Into the system…

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Posts Tagged ‘relationships

8mg…

with 8 comments

I saw Dr M this morning. I’d not seen her for ages. It was back in July, just before I went to Europe (I haven’t written about my trip, but anyone following my twitter feed will know that I spent 2 and a half weeks InterRailing during July/August), so a lot has happened since then. She suggested that it was a good sign I hadn’t needed to see her sooner, but I indicated that it wasn’t especially. It probably would have been if I hadn’t have wanted to see her about a month ago. I couldn’t get an appointment then. This was the first Monday we could both do.

She asked about my trip. She was impressed and relieved that I managed on my own whilst I was away. It feels so long ago now, I didn’t really know what to say, other than that I coped, enjoyed most of it, but found it really exhausting.  I could have told her more, but didn’t see the point. There was limited time and plenty of other things to cover.

We talked about things with the bloke. Before I went away, things between us had been somewhat up in the air. When I last saw Dr M, there was a very real chance that we would split up. I haven’t written about this here before now, because I don’t think the bloke would be overly comfortable about me sharing this with the world.

The whole idea of the trip to Europe, was to give us some time apart to reassess things. I was going to just take a “boring” holiday somewhere, but options are limited for solo travellers and I’d always wanted to go InterRailing, so I decided to give it a go. It also seemed like a great chance to test myself to see if I could be more independent and to cope on my own.

I’d talked about all of this at my last appointment and Dr M was keen to know what has happened since then. Things between us have settled down and pretty much gone back to how they were before things became difficult. It’s almost as if nothing had happened. Neither me, nor Dr M could decide if this was a good thing or not. On the whole, it is probably good. Things were not good at all when I left and it is nice to know that he missed me a lot, but it has also been a little disappointing. When I got back, we talked a bit about what had happened and how we should try to improve things and appreciate each other more. Unfortunately, it doesn’t feel like anything has changed or improved.

We talked about my trip to Occy Health. I explained what he said about not starting a proper scheduled return yet, but how we tried to think about the ways we can solve some of the problems that are stopping me from getting back to work. I told her that he’d said I could try to visit the office and that I managed to go to a meeting last week for a couple of hours, which she was impressed by. It was a really big step, so that’s good. However, she seemed disappointed that there was nothing further planned yet. I suggested that I will probably try to go in again in the next week or so, but I hadn’t decided when yet. She wanted me to try to commit to a time and hoped that I could start to go in on a more regular basis, even if it is only once a week for a few weeks. She thinks that a routine and commitment to going to work on a specific day, would help me prepare for it better. I said that is actually what I’d hoped for, but that Dr Occy Health wasn’t sure and she seemed to accept this, but she thought it would probably be okay if I chose to do it, rather than having my work-place imposing it on me. She may be right and I was considering this myself. I will try and decide when would be best.

We did talk about my mood and how it has recently dropped quite a bit. I don’t think she was too concerned or especially surprised, although she was possibly a little disappointed. She asked about the usual stuff . Sleep, suicide, anxiety… She was not surprised to hear of my nightmares or generally rubbish sleep (occasionally too much or usually too little and never feeling rested). I had to admit that suicidal thoughts had returned, although they were a lot less frequent and different to how they were a year ago. She hadn’t actually realised that the thoughts had pretty much gone away over the summer, which was a surprise. I’m sure I’d told her last time that I wasn’t really suicidal any more and that I no longer felt that life was completely hopeless. Although I can feel pretty awful at the moment, I have got my hope back that I can be well again. A year ago, I could never imagine a life without feeling horrifically depressed, so it was no wonder I could see no future and wanted to end it. I do get frustrated at the fact that I have got worse again. I wonder if I will always be waiting for the next relapse and if so, is it worth it? I am able to cope with these thoughts at the moment, as I still have some hope of a recovery.

We talked about the risk that I may do something impulsive if I have a particularly bad day. I told her there was no immediate risk of me killing myself and that I have no intention to make any detailed long-term suicide plans like I have in the past, but that I couldn’t guarantee that I wouldn’t just do something on impulse. I don’t tend to be impulsive and have never made the decision that way in the past, but if an opportunity presented itself, there are times when I can be very tempted to take it. She recognised this and I guess she knows that there is always a greater risk of completed suicide when people are either recovering or deteriorating. When you are really, seriously depressed, it is far too much effort to kill yourself, but when you’re having a bad day after a series of not-so-bad days it can seem a lot worse and you are also more likely to have the energy and drive to do something about it.

I mentioned that I felt that the arrival of autumn did not seem to be helping and she agreed that there was probably a seasonal element. She had noticed back in the spring that things seemed to improve a lot faster for me when the weather picked up in April, so it is natural, I guess, that things would get worse again when the summer ended.

