Archive for bipolar 2 disorder

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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Countdown to Abandonment – C: Week 33

Posted in C, Moods, Psychotherapy, Triggers with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Wednesday, 9 December, 2009 by Pandora

Those that follow the Twitter stream that I have allied with this blog will know that I did not intend to write a blog today (LATER: yesterday). I was feeling a bit low after CVM called me this morning to report that her father had sadly died early this morning (LATER: well – technically now yesterday morning). However, sitting here brooding won’t do either her nor me any good, so I decided to go ahead and write it anyway.

CVM is very much in my thoughts and I wish I could do something to ease the pain of her and her family. I am publicly sending my sincere condolences here. ❤ xxx

I know that I have an annoying tendency to open these posts on C with, "today was weird," or some such. Well, Thursday really was strange. It was totally bizarre. C was evidently puzzled by certain directions it took, and when I told him at the end that it had been “weird,” he actually responded by saying that it had, indeed, been “different” (for what it’s worth I feel reassured rather than invalidated by this).

I’m not sure if the written word can adequately convey the oddness of the session, because although it can look disjointed, it would take a better writer than I to convey the sudden and sharp shifts in mood, the nuances of the spoken tones, the randomness and subtlety of the non-verbal communication that took place. Nevertheless, as ever, I shall try.

It was very much a meeting of three parts. During the first – I dunno? – maybe 10 or 15 minutes I sat there petulantly, stubbornly avoiding his gaze and giving one word answers (at best) to any questions he posed. For once he had the decency to open proceedings, and not piss about waiting for me to do so. He said he was aware that part of me was attached to “here” (this annoyed me, though I did not say anything to him – I am not attached to his fucking office for Christ’s sake, I am attached to him!) and that I was concerned about the cessation of therapy. Wow, insightful. I’m absolutely profoundly impressed, Dr fucking Freud-Einstein-Mary Poppins.

I’m ranting about him now for stating the obvious, but I also got really pissed off when he strode into the territory of conjecture. He said he was also aware that I was unhappy that I only had 50 minutes of his time each week and that I was annoyed that I couldn’t just turn up or phone him or whatever outside that time.

This sent me into a rage. At no point have I ever said such a thing. Struggling to control my anger, I snarled that his comment was unfair, and that he was putting words in my mouth. I asked him to exemplify exactly when I had made these assertions to him.

He admitted that I hadn’t, and moved on, but I think I now realise where he got this from. Some months ago – I can’t find the relevant post offhand, sorry – I had asked him who I was meant to contact in an urgent situation (because if my life depends on it I still want to avoid the fucking Crisis Team). Could I have a CPN, a social worker – anyone at the two CMHTs based at C’s hospital? I don’t remember his answer but it was some nonsense about ringing Lifeline or the Samaritans. Yeah, thanks C. So he had obviously read this request – a reasonable one, in my view, given that CMHTs are meant to be multi-disciplinary and he is only one tiny part of them – as a demand for his attention outside of our sessions. This was profoundly irritating. If he had failed to understand my question, then he should have asked for fucking clarification.

Anyway. To follow on from the uncertainty of the last couple of weeks, he brought up the matter of how long he can continue to act as my psychotherapist. Apparently, he can offer 10 week blocks, with four weeks at the end to deal with the closing of the relationship. Fair enough? Well, no, not really; he can only offer me two of these blocks – ie. 24 further weeks (beginning on Thursday 10 December) in total. Now, that will amount to something like 57 total sessions (including the three assessment sessions at the beginning and the four ‘leaving’ sessions at the end) which ostensibly sounds fair enough. Unfortunately for me, BPD is well known to take a very minimum of a year to treat properly, and usually three or four.

I didn’t tell him this as, in the past, every time I’ve made reference to my diagnoses he’s come off with (or at least inferred) some crap about fixating on labels. Heard it all before, C. So instead I asked what I was supposed to do if things weren’t adequately improved by that point.

He said, “I would expect you to have made progress by then – I feel you have made progress.”

Great – I’m so glad one of us does. Most reassuring. I pressed on. “But what if I haven’t?”

He said something suggesting that I shouldn’t be expecting cures from psychotherapy, at which point I interrupted him by telling him I didn’t even believe in cures and, in fact, didn’t especially want them. My question, I insisted, was in the context of alleviating the worst of the psychological pain and providing me with coping mechanisms and greater understanding that I could take onward in life. What if that had not been achieved within his stated timeframe?

I honestly don’t recall his answer, but there was a strong inference in whatever it was that if we were unable to progress by then that there was effectively nothing he could do for me (an assertion with which I do not agree, but what do I know – I’m just the stupid mental that sits opposite him).

No arguing with that, then. That’ll be it. The end. Finito. Fuck you, SI. In response, I just sat there looking at the ground for a while. It’s difficult to articulate how I was feeling. It was a veritable cocktail of fear, dread, hurt, anger, bitterness and depression. I fought, ironically using the breathing exercises that C had so fervently espoused, against tears and rants. I fought them because I didn’t want to give him the satisfaction of knowing that this abject rejection completely fucking cut me to the core. But he knew. Of course he did.

After a minute or two, he proceeded with that usual question of ultimate annoyance, “how do you feel about that?”

One thing I’ll say in his defence was that at least he was completely straight for once. Often he dodges and dives from material that he doesn’t really want to bring up with me for fear of setting me off (or such is my supposition for why he avoids it), but on this occasion he was upfront and honest, and through my anger and hurt, I felt appreciation for that. I told him so.

He told me to think about this over the next week (“but not so much that you end up ruminating on it” – as if that wouldn’t happen!) and bring all of my thoughts and feelings on the matter to him in the next session. He said, “you’ll probably feel anger, frustration…”

Once again, I got really mad at him for putting words in my mouth, so he desisted from that angle of probing. Whilst it will indubitably be the case that I am angry – I already fucking am – and whilst it was indubitably the case that, in an ideal world, I could phone and/or meet him outside of scheduled sessions, how dare he presume any of that. If he wants to know my thinking on these matters he should fucking well ask me – it’s not like he’s never asked before. He shouldn’t just assume that his suspicions are gospel, regardless of the probability of their accuracy.

During the silence that ensued, I fought a mental battle with myself. One side was crying out, “but that’s another six months! You should be grateful!”

The other responded, “the NHS has failed you yet again, SI. They are ignoring all research on your diagnoses.”

For once, the negative side was, I am convinced, the more rational. BPD takes a long time to properly treat. It is as simple as that.

Finally I said to him, “why do you do this job?”

I knew he would respond with a question, and indeed he didn’t disappoint.

“Can you tell me why it is it important for you to know that?”

“I’m curious.”

Once more, I knew he would fail to answer, and instead question me again. Once more, I was correct.

“But what is it that gives rise to that curiosity?”

I laughed cynically in his face. “Just answer the fucking question,” I demanded. “Please.”

He looked away and appeared thoughtful for a minute. Eventually he said, “because I think it is of value.”

I nodded non-committally and waited for the backlash.

Well, apparently my questioning his decision to practice clinical psychology ties in with my intense rage towards him / the health service (because that couldn’t possibly be fucking justified could it? Oh wait, it could!) and my assertions last week that he was a ‘headfucking sadist’.

I winced. “Yes, sorry about that,” I muttered awkwardly.

“No, no,” he insisted. “You should bring that anger with you.”

I ignored him and said that it must be something of a nightmare to spend an hour with me every week.

He sort of laughed and said that I have to spend all the time with myself. (This could be read as an invalidating statement, which it shouldn’t be – there was more to it than this, but I don’t recall the specifics. Whatever the case, the point was actually made more sympathetically than I’ve made it sound).

“Yes, that is a disability,” I mused. “But honestly – I’ve been such an angry child here recently, it must be shit for you.”

