Archive for the NHS is shit

Suicide Attempt Epic Fail

Posted in Moods, Triggers with tags , , , , , , , , , , , , , , , , , , , on Sunday, 17 January, 2010 by Pandora

*** STANDARD TRIGGER WARNING: POSSIBLY TRIGGERING MATERIAL IS UPCOMING; I HEREBY ADVISE YOU AGAINST READING IT IF YOU FEEL THAT IT MAY SET YOU OFF…BUT I KNOW YOU’RE GOING TO READ IT ANYWAY, SO THAT’S A BIT POINTLESS, BUT I PROBABLY LIKE YOU BECAUSE I LIKE EVERYONE THAT I KNOW READS THIS DRIVEL, SO PLEASE DON’T HURT YOURSELF.  NOT BECAUSE OF INADEQUATE LITTLE ME ANYWAY.  IF YOU DO SO I WILL HAVE TO COME ROUND TO YOUR HOUSE AND SHOUT AT YOU AND/OR KILL KITTENS AND/OR CLUB BABY SEALS AND/OR SLEEP WITH RICK MAYALL.  NOW YOU WOULDN’T WANT THAT WOULD YOU, SO EITHER DON’T READ THIS SHIT OR A LEAST MAKE SURE YOU ARE NOT COMPLETELY MENTAL AT THE TIME OF DOING SO.  OK?  OK.  THNXBAI. ***

I’m sure that most of you are familiar with what I did on Friday night(well, technically, Saturday morning) given my bizarre running commentary on same on Twitter.  Of course, not everyone who reads this blog uses Twitter, but nevertheless, you can derive the basics from the title of this post.

It wasn’t a “cry for help” or some sort of silly borderline strop.  It was an absolutely pathetic attempt, I will admit that, but it was a nonetheless serious attempt.  I genuinely wanted to die.  I did.  No bullshit, straight up – death, not attention, was what I sought.

Nothing especially bad had happened on Friday – I was just miserable for most of the day.  I met A for dinner and a few drinks, which was pleasant actually, and when we got home, we listened to some music and were generally rather contented.  But I kept thinking how much easier things would be if I wasn’t in existence.  Not just for me – although I admit that was a major motivating factor – but for everyone.  I add nothing to anyone’s life.  A million people could tell me otherwise, but I’d never believe them.  I am a worthless, useless slut of sheer, unadulterated and fetid disgustingness.  Or at least that’s what I thought then.

So when A went to bed, circa 1.15am, I laid into myself with the scalpel.  Few parts of my body are unaffected – self-harm is strongly in evidence on ankles, arms, abdomen (there words there, just slashes elsewhere), elbows – the works really.  As I was doing it, I thought that I might as well go one step further and slit my wrists, the hopeful and intended result being my bleeding to death.

Now, people could say, “but a serious suicide attempt requires planning, and this was an impulsive act.”  I do accept that, and can see why it looks like nothing more than a pathetic gesture.  All I can say to convince people otherwise is that it felt absolutely and completely genuine at the time.  I wanted to die.  I really did.  I always remember (or rather don’t) the nothing that I experienced under general anaesthesia when I had an operation a while back.  I longed so fervently for that nothing again – and for it to be a permanent state.

So, I took a few minutes to write a note to my mother and A, with acknowledgements of a few friends, then went in search of an analgesic spray that I keep for sprains and the like.  An attempted suicide is not like self-harm; it’s not performed in the pursuit of pain.  No, pain was not a commodity that I lacked, so I sought to minimise more of it.

I’ve read this on the suicide newsgroups, but I was nevertheless surprised (or at least I am retrospectively) by how calm and contented I felt having made the decision to kill myself.  It was reassuring and comforting to know that I would not have to continue with this sorry excuse for a life, that there would soon be nothing.  Nothing was all I wanted.

I cut my left wrist first.  I tried to cut deep, but my skin was ungraciously unco-operative, refusing to slit to any meaningful degree.  This irritated me considerably, but I let it pass and decided to return to it.  So off I moved to my right wrist, which curiously proved considerably easier.  I’m generally right handed, so wielding a scalpel with my left hand would not be the most obviously effective way to garner a major life-threatening wound.  But initially, I thought I’d spotted success.

