Trying to talk…

I have struggled to write this week. I have sat and stared at the screen many times, but failed to pull anything together.

Twice this week I’ve brought up the problems that I mentioned in this post (basically thinking about splitting up with my bloke but feeling that I can’t for various reasons) with professionals and both times I found little solace or support. I tried to convey just how much distress this is causing me, but I seemed to fail. It’s frustrating when you are expected to talk to people about things, yet when you do you get little in return. I need to work this out in my head, but feel stuck. The thoughts are feeding my feeling of hopelessness and of course that only encourages the negative thoughts. It is making me worse yet it seems to be seen as a distraction and not worth talking about.

The first person to fail to help was my CMHT worker who I saw on Monday. I tried to talk to her but found it really difficult. She kept trying to use the “think positively” stick and didn’t seem to want to listen. She also tried to explain to me the effects of mental illness a million times. As if I don’t know them already! I hate being patronised. Generally the whole conversation was awkward. I hope things improve or there’s no way I’m going to be able to work with her long term.

Then on Tuesday I saw my therapist at The Priory. She also failed to grasp how much I am struggling. It was our last session so she was keen not to talk about new topics. It didn’t seem to occur to her that I’d have liked to use the session to help rather than just talk about superficial things. I guess she didn’t want to leave me stranded if we didn’t cover everything.  I don’t know how I feel about it being our last session. I don’t know how useful the sessions have been, but it was always something in my calendar each week. A constant in a world of uncertainty.

Today has been my last day of day care at The Priory. It hasn’t hit me yet but I am going to miss it. I’ve been going for therapy there since October and it has been a big part of my life. I’ve spent over 3 months living there!. I will be back a couple of times yet to see Dr G, but other than that it’s all over. I will miss the empathy and support you get there. I will miss the time out to think. I will miss the food. It is going to be a big loss and I’m not sure how I will deal with it. I know I will have to leave sometime, but I wish I was leaving through choice and because things were on the up, not because of money and NHS politics.

I think I’m going to have to give up now. I can’t write right now. My head is in pieces.

Hope or Hopeless?

Reading back over my last post, I’m struck by the hopefulness of it. I didn’t think I felt especially hopeful when I was writing it, but that is the sense I feel looking back. At the time, I thought I was going through the motions, self-censoring my words to make it seem like I was hopeful. I had it in my mind that I would not return from London. I had it in my mind that I had to present that I was okay and going to be safe down there for my partner’s sake, but deep down knew I’d be battling against the safety measures that I had put in place.

As you can see, I have returned from London, so maybe my hopefulness was genuine? Maybe I realised that I would overcome my suicidal wishes and survive the weekend? I don’t know. My hope is as fleeting as my moods.

It was touch and go at times. On Sunday night, I genuinely thought I would not return. I had a clear plan in mind and was preparing myself for it. I was on the edge. I didn’t want to go home. I wanted to die. I got scared by my mind and the clarity of it and forced myself to take double sleepers to knock myself out. I think they worked. By morning, I woke feeling less certain of my plan and keen to get home. I felt mildly optimistic and even, dare I say it, happy?

How can one’s perspective on things change so quickly? I don’t know if I am coming or going. I don’t know if I am full of hope or hopeless.

My weekend, overall, was good. My mood was unstable, as is the usual, but I did enjoy Saturday night. Lots of alcohol and lots of dancing and I was okay. Moments of withdrawal and sadness descended if I stopped to breathe, but I kept them at bay with a relentless performance of “coping”. I tried to live in the moment, something we are continually preached about at The Priory. It was enough to keep me going and even enough to let me smile a little and actually believe in it and mean it.

Sunday was a slow one and much harder. I didn’t have an alcohol hangover, but a mood one was definitely apparent. We didn’t do much. Stayed in the flat most of the day and went for food in the evening. There was no pressure and with that, I could manage. I had to battle against the thoughts in my head, but without any need for a performance, I could concentrate on that and concentrate on the moment. It was okay.

Last week I didn’t see past the weekend. I didn’t expect to see today. A friend of mine said to me on Friday, life is like driving in the dark. You can only see as far as your headlights allow you, but you know that if you keep going you will see a little further and if you keep going like that you can go all the way. I think that is how I’m living life at the moment. I can’t see very far. I don’t really want to see very far, but I am still getting through each little bit. I just hope that my headlamps don’t go out any time soon or the fog doesn’t get any worse. I’m still struggling and I hate it.