I saw his eyebrow quiver slightly at my use of the term ‘angry child’. Excellent. It had been intended to pique his interest.

“I’ve been reading about schema models recently,” I proclaimed, triumphantly.

This is where part two of the discussion began. Let’s call it Intellectualise my Mentalism.

The other week, when I was convinced my therapy with C was coming to a dramatic and premature halt in January, I rushed to the Yellow Pages looking for suitable therapists. I was looking primarily for practitioners of psychodynamic therapy, as I have been receiving from C, because it’s the only type that I have found remotely effective to date. However, I was open to exploring both schema and gestalt therapy, having read quite a bit on both, and found practitioners of both in the vicinity. As two major studies have demonstrated its effectiveness for all symptoms of BPD (unlike stupid DBT), I have more faith in schema therapy, even though it does involve some wanky (if apparently advanced) CBT, for which (as you know) I have no time, so – convinced I was in imminent danger of abandonment from C – I Googled “Schema therapy borderline personality disorder” and came up with this book. On a whim, I bought it.

The book contends that people with BPD have five main strands to their character:

  • The healthy adult (the authors admit this seems an unlikely component, but make the reasonably fair point that many with BPD are not always going mental. Not that they put it quite like that, of course).
  • Detached protector – this mode sees the patient protecting the harmed brats that form part of her consciousness.
  • Punitive parent – “everything is my fault” mode. Must punish myself. I am usually pretty good at this, especially in session.
  • Angry or impulsive child – furious, mainly as a defence mechanism. It is convinced it will be fucked over. It is also angry that its needs / rights are not met. (I am a walking stereotype).
  • Abandoned or abused child – alone, no one cares about it, whinges, cries, blah de blah.

I told C that today I was the protector. I was avoiding his questions, getting irritated when he probed me – classic protector traits, according to the book.

We had a discussion around the whole concept of schemas, schema therapy and its development, which to my amazement resulted in him bringing up the term ‘borderline personality disorder’ in a completely unsolicited way. He went on to explain the schemas seen in BPD in more detail, to the absolute delight of my ears and my mind.

Feeling that we were on something of a discursive roll, I presented him with a print-out of this post from Kathy Broady’s blog. I had analysed the piece bit by bit in terms of its applicability to me.

I pointed out that it was written by a DID therapist, however, and that therefore it might not all apply directly to me.

He sort of shook his head and said, “there’s a debate in psychiatry and psychology as to whether or not DID and BPD exist on a continuum. At the very least, there’s often an overlap of symptoms. So therefore I’m sure some of this stuff can apply.”

(For the record I think I’d identified about 18 of the 20 signs Kathy listed as being applicable to me to one extent or another. Fuck! Is there more I don’t know about?!).

Satisfied with this response, I gestured for C to go ahead and read the list. Not wanting to sit there like a numpty whilst he read it, I stood up and looked out the window.

I could see out of the corner of my eye that he was looking at me, puzzled. I turned to him.

“What, am I not allowed to stand up now?”

“Well, yeaa-ahhh, you are,” he began, doubtfully, “but I’m just wondering why you’re standing up.”

“You’re reading that, so I’m going to look out the window,” I replied.

“I think you’re trying to distance yourself from the material in this article,” he told me. “It would be better if you sat down and faced it.”

So, the mere gesture of looking out the window is reflective of an entrenched tendency to avoid confronting one’s problems, is it? Well, fuck me, I’ve heard it all now. I was going to argue, but decided against it, not really seeing any point. I made an arm gesture of “you win” and sat down, internally laughing at how absurd I felt his deep reading of my meaningless action had been.

C read the list – to my annoyance, he read a lot of it out loud – then paused on one particular point. I don’t remember which one it was, but I’d provided an ‘analysis’ at the end along the lines of, “I do this, I do that, blah de blah.”

“Blah de blah?” he queried. “What does that mean?”

“I don’t know,” I said. “It’s just flippancy.”

“Yeah,” he agreed, “but where does that flippancy come from?”

“It’s stylistic,” I argued (I’m sure most readers of this blog will agree that I have a penchant for flippant remarks). “It’s just my writing style. You haven’t read any of my writing…”

“But…” he went on.

Enter stage three of the session – the mad, maniacal bit.

“Right,” I said authoritatively. “You don’t believe me that that’s how I write? Well, let me show you.”

From my bag I pulled out a print out of this post, my (latest) rant on the NHS. I began randomly reading some of the more colourful parts of the rants, in a deliberately exaggerated and dramatic voice. When I finally drew breath at the part where I talked about reading Grey’s Anatomy at the age of five, the completely befuzzled C interrupted me, exclaiming, “what’s happening here today?!”

He looked completely bemused, and on reflection I can’t say I blame him. It was a bit of a random tangent.

I defended myself on the grounds that I wanted to demonstrate to him that the flippant comments he’d seen on the trauma list were sod all in comparison to the flippant comments made by me elsewhere.

“But,” he said, metaphorically stroking his chin, “we’ve been all over the place today [I’m not sure that he phrased it quite like that]. For the first while I thought you were quite upset, quite agitated…now I’m not sure what you are…angry? And in the middle we perhaps intellectualised matters a little.”

“Oh fuck, I’m sorry!” I cried. “I led you into that.”

“These meetings are a co-construction,” he insisted. “I’m just as culpable for any straying off course as you are – we just have to be careful not to head into intellectual territory too much.”

He pondered for a minute and, referencing point 10 on Kathy’s list of trauma signs, said, “your rush to apologise just now ties in with that.” He noted that I had commented on the list that my self-blame wasn’t excessive because that for which I blame myself is, in fact, my fault.

“You do realise, objectively, that it is excessive, don’t you?” C asked.

“No no no, it’s my fault. It’s my fault,” I contended. “Just now I seduced you into that discussion on academic psychology. It was my fault, I’m sorry.”

Readers, why – WHY?! – did I have to use the word ‘seduce’? Why? A dozen other words would have sufficed. It just rolled off my tongue, as hyperbolic metaphors often seem to do.

He raised his eyebrow and narrowed his eye slightly. “Seduced?” he enquired.

Fuck. FUCK. FUCK FUCK FUCK! Now he thinks I want to fucking fuck him. Fuck fuck fuck.

I felt my cheeks turn red in utter mortification and in my rush to defend my use of the term, on the grounds that it was figurative, probably made an utter tit of myself – thus reinforcing any belief he might have that my transference is of an erotic nature.

Fucky fuck, shit and damn. I did try my best to explain what I’d meant, but I was flustered, and in any case it probably looked like a case of the lady doth protest too much. So eventually I gave up, looked down and gestured for him to continue to read the trauma list.

Thankfully for once he had the grace to do as he was told and not press me. He read on in silence this time, and when he’d finished I asked him if he thought the points included were applicable to me.

He said that he thought they were, and indeed that a lot of it had already come out in therapy and that we were beginning to address those issues.

He handed me the list back, and I read over it. For some reason I then went into a dysphoric but energetic rant against myself, telling C that I was “nothing but histrionic” for thinking any of the list was applicable to me, and indeed for bringing it to him.

He listened to and watched me in a kind of bewildered way. Perhaps he’s not that familiar with mixed states.

“Well, this has been weird,” I declared.

He cleared his throat, as if for dramatic effect. “It’s certainly been…” – he searched for the word – “…different,” he acknowledged finally, with a slight wryness I thought, which I found bizarrely reassuring.

“I was nervous about telling you about the schema book,” I admitted to him, rather randomly. “I’ve always got the feeling from you that you think to so much as mention a diagnosis is to fixate on a label.”

“Not necessarily,” he began. “It’s very important not to fixate on it, indeed. You mustn’t allow yourself to be ‘built’ around a diagnosis. But it can have benefits, yes.”

