Archive for psychiatry

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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Article of the Week: Week 1

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

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

Article of the Week

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

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

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

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

Honourable Mentions

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

Hopelessness and Despair

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

The Secret Life of Psychiatrists

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

Psychiatric Abandonment: Pitfalls and Prevention

Any Suggestions?

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

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Shiny Award Thingy from Mental Nurse

Posted in Moods, Random with tags , , , , , , , , , , , on Friday, 1 January, 2010 by Pandora

I know some of you follow the insightful and informative Mental Nurse blog, written by…er…mental nurses. As regular readers of it will know, each Saturday (usually) they publish a review of that week’s musings in the mental health blogosphere, terming their summation ‘This Week in Mentalists’. I was featured once, with the child sex abuse post, catapulting it to the most read spot on my blog.

Anyway, at the end of the year Mental Nurse let their readership vote on the best blogs in given categories, and this year’s winners and runners-up have just been announced. No, yours truly has not won anything, as in I have not come first or owt like that…but this blog did come joint third in the Personality Disorder category.

😀 😀 😀

This Week in Mentalists Award Winner 2009

First place in the category went to the very worthy winner of Genius Gone Wrong, whose blog I follow and whose comments I have had the honour of having here. Second place was Becoming Hannah, and my fellow third-placed contender was Writing in the Margins of My Mind. I shall look forward to reading these blogs, plus other mental health blogs that were featured as winners.

Thank you to all who voted for this blog. It was an honour to even be mentioned as a possible contender, never mind to be actually placed. I really do feel very honoured.

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Reflections on 2009

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

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

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

THE BAD

Being Mental

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

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

Specific Issues on Mentalism

–> Psychoses

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

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

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

–> Dissociation

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

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

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

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

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

–>  Self-Harm

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

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

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

Losing My Job

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

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

Trouble with the NHS

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

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

Christmas

It was fucking God-awful dreadful.  Enough said.

C

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

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

THE GOOD

C

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

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

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

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

Diagnoses

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

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

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

Turkey

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

This Blog

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

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

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

Twitter

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

–>  Thank Yous – Twitter

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

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

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

–> Thank Yous – Blogging Buddies

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

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

Again this is not an exhaustive list.

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

Friends

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

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

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

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

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

A

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

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

AND FINALLY…

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

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

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

Yours ever

SI x

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Countdown to Abandonment – C: Week 33

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“I’m curious.”

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

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

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

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

I nodded non-committally and waited for the backlash.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“But…” he went on.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Until It Sleeps

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

The iPod has been acting as a mindreader again.

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

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

Until It Sleeps

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

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

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

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

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

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

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

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

I don’t want it, I don’t want it…

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

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

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

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


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Mad versus Bad, Stockholm Syndrome and Defending HIM

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

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

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

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

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

Perpetrators purposefully create this kind of dependence in their victims.

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

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

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

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

“He must be mad,” she concluded.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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