Archive for hypomania

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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An Impasse – C: Week 26

Posted in C, Psychotherapy with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Thursday, 15 October, 2009 by Pandora

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“I hate myself, I hate myself so fucking much,” I whinged.

Apparently that is “not helpful”.

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

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

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

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

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

“I don’t know,” he admitted.

“Well, that’s great, thanks.”

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

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

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

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

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

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

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

I agreed.

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

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

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

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

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

“Well-intentioned,” I responded.

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

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

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

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

“OK,” he said, encouragingly.

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

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

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

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

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


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I Hate the Therapeutic Relationship – C: Week 25

Posted in C, Moods, Psychotherapy with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Friday, 9 October, 2009 by Pandora

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

He asked about the content of the psychic debate.

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

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

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

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

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

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

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

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

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

Etc.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Yeah, but you know what I mean.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“Yes.”

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

“Yes.”

“Scrutiny.”

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

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

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

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

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

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


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Hearing The Voice (and Other Psychoses)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

Posted in Everyday Life, Medications, Moods, psychiatry, Triggers with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Tuesday, 29 September, 2009 by Pandora

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Posted in Everyday Life, Moods, Random Mental Health Related Philosophising with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Monday, 28 September, 2009 by Pandora

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

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

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

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

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

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

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

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

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

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

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

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

How SI Spends Her Leisure Time

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

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

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


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Things are Bad

Posted in Everyday Life, Moods, Triggers with tags , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , on Saturday, 26 September, 2009 by Pandora

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

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

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

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

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

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

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

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

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

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

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

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

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

Sorry for whinging.