We talked about my medication and she agreed that it probably needs a tweak, if only to help me get through winter. Her first instinct was to add Quetiapine. Apparently, it was licensed the other day in the EU as an augmentation treatment for Major Depressive Disorder, although she admitted that most psychiatrists had been using that way for a while anyway. She asked if I’d been on it before and I confirmed that I had. I was taking it along with Venlafaxine, back in February 2009 when I overdosed on it. She asked what doses I’d been on and I said I couldn’t remember but I did get right up to 550mg. She said that for MDD they use a max dose of 300mg, but I had been on that sort of a dose for a while too, so I’m not sure it would help. I also mentioned that it never seemed to help with insomnia and that I had put on weight last time. She said she didn’t expect it to help the insomnia and she seemed genuinely surprised about the weight. Although it didn’t help me with insomnia, I know plenty of people who find it knocks them out, so that seems a little strange. There are also plenty of people that have found it made them put on weight too, so I am not alone. Both drowsiness and weight gain are listed in the common side effects, so you would have thought she was aware of that. Anyway, I said no to Quetiapine.

The other options were to do nothing, increase the Reboxetine, swap the Reboxetine or try to add something else. I wasn’t sure doing nothing was a good idea and we both agreed that stopping the Reboxetine was a really stupid idea, as it is the first AD that has ever helped me. Reboxetine has shown that Noradrenaline is probably the key to my wonky brain chemicals and there aren’t many others that help on that front, so we’re not sure what else to do. She didn’t have any bright ideas of anything else to try really. If not quetiapine, then she said we’d probably be looking at augmenting with Lithium or another anti-depressant, but she wasn’t sure what would be best. She said she would have a look for some ideas though before I next see her and she was welcome to any suggestions I may have – so if anyone has any ideas, let me know. I’ve been on most of the common combinations already and my only real thought is perhaps bupropion, but it’s not licensed as an AD here (although it is used an awful lot in the US), so I don’t know if she’d give it a go. I know a couple of people who have found it helpful though, so it may be worth a try.

In the end, we decided that increasing the Reboxetine was probably the best option for now, although I am worried about how I will be with the side-effects. It is worth a go though and if it is too much then we will have to try something else. I hope it helps, without making me feel too awful. She said she’d get a letter sent to Dr N. I have plenty left at the moment anyway, so will just increase the dose myself for now. It only comes in 4mg tablets anyway, so it makes little difference. So yes. I am now going to be taking 8mg of Reboxetine. I didn’t actually tell her that I’ve occasionally taken 8mg anyway, when I’ve not been able to cut one of the tablets in half to make the 6mg. One day doesn’t make much difference though, but 8mg over a week probably will. We will see anyway.

After that, I remembered that I had also been for the therapy assessment. I told her what had happened and that I will probably be waiting for someone to come back from maternity leave. She named the person she thought it would be. We shall see what happens anyway. She isn’t impressed that I’ve been waiting over a year and was shaking her head saying “it’s probably only going to get worse, only going to get worse…” as she looked at her diary to book our next appointment. It really isn’t good.

Anyway, time was up then and I had to go. I see her again in 6 weeks, so we shall see how we go with the Reboxetine.

Written by intothesystem

Monday, 11th October 2010 at 2:08 pm

Bombshell…

with 16 comments

On Wednesday night Dr M dropped a bombshell and then ran away whilst it detonated.

Contrary to what was said in ward round on Tuesday, “yes, it does sound like a mood disorder. We shall discuss your notes and call you in later to discuss medication”, they are now questioning my diagnosis, saying my picture doesn’t fit with their understanding of Bipolar Disorder. Now, considering this is based on a half hour conversation with me and a couple days of uncharacteristically fast (for me) mood swings, I am concerned.

They said they want me assessed by the clinical psychologist, which may take “many weeks” before they make any decisions. She isn’t sure where I should wait, here or at home, but is concerned about my safety (which to be honest she needs to be! Being in here doesn’t exactly do anything to convince you life is worth it, when you have already given up).

She said she doesn’t want to change my medication as it might influence the assessment. No mention of taking me off my current meds, which could be doing the same!

Then the meeting was over and I was left to handle the fallout alone.

I am a little shocked. They haven’t seen my Priory notes as the CMHT has lost them. I was under the care of The Priory for many months and I think they had enough time to assess me. Not make assumptions based on a short conversation and observations over a couple of days, which have obviously been influenced by an overdose and stress!

I am concerned that the change of tack seems to have come after J spoke to them. What on earth did she say, especially as she didn’t exactly know me or get the full picture as I didn’t trust her?

