Into the system…

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Archive for November 2009

Waste of Time…

with 15 comments

So I saw Dr D today for the second time. My social worker came in with me, along with a junior doctor who looked about 12.

I didn’t know where to start. I had taken some notes with me which helped a little, but I’m not sure how much he actually paid attention. I ended up having to explain most of my notes when he questioned me.

It seems he doesn’t really know what to do with me. He asked about antidepressants again, but when I reeled off the list of medication I’ve tried, he said I’ve pretty much exhausted the list. He decided to just leave my meds as they are. I’m a little disappointed about this. Although my current medication regime is the best combination so far (as in I haven’t gone *completely* batshit crazy on it), it’s hardly doing the job. I was hoping he’d have a suggestion of something else we could add. It just feels that by leaving the meds as they are, nothing is being done to try and improve things.

I brought up the subject of work and when I was likely to go back. He told me I’m still very ill and that I shouldn’t try to run before I can walk. Clichéd I know. I still find it weird when I’m told that I’m seriously ill. I guess as much as I do know differently, I still have those niggling thoughts that mental illness isn’t real illness. Everyone else’s prejudices still rub off on your subconscious.

I tried to push the subject saying that work were interested to know when I was likely to start a return to work. He just told me not to think about work. He just said the usual things about mental illness not having any exact time-scales. Apparently the CMHT are trying to get me better as fast as they can. I’m not exactly convinced. It feels like nothing has been done to try and get me better so far.

I also brought up driving and he just reiterated the need for me to be “stable”. He didn’t give any indication of what that means, just that I am not well enough to drive at the moment. Apparently all of these things will just happen when I am well again and I shouldn’t think about them. Easier said than done.

I mentioned the EAP therapy and he agreed that it might be helpful for me to have some support whilst waiting for the Enhanced Day Therapies referral to come through. Useless social worker, J was meant to chase up my EDT referral but hasn’t, so we shall see if she does it now she’s been reminded by Dr D. I think he was quite pleased to hear this about temporary therapy because it meant he didn’t have to do anything now himself!

The appointment didn’t last long and just felt like a complete waste of time. Apparently I will see him again early next year. No doubt it will be more of the same.

Regarding the EAP service. Yesterday, I was contacted by one of their counsellors to book an appointment. Unfortunately they were based in Liverpool, which is a two hour trek by bus from here (train would cost me money, bus is free!). I contacted the EAP today to ask if there was anyone I could see in Manchester. They’d linked me to someone in Liverpool because my address comes under Warrington, but Manchester is actually much easier and closer. Unfortunately all of their counsellors in Manchester are currently unavailable, but one comes back from holiday at the end of the week so they are going to ask them then. I guess we shall have to see what happens. If they can’t do it then I will probably give the Liverpool guy a go, but I’m not sure if it will be worth it with all the travelling.

Meh. I really feel crap now. Headache is raging (come on Propanolol! Work!!) and I just feel really demoralised by the crapness of the CMHT.

Written by intothesystem

Tuesday, 24th November 2009 at 6:31 pm

Doctors and EAPs…

with 6 comments

I saw Dr N on Thursday. It was good to have him back.

I wasn’t really with it at the appointment. I couldn’t focus and didn’t know what to say. I have felt pretty numb over the past few weeks and I couldn’t convey how I felt. At one point he just said “Are you okay? Have you been sleeping? You seem like you’re on another planet”. I told him that sleeping was a silly question, which he admitted, but he was right. I was very tired and vague. The fact he’d noticed though was good. It makes a change from other doctors that clearly pay no attention to how you really are.

I explained that I’d been having problems with headaches over the past couple months. I’ve literally had a headache every day for about 3 months, sometimes incredibly intense pain, other times just a dull ache, but nearly always there in some form. Beta Blockers are meant to be effective in preventing headaches, so he was a little concerned seeing as I’m already taking propanolol (for anxiety/agitation). We’ve decided to increase the dose and also switch to the modified release version so I’m now taking 160mg daily instead of 40mg b.d. Hopefully it will have some effect.