I was captivated by the blood.  It was the most blood I have ever seen from a deliberate act of self-harm.  Dark, and think, and oozing, and beautiful.  It completely mesmerised me, and I could almost feel my life ebbing away with it.  That was an eminent comfort to me, and I felt moved and calmed, yet slightly euphoric.  God, what a beautiful and welcoming thing death seemed to be!

But wait.  The blood was oozing, not spurting.  That meant that I had failed to sever a major artery, and rationality came flooding back: if one is going to off themselves by cutting, they really should cut vertically on their arms, not horizontally as I had done.  Vein cuts generally won’t lead to a successful suicide, and indeed artery ones don’t always either. Plus such wounds can lead to nerve damage in one’s hands if they fail to bring about death.  This was the shittest suicide attempt in the world!

I was filled with self-disgust, but even more than that, irri-fucking-tation.  Not anger or fury, but irritation.  I was irritated that my peaceful comfort in an imminent death had been shattered.  For fuck’s sake, I can’t even kill myself with any fucking gusto!

I sought advice on Twitter (that well-known bastion of medical knowledge), still watching the blood ooze heavily from my wrist.  The consensus was that it wouldn’t off me, but that I should go to Accident and Emergency nevertheless and get the thing stitched.

I considered this.  The thing wasn’t going to kill me, self-evidently, but it may have led to nerve damage.  If I was, however unfortunately, going to remain alive, then I might as well do so with a functioning right hand.  I rang a taxi to take me to the hospital, which is less than five minutes’ drive away.

Whilst waiting for it, I cleaned both wounds up a bit (although superficial, the left one was bleeding satisfactorily) and bandaged the right one as best I could.  The bleeding was still very heavy though, and before the taxi even arrived, it needed changed.

I called up the stairs to A to tell him that I had been advised to go to Casualty.  He got up and told me that he was coming with me, a suggestion against which I protested, though admittedly rather mildly.

I don’t remember the taxi trip at all, and have only the vaguest recollection of checking in at the A and E reception.  I remember telling the woman that my suicide attempt was one of the most pathetic in history, and being surprised by how much data she was able to access on me from her computer (1984 is with us, readers).  I also recall that the waiting time was estimated at seven hours, but for some reason I allowed myself to believe that it would never come to that.  How absolutely and completely wrong this assumption proved to be.

To be fair to them, I was very quickly seen by a triage nurse, who opined that the slit on my right wrist probably needed stitches.  She put steri-strips on it to close it as much as possible until such times as I was seen by a doctor.  She was a young girl – I’d guess younger than I am – and was remarkably sympathetic.  I was bawling my eyes out like a bloody baby by this stage, but this girl did not try and rush me, nor patronise nor judge me.  She simply listened and tried her best to be supportive.  Alas, though, eventually I had to go back to the waiting room.

And so it began.  The mind-numbing, seemingly endless, hideously interminable wait.  It is, I imagine, exactly what the final wait on death row is like – though at least if you’re a suicidal, schizo bitch you can expect a satisfactory outcome at the end of that particular interim period.  I had no idea what to expect at the end of this one.

Wait.  Wait.  Wait.

Heat.  Heat.  Heat.

Atrophying mind.  Atrophying mind.  Atrophying mind.

If swear to God that if one wasn’t suicidal to begin with, it was enough to make them so.  I can’t describe why it was so bad, but it was.  It really was.  Thank God for Twitter (on which I will remark later) on my mobile, though of course the bloody thing’s battery packed in on me eventually, leaving me once more to the doom and nothingness that was Casualty.  Well, I know earlier I was extolling the virtues of nothingness, but that particular brand of nothingness has the decency to lack consciousness.  The A and E version does not demonstrate such wonder.

After the seven hour mark had passed, I went back to the desk and asked was I going to get seen.  By this point it was after 9am.  The woman consulted with a doctor and, interestingly, he almost immediately proceeded to take me through the double doors of doom.  I’ve said it before, but I’ve wondered are there gas chambers through there.  I felt like I was walking the plank.