I can also sense what is coming. A borderline diagnosis is ahead on the tracks and coming at me fast (or slowly as it’s the NHS). I wouldn’t mind if this seemed to fit, but I am fairly familiar with the criteria and nature of the condition. It doesn’t ring true with my experience. I have no fears of abandonment – I am fiercely independent and quite happy to accept someone won’t be in my life any more, e.g. when therapy has ended. I may miss the person or thing, but not object to losing it and will not try to stop them. I do not have stormy and unreliable relationships – I have been with my partner 7 years. We argue like man and wife and our relationship is strained by this episode of illness, but I don’t love him one minute and hate him the next. My mood swings are not generally reactive and *usually* slower than those suggested for BPD. I don’t suddenly want to kill myself after bad news. Yes, I can express frustration or be upset, but not out to a level that is out of the norm or to extremes. I do not act impulsively without considering the consequences. My major suicide attempts have both been a result of a huge amount of thought and planning. In fact, aside from my mood swings I don’t think I am generally a person of extremes. I also have no past trauma, which is often involved with the condition. I could probably half meet maybe 3 or 4 criteria, but never the 5 needed by the DSM or the descriptions given in the ICD. I’m aware I am having to simplify things through lack of space or time – my thumbs will fall off if I write everything I want to, but I think you get the idea.

Also worth noting that borderline PD is one of Dr G’s specialisms and she never mentioned it to me. She tends to be pretty straight with people, so if she thought it was that then surely she would have been able to say so? She also wouldn’t have referred me to Dr P, him being the mood disorder specialist.

I can’t help but feel this is all part and parcel of the way this label can be misused. Don’t fit classic diagnosis, don’t respond to first line medication, female, suicidal and have mood swings. Oh BPD will do. Lets try and put the square peg in the round hole.

Maybe they aren’t thinking Borderline PD, but the mention of psychologists and lack of anything else even remotely close, suggests they are.

I am also frustrated at the lack of desire to do anything whilst waiting for the psychology/therapy assessment. Even if it was BPD, medication can be helpful with treatment and is often following the same kind of strategy as Bipolar II. She may in a couple months time go back to my current diagnosis, make the same changes and in the meantime I have wasted months of my life stuck on this ward. There never seems to be much desire to get you out, unless they suddenly need a bed then you can be out on your ear, recovered or not.

There are a lot of questions and no one has given any answers yet. I wrote a list of the key practical ones and handed it to my nurse to pass on yesterday, but no mention yet. I suspect I will be waiting until ward round next week.

After all this, my bloke went to see Dr N yesterday for his opinion. I thought this would help but it has made me more confused. Apparently Dr N is quite pleased I am being reassessed as he was never convinced by my diagnosis and he even suggested Dr G wasn’t. I had suspected this myself, but when I questioned Dr G on it, she said she agreed with Dr P. My bloke and Dr N apparently discussed borderline PD for a bit too. My bloke also expressed his concerns about rumination (he seems to think if I stop overthinking and forget about my illness I will be okay) and my blog came up. Apparently Dr N didn’t know I was still doing it! Surprised by this as everyone else, including the CMHT knew. I kinda feel left out of my own care again, so am wishing I had been there yesterday, although I know it is not practical.

Since then I have spent a lot of the last day or so pondering all this. I had a visit from Em in the afternoon which was lovely of her and a short break from everything.

My bloke came in the evening. It was his birthday but he wasn’t exactly full of birthday cheer. Em had got me a cake to give him, which we shared some of, but then we spent the rest of the time talking about all this. He has been doing a lot of research, trying to fix everything and find solutions (typical man).

He has been going over the rumination thing and my lack of positive thinking. I know I overthink. I even overthink good things. The problem is I always have and it feels like part of me. Questioning that feels like a direct attack. It may be an exacerbating factor, but it isn’t the only problem and I also don’t know how I could really change this. I can tell myself to stop and distract myself, but the running commentary just carries on and questions me further. I will almost overthink, overthinking. Distraction works to a point, but when I stop I just go into thinking overdrive instead and I can’t distract forever.

He has all these suggestions of how I can get better and things I need to do. Thinking and therapy techniques, supplements, the usuals of exercise etc. Many of these I do try to employ already and it is all well and good to suggest them, but at the end of the day I am: a) unwell and that can make it hard to do anything, especially when I’m in crisis and all logic goes out of the window, b) stuck in here so many of the suggestions are impractical and c) they may help to some degree but none of these things are going to fix things.

It still feels like he basically wants me to buck my ideas up. I was getting frustrated by this. I know he means well and is trying to help, but I wish he was perhaps more sensitive in his approach. He has gone from acting caring and supportively over the last couple days to criticising me again. I do wish things were all as simple as a bit of CBT, some positive thoughts, routine, eating and exercising well and some distraction. Sadly they are not.

