Therapy Non-Assessment…

So I actually posted this a couple of days ago in a rush and then realised it wasn’t really finished and didn’t make much sense so pulled it. It seems plenty of you have actually read it anyway as google appears to have cached it. That’s nice of google isn’t it? dammit.

I have been trying to write about the assessment on 3rd September since it happened, but I don’t really know what to say because it didn’t really happen. Hence the “non-assessment” in the title.

The psychologist who was meant to be assessing me found out a few days before that she will be moved out of the team soon and therefore she won’t be taking on any further case-load. When I arrived, she asked me if I wanted to bother with the appointment at all as I will have to go back onto the waiting list and be reassessed when a new therapist is available. As I’d already made the effort to get to the appointment and my lift wasn’t due for another hour, I decided I might as well stay. Why they didn’t just phone me before and cancel I don’t know, but the psychologist suggested we had a chat about what “is going on for me now” and how therapy might be able to help me.

Talking about my current “needs and problems” was pretty difficult as I don’t know what they are. So much has changed and happened since I was initially referred over a year ago. Enough has happened since I was assessed by a psychologist in January too. I don’t know how much she knew of my notes, so I didn’t know where to start. There is too much to cover, so I just tried to focus on the present. The problem with the present is that there isn’t all that much going on.

She asked me what I hoped to achieve or what I want from therapy. I have always found this a hard question to answer, but I really don’t know any more. When I was really low, my answer was always just to feel better. Not exactly an easy task or one that had any obvious answers. Now I have even less idea what I want.

The fact that things have improved so much since introducing the reboxetine has left me wondering if I need therapy any more. The success of the reboxetine does suggest that my depression was mainly down to a chemical problem, so maybe therapy won’t be that helpful?

I do conceed though that although I may be feeling a lot better, that doesn’t mean there aren’t things I should be looking at. I am aware of things that do make me more susceptible to depression and other issues that exacerbate my mood when I am low, so I do want to try and address those. Only thing is, I don’t know where to start. I find it hard to remember what I was thinking and how things really were when I was so ill. I look at some of the things I wrote back in January and I wonder if I was delusional. My thoughts back then make so little sense to me now. How do I try and tackle those things if they’re no longer fresh in my mind? How can I make sense of thoughts that made so much sense then and so little sense now?

I hate the fact that Dr M judged me so quickly on how I was back then and I still wonder if she has changed her view since. She wanted to wait for the therapy assessment to discuss my diagnosis, but it seems I will have to wait longer for that too. I wanted to bring this up with the psychologist, but I was too scared. I am curious to know what a psychologist would think of me now that I’m thinking a little clearer and acting a little more like myself. Would they still be so quick to want to slap on a PD label or would they try to get to know me a bit better first? I don’t think I want to go back to the argument of diagnonsense though. I am not sure the label matters at the moment and it may be best to leave alone. Questioning things only seems to lead to more problems.

I managed to bring up some of the issues I know I need to discuss with her, but there were a few things that I didn’t know how to broach. It’s really hard to just open up to someone you’ve only met for five minutes and I do wonder how they expect us to do this on demand. The world of mental health assessments is a strange one. I don’t know how she is going to react or what she might think if I’m honest about some things, so it is quite hard to know how much to say. We didn’t talk about my past really or anything in depth, but I know I will have to again at some point.

We talked a bit about what therapy I’d had in the past and what kind of therapy I think might help in future. She was quite impressed by the range of therapy I’d experienced at The Priory, my understanding of therapy techniques and the list of things I’d tried to work on in the groups. I pointed out that a lot of it had been helpful in helping me manage things, although it didn’t really feel it at the time. When you’re really ill, therapy really isn’t helpful, but a lot of what I learnt back then has been more use as I’ve been recovering. I did point out though that although I’ve done a lot of therapy it has always been limited. We were scared to look at anything in too much depth, because we never knew when the funding would end and it seemed too risky to dig too deep and potentially leave things hanging.

We both recognised that intellectally I understand a lot of what is wrong, but sometimes in practice, especially emotionally, it doesn’t always help to know that. I can understand the cycles and can even intervene with the thoughts and behaviours, but somehow it doesn’t seem to change the way I feel. If anything, intellectualising things can actually complicate matters, because I end up getting frustrated that I feel no different, even though I try to do all the things that “should help”. With this in mind, she said a psychodynamic/psychoanalytical approach would probably be more helpful as she didn’t want me to intellectualise things too much. Dr G always said this too, so I was expecting that. She thought that CBT is probably not going to help, because of the risk I’d intellectualise things too much and would avoid connecting with things more emotionally. I am glad about this as I feared that I would just be offered a short course of CBT, which often seems to be the only therapy on offer. She seemed to agree though with my general assessment of CBT. I think it can be useful for some people, particularly those with milder, usually reactionary, depression, stress and anxiety-related problems, but for anything more complex it’s often a waste of time or can even make things worse.  I always get fed up of the assumption that CBT will fix all my problems and if it doesn’t then it is my fault. The NHS, politicans and everyone else seems so fixated on CBT and how it can be the answer to all mental health issues. Although I agree that therapy can be important, CBT isn’t the only therapy out there. It is not a panacea. It doesn’t work for everyone and in my experience it doesn’t really help me.

We talked about what kind of person I would feel best working with. I pointed out that I generally find it easier to talk to and prefer to work with men, but we also recognised that it might be good to challenge that by seeing a female therapist, especially as I think that  my relationship with my mother is definitely one that needs to be looked at. She said some motherly transference may be helpful! I find that thought a little scary and I’m not sure I want to go there, but she may have a point. She mentioned that someone is due back from maternity in November who might be suitable, but she wasn’t sure what was happening with all the service changes.

