine?” I challenged.

It was meant mainly as a sarcastic and rhetorical question, but he answered anyway.  “If we met in other circumstances, that’s probably exactly the conversation we’d be having,” he mused.  “But I know that you know that this circumstance has to be one-sided.”

As it happens, I do know, thanks very much – and I don’t like it and it isn’t fair.  And yet it protects me from the probable sheer ordinariness of this man that I so pathetically look up to.  But that’s another matter.  I told him, truthfully, that if we met socially, I would still not be telling him the specifics of what happened at Christmas.

Actually, if I’m 100% honest, of course I wanted to discuss it with him (in his capacity as my psychotherapist) – aspects of it anyway.  I was horribly mortified (as well as disturbed) by what ‘They’ wanted me to do on Christmas Night, and didn’t especially want to outline that in specific terms, but I did want to tell him of the fear and anguish that took me to that point.  Yet I felt absolutely unable to give myself permission to do so.

We sat in silence for a bit.  I knew he would break me sooner or later, but I decided to fight him anyway.  I was thinking about the psychoses, which led me to question how I had described them here on WordPress.  In doing so, I was reminded that I won an award for this blog on New Year’s Day from the fabulous Mental Nurse blog.

“My blog won an award,” I randomly blurted out at him, with thinly-disguised pride.

C seemed quite excited by this news and congratulated me, then paused.  “I really want to ask you more about this,” he began, “But I’m wondering if we shouldn’t leave it until later – I don’t want to avoid the issue of Christmas.”

I wanted to avoid the issue of Christmas.  It’s my fucking therapy, can’t I talk about what I like?

But I gave up the fight, and gave the man what he wanted.  “There were issues with the voices,” I admitted finally, tapping my head (as if he didn’t know what voices I damn well meant).

“OK,” he started.  “What sort of ‘issues’?”

“No, no, no, we’re not going down that road.  It’s enough that you know that the day was stressful and I went doolally in the evening, though mercifully not in front of the 3,820,691 people with whom I was forced to spend the whole sorry day.”

“But how could it not have been traumatic?” C asked.  “I really fail to see how it could not have been, what with you having to see and interact with your uncle.”

“You’ve built it to be all about him,” I replied.  “It’s not – not entirely.  To say my family is a freakshow is to insult freakshows.  I just cannot put into words how fucked up and weird they all are, and how much I have nothing in common with them.”

“I remember you saying before that their ‘weirdness’ was difficult to convey, but I do have some sense of that.”

“They’re worse in a collective,” I continued.  “As individuals – well, I can’t pretend I’m their biggest fans, but they’re more tolerable.  But their group dynamic is seriously – epically [not that that’s a word] – bizarre.”

Moving away from this slightly, C went back to the voices.  I told him that I had already said I was not going into that and requested that he left it be.

“I’m not really so concerned about what they actually said,” he told me.  “At present I’m more interested in why you don’t want to tell me about it.”

I should have been expecting such a question, but I hadn’t been.  I thought about it for a moment.

“I’m very aware that we’re sitting in Psychiatric Outpatients and that the bin’s over there,” I said, leaving him to infer the rest.  “I can’t get away quickly here.  At least in your normal office I have time to flee before you all catch me.”

I got the usual spiel of crap about how he would only call a psychiatrist or my GP if I was at a serious and imminent risk of harming myself.  Or others, he added, almost as an afterthought.  I laughed bitterly.

I don’t remember the exact discussion that followed, but he seemed to have established that on Christmas Night it was ‘others’ that ‘They’ were trying to get me to hurt.  He never said it straight out, and I never confirmed it, but there seemed to be a shared, implicit understanding that this was what had occurred.  He sought to reassure me in as strong terms as he’s allowed to that he would not call anyone to have me sectioned unless he thought that such harm was absolutely imminent.

“I don’t believe you,” I told him.

Ouch.  I think that one cut him a little (no pun intended, not that I’ve been too bad vis-a-vis self-harm of late).  He asked why I doubted him.