Edit: Maybe this is unfair. The conversation was frustrating and I did feel attacked at times, but I am glad he is trying to help. Some of his suggestions were helpful. There are good bits within the bad. I do just find it hard to see them and I don’t know how much I can do right now.

Today looks pretty bleak and pointless. More waiting and the thought of another long weekend ahead is tiresome. I asked about having Nikki, coming to visit so we could have a walk around the grounds, utilities the nurse said I need to get it sanctioned by the doctor. Considering I am not on a section and would be escorted by my partner this seems unfair. I wish I could just walk out and although in theory I can, they are unlikely to let me. A section would probably beckon, if only an assessment one.

I am tempted to ask for some haloperidol! It is the only thing to ever sedate me and although it turns me into a zombie, I’d quite like to sleep away a few days in an antipsychotic-fueled daze right now. It is not practical in the real world, but in here it doesn’t matter. I don’t have any PRN written up as nothing really works.

Anyway this is pretty long and I’m scared it won’t post! I better go. Xx

Am I Being Fair…?

with 14 comments

A question that is plaguing me and my relationship at the moment.

My partner has been objecting to what I’ve written about our arguments lately. I am not sure he appreciates me writing about our relationship in such a public, but one-sided way. Maybe it is unfair to expect him to sit back without the opportunity to say his piece, but I need somewhere to work all of this out. I need to know if I am making sense. I need someone to listen.

He is of course right that I am only showing my side of the story and I am not giving him the opportunity to defend himself. Maybe I could let him write his own post, give his own argument, but I’m not sure it would be suitable for publication! ;) It is true though that much of what I have written has presented the facts and I am not trying to criticise or upset him with these posts. He did indeed call my illness a “stupid teenage fantasy” and does indeed make little snide comments about my blogging, so he cannot argue with that.

He tells me though that I do not realise how much the things I write hurt him and that I shouldn’t portray him as some big evil monster. I don’t mean to do that. He isn’t. We really do have our problems at the moment, but I don’t think he acts with any malice. I don’t think he gets any pleasure out of annoying or hurting me. He just doesn’t know how to deal with everything that is going on. I’m pretty sure he genuinely tries to understand better, but I am just not sure that it works.

One thing he said was that his sulking is not in any way aimed at me. He said that when he read about me stopping my medication he was really angry and that when he went off to sulk he wasn’t trying to manipulate me, he was just taking time out so he didn’t do or say something he may regret. That seems fair enough. There are times I have to take myself away from a situation. The problem is though I am unsure. Even if he doesn’t mean it that way, it still puts me on the back foot and makes me feel guilty. Of course he says that is my problem and that I shouldn’t think everything is about trying to hurt me. I guess it is my own fault for feeling guilty, but perhaps he should find another way of staying in control and maybe he shouldn’t give me the cold shoulder when I try and find out what is wrong.

When I said that our long conversation (argument) on Saturday night didn’t get us anywhere he was upset as well. He felt it did help and that we were getting somewhere. He argued that I am always seeing the negative in things and that we’re never going to get anywhere if I continue with that attitude. Yes, we did say things that needed to be said, but I am unsure if we actually got any closer to finding a solution. I know that he was trying though.

We had another one of those conversations on Sunday night. He said he’d been making a concious effort all day on Sunday not to make the biting comments I find so frustrating, yet I can’t say I noticed an improvement. This confuses me. Are things really not as bad as I think they are, but because of the negative nature of depressed thinking I am feeling things more acutely? Am I just making things up to taunt myself with?

We seemed to spend a great deal of time discussing the merits of twitter. I do think things have escalated on the blogging-hatred front since I started using twitter more regularly. You may remember that I wrote a blog post about my feelings on twitter about a month ago. I myself was sceptical of its merits, but I have come around because I do genuinely think it is helpful and dare I say it? I enjoy it. I enjoy being in the middle of discussion between an interesting group of people. I like the fact that twitter is taking my blog to new audiences. I like the fact it is quick and I can log my thoughts without having to dwell or develop them.

One of his arguments was that 140 characters is far too little to say anything constructive. I thought that too at first, but I am amazed at what you can actually convey through a few short messages. Thoughts after all aren’t logically constructed into sentences and paragraphs when you have them, so sharing a few snippets can still get across the same message.

His other was that he doesn’t understand why I want to broadcast little snippets of info to a bunch of strangers. He doesn’t really understand why I want an audience on my blog. I know I didn’t really start writing this for an audience. I started as I hoped it would be therapeutic, but I have found it helpful, interesting and encouraging to know there are people out there that care. I have met people who I do genuinely count as friends and I have received a great deal of useful advice and support. I wouldn’t get all that from a paper journal hidden under my bed.