It seems that the therapy service for our local Mental Health Trust is out to tender. It could be taken on by another part of the NHS or a private company, but at the moment it basically means there isn’t really a service at all. A lot of the therapists are being transferred to other parts of the trust and the waiting lists are just getting longer. They hope it will bring about improvements in the long term, but it’s not really helping me. They expect to take on new therapists when the future of the service is decided, but how long that is going to take seems to be anyone’s guess. The psychologist warned me that because of the changes it may well be January before someone will come available to assess me properly, so it is unlikely that I will receive therapy now for another 6 months.

Towards the end of the session we talked for a bit about the failings of the NHS, specifically around the provision of therapy. She agreed that IAPT is making it harder for people with more severe conditions or complex issues to access therapy. Money is being diverted towards CBT at the expense of other forms of therapy. IAPT specifically focusses on providing CBT for people with mild depression and anxiety, which is all well and good, but it is doing so at the expense of others. Potential new therapists are tending to go into CBT because that’s where the money is, so it’s only going to cause bigger shortages and problems in future. I read something recently that said that a lot of money in the NHS is wasted on catering for the “worried well” and I think that this probably applies to the provision of CBT too. If someone hints of showing signs of stress or depression, there’s a good chance now they will be referred for a short course of CBT, so that the NHS can claim that they are offering people “talking therapies” over medication in more cases and that they are meeting targets to make therapy more accessible. These cases will skew the stats and will make it easier to ignore the smaller number of people with more severe or enduring problems that are waiting for therapy even longer.

Anyway, after all that, we did agree that we’d meet one more time to discuss in more depth what my aims may be and what I want from a therapist. She said if I’m going to have to wait a while longer yet, I may as well make myself a shopping list for what I want from therapy and my therapist! Quite a good idea I think, although how much my requests will be honoured is anyone’s guess. I may as well make use of the appointment time whilst I’ve got it though and maybe she can give me some idea of where to start. I see her again on Friday, so fingers crossed it will be helpful in some way.

I am pretty disappointed by the whole thing though. Not only because I will be waiting much longer and I got my hopes up about this assessment, but because I think I probably could have worked with her. It’s a shame she is being moved elsewhere and I will have to see someone else. The whole system is a total failure and I’m fed up of it.

Back in time…

It felt very strange to see DP again yesterday. It was like going back in time.

On my way there I was trying to remember what he looked like, but all that came to mind was the fact he was bald. When I got to the therapy centre, it took me a minute or two to recognise the building. It kinda made me realise how fuzzy my memory is of last year. I still blame ECT.

Memories started to come back though. Silly things like waiting in the kitchen until he was ready, taking off your shoes (both of us without undoing them!) and the blue sofas lined up against the wall.

We didn’t dwell on the paperwork. CORE outcome measure form and a couple of consent forms and that was it. A pleasant contrast to last week’s 50 minute form filling marathon!

Then of course he turned to me and asked me to start. I knew he would sit there in silence for the full hour if necessary, so it didn’t take me long to get going. I had taken notes with me, hoping I could update him on the last 18 months quickly without having to say anything. Sadly he wanted me to talk over things myself. I kinda knew that was coming.

I went over the main points. Last summer, The Priory, February’s overdose, ECT, Bipolar diagnosis and since. All the stuff I’ve been over a million times now. I can’t really remember, but I don’t think he said much at this point. He never did say much. I think he was a little shocked though.

The conversation moved onto what use the sessions are going to be. He seemed doubtful as to whether there was any point in working together for only four sessions. I explained the theory – that it would give me a little support in the interim and help me identify areas to work on long-term, but I am not sure he agreed. I am wondering if he just doesn’t want to work with me again. I am worried that I might have scared him off. I don’t know. I feel quite paranoid about it all.

We talked about how things are now. He asked what the current situation was care-wise, family-wise etc. I filled in some gaps. We talked about my mood too and that being what it is at the moment we got onto the question of self-harm and suicide. I think he was a little concerned and possibly a little panicked. I do wonder if he is used to dealing with this, but then surely most people in therapy have considered such things?

He pointed out that my risk level means I am a “red flag” client and he will need to talk to the EAP about whether or not we should continue. I remembered this from last time. I was a red flag last year and I’m not sure there has been a time since when that status would have been lifted. I am wondering if he is using this as a way to escape me. The other EAP therapist didn’t bring it up, but nothing has changed really when it comes to risk levels. I pointed out that the EAP were aware of my situation when they took me on this time and I hope that means it won’t be a problem, but he said he still wanted to talk to them.

He asked me about a verbal contract too. He wanted me to give my assurance that I won’t do anything to harm myself whilst I am seeing him for therapy. A repeat of the request from the EAP counsellor really. I struggled to give it, not because I have plans to do anything, but for other reasons. I think part of the reason is not wanting the added guilt. The guilt I get from wanting to break those assurances, because the suicidal thoughts are still so strong. I feel bad for even having the thoughts. I guess my reluctance is also to do with the fact I don’t trust myself any more and don’t see the point if I can break my promise. I had given my assurance to people I wouldn’t act when I made the attempt back in February and it wasn’t enough. I have assured myself enough times that I shouldn’t act, yet it wasn’t enough in the end. There have been other times though that making a promise to someone has been enough to make me think more than twice, so maybe it is worth it.

Towards the end we talked about next steps.

He thinks I should be getting more NHS support at the moment. I think he may be right, but I wonder what support there is. What point is there in the crisis team? I’m perpetually in crisis and I don’t think it would be helpful. What point is there in contacting the CMHT or asking for a urgent psych appointment? Useless social worker, J is on holiday and Dr D didn’t know what to do with me when I saw him last month anyway. What point is there in bothering Dr N any more than I already do? He has nothing more to offer me.

As we finished up, DP told me to email or text if I need to, which I am grateful for. I guess the fact he offered that option shows he cares and is trying to help. He certainly didn’t have to.

