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Posts Tagged ‘help

A Little Clarification…

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My last post, Distressing Diagnosis… was a little on the rushed side and basically unfinished when I posted it. I knew if I didn’t publish it when I did, I wouldn’t get the chance for a while, but I kinda wish I’d held back. I’ve been back and edited it a little, but it still doesn’t say everything.

Edit: (17/03/2010) – I’ve actually ended up reworking this post quite a lot too. I didn’t read it back yesterday and since then I’ve realised it was all over the place and made little sense. It is a little better, but I just find this so hard to write about objectively. I am struggling with it all.

Lets get one thing straight. Dr M isn’t a horrible person or a bully. In many ways she’s actually quite nice and well meaning. She is trying hard to help. I can see that and I appreciate it.

She said she doesn’t want to do anything that will make me worse, and she did agree to remove the diagnosis in my notes when I said it wasn’t helping. I guess I can’t really argue with that. I asked her to change her diagnosis and she agreed to do so. I don’t think she’s changed it in her mind, even if she has on paper, but that is at least something.

She genuinely thinks she is helping and that she is doing the right thing. She keeps saying that she will make me better and that the future is hopeful. She is always very positive and encouraging. Many patients probably really appreciate this approach, but I find it a little too much. I don’t see enough evidence to support her positivity and that can actually be damaging. It makes me lose faith and trust. I find that she can ignore the negative, which means I don’t feel like I am being listened to or taken seriously. Unfortunately she doesn’t seem able to recognise this or she is unwilling to adjust her approach.

She also gives me her time – lots of it. She tries not to rush her appointments and lets them take as long as they need to, even if that means she runs behind fairly often. One of my ward rounds was over 90 minutes long, which when I realised seems pretty incredible. She saw me regularly on the ward in addition to the weekly ward rounds. She is now seeing me fortnightly as an outpatient, as opposed to the huge expanses of time between each CMHT appointment (4 months!). This is a good thing. It is closer to what I was used to in The Priory and a vast improvement on my other NHS experiences. Usually they sit you down and before you know it the appointment is over and nothing seems to have happened.

There are certainly good points to her care so far. I think it probably is an improvement on my other experiences with the NHS, but there are issues and I am finding those hard to deal with. Overall though I don’t think she’s a bad psychiatrist. I am just not sure she is the right doctor for me and I am not sure I am the right patient for her. Things just don’t seem to be working.

I don’t think it helps that we just don’t seem to get on. She was not impressed with my initial request to not be patronised and I think that clouded her opinion of me right from the start. She doesn’t seem to understand my job and why I like it. She doesn’t seem to know how to deal with me questioning her. I have a real sense that she just doesn’t like me for some reason. There was one point that she pretty much said that she couldn’t get on with me in “real life”, although I can’t remember the context now. My bloke tells me that is paranoia, but I remember it because I was shocked at the lack of professionalism and was upset that she didn’t like me.

I know I can’t hold this against her though. People don’t get on with each other and that’s a fact of life. If she doesn’t like me then fair enough. I’m not sure I’d get on with her in “real life” either. It wouldn’t matter though if it didn’t affect our therapeutic relationship. I worry that part of the reason she has diagnosed NPD purely stems from a sense that she doesn’t like me. Is it because she thinks I’m arrogant because I didn’t want to be patronised? Is it because I don’t agree with her opinion? I fear that in many ways it probably is.

It’s always going to be easier to trust and work with someone you get on with and I am finding this hard. It was one of the things I found great about working with Dr G. We got on well and could talk about anything, not just my treatment. It felt a lot more therapeutic and less clinical, which I think is important when dealing with mental illness, which is so entwined with emotion. I miss the way things were with Dr G and I am not used to the change. I don’t see the relationship with Dr M ever being like that. I find it hard to talk to her and hard to trust her. I am meant to tell her how I feel, yet I don’t feel comfortable doing so.