I was led to a room that, aside from the lack of bars, did a wonderfully accurate impersonation of a prison cell.  It, like the waiting room, was painted (if you could call it that) in one of those bland non-colours that are designed to half-sedate people into compliance.  Just like they have in customs halls at airports.  I was utterly exhausted, mentally and physically, yet my agitation just increased more on arrival in this room.  I found myself barely able to even speak to the doctor, though he seemed like an amicable enough man.

Amicable…but competent?  I’m not sure.  He asked a few questions then went to call the liaison team from the bin, without examining my wrist.  I called him back and asked him did it not require stitches.  He looked at it, in a horribly cursory sort of way (without even removing the steri-strips), then declared that that with which it was already dressed was “quite adequate”.

Again, I’m not sure.  The cut was pretty deep and the resulting blood loss, whilst not life-threatening, had been relatively considerable.  It wasn’t as deep as the (accidental) cut to my finger a few months ago, but it wasn’t that far off it.  Lovely GP told me that I should have had that injury stitched, so I was surprised at this doctor’s belief that this one didn’t such treatment.  I was especially surprised that he didn’t remove the steri-strips to check.

Surprised, yes, but at the time I was so indescribably fed up and so unbearably consumed by exhaustion that I didn’t care.  I just wanted to go home (so any attempt to admit me to the bin would not have gone down well, not that I’m sure I’d have had the energy to fight the bastards).  I said so to the doctor, who said that he wanted the psychiatric liaison woman to see me.  I asked how soon that was anticipated.

“Oh, she’ll be over shortly,” he said nonchalantly but apparently genuinely.  Based on that premise, I agreed to stay and meet the woman in question.  I went to get A and brought him back to the cell, where at least he was able to sit in a slightly more comfortable chair.  I used much of the time between the departure of the doctor and the arrival of the mental woman to apologise to A.  I was horrified that I had put him through such trauma.  From my own perspective, I didn’t – and frankly don’t – give a toss about my suicide attempt, but I absolutely abhor myself for putting him through it.  I kept telling him that his life was better before he met me, which as far as I can tell it indubitably was.  He denied it, claiming that he had been lonely prior to the crossing of our paths.  But surely loneliness is preferable to having to tolerate a borderline freak with a scalpel fetish on a daily basis?

There was plenty of time for such apologies.  Plenty indeed.  The doctor left my cell about 9.15am, and the woman from psychiatry finally arrived just before 1pm, after three enquiries from A to staff about her whereabouts.  If anything this waiting was even worse than the seven hour one of earlier; perhaps it was because we were so completely brain-dead exhausted by then, or perhaps it was simply because the ‘examining’ physician had strongly suggested that the wait for this woman would be pretty short.  It must be that, in A and E, anything under three years is short.  Absolute fucking shit.

Anyway, eventually she did arrive, just as I had finally persuaded A to leave.  I figured there was no point in both of us losing even more of our wills to live (not that I had any in the first place, but you know what I mean), and in any case the poor cats needed fed.  So as I went to a “more private” room with the woman, off A went.

She was a nice woman, but perhaps unsurprisingly was about as useful as a rolled-up election manifesto being shoved up my arse.  We discussed what has stressed me of late (Christmas, C’s dickery, just general mentalism), self-harm in general, the history of my mentalism, my physical health, my weight (“it’s not uncommon in people who’ve been sexually abused to deliberately but unconsciously become overweight, so as they make themselves – in their eyes – less attractive to potential abusers”, apparently) and current eating habits (don’t eat – binge – throw up), and other related wank that I don’t really remember.  She did keep asking if I still wanted to die, and I kept being very careful with my response.  On the one hand, I didn’t want to lie to this woman who was being understanding and down-to-Earth with me, but on the other I didn’t want to say ‘yes’, and find myself sectioned.  I doubt that I would have been, given the low level of resources that this Trust seems to have devoted to mental health difficulties (this isn’t my usual Trust, for the record, as this all took place at A’s house and my normal Trust is based on my address at my mother’s house), but it was always a horrible possibility.  So I just said that I didn’t know.