Overall the session was hard work and quite strange, but I left feeling relieved. I think it was helpful. I don’t know though. It is hard to tell.

In other news, today I had a phone call from the therapist I saw last week wondering where I was. The EAP had forgotten to contact him to say I wouldn’t be seeing him again. I wish I’d cancelled myself now, but I just didn’t know what to say. I feel bad that he was waiting for me. I hope the EAP pay him for the mix-up!

Discharge…

So it is official. I am being discharged from The Priory by Dr G. I contacted her yesterday about the outcomes of my NHS appointment and her secretary called me back to say she will sort out the discharge paperwork and copy all my notes to send over to the CMHT. I knew it was coming, but it was still a little weird to know the decision has been made and put into action.

I am really going to miss her support. In a couple of days it will be a year since I first met her and a lot has happened in that year. She has been there through everything and has done her best to help. I wouldn’t be here by now if it wasn’t for her. On many an occasion my promise to her to keep going has stopped me acting. I am not going to say I’m grateful for that, because I still wish I wasn’t here, but I am sure my family are grateful.

Mood wise I’ve come back down from last week. Things started to calm down on Friday and by the weekend I was back to numb, monotonous depression. I’m missing the buzz from last week and disappointed that the promise of hypomania hasn’t been fulfilled, but in a way I am glad it is over. Impulsivity is always a real risk when I am wired like that. The flat depression isn’t fun either though. I am so bloody bored of feeling like this. Able to function, but wishing I wasn’t. Stuck in some kinda half-existence, where I go through the motions but feel so little and care even less. In a way it is better to feel worse, because at least then you are feeling something.

Today I was interviewed for local radio. Next week they are focussing on mental health in the run up to World Mental Health day on 10th October. The BBC came to Creative Remedies this afternoon as they want to feature the scheme on one of the shows. I was a little surprised when the staff asked if they could interview me. I had no idea what I was going to say, but managed to get through it and hopefully with a little editing I will sound half-coherent. I’m not quite sure why the outreach team picked me as I’ve not been going for long, but I guess I come across as fairly confident and talkative in sessions, where as a lot of people are quiet and reserved.

The team were asking me about ideas for advertising and improving the scheme. There are a lot of things they could do with it so it will be interesting to see how things go and what suggestions get implemented. They also want to set up a website about the sessions and to have somewhere to display our work. Of course I have experience in that area, so it looks like I’m going to work on that with P, one of the outreach workers. I think the team are quite keen to make use of my skills!

Not much else to report. Life goes on.

Pathways to Work…

A couple of days ago I got a letter from the local jobcentre asking me to come in for a “Pathways to Work” interview in two weeks time. The Pathways to Work scheme is designed to get people of incapacity benefits (IB or ESA) and back into work. It is geared at people who do not have jobs and the support offered is all about work experience, improving skills and finding a job. For someone who already has a job but is just too unwell to work, this is obviously a complete waste of time.

The literature that came with the letter was even more frustrating. There were a number of “success stories” of disabled people who had successfully got into work through the Pathways to Work scheme. The disappointing thing was all of these people had got minimum wage jobs in local supermarkets, washing dishes in kitchens or working in DIY stores. There were no teachers, lawyers or accountants. No doctors, nurses or IT consultants. No one was in a managerial position. Everyone was in a basic entry-level role, with few prospects for career progression and no doubt earning very little. I know for some people, a job in a supermarket is a massive achievement, but for many it is a massive step down. Not everyone on incapacity benefit has had a poor education or learning difficulties. Some of these people are highly intelligent, highly employable and have been previously very successful until they became ill or disabled. Surely these leaflets are not providing a positive image of disability? The leaflets should be saying, “look, you’re disabled but that doesn’t mean you can’t be successful and get a great job”. Instead they seem to say, “Oh, you’re disabled so you are obviously only capable of stacking shelves in a supermarket”. It is as if disabled people aren’t worthy of aspirations and successful careers.

This poor image of disability is reinforced by the services offered. Improve your CV. Training opportunities to improve your skills and employability. Work placements and buddy schemes. Money for attending job interviews. All of these things suggest that disabled people aren’t employable and need all the help they can get to find a job. Disabled people clearly aren’t capable of thinking for themselves and writing their own CVs. It may be true that in the current climate everyone looking for a job needs help, but this all seems very patronising and demeaning.

The other impression you get from the leaflets was the familiar story that people on incapacity benefit should just pull themselves together and get to work. There was a real sense of the Government’s displeasure about people being on disability benefits. On the first page it states that Pathways to Work is a key part of the Government’s plans to get one million people off incapacity benefits by 2015. Is it really feasible that one million people will recover from their disabilities? In theory it would be great if one million people became well enough to get back into work, but to me, the answer is not Pathways to Work. The answer is improved health care; quicker access to therapy for mental health patients, shorter waiting times for knee or hip joint replacements, more research into treatment for conditions like fibromyalgia, MS and chronic fatigue syndrome. People need successful treatment and support that will help them to recover and manage their condition. Help finding a job or gaining work experience isn’t going to make them well. Yes, working can improve well being and confidence, but for many it is just not an option.

ESA Medical…

I know I’m updating a lot all of a sudden, but I guess there are things I want to document this week. My talkative mood is probably helping too.

I made it to my medical this afternoon. I am so glad it is over.

I was all over the place during the interview. The doctor kept asking the same things over and over again and it was tiresome. My head was spinning, thoughts racing, agitation brewing. I kept forgetting what I had just said and found myself getting more and more worked up. I couldn’t keep still from the agitation. It didn’t help that she wasn’t following things, but I don’t know if that was me talking too fast or her being a bit slow. She kept mixing my doctors up (I know it’s complicated. I still have 2 psychiatrists!) which was getting really confusing.