As for twitter and an audience. I only really intended it to be aimed at my blogging audience. Little extra snippets of information for those that already read. Little updates for when I don’t have the words for more. It has developed into a new outlet though and also a new source of readers to this blog.

We also talked about me and my illness. His main argument was that I do not try hard enough to get better. This is an argument I hate, because it implies such a lack of understanding about mental illness, that I thought I could have changed by now. It doesn’t matter how hard I try, it isn’t going to take this illness away. I may be able to ease some of the symptoms, but that will be as far as it goes. Yes, I know that lifestyle changes can be useful and I even know that eating better and exercise can help, but it is not a panacea. The eat better, exercise more, be a better person stuff just doesn’t wash.

He is worried that I am pinning all my hopes of recovery on finding a wonder drug and/or therapy and that I am not going to do anything myself to get better. I am hoping that one day I will find a cocktail of medication that helps. Most of the people I know that have had some recovery have been aided in that by medication. It is often pointed out at The Priory that you should take a three pronged approach to recovery: medication, therapy and lifestyle change. By pinning my hopes for recovery on therapy and medication I am not being lazy, just realistic. I would also hope that the fact I have hopes for therapy (when the NHS finally get their ass in gear) does suggest I want to do some of the work to get better myself. Therapy is far from an easy process and involves a great deal of hard work, work which I am going to have to do.

As an example of how I am being lazy and not trying hard enough, he says that I haven’t done anything to improve my sleep, except take a few pills. I have tried medication, but I’ve been through the sleep hygiene stuff too. Admittedly I’ve made less effort in recent months, but only because I have given up hope. I have spent years swinging between hypersomnia and insomnia, although in recent years I’ve been firmly in the insomnia camp. I have tried all sorts of things and nothing has succeeded in restoring “normal” sleep. What is normal is questionable anyway, because there are times when 4 hours is fine, other times when 4 hours is no where near enough and even times when 4 hours feels too much. Sometimes I can have 2 hours sleep and feel fine. Sometimes I can have 2 hours sleep and feel awful. Other times I can have 7 hours sleep and still feel exhausted. I guess it’s all linked to mood, but I guess it also means my sleep will never be great.

He suggests I need to follow more of the CBT and self-help stuff we went over at The Priory. Setting myself a routine and activity scheduling. I do need to get back into a routine, but it is understandable that things go haywire over Christmas. I know activity scheduling was something that was always encouraged at The Priory, but I never really found it helpful. I also worry that this is just another means for exerting control. He can try and make me follow a routine he approves of and if I don’t stick to it, then he can get angry and tell me I’m not trying hard enough.

His latest suggestion is that I only use the internet/blog in the evenings to try and contain the time I spend on here, but I fear this is merely so he will be around at the time I’m doing it. Of course him being around will mean I will spend even less time on here because the automatic guilt-trip will be triggered and secondly, he will be able to keep an eye on me whilst I do it. When I tried to go online this morning, forgetting this had been suggested, he got angry at me and told me I was only allowed online at night and that I should do as I’m told. I had never agreed to following his suggestion, yet he was determined to enforce it. I am not sure I’m comfortable with his assumption that I will do as I’m told

I can’t remember what else was discussed on Sunday. I don’t exactly enjoy the arguments and I have found my short term memory seems to be pretty selective. Some of the bits that provoke the strongest emotion and reaction stick, but the rest slips through my hands like sand.

I do remember that I gave up before the bloke was ready to stop. I couldn’t take any more of the argument and at 2am or whatever it was I was too tired to discuss anything properly. He was annoyed at this, but I couldn’t help it. I didn’t want to start the discussion then anyway. It would be a lot easier to talk about such things when I’m actually functioning properly.

The thing is now I am confused and conflicted. I wonder if I’m being fair. I wonder if this is all my fault and if I am overreacting. I wonder if I am just seeing the negatives all the time. But things have got to the stage now that I am always suspicious of his motives. Is he trying to make me feel bad so that he can control me? Is he trying to guilt trip me into compliance? Is he just saying all of this to get his own way?

I wonder if anything will ever change. I really don’t know what to do.

Alison suggested on my last post we had some time apart and it is something I have thought about a lot myself, but I do not know how feasible it is. I hope that him going back to work will help. At least it will give us a few hours space. His cold is now improving, but his attempt to get to work this morning proved futile due to the snow. Both routes out of the village towards Warrington were difficult – one impassable and one almost so and he didn’t want to get stuck on the way back, so he turned around and came home. Unless it dramatically warms up overnight there’s little sign of him getting there tomorrow either. We’ve had another couple of inches since he got home this morning.