In part, it is because I feel that some of the trust has been broken between us, owing to the whole uncertainty over the continuation of treatment – though in fairness, he was good in this session and I feel it might have been built up a little again.  Other reasons are just how terrible the episode was – I mean, I was told to kill a fucking not-quite-two year old, how much worse does it get? – and the fact that I’m preposterously paranoid.  Probably the simplest reason is that I often genuinely feel that I should be fucking sectioned, though I really, really don’t want to be.

In any case, I do believe that C wouldn’t section me unless he felt it absolutely imperative, yet I don’t believe it at the same time.  I believe two absolutely polar opposite things simultaneously – not an unknown state for me.  I told him so, and he seemed to understand that.

For some reason, presumably relating to all the discussion about Paedo and the multitudinous weirdness of the McF dynasty, C and I ended up discussing how my mother didn’t believe me about the sexual abuse, and about how she seems to go out of her way sometimes to put me down, or to compare me (negatively) to others (particularly SL, who she seems to fucking idolise).

C said, “it seems to me that your mother has been severely traumatised by her relationship with your father.”  Now, I genuinely don’t recall what he said next, but I think it was something along the lines that she therefore seeks solace in the McFs and, despite what she may say, finds it hard to believe that they are capable of fault – even when it’s rape of her daughter.  I don’t want to put words in C’s mouth, though, so don’t take that as gospel.  Of course, whilst I cannot disagree with the aforesaid conjecture, my own take on things is that she will always remember that I am my father’s daughter (she will even say it from time to time when she wants to hurt me).  In any case, I am certainly not the daughter that she would have wanted.

I agree with C that she is completely traumatised (not that she’d admit it herself), but was surprised by him coming out and telling me that was his view in such forthright terms.  In any event, this tangent didn’t especially add much to the session, except to exacerbate the rawness of the hurt I was already feeling.

So that was his next tactic – the perennial, “how are you feeling?”

I couldn’t verbalise it at first.  I just felt so something, so indefinably sad and upset and low.  He quietly encouraged me to try harder to express it more exactly.

Eventually, through gritted teeth, I seethed, “I feel hurt and sorry for myself and vulnerable, are you happy now?”

Unfortunately he thought this comment was sarcastic, intended as a snide take on what he wanted to hear.  Admittedly, the manner in which I had said it could easily have been taken that way, though it was meant to have come across as a dramatic, “there!  I’m finally admitting the truth!  I’m deflated but this is progress, isn’t that fantabulous?” kind of gesture (fail!).  I apologised, and advised him that the content of my comment was serious.

Yes, I admitted to being vulnerable.  What I didn’t admit, of course, is that I want C to protect me from all that which makes me vulnerable.  I want him to put his arms around me, stroke my hair, tell me in his gentle voice I will be OK, and protect me from all the bad that exists in the world.  Of course I didn’t tell him that, but admitting to this hideous vulnerability that I’ve been repressing for I don’t-know-how-long was a start.

“Unwillingness to feel or express feeling of these things is very common in people who’ve been brought up in abusive and traumatic backgrounds,” he told he, tilting his head to gauge my reaction.

“‘Abused’,” I repeated wistfully, looking away.  The branches of the trees outside were blowing back and forth in the wind, stripped bare of their leaves.  I felt as emotionally naked in front of C as they looked.

“You don’t think you’ve been abused?” he checked, apparently confused.

“No,” I replied quietly.

“You were sexually abused by your uncle!” C said, determinedly.

“And I responded to that and other things by dissociating and emotionally numbing myself.  Fat lot of good it’s done me.”

“It probably did at the time, though.  It was a means of self-preservation during those times.”

There was a pause, then I randomly spat out, “I disgust myself.  My vulnerability disgusts me.  I disgust me.  Fucking schizo bitch!”

“You’re one of the most self-critical people I’ve ever known,” C told me, taking a very slight tone of authority.  “My worry is that this is a major stumbling block.  I really think if we can develop some self-compassion in you, it will help a lot.”

“You said a moment ago that dissociation etc was a means of self-preservation.  It ties in with the psychology discussed in a book I’ve been reading.  It is, shock horror, a self-help book, one designed to teach you strategies to soothe yourself when you go mental.”