I also struggle with the fact that she doesn’t seem used to dealing with patients who are capable of getting dressed, eating and general functioning. Even if you had just tried to kill yourself, said you felt absolutely terrible and were threatening to do yourself in, if you could get up and about, communicate, eat and drink etc. then you are not really depressed and should be discharged. There seemed to be little acknowledgement of the fact that patients hide how they are feeling and put on a mask. There was a lot of focus on the functional side of depression and little acknowledgement of the emotional side and how patients felt. I wasn’t the only person who noticed this. A few of the more functioning patients felt that they were always being pushed to go home, treated as if they weren’t really ill and made to feel like they were a fraud. One patient was discharged too early a couple of times because she always hid how she felt and seemed “well” but she ended up back in hospital within days. You would have thought they would realise this was a problem. I don’t think this is purely down to Dr M. There were unbelievable bed pressures and the nurses weren’t exactly great at observation, but at the end of the day she makes the decision to discharge.

I wondered if this was because she is used to treating patients who aren’t functioning – those who are catatonic, staying in bed, barely speaking etc. In many ways these patients probably are more severely depressed, but that doesn’t mean they are more “worthy” of being in hospital. Non-functioning patients are a lower risk because they aren’t even capable of hurting themselves, where as a functional patient who is dealing with distressing thoughts needs to be kept safe. There didn’t seem to be much acknowledgement of this. I always felt like I was being told my problems weren’t important and that it didn’t matter how I felt.

Maybe Dr M has a problem working with me and other patients in a similar situation because she just finds it easier to deal with patients that do as they are told and don’t answer back. I guess anyone would find it easier to deal with people that follow blindly and don’t question things, but it is wrong to judge those that aren’t like that. Maybe it is as simple as a power trip. She likes to be in control and feels threatened when that power balance is upset? I don’t know.

It was also a common complaint on the ward that she thinks she’s really in touch and that she knows what you are thinking, but the reality is she’s often a long way off. Sometimes you get this hint that she might actually understand and then she says something else to contradict that five minutes later. It can be quite frustrating because you get this feeling of hope that she is listening and understands and then you get disappointed. You often feel like she is jumping to conclusions or judging you and I find it hard to talk to her. I don’t have this problem with Dr N and I never had it with Dr G. They listen to you and seem to understand what you are trying to say.

I think my feelings towards the NPD diagnosis have made it hard for me to work with her. I am offended and upset by it and I associate her with this distress. It feels like a personal attack and I find that hard to deal with. I don’t want to be considered as narcissistic, arrogant, self-serving etc. I want to be a “nice” person, someone that people can trust and get on with. I read the descriptions of people with NPD and I am scared that anyone could think I was like that. I am disgusted with myself that someone can think I am the horrible person that the NPD diagnosis describes. I can’t handle my thoughts and emotions around this and I need someone to direct those frustrations at. I guess naturally I will direct them at her. As much as her views of me may be misguided, my feelings towards her are skewed because of my feelings around this.

I still don’t think the NPD diagnosis is very accurate (although I do understand to some degree why she may have diagnosed it). I certainly don’t think I meet the criteria and I think she was wrong to diagnose it in the way she did. I really question her judgement and it is going to be hard to work with that in mind.

Personality disorders seem to be her diagnosis of choice and that worries me. She seems to be giving anyone that doesn’t respond well to medication, functions “too” well or who doesn’t fit in the usual boxes, a personality disorder. There was someone on the ward who was diagnosed with Bipolar Disorder many years ago and she had seen multiple psychiatrists who agreed with that diagnosis. Dr M began treating her, quickly questioning depression and suggesting her personality was to blame for her thoughts. There seemed to be no logical reason for this, only the fact that she functioned fairly well and medication had stopped working.

I guess in many ways a PD diagnosis means the emphasis is on the patient to get better and not the doctor. If the patient doesn’t improve the psychiatrist doesn’t need to justify herself in any way. The patient is also fairly powerless because any questioning of the diagnosis could be considered a symptom of the disorder. “I’m the doctor, you’re the mental, now do as you’re told”. It probably helps that there is enough of an overlap between symptoms of a personality disorder, general life experience and other conditions that there will probably always be some evidence you can use to back up your opinion.

A little off topic perhaps, but I do still want a second opinion on the diagnosis, but I don’t know how I go about getting it. With the diagnosis lifted from my notes, I don’t know where I stand. My personality is now “under investigation”, but does that mean she is going to change the way she thinks about me? I doubt it. Do I just wait and see what happens when the therapy referral comes through or do I try and get things clarified now? Presumably there are still mentions of the narcissism on my notes, so will that influence things in future?