My mood dropped again yesterday. I was at The Priory and although Art was reasonably relaxing, Support was uncomfortable. I was agitated, unable to stay still and the conversation was irrelevant to me for most of the session. I sat and tried to listen, but all I could think about was my unrealised plans from the weekend. When it was eventually my turn to speak, I unleashed my frustration at my mood. My frustration at the speed in which it twists and turns. I did not know what else to say and neither did anyone else. Their depression is explained by divorce, family issues or work stress. Mine is explained by nothing. By faulty brain chemicals or a disordered personality? I do not know and I still don’t have any answers. I am fed up of it.

I don’t know what else to say anymore. On Sunday, I had lost all hope. On Monday, it returned. Yesterday, it was wavering. Today, I do not know.

London Bound…

I’m traveling down to London this weekend for a friend’s birthday. I’m sat in the first class lounge waiting for my train at the moment. I am glad I booked a first class ticket. It’s far more civilised than cattle class.

I’m a little apprehensive. I had to promise I would keep myself safe this weekend and although I said I would, I don’t know if I can 100% guarantee that. I hate that I can’t promise and know for sure, hand on heart, that I will be safe. There is no guarantee that I won’t flip out and do something impulsive, but I’m hoping I won’t. I know I am putting myself in a situation where the temptation could be there, but I know I need to face it. My nurse on the ward would talk about empowerment and how I have to face it. I know that I’ve been okay up to now since I left the ward and I just have to keep it up, but this is my first weekend away on my own, so I hope it goes okay.

I looked at my thoughts around this in my CBT group this morning and it was helpful. The therapists worked with me to come up with some ideas and plans to put in place to make myself safer. I just wish I didn’t have to do that. I resent it. I did find the session helpful this morning. I just wish there wasn’t this negative commentary in my head counteracting every rational and sensible thought I have and making me want to rebel against the safety measures. I’m going to try and help myself. I really am, but I have to fight to stop my mind from undermining me.

The weekend should be enjoyable. I hope my depression doesn’t make that impossible. I will be staying with good friends and we have fun things planned. I just hope I can feel the enjoyment and not be too negative.

There are a few pitfalls I have to avoid. Tomorrow, I will see a lot of my work colleagues that do not know that I am ill and have been on sick leave for six months. They will be asking questions of me. What client have I been working on? Why wasn’t I at the last conference? etc. and I will need to respond. I think most of them are fine and I will probably be honest with them, but it still might be a bit weird. I certainly don’t want to bring the atmosphere down and talk about my illness when we should all be partying, but then I will have to give my justification for being very careful on the drink front. Just one or two makes me drunk on these meds and I know it does nothing for my mood, so I need to be careful.

I hate this illness. I hate how it means every situation needs thinking about. The risks need to be considered. I have to think about how I am going to keep myself safe. I wonder if I will enjoy things, when usually there would be no question. I worry about the consequences of things. I have to think about what would be best. I resent having to keep myself safe. I hate the fact that I don’t 100% trust myself. I hate that my partner doesn’t trust me and worries about me. I hate that my friends feel they need to keep an eye on me. I don’t want to be a burden and someone that needs to be looked after. I don’t want to think about these things.

I should be back on Monday.

From next week my therapy days change. I will be going Tuesdays and Fridays as opposed to Monday, Wednesday, Friday. There is an extra day to face, but I know I just have to do it.

November 4th: Out of the hospital…

On November 4^th, 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.

September/October: Meet the Shrink…

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 2^nd.

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.

August – November: Up to now…

I know I’ve been pretty quiet since I returned to the blogosphere, but I’ve generally been pretty busy with day care and when I haven’t been, I’ve been too ill to write or busy working on therapy homework. Or at least pretending to be busy working on therapy homework.

One of my therapy groups is something called Life Maps. For this session we have to create a “map” of our lives to date, highlighting key dates, events and people from our life story. We can do this however we wish, such as a big timeline, bubble charts or just written as prose, as long as we can use it to explain our story. During the sessions we look at an area of our map and by talking though our story, we can look at the key events that have shaped us and also keep an eye out for repeated behaviour and issues which may or may not have contributed to the development of our illnesses.