C was delighted by this.  He asked me if it was any good, my response being that a lot of it (as with any such text) was “wank”, but that despite this, there were some good, and vaguely intelligently written, parts to it.

The thing is, I’m not always as critical of myself as I seem to be in psychotherapy.  I can only surmise that that is when the truth really comes out.  The raw, visceral nature of everything that’s gone or is wrong with my life is so palpable and explicit in those 50 minutes, and the true depth of my self-hate is exposed.  Eugh.

He went on to say that it was not desirable to rid me of my “sarcasm and [my] wit” (he said I was witty!!!  Smiley me!), but that he thought aspects of that fed into my lack of self-compassion, and that we needed to strike a balance.

“And I’m encouraged by the fact that you’re trying,” he concluded.

I left feeling psychologically battered and bruised, even so much as allowing myself a tear as I drove home (how self-compassionate), but I was also quietly encouraged and reassured.

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Flogging a Dead Horse with C – Week 35

Posted in C, Everyday Life, Psychotherapy with tags , , , , , , , , , , , , , , , , , , , , , , , , on Wednesday, 6 January, 2010 by Pandora

Christmas and the arrival of 2010 have seen some disruption to your usual service from SI. It seemed impossible to get a chance to write on the latest C session, given as these post seem to be the most ridiculously detailed.

This post shouldn’t be overly detailed, as a lot of it was repetitive bullshit regarding the annoyances of the previous week. Nevertheless, here we go.

Upon leaving C’s company the previous week, we had agreed that we would use week 35, the last week before a break of three weeks owing to Christmas, as a session to discuss how I would manage the so-called festive season.  In reality, that bit ended up taking approximately five minutes at the end, and although it was ever so slightly more helpful than some of the nonsense he’s come off with at other breaks (“breathe!”), it was still not entirely helpful.  But then again, he’s not my guardian, is he?  Much as I would like it that way.

I say we were flogging a dead horse because the majority of the discussion centred around the same crap we had discussed over the previous week (leave a comment or get in touch if you need the password) and the week before that, ie. my anger and distress about his decision to cut short my treatment, and my general disgust about the NHS’s abject failure to adequately treat me since I first sought help for my mental health problems.  I do understand that in some ways maybe C sees exploring my reactions to this as a form of projection or transference, and maybe in some ways it is: perhaps I feel so rejected and aggrieved because that’s how I was meant to feel about my father, uncle, ex, etc etc.

However, it endlessly frustrates me that I cannot just simply be angry because I have been so horribly fucked about by the health service.  Again, in this session, C reiterated that the 24 week limit (starting from tomorrow) was his decision; he said he was “not a robot” controlled by the NHS.

It completely contradicts all the stuff he says about my right to be annoyed and about how BPD should really be treated, and we went round and round in circles on how I could not reconcile his two contrasting views, and about how he either couldn’t or wouldn’t explain it properly.

I also, having decided as a result of the preceding week that he hated me, went to find out whether or not this was indeed the case.

I said, “if I ask you a question, will you promise not to answer with a question?”

He shifted uncomfortably, then admitted that he was unsure as to whether or not this was achievable.

I asked him anyway, on the proviso that if I thought he was “blagging” his way through his answer I would pull him up on it.

He did come off with the form bullshit such as, “why is it important for you to know that?” and whatnot, but I was pleased when he finally admitted that he too had found the preceding week “frustrating”.  So he is a human after all!

He said that I had been “very angry” with him, which I thought was unfair.  I told him that I genuinely hadn’t been angry with him, merely the system, until he confessed to having been the one that decided on the time limit.

“But you were angry with me then,” he pointed out.

“Yes,” I said.  “You had seemed so supportive of me prior to that; you agreed that my situation was wholly unfair.  Then you completely contradicted that by admitting to this arbitrary limit crap.”

And so back we went to flagellating that deceased equine.  More questioning demands from me, more bullet-dodging from him, no progress from either of us.

He had asked me in week 34 to seriously consider whether or not to continue with therapy, as I “had” to agree to the time limit as part of the contract (which strikes me as being quite unreasonable, as contracts are meant to be negotiated rather than forced in this type of setting).  Apparently if I don’t accept the limit, I cannot continue treatment.