Even if he does get to work soon, a few hours apart probably isn’t going to be enough to help. Would a temporary separation be useful? It might make us realise what things we miss about each other and it might give me some space to get better. Our relationship was once long distance and it is true that absence makes the heart grow fonder. I just don’t know if he’d be happy about it and I don’t even know if I could. Things are not good at the moment and I wonder how Dr N and the CMHT will react if I am on my own. I wonder how I would cope. I worry that I would end up in hospital, perhaps not because he would get me sectioned or maybe even not because I couldn’t cope, but pretty much because there is no where else for me to go. I can’t exactly go home – my support is up here and I’d go mad after a couple of days with my parents anyway and I don’t really have any friends I could stay with. I don’t have anywhere else to go.

As has been mentioned before, I don’t think I am well enough to make any big decisions on our relationship whilst I am still in the acute throes of this illness. I am pretty sure things would be a lot easier if I was well. My illness has skewed the power relationship and I think that has escalated the worries about control. I think he wants to control me, because he wants to keep me safe. I am in a weakened position naturally, because he is my carer and ultimately if he wanted me in hospital he could make it so. Before I was his equal and I had things of my own and they gave me freedom. I had my career and my work friends, both of which I have lost through illness. I find it hard because I don’t feel I have anything of my own any more and that only adds to the feeling that I have no freedom anymore.

Admittedly we argued before I was ill, but it is true that arguments are a fact of life in relationships and things have been so much worse lately. The problem is, I can’t really remember the good times. A combination of depression and the effects of ECT means they’ve pretty much gone. I can barely remember our engagement. It makes it very easy to think that our relationship is all bad and maybe it should be over, when really things are just a little difficult at the moment and there is a lot going for us. NYE was our 7 year anniversary. That’s a long time and we must have been doing something right to get this far.

You would be forgiven for reading this post and thinking that our relationship struggles are the only thing going through my mind at the moment, but they are not. These struggles are the thing which I feel most able to write about, but on top of all this there are other struggles going on. I want to write about them, yet I am scared about doing so. The depression is pretty intense, but the agitation is back again and the only respite I have is my appreciation of snow. I love snow and it has been a welcome distraction from the worst of my thoughts. Sadly I know that as the snow melts that respite will disappear and I will be left with the misery that fills the rest of my mind. I do not relish that thought.

NHS Psychiatrist…

with 5 comments

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.

Trying to talk…

with 10 comments

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

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

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

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

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

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

Written by intothesystem

Thursday, 16th July 2009 at 8:31 pm

Sexuality…

with 8 comments

I initially started this post last July when there was a discussion about the lack of gay mental health blogs from both Lexie and Aethelread but I never got around to completing my post and following them up myself.

More recently Kate got me musing on the subject of sexuality again and I thought it was time to resurrect the draft that I started so very long ago.

Like last time, it may take me a while to work out what I want to say and I don’t know if I’ll ever manage to complete it. It’s a topic that is still so very tangled in my head despite going through a whole battle of acceptance a few years ago.

In particular I remember from the initial discussion that, Aethelread said the following:

On the one hand, I think it can lead to us being so keen to stress that being gay has nothing to do with mental ill-health that we decide not to mention our sexual orientation when we blog about our MH problems.

For me, I think this hits the nail on the head. I’m not sure that it’s because of guilt as he suggests, but I think the reason I’ve not mentioned my sexuality before, is that I do genuinely believe it is unrelated to my mental health.

For those who have been reading my blog so far, you would be forgiven for the assumption that I’m straight. I’m in a long-term relationship with a man – a decidedly heterosexual arrangement. In fact, I’m engaged to that man. However, my sexuality isn’t that straight-forward (if you will forgive the unintentional pun!). I have always hesitated to attach this label to myself, because it’s not one I particularly like the sound of, but it is the one that fits. I’m bisexual.

In many ways I am lucky in that I can always let people have their assumptions. It is entirely my choice whether or not to disclose my sexuality and it is nice to have that choice, but then again if I was straight I wouldn’t need to make that choice, would I? My relationship with my partner makes it even easier for people to assume I’m straight, but I find that difficult at times. It often feels like I’m hiding part of my identity and not being honest about who I really am. It’s something I’ve struggled with because I don’t want to have to shout from the rooftops that I’m not straight, but then again I don’t want to hide matters either. I wish that bisexuality was commonly accepted and that people didn’t make assumptions that you are either gay or straight based upon your current partner.