I told her about C’s intention to cut my psychotherapy short and about VCB constantly fucking me about.  I also told her that I now have a new VCB, a woman who I am to meet for the first time on Wednesday.  The liaison woman reckoned she knows NewVCB, and says if it is indeed the same woman that she is “lovely – really bubbly and friendly.”  That’s better than her predecessor I agree, but ‘bubbly’?  How does a mental who’s just tried to catch the bus deal with someone chirping about and loving life?  Fuck.

The long and the short of it is that she is going to ring LGP, NewVCB and, crucially for me, C, tomorrow morning to report on Friday’s occurrences.  I say ‘crucially’ regarding C as I profoundly do not want him to know about this.  A and A’s best mate W (who A was keeping in touch with during this whole episode via text message) both place the blame for my suicide attempt solely at C’s door.  Naturally I have been trying to defend C.  I have my own psychological agency; he is not responsible for my actions.  A agrees, but still strongly believes that what he feels is C’s ineptitude has at least “precipitated” this.  I don’t know what I think.  I just don’t know how I am going to face the man after this.  I don’t see why I should be so mortified – after all, A, W, all my Twitter friends and now all my blog readers have been party to the most minor of details in relation to this, and C will know a mere few (unless I confide further in him, which as of this writing does not seem likely).  I suppose that I am worried that he too will think that I did what I did solely because of him, and I don’t want him thinking (knowing?) that he has that level of power over me.

Anyway, the woman told me that when I got home I was to give the scalpel and its associated blades to A.  I protested most vehemently against this.

“If I want to kill myself, I’ll find a way,” I said.  “Removing the scalpel will not prevent that, but it will prevent the only real outlet I have for calming my mentalism when it’s at its worst; non-suicidal self-harm.”

She said, “have you ever been referred to a self-harm team?”

I responded in the negative, and she said that she would, therefore, try and refer me to one.  It is difficult because I officially live with my mother, and therefore in a different Trust area – my Trust, surprise surprise, doesn’t have a self-harm team (one thing I ranted about in the advocacy letter, at C’s suggestion).  Nevertheless, she said, she will try.  So I suppose that was one positive to come out of the whole awful experience.  As I said to her, I actually don’t want to stop self-harming as things presently stand; it is the only way to cope sometimes.  What I do want, though, is to want to want to stop it.  I don’t put much faith in these self-harm team people really, but it is at least an avenue to explore.

She once again asked if I had any thoughts of going home and trying again to kill myself, and once again I made some sort of ambiguous noise.  However, she took this as a ‘yes’, and to that end took me back to the doctors’ station to seek my discharge, which was instantly given without any further examination or questioning.  I left, and walked home alone.  I had been there 12 hours, and not a thing of any use – save for the possible self-harm team referral – had occurred.

When I got home I found evidence of what happened all over the living room floor.  Mercifully, there were no blood stains on the carpet, but there were maybe eight tissues that were absolutely saturated.  Blades lay scattered everywhere, though the scalpel itself was curiously absent and has remained elusive (A swears he didn’t find it).  I tidied the place up, grateful that A had been seemingly oblivious to it all.  He had had enough trauma.

I found him in bed listening to the radio.  I crawled in beside him and begged for his forgiveness, and I am very lucky to be able to report that it was granted, on the proviso that I don’t do this again.  I promised I wouldn’t, though A wonders if that is a promise that can be kept given how strong the compulsion to die can be at times.

All I can say is that I will try my best.  I really will try my best.  To look at it from a cynical perspective, I really don’t want to have to go through 12 hours of unmitigated hospital shite like that again.  The inadequacy and comical inefficiency of the NHS never ceases to amaze me.  I mean, OK – had there been some big emergency in, I could have understood the waiting there like complete numpties for 28 years – but there wasn’t.  There were a handful of other minor injuries, so it was just complete and utter shit.

How do I feel now, about 30 hours after getting home?  I feel remarkably not-too-shit, though there seems to be a permanent, cynical sneer across my face (though that was quite possibly there long before Friday night).  I still think the world is a shithole and that my life is a mess, but I am simultaneously touched by the generosity of some people, both out there in the ether and here, in ‘real life’.  See here and here for just some examples of individuals that prove that Twitter is very, very far from the facile, meaningless shite that many in the media present it as.  I fully believe that were it not for Twitter, I may well have successfully killed myself in the last nine months – not on Friday probably, admittedly, but at some juncture.  It is the best support group that I can imagine.

