Into the system…

blogging, work, mental health, therapy, disability, benefits and more…

Archive for November 2008

Mumbai Shootings…

with 6 comments

I heard the news on the radio this morning as I was still half asleep. My partner’s alarm talked of Mumbai and shootings. I then proceeded to dream (?! I’m not sure I was dreaming, it was that half-state between wakefulness and sleep where your mind can wander and take a life of its own) firstly about contacting the people I know in Mumbai to check they were okay and then about being in a hotel as a hostage. When I returned to the real world and woke up, I couldn’t remember if the texts I sent when dreaming had really been sent. They need to be, but I don’t think they have yet.

I can’t believe what’s going on. I think it’s almost guaranteed that someone from my company would be in one of those hotels and no doubt many of our offshore colleagues were passing through the station. My last project had about 600 staff in Mumbai and I worked closely with some of them (well as closely as you can when there are 4500 miles between you). I hope everyone I know is okay. I hope everyone I don’t know is okay, but it’s clear from the news that isn’t the case. I’m still waiting for my company to send out an email about the events. I am sure they are busy trying to establish if all of our staff our okay, but I am surprised they haven’t sent out anything yet. It is hard not knowing anything.

It’s weird though. This news has kinda snapped my focus away from myself for a little while. I was really low last night and I am still shaky, but I am concerned about others and not myself right this moment. If I do think about how I am, I realise that I’m not that good, but it seems insignificant.

The reality is, the insomnia is pretty much back. I do get a couple drug induced hours of sleep and then wake up and stay awake for hours in the middle of the night. My appetite is waning again. I didn’t eat much yesterday. I wanted to hurt myself last night, but was unable to with my partner around. I don’t think I want to right at this moment. I’m still indifferent to life. I still see no point and I still feel like I am just carrying on for the sake of existing, but I don’t know what else to do right now. Suicide is still there, it’s still a fixation a lot of the time, but I am trying to hold on. I don’t know what I’m holding on for, but at the moment I think I should. We will see.

I am worried about my partner. I think he is on the verge of giving up on me. He only wants me fixed and as I’m not fixing I don’t think he knows what to do. I don’t know how I feel about this.

Written by intothesystem

Thursday, 27th November 2008 at 11:26 am

Past Lives…

with one comment

Over the last couple of days I’ve been reading a lot of my old online journal entries. It’s weird to read back. I have forgotten so much. So many of my entries talk of nightmares, insomnia and mood swings. I blamed hormones back then, but it does make me wonder; was this just illness, unnoticed? I have posts describing agitated depression right back from being 15. I have other posts describing hypomania, yet I did not know to call it that at the time. I just thought I was happy. Other posts are melancholy. Most of them are monotonous, repetitive and boring, but there is some interesting stuff too. I wonder what my psychiatrist would make of my old diaries. I am going to copy out some of the key entries for my life map. I think it will help to flesh it out with my own descriptions of events from the time, rather than my retrospective ones. I’m cautious about medicalising my teenage mood swings though. I don’t really see how I can put them down to anything but the natural course of adolescence.

Aside from that, I’m not sure how I am at the moment. I was a little on the agitated side again yesterday. I struggled to stay still or focus in group and felt a bit irritable, but generally manageable. Today, I have spent a lot of the day in bed and just been cleaning or reading stuff online. Not exactly a productive day.

I am still a little on edge. I am just waiting. Waiting for things to change. Waiting for someone to help. Waiting for someone to tell me what’s wrong. Waiting for the medication to work.. Waiting to feel better… or worse. Waiting to see what happens next. I just don’t know what’s coming and I don’t know how long I can keep waiting. It’s all the same. It is all so pointless. Why am I waiting?

Frustration…

with 5 comments

So since I’ve returned to blogging I haven’t actually had that much time to write about how I’m actually feeling at the moment. I’ve caught up on the past, but not looked at the present, let alone the future.

I’m currently frustrated and agitated. This has basically been the case on and off all week and I’m not sure how I feel about it really. It feels like I’m on edge and it could go either way. I could either become more and more hyper or I will drop off a cliff fairly soon. Neither option particularly appeals, as I suspect any hypomania would be of the dysphoric form. The experience that is a mixed mood is one I am frequently familiar with these days, but not one I enjoy that much. As Seaneen describes it, it’s a particular form of hell. Alternatively, the falling off a cliff is not much fun either and I’d rather not go there if I can!