“On that note,” I told him, “I am prepared to accept it, but only if you accept – because this works both ways – that I am going to fight it.”

He asked what I meant by ‘fighting’ it, prompting me to withdraw a copy of the letter to the advocacy groups out of my pocket.

“It’s only fair that you read that, given that you’re going to be involved,” I told him, handing the document over.  He took it and began reading.

I sat there and watched him reading it for a minute or two, then stood up and walked to the window, knowing perfectly well that he would almost certainly comment on this, as he had done two weeks previously.  Indeed, he didn’t disappoint.

“I’m wondering why you got up, SI…” he pondered, as he continued reading the letter.

“It’s not reflective of anything,” I spat cynically.  “I’m not denying my hurt or failing to face up to my problems.  I’m simply looking out the window whilst you are occupied with reading that.  Am I not allowed to get up, C?”

He shrugged and muttered something along the lines of that I was, in fact, allowed to get up, then continued reading in silence.

He eventually looked up and said, encouragingly, “it’s a good letter.  Who all are you going to send it to?”

I told him about the advocacy groups, Mindwise and the NI Association for Mental Health.

I was astonished – and delighted – when he then proceeded to actively encourage me to also send it to both the Chief Executive of my Trust, and the head of the mental health directorate of same.  In the end, he forgot to give me the person’s name, but as it turns out it’s been passed to him anyway (more details on how the letter has progressed in a future post).

C said, “you’ve also made reference there to people I think are in England – perhaps it would also be worth adding information about provision for personality disorders in other Northern Ireland Trusts.”

I asked him what such provision existed, knowing that people with the most serious PDs are in fact sent to specialist units in England as there are no facilities to treat them here at all.

C said a self-harm team exists in one of the other Trusts here.  “Although not everyone who self-harms has BPD, and not everyone with BPD self-harms, they would probably see a disproportionately high rate of people with your diagnosis,” he said.  “No such team exists in this Trust at the minute.  There’s discussion ongoing about making the existing team a regional, cross-Trust one, but it hasn’t yet come to anything.”

He talked on for a few minutes about plans our Trust has for action on personality disorders, and how they don’t seem to much be coming to fruition.  But the best part of the session was when he asked me if he could have a copy of the letter.

“I think it would be good for my line managers to know how you feel about all this,” he said.  He went on to say something (I don’t recall what) indicating that there might be some benefit to me in this, but was very quick to point out that it was my choice as to whether or not he did take a copy for them.  I readily agreed, of course, delighting in his apparent desire to act as my advocate to the bureaucrats above him.

Now, of course, I am convinced that he took the letter so he and his twatfaced bosses of evil can formulate some plan of self-defence in advance of hearing from the advocacy groups.  It was not in my interest at all – merely their own.  No doubt over the next few weeks we’ll see which way it actually is.

Eventually – I don’t remember how – I said that he must get sick of his job, what with all the whinging he would have to listen to.  “I accused you of being a sadist a few weeks back,” I said.  “Now I think you’re a mashochist.”

He accused me (sympathetically, to be fair to him) of splitting, which on reflection makes me slightly irritated, but at the time I agreed and called myself all the names of the day for employing this “silly psychological process.”

C leapt to my defence.  He said he knew that I had long since known I was guilty of splitting, but that it’s now “emotional for [me]”, not just something I recognise intellectually.  And it is OK, I do not need to berate myself for it, because I have suffered serious traumas, apparently, that have caused this defence mechanism (which is not silly, he contends) to develop.

On that note, as I recall it anyhow, we moved on to the discussion about the dreaded Christmas.

C’s advice was basically to get the fuck out if I felt anxious or overwhelmed.  I said that was easy to say, but he didn’t have to listen to my mother’s wrath if I did so.

He advised me to talk to her in advance, but I protested against this as well.  “When I told her about what happened with my uncle, she said I made it up to avoid going to his house,” I reminded C.  “So how can I justify my anxiety?”

“Blame your crowd phobia,” C said.  “She can’t be critical of that, can she?  There will be a crowd there, won’t there?