W and of course, in a beyond-words sort of way, A, also prove that maybe, in the midst of all the darkness, there are some people who make this existence less shit.  I am grateful that people care.  I hate my life, very profoundly do I hate it, but in terms of having people to give a shit, I am glad to declare myself a fortunate individual.

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The Advocacy Saga Continues…

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

Following on from the original letter to the advocacy charities and the inadequate response received, here is the latest. I will also be sending the original letter to my Trust’s Patient Council.

Hopefully I will not have any more two-posts-in-one-day-marathons for a while.

Dear Admin Woman Who Wrote to Me the Other Week

Re: Advocacy

Thank you for your letter dated 4 January in response to mine of 17 December. I must confess to feeling very disappointed by the surprisingly brief response of your advocate; however, I did take the advice given, and I discussed the matter with both my consultant and, again, my clinical psychologist [actually, I didn’t discuss this with the consultant, as I don’t see her until Wednesday, but they will never know. C absolutely assures me that it is not the consultant’s decision, but his].

Both advise me that the length of treatment provided by the psychologist is decided upon by the psychologist himself and not the psychiatrist as your colleague believed. My psychologist unfortunately maintains his position of ceasing psychotherapy after the period previously specified (now 22 weeks from today), despite acknowledging that my illness should really be treated through long-term therapy. This contradictory position is a clear illustration of what seems to be unwillingness on the part of the Trust to prioritise and allocate adequate resources to the treatment of mental illness.

In light of the above, can I please again ask that your advocacy service looks at this case. I am very concerned that if treatment is halted prematurely that not only will I have failed to have made any significant progress, but that in fact my mental health will be seriously negatively affected. Arguably, given the number of difficult issues that therapy brings up for an individual, starting but not completing a full course of therapy is more damaging to a patient than receiving no treatment at all. I would be extremely grateful for your help, as I do not feel that I have the cognitive resources to fight this battle against what amounts to medical negligence myself.

To summarise, the decision to cut short my treatment has no proper basis in a clinical analysis of my condition. The clinical literature is very clear that borderline personality disorder requires more intensive and longer duration treatment than I am being offered. I would suggest that this is an illustration that the Trust is not appropriately prioritising the allocation of resources to the treatment of mental health difficulties. I would hope and expect that this is a matter of concern to Mindwise and look forward to hearing from you soon.

Thank you in advance.

Yours etc.

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

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

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Victories and Failures: Updates on *Those* Letters

Posted in Context, Everyday Life, Moods with tags , , , , , , , , , , , , , , , , , , on Saturday, 9 January, 2010 by Pandora

Let’s deal with these chronolgically and, coincidentally, in order of bad to good.

FAIL

On 17 December, I wrote to two mental health advocacy groups (Mindwise and the Northern Ireland Association for Mental Health) regarding the whole ‘you can only have 24 more sessions’ bullshit with C.  Both have now responded, and both have represented something of an epic fail.

Mindwise simply told me to discuss the matter with my consultant psychiatrist, as “they would be the ones making the decision”.  Well, I will, when I see my (new!) consultant on 20 January (over a month late, might I add).  However, as regular readers will know, Psychiatry have been one of the problems I’ve been having with the NHS during this most recent breakdown (though to be fair, this was not outlined in the letter).

Talk about passing the fucking buck.  It was simply a case of pushing responsibility onto someone else, and not wanting to tackle my case themselves.  Is it because I is borderline?  Everyone hates a borderline, innit.

Should the meeting with the psychiatrist not yield results, though, I am going to write pompously back to these tossers and demand their assistance.  Either that or the media will be learning of their incompetence and unwillingness to help a mentally ill individual, which is exactly what they exist for.

I heard from NIAMH yesterday.  Apparently, their advocacy service does not operate in my Trust area.

Forgive me, but is it not the NORTHERN FUCKING IRELAND Association for Mental Health?!  At no point does the name of the charity remotely infer that it is not operational across the entire country.  How, then, can they not operate in my Trust area?  Is it because I is borderline?  Everyone hates a borderline, innit.