I saw Dr G yesterday. This is the primary cause of my current frustration. I wrote to her, as I’ve felt that I’ve not been getting anywhere lately trying to talk. I asked about diagnosis again, but she was fairly evasive. She talked about how I had various issues, primarily that of a mood disorder, but there were other things at play. She mentioned the question over a personality disorder diagnosis and was quite vague about this. She said that although personality disorders are one of her specialties (especially Borderline PD) she is reluctant to apply the label of a personality disorder on anyone for various reasons. Mainly she said that it is such a misunderstood label and can often be bandied around to avoid giving treatment. I don’t know if that means she does think it could be applied to me or not. I couldn’t really tell from what she said and I suspect she is still not sure.

I also tried to discuss the best treatment options for me going forward. I explained that I didn’t feel I was making much progress, if any, and that I was frustrated by this. She seemed to think I was making progress, but that it was going to be slow. In terms of therapy, she didn’t think there was much else that we could do. She seemed confident that it will help me to manage my condition and will make a positive difference. So far I’ve not been so convinced. I want it to work and I want it to help, but I just don’t know if it is. In some cases I’ve been using many of the techniques for years to manage my condition, but I’ve just not been able to keep it up over the past few months. These skills just aren’t working anymore and it makes me feel like a failure for not feeling the benefit. CBT frustrates me, because as much as I try to counteract the negative thoughts with evidence, rational thinking and the rest, it doesn’t work. There is still this inner commentary counteracting everything I do, telling me it is all pointless and that I am wrong. I don’t know how to stop it. I sometimes wonder if I am just too ill for therapy at the moment. A lot of the time I just feel like I cannot engage and make the most of it. I don’t know when or how that is going to change.

She also went over my meds. She wanted to put up the Venlafaxine, but decided it was probably not a good idea due to agitation I had been experiencing. She’s going to review in about ten days, but said she may put it up then if I’m not feeling much improvement. We also moved all the quetiapine to a night dose, so I’m now on 225mg Venlafaxine in the morning and 350mg quetiapine at night. I am not sure how I feel about the quetiapine. I suspect without it I’d be sky high or unbearably agitated, yet I hate the numbing feeling it leaves me with a lot of the time. I just feel fuzzy, foggy and empty a lot of the time, but maybe that’s not the quetiapine at all. Maybe that is just how I am at the moment. I don’t know.

I left her office feeling extremely frustrated and even more agitated. I didn’t know what to say. I just felt like I wasn’t getting anywhere. She is still avoiding the question of diagnosis and is still telling me to be patient and keep trying. This was not the answers I was looking for. I had gone in there with my notes, hoping that I’d get some answers to my questions, but the reality is I left with the same questions I entered with and a feeling that she isn’t really listening. I don’t know if that is really the case, or if she is just powerless to help. She doesn’t think there’s much else we can do at the moment. She tells me there are no guarantees, but she hopes that I will get there slowly with the right medication, right therapy and enough will power and patience to stick at it. I don’t know how I am going to find the will. I just feel that I am battling and battling and not getting anywhere. Every step forward is followed by two steps back. I didn’t really know how to tell her I am so close to giving up. I cannot handle the waiting and uncertainty much longer. I can’t handle feeling like this much longer. I don’t really see where I am going with this and don’t see any way out. It feels like I’m never going to get anywhere, I’m never going to get better, I’m never going to understand this illness, I’m never going to be able to really talk to people, I’m never going to just be happy and content, I’m never going to win against the negative thoughts, I’m never going to want to live, let alone know how to handle it. I know that sounds awfully defeatist and pessimistic, but I’m being driven that way by illness, frustration and constant disappointment. I just don’t know what else I can do.

