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Posts Tagged ‘The Priory

Diagnonsense…

with 34 comments

This post is inevitably going to be very long. I have been thinking about what to say for days now and I just haven’t been able to force myself to do it. I need to write though as I must get this straight in my head.

I seem to have writers block. I sit down here with the intention of writing and making sense of everything and I can’t do it. I try to put all of these thoughts down onto the screen and I can’t. There are too many conflicting worries. Too many fears. I know what I have to say, but I am scared. I am scared of writing for making it real.

As you may have read, there was talk about changing my diagnosis when I was first admitted. I was a little surprised and worried about this to say the least. It was hard enough getting a firm diagnosis the first time, let alone having to go through it again. I had accepted the Bipolar II diagnosis and was felt it was accurate. I’ve not found any other diagnosis that describes my experience as well, although I do accept there are so many overlaps between psychiatric diagnoses that it is possible to get things wrong or mixed up.

I am uncomfortable with the idea that Dr M seemed to decide I didn’t have Bipolar Disorder in about 10 minutes. She referred me to Dr S, who is a consultant psychiatrist specialising in psychotherapy. She’s involved with the EDT team that I have been waiting on since last year.

Dr S assessed me over two, hour long appointments. Dr M wanted someone with a therapeutic background to assess me and provide input on my diagnosis. Dr M was obviously considering a personality disorder, although amazingly it seems not the one I thought she was (BPD). I am starting to wonder though how much Dr M influenced Dr S’s assessment.

Dr S asked me about all sorts of stuff. We did the usual history thing and she dug deeper on some things. She asked me a lot about my mood. One thing I was uncomfortable with was the constant assertion that my experience of high moods, could just me not recognising normal moods because I spend so much time depressed. I don’t agree with this. It is not normal to be working 16 hours a day, hardly sleeping yet not tired at all, running around your office doing a million and one things, laughing and talking constantly and generally not being able to concentrate on anything.

At the end of our second session, she told me what she thought. She agreed that I had “some form of mood disorder” but wouldn’t commit to anything. She told me that she was leaning towards recurrent or chronic depression rather than Bipolar II disorder, but wouldn’t dismiss that completely. She also mentioned “personality traits” (mainly perfectionism and high standards) that she said perhaps made me more susceptible to mood episodes, but she also said she didn’t think there was enough to suggest a full personality disorder diagnosis.

So what did Dr M think? I tried to find out, but she kept avoiding the subject. With regards to mood, she did mention dysthymia at one point, but surely by definition dysthymia would never be severe enough for hospitalisation? There were times when she even questioned whether or not I was, or had ever been depressed, which seemed bizarre.

When asked about the personality side of things she said she  “didn’t want to open any boxes that can’t be closed”, implying that it could be dangerous to give a diagnosis without being certain. She said there were personality traits which she was concerned about, particularly focussing on “high standards”, but she didn’t feel any were severe enough to consider a full PD diagnosis. She would also tell me that labels weren’t important and that we should focus on trying to “change the way I see the world”.

I saw Dr N a couple of weeks ago and he said my diagnosis had been changed on the system. This sparked my curiosity because I couldn’t get Dr M to commit to anything. I asked him what it said and he looked it up. It just said “moderate depression” and “personality disorder”. Nothing more specific than that. I think we were both curious as to what PD, although I think he suspected borderline too. After all, he had even suggested it back when he first met me, but it hadn’t been mentioned again since.

I saw Dr M again last week. We got through pretty much the whole appointment before I eventually found an opportunity and the courage to ask about my diagnosis. She had to look back through my notes to find it, which is a little scary. You would have thought she’d know what diagnosis she had given me.

It states clearly:

  1. Moderate Depressive Episode
  2. F 60.8 Other Specific Personality Disorder.

I have issues with the first diagnosis, but didn’t express them because I was so surprised and concerned about the second point. I didn’t know what F60.8 actually said, so I asked her what PD she referred to and she mentioned Narcissistic, which I was surprised about. Of all the PDs I had considered she might give, it was not that one. I told her this and she just said that she “felt the signs were there” and that Dr S agreed with her. I told her what Dr S had said to me; that there were some unhelpful personality traits and that I accepted those, but also that either of us didn’t think any constituted a full personality disorder diagnosis. Dr M then tried to justify her decision by saying it was not the primary diagnosis, but that if she thought it was there it should be documented. Somehow she seems to have decided to open the box after all.

I wanted to question how helpful any personality disorder diagnosis would be, let alone an inaccurate one, considering there aren’t any specialist services or extra treatment available here, but we had already gone well over my time and I didn’t have the fight or words to argue.

I want to argue though. I want to fight. The more I have read and the more I think about it, the more unhappy I am about this diagnosis. It doesn’t seem accurate and really doesn’t seem helpful.