“Yes,” I replied.  “And they’re all part of the problem – it’s not all about my history with my uncle.  I have nothing in common with them and it’s a weird matriarchal set-up, where about 18 different generations all live under the same roof.  They’re freaks.”

He said, “are there children living there?”

I was horrified.  He was obviously wondering if anyone else is presently at risk from Paedo.

“Now you’re angry with me for putting the baby and all the other generations in danger.  I’m sorry,” I raced, in a bizarre panic.

C looked at me, his eyes wide-open.  “Where did that come from?” he enquired, surprised.

“Oh, you’re not angry with me?  Then I’m using you as a board for my anger at myself, am I?”

“OK, you’ve lost me,” he admitted.  “Just…just remember – get out.  Talk to your mother in advance, blame your crowd phobia if you have to, but if you feel yourself becoming tense, get out of there, even if only for a few minutes.  Allow yourself to be anxious about this.  How could you not be?”

And that, folks, was really that.  Of course, you know how ridiculously awful Christmas turned out to be, but I did remove myself from the others when I went so horribly mental, so I suppose I did at least follow the advice given.

As I was leaving, I wished him a Merry Christmas.  He said, admittedly cautiously, “you too,” causing me to laugh bitterly.  I think he knew that it was inevitable that the season would be utterly shite.

So, the three week gap is due to be over tomorrow.  Of course, I am convinced that C is dead again; either that or therapy will be cancelled due to the stupid, horrible, pointless fucking snow, and I need him so desperately at the minute.  Though I have not heard anything about a cancellation today, and I suppose I would have expected an advanced notification were the snow to fuck everything up on the monumental scale that it has in Britain.

The last time he was on holiday, in August, I didn’t miss him that much.  But this time I have, and I need him to help me pick up the pieces of the last few weeks.

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Reflections on 2009

Posted in C, Everyday Life, Moods, psychiatry, Psychotherapy, Random, Random Mental Health Related Philosophising with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Thursday, 31 December, 2009 by Pandora

Wasn’t it 1992 that the Queen said was her annus horribilis?  Well, let’s fast forward 17 years to now, New Year’s Eve, 2009. This year has turned out to be the annus horribilis of your humble narrator – mostly. I’ve been on the brink of sectioning on a number of occasions, the brink of suicide on others, I’ve developed serious psychoses, I’ve been twatted by the system and I lost my job.  Yet, there are a few glimmers of non-shit somewhere in there.

To that end, here, for your dubious delectation, is the good, the bad and the ugly (well, the bad and good anyway) of the last 12 months in the world of this PsychoFreakBitch…

THE BAD

Being Mental

Perhaps rather obvious, but yeah, being mental hasn’t been a great deal of fun.  I know I’ve argued that if I could flick that figurative switch to the sanity setting I wouldn’t do so, and I still hold to that, but nevertheless, the panics, depressions, mixed states, psychoses and frantic states are not exactly things that I enjoy.

As you know, faithful, darling readers, I have been mental for many years – my first diagnosis was in 1998, but in reality I did have some manifestations of madness well before that juncture.  However, 2009 was by far the worst year for it, as I think most of those close to me would attest.  The dysphorias, the exceptional levels of anxiety and the psychoses, all having existed before, have been exacerbated so considerably during the last 12 months.  I’m not sure why; maybe it is the intensity of psychotherapy, maybe it’s medication, maybe it’s simply the ‘proper’ development of BPD and/or bipolar disorder, given as they tend to manifest most strongly in one’s 20s, maybe it’s another psychiatric illness altogether.  Maybe it’s nothing more than coincidence.  Either way, it is.

Specific Issues on Mentalism

–> Psychoses

Tom was alright, but ‘They’ have been a hideous bloody curse.  Even with the anti-psychotic, ‘They’ are almost ever-present, though their severity was mostly reduced with said medication.  The worst manifestations of ‘They’ were when they tried to get me to kill myself and, worse again, when they wanted me to kill MW on Christmas Day.