“I’ve found it helpful,” I said. “For one thing it’s enabled me to connect with a range of people who have been a great support network.”

“Good,” he declared. “No, I have no problem with diagnoses. It’s just important that you know that it’s not ‘borderline personality disorder’ that comes into this room, it’s [my name].”

I nodded. I think I do keep a sense of perspective on the diagnoses; if someone asks me about myself, unless it has been directly in the context of mental illness, I’ll usually tell them I’m a rock bird with a love for reading, writing, pubs, sci-fi and Newcastle United. The illnesses are part of me, and I am not ashamed of having them, but they’re certainly not the whole story.

As I was about to leave, C asked me to think over the prospect of there being a maximum of 24 weeks of the process left in order for us to discuss it at the next session. He all but begged me to “bring the anger with [me].” I protested that I couldn’t do so with absolute impunity, as I couldn’t face being heard screaming at him by those in the offices adjoining his.

He looked extremely taken aback at this, which I still don’t fully understand. I have social anxiety for Christ’s sake, does he honestly expect that I can allow anyone but him to be party to my rants? In any case, his secretary phoned today. Having convinced myself at the weekend that he was dead (whilst simultaneously reckoning that he wasn’t dead, but nevertheless believing that he was), I was horrified about what she had to say. Mercifully, so far C is not dead and will see me on Thursday at the normal time – just not in the normal place, due to building work. He is temporarily moving back to VCB’s stomping ground.

In a way, it’s worse to lose it with him there than in his own office. The office in which I suspect I will meet him is next door to the one VCB shares with other psychiatrists. These cunts all have it in their power to section me should I really lose it, which is hopefully unlikely but frankly not impossible, especially with ‘They’ still hovering about from time to time (though wouldn’t you know it, the anti-psychotic has seemingly killed Tom. Just my luck to lose the ‘good’ psychosis and retain the ‘bad’). On the other hand, an advantage of this location is that the building is attached to the day bin and adjacent to the actual bin, so hopefully they’ll be used to having crazies losing it on them fairly often.

As for now, I don’t know what I think. The argument is still ongoing in my head – More NHS Fuckovery, I’m Calling an Advocacy Service vs. Well, It’s Another Potential Six Months, Be Grateful. The truth is I feel both at the same time. A little bit positive, but more than a little bit lost.

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“I Hate You, Don’t Leave Me” – Therapy Sucks – C: Week 32

Posted in C, Moods, Psychotherapy with tags , , , , , , , , , , , , , , , , , , , , , , , , on Monday, 30 November, 2009 by Pandora

The best-selling text written on borderline to date is a book called I Hate You, Don’t Leave Me, by Jerold Kreisman. I am struck by how much that title applies to this weeks session with C, which was fraught. Fraught fraught fraught. In a way, given parts of the post regarding last week’s session and my slightly more generalised anti-NHS rant of Wednesday, this should not be a surprise. On the other, given how passive – nay, submissive – I am known to be towards C, the fact that I was able to let it be fraught was surprising.

Not unlike last week, my memories are rather skewed. My most clear recollections involve me shouting at and insulting him and then threatening to walk out, then later breaking down and crying for what seemed like ages, in a defeated, resigned sort of fashion. Am I defeated and resigned? I’ll see if I can make some sort of sense of it all, but don’t expect miracles.

OK, so I went into his office and sat there like a knob, as seems to be fairly typical these days, as I refuse to start the conversation (no doubt an avoidance tactic). I had vowed to A that I would bring up the material in the aforementioned NHS rant, but as I sat there under C’s silent and enquiring gaze, I felt that I was going to chicken out completely. Eventually the silence led to the usual miserable whinge from me about wasting his time.

I saw my opportunity here – an opportunity to somewhat surreptitiously bring up my concerns, under the pretence that I was concerned about wasting C’s time. So when he yet again asked me why I felt the silences were so bad (apparently they can be very revealing and useful – since when did this become psycho-fucking-analysis?), I responded with something like, “well, we have a limited amount of time to talk about a number of things about which I need to talk. 50 minutes today, something like five more weeks overall.”

I don’t remember his verbal reaction (if any), but I think I noticed a split-second narrowing of his eyes at this, denoting confusion at the statement.

I have no idea what happened next. He must have probed me on my assertion that we only had five weeks of therapy remaining, though I distinctly don’t recall him doing so until later. In any event, I started babbling on about how I’d spent the preceeding few days looking online and in Yellow Pages for an alternative psychologist of a similar therapeutic bent to assist me on a private basis, but that I was having no success so could he please recommend someone, because if he wasn’t going to treat me until I was well enough to face the world without a therapist, then someone else would have to do so.

Again, the sense of confusion emanating from him was palpable, and I think he actually questioned why I’d felt this exercise was necessary.

I can only imagine that this was the point where I demanded specific answers from him on whether or not we were going to discontinue our relationship in January. Most (though not all) of the rest of the session centred around this, but I can’t be bothered to break it down into a specific chronology, and am not sure that I could even if I wanted to.

The very much paraphrased essence of this bit of the meeting was:

  • C – I never said it would discontinue in January.
  • SI – fuck you, you did.
  • C – I said we would review it.
  • SI – Same thing.
  • Repeat 700,000 fucking times
  • C – but you know it’s finite.
  • SI – but it would be irresponsible of you to make it finite now. MEGA RANT ABOUT THE NHS – Starting with point 1 from last post (if they’d done something with me when I first showed outward signs of being mental, then we’d probably not even be here), moving on to point 2 (it’s either the bin or C – latter is surely cheaper, but the NHS is such a stupid fucking bureaucratic mess that they won’t consider that).
  • C – you may well be right but unfortunately that’s the way it is.
  • SI – how do you expect to adequately reverse two decades of mental illness in less than a year?
  • C – answer not recalled but probably some politican-esque answer of avoidance.

Blah blah blah. He kept refusing to tell me directly whether his reference to reviewing things in January was a suggestion that we would end things then. He did, however, have the audacity to ask me what I wanted him to say. Hmm, that wouldn’t be obvious or anything, would it?

I said, slowly and menacingly, through (very evident) gritted teeth, that what I wanted him to do was to give me a straight fucking answer.

I don’t remember what he said, but it wasn’t a straight fucking answer – so I lost it. I absolutely, completely fucking lost it. I felt the anger well up in my stomach, like some sort of raging inferno, and felt it rise through my internal organs, eventually finding its way to my vocal chords.

I screamed at him, “I’ve fucking had enough of this. I’m leaving right now!”

And, indeed, I got my things together and went to stand up, but he started blathering on again – so, curious though still furious (I’m a poet, didn’t know it), I relented and sat back down. I think he was asking me where this anger was coming from or some such other non-sensical wank given that it was profoundly fucking obvious where it was coming from. (Or maybe not. Maybe I am angry at my father for abandoning me and C, in his role as a temporary surrogate father, is now bearing the brunt of that anger thanks to the perceived threat of abandonment. Oh yes. It must all be to do with one’s subconscious, mustn’t it? Nothing to do with the fact this uncertainty is fucking with an already fragile mindset. Fuck off, psychology).

I threatened to walk out again, telling him that if we were going to end things that we might as well just do it now rather than waste more of our time, but he kept managing to entice me not to leave.

I then spat at him (in something of a stylistic homage to part of this post) that he was “nothing but a fucking sadist” because he and the profession to which he belongs do nothing but make people relive trauma and misery and that it takes “a special kind of twisted individual” to think that that’s an enjoyable career path. I asked, rhetorically, if he’d use the old cliché of ‘I want to help people’, sneering about that being used as some sort of defence of his decision to practice clinical psychology.