I am less concerned about the depressive episode diagnosis, although that has its problems, but the personality disorder diagnosis is really concerning me. I find myself offended and ashamed by it. No one wants to be considered self-serving, unempathetic and arrogant. I think the shame has actually been one of the barriers to posting about it. I don’t even want to put my name near the diagnosis I’m so unhappy about it. The fact it is written in my notes for posterity is disconcerting to say the least.

So what is wrong with this diagnosis?

Firstly “Moderate Depressive Episode”.

If you consider the ICD-10 explanation of this diagnosis, F32.1, you have to note that by referring to a depressive episode you are implying that it is the first episode of depression. For me this is far from the case and I don’t like that my diagnosis neglects to consider any past mood episodes. It is almost as if she doesn’t believe I have been depressed before.

I also question the severity, but I understand that this can be subjective. Many people would go off my BDI score, which is still above 40 (severe depression is considered 30+). I do have more than four of the ICD-10 listed symptoms, but I would also suggest that some of these symptoms are marked and distressing, making it severe. Actually attempting suicide would surely put the suicidal ideation into distressing territory? Worthlessness, guilt etc are all pretty marked too. The thing is I still function reasonably well so people can be forgiven for thinking I am better than I am. It also doesn’t matter. The treatment for a moderate episode varies little from a severe one and it doesn’t make much difference whether it is my first episode or 10th.

What about the lack of acknowledgement of hypomania or high mood? The treatment for Bipolar II Disorder is different to that of Major Depression. I have responded much better to the introduction of Lamotrigine as a mood stabiliser than I did to any antidepressant to date. What if they try to take me off this? Would I respond better to a different one and will they ever try it? Usually antidepressants make me agitated and unstable. I have been okay with the Reboxetine so far, but it doesn’t seem to have lifted my mood at all, so what will happen if they change it? What if I am given an antidepressant that sends me skyward? It worries me.

At the end of the day though I am depressed at the moment and that’s the important thing. It’s the other diagnosis I’m most concerned about.

So – F60.8 “Other Specific Personality Disorder” (Narcissistic).

The ICD-10 does not give individual diagnostic criteria for the disorders listed in this category, so I will assume that the DSM-IV criteria is what Dr M is referring to, after all she had a copy of the DSM on her desk when I saw her.

The criteria for Narcissistic Personality Disorder is as follows:

A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)
  2. is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love
  3. believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)
  4. requires excessive admiration
  5. has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations
  6. is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends
  7. lacks empathy: is unwilling to recognize or identify with the feelings and needs of others
  8. is often envious of others or believes others are envious of him or her
  9. shows arrogant, haughty behaviors or attitudes

It is also a requirement in the ICD-10 that any specific personality disorder diagnosis meets the general diagnostic criteria for personality disorders.

According to ICD-10, the diagnosis of a personality disorder must satisfy the following general criteria, in addition to the specific criteria listed under the specific personality disorder under consideration:

  1. There is evidence that the individual’s characteristic and enduring patterns of inner experience and behaviour as a whole deviate markedly from the culturally expected and accepted range (or “norm”). Such deviation must be manifest in more than one of the following areas:
    1. cognition (i.e., ways of perceiving and interpreting things, people, and events; forming attitudes and images of self and others);
    2. affectivity (range, intensity, and appropriateness of emotional arousal and response);
    3. control over impulses and gratification of needs;
    4. manner of relating to others and of handling interpersonal situations.
  2. The deviation must manifest itself pervasively as behaviour that is inflexible, maladaptive, or otherwise dysfunctional across a broad range of personal and social situations (i.e., not being limited to one specific “triggering” stimulus or situation).
  3. There is personal distress, or adverse impact on the social environment, or both, clearly attributable to the behaviour referred to in criterion 2.
  4. There must be evidence that the deviation is stable and of long duration, having its onset in late childhood or adolescence.
  5. The deviation cannot be explained as a manifestation or consequence of other adult mental disorders, although episodic or chronic conditions from sections F00-F59 or F70-F79 of this classification may coexist with, or be superimposed upon, the deviation.
  6. Organic brain disease, injury, or dysfunction must be excluded as the possible cause of the deviation. (If an organic causation is demonstrable, category F07.- should be used.)

I guess you can draw your own conclusions from reading the criteria and what you know of me from reading here. I guess others may have a different opinion of me, but I hope they can see that this is not what I am like.

I have decided to go through each point of the NPD criteria myself to see if I can work out what does and doesn’t fit.

1. Self Importance

has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements)

I really don’t think this is the case. I often downplay my achievements, because I can actually find it hard to admit them, even recognise them. I was bullied at school for being clever and a “swot”, so I am not really comfortable with admitting my successes to people. Yet when I’m assessed by mental health professionals I do of course have to talk about my achievements and talents, so I guess they can be forgiven for not realising this. It’s hard not to talk about these things when you are asked to give your life story. I have a good job, which I have been successful in, I got a 2.1 at university, I got 3 As at A Level, I got 11 GCSEs including 4A*s and 4As. These are facts though, not exaggerations.