On Friday I got a phone call from HR. I have a new HR Rep, R. She introduced herself a couple of months ago, but hasn’t been in touch since. She was meant to call me regularly but hasn’t, so it was quite a long catch up. She asked me about therapy referrals, my social worker and psychiatrist. I told her there wasn’t much to say. Therapy referrals take forever, my social worker is still useless and I don’t see my psychiatrist until tomorrow.

She asked me when my last occupational health assessment was. It was over a year ago, so she said she will look into that again. I don’t know what an OH assessment will achieve. I get the impression they only want me to go so that work can say they are doing something to help. I don’t think there will be any pressure on me to get back to work, but I may be wrong. I guess it depends on the doctor I see. I have the same fears I had about the ESA medical. Fears they will tell me that I am making it all up and should just go to work.

If I do go, I wonder if I will see the same doctor as last time. He seemed to be pretty knowledgeable when it came to mental illness and was the first medic to suggest that Bipolar Disorder was a possibility. Shame it took a further 7 months before an agreement was reached on that topic. When I’d brought up his thoughts later with other doctors they didn’t seem interested. I guess they wanted to make their own decisions.

It may be useful to discuss work though. I haven’t managed to get much of an idea from the CMHT about when they think I will be ready to go to work. I am going to try and talk about it with the psych tomorrow. Dr N keeps asking me if I’ve heard anything from HR or whatever, but there hasn’t been anything to tell. I told him about my medical result too and I think he was a little surprised I’d been placed in the support group, although I think it also told him how ill I’d been on the day of the medical. I am not sure he quite understood how bad it was when I’d told him before.

The other thing R mentioned was regarding our company Employee Assistance Programme. I was told that they had been running a CBT trial and maybe I should consider asking about it. I told her I was pretty skeptical about CBT, but it could be useful to have some contact with a therapist whilst I am waiting for the NHS to do something. I agreed I’d give them a call anyway.

I was on the phone to the EAP for ages. First of all someone took my details and asked why I was calling. I explained I’d been told about CBT by my HR rep. She explained that they only offered telephone and online CBT (I’m guessing Beating The Blues!). I told her I wasn’t sure about that, but she said she’d put me through to the counselling team for an assessment and to discuss what might be helpful.

The counsellor was lovely. I explained I’d been on long-term sick leave for mental illness and that HR had suggested I got in touch. He asked me for a potted history, which I gave him as quickly as I could manage. At the end he just kinda went “oh, blimey”. I mentioned I’d had CBT whilst at The Priory and he asked me what I thought of it. I was honest and said that I was pretty skeptical and generally thought it was common sense, useful for mild depression, but ineffective for me. He asked me why I’d even bothered calling then, which was a sensible question. I said that I guess I thought it might be useful to have some contact with therapy whilst waiting for the NHS. Apparently his assessment of CBT was similar to mine and he didn’t think online CBT was going to be much help. He explained that usually a case like mine would be too complex for them to consider, but he wanted to help. He suggested that because I am waiting for long-term support, but I’m not getting the help I need currently, he felt it might be possible to refer me to the face-to-face service temporarily. It would only be four assessment appointments, but it might help me to work out what I want to work on when my NHS referral actually comes through. I agreed that this may be helpful. He asked me more questions then. Mainly about risk and safety. He stressed that his boss wouldn’t allow him to go through with it if they felt I was at too much risk. I had to give him the assurance I would be safe for the next four weeks, which was difficult even now. I am keeping myself safe at the moment, but I don’t know if or when that will change. At the end of the call he explained he would need to ask his boss to authorise my case, but hopefully it would be okay and then he wished me luck.

I am awaiting the phone call back to arrange my first appointment. He said if his line manager had refused he would call me back straight away and I didn’t hear anything, so I’m hopeful. I do think it could be good to just see someone for a few weeks. I don’t trust my social worker and have very little other support. In some ways I’m hoping it will be the same therapist I saw through the EAP back in April/May 2008, but I don’t suppose it will be, but you never know.