I continued with my contempt-filled bile, telling him that he didn’t want to help people, that instead he wanted to “headfuck” them (I was gratified to see how agog he was at this. “Headfuck?!” he repeated, apparently aghast and astonished. Hahaha). “You’ve had your fun with me,” I asserted, vindictively, “so now you want someone else to headfuck.

He harped on the ‘headfuck’ comment for a bit, asking me to explain it, but I don’t remember exactly what he said and neither do I remember my response. So let’s (regrettably, cos that was fun) move on; at one point he asked what it would be like to end therapy. I said that I would have no real outlet to help me cope with the enormity of what I feel and of what I want to talk about. I said that I was emotionally (yes!) fragile in the extreme and that being left alone with the totality of my mentalism might well send me over the edge.

And how would it feel to continue, then, he pressed. Well, we have reached a point in our relationship where I feel that I can trust him enough to fully explore all that needs to be explored (not that that will be easy, but at least I think I can do it now). Our relationship is, I feel, the only adequate vehicle that I have – and have had – for a recovery of sorts. Only with his support and guidance can I face these things and, hopefully, move on from them. Or something – I don’t remember the exact nature of what I said. It was something like that.

Was it at this point that I uttered those tiny but synchronously hugely vile, belittling words? I don’t know, but this post is so disjointed anyway that it hardly matters. I said, “you can’t have escaped the fact that I’m very attached to you.”

He didn’t specifically respond to that as I recall, but at some point or other he did say that terminating therapy was going to be “a problem” whenever it happened, irrespective of whether we continued now or not and whether we’d worked through things properly. He didn’t say it, but the clear implication was that that would be due to my attachment to him. He’s right; I can’t deny it, it will be fucking horrible. The only thing I can say is that I would hope to be in a better mental place to deal with such a difficult prospect further into the relationship; right now, I am convinced that it would merely result in a hospitalisation – or even a possible run to catch the bus.

The long and the short of it is this: (a) we will review progress this Thursday rather than in January, as he recognises the enormous pressure that Christmas places on me, which will be compounded by his fortnight’s worth of absence at said point; (b) again, he stressed, there would be at least four sessions in the run-up to a termination of treatment devoted entirely to how to deal with that cessation (and it would probably more like six sessions); and (c) he is happy to continue ‘working’ with me as long as there is actual work being done – he won’t just do it for the sake of avoiding ending it.

On (c), I accepted the reasonableness of this position, but told him that if there were occasions where I found it very hard to talk to him about a particular issue, I did not want him to be of the view that that was me simply trying to manipulatively (not that that’s a word) extend therapy. I wanted him to be aware that some issues are just difficult to face, and it will take yet more time to address them.

He seemed surprised that I thought he would think that I would try to draw out the process, but assured me that he wouldn’t and didn’t subscribe to such thinking.

It was probably here that I started crying. I babbled incoherently through my sobs and he couldn’t understand me, and kept trying, in this annoyingly understanding and compassionate tone, to get me to repeat myself. Eventually I managed to articulate that, although I desperately want to continue with psychotherapy, the idea simultaneously petrifies me as I really don’t want to think or talk about so many things that I probably need to think or talk about (deja vu, anyone?).

I sat and cried for a few minutes, then started (literally) beating myself about the head as punishment for crying. He told me to stop it and said that I should allow myself be upset and indeed that he would actively encourage my tears if I was feeling an emotion that may precipitate them. For once I did as I was told, sitting silently in tears for a few minutes. As I said at the start of the post, for some reason I just felt terribly defeated – even though I shouldn’t because it seemed like I had got what I wanted – ie, C was saying that we could continue the psychotherapeutic process. Perhaps I felt defeated because continuing is agreed with the qualification that we are actually still doing something constructive – my visceral desire, of course, is to have him in my life permanently in some way. But this is armchair psychological conjecture; I have no idea why I felt this weird resignation. Perhaps it is simply that I was exhausted by riding on the rollercoaster that this session had been.

At what I think was my instigation, there was a discussion around the fact that it’s basically taken me six months and more to even begin to open up to him properly. I have discussed many things in sort of superficial ways, but I’ve not gone into much detail about specifics relating to my past at least and certainly, I have very rarely – if ever – behaved in a fashion like I did in this or the preceeding meeting whilst in session. I, of course, lambasted myself left, right and centre for being a time-waster.

C disagreed, opining that it was perfectly reasonable for me to have taken all this time to ‘test’ him, to make sure that he was worthy of my trust. Apparently he does not believe this to be time-wasting at all.

Whilst that is ostensibly reassuring, of course I find this a rather curious declaration on his part. If it was reasonable for me to have taken so much time to get to know him (well, kind of) before opening the floodgates, then how can it be unreasonable for me to expect long-ish-term therapy from this point to examine relevant issues from my past, or of transference, or of my life right now? The notion of continuing on some sort of rolling contract, rather than setting an initial timeframe of, say, six further months, seems incompatible to me with the idea that it was a positive thing to have used up the first six months essentially getting to know each other.

Anyway, I dried my eyes and apologised for shouting at him and for “being nasty”. Ever the psychologist, C replied by stating that if that was something I was harbouring, that it was good to demonstrate it to him, and that he would encourage me to do the same in future. He’s right of course, but it seems so terribly cruel for me to sit and shout “sadist! Headfucker!” or some such across the room, when the reality is that I don’t actually believe that and that I probably just wanted to hurt him (which I have no doubt he realises).

One thing I remember clearly about this session was that he seemed reluctant to let me leave. Normally, on the 49th minute mark, he pipes right up with the “we’re going to have to leave it there” line, and uses the remaining seconds for very brief housekeeping or, simply, goodbyes. On Thursday, I kept grabbing my stuff to leave, but he kept interrupting. It was odd and, looking back now, seems a little unsettling; he must have been seriously troubled by my mental state at the time.

Indeed, he said that he was concerned about how much I ruminate on therapy and that, that day in particular, he wanted me to find something else to occupy my mind, noting how difficult I had found the session.

I told him I would go home and kill people on Grand Theft Auto: Liberty City Stories.

He laughed (I don’t know why because I was absolutely serious) but continued by asking me what I enjoyed.

“All my interests are solitary pursuits,” I advised. “Aside from GTA and other video games, I don’t do much and don’t enjoy much. I do enjoy writing the blog, but one needs a specific mindset to write about difficult things and I am really not in it right now.”

(As an aside apparently C now thinks this blog is a good thing, despite the cuntified whinging that I reported here. Well, not that he thought it was a bad thing then per se – he just thought I was too fucking braindead to be careful in what I wrote here. Anyway, he now believes, correctly, that I seem to find the composition of posts cathartic and that I have found immeasurable support through the people that read what I write. If you don’t already know, folks, this is absolutely true. Thank you).

In the end we agreed that I would make an effort to rejoin the gym – as they all bloody do, C thinks exercise is imperative in promoting mental health. What’s more, though, he seems to be of the view that the physical effort required in exercise alleviates anger, stresses, blah blah. Personally, I find the gym insurmountably boring, but I’m unlikely to try and do myself in there I suppose, what with the other fuckers about. I haven’t rejoined it yet, but I will tomorrow. As for that day, despite my expectations that I would go back to A’s and my promise to C to actively take my mind off the session, in the end I went to my mother’s house and straight to bed. Rather than reveal why, I let her think I was ill.

So, how do I feel now, several days later? To be honest I don’t know. Although C said he was happy to continue working with me as long as we were not just avoiding the end of therapy for its own sake, the lack of a more definite answer and indeed timeframe still annoys me, and I am nervous about this week’s session as of course we are to review progress to that point. I do think significant advances have been made, as it happens, and I assume that C must too otherwise he wouldn’t have felt it was reasonable for me to take six months to get to this juncture. But nevertheless – I am dubious about what he’ll arrange next. Another 10 or 12 weeks – or something more meaningful?

