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Posts Tagged ‘personality

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.

Tiresome…

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Another week has passed and I’ve not written again. I don’t know where all the time goes.

On Monday someone came from Birmingham University to interview me for Mood Disorder research. It didn’t take as long as I thought it would, but that may be because I was hardly verbose. I just generally ended up saying “yep” to every question. There were questions about your family situation and stuff. Then there was a series of questions about depressive symptoms, all of which I have experienced at some point or another. She recorded that part of the interview and the following part about mania. There were questions about agitated depression and dysphoric mania too, both of which I’ve experienced and most of my depressions are agitated.

There was a section on psychotic features, most of which didn’t apply, but there were some things mentioned that I’ve experienced and never really considered psychosis before. Those dissociative experiences and weird feelings where the world don’t quite feel right were given air time. There are times when I lose all sense of size and relativity. Paranoia too, but I guess everyone experiences that at times.

There were questions about medication and treatment. I realise now that I forgot a load of drugs that I had been on. I don’t know if it’s worth emailing to let them know. It felt weird when there were questions about hospitalisation and ECT and it made me realise just how ill I have been.

Her list of symptoms and questions made me realise that I can’t deny having Bipolar Disorder. I had experienced pretty much everything mentioned for both depression and mania (although generally not as severe on the manic side). I sometimes wonder if I’m actually just plain depressed as I spend so much more time on that side of the coin, but I can’t deny that I’ve been manic or at least hypomanic plenty of times too. More so, it made me realise that I am really quite severely ill. I often think because I have Bipolar II disorder, rather than I, it means I’m not that bad, but I guess that isn’t really the case. I’ve been lucky to have not had any real psychotic experiences and severe manic episodes, but my depressions are pretty much as severe as they get and I’ve been through a lot treatment-wise too.

At the end the girl tried to take my blood, but failed. I have really terrible veins. Small and deep. She’s given me a pack to take to my GP so they can take it instead. I wonder if they ever will find a gene or two that causes all of this.

Afterwards I completed the questionnaires she left me. Millions of ticky, or rather crossy, boxes. A lot of personality type questions about honesty, social anxiety and esteem. A section on events proceeding first experiences of illness, which for me was pretty much uneventful. No bereavements, abuse etc during my childhood.

Tuesday was fairly dull, except my father popped in for a couple of hours. He was in the area for a trade show so came over for dinner in the evening. We went to the new Fish and Chips in Alty and then came home and had cake. Good food and it was nice to see him for a wee while.

On Wednesday I saw Dr N for my fortnightly visit. I was pretty honest with him about how the past couple of weeks have been. Things have gone steeply downhill since a month ago and he was concerned. We talked about self harm and suicide again. We also talked about my social worker and seeing the NHS psychiatrist. He warned me that the NHS psych will probably try and get me to try an anti-depressant again especially considering the drop in mood over the past couple of weeks. He made some comment about “that’s all they [NHS psychiatrists]  seem to do”, which amused me. I’m worried about this though. I don’t think it is a good idea considering how bad things were when I was on them, but then I wonder because things have not exactly been great without.

I forgot to take the blood pack with me, so he’s going to do it next week when I’ve seen Dr G. No doubt I will have a meds increase to sort out as well.

This morning I had a visit from J, my social worker. It was a long one and I found it tiring. I tried to be honest with her too, talking about the increase in suicidal thoughts and the agitated anger outbursts that have been happening for a while. It was shaming to talk about wanting to hurt people and myself. I felt uncomfortable and was fidgeting a lot. She was pushing for info though and I felt obliged to supply.

I was alarmed when she mentioned the crisis team and hospital. I managed to calm her down and say that I’ve managed to keep myself safe over the past couple of weeks and I think I will be able to going forward, but even still. She agreed with me in the end and said she will not take action, but she kept reiterating the fact we could get the crisis team out. I don’t trust the crisis team and I certainly don’t want to go through the NHS inpatient experience again. I don’t want to put my family through that either. I am scared that my bloke will be shocked it was even considered. I have not really let on that things have been much worse in the past fortnight. I have to phone her or ALERT if things get worse again, although I still don’t have their number so not sure how to do that.

She wanted us to talk about what her role was and what I want her to do for me. I didn’t really have an answer as I find her a little useless and wonder what the point of her appointmesnts is. I was keen for her to liase with other services and make referrals for me though. We discussed other things out there, especially therapy. She is getting me on the list but warned me it will be an incredibly long wait, even just for an assessment. She also suggested Beating The Blues in the interim, but it’s more CBT and I’m not sure Kate had much positive to say about it. I start Creative Remedies next week and Positive Thoughts in a couple of weeks so we shall see how those go. She also suggested I tried the Day Centre in Warrington. I’ve been once before, but was too scared to talk to anyone there and left after 5 minutes reading the notice boards. She suggested she took me in and introduced me, which may be better. I said I will see how Creative Remedies go first and then decide.

There was a lot of boring stuff about setting expectations for recovery and doing things to help. It was a repetition of much of what she’s said before and got quite tiresome. She talked a lot about my work and how if I am ever to go back things will have to be different. We talked about the competitive nature of the company and she seemed appalled at the way things work and shocked that I accepted it. I think she really wanted me to consider leaving and working elsewhere, but didn’t dare say as much. I know things will have to be different, but I am not sure I want them to be so different I leave my job. We will have to see.

This afternoon I need to get down to some serious baking. My friends who get married tomorrow have asked for contributions to the buffet and bar instead of traditional wedding presents. Hopefully I can knock up some yummy contributions and everything goes well.

Hope everyone out there is okay. Take care folks xx

Hope or Hopeless?

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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.

work, work, work: life before sign-off…

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This is the second part of my post about work. The previous post can be found here.

I’ve been thinking about work and my performance in the weeks before I was signed off and trying to work out where I got the point that I was not fit to work. It’s strange because one of the things I struggle with most is working out how much things were a result of my depression/mental illness and how much of it was a cause. I can’t work out where the lines blur. It’s hard to distinguish illness from personality and circumstance. How much of it is depression, how much of it is part of my nature and how much of it was caused by the pressure of the job in general? It’s all one big melting pot and I’m not sure what to blame.

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