Today I saw Dr N, my GP. As always it was nice to see him, but it’s more of the same really. He was concerned by the agitation, but was convinced the venlafaxine is to blame. He didn’t really know what to say. He said he felt pretty impotent at the moment and it’s true. There’s nothing he can do whilst Dr G is managing my medication. He suggested it might be worth adjusting my meds, but we have to wait and see what Dr G says. He just tried to be encouraging, telling me to try and distract myself and channel the agitation and to just stick with it. I don’t really know what to say to him anymore. He just tells me week after week that there’s no easy solution, but hopefully we’ll get there eventually. I feel like I’m letting him down by not getting better. I feel that I’m letting everyone down.

I think I’m on the edge. The edge of this mood, the edge of reason, the edge of life? I don’t know. I just don’t know what to do anymore and don’t see where this is all leading.

November 4th: Out of the hospital…

with 4 comments

On November 4th, the 28 day limit on inpatient care was reached with my insurance, so I was to be discharged. I had spent the days prior to my discharge panicking about it, knowing I was no better than I was when I was admitted and worrying that I wouldn’t be safe. I did not want to be discharged. I felt safe on the ward and needed the support. It felt like my safety net was being whipped away before I was ready. I couldn’t comprehend life outside of the ward. It was too scary and daunting.

It was clear I wasn’t ready to leave and Dr G said she’d have ideally kept me in for a few more weeks, but it wasn’t to be. When ward round came around that morning, I was in a state. I couldn’t think straight, was shaking and could barely talk. Her words washed over me and I couldn’t comprehend leaving. I was disappointed that she didn’t seem to acknowledge my fear. I know she told me about what support was available to me afterwards, but it didn’t feel like enough to calm my fears. I was terrified.

Later, I met with the therapy coordinator, J and this was a big help in preparing me to leave. He managed to calm me down a little and helped me to accept that I would be leaving. We looked at the options for day care and talked about the things I could do to get extra support on the outside. Eventually we settled on a programme and I had time to pack and get ready to leave before my last therapy session.

I was sad about leaving. Although most people that I had made friends with had been discharged ahead of me, there were still people I knew I’d miss when I left. I didn’t really want to say goodbyes, so it was kinda convenient that my departure coincided with dinner and everyone was in the restaurant. We took my stuff through to the car and then I got ready to go.

It was very weird being free to leave, after spending the previous four weeks being escorted everywhere by a nurse. I had taken some leave whilst I was on the ward, so it wasn’t a completely new phenomena, but it was still quite strange. It left me in a daze and this was kinda how it felt for the next few days really. It’s weird when being at home feels like a strange experience, but that was how it was. I’m still getting used to it really.

Written by intothesystem

Monday, 17th November 2008 at 7:42 pm

October 7th: Into the hospital…

with one comment

When I saw Dr G, I had been told I would probably have to wait about a week for a bed to come available, so I was shocked on Tuesday 7th when I received a phone call from admissions at about 9.30am. They asked me if I could come in for 11am as a bed had become available. I told them that there was no way I could get ready for then, so we agreed on 2pm. I then realised I had a mad rush to get ready.

I had to go shopping. I had no clean clothes and I needed underwear, nightclothes and slippers. My partner came home from work and we made a mad dash to pack and get the things I needed. We got ready and drove to the hospital ready for my admission. I was shown into one of the consulting rooms and asked to wait for the doctor. When they came, my other half left me to it and I went through the admissions process. The doctor on duty was terrifying. I didn’t like him and so rushed through the questions as fast as I could, leaving out loads of information. I hadn’t realised that the questions would be forming the basis of my initial notes and that they didn’t have access to the history I’d already given Dr G or I’d have made more of an attempt to be open and honest. I really didn’t like him. After the questions I was shown to my room and then came a short physical examination, which proceeded to make me feel very uncomfortable. He poked and prodded me and then handed over to the nurse. I was left for a while and then the nurse came back and asked me a few more questions, got me to sign a few forms and explained that he would become my “named nurse”. I was then left to settle in. I didn’t know what to do with myself. Slowly I unpacked my things and found my way around the room.