She didn’t seem to ask me much about what I can and can’t do. She did ask if I got up, dressed etc (yes, with bullying from my bloke). She asked me if I went anywhere (yes, if someone takes me – I mentioned Creative Remedies). She asked me if I saw friends and socialised (sometimes). She asked about driving (no, not since October 2008).

We talked a little about my overdose in February and what happened afterwards. We talked about ECT. I told her when I’d been in hospital. We talked about my current care – The Priory and transfer to NHS, who does what. She asked me a million times if my doctors knew what I was telling her and who was most up to date with everything. I didn’t know why she was asking that so much. Maybe so she knows whether to trust any information she gets from them or so she could check up on what I was saying?

She kept asking me about suicidal thoughts. She wanted to know why I hadn’t tried again if I still experience the thoughts. She asked me literally 30 times if I had any active plans, maybe even more. She seemed quite concerned when I was honest about the extent of my thoughts, even though I have no real means or firm intention to act at the moment.

I was forced to talk about anger and violence. I couldn’t deny that it has been a problem of late, but I didn’t want to be seen as “dangerous”. I felt so uncomfortable talking about it.

We talked about mood. I found it hard to convey what it is really like. I told her about the current agitation and how this is a fairly new development. She suggested the agitation could have been caused by anxiety about the appointment. I didn’t think it was and denied it at the time, but since I’ve thought about it some more I think it may well have contributed. I really was all over the place whilst I was in there and anxiety must have been exacerbating the situation. I tried to describe the aching, dull, flat, numbing depression that has lingered on and off for ages. I tried to describe the mixed agitated depression that is often a problem. I don’t think I succeeded on any account.

I mentioned that my partner had given up his job to care for me and she asked me about this. Is he with me all the time? How often does he leave me on my own? Who does what in the house? Do I ever go out on my own? etc. etc.

When we went over my meds, she seemed surprised that I am taking melatonin and even asked if it’s a hospital-only prescription. Considering melatonin can be bought over the counter in the US, it does make you wonder why it is so reluctantly used over here. The CMHT seemed surprised too.

At one point towards the end, she left the office to go ask her colleague something and I couldn’t help but burst into tears. I’d been holding myself together up until then, but the stress of it all tipped me over the edge. I don’t know what it was as I barely ever cry these days. Girlie hormones probably aren’t helping at the moment, but even still it seemed ludicrous. Unfortunately she came back in whilst I was trying to pull myself together and then asked me a million questions about why I was crying. I was worried she would think I was putting it on for effect or something. I genuinely couldn’t help it, but was so embarrassed and paranoid about it.

Although she asked me a million questions I don’t know if she has got anywhere near enough information. Most of the stuff didn’t seem to be very relevant to whether or not I can work. Maybe she was just nosy? I guess that’s her job.

I cannot convey how erratic the whole appointment was. Questions were being fired in all directions and I was so mixed up I couldn’t answer her. My sentences were blurring into one. I was jabbering on and on and going off on tangents. I didn’t say half the things I should have. I was not clear at all. I’ve been going over things in my head since, trying to make sense of it all. Trying to work out her intentions and what she was thinking and asking. I know I should just forget about it and wait for the results, but my head is just looking for things to think about.

One thing I have noted is the clear effect of stress. I was anxious and stressed by the situation and I could not deal with it at all. I was turned into a whirlwind of agitated confusion. I’m just thinking about work and similar situations where I have to answer questions and think about what I’m saying. Conference calls for example. There is no way I can handle one at the moment. It’s okay doing that with a doctor that is trained to deal with it, but it is not okay to talk like a madwoman in front of your boss.

In some ways my inability to deal with the situation may stand in my favour. I suspect now I probably came across quite mad. After all, I need her to think I am too ill to work. The problem is, I think I may have come across *too* mad. I was incapable of answering her questions and I’m worried I may have messed up in some way. I’m worried I didn’t answer things clearly enough or that I missed things out. I am paranoid that she was trying to catch me out. I’m really worried she will think I was putting it on or making things up. I wasn’t, but I wasn’t “myself” either and that could be problematic.

Afterwards I was tired and didn’t really want to do anything. The session took it out of me and I needed processing time. Kinda like therapy actually. I guess it was similar in that I had to talk a lot about how I was feeling and what has happened.

Unfortunately I wasn’t really given that processing time as my bloke wanted me to do stuff. He forced me to clean my car, which took ages at it was filthy. As I’m not driving at the moment my lovely little car spends most of its time sat on the drive. It has been sat still so long that green slime was growing on all the window seals. Not good. It’s looking better now, but there are still bits that aren’t quite there.

My thoughts are still racing. I walked the dog this evening and I thought that would help calm me down but it hasn’t. I was distracted thinking about the medical, work, suicide, random pointless stuff, everything. I have music spinning around in my head on top of everything else. The “We buy any car” advert is driving me mad… we buy any car, we buy any car, any, any, any, any, we buy any car… Make it stop, please!!

I suspect I won’t be updating quite so much in the next few days. Nothing is happening. We are taking the dog to a breed show on Sunday, but that is all I can think of. I will see Dr N sometime at the end of next week. I have Creative Remedies too, but nothing unusual or exciting coming up.

NHS Psychiatrist…

Bloody hell, the CMHT is in a weird and slightly scary location. The building is a dilapidated old school on a council estate, with rusty railings and dodgy damp portacabins. It was in one of these cabins that I had my appointment. My social worker met me and took me in. The ceiling was falling down from damp. It really shows how much priority mental health care gets within our social services and NHS. Most of the other council buildings are shiny and swish.

It turns out that the NHS psychiatrist I saw today has seen me before, although I wouldn’t have known if he hadn’t have told me. Dr D assessed me in February after my massive overdose and arranged for my admission to the NHS ward back in February. I don’t remember the assessment at all, but vaguely remember his face.