I wonder if I should ask about the Affective Disorders clinic in Manchester. A couple of people have suggested it to me and they have someone who focusses on “complex needs”, who may be able to comment more on the relationship between my mood disorder and any personality problems. There’s also the CUPS service in Cardiff, who has a similar service offering second opinions to anyone in the UK with complex mental health issues. The problem with these services is they require referrals from your consultant and I don’t know how to ask her, without sounding like I don’t trust her opinion.

I don’t know.

I still don’t really know what to do or think about it all. In some ways I know I should just try and forget about it now that the problem label has been rewritten, but the therapeutic relationship thing is a problem. I still have to see her every couple of weeks after all and I don’t know how things are going to work.

I guess my conclusion is though that Dr M isn’t all that evil. It’s the NPD diagnosis that’s the problem and it is going to be an elephant in the room for a while I think.

September 9th: The Bridge…

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In the lead up to September 9th, I had become increasingly suicidal as my hope for some help and improvement ebbed away. I started to develop a plan to change things. My manager had arranged a meal out for the team and although I was still on sick leave she had invited me. I knew I would be on my own and that it was likely to be my last opportunity for a while to do anything. I wrote my suicide notes, tucking them in the dash of my car before I left. As the day went on I found myself increasingly nervous about the night I’d planned. The meal was good, but it felt a bit weird, knowing I’d planned for it to be my last supper. Instead of driving home after the meal, I drove to a local bridge, one which crosses high above the Manchester Ship Canal. I parked my car on the other side, left my notes on the dash and began the long walk up across the bridge in the dark, torch in hand. The road was busy, which was off-putting. I was terrified that someone would see me and stop. I was terrified that I would be found and sectioned. I got to the top of the bridge and stood at the side looking at the barrier I needed to climb. I moved closer, but the traffic was still busy and distracting. I just stood there, frozen. I wanted to make myself climb and fall, but my head was disconnected from the rest of me. I couldn’t move. I was still terrified that I would be found. I was terrified someone would slow down and didn’t want to be seen. I kept trying to will my body along, but it didn’t work. I eventually realised I wasn’t going to be able to do it. I don’t know why. I wanted to, but something stopped me. I told myself I could give myself another week, but if I still felt like that in a week I would do it. I walked back down and drove home, annoyed with myself, but relieved too. I was relieved I hadn’t been found.

The following week was difficult. I was determined to keep my promise of another week, but found it hard. I regretted my missed opportunity. At night, I beat myself up over my cowardice and was ashamed by it. I was frustrated with myself and didn’t know what else to do. I couldn’t think about anything else but trying again. I hated that I couldn’t speak up and tell anyone. I was too scared and ashamed. I just had to keep the turmoil to myself and hated it.

Written by intothesystem

Monday, 17th November 2008 at 7:40 pm

Continued existence…

with 5 comments

I want to write, but I just don’t know how to put things into words at the moment. I am unsure of how I feel, of where I stand and of my future.

I should be working, but I guess I can award myself a lunch break. It’s not something I am used to doing though. I have always worked long hours, without breaks. I am still a workaholic. Nothing changes.

Working from home today. It feels easier. Less pressure and the option to be myself; just stare at the wall if I need to. I have got more done than yesterday, but I’m still struggling. It is a pointless, continual existence. I can carry on, but I don’t know why I am.

I feel isolated. Both my HR contacts are on holiday and there is no one to go to. I want to discuss flexible working and other options, but I don’t know who to ask. I know I should be shouting up. I know I should be telling people how I feel and asking for help, but then there is no one here to listen. My line manager is busy and has enough on her plate. She has been supportive, but I don’t want to be a burden. I’m trying to let her get on with things. Trying to support myself.

I know I should go to my GP, but I don’t trust her and can’t open up with her. I wish there was another way. Someone else to go to, but I feel so cut off. I’ve still not heard from the mental health team. I don’t know who else to ask.

Things are back to how they were when no one knew. I’ve stopped talking to people. Stopped asking for help again. Started pretending things are okay. It’s easier to just put on my happy face again and pretend everything is sorted, even though it clearly isn’t.