As for my sexuality and its involvement in my illness, I do not really think there is much of a connection. I have battled with acceptance in the past and things have added to my confusion at times of crisis, but it’s not something that is directly responsible for my mental health problems. This is something that thankfully my therapists and Dr G at The Priory have agreed with me on.

It took a long time for me to even bring up my sexuality at The Priory because I was scared that it would be blamed for my issues. At the time, I was really scared that my bisexuality would be seen as another reason to slap on an unstable (borderline) personality disorder label – after all, uncertainty over sexuality is meant to be a trait. The thing I wanted to make clear was that I was no longer uncertain about my sexuality; I had accepted the fact that I like both men and women. I was scared that my sexuality would change the way people saw me. I was scared that it would become a problem because everyone else thought it was. I was scared about prejudice.

It got to the stage though that I felt it was becoming a problem because I was hiding a part of me. I kept thinking about it and it felt like I was living a lie. When you are going through therapy I guess it’s important that every part of you is on show. I felt that I needed to be honest and open up about things. I didn’t know how I could do it. I wrote to Dr G in the end. Thankfully my fears weren’t realised and she was very supportive.  My issues with my sexuality were boxed up carefully to be treated as a side problem, not the main affair, and everyone seemed to agree with me that we couldn’t use my sexuality as a scapegoat for my mental health issues.

As for what Kate wrote, I know how she feels. I have been through many of the same thoughts and issues over the years. The issue of acceptance is a difficult one and I think it’s something that I will always have some issues with. I also understand the fear of bullying, the fear of being different and the fear of scaring off your friends, especially female ones who may think you’re hitting onto them. Coming out is scary.

One of the things that made it so hard for me to accept that I liked women was the fact I used to be bullied and one of the things they used to say was “Lesley, the lesbo”. (oops, there goes my real name.. let’s just leave it hidden here and hope most people don’t notice!). An unoriginal put down considering my name, but one I used to hate. I began to associate being a lesbian with bullying, so it’s no wonder I was reluctant to admit I liked girls.

Another reason was my mother. I remember when there have been stories about lesbianism on TV she would always say how disgusting it was and would always expect me and my sister to say the same. She had no issues with gay men, but couldn’t accept lesbianism at all. This of course is difficult, because you don’t want to go against your family’s expectations. I don’t want my mother to be repulsed by me. This is why my mum will never know. What she doesn’t know won’t hurt her and it’s easier for her to just assume I’m straight. If I wasn’t with my partner and was going out with a girl I guess things would have to be different, but I guess I’m lucky in that way.

Being bisexual I think there are added issues. Homosexuality is becoming more and more acceptable, but there are still prejudices towards bisexuality from both the straight and gay camps. Biphobia takes many forms, but generally there’s a belief that bisexuality doesn’t exist or there’s an assumption that bisexual people are promiscuous. I may not be fussy, but that’s because I see people for what they are and am not bothered about gender, not because I just want to shag anything that moves.

I often feel like I don’t fit in. I am not straight, but I am not gay either and that leaves me caught. I feel as if I don’t know where I belong. Although I am in a relationship with a man, that doesn’t mean I want to live an entirely heterosexual existence. Doing so would be denying the other half of me that is just as interested in women. It’s a difficult one and one I don’t think I’ll ever really overcome.

I think I’ve rambled enough about this for now. As I said before, I still struggle to untangle all my thoughts on the topic and as such my writing is confused. I don’t really know what I wanted to say, other than to come out here too.

Written by intothesystem

Tuesday, 16th June 2009 at 2:25 pm

Yo-yo…

with 5 comments

I’ve been up and down like a yo-yo this week. Since the crash back down last weekend I was up again Sunday night and quite hypomanic, giggling unnecessarily and unable to sleep. Monday was a slightly more even day before a complete meltdown on Tuesday. I was highly emotional, stressed out, suicidal, angry, hyper and generally out of control. I couldn’t control the agitation or my emotions and ended up crying and laughing hysterically. It was almost as if I just couldn’t cope with the tension that was mounting inside me and I didn’t know what to do, so my mind and body went totally crazy. I was all over the place, felt really out of control and generally not in a good way.

My meltdown on Tuesday also saw me telling my other half that I wanted to break up and couldn’t cope with our relationship. I just want things to change and at the time it felt like the easiest thing to change would be for us to break up. I clearly wasn’t thinking straight (breaking up would be far from easy!), but it does scare me that when I get like that I want to push him away so much. I really was hysterical and I wonder if my out of control emotions are trying to tell me something. I don’t really know if I can cope with this relationship much longer, or rather I don’t know if this relationship can cope with this illness much longer. I suspect my doubts are just another sign of me wanting to isolate myself so it’s easier to do the deed, but I don’t know.