The appointment was fairly routine. He asked me about discharge from the ward, what happened at The Priory, what has happened since. He asked about current mood. He asked about history, self harm, suicide, family history, childhood, education etc. All the usual things. It was a chore going over it all again. The more often I do this history thing, the less I manage to cover and recall. I just skip over things because I have said them so many times I forget what I’ve told who. I think he got the main points though.

He didn’t change my medication at all, as my social worker had warned me. He seemed to think that my current meds were doing some good and that we should persevere. I didn’t know if to ask about Dr G’s planned increases up to 300mg. I think I should have, but I couldn’t find my tongue. He said my meds would be reviewed when I next return to the CMHT.

One positive outcome was a referral to therapy. My social worker needs to get this done, so I’m not holding my breath considering her previous record, but we shall see. He said the waiting list is extremely long, but the sooner the referral is done the better. As I have covered most of the shorter therapies at The Priory, especially CBT, he said they probably won’t bother with these, but he was keen for me to have psychodynamic therapy. He thinks I will need to be in intense psychodynamic therapy for years. I had expected to do some psychodynamic stuff as Dr G had mentioned it in the past, but I thought it would be for a few months. I didn’t think I would need years. I guess I never really saw the whole psychoanalytical, lie on a couch and talk about your childhood thing as for me.

I wonder what issues he thinks I will need so long to deal with. I started on some psychodynamic stuff at The Priory when I did “Life Maps” and I grappled around for some reasons for all of this, but my childhood was uneventful and I don’t know what problems there are to find. I know there are some relationship issues with my mother and I was bullied in primary school, but aside from that I am unsure. I don’t think these are deep enough and I see my condition as largely chemical.

The plan is for me to continue on these meds, wait for a referral to therapy and see him (or someone else on the team) again in around 8 weeks. This wait is better than I’d feared but it still seems a long way away. I find the future so hard to comprehend I don’t know how I will get through to then. I was told to continue to see my social worker and to use the ALERT service, the CMHT in hours, the crisis team or A&E if things get worse, but I don’t know how easy that will be. I tend to suffer in silence and hide how bad things are getting, even now after everything.

I’m glad the appointment is over. I was so nervous and didn’t really know what to expect. The next step is to contact Dr G and tell her what happened. I think she will be glad about the therapy as she had wanted to find me something before. I am scared about letting go of her support, but know I will have to eventually. Dr D seemed a little concerned that I had still been seeing a different psychiatrist and I think he wanted that to stop. I understand it would be complicated. I guess I’ve always got the option of going back to Dr G if I felt I needed it. Dr D asked me to contact Dr G and get her to send a summary of my care at The Priory and a date for which I will be discharged by her as well as a list of the therapy I’ve had at The Priory. It all seems quite final.

p.s. I updated the My Story page today.

A long week…

A lot has happened in the past week. I kept meaning to write, but time got away from me.

I saw Dr G last Tuesday and was disappointed. It was a fairly pointless appointment. I did mention my dip in mood in the weeks prior to seeing her, but she didn’t have much to say. She increased the Lamotrigine again by the minute amount of 25mg, so I’m now up to 125mg b.d. She asked me about the hand over to the NHS. She seems ready to hand me over and doesn’t seem to want me to continue seeing her once I’m in the hands of the NHS. She thinks it will complicate things, which it would, but I trust her a lot more than I trust the NHS and I appreciate the constant input. I’m worried about the frequency I will be seeing the NHS psychiatrist. Talking about this with my social worker today, she said that if people are “stable” they will only see the psychiatrist every 6 months, even if that stability isn’t a particularly nice state to be stable in. She said I may see them a little more often at first, but even then it may only be every 3 months or so. This terrifies me. At the moment I always have that “if I can get through the next fortnight until I see Dr G, things may be okay”. This can keep me going. Knowing I’m on my own for months may be enough to make me give up again. I know I can ask for a rapid access appointment if things get scary, bad, but I’m not sure that’s enough and I can’t be asking for one every month or so!

On Tuesday night I learnt the bad side of knowing lots of people with mental health issues. One of my friends who I met in The Priory texted me to thank me for being her friend and to apologise for the fact she was going to kill herself that evening. I didn’t know what to do as I felt powerless to intervene and hypocritical for wanting to do so. She had been a long-stay patient in hospital and I believe was on overnight leave at the time. In the end I contacted the hospital she had been at and told them what she’d said. They wouldn’t discuss it with me due to patient confidentiality or even acknowledge what I had said, but I hope it alerted them and was of some help. They told me to call the police instead as they would have the power to intervene, but I didn’t want to do that. She tried to call me a couple of times in the evening but I missed the calls and when I called her back she didn’t pick up. I was worried but I did what I could. I was relieved when she later texted to say she had been picked up by the police, although worried for her. The hospital she had been in have chucked her out, presumably for breaking the rules of her overnight leave. I’m shocked and appalled by this decision as she’s at her most vulnerable at the moment. The people who are meant to be caring for her have dumped her when she needs them most and she is now alone and extremely ill. Last I heard she was staying with some friends and I just hope they can keep her safe.

This whole thing was triggering for me. I wanted to help her and intervene with her decision, yet I myself wanted to do exactly what she was doing. I was jealous of her at the same time as worried for her. I was angry at myself for being so hypocritical. I knew that if I was in her position I’d have been frustrated if she had intervened, but then I still wanted to do something. I couldn’t just stand by and let a friend die. I was comforted by the fact that she had contacted me. It suggested to me that she wanted someone to do something. She’d have gone alone and quietly if she was completely determined to succeed.

Wednesday started with a trip to Dr N so he could steal my blood for the mood disorder research. He struggled to get anything out of me. Spent ages trying to find veins in my arms and used my wrists in the end. The first attempt failed and has left me with terrible bruising and some wrist pain. The second attempt was eventually successful, but painful as he pushed the needle around in my wrist. We got there though in the end.