I need to go now. I have more to write, but no time. My bloke is going back to work part-time and I have the psychiatrist tomorrow. I guess I will update more soon.

The ECT Experience…

with 3 comments

Whilst I was having ECT I never really wrote about it. I was in hospital with only mobile access to the Internet. I was exhausted, often in pain and not really in the mood for writing. Recently though I’ve been inspired by this blog and Seaneen’s appeal for ECT info to document my experience. I’m worried that if I don’t do it now, I’ll forget what happened all together.

Ultimately my experience with ECT was a failure. I had 11 treatments, some unilateral and some bilateral. I barely responded at all and in the end we gave up.

ECT was seen as the last resort. I was about as severely depressed as you can get and no one knew what else to do. I wasn’t sure about having it, but at the time I wrote that anything was worth a try. I think I was so depressed I didn’t really care what happened to me. I know I secretly wished it would go horribly wrong, so overwhelming were the thoughts about death.

I went into the treatment with a smidgen of hope as at least we were trying something. I felt little, but I knew my family wanted it to work. We had to believe it would work, as the alternative was too horrible to comprehend. Other patients at The Priory had been through ECT and come out the other end much improved. ECT had been lifesaving for them and I hoped it would be the same for me.

The procedure was a lot less scary than I had feared. We were woken early by the nurses, our blood pressure and temperature taken, then we were bundled into a taxi with the nurses over to Cheadle Royal. The Priory doesn’t have an ECT suite any more, so treatments were taken there.

There was a waiting room, where we’d sit waiting our turn. There was usually three or four of us being treated at the same time. Three from The Priory and a day patient from elsewhere. Eventually we’d be called into a prep room, where a girl would wash our forehead and neck and attach EEG stickers. Next we entered the treatment room. We’d climb onto a bed and Dr Shock would ask us how we felt. We would be attached to the monitors and then the anaesthetist would take my hand and try to insert a cannula.  This was where it got difficult to me. My veins are small and deep and finding one proved near impossible at times. Multiple attempts, hands like colanders and a number of bent needles later and we would be ready to go. After a few treatments like this, the anaesthetist ordered some microwave lavender bags, which I’d be given to warm my hands. ECT quickly became associated with the smell of lavender.

I’d never had a general anaesthetic before my first treatment and I didn’t know how I’d feel. I soon got used to the feeling. Twice a week for nearly 6 weeks, you have little choice. The liquid would ooze into my veins. I could feel the cold liquid flowing in my hand and then I’d drift off into a blissful sleep. When I was ill I’ve never had any other sleep as nice as that. Next thing I knew I was in the recovery area, oblivious to what went on whilst I was asleep.

Throughout my treatment and since, I’ve always been curious to see what happens in between those moments. I often wondered about asking if I could watch someone else go first, but was certain I’d be turned down. I know they apply a current to my brain and I have a fit, but what does it actually look like? Who does what?

A few times I awoke covered in blood. The cannula would slip out during the fit and I’d be left with a red tshirt. The first time it was a bit of a shock and slightly scary, but once I knew what had happened it was okay.

As we woke up, our vitals were taken regularly. Each of us would have a nurse, who would keep a close eye on us, administering pain relief if required. It was always required. An hour after our treatment we would be allowed up and given tea and toast, or water and toast in my case. Then we were bundled back into the taxi and taken back to the ward, where we usually went straight to bed.

At the time, the side effects weren’t so bad. I usually had a thumping headache, more so after the bilateral treatments. Sometimes I would ache all over. My jaw was often painful. My appetite was normally dodgy and I felt queasy from the anaesthetic. My memory seemed to be pretty much in tact. I’d written all my passwords and things down before I went, but I don’t think I ever needed to refer back.