I am sorry that this entry is so confused and disjointed, but that’s an accurate representation of my mental state during this session and, to a lesser extent, of the entire session itself.

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I Ain’t Happy with the NHS…Again

Posted in C, Moods, Psychotherapy, Triggers with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , on Wednesday, 25 November, 2009 by Pandora

This uncertainty with C is doing my head in. I spent this afternoon looking online and through Yellow Pages for private clinical psychologists in my area and found the sum total of two such half-decent practitioners, one of whom I’ve already seen (!). I then tried to work out if I could even afford weekly private therapy whilst unemployed – it can be done, in the most literal of senses, but it’ll take about half my monthly earnings to finance it.

Maybe I am overreacting and maybe C has no intention of ending this herapy in January, unless there is some miracle (and if there is some miracle then it is obviously fine to finish in January – but of course there will not be). But the mixed messages from him are sublimely frustrating – “don’t worry, we will never just suddenly end things” and “we will get there” versus “you know this is a finite process on the NHS,” yadda yadda yadda.

Partly the annoyance is with him and partly it is with this stupid bloody system. Sometimes I think we’d be better off with private healthcare after all.

On the one hand, C is the person that makes the immediate decisions on how long he sees his clients (as far as I can tell, anyway), so he could just say to me, “let’s keep on meeting for the next six months,” or whatever. He refuses to lay down any long term plans, ostensibly as he feels it is important to work to short-term-ish goals. I disagree, but at least he has a rationale, and in any event I am no psychologist. However, if therapy is coming to an end in about five weeks then what is the rationale for that when I am clearly still a nutjob?

On the other hand, C is constrained by all the financial bullshit of the NHS, not to mention the ludicrousness of the service’s inherent bureaucracy. No doubt he has targets and timeframes, must palm off the stupid mental within a few months cos the trust can’t (won’t) pay for the stupid mental any further than that and if he hasn’t cured the stupid mental in that time then he is an evident failure, don’t you know. Targets, man, targets!

The problem with this is that it will end up costing the health service much more in the long-run, and perhaps in more ways than one.

Let me break it down.

  1. I am 26. I have been utilising mental health services on the NHS since I was 13. Had I seen a proper therapist for a proper length of time then, how much money could they potentially have saved themselves? Instead, as this post attests, six different public sector salaries were funded, some of the resources of which were devoted to me. Epic fail. (Of course my own money was spent on three other therapists because of the NHS inadequacies. Epic fail again). The point is, one way or another, I will end up back at the GP’s or psychiatrist’s office begging for help yet again, and we’ll be back to square one. Why not just agree a sensible timeframe with someone I know and trust – and clear things up to whatever extent that is achievable – now?!
  2. I am so mentally and – yes – emotionally fragile as things stand that if therapy ends in the near future I am convinced I will end up in the bin. One hour of C’s time per week versus 24 hour care by several RMNs, psychiatrists and auxiliaries. Which one sounds cheaper to you?
  3. A third possibility, and this may be seen as a threat which it is not intended to be, is that I finally can’t cope and do myself in. When my mother and A instigate litigation against the NHS, as they inevitably would were this possibility realised, even if the NHS won hands down, they would be forking out a fortune to fund their fuckhead solicitors. I used to work for litigation solicitors specialising in the public sector. I know what they charge; even for minor cases that are easily contested and won, it is a bloody fortune. That’s not even including barristers’ fees if it came to court, or out-of-court settlements.

Other points to consider are the following:

  1. Dr C is constantly reminding me that psychotherapy is the “mainstay” of my treatment (rather than medicine), yet it seems to be her intention to see me long-term, albeit hopefully only for monitoring purposes once a suitable cocktail of drugs is found. How can therapy be the mainstay of my treatment if I am only seeing her, who only deals with the medicinal and organic sides of things?
  2. I know I’ve ranted about this before, but it so utterly and completely fills me with disgust and contempt that I have worked in both full- and part-time capacities since I was 14, and given 11% of my salary to the health service since I was 16. I had two major breakdowns, including this one, during that time – but it still amounts to, I think, eight years of work. When you think about it, is it really that different from US health insurance? Maybe the percentage figure is lower, but then my employers had to pay a percentage of my salary for my insurance also. So why would I get medium- long-term therapy in America, but I can’t here?
  3. I am familiar with people in other NHS trusts that have been guaranteed therapy of at least a year and a half on the health service. Now, one person I can think of has a lot more issues than I do, and so that’s fair enough – however, that individual is one of five people I can think of off the top of my head. I would hasten an educated guess that I have much more psychological baggage than each of those other four, but if not, certainly two or three of them anyway. Why, then, is it OK to fuck me about? (Incidentally, I noticed none of them had any trouble seeing psychiatrists either, so maybe my trust is just shit. Now it sounds like I’m playing a teenage game of “but they’re allowed it, so why am I not” – but I hope I’m not. I’m just genuinely mystified as to why my case is different).
  4. As stated yesterday, I have been mental for many years. I received my first diagnosis (clinical depression) 13 years ago or so, but as I have discussed here at other junctures, I was mental well before that. Normal children don’t try to amputate their limbs. Normal children don’t hallucinate. Normal children aren’t obsessively paranoid. Normal children don’t deliberately coop themselves up in the house, listen to Bach, read Grey’s Anatomy and seek out the company of the elderly for intellectual discourse. They go outside and play with their friends. So when I said ’13 years’ yesterday, I probably really meant 23, to be honest. Point being, how can two decades of madness be alleviated in less than a year? It’s fucking preposterous.
  5. If I had a physical ailment, the NHS would treat me until it was cured, or, were it chronic, then indefinitely. I am not asking for indefinite treatment for my psychological difficulties, make no mistake. But the striking inequalities between the health service for physical health and the health service for mental health disgust me.

In any case, I cannot see why C has to keep reminding me that the psychotherapeutic process is finite. Of course it is fucking finite, I am not stupid – and I certainly don’t want to be in need of it indefinitely as I want to be able to manage my conditions by myself. However, for the NHS’ sake as well as my own, surely that finity (if that’s a word) ought to be directly correlated with the progress of the patient? Surely it is the height of irresponsibility to discharge someone that is clearly still fucked up and only going to, at best, waste more resources?

Fuck it all to hell. I feel like emigrating.


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Be Angry With The Filthy Whore – C: Week 31

Posted in C, Moods, Psychotherapy, Triggers with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Tuesday, 24 November, 2009 by Pandora

Thursday was fucking traumatic, a state of affairs of which you are probably aware given my citation of the disturbing imagery of Metallica’s Until It Sleeps that evening. You’ll have seen on that post that my iPod was reading my mind again in playing it – and other songs on similarly dark themes – but what is most interesting about this is that this strange form of electronic ESP took place as I was driving home from an utterly pointless dissociative trip to a coastal town about 20 miles from home.

My first proper awareness of going to said town was when I realised I was in the centre of it. I do have a very vague recollection of noticing my normal turn off and thinking that the traffic was heavy, but at no time did I think, “why the fuck are you not in that heavy traffic?” I don’t remember deciding to drive on, and I don’t remember the journey. Another small-scale fugue-like episode. Sweet.

I had been quite good on the self-harm front of late, but the good spell has been broken. ‘Bitch’ and ‘grief’ are the latest, though I don’t remember doing the former (it must have bled like fuck though as I had seemingly used a towel to stem the bloodflow). Grief. Am I grieving for myself, or for what I should have been? If so, is that good? Presumably one is meant to say, “well, the self-harm bit isn’t good,” but you know me folks – not really one to listen to that sort of argument. A is raging with C; in A’s eyes, it is C’s fault that I have taken to cutting myself again. But it isn’t. It really isn’t. All C has done is facilitate triggering discussions, and been someone to whom I am hopelessly attached, which is hardly his fault. We can’t avoid matters of this importance simply because there is a risk it may act as a trigger; the entire psychotherapeutic process would then be pointless, and I’d be left as mental as I ever was.