Of course, the psychotic symptoms were not limited to hearing voices.  The shapes continued amok throughout 2009, though in retrospect I think I can say that I maybe noticed some abatement of their severity when I started taking Olanzapine.  However, I also developed new hallucinations, such as music, knocking and whimpering.  And I hallucinated my erstwhile stalker once.  Fuckin’ A.

Oh, and let’s not forget the delusions – A was in collusion with GCHQ, the sun and signs were watching and/or communicating with me, ‘They’ steal the thoughts from my mind, my cousin ScumFan was a drug dealer, A was not A but A’s sister, yadda yadda.

–> Dissociation

This has been pretty fucking annoying and at times highly disturbing.  There have been a number of times that I have found myself in dissociative fugue states – being in random places some distance from home, having no idea how or why I got there.  I need not explain the potential implications of these (admittedly relatively minor) fugues to my readership.

Of course, it does not take a fugue to make a dissociative episode.  Despite my ability to write 3,000 or more words on my sessions with C, my psychotherapist, it is not infrequent for me to dissociate parts of these meetings, particularly (unsurprisingly) when we are tackling something difficult together.  Several of the fugues have been in the wake of sessions with C.

I’ve also found myself in amnesiac states during or after arguments or highly stressful events, and of course I have the standard BPD features of depersonalisation and derealisation – forms of dissociation, I believe – on a frequent basis.

Although I’ve experienced depersonalisation and derealisation for years, I’ve only knowingly experienced full dissociative episodes – ie. proper periods of amnesia, losing time – in the last year.  Well…maybe it began in 2008, but it would mostly have been in 2009.

However, I only remember the rape and other parts of the sexual abuse in flashbacks, for example, and in discussion with C we have found that I have many ‘symptoms’ characteristic of someone who dissociated something traumatic in childhood.  The suggestion has been that, given the strength and quantity of these symptoms, there may be more than I don’t consciously remember.  I hate the idea for its own sake, obviously, but I hate it even more by virtue of the fact that it is not recalled (if indeed it did happen); it leaves me with a distinct lack of control over how I now react to triggers.  Perhaps that can be addressed in therapy over time (if therapy even fucking continues over time).

–>  Self-Harm

Is self-harm even bad?  Sometimes I really do wonder.  As a way to cope, it works.  As a way to fascinate (by virtue of watching the beautiful krovvy), it works.  As a way to seek absolution, it works (albeit temporarily).

Still, it serves as a permanent record of a very horrible year of my life, and I suppose in that way it could be considered a bad thing.  It’s something that, as of this writing, I feel quite nonchalantly about, but who’s to say in 10 years or something, I won’t look at my scars and feel triggered back into mentalism from which I may have found some relief?

I’m classing this as a bad thing of this year because, prior to 2009, I hadn’t engaged in any serious self-harm for years.  2009 saw it return on a relatively frequent basis.

Losing My Job

In reality, I was nowhere near as upset about this as I should have been, but one thing I really do detest is being in the hateful position of being dependent on the state for my living.  I had always dreamed of a career (not just a job) and the opportunity to use my intellect in a meaningful fashion.  I did not want to end up being a dolescum, and this is still something that I am hoping to change in seeking treatment for my madness.

So I suppose that is the worst part of losing my job; I now am officially everything that I never wanted to be in my adult life.  It’s also awkward from the perspective of my developing my career; having to explain a gap in employment of whatever length and an incapability dismissal will not be a lot of fun.

Trouble with the NHS

It all started with all the trouble with getting an appointment with, and then sustaining appointments with, the VCB.  Then C waded into the quagmire with his ‘I can only offer you 24 more sessions’ bullshit.  As you know, of course, I am fighting this.

Then there was Dr Arsehole just before Christmas (about whom I will write in the next ‘C’ installment), and the latest is that I have an appointment with Psychiatry on 20 January (more than a month after I was meant to have my most recent review appointment)…but not with VCB!  No, readers, apparently I am seeing ‘Dr M’.  What in the fuck..?  I might not like VCB, but at least I had got to know her to some extent.  But now they’re fucking me about again.  Arsecunt.

Christmas

It was fucking God-awful dreadful.  Enough said.