Simple right? Haha!! It is hard work. I have barely started to go through things and everything I’ve covered so far seems pointless and unrelated, except the info from the last couple of months. I feel guilty for my lack of progress. I need to look at my teenage years, but I am struggling. My concentration is shot to pieces due to medication and illness and my memory is terrible, so trying to recall events of the past 22 years is not easy. Problem is, I know I can’t use that as an excuse. Everyone else is in the same boat. My perfectionism also haunts me and makes it difficult for me to put things to paper, for fear of it not being right, but I know I need to fight this. I hate that I am not making the most of the therapy offered to me, but I am just not well enough. I know the therapy coordinator was worried I wouldn’t be up to it, but I want to prove him wrong. Problem is, I’m failing so far.

Anyway, I explained how Life Maps works because I decided to try and kill two birds with one stone and type up a potted history of events since I left the blogosphere, covering my path to hospital and beyond.

It has been a crazy few months. This doesn’t really begin to cover half of it, despite the amount of detail I’ve included. I just couldn’t explain how it’s felt to go through all this. It’s been a whirlwind. The future is still hazy. I am still unwell and still waiting for answers. I hate that despite all this, things really haven’t changed all that much since August, when I was last blogging. I just hope that things start to change soon, as I don’t know how much more I can go through before I break.

I’ve decided to do this as a series of posts as it is really long and unwieldy. Below, you can see a number of titles linked to the other posts. I hope this works out okay.

EDIT:– Why are trackbacks so unreliable? If you make a post with lots of links they don’t all ping at the same time. Usually only the first link pings. You then have to keep editing and saving the post until they all work. Stupid thing!

August/September: New GP, New Meds…

September 9th: The Bridge…

September: Caffeine Crisis…

September/October: Meet the Shrink…

October 4th: Tell the parents…

October 7th: Into the hospital…

November 4th: Out of the hospital…

Exhaustion…

I’ve just got back from day care and all I want to do is curl up and sleep. I have a stupid cold coming on and am emotionally and physically drained. After my afternoon group, I was going to go down to the ward, but I realised I didn’t want to because if I did I wouldn’t want to leave again! I know I need to move on from that being a safe place and get used to being at home again, but it’s hard. I just wanted to hide away.

I’m physically exhausted as I have to walk back a couple miles to catch the bus home and I’m feeling rubbish with this cold. The alternative to a long walk is waiting a few hours for my other half to finish work and come pick me up. That or pay for a taxi I guess. Not ideal. I’m unable to drive at the moment due to my medication.

Anyway, I’m going to hide in my bed for an hour or two. We have visitors this weekend, arriving in a couple hours. I don’t know how I’m going to cope. Too tired.

Into the community…

So I was discharged on Tuesday, following four weeks as an inpatient on a private acute psychiatric ward. I was not ready to be discharged, but my insurance had a 28 day inpatient limit, so there wasn’t much choice. I certainly can’t afford to self-fund!

So I’ve returned to the community and so far it feels a bit strange, but I’ve been okay. If I’d been chucked out on Monday there might have been a different story. My mood was on the floor, suicide the only thing I could think about. The same horrid scenario replayed over and over in my head, blocking out all my thoughts and stressing me out. I couldn’t comprehend leaving the ward in that state. Luckily, my mood picked up around Tuesday lunchtime and I’ve been “okay” since. Still low, still struggling to think, but not too bad. For once, my mood shifted at the right time!

In terms of where I am now. I’m still not formally diagnosed; this episode of illness just has the vague description of “depressive episode”. Whilst I was in hospital, I had two short periods of hypomania, demonstrating the clear shifts of mood I’ve been experiencing for most of this year, but this still hasn’t been enough to solicit a diagnosis. My psychiatrist is hedging her bets a little. She believes I do suffer from a mood disorder, but she is not being more specific than that. She said that the predominant picture is one of depression, but that this is complicated by the fact I do have obvious shifts of mood, suggesting that perhaps my diagnosis lies within the bipolar rather than unipolar spectrum. She is still uncertain though and won’t commit to this. She also added that my condition appears to be somewhat complex, due to added complications with my personality (perfectionism, passivity, workaholic). I suspect she is weighing up the decision to slap on a personality disorder diagnosis or two. I’m sure my symptoms could be moulded to satisfy one if she deemed fit. This lack of diagnosis is both frustrating and a relief. I am glad she isn’t rushing into things. I’m glad she hasn’t just wheeled out a diagnosis of borderline personality disorder because I self harm and have been difficult to treat. Yet, at the same time I wish she wasn’t being so vague. I want to know if I need to accept this is a chronic condition that I will be dealing with for the rest of my life. I suspect that it is, but I can maintain a state of denial until she confirms this for me. I want to know what it is I’m facing.