I was on 1 in 30 observations, so a nurse popped their head around the door every thirty minutes. Most of them introduced themselves the first time, but there was no way I’d remember any names. I was far too anxious and uncomfortable. Later someone asked me if I wanted to go to dinner or to order something to my room. I decided I had to brave the restaurant sooner rather than later, so agreed to go and get something. I was on escort, so that meant a nurse had to walk me between the different buildings, including the short walk to the restaurant at meal times. This was a status that was to remain the whole time I was an inpatient. Usually people were only on escort for a couple of days whilst they settle in, but they were anxious that I would do something stupid and insisted on keeping a regular eye on me. It was weird though being followed by a shadow all of the time.

On my first night I was met by a very manic patient, A, who decided she would introduce me to everyone. This was terrifying, but I was glad of it. She dragged me into the lounge and announced me to the fellow patients. I stayed for a while and talked to people, but I was pretty nervous and really wanted to run and hide in my room.

The next day was awful. I spent most of it alone in my room feeling terrible, occasionally interrupted for blood tests, a therapy assessment and other admissions rituals. The nurses would pop their heads around the door regularly and every time I was asked if I was okay, I would say yes, no matter how bad I felt. I began to look for ways to self harm and this became a focus. I didn’t know what else to do.

Thursday brought my first ward round, but I can remember very little of what happened. I can’t even remember if it was multi-disciplinary or one-on-one. I think it was MD, but Thursday ward rounds were usually 1:1 so I can’t be sure. It did bring about a change in medication. The Citalopram was to be phased out and Venlafaxine was to be phased in.

I also got to start therapy, which was a relief. It gave me something to fill my days with and stopped me staring at the wall, thinking about ways to hurt myself. This coincided with a fairly dramatic lift in my mood. I went from being suicidally depressed to hypomanic in a matter of hours and by Thursday evening I was running around the ward with A, both of us as high as a kite. I was agitated and couldn’t keep still, my mind racing at a million miles an hour. I retired to my room when I realised I was probably driving everyone else mad and then proceeded to draw all over my legs and entertain myself by listening to The Ting Tings on repeat. I don’t know what time I got to sleep. It was late. Friday was a continuation of this mood, but things started to darken on Friday evening. The weekend was spent on the ward and my sister visited, bringing cakes and presents.

The rest of my admission is all a bit of a blur. It was a great big melting pot of therapy, medication, mood swings, anxiety, depression, suicidal thoughts, lots of self harm, which was getting increasingly out of hand, ward rounds, nurses, visitors, CBT, art, agitation, friendship, talking, TV and jigsaws.

October 4th: Tell the parents…

with one comment

I really didn’t want to tell my parents. I was too scared of their reaction and had been hiding everything from them for so long I had no idea where to start. My partner tried to convince me and told me that if I didn’t tell them, he would. I realised I had no choice, so agreed that I would try and tell them. In the end, I wrote them a short letter explaining that I had been off work due to depression and was going to be admitted. I avoided the gory details, but explained some of what had happened in the lead up to my admission.

It was a coincidence that my parents were going to be in the Midlands on the Saturday, so I arranged to meet them at my sister’s new uni house. When we arrived it was strange. We just did all the normal stuff. Got shown around the new house, handed over presents and sat in her room. I was nervous and wanted to get it over and done with, but knew I had to wait until there was a suitable time.

I told my sister first. I gave her a copy of the letter and told her to read it. I told her I had something I needed to tell her and that I wasn’t pregnant. I knew that would be the first conclusion everyone would jump to. She cried lots and I didn’t know what to do. She was sympathetic, but I hated that.

Afterwards my parents came in, so we got them in the lounge and repeated the ritual. Handed over the letter and asked them to read. They were shocked. They asked some questions but mostly just exclaimed over how shocked they were. My mum went pretty quiet. They told me they’d support me, but it was just very weird. I don’t know if it was a relief. I think it must have been, but I was just so nervous I don’t think it felt like it at the time.

We went for a meal later and things proceeded as normal really. There were a few awkward questions about what I expected would happen during my admission and what the long term aims were, but generally it was okay. I was glad to escape afterwards though.

Written by intothesystem

Monday, 17th November 2008 at 7:41 pm

September/October: Meet the Shrink…

with one comment

Late September: Referral to Psychiatrist

I returned to Dr N shortly after my trip to A&E. I was embarrassed about my previous visit to him and quite apprehensive, but it was okay. He was lovely as ever and showed his concern. He apologised for sending me to A&E, but pointed out he had to. He was concerned that I could have taken something else and not be telling him, so needed to get things checked out. I explained what had happened in A&E and following, with the crisis team. He was pretty shocked and disappointed that they hadn’t offered me more support or a proper assessment.