I’m unsure as to what exactly this entry will amount to, as I remember surprisingly little of the session – perhaps unsurprisingly. But let’s start at the very beginning and see what happens.

C pointed out that he’d been looking through his diary and saw that our current contract was due to end shortly (he thought there were two sessions remaining after Thursday; I thought one, but as it turns out it will not matter). This was something of which I was horribly well aware. Having only begun to open up to C properly in the last few weeks, I was convinced that he’d see me as a manipulative bitch – it looked, to my cynical mind, like I was trying to wrangle more time out of him by leaving the avalanche of confessions until this point. Given that my primary diagnosis is borderline personality disorder, it reasonably follows (in my eyes) that he could believe me to be manipulative, as the psychiatric establishment still seems to think that about those who have BPD more than any other psychiatric problem.

Of course, he didn’t like either the idea that he would find me manipulative, nor in particular that he would think this because I have BPD – that fixates on labels, don’t you know. Actually, it doesn’t, because it’s what I think he should think anyway – the fact that BPD is the only psychiatric diagnosis to still be treated with open contempt by mental health professionals just reinforces that point – though to be fair, I have not experienced that disdain personally, thank God.

I honestly don’t think I was being manipulative – not consciously, anyhow – but it did look like it, and that had been my worry all week. Of course, C refused to concede that this was the case in his eyes. Did he point blank deny it? I think he may well have done, but I don’t remember clearly enough to say for certain. What he was willing to admit to was that I may, consciously or otherwise, fear the end of the relationship, and act accordingly to preserve it. Which is apparently not manipulative. Hmm.

The issue of the end of therapy raised its ugly head a couple of times during the meeting. What he said at this juncture was that we should “…continue seeing each other until Christmas, at which point [he’ll] be off for a fortnight, and then we’ll review the situation in January.”

Review the situation in January. You can take a wild guess as to what I think about that. He is going to throw me out with the dirty water in cunting January. Just over a month away, after the most stressful time of the year for me (ah yes, I’m sure you’ll be treated to a delicious rant about fucking Christmas in the near future, dearest readers). A tells me that this is not what C meant; apparently, he literally meant that we shall review the situation, and if further therapy is required (as if it won’t be), then that is what the case shall be. Well, Ms Rationality of course says, “yeah, right” to that. He is going to abandon me.

I honesty don’t remember how I reacted in session to the comment about ‘reviewing things in January’. I think I simply agreed and didn’t voice the aforementioned rejection worries, but I wouldn’t swear to it. As I said, it did indeed come up again, but I don’t remember under what circumstances. I can and do appreciate that the relationship can’t be permanent – in the most rational of ways, I don’t want it to be. I want to live an independent life, free of a need for a surrogate daddy. But can C realistically expect to change 13+ years of misery and being fucked about by the NHS in seven-ish months, particularly when I have such a strong neurotic attachment to him? Trying to be objective about it, I cannot honestly fathom that as reasonable, except in especially productive scenarios (which are about as applicable to me as…um…er…something that is very un-applicable to me). This is a personality disorder. It is ingrained into every metaphorical fibre of my self, the conscious, the unconscious, whatever – and it is causing me to self-destruct. Can something of such enormity and longevity honestly be treated adequately in just over half a year?

In any case, eventually the discussion – predictably enough – returned to the eminently delightful subject matter of the preceeding week. Eugh. It was me that raised it, though not exactly through choice; we were talking about something else (no idea what now) which triggered some sort of memory – it’s a shame I’ve forgotten what that subject was, as it would be useful to know these triggers, especially in cases where there is no obvious correlation, as I think the case was in this instance.

I became rather agitated and told C that I wasn’t “going there”. I hid.

Despite my telling him to leave it, he continued to probe me – but gently and quite subtly, to be fair. I eventually admitted that I was thinking about the Pandora’s Box.

My memory is even more fragmented from here on in, though some things do stick out in my mind very clearly. I was very, very careful not to verbally articulate much at all; at one point I desperately begged, “look, don’t you see where I’m going with this?” But it appears that he believes that I need to say the words. I still have not used the word ‘rape’, and strictly speaking he could still be under the impression that it was something other than rape – but he’s not that stupid.

He must have asked what was so troubling about verbalising this material, because I remember then telling him that I am fairly tolerant of articulating the gruesome information on this blog.

“Which is odd,” I mused, “given that it is all the more real when it is written down, even more so than if I verbally discuss it. It’s there, on the blog, in black and white.” (See here, for example).

I went on to postulate the idea that perhaps it is easier to deal with in writing because I can rationalise everything; life events become something that is seen in the third person, by a narrator, an observer with at least a modicum of theoretical knowledge of that about which she writes. If I have to talk about it, I have to feel it. I am there, in the midst of it, with the rawness, the vileness, the trauma of it all.

He agreed. He didn’t say so, but a sense that he wants me to feel that repressed pain was very palpable. Maybe that is why he was such a cock when I put this, and other shit, in writing for him – in fact, I’m certain it is. What kind of profession capitalises on other people’s grief? If I asked him why he became a clinical psychologist, I’m sure he’d respond along the lines of that old cliché, “I want to help people.” What, by making them relive their darkest memories, by making them suffer through them all again? Does that not take a special kind of sadism?

I am, of course, being a little facetious; I don’t believe C to be a sadist in the least, and I do believe he is in his job for the right reasons. But the human mind, and the sciences that arise therefrom, are odd things indeed. It strikes me as strange that it is an apparent psychological necessity to directly face that which you most revile in your past, before you can heal from the wounds it inflicted.

But this is not a post about the curious concept of psychology as an academic discipline, nor is it a post about the mindsets of those practising this form of figurative alchemy; it is a post about a session I had with my therapist. So…was it at this point that I lost it? I’m not sure, but anyway, in my next clear memory, all I could see in my head was the INCIDENT, or more specifically, the moments during which I was pushed to the floor of the outhouse in which it took place and served up as tasty piece of young meat for the delectation of my uncle. I recall very strongly that (in C’s office, not in my mind) I had my head in my lap and was pelting my skull with both fists with as much strength as I could muster. I have never done anything of this ilk in C’s company before.

And so he too did something that he has never done before; he raised his voice to me. He didn’t shout, but he did raise his voice just enough to try and penetrate through the mentalism that had tenaciously gripped my mind.

“SI!” he called. Well, he didn’t of course – perhaps it will surprise some of you to learn that I have a name, a normal, very ordinary name, and he used that instead – but you know what I mean. One thing I’ll not forget about this session was that he actually used my name three times, and at one point I used his too – these things are unheard of in the whole time we’ve known each other. Does it mean something? Why do I attach such importance to something so apparently normal and trivial? Is it because using names is personal, and that I want to see him as a person, not a canvas? Who knows. I certainly don’t, but I do know that that memory sticks with me.

I think he must have somehow brought me back from this mental place, but I don’t remember the specifics. The next part of the conversation that I recall was when he asked me how I felt about myself and that I told him that I felt like a “dirty, fetid little slut.” I then rationalised things for a bit, proclaiming that I am in actuality not a slut. Unfortunately, I still felt (feel) like one.

Then I lost it again. “I’m a filthy whore,” I spat, hiding from him again with my hands.