I didn’t really mind the treatments, but I was frustrated at the lack of response. The night before each treatment we’d be given the BDI and would tick the boxes and I couldn’t see any improvement. I know my scores did improve a little, but one or two points is nothing when it is scored out of 60-something and the miracle I was hoping for never materialised. There were a couple of days after one of the early sessions where I became quite hyper and agitated for a short while, but that didn’t last either and could have been down to something else.

One of the others having ECT with me improved fairly rapidly, which was great news for her, but I remember feeling a little jealous. She was discharged from hospital before I’d even finished the treatment, although I think she had a couple of sessions whilst she was an outpatient. The other person improved gradually, but she did improve. She would have a boost for the first day or two after the treatment and the improvement would ebb away, but over time it seemed to ebb away a little slower. ECT definitely helped her to get better, although I don’t know how she is these days. I seemed to stay the same regardless. ECT wasn’t working for me.

Dr Shock would ask me each time how I felt and I never knew what to say. She would tell me I looked brighter, but it felt like she was only saying that to convince herself it was doing some good, not because she really believed it.

Towards the end, I knew we were running out of steam. I could see the medics were giving up. When the decision was finally made I wasn’t surprised but I was disappointed. I felt like a failure and I felt annoyed that it hadn’t worked. It was meant to be the cure and it failed. I felt like I should have tried harder to make it work. I worried it was my fault and that everyone thought it was my fault and that I just didn’t want to get better.

There is something to be said for it. It may not have actually lifted me out of my depression, but I think it did help keep me safe whilst I was at my worst. I suspect my insurance wouldn’t have renewed the funding if I didn’t need to be kept in hospital to have the ECT and at least whilst I was having the treatment I was often too exhausted and unwell to act upon the suicidal thoughts that were so strong at the time. Maybe if I wasn’t being told to wait and see if it worked, then perhaps I’d have been more determined to kill myself. I don’t know. I guess you never can know. Maybe I’d have been even worse if I hadn’t have had it, although I don’t know how much lower I could have got.

After the failure, came the assessment from Dr P and the diagnosis of Bipolar II Disorder. It was suggested that my lack of response to “traditional methods of treating depression”, showed that I wasn’t suffering from “straight” depression. I had suspected that for a long while before, but I don’t know why it took ECT to decide this as I know ECT can be used to treat Bipolar Disorder too. I am grateful for the ECT for accelerating this diagnosis, but it seems an awful lot to go through just to get another assessment.

The long term effects of ECT have only been showing themselves over the last few months. I didn’t think the memory loss was significant, but as you go through life there are reminders of what is missing. People mention things that happened and I have no recollection of them at all. Silly things like ordering a meal in a restaurant commenting that “I’ve not had this before”, only to be told that I did back in April when I went there with my parents. Not only had I forgotten my order, but I’d forgotten I’d even been there with my parents.

It’s not just from the treatment period either, but before too. A lot of last year has disappeared and I only have my blog and my family’s memories to remind me. Distant memories that were once clear are now fuzzy or gone completely. I have lost a lot more than I’d realised at first. They say that the memories will come back with time, but I seem to be forgetting more, not less. I don’t know if it’s just because as time goes on I find out about more of what is missing.

I don’t think my short term memory is that bad. I am forgetful, but I’ve always been a little. For most people it is the short term memory that is worst, but I seem to have got off fairly lightly on that front. I guess this is something.

I’ve alluded to this at other times, but I think ECT has had an effect on my thinking ability too. It’s hard to know for certain, as depression can stunt your cognitive abilities too, but I am not as sharp as I used to be. My partner often says that I’m slow. I am not very quick on the uptake at times. I find it harder to think and harder to solve problems. My arithmetic seems worse than before.My concentration is poor. Even when I’ve been a little high, I don’t feel as capable as I did before. Things I used to find easy can be a challenge. I feel like I’m a little blunted. I pride myself on my intelligence, yet I don’t feel as bright. I wonder if I’ll ever regain what I used to have and if this will improve.

