Archive for mental health stigma

Article of the Week: Week Two

Posted in Article of the Week with tags , , , , , , , , , , , , on Wednesday, 13 January, 2010 by Pandora

The Main Course

My favourite psychiatric article this week was on schizophrenia.  Specifically, the piece from X-Ray Technican Schools (I agree that this seems a curious place to have an article on schizophrenia) provided a concise, accessible but intelligent refutation of the many myths that surround this illness.

One of my pet hates is the mistaken belief that so many seem to hold that schizophrenia is, or at least shares key symptoms with, dissociative identity disorder.  I suspect I’m preaching to the converted on a blog about mental illness, but lest there be any doubt schizophrenia does not involve multiple personalities!!!

Another mistaken and highly stigmatic belief that I despise is that mentally ill individuals (especially schizophrenics) are more dangerous and/or violent than normals.  This simply is not true, as statistics frequently demonstrate.

This article analyses these two myths, plus eight others, discussing how they’ve arisen and why they are false.  Many thanks to Wounded Genius for posting this for us to find.

10 Myths About Schizophrenia

For Afters

There were so many excellent articles upon which I stumbled this week that it’s hard to narrow them down.  Here’s the runners-up that I’ve come up with.

A close second to the above schizophrenia article is a piece in the New York Times that discusses the “Americanisation” of mental illness.  By “Americanisation”, as far as I can tell they really mean “Westernisnation” (not that that’s a word).  This is quite a long article, but its well worth sticking with.  It goes into considerable and fascinating detail as to how some mental illnesses are (or were) culturally dependant, and how they now seem to be becoming increasingly homogenised – in line with Western interpretations.

The Americaisation of Mental Illness

Jonah Lehrer at Science Blogs have a post on daydreaming, and why it isn’t necessarily such a waste of time:

Intelligence and the Idle Mind

Science Daily reports that migraines may have links to child abuse.  This could explain a lot…

Abuse in Childhood Linked to Migraine and Other Pain Disorders

Finally, I want to have a look at two articles from Psych Central that discuss transference and the therapeutic relationship, both written by Sonia Neale.  The first discusses how the therapist can never really return your transference – not in a manner in which you would know it anyway.  It discussing how what it terms ‘transference love’ is very real, given as all any of us ultimately want (allegedly) is to be loved, but will always (sadly) be one-sided.

Transference is Not Transferable

The second article explores a similar, but distinct, aspect of therapeutic relationships – that fantasy that we can or will, eventually, be friends with our psychotherapists.  Ms Neale discusses why this is a bad idea, but argues that it’s not necessarily transference but a genuine connection that drives this.

Why You Can’t Be Friends With Your Therapist – Ever!

*SI walks away, whistling innocently*

Anything Else?

Any suggestions for Article of the Week are very welcome, as are comments on those posted here.  Get in touch or leave a comment.

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The Fantasy World

Posted in Context with tags , , , , , , , , , , , , on Wednesday, 16 December, 2009 by Pandora

Tonight, as I was editing the ‘About‘ page briefly, I was reminded that I had mentioned my pathetic little fantasy world there, but that I’d never discussed it in detail elsewhere on the blog.

Well – I’m not about to.  I don’t think I’ll reveal the specifics of it to anyone, ever.  But I will say a few words.

I suppose the best way to put the fantasy world is that it is just like a grandiose delusion (or such is my supposition) – except that I don’t believe it is real.  There’s a fine line here between creativity and madness; if I had written down all this stuff and sent it to a publisher, it probably would have made quite a successful (if far-fetched) novel (or set of novels).  Alas, any such attempt now would make people aware of the specifics of the fantasy world, and I couldn’t cope with the shame of that.  Plus I wouldn’t have the motivation to write a fucking novel anyway.

The only people that I’ve spoken to about the fantasy world are A and C.  C didn’t seem especially concerned about its presence, though I was interested to note recently that, after the development of ‘They’, he asked if ‘They’ were connected to the fantasy world in any way.  It had always been my concern that my use of the fantasy world as escapism would actually develop into an actual escapism – a complete break from reality.  And cevidently that was on C’s mind at this later juncture too.  So far it hasn’t happened, but it is still a worry.  Having said that, frankly sometimes I wish I would just lose all contact with reality and stop teetering on the brink of it…but that’s a whole another post.

Anyway, both A and C, and in fact all of the most significant personnel in my actual life, figure to some degree or another in this fantasy life.  However, they are supplemented by an entire cast of fictional people, some reflective to some extent of real people, others purely borne entirely out of my imagination.  The fictional people are crafted down to their wrinkles, down to whether or not they like brussel sprouts.

The universe itself is similarly crafted.  My living and working environments are also detailed to the nth degree, and on a major scale.  The streets I walk, the strangers I meet, the pubs and cinemas I go to, the books on my shelves.  Everything is covered.  It really is like an entire other life, and I can slip into it at will.

I am completely unsure as to what this means psychologically, but let’s not overcomplicate matters, and take it broadly at face value.  In the fantasy, I have a wonderful job and am very much the confident(-seeming) person that I was as a child.  I am surrounded by people who, despite my idiosyncrasies, like and respect me.  I have a stable and loving private life.  I have money, though not riches and my own home, though not a mansion.  Basically, I have the perfect young professional’s life.

From that, it would be easy to say, “well, it’s merely reflective of a longing, perhaps of regret over missed opportunities.”  And maybe it is.  Except, it’s not that simple.  In the fantasy world, I am still mental.  Does this go back to all the wank I wrote a few months ago about not flicking the metaphorical switch to sanity if given the chance?  Maybe.

Maybe also it’s reflective of my feelings on the stigma of mental illness.  I want to have achieved all of these things despite being mental, thus proving that mental illness is not a barrier to success.  But I have to ask myself, if this is indeed the case, is it because of altruism, or is it another narcissistic desire for me to achieve something?  Probably the latter to be honest.  What a self-centred bitch.

When I told C about it – probably back in April or early May – I broke down and cried for ages because of the shame and self-disgust I felt about not being content with my real life.  It was the first time I’d wept like that, and as regular readers will know, it is not something that I have done with frequency since.  I derided myself to C as “completely fucked up.”

And I am.  I really am.

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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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