After this it was a trip to my office. My work laptop was due to be upgraded so I had to go drop it in to the IT department. It was weird to be in my old work environment. It made me realise that I really missed it. I wish I could just go back and do my job.

I had Creative Remedies in the afternoon. It was visual arts this time, which boils down to painting. I was disappointed by the class as it is restrictive. We had to start with a “colour wheel”, which made me feel I was in primary school. I know very well which colours mix together and what primary and secondary colours are. For our first project we have to choose images from a selection of Japanese, Egyptian and Art-Deco pictures and use these as inspiration. It feels very much like art at school, which is frustrating as I’d rather paint whatever I liked. I was impressed with the materials on offer though. We get a portfolio folder and sketchbook, access to good quality acrylics, watercolours and gouache paints and canvasses to work on. It’s all free so I can’t really complain. The teacher does seem to be experienced and the outreach workers are the same as on Monday’s session, so we should be able to develop a good relationship with them. I’ve been getting on well with one of them in particular already. It is basically just an art class though and not art therapy at all and although it gets me out of the house and doing something it doesn’t seem therapeutic. I miss the emotional freedom of art therapy at The Priory and the therapists there.

Wednesday evening saw us heading over to Snowdonia for a few days camping. My parents and grandparents had rented a cottage over there for a week, so we joined them for a couple of days. It was nice to get away for a few days, but I was feeling a bit flat a lot of the time. A good campsite near Beddgelert, we enjoyed nice food at The Goat Hotel on Wednesday evening.

The highlight of Thursday was a trip to Harlech castle, but a further reminder of my illness. Disabled admission was one such reminder. A bonus in that it was free, but even still I feel weird asking for it. I find it hard to think of myself as disabled. The second reminder came from climbing the towers. I felt uncomfortable at those heights. I am not scared of heights in any way, but I wanted to jump. If my parents and partner weren’t with me it would have been a huge temptation. I don’t think I could do that in front of them though. The image of my fall would haunt them for too long. Aside from this though it was good. I’ve never been such a big fan of ruined castles, but the views were fantastic.

Friday brought beautiful weather and a trip to the beach. We struggled to find one where our dog was welcome, but eventually stumbled across a beautiful little cove, with golden sands and shallow water. The beach was almost deserted with just one other couple there most of the time. We went for a swim, which was of course cold, but good. It was lovely to see our puppy swimming properly for the first time. I felt like a proud parent. There were also lots of little silver fish swimming around, which was unusual but made me a little squeamish.

We came home on Saturday, amidst drizzle and murkiness. A real downer after the lovely day on Friday. Our tent was soggy and I hate packing at the best of times, so I felt pretty awful. I’ve just felt pretty low all weekend and have had little motivation to do anything. I just want to hibernate really.

The highlight of today was another trip to Creative Remedies. I have enjoyed it and I think I will continue to, but I am still unsure of the therapeutic benefit. I wonder whether the vast amount of money that is being spent on this should be put to better use elsewhere, especially in reducing the waiting lists for other therapy.

My social worker came over today to check up on me before we both go and see the NHS psychiatrist tomorrow. She had some paper work to read and sign – mainly my risk assessment and enhanced CPA. It was weird to read a catalogued list of risks and declarations of my suicidal thoughts. She asked me what I wanted from the appointment tomorrow and tried to set some expectations. It seems that we will go over history and recent mood. It is apparently unlikely that the psychiatrist will change my medication on the first meeting and it is likely that I won’t see them again for a while. I don’t see the point in just going over my history and not actually doing anything. He can find the history in my notes and I’d rather use this appointment to make some changes that may help me to recover. We will see though. Wish me luck. I really fear I am going to need it.

Mad Men…

Again it has been 10 days since I last wrote. I don’t know where the days have gone.

I saw Dr N last Thursday. Just a routine appointment to pick up my scripts, but it was good to talk. He asked the usual questions. Mood, suicidal thoughts, self harm etc. He seemed concerned. More so than in recent appointments.

He pointed out that he could see my scalp was in a bad state. As well as the trich, I also struggle with skin picking or Dermatillomania to give it the technical name. My scalp gets the worst of it. Every day, usually at night, I pick and scratch at my head until it bleeds. It’s covered in terrible wounds, some a few centimetres across. My hair hides the worst of it, but it’s got so bad that it can be seen at the moment. It’s always worst when I’m not sleeping well as I tend to lie awake scratching my head to distract myself from the insomnia.

I have done it for years, longer than the hair pulling even. I think it started when I had chicken pox as a child and I would itch my head. I was maybe 8 or 9? I can’t really remember.

I was shocked that Dr N noticed and mentioned it. I’d confessed it to him a long while ago, but he had never brought it up before. I tried to change the subject pretty quickly and felt uncomfortable that he had seen.

Both the skin picking and hair pulling make the hairdressers a nightmare. My hair is thin in places and there are bits where it is really short where I’ve damaged the scalp so badly it doesn’t grow properly. The scars and cuts are awful and would make most hairdressers flinch. I’ve been asked what has happened so many times and I don’t like making up lies, but I’m too ashamed to tell the truth. One hairdresser even insisted on putting on gloves when she saw the wounds, too afraid to touch them. I last had my hair cut when I was in The Priory, knowing that the hairdresser there would be understanding. I often go over 6 months between a hair cut and it’s been a year before. I try and avoid it as much as possible, even if that means my hair looks rubbish and gets far longer than I’d like. My hair really needs cutting, but I just can’t face it.

Other than the trip to the GP, very little has happened. I’ve spent lots of time watching back to back episodes of Mad Men. If you haven’t seen it, it’s an American TV series about advertising executives during the 1960s. Over here it has been shown on BBC Four, but that doesn’t mean it’s dull and serious! I loved it the first time round, but I watched a lot of it whilst I was in The Priory and ECT has erased most of it from my memory. Watching it again has been a little weird as it brings up memories of those times. I started watching it again because I saw that Series 3 has started in the US now. Will be good to have more to watch. It kills a few hours and takes me away from this world for a little while.