In fairness, at least they did suggest some sort of action I could take.  They said I should try the Trust’s Patient Council service, who apparently deal with matters like this.

I will heed their advice, especially given that a Twitter friend had some results via the Patient Council in his area, but not until I have heard back from the Trust, who were copied in on the original letter.

POSSIBLE WIN

As you know, the advocacy letter was copied to the Chief Executive of the Trust.  Not wanting to be arsed himself, the individual in question passed my letter to the Director of Mental Health services.

This bloke wrote back to me a few weeks ago, telling me that he had requested more information and that he would be in touch once he had received same.  I have not heard more from him yet, but am hopeful that the mere act of kicking up a fuss like this and threatening to contact the politicians and the media might be enough to get some action from him.

I won’t hold my breath, of course, but I will cross my fingers.

WIN

HAHAHAHAHAHAHA!  Asshole GP has backed down!

Apparently, Dr Bellend/Twatbag/Arsehole/whatever-else-I-called-him “would like to apologise” and accepts that his attitude fell short of “desirable [surely ‘necessary’?] professional standards”.  Ha!  Muah-ha-ha-ha-ha-ha!

The letter went so far as to offer me the opportunity to meet the Practice Manager and Dr Knobjockey to further discuss the matter.  I will not accept the invitation, but I suppose it was good of them to offer it.

As I have generally been well supported by the practice (recently, at least), I won’t be a dick over this.  I’ll write back and accept Dr Fuckwit’s apology, and just hope that I won’t have to see him again.

MEH

And that, folks, is the latest news on that front.  I feel smugly satisfied about the GP letter result, but of course am rather disappointed that the advocacy charities are not actually doing anything that remotely resembles advocacy.  But we shall see how this continues to play out over the next few weeks.

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Flogging a Dead Horse with C – Week 35

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

He said, “are there children living there?”

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

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

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

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

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

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

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

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

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

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The Latest NHS Complaint

Posted in Mental Health Diagnoses, Moods, Triggers with tags , , , , , , , , , , , , , , , on Monday, 4 January, 2010 by Pandora

The week before Christmas, I had to see a GP that I don’t normally attend, owing to the fact that LGP is so popular that I couldn’t get an appointment with him. The appointment was mainly to confirm the diagnosis of IBS, given as I had a number of blood tests to rule out other conditions. The below, addressed to the surgery’s Practice Manager, details what took place in the appointment.

Dear Sir or Madam

Re:​ Complaint

It is with regret that I am writing to you in order to make a complaint about an appointment that I had with Dr Arsehole on Friday 18 December 2009 at 8.40am. In particular, I wish to make my views known about Dr Twatbag’s dismissive and patronising approach in relation to my health issues.

The appointment was primarily scheduled to discuss a physical health problem. I had been told previously by a colleague of Dr Shithead’s that medication was available to assist in the management of this condition, a fact that Dr Wanker confirmed. However, he then refused to prescribe me anything to alleviate the severity of my symptoms, citing my age without providing any substantive reasoning. I am baffled as to the relevance of an individual’s age to their need or otherwise for medication, and was not offered an explanation. Furthermore, Dr Knobjockey chose to fixate on my weight at this juncture. I do recognise that I am overweight, but as intimated to the doctor, have recently been dieting and exercising, resulting in the loss of over three stones. Despite my attempts to make this clear, the physician continued to speak condescendingly to me about the strain on resources that the “obesity epidemic” is causing.

However, it was a discussion around my mental health that caused the most offence and which, in my view, demonstrated not only a lack of sympathy for mental illness, but in fact ignorance surrounding this group of health conditions. When I asked for medication to help combat insomnia and anxiety, Dr Bollockfist refused, in an irritable and frankly almost hostile fashion. In the past I have been refused these medications, and would certainly not issue a complaint on those grounds alone. However, I do not think it is unreasonable for me to have expected this request to have been denied respectfully and sympathetically, with an explanation of the reasoning.