I think he actually went as far as to tell me that I am not a whore, but that could be a phantom memory. I mean, how the fuck would he know? I could have sold sex in 28 European capitals for all he knows. One thing he definitely did do was try and help me regain my composure. I sat up and pretended to be fine, sticking out my hand to measure how much it was shaking. I have used an incident when I was about 15 as a yardstick to measure anxiety; the day after I found out about an incredibly twisted lie from my first real boyfriend (a long story that I will have to detail some day), I went into school and, in English, happened to notice how much my hand was shaking. That denotes severe anxiety and/or anger. If the shaking is less than that, things could be worse.

I told C about this. However, a brief reference to the lying cunt of an ex must have touched on the self-disgust I was already feeling over my own lying to C about the INCIDENT (when we first met I told him it was ‘mere’ touching, but that was only part of it, obviously. More on this shortly). I told him this – still without using that word – and went into a major self-invective of utter disgust and abhorrence. It was filled with ranting about how much of a shameful, lying, grotesque, hateful slag I am, lying to the one person that might be able to bring me back a little hope in this sorry mental battle, and about how guilty and sorry I am, blah blah de blah.

When I took a second to draw breath, he jumped in to try and (a) reassure me that I had nothing to feel guilty about and (b) establish exactly what it was that I felt I’d lied about.

I answered (b) first, at least to the best of my recollection. He’d specifically asked in our initial assessment sessions what form the sexual abuse took. As is my wont, I had avoided articulating myself properly, and instead managed to answer the question merely by his probing. I think, though I am not certain, that he asked if I was raped, and that I said ‘no’. I am sure that when he asked if it was inappropriate touching that I said ‘yes’, and that I led him to believe that that was all. In my defence – and I told him this in the session to which this post refers – I have dissociated a lot of the INCIDENT. I remember ghastly, loathsome pieces of it in fleeting glimpses, like looking at still pictures in an album or, sometimes, short video clips. I remember the sensations of pain and terror in these moments too. I am grateful that the memories are so brief, but also resentful of it too, as it feels like it removes my power to understand the INCIDENT and my reactions to it. Furthermore, obviously part of me does remember it, and that part is mentally fucked – perhaps it would be easier to address were it all consciously there at the front of my mind.

Anyhow, I then proceeded to respond C’s (a) point. “I lied to you,” I said simply. “Aren’t you angry with me?”

“No, of course I’m not angry with you.”

“Why not? You should be.”

He sort of laughed (he mustn’t have realised I was serious), but seeing the look on my face, he desisted from doing so abruptly.

“SI,” he said again, firmly, looking straight at me. “Do you seriously think that I should be angry with you?” His tone was a more compassionate version of ‘incredulous’.

“Yes,” I began, “fucking dirty, lying, grotesque little bitch, fucking…”

“One,” he interrupted, rather dramatically, leaning forward and counting on his fingers as he did. “We had only just met and you can’t honestly have expected yourself to deeply discuss such sensitive matters with someone you didn’t know. Two, you didn’t lie, you omitted some information…”

“But then that’s a lie of omission…” I began.

“Three!” he went on, raising his eyebrow in a surprisingly authoritative fashion, signaling that I was to let him finish, “three, this is hard for you to talk about, so it is not surprising you withheld it. What is there to be angry with?! I am not angry with you, and neither should I be.”

Well, that was me told, then. I was quite taken aback by the forcefulness of his tone. Actually, ‘forcefulness’ is a horrid word to use as it has negative connotations – let’s say ’emphatic’ instead. He was incredibly emphatic. I gaped at him in a sort of stupefied disorientation for a minute or two.

He sat back in his chair, recovered his blank canvas and either asked me how I felt, or signalled for me to speak.

“Um…” I muddled. “That’s reassuring. I do feel reassured. But it also confuses me; you have a completely different attitude to it from me.”

He seemed to understand that in fairness, which not an awful lot of people would. He was able to see the black-and-white chain of logic that I was following in believing that he ought to be angry, but luckily for C things in his world do not seem to be as black and white as they are in mine.

I don’t remember how things ended. I know that I was battered and bruised psychologically (and physically to boot what with punching my head). At no point had I been tearful, but one does not need to weep to mentally suffer. I went and sat in the car and phoned A for catharsis and reorientation purposes. Although the trauma of reliving the INCIDENT had been the most awful aspect of the session, the fact that I fixatedly whined to A that C ‘wants to abandon me’ before I even touched on the rest of things is very telling.

In later discussions A urged me to tell C about this abject fear. What’s the point? C already knows I’m terrified of him abandoning me. Perhaps the real question is ‘is my attachment to him healthy?’ There have been mixed views on this from the readership of this blog. cbtish, for example, thinks it puts me in an intolerable position (cbtish is a therapist). Vanessa from eTransference, a clinical psychologist in training who has a particular interest in the phenomenon of transference, thinks it ought to be encouraged in many ways. Others undergoing therapy – bourach and thesamesky (who’s also a counsellor) for example – have their own struggles with the therapeutic dyad (bourach in particular will understand why I thought C should be angry with me, given this post of her’s).

I don’t know what the answer is; just that the attachment is very real. Just that I feel guilty for withholding information and for lying (though he wants me to stop that – and I’ve just remembered that the session ended with him asking me, again, to try and not post-mortem things in therapy. Oops. He was also worried, after what happened with VCB’s SHO in September, that his actions or words could have a…er…detrimental effect on me. Double oops. All I can say is that I think our current dialogue is progress, regardless of any self-harm that follows). And at least I am far from alone in withholding, and even lying.

But it’s still all a bit of a quagmire, yes?

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Until It Sleeps

Posted in Moods, Triggers with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Thursday, 19 November, 2009 by Pandora

The iPod has been acting as a mindreader again.

I’m not in the habit of doing this as this blog is mine; my life, in my words. However, sometimes others just say it (whatever ‘it’ is) better than me, and this is very much one such occasion.

So, ladies and gents, I give you the nature of my present sorry existence – as presented by Metallica.

Until It Sleeps

Where do I take this pain of mine
I run but it stays right by my side

So tear me open and pour me out
There’s things inside that scream and shout
And the pain still hates me
So hold me until it sleeps

Just like the curse, just like the stray
You feed it once and now it stays
Now it stays

So tear me open but beware
There’s things inside without a care
And the dirt still stains me
So wash me until I’m clean

It grips you so hold me
It stains you so hold me
It hates you so hold me
It holds you so hold me
Until it sleeps

So tell me why you’ve chosen me
Don’t want your grip, don’t want your greed
Don’t want it

I’ll tear me open make you gone
No more can you hurt anyone
And the fear still shakes me
So hold me, until it sleeps

It grips you so hold me
It stains you so hold me
It hates you so hold me
It holds you, holds you, holds you
Until it sleeps

I don’t want it, I don’t want it…

So tear me open but beware
There’s things inside without a care
And the dirt still stains me
So wash me ’till I’m clean

I’ll tear me open make you gone
No longer will you hurt anyone
And the hate still shames me
So hold me
Until it sleeps

(c) James Hetfield and Lars Ulrich, Metallica (from the Load album, 1996).

I will write properly tomorrow, but in the meantime you can listen to and watch the video for the above here.


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Mad versus Bad, Stockholm Syndrome and Defending HIM

Posted in Context, Random Mental Health Related Philosophising, Triggers with tags , , , , , , , , , , , , , , , , , , , , , , , , , on Thursday, 19 November, 2009 by Pandora

The phenomenon of Stockholm Syndrome has been bandied about a lot in the media recently, in the wake of the Jaycee Lee Dugard abduction and, to a lesser extent, in discussion of the Fritzl case (though I am not sure to what extent Elisabeth Fritzl was affected by it).  There is a particularly good article, by trauma therapist Kathy Broady, on the condition here.