Along with the memory and cognitive effects, there is a physical side effect. The right-hand side of my jaw has been problematic ever since. It locks and it grinds. Sometimes I can’t open my mouth at all. Other times I get shooting pain right through the side of my head, where my jaw is stuck or out of place. I don’t know if there is a solution, but I suspect I will be stuck with this for ever now. It may not be anything major, but it can hurt and is annoying.

I don’t think I’d mind these effects at all if ECT had worked. If I was now stable and free of depression these issues would be worth it. It’s just that for it all to be in vain, it seems a lot to go through for no gain.

I am still disappointed. ECT had been that final resort and was something I could hold in my mind as a possibility for change. For me, I always need to know that there is another option and this was just another one that we have exhausted. When I have run out of options then I will really give up. I don’t think I’d go through it again, even though for some it can work a second time when it had not the first.

All that said, even though ECT didn’t work for me, I still wouldn’t discourage people from trying it. You have to weigh up the potential benefit with the possible effects, but if it works, I think it is worth it. It is usually only used when all else has failed and in that case what else do you have to lose? I have seen it work for others, I am just jealous it didn’t for me.

*Sigh*…

with 4 comments

I don’t really know what to say. I have posts I want to write about specific topics, but I don’t know where to start. Head is a bit fried really and I’m just so unbelievably exhausted.

My social worker came yesterday. I had forgotten she was coming and had a bit of a panic when my phone alarm went off. To put it bluntly, she really is full of shit. She spouted all this stuff about positive thoughts and recreating brain pathways and activating synapses, when she clearly had no idea what she was talking about. She was basically waving the CBT stick at me, but tried to dress it all up in technical language and scientific explanations. I am fed up of her suggesting that all my problems will be fixed if I just apply some CBT, think positively and buck my ideas up. I have done a lot of CBT in the past, most of which is common sense. I’ve been applying CBT methods myself most of my life, long before I even knew what CBT was. How do you think I managed to cope with the depression of my childhood, teens and university years? Things have got worse and these methods just aren’t enough any more. CBT doesn’t work for everyone. There is limited evidence to suggest that CBT works with Bipolar Disorder and severe depression (and apparently that’s what it is) anyway, but still they persist. Maybe if I just try that little bit harder it will? Maybe it’s my fault it doesn’t?

Yesterday, I also managed to cut my wrist. This was an accident involving some wire netting and our fish tank. It’s a clean cut, about two inches long, right across the top of my wrist. The blood poured and I felt this massive urge to make more. I’ve not self harmed at all for a couple of months,  but it was a clear trigger. I’ve never really cut. A couple of times perhaps, but it’s not my chosen method of self harm.

When I was last self harming I don’t think I wrote about it, not wanting to alert my partner to the fact. There was a hammer lying around the house, not put back in the garage after some DIY. I was routinely hitting myself with it, all over my body. Sometimes it would bruise, but these could easily be blamed on the dog. She’s bruised me herself enough times. Other times it hurt like hell, yet didn’t leave a mark.

I can’t remember why I started again. I just felt the need one day in the summer, saw the hammer and that was it. Actually I don’t know if the hammer or the need came first. Maybe I was triggered by it then.

This seemed to help for a while. It released some frustration. Things carried on for a couple of months, but then it stopped as quickly as it started. Again I don’t know why. Soon after, we tidied the garage and the hammer went back.

Now I am struggling with the urge again. I want to hurt myself. I don’t know why. I don’t even think it would help. I just want to do it. I have resisted so far and I will keep resisting but the thought is niggling away. I wonder if I will ever get away from the temptation to hurt. I seem to stop and start without rhyme nor reason.

Written by intothesystem

Tuesday, 17th November 2009 at 1:19 pm

Recovery, Scoring and ESA…

with 8 comments

It’s been a strange week really. I seem to have spent the week being confronted with the fact I’m still a lot more ill than I thought I was.