My current medication regime is as follows:
8am: 225mg Venlafaxine (Effexor XL) & 50mg Quetiapine (Seroquel).
4pm: 50mg Quetiapine
10pm: 250mg Quetiapine

So far, I am unsure how much it is helping or not. I suspect the Quetiapine is helping with my sleep. The drowsiness kicks in fairly soon after taking my nightly dose and although I am still waking fairly frequently and not feeling all that rested, I am definitely getting more than before. I think it is also helping to level me out a bit. My mood isn’t spiking as much as before, but just seems to swing between varying degrees of lowness, instead of going from very low to a little high. I started on a tiny dose, but almost every time I see her she adds more!

I do not know if the Venlafaxine is helping. My mood is predominantly low at the moment and the suicidal ideation is still around fairly often (which I guess could actually be the fault of the Venlafaxine – it has a reputation for increasing suicidal thoughts), so I suspect not, but then if I wasn’t on it would things be different? I wonder what her next move will be with this. She has upped my dose a few times to get to this point, but I suspect she won’t up it again.

I start day care tomorrow, attending Mondays, Wednesdays and Fridays for the next six weeks. I will be continuing with some of the groups that I attended as an inpatient and starting some new ones. I am looking forward to some of them, but apprehensive too. Therapy is hard work and often makes you feel worse, not better.

Tomorrow, I have group CBT and Expressive Therapy. I am still to be converted on the CBT front. I’m not sure CBT is all that helpful to me, but the group is quite good as there are two therapists, which ensures everyone gets some individual support. Expressive therapy is a bit like going to playgroup and is different every week. We may be painting, playing games, doing role plays, singing or whatever, but it’s usually quite fun. A bit of light relief for a Friday afternoon anyway.

It will be really good to see people again. I should get to see some of the people who were inpatients at the same time as me, as well as the day patients I’ve met in group. You find that you make close friends easily when you are in a hospital environment or group therapy situation. You learn things about people that you’d never share in the outside world and become intimate friends very quickly. The empathy between patients is something that’s hard to find elsewhere. The only other place I’ve really experienced it is in this blogging community. It’s not just between the general psychiatry patients (depression & anxiety) either. Even the addiction and eating disorder patients have that sense of shared experience and empathy. I do miss the fact I could just walk into the lounge and there would always be someone you could talk to that would really understand. I think so far, that is the hardest thing about being in the outside world.

Generally I think I should be safe over the next few days assuming my mood stays roughly like this. I’ve got a friend coming over this afternoon so that should be good. Although my bloke is out this evening I think I’ll be okay. It’s a bit weird being on my own after 4 weeks of almost constant supervision, but so far I’ve not been too worried. Tomorrow I am in day care, which I am looking forward to, although I’m a little worried about how I’ll feel when I go home after a day at the hospital. Therapy can be draining and it might leave me feeling weird without the safety net of the ward to go back to afterwards. The weekend brings visiting friends and bonfire night, so I should be suitably distracted throughout and Monday brings a return to day care and a review with my psychiatrist. I dread the review a little as I am terrible at getting my needs across, but I will try and prepare a little beforehand.

I’m not sure that “being safe” should be all I’m aiming for, but it is all it feels I can aim for at the moment. I guess I should be pleased that I can feel safe. It is an improvement. A couple of days ago I really didn’t think I’d be safe in this outside world and so far I have been. I am still uncertain though and still don’t trust myself completely. I think I do generally feel as if I may be existing for existence’s sake. That doesn’t make things easy. I get close to giving up more often than I probably should, but it is incredibly draining just going through life for, what feels like, the sake of it. I just have to keep telling myself it will be worth it. I just have to get through this period of crapness and hope for things to change. Not easy though.

Anyway, I have written enough for now. I will update on the weeks before my admission sometime soon, although I don’t really know where to start. It has been a crazy few months.