In other news, my bloke may be going back to work a little part time. He left his job to care for me since I came out of The Priory last May. His replacement has quit suddenly, so his old employer have asked if he can do a few hours until they can find someone else. He went in on Tuesday morning, but hasn’t been in again yet.

For me, this is quite exciting. I feel that I am getting a little independance back, being left alone for a few hours. I miss the time I got to myself when he was at work. It is hard being together 24/7.

It is a challenge though. I am still fighting the thoughts and the time alone makes them harder to ignore. It feels like tempting the devil. The monster tells me that “you can do it now, you know you want to”. Over the past few months I’ve had little opportunity to act on my suicidal thoughts. These few hours alone change that and I know there is a risk. My bloke worries about it and I don’t want him to, but I know his worries are justified. I wish I could give him a 100% guarantee that it won’t happen, but I don’t think I can. I am in control to a point and will fight as much as I can, but I can’t guarantee that I will win. The thoughts are intrusive and often impulsive and I know I could act on them before I even think about it. They can spiral out of control and it can be hard to stop yourself when you get to a point. I know I need to hit the panic button before things get that far. I’ve told him I will, but I can’t even guarantee that.

Despite the risk, I still want him to go. I felt bad that he left his job for me as it is. I want him to be able to work again. I can’t be watched 24/7 forever. I am going to have to take this step eventually and it might as well be now. I could be waiting the rest of my life if I waited for the thoughts to go away. I don’t want to let the thoughts win. If he stays at home with me I am doing that. I am letting the thoughts control my life.

Generally I’ve been pretty low over the past few weeks. I’ve been lower, but not much lower than this. I am carrying on, because I don’t know what else to do, but it’s a struggle. Most of the time I just feel so empty and numb. There are still a few better moments, but less than there were a month ago and the average score is down. There are still worse moments too. Fits of rage, agitiation, arguments. There’s this little bubbling pot and occasionally it boils over.

I am disappointed that improvement has stalled. It feels like I am failing. Maybe I’m not trying hard enough to get better. Maybe I am just stuck in depression. There had been seeds of hope, but I am not sure they will propagate. I don’t want to give up on the Lamotrigine as it has been far better than anything else I’ve tried, but it’s just not doing enough. It seems I am heading into a long period of mind-numbingly dull depression, with only the occasional painful period of agitiation thrown in to liven things up. I guess I am already there and I don’t see any way out yet. I don’t know what all this means. I guess I will have to talk to Dr G when she’s back from holiday and see what her thoughts are. I suspect she may eventually give in and resort to the Lithium. She’s threatened it often enough.

I don’t have all that much coming up to look forward to.

Like Seaneen, on Monday I have someone turning up to interview me for the Cardiff and Birmingham Universities’ Bipolar Disorder study. I am a little scared about going over everything and hope it won’t make my mood worse. I feel forewarned having read Seaneen’s post, so it may be a little easier, but it’s true that it isn’t fun for anyone reliving your worst moments. I do think it will be interesting though and I definitely want to support research where I can so hopefully it will be okay.

I see the chocolate teapot again on Friday 11th. She’s actually done some stuff at last. I finally got the referral through for the ALERT service (Out of hours telephone support). They haven’t called me to give me the number yet so I can’t use it, but at least she’s contacted them. I also got the dates through for the Creative Remedies groups. I start on 16th September. There’s a performing arts group and a visual arts group, both lasting 2 hours a week, so that will give me something to do.

I’ve also got a wedding to go to on the 12th, my NHS psych appointment on 22nd and an ESA medical on the 24th. I’m really dreading the latter. I am scared they are going to tell me I’m not ill, I’m just making it all up and I should go back to work. I’m scared they will think I’m a fraud. I did the questionnaire really quickly and sloppily as I just wanted it over and I’m worried now that I didn’t say enough. I have read so many horror stories lately that I am quite worried, but I just hope I can get through it. I am claiming under the youth rules as I haven’t paid enough NI and can’t claim income-related due to my bloke’s savings. Unfortunately they didn’t take the youth rules into account at first and rejected me, so I’m having to appeal. Usually you only get a medical after you have been claiming for 3 months and although it is over 3 months since I applied I haven’t been paid a penny yet due to the appeal. I just hope it gets sorted out soon. Benefits are a nightmare. I don’t see how anyone gets away with claiming when they are not entitled. It seems that most people who are entitled can’t even get them.

Anyway, enough for now. If I posted more often they wouldn’t be such mammoth posts. I shall try.

Short Pause…

It’s been 10 days since I last posted. Each time I keep thinking I should start writing more often again, but it doesn’t seem to happen. The gaps seem to get larger, not smaller.

I often think of things I want to write about, but I don’t seem to translate those thoughts into posts. I wanted to write about the NHS when the #welovetheNHS campaign was in full swing, but now I can’t really remember what I wanted to say and the moment has passed.

The last week or so has been up and down. A phrase I say so often.

I went to my parents for a few days last weekend. On Monday my sister, the dog and I trecked over to Porthcawl for the day. It was lovely weather and we enjoyed a splash in the sea, some fish and chips and icecream. Not a bad day really.

Tuesday involved bringing the dog home on the train. It was stressful, but we managed to get back safely. She slept a lot of the way taking up most of the aisle.

I saw Dr G on Wednesday. She increased the Lamotrigine again. I’m now on 125mg Mane, 100mg Nocte. Again it was an increase I expected. She is increasing the Lamotrigine by 25mg every 2 weeks. I wonder if it’s worth seeing her each time or if I’d be better off asking her to give my GP the instructions to increase it, thus saving myself some money. Seeing her every 1-2 weeks is not cheap.