On Wednesday I had an appointment with Dr B. He’s another GP at my local practice and as Dr N is on holiday for two weeks I had to make do with him. He’s okay, but a little brisk. Every time I’ve seen him he’s made me do a PHQ9 form to assess my levels of depression. It’s similar to a BDI I guess, but with fewer questions and less detail. My score was in the twenties (out of 27), putting me in the severely depressed category. I knew I was still depressed but I’d kinda expected it to have moved into the moderately severe category by now. I do feel better than I did back in February. The depression is less absolute, but I can’t deny that I still think of death and suicide every day, I’m still not sleeping and I still feel pretty tired and down.

For curiosity’s sake I did a BDI as well. I ended up doing it twice as I find it so difficult to decide between answers. My pessimistic score (choosing the worse option if I couldn’t decide) was well over 50. My optimistic score (choosing the better option) was about 45. 30+ is classed as severe depression so it’s a pretty similar result to the PHQ9. It’s a vast improvement on the 60+ (out of 63!) I was scoring in February. I racked up one of the highest scores ever seen at The Priory back then, which is pretty scary really. The improvement is not enough though. How can this be recovery if I’m still in the severely ill category?

I don’t know if I am really severely depressed though, even if my scores say I am. I have been depressed for so much of my life I’m not sure if my results are skewed. I expect even when I’m what I’d describe as well, I’d still be scoring a mild depression score at least.

I was talking about this with a medic friend last night. We were talking about the GPs in the village and I mentioned I’d seen Dr B. She asked me what he was like and I basically said he was okay, but he asks me to do the PHQ9 whenever I see him. She said that GPs are obliged to demonstrate they are giving “adequate monitoring” to depression patients and the PHQ9 counts towards this. It’s interesting as I don’t remember ever doing one with Dr N. I guess he prefers to give adequate monitoring with actually asking me how I am, rather than getting me to select ticky boxes.

I mentioned my scores and how I wasn’t sure how accurate they were. She suggested that sometimes the scores can be a little skewed by insight and they often don’t reflect how well someone is functioning, which seems fair enough I guess. She said I’m clearly functioning a lot better than my scores suggest, which I think is true, but I guess that comes with years of practice in hiding things. I function in autopilot, hiding the thoughts, but the thoughts are still there.

To add further doubts to my idea of recovery I got a letter from the ESA decision maker yesterday. They are finally processing my application under the youth rules and the decision maker has sent the sheet explaining how much I will receive. Looking at it, I’m being paid the amount pertaining to the Support Group. I presume this means they have my medical result and not only have I passed, but I am deemed too unwell to even contemplate work and thus have been placed in the Support Group. This is a big surprise. I had worried so much that I wouldn’t even pass the medical, let alone be placed in the Support Group. I haven’t received the letter confirming my medical result yet, so I wouldn’t be surprised if this is wrong, but it shouldn’t be. I will be interested to see what score I actually received. Another set of points telling me how ill I am.

I don’t know how I feel about being in the Support Group though. In a way it is positive. It means I don’t need to do the pointless Pathways to Work interviews and I also get a little more money, which of course is good. It means there is no pressure to try and get back to work before I am ready. I will not be bullied by the DWP to do so.

At the same time though I can’t help but feel disappointed. I feel like I’ve been written off. I am too ill and disabled to even consider working. That’s something I can’t handle and really don’t want to admit. I want to get back to work and I want that to be something achievable in the near future. It makes me feel like this is all pointless. I want to be recovering and this makes me wonder if I really am. I had felt I was making progress, but that progress is clearly not enough. This is all just fuelling the “fuck it, this isn’t worth it” thoughts. I don’t want this.

I’m a little worried too and I almost feel guilty. I wonder whether this is the right decision. I kinda feel like I have cheated the system because I didn’t expect to pass the medical. I know how notorious these medicals are. I know that hardly anyone passes, let alone gets placed in the Support Group. I wonder why I have got through when so many others haven’t? Am I really that bad? I know I can be in denial and I guess in a way these doubts show that, but I am still unsure. It just feels a little wrong.