C

Not C himself; of course I don’t know the man in any realistic way, but my sense of him is positive.  OK, he does wind me up sometimes, and it is not at all unknown for him to actually anger me, but generally I am very fond of the man, regardless of whether or not that is simply a case of transference.  However, psychotherapy is not a fun process.  It’s not fun at all.  In fact, I believe firmly that it has made me more mental than I already was.

It therefore seems ridiculous to continue with it, but there’s method in the madness…

THE GOOD

C

‘Him again?  You just said he was a bad thing in this year!’

Yeah, I did, but he’s also been one of the most fabulous things.  Aside from my absolutely obsessive attachment to him, which I am pretty sure I wouldn’t have were I not very fond of him in a non-transferential sense, I believe the therapy is good for me, and is working.  Yes, it has made me more mental, but I believe this is a temporary state.

In being forced to (re)live some of the most horrible things about my past and, to a lesser extent, my present and potential future, it seems inevitable to me that my conditions would be exacerbated.  I had to get worse before I get better.  That was what I expected well before I commenced therapy with C, and that is still my belief.

Additionally, and this is probably related to the transference issues, C is the only person to whom I will talk completely openly.  For a long time, I would literally discuss many (not all) things with him, but it is only in the last couple of months that I really have stopped abstracting things.  I’ve now let my guard down and allow myself to be vulnerable around him, and I trust him.  That kind of relationship, however strangely asymmetrical, is a big achievement for me, and I think if it is allowed to continue as it should that it will pay dividends in terms of my mental health.

Diagnoses

Some people hate them.  There are a number of other mental health bloggers for whom I have the utmost respect that consider diagnoses ‘diagnonsense’.  I do get where they’re coming from, but I am grateful for mine.

It helps me to be able to attribute certain symptoms to an actual illness.  Now I’m not saying I use the conditions as excuses, but they do explain some erratic and bizarre behaviour, and I find that rather comforting.  Furthermore, in saying I have certain illnesses, it makes my range of symptoms part of something, rather than just a nebulous bunch of ‘things’; quantifying it in this way makes it seem more real, I am convinced, to others.  Just throwing the term ‘depression’ out makes it sound like a cop-out (NB. please note that this is not my view of real depression at all – I just think that some people, ignorant of mental health issues, view the word this way.  They believe that “I have depression” equals “I’m depressed,”, which of course those of us who have been there know to be a fallacy).

One further positive I’d add about the diagnoses is that they have enabled me to connect with others that have the same (or similar) disorders.  I will be eternally grateful for that, and for the support and kinship those individuals have given me (see more on this below).

Turkey

Our holiday to Turkey back in September was probably the happiest time of this year.  As I wrote at the time, I felt entirely contented throughout our stay, and indeed we enjoyed it so much that we are returning to a resort close to the one from 2009 again in May 2010.  I will never forget the crystal clear waters, the warmth of the locals and the sheer relaxation of lying about in secluded coves.  Whilst reading Social Factors in the Personality Disorders: A Biopsychosocial Approach to Etiology and Treatment, of course.  I mean, obviously!!!

This Blog

I will always be thankful that I started writing this blog, and indeed that I kept writing this blog.  My initial hope was that it might help me to identify triggers, but to be honest in that regard it hasn’t been as successful as I might have liked.  It has, however, given me a focus – writing is an activity that, despite the sometime difficulty of it, is something that I enjoy, and can direct my energy towards.  It also serves as a chronicle of what has been an extremely difficult period in my life, but one that is also likely to be a highly formative one too, if I don’t end up offing myself.  I’ve found it fascinating to rediscover diaries I kept in the past, and no doubt I shall find the same with this – though I hope that I will still be maintaining this journal well into the future.

I’ve been ever so grateful for the wonderful feedback I’ve been given on this blog too.  Some people find my writing style engaging, which is a huge compliment; others find solace in the fact that they are not alone, as what I’ve written correlates with their experiences and/or feelings; yet others seem to be grateful to learn directly what everyday life, therapy or whatever with my various diagnoses is like.

On a similar note, the blog has enabled me to meet so many people with whom I have found affinity.