I can’t admit how bad I feel and how hard this is. There’s this piece of me that wants to fall apart. This self-destructive urge that wants me to go back to work and fail spectacularly, because then I can say “I told you so”. Then I could show just how hard this all is, without having to admit it. I could show that things are far worse than I make out they are. I have suggested I’m coping to those that ask, but I’m not. I am still on the edge. I’m still close to breaking down completely, holding it together for no reason that I can see.

There frustrating thing is the lack of light at the end of the tunnel. I still see no future and no point. It’s something that niggles away at me constantly. I try to pretend I’m okay and things are improving, but I know there is no point if I don’t see a future. I can carry on like this. I can keep going, keep working, keep pretending, for days, weeks or years. I could do it, but I see no point in it. Is there any point for existing for existence’s sake? Is there any point in continuing to work, continuing to live, if it is always going to be this way? It makes any kind of effort or recovery seem pointless. Impossible, even. I don’t know why I’m still here. I wish it was easier not to be.

Written by intothesystem

Friday, 1st August 2008 at 1:33 pm

improving a little…

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I feel a little better. I think.

Even only a couple days later, I find it hard to remember quite how low I was. Reading back what I wrote on Friday is slightly worrying, because it is weird to think when you feel a little better, that only a couple days ago you wanted to kill yourself.

On Friday afternoon I did eventually make it to the pool and spent a couple hours faking normalcy, but I retained an unhealthy obsession over suicide for much of the day. Somehow I retained the little scrap of fight though, enough to keep me here at least.

I woke up still feeling low on Saturday, but ready to switch into normal-everything-is-ok-mode, as my sister was due to arrive at lunchtime. She was coming to visit for the weekend and as she doesn’t know anything about what has happened and I don’t intend for my family to find out, I had no choice but to spend a weekend pretending I felt fine. Pretending you are okay when you’re really feeling awful is difficult, but I’m well practised. Even still, by Saturday night I had a splitting headache and had had enough.

Sunday was a lazy morning. My sister tends to get up late, so it was a good excuse for me to be lazy too. In the afternoon we went to see Antony Gormley’s, Another Place at Crosby Beach. I was still in a weird mood and was preoccupied by the idea that the figures were wandering out to sea to their deaths, wishing I could just join them, but knowing my partner and sister were with me it was pointless thinking like that. Our visit was only short – we were going to stay out longer, but had forgotten suncream and got hideously muddy in the quick-sand. I guess by pretending to feel normal, it was becoming easier to believe it really. I guess my mood did start to improve a little and the gorgeous weather was definitely helping.

This morning I don’t know how I feel. I feel better, but I think I’ve only returned to that numb state of being able to function, but not feeling all that great. I’m not desperately suicidal right now, but I still feel low.. I wouldn’t mind that much if I died, but am not in a position to DIY.

What is strange with all this, is how these awful, crushing, suicidal lows can be so fleeting. I find myself wondering why I drop to such lows so quickly, but then come back up to this moderately-depressed state just as quick as I’d fallen. It scares me that one day I won’t come back up. I also find myself frustrated as I don’t know what to do with myself when I fall down there. What happens if I do give up the fight and give in to the thoughts? All I might have needed is a couple more days and I might have come back up again. What is frustrating is I won’t remember all of this next time I fall. I will feel completely overwhelmed and unable to cope, just as I have time and time again before.

Aside from that, I wonder if this nothingness, moderate depression is the best I can hope for. It seems to be my normal state these days – so maybe that is normal? I know I haven’t tried medication and that might be what I need to push this to normal, normal, but then I wonder if it will really help, or if I am naturally like this. Maybe I’m not meant to feel anything. Maybe a low mood is normal? What would I know? I’ve nothing to compare it to.

The other thing I wonder is, when is it okay to ask for help? How do I take myself seriously when I know that it might pass, but then again, what happens if a) it doesn’t or b) it’s too late. I don’t know if to tell my GP about the mood I crashed into at the end of last week or not. Does she need to know, or is it more important that I’m feeling a little better now? I don’t want her to keep me off work any longer than I have to, so I am reluctant to let her know I had a relapse, yet I also don’t want to keep relapsing. I just don’t know what to think any more.

Written by intothesystem

Monday, 14th July 2008 at 5:05 pm