I wonder if this process is designed to make you feel guilty? There is such a stigma against incapacity benefits, that you feel awful to be claiming them, yet if you are entitled to, it would be stupid not to. There is so much attention paid to people that cheat the system that genuine claimants worry they will be tarred with the same brush. I had no intention of cheating the system and I didn’t do anything to do so. If anything I down played how bad things were. There was no exaggeration, yet I feel like I have cheated. Surely this is wrong? Surely I should just be glad that the right decision has been made? Yet the doctors at Atos have such a bad reputation I even question a positive decision.

Stream of Conciousness…

with 10 comments

I started this post on Monday, but didn’t get time to finish it. It’s now Sunday! I don’t know where my weeks are going. I keep snatching five, ten minutes or so to write, but it takes me half that time to work out where I was before. I keep wishing I could write more, but other things get in the way. I guess more accurately I could say another person gets in the way. My bloke is still not too keen on me spending time on here and that means I usually have to fit it in when he’s not around.

At Creative Remedies on Monday we were asked to write. To write and to keep writing whatever came into our heads for three minutes. I wrote something private, something which I had thought about writing on here for a while. My thoughts were about how I come across at Creative Remedies. I behave like I used to at work and at uni. Friendly, helpful, bright, but hiding how I actually feel. There is a front there that hides the illness. An act. I feel like I have two halves. One outgoing and intelligent, the other ill and flawed. One bright, one dark.

I soon wished I hadn’t have written this. The next step of the exercise was to place our work in a pile on the table. Each one would be passed onto someone else who would then highlight the bits they most liked. The idea was to give us suggestions of how we could turn our stream of conciousness into something a little more creative. I didn’t want to share these inner thoughts. I didn’t want to let anyone in and break down the front. It was made even worse because my notebook is distinctive so whoever got it would know it was mine.

I felt almost sick as I handed over my book. I was given someone else’s piece. Theirs was fairly personal too, but completely anonymous and it gave me no real idea of the context. It didn’t let me in like mine would let someone else in. I was jealous of the guarded nature of their writing.

I could see who had mine. They were writing fervently on my piece. I worried about what they thought. They hesitated to pass it back still writing away. She glanced over at me and mouthed the words “is this yours?”. I had to reluctantly nod as she brought it over to me. Everyone else was scrabbling away at the pile trying to find their own.

I looked at her words. They were kind and expressive, but I still felt a little violated. She had liked my writing, yet I still felt uneasy. She was worried for me. She could feel the sadness and emotion in my words and wanted to comfort me. She later asked me if I was okay. It felt strange and I wasn’t comfortable with her concern. I don’t know that I deserve it.

I know she will never see me in the same light. She is the one person that knows the façade isn’t real. She will look at me with suspicion wondering what is behind the act. Wondering how I really am. I feel like I’ve been found out.

It’s weird how I can write here, knowing anyone could read this, yet I am so uncomfortable. It’s weird how I’m actually considering dropping my anonymity on this blog, yet I didn’t want to drop the act with one person. How would I feel if the same person came along and read all of this? I don’t know.

I don’t know how I really feel about these two sides. I guess in some ways the act shows I am making progress. I can hold myself together in front of people now. I can portray a sense of capability and confidence.  I can actually do things and at times I even enjoy them. There have been times in the past year or so when there was no way I could hide anything and enjoyment was a foreign concept. I was a mess, unwell and visibly so. That’s not true any more.

Yet, I am not sure it’s a good thing. I wasn’t well a year ago when I was first admitted to The Priory and I behaved the same in therapy. I was the sensible, level headed, friendly one. I spent more time giving others advice than I did talking about myself. I was the helpful, confident person. People even wondered why I was there. I seemed fine. I wasn’t.

I don’t really like the act. I don’t like its return. I have worked so hard in therapy to break it down. To be more open and honest about how I feel. To be more true to myself. For the therapists at The Priory, I was making progress when I started to talk about myself. I was chastised when I went into helpful, clever mode. I wonder if I should chastise myself when I act like this now.