Twitter

By far the best thing I have done this year was join Twitter (I’ve met many brilliant people through the account allied to this blog, but even more again through my ‘main’, slightly less anonymous, account).  I have met so many wonderful people – both mentals and non-mentals – through this service that I could not possibly thank them all here, much as I’d like to.  The support, friendship, empathy and, frankly, in some cases love that I have been shown has been a source of immeasurable help, more than the personnel concerned will ever know.

–>  Thank Yous – Twitter

CVM*
K*
@bourach
@woundedgenius / @behindthecouch
@notbovvered
@fromthesamesky
@error505
@an_other
@kimshannon
@helentaustin
@benpolar

* Both of whom I now consider ‘real life’ friends – I have met K and communicate with her most days; I haven’t met CVM, but again communicate with her most days and certainly will meet her when finances and circumstances allow the travel.  I love them both.

The above is far from an exhaustive list, but there are others that I cannot mention to protect either their or my anonymity.  Some to whom I am incredibly grateful are not even aware of the fact that I write this blog.  That does not mean I value them less, however.

–> Thank Yous – Blogging Buddies

Some of the above-named individuals of course keep blogs, but they are not people I met originally through this medium.  The following are.  Thank you to:

Alix Rites
Crazy Mermaid
Borderline Case
The Prozac Queen
Pumpkin
Vanessa
NiroZ (no longer blogging, alas)

Again this is not an exhaustive list.

It is my honestly held belief that were it not for the aforementioned individuals – both the Twitter friends and blogging mates – I would either have killed myself or been horribly sectioned this year.  So thank you to all of you listed, to many not listed, and extra special thanks to a select few – I hope you know who you are.

Friends

Of course, real life friends have been of immense value to me this year too.  I haven’t been fortunate enough to see my best friend D an awful lot, but we’ve have corresponded via email and communicated via the hated telephonic device, so of course I am very grateful for his support.  In spite of an acrimonious break-up of a serious relationship, not to mention other problems, D has still been there for me through all of this sorry year, and for that I am significantly in his debt.

B has also been very supportive.  It’s not that we tend to go into great detail about issues of concern, but he’s just there, and that means a lot.  In particular, like D, his ability to provide a metaphorical shoulder to cry on whilst dealing with significant difficulties in his own personal life is testament to his integrity and the strength of his friendship.

AC has also been great; as well as actually giving a shit and supporting me through mental illness, AC has also been there just for those ordinary, everyday things that friends do together – the theatre, lunch, whatever.  I also must hat-tip DL for this too.

Honourable mentions to A’s friends and family too.  Even though they’re (mostly) not conversant with the finer points of my mentalism, they nonetheless have been a source of fun and comfort.

And of course a re-acknowledgement of CVM and K 🙂

A

Saving the best for last.  He’s seen it all, and it all ain’t pretty.  Yet he is still there.  Still loving, still comforting, still supporting, still protecting, still fighting the corner, still providing, still entertaining, still staying sane.

There are no words.  ‘Thank you’ seems so woefully inadequate, but it is all I have.  I just want to make it publically known that I will always owe a debt of gratitude to A for everything he has put up with this year.

AND FINALLY…

This post might lead you to believe that there was more good than bad this year, and I suppose in the most objective of senses that may be true.  This is why something like CBT will never work therapy-wise for me; it doesn’t matter how much evidence there is or is not for a belief – the belief is still held.  The reasons for the belief need to be explored fully and processed.  But I digress.  My point: 2009 was an absolutely fucking shit year, and I will be glad to see the end of it.

But I have hope.  A small glimmer thereof, but a glimmer nonetheless.  Not of a miraculous cure, but of some stability maybe.  With the help of C (I hope) and the love and support of my fabulous friends, both those in the physical world and those online, there might just be a path to stability somewhere down the line.

Happy New Year folks.  If ‘happy’ is ambitious, then at least I wish you peace and something approaching sanity in 2010.

Yours ever

SI x

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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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Protected: Why Does He Hate Me? C: Week 34

Posted in C, Moods, Psychotherapy, Triggers with tags , , , , , , , , on Sunday, 13 December, 2009 by Pandora

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