Regarding my chronic sleep deprivation, Dr Cuntfeatures unhelpfully told me that a lack of sleep, no matter how long-term, “won’t kill [me]”, failing utterly to offer any practical help or advice on the matter. Perhaps this is, literally speaking, true, but this denies the extremely serious effects a lack of sleep can have on normal daily functioning. I am also fairly sure that this does not constitute professional advice nor assistance. I should not have to point out that forced sleep deprivation is used as a form of torture.

Dr Bastardface discussed insomnia that he had experienced following a personal bereavement; whilst obviously I have the greatest sympathy for his loss, I fail to see the relevance of the example, and indeed believe that the implied suggestion was that because my insomnia is not necessarily circumstantial that it is therefore somehow less real or less deserving of attention than a lack of sleep caused by a distinct traumatic event. He then, to my astonishment, point blank denied a connection between psychotic symptoms and insomnia. Might I be so bold as to suggest that Dr Dickhead researches this more fully; insomnia is, in fact, well known to cause or increase psychosis and the symptoms of psychiatric illness (source).

In discussion of the illnesses that (at least in part) contribute to the aforesaid, I was dismayed by the allegation that I was simply trying to “medicalise” my conditions. I do not believe this to be fair at all – I am presently undergoing intense psychotherapy and merely wish to try and manage my symptoms until it has reached a satisfactory conclusion (incidentally, please see the enclosed letter to Mindwise regarding the disturbing possibility of a premature cessation of this necessary process. If I cannot receive psychotherapy to sort through my illnesses psychologically, I fail to see what choice I have but to seek medical intervention). I would add, also, that even if I were ‘medicalising’ my illnesses that they are, indeed, at least partly biological. Borderline Personality Disorder is thought to exist in individuals with a biological predisposition (sources) and bipolar disorder is considered primarily a medical illness (sources). Both are, of course, considered serious mental illnesses, having disproportionate rates of psychosis, suicide and self-harm (sources).

Incidentally, I noted with interest that my file does not reflect these diagnoses, still stating that I suffer from depression and anxiety. Whilst these co-morbidities do exist, my primary diagnosis is BPD (with psychotic features) with a differential diagnosis of bipolar disorder, type II.

Overall, it was not so much what was said that upset me (though I felt that to be lacking too) as the manner and tone in which it was said. Although I felt Dr Bellend’s response to my physical complaint was inadequate, it was at least presented fairly amicably by him. His attitude to my mental illness was, however, dismissive, unsympathetic and thoroughly unhelpful – I would say it bordered on disdainful, indeed.

Whilst I appreciate the subjectivity of this judgement, I would hope that the fact I have never made a complaint about [the practice] in my life until now would indicate that I am not wont to take things out of context. Unfortunately I got the distinct impression that the physician was dubious as to the sincerity of my illnesses and that it was felt that I did not have ‘real problems’ (though should he require a list of traumatic events that have helped to contribute to my psychiatric illnesses, I should be happy to provide same). It is sad that such stigma is not only present in society, but apparently in the medical professional also. Dr Cockhead, like anyone, has a perfect entitlement to hold such a view privately, but given his chosen career should not allow it to impinge on his professional practice.

I would like to make clear that, in general, I have felt very much supported by the professionals at the practice – in particular, I would like to thank [LGP], [the Nurse Practitioner] and all the nursing staff for the support, respect and professionalism that they have shown me. I have also had the pleasure of having positive interactions with Dr Ballbag in the past, and would therefore hope that this incident merely represents a ‘blip’ in the professionalism of his practice. However, given the distress it caused me and the apparent lack of awareness that it represents, I felt that it was imperative to bring it to your attention.

Thank you for your time.

Best regards.

Yours etc.

Enc (of the letter to the advocacy service).


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The Advocacy Letter

Posted in C, Context, Everyday Life, psychiatry, Psychotherapy with tags , , , , , , , , , , , , , , , on Thursday, 17 December, 2009 by Pandora

Dear Sir or Madam

Re: Advocacy in Accessing Mental Health Services

I am writing to enquire as to my rights and to what extent you can assist me in accessing the services to which I am entitled.  I am diagnosed with borderline personality disorder with psychotic features with a possible co-morbidity of bipolar disorder, type II.  I take anti-depressant and anti-psychotic medication, and although I only received the diagnoses in June 2009, I have been utilising mental health services both on the NHS and  in the private sector since 1998 (having originally been diagnosed with clinical depression and social anxiety).  The care that the NHS has provided has always been wholly inadequate; until recently, any therapy I have been offered has either not come to fruition, has ended abruptly or, in one incident, has seen me being regarded with outright hostility.