I find myself wanting to be on my own for many reasons. Yes, it would be the loss of another “protective factor” and would make it easier to kill myself, but I know that our relationship didn’t stop me trying in the past and when I’m in that state of mind it wouldn’t stop me again. I do want to be on my own though and not have to worry about how my behaviour affects my partner. I wouldn’t have a battle every time I want to stay in bed a bit longer because the illness is holding me there. I wouldn’t be feeling like I was a child under his control because I’d be able to go out whenever I wanted without having to ask permission. I could learn to cope with things on my own and I think that would help me to re-engage with life again. At the moment I don’t feel that I can.

There are of course many reasons to stay together and for balance I guess I should mention those too. We’ve been together a long time and been through a lot and there is no reason why we can’t get through this too. I do love him very much and although I struggle with that love a lot of the time it is still there. There are practical things like we live together, have joint bank accounts etc that make division difficult – we can’t just stop seeing each other. Generally, splitting up would not be easy even though sometimes it feels like the easy option.

Seaneen once wrote that her illness, or rather the possibility that she might kill herself, is like a lodger within her relationship and I know what she means. There’s this third person that gets in the way all the time and makes things more complicated. This illness, especially the risk of suicide, is something that intrudes on every aspect of your relationship and makes it very difficult for things to be okay. There is always going to be that fear and this means there’s an imbalance of power. For us at the moment, it feels like it’s the illness in control and the illness with all the power. I feel like the lodger is getting in the way all the time and I don’t know if we can learn to live with it. My partner just wants everything to go back to how things were before, but that just isn’t going to happen. I don’t know. I hope we can get through this in one piece, but I’m not sure it’s guaranteed.

Anyway, Wednesday was a really low day. I was getting fed up of the turbulent nature of my moods and just wished that things would sort themselves out. I had no motivation and just wanted to hide from the world. Hibernation would have been nice. Suicide would have been nicer. I just had no desire to live. I still don’t most of the time. I wonder when that is going to change.

Thursday was a day of medical appointments with me seeing Dr G and Dr N. Dr G’s appointment was fairly uneventful. She didn’t want to increase my lamotrigine again so soon as it has to be titrated up very slowly. She did however add an extra 1mg PRN to the haloperidol so I’m taking 2mg regularly now and the additional 1mg if I get agitated.

We did talk about a few practical things though. It seems I do need to notify the DVLA about my condition and it is likely my license will be taken off me. When I last asked her about it a long while ago, prior to the suicide attempt in February and my Bipolar diagnosis she told me I didn’t have to, but things have changed. I guess my condition is taken more seriously these days.

We also talked about Disability Living Allowance. Dr G says I should be receiving it. It seems I should have applied a while ago but I didn’t know. It’s a shame that it cannot be backdated either. I spent Thursday night trying to put together my application. The form is a complete bitch and took me hours and I still don’t know if I’ve told them enough to convince them that I am deserving and ill enough. It doesn’t seem very geared up for people with mental illness. Lots of questions about personal care and mobility and little opportunity to explain just how much of a bitch living with mental illness is. I just hope that Dr G and Dr N can convince them for me. I’m dreading a medical assessment as I just don’t know if I can be honest with a new doctor. I suspect I would come across as too high functioning or maybe I’ll just be so anxious I can’t speak.

My trip to Dr N was disappointingly brief, but I had little to say really. Not much has changed. He just looks at me with pitying eyes these days whilst administering the necessary prescriptions. I only realised afterwards that the haloperidol supply he’s given me only covers 5 days if I use all the PRN. I haven’t been doing, but even still that’s not ideal. I don’t want to have to go back to him too soon. I feel like I am wasting his time. It’s bad enough being on weekly prescriptions and having to waste his time seeing him every week when I don’t really have anything new to say to him.

My mood on Friday was up and down just in a day. I started the morning low, but felt better by lunchtime. I had a good afternoon with Chouette, Kate and Hannah. It’s nice to talk about things and know that they understand, but it’s also nice to chat about normal things like university and living in Manchester. In the evening I went for a meal with some uni friends and although it was nice, I was tired and struggling to engage. My mood was falling throughout and by the time I got home it was on the floor again. I had to try and keep up appearances for a little longer whilst people were around.

Afterwards, things became difficult. My partner was upset and wasn’t talking to me. I don’t know what I had done to deserve that. I felt awful and couldn’t find out what was wrong. I was exhausted and wanted to go to sleep, but couldn’t because again our relationship was struggling because of this illness. I am fed up of it.

Yesterday was a long day. I was so busy it was hard to know how I felt mood wise. I was low but distracted. I’m just glad it is over I think.