For those of you not familiar with the issue but who don’t have time to follow the links, Ms Broady puts Stockholm Syndrome thus:

It is when victims form positive, caring attachments with their violent perpetrators.  The more victims have to depend on their perpetrators for their very survival, the more likely the victim will form an attachment to their perpetrator…

[Victims] knew that their life and basic survival needs were completely dependent upon keeping the perpetrator happy.  They learned to base their own survival on effectively meeting the needs of the perpetrator, and the perpetrator had the power to decide if they would live or die.  To survive, they became loyal to the perpetrator.

Perpetrators purposefully create this kind of dependence in their victims.

As far as I am aware, and it fairly logically follows given the above set of circumstances, Stockholm Syndrome is most frequently seen in cases of long-term abuse (and is thus not particularly applicable to me).

During a recent documentary on the Dugard case, my mother sat aghast as the narrator described how Kaycee and her two daughters wept as their abuser (and father of the two younger girls) was arrested.  She admitted that, had they randomly told their story without proof, that she would have thought them to be either unforgivable liars or seriously afflicted by folie a trois.  How, she argued, could you care so deeply about a person who had so horribly and systematically abused you?

I spoke to her at length about Stockholm Syndrome, but to little avail.  She understood the concept in theory, I think, but was nevertheless unable to grasp how it could actually be.  The whole idea is so alien to her that she cannot conceive of it being a very real condition, borne – initially at least – out of necessity.

A similar, though distinct, query arose with her when the Fritzl story broke last year.  “But how is it possible for her father to have done this to his daughter?” she despaired.  As with the Dugard case, had the story not been there in black and white, I don’t think she would have believed it.

“He must be mad,” she concluded.

Quite possibly.  Indeed, quite probably.  But at what juncture do we allow abdication from Fritzl’s personal responsibility (not to mention his duty of care to his daughter, morally if not legally at her age), due to the fact he clearly had a twisted and sick brain?  When does bad become mad, and/or vice versa?

Anyway, the point of this post is not to write a psychocriminological masterpiece on Stockholm Syndrome.  I’m only here to say that, although I do not believe for one second that I have it or anything approaching it, I do understand it.

I suspect some of my readers – those few in my real life, in particular – will dislike the latter part of the title of this entry.  “Defending HIM” – ‘Him’ being MMcF’s husband, perhaps unsurprisingly.  I am going to defend him…but, and it is a very BIG ‘but’, that does not mean that I am defending his erstwhile actions towards me.

I mentioned in the last post that I’d explain why I had become less concerned for MW’s welfare so let me clarify that point.  I have been exposed to Paedo in large doses twice recently and have found myself to feel nothing other than overwhelming pity for the man.

In some ways, I have done for many years, but he was so much a shadow of his former self of late that the sense of sorriness felt all the more palpable.  I think I have alluded to the fact before that he is mental too, suffering from some unspecified psychotic disorder.  He, like me, takes Olanzapine to counteract it, and it has been effective in its indicated usage.  But he is now incredibly depressed regardless.

So what, SI?  (a) Doesn’t he deserve to be and (b) depression is treatable, so why are you decreasingly concerned for MW?

(a) Well, yes, maybe he deserves to be.  But the man has had no life.  His life, for as far back as I can remember, has been nothing more than a pathetic existence.  He was forced to marry MMcF when they were both very young, as she was up the stick (a reviled state of affairs in the ’50s), and he has been under her tenacious grip ever since.

As I have stated on the page about the people in my life, at face value MMcF is a lovely woman.  The reality, however, is that she is domineering, manipulative, cruel and overwhelmingly demanding.  I consider it no coincidence that the two of her children that still live with her – S and K – both have no lives.  In their 40s now, they will never leave that house.  I also consider it no coincidence that S had very severe social phobia and still has depression (she claims she has bipolar disorder, but none of us have ever witnessed anything approaching even hypomania, and she only takes Venlafaxine, no mood stabilisers.  But what do I know) and indeed that Paedo is severely delusional.  The two other sons eventually escaped, but are nevertheless intrinsically linked to every brick of the house’s build, as are their children.  S’s daughter seemingly escaped but her, her husband and little MW might as well move in because they are always there.

The hold is enforced by MMcF.  Frankly I am scared of her.

Now, re: Paedo.  Well, given his entrapment, I actually can understand a willingness on his part to stray.  Could he separate from her, divorce her?  He could – or could have, more accurately – but even if he had, she would have manipulated him back.  I guarantee it.

So, yes, I feel sorry for him, and long since have.  MMcF does nothing but criticise him, and yet he serves her and complies with her selfish desires without complaint, and endlessly worries about her health and welfare (neither of which are great).

It does not, however, condone child molestation, because quite clearly nothing does.  No matter how shite his life may be, may long since have been, I did not deserve to be raped by him (nor, of course, by anyone else).

All I am saying is that the person is distinct from the act, no matter how heinous or twisted that act is, so I have the ability to feel pity for this man, who did this most horrid of things to me.  I don’t like him, and I most certainly do not love him, but I feel regret that he’s had such a waste of a life, and if I can feel that, then I can completely understand how in more serious cases of abuse that that could progress to compliance, submission, friendship and even love.

(b) Yes, depression is treatable, and Paedo may well be able to be treated for same.  Still, it is very chronic, and with the aforementioned shitty life, will be all the more difficult to shift.  We have a saying in Ireland: if a person is perceived to be on their last legs or just otherwise haggard and decrepit, it is often said that they are “done”.  Well, Paedo is thoroughly and utterly done.  Quite honestly, death would be a mercy to the man.

So on the balance of probability now, I am fairly sure that he simply isn’t either physically or mentally capable of posing a threat to MW, MW’s impending sibling, or any other member of that (or any other) generation.  He is beyond it.

Of course, I am not, and cannot be, 100% certain of this – who is ever 100% of anything?  As such, I will remain vigilant and will tune my awareness to any changes in MW’s behaviour as finely as possible.  If I think for a second that the child is under threat, I will act.  I will break Paedo’s neck myself if needs be.  However, I do genuinely not perceive this as likely at the present time.

To address my mother’s points vis a vis the sad Dugard and Fritzl cases.

If you, mother, find it so hard to accept Kaycee and her children’s attachment to their abuser, consider proportionally the defence your daughter has just given of hers.  Does it seem so alien now?

Furthermore, as stated Stockholm Syndrome develops of necessity – in the case of most long-term trauma victims, because they cannot escape the situation, so it is better to ’embrace’ (for want of a better word) what the abuser wants, in order to make life somewhat more tolerable.  In my case, evidently a less serious one, I would also say that some of my reaction to Paedo has developed of necessity.

I have basically accepted him, and I have kept the story to myself, to save an entire extended family.  Others could have been abused, I know, and I will never stop wondering if I could have prevented that – but I would have had to go to the police, alone, as a traumatised child, and with a total lack of evidence, what would have happened anyway?  So, with the best will in the world, I could hardly have prevented harm to that generation, and so I did all I could in the circumstances – I tried to keep the family my mother loves together.  And now I am looking out for the next generation’s welfare, which is the best I can do now.  I cannot ruin a family over an incident 16 years ago for which I have no evidence.

So no, abused individuals do not automatically hate and reject their abusers, for a multitude of reasons.

Finally, why is it really so impossible to believe that close relatives can and do abuse those close to them?  Many readers will be aware that most acts of sexual violence are perpetrated by someone known to the victim.*  Well, I can’t say the rape and the overt sexual behaviour were particularly systematic in my case but still – he was my uncle, I was his niece, so there you go.

* Child Sexual Abuse Fact Sheet, National Child Traumatic Stress Network – http://www.nctsnet.org/nctsn_assets/pdfs/caring/ChildSexualAbuseFactSheet.pdf


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