I questioned him on the borderline thing and he kinda avoided the question, horrified that the A&E department had been stupid enough to show me the letter, but did suggest that he wasn’t attempting to make a psychiatric diagnosis, more trying to assure I got the right attention in A&E. I wasn’t really happy with his response, but nevermind. He’s since redeemed himself.

Anyway, I asked him what other options there were and reminded him of my health insurance. In the end we agreed that a referral to a private psychiatrist was probably the best option and he arranged to do this.

When I saw him again, he explained he was referring me to Dr G and had written the letter. When I got to see the referral letter I was a little horrified. It was hard to see everything in black and white, honest and accurate as it was.

The referral process was quick and I managed to get a cancellation. An appointment was booked for October 2nd.

October 2nd: See Consultant Psychiatrist, Dr G.

I was absolutely terrified before my appointment. So terrified, I managed to miss the turning on my drive there and took a while to realise I was going in the wrong direction. I was not really in the right frame of mind to be driving. I got there safely though and was pointed in the direction of a waiting area. She was running quite late, although no one thought to tell me, so I sat there nervously looking at the clock, worrying I’d been forgotten or was in the wrong place. Eventually she came down to find me and led me up to her consulting room.

I was relieved to see there wasn’t a couch. I was terrified I’d have to sit on the cliché psychiatrist’s couch. No one prepares you for what it is going to be like, so I was relying on Hollywood’s interpretation of the psychiatrist for clues. I sat in a small, blue armchair and she began. She explained that the session would take around an hour and that she wanted to go over some of the things discussed in the referral letter and gather an overall history. Then she left it to me to talk.

I am not good at talking. I find it very difficult to open up, but I knew I had to if I wanted to make the most of her expertise. So I went through things. I probably forgot stuff. I was very nervous and didn’t know what to say, but we got there. Afterwards, she wanted to lay out the options for how to proceed. We discussed medication and Quetiapine (Seroquel) was brought up as a possibility. Then she dropped the bombshell. She thought I should come in as an inpatient. I was completely shocked by this and did not know how to react. I had not expected it. She did say if staying as an inpatient wasn’t an option, day care would be the second best thing, but she really wanted me to stay. I couldn’t really think straight after this. I was worried about what my other half would think and terrified at the prospect of being admitted.

At the end of the appointment, she showed me down to the ward and the woman in admissions showed me around. I think they wanted me to see that it was more like a Travelodge than a hospital and were trying to put me at ease. There were no beds available so they explained I would be put on a waiting list and it was up to me if I accepted and came in.

A million thoughts were racing through my head after this. I was worried about what my partner would think. I was anxious about the argument that was likely to follow when I told him. I was worried it was all an overreaction. I worried that maybe I’d been exaggerating things to make them seem worse than they were, yet at the same time I was glad to be taken seriously for the first time. I was cynical and thought that she probably just wanted to make the most money she could from me. Mostly I was just plain scared. I didn’t know what to expect and also knew that if I was to be admitted I would need to tell my parents.

An argument did follow and it took a while for my partner to come around to the idea. He didn’t want me to go in at all. I’m not sure he had realistic visions of what it might be like and seemed to worry it would make me worse. I also suspect he didn’t want me to go because he’d miss me and he was probably worried about not having me around to look after the house too! He did say that he wouldn’t want to visit me there and considered going away for a few days, but in the end he didn’t.

I also went and saw Dr N to get his advice. He agreed that I should be admitted and was glad that I was finally getting some support. He told me he’d have wanted me admitted to the local NHS unit if he thought it would do me any good, but said that it was so terrible it would probably do more harm. I think that’s a sad reflection on NHS mental health services. He also told me he’d been a ward doctor at a Priory hospital for a while, so knew what it was like and thought it would be beneficial. We talked about the benefits of staying over day care, such as not having to drive to and from the hospital after a challenging day of therapy. He really helped me to make up my mind and I made the decision to be admitted.