At times I wonder if the act was what broke me in the first place. The act was a problem before, back when I was at work. I kept going, working harder and harder to hide how I felt. At times fuelled by unidentified hypomania, at other times fuelled by denied depression. I didn’t want to admit I couldn’t cope. I didn’t want to fail. I wanted to be confident and capable and not at mercy of emotions or illness. I drove myself into the ground until I snapped and my world fell apart.

I am worried I will do that again. I have been doing new things and taking on new projects over the past few weeks. I have ideas, I want to do things, I want to be successful. It’s a familiar feeling. My life has been full of periods where I take on new things and projects, but more often than not I take on too much and cannot cope. With hindsight some of these periods can be clearly attributed to hypomania, but others I am less sure. I wonder if it is just my personality. I don’t want to immediately see everything as something to be pathologised, yet I also want to learn from the past. I need to recognise the patterns and change them. I don’t want to keep crashing head first.

I don’t know what my mood is doing at the moment. People ask me how I am and I don’t know how to answer. I’m depressed, yet am I? Yes, the signs of depression are there. I feel numb, empty, suicidal. Negative thoughts, anxiety, paranoia too. The physical signs are out as well. Headaches, insomnia, tiredness. It all points to depression, but it’s not the whole picture. I am excited about new projects, interested in things (albeit not everything), doing stuff. Where is the anhedonia? I don’t think it’s a mixed state either though. Not in a classic way. I am not really sleeping, but I am tired with it. My thoughts race, but no more than is really usual for me. I am a little on the snappy, agitated, quick-to-anger side, but not physically agitated or excessively so. I don’t feel like things are going too fast. yet. I wish my mind would make it’s mind up. I feel almost lost within my mood.

Going back to the topic of anonymity and this blog. I don’t really want to be anonymous any more. I am not ashamed of my illness and I think it’s so important people are open and honest about these things. We can’t break down stigma if we’re too afraid to talk openly about mental health.

I am not even worried about employers googling me. I have no intention to leave my company any time soon. Even if I was looking for a new job, if a company didn’t want to employ me after reading this then I wouldn’t want to work for them anyway. This may limit my career in future, but it’s something I’m willing to take the risk on.

There is a problem though and it’s my family. I am not sure I am willing for them to know how I really feel. I don’t want them to worry. I know my partner reads this already, but with my parents I am even more economical with the truth. I have never been open with them and I’m not sure I’m ready to start. I guess it is doubtful they will ever google me and find this anyway, but it is still a risk.

I realised though recently it’s not even that which is the main problem. It’s actually the stuff about my sexuality I’m most scared about. I thought I was comfortable with it. I thought I’d worked through everything a few years ago when I really went through a crisis of identity. I haven’t. I am fine with coming out knowing the people I am talking to are open minded, but I am not so sure about the rest of the world. More specific I’m not so sure about those closer to me. It doesn’t hurt if some stranger says something horrible, but if it’s someone I know it’s different. I know my mother can be quite homophobic and I suspect her opinions on bisexuality are even worse. I don’t want her to find out. I have always said that she doesn’t need to know and what she doesn’t know won’t hurt her. I suspect other members of my family would be even worse. I just don’t think I can face it.

I realised the other day that I’m not as comfortable as I’d like with my sexuality in general. The other night I was at the pub with a friend and somehow we ended up talking about gay couples. I mentioned a girl I know who used to be in a gay couple and she now goes out with a bloke. She made some comment about him “turning her” and I pointed out that she could be bisexual. She seemed a little taken aback by that and I didn’t know what to say really. It could have been the time to be honest myself, yet I was uneasy with her reaction. I wish I was comfortable enough to be completely “out”, but I guess I’m still not there.

I guess I could always go back and censor myself. I could make any mention of my sexuality private and I’d be safe, yet I don’t want to. I guess I could throw caution to the wind, face my fears and all of that, but I’m not sure I can do. I don’t know what to do.