Since 29 February 2009 I have been seeing a clinical psychologist on a weekly basis for psychotherapy broadly of a psychodynamic nature (though the  approach is integrative).  As of today’s date, we have had 35 sessions in total. It has taken me some time to fully open up to and to trust this psychotherapist, but now that I have, I feel that progress is being made, albeit slowly.  I believe that further progress can be made through this relationship.

Unfortunately, my psychologist has informed me that he can only continue to offer me therapy for 24 further weeks (starting from the next session).  This would, of course, equal 59 total weeks of therapy (including three assessment sessions at the start, and four sessions to end the therapy).

As you will be aware, all published research on borderline personality disorder strongly recommends long-term therapy for the condition. Indeed, NHS and NICE guidelines on this illness and on personality disorders in general completely contradict the view that one year’s worth of psychotherapy is remotely adequate treatment.  I believe that the New Horizons consultation recently undertaken by the health service would not support this situation either.  I strongly believe that not only is long-term treatment advisable, it is in fact necessary to deal effectively with my condition and therefore I feel that it is my entitlement.

Whilst I appreciate that resources are limited, I am frankly disgusted by the postcode lottery that seems to be in operation.  For example, I am aware that there is a specific self-harm team within the <other NI area> Trust – whilst self-harm is not, of course, by any means the only symptom of BPD, I am sure that this team would work frequently with individuals with this diagnosis and would thus understand it well.  Furthermore, I am familiar with several other individuals that have this (and other) disorders – in most cases less severe than mine – that have received guarantees of treatment lasting at least two years (in some cases) and three years (in one).  I have yet to encounter a single other individual who has received only a year’s guaranteed treatment.  My psychologist himself admits that ideally BPD should be treated twice a week for a minimum of 18 months.

I believe that if therapy comes to an end as proposed that I will in fact undergo a significant regression, and probably end up utilising yet more NHS resources.  I am unable to work, and am in the regrettable position of being dependant on state benefits – a situation that I abhor.  Any saving of government resources in cutting short my treatment is, therefore, a false economy.  I also feel that the worry of treatment coming to a close will overshadow my relationship with my therapist thus preventing us from tackling more substantive issues together in the relatively short period we have remaining.

Additionally, I understand from the various guidelines from the health service that multi-disciplinary approaches are considered desirable and indeed necessary for personality disorders.  To that end, I am surprised that I have never been offered access to the CMHT’s social workers, CPNs or occupational therapists, despite presenting symptoms perhaps best dealt with by such individuals in conjunction with my psychologist.  Although I have had one experience of the Crisis Response Team (which, I might add, was an utterly appalling meeting), I have never been advised on how to contact them again in an emergency, of which I have had several in the past year.

I am not prepared for the NHS to once again treat me as a second class service user and am prepared to contact MLAs, MPs, the relevant Minister and Permanent Secretary, and indeed the media in order to obtain the treatment to which I am entitled.  I would therefore be strongly grateful for your advice and assistance on (a) ensuring that I obtain a guarantee of continued psychotherapy, in line with NHS guidelines on the longevity of same; (b) ensuring that said psychotherapy can preferably continue with the therapist I presently see, as of course issues of trust and abandonment are a big part of this illness; and (c) ensuring that I can have access to the full range of services from the CMHT and the Crisis Team in an emergency.

As you know, borderline personality disorder, especially when psychosis is involved, is a severe mental illness and in this case has not been taken seriously.  I feel that this matter is urgent and desperate, and to that end would be very grateful for your help and advice.  Should you require further details, or if you would simply prefer to correspond via another medium, please do not hesitate to contact me via email on <my email address>.  I look forward to hearing from you.

Thank you in advance.

Yours etc.

Copy to: Chief Executive of my Trust

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