I can’t remember what else we talked about. I remember her telling me she still thought it was too early for me to go back to work. Disappointment and relief. Disappointment that I am not well enough to go back. Relief that I don’t have to make the decision yet and that I am not being forced to go back too soon.

My social worker is still useless. I saw her on Thursday after forgetting I was meant to see her on Tuesday. She turned up at my house and I was at my parents 140 miles away. I guess that makes me useless too.

Anyway, we talked for a little while. She asked me if I’m interested in the creative remedies therapy group and the “positive thoughts” group. She’d forgotten to bring the information again so I’m not entirely sure what I’m letting myself in for. I agreed to both though so we shall see what happens. I’m pretty skeptical about the positive thoughts one. She said it’s simplified CBT, which rings alarm bells, especially as I’ve done non-simplified CBT in the past. I have visions of us sitting in group having to repeat affirmations. The groups are meant to start in September.

J came up with excuses about her failure to complete the referrals so far saying that the problem is she’s useless at doing paper work. More alarm bells ringing when she said that. I’m sure form-filling must be a huge part of her job so I wonder why she’s doing it if she can’t be bothered. I hope she does the referrals but I’m not holding my breath.

She also told me she’ll be with me at my psychiatrist’s appointment in September. I don’t want her to be, but I guess I have little choice. I’d rather I was on my own. I generally find I’m more comfortable with the psychiatrists and I have no trust in her at all, so I think I will find it hard to be open.

She didn’t think my appointment was with Dr B because the time doesn’t correspond to one of her clinics. I’m not surprised at that, but still a little disappointed. She did say who she thinks it will be but I can’t remember his name. Apparently he’s quite new and she doesn’t know what he’s like, which is a little worrying, but I get the impression that is quite normal with the NHS.

The rest of the time lately has been littered with arguments and random drops in mood. Friday evening was difficult. After a long argument with my partner I became hysterical and couldn’t stop crying. I find myself wanting us to break up and these episodes only make that wish stronger. I don’t know how we can carry on like this. The arguments are frequent and pointless. They just hurt us both and make life so difficult. I want to isolate myself from it all. It fuels my desire to not be here.

Earlier today I read this post on mentalnurse.org.uk. It talks of the anger at being saved from suicide. I still feel that anger and unlike Torah, I am not pleased to not be dead. I still wish that I had not been saved. I remember the disappointment of waking up and knowing I’d failed. I remember people asking me if I was glad to be alive and thinking they were insane. I still don’t understand how they could ask that. I didn’t make the decision lightly. I knew I didn’t want to be here anymore and failing to complete my plan did not change that decision. It’s still not changed that decision. I still want to be dead.

That’s not to say my suicidal ideation has not lessened. A few months ago I was constantly actively suicidal. Always thinking of plans, always looking for the next opportunity, always battling the thoughts. Now my thoughts come and go, but they are still a frequent annoyance. I have moments when the thoughts lessen, but I am never glad to be alive. Most of the time I’m still wishing I was dead.

I do not see the point in life, nor the appeal. I don’t understand anyone who is glad to be alive. I see life as a long hard battle with no positive outcome at the end. I don’t see why anyone would put themselves through that for any longer than is really necessary.

I don’t know what will come of these thoughts. I have managed to resist over the past 6 months, but I do not know how long I can keep this up. I have been kept safe for most of that time, unable to act when I have most wanted to. That supervision will of course continue while I still harbour the desire to be dead. I wish it wouldn’t but know I can’t stop them. There is anger there of course. An annoyance that I am not in control of my own life. I understand their reasons though and I know I have no choice but to comply. I just wonder how long for.

I wish that things will change. I wish I could find a zest for life. I wish that I could see a point to it all. I wish that there was enough hope to keep me going.

I find myself wanting to force the change, but I can only see one option for that and I know it’s not the one that everyone else desires. I worry that I will take that option regardless. Suicide is always the fall back position. My trapdoor to escape all of this.

Urgh…

I feel awful. I don’t know why, but my mood has dropped like a stone.

I saw Dr G this afternoon. I didn’t really know what to say to her. I just said that my week had been “more of the same”, but she tried to probe further and wanted me to tell her how I actually felt. For some reason I didn’t feel able to. I was just vague and didn’t know how to explain things. She asked me about my suicidality. All the way there I’d been thinking about how I could still do it at any point if the opportunity presented itself. Suicide was on my mind. Yet when asked, I played things down. I said that the thoughts were still there, but that some of the time they aren’t as strong as they have been. I said that, when only a few minutes before seeing her they were as loud as ever.

I think most people would be surprised at my suicidality, even now. I suspect that most people think I wouldn’t do it now as I’ve managed to resist for so long. I suspect that most people think things are improving and I am on the way to recovery. The reality is though I am kept safe and if I wasn’t, I’d be long gone.

In some ways maybe I am on the way to recovery. Lamotrigine has been the first medication to not make me worse, and maybe with time it will make things better. My concentration has improved a little and I’ve started to read again, something I wondered if I’d ever do again. I am usually not grappling with the most extremes of my mood any more, although I still have my moments. There are enough encouraging signs to give Dr G and others some hope.

The problem is it is not enough and I still feel hopeless. In many ways I’m still as ill as ever. I could give up on these signs of recovery at any point. I could and probably would end it all given the chance. It may not work and then I’d be back to where I was last February, but I’m certainly willing to take that risk. I don’t care that I may get better. At the moment things aren’t good enough to want to survive.

I am still not sleeping – rarely getting more than a few hours. Dr G has decided that it’s worth trying Melatonin (Circadin). I need to see Dr N to get the script. I hope it helps. Anything is worth a try.

We also talked about how we are going to manage things until I see the NHS. I will continue to see Dr G for now, but I will probably have to be passed over following my appointment with Dr B (or her team) in September (if I make it that far :S). Something I am not overly keen on.

I wish all this could be over. *sigh*