I don’t believe I am superior, certainly not to anyone with equivalent achievements. Most of my colleagues at work have a similar background to me and I certainly don’t consider myself superior to them. Yes, my academic record is superior to someone who left school with 3 Cs at GCSE, but that doesn’t make me superior; just better at school.

I think this is hard when you have been generally successful. You can seem like you are bragging when you are not, it’s just the truth. I remember during the assessment with Dr S there was a lot of focus on my achievements and suggestions that considering my age I had done well. I generally agreed with her, but now I almost wonder if she was fishing for this.

2. Grandiose Fantasies

is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love

I don’t even believe in unlimited success or ideal love so how I can be preoccupied by fantasies of these things, I don’t know. When Dr M and Dr S had been talking about high standards, they actually seem to mean in this sense, rather than the perfectionist sense, which I didn’t realise until this diagnosis was made. So I’ve been agreeing with them when I actually disagree. They seem to think I expect to be highly successful and powerful. I don’t. In the past I had been fairly ambitious, expecting to do well at school and going on to get a good job, but I don’t expect “unlimited success”. Anyone with a good academic record starting out on a career similar to mine has similar expectations. This is usually something to be considered positive and not out of the ordinary. Now of course I’m depressed and even the most simple tasks seem ambitious, which would suggest that these thoughts aren’t pervasive either, therefore not meeting the diagnostic criteria.

There was a short period fairly recently where I had thoughts of going into politics as I wanted to make a difference and there was a lot of focus on diversity in politics and increasing the number of women in parliament. I can be passionate about issues and want to do something about them. I guess I may have been fantasising a little at the time, but even still this is not an unrealistic ambition. I have been interested in politics for years and often considered it as a future career option, but not because I want to be all powerful.

I have had the odd grandiose moment when my mood has been high though and I have admitted this. Of course they question whether or not I’ve ever experienced hypomania, so will put this down to personality rather than symptoms of a mood disorder.

3. Special Status

believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions)

This is one that I guess I can identify with, although I am not sure it is correct. I do not believe I am special as such, but I guess I do feel more comfortable with people that have a similar background or interests to me. I think everyone does though to some degree and it is not like I will not associate myself with other people. I try to judge people on their merits and will talk to anyone.

I can see why they may think this is true though. During my assessment with Dr S she asked me about my regrets regarding me degree choice. She asked about how I chose my course and one of my considerations was choosing a respected university. This consideration was mainly to keep my career options open as opposed to anything else. There are plenty of graduate employers that only recruit from top universities. I guess this could be seen as wanting to be associated with “high-status institutions” though, so they may well use this as an example when diagnosing me.

4. Admiration

requires excessive admiration

Erm. I don’t know how to reply to this. I cannot deny I can have difficulty responding to criticism and that I like praise, which I guess may come under this category, but I don’t require or seek excessive admiration. If someone likes me that’s a bonus, but if they don’t then fine.

5. Entitlement

has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations

A sense of entitlement? I expect fair and reasonable treatment, but I don’t expect favourable treatment over others. I am a strong believer in equality and a sense of entitlement would go directly against this.

I can at times be stubborn and this could be misconstrued as expecting compliance with my expectations. I will compromise, but I try to be assertive as well. I don’t see this as entitlement though. We are usually encouraged to be assertive when in therapy, so it would be wrong to judge this as being narcissistic.

6. Exploitative

is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends

It is criteria like this that makes me so uncomfortable about this diagnosis. I don’t want to be considered self-serving. I don’t take advantage of others in order to get ahead and I find it horrible when people do. Some of examples given are things such as dressing provocatively to get your own way. Ignoring the fact that if I dressed provocatively people would run to the hills, I would never do this. I hate the idea on too many levels.

7. Lacking Empathy

lacks empathy: is unwilling to recognize or identify with the feelings and needs of others

There are two sides to this for me. In many ways I am often considered too empathetic. I consider other people’s needs often to the detriment of my own. I was told off repeatedly by the therapists at The Priory for considering everyone else first, for listening to the others and offering them advice and support, but for not giving myself the opportunity to speak and receive that support back. I would like to think that I understand how others feel and that I am sensitive to their needs. I certainly try to be, so I am not unwilling.

Yet, I know occasionally my bloke finds I have a lack empathy towards him. He says I don’t realise how much the things I say and do hurt him or recognise how he is feeling. I think our relationship is an isolated case though, because there are many ways in which I act different with him than I do with others – lack of assertion is another.  I also don’t think depression helps matters much. I guess a suicide attempt could be seen as not taking other’s feelings into consideration, but if you knew how much I worried and obsessed over this beforehand you would realise it is not.

8. Envy

is often envious of others or believes others are envious of him or her

I think everyone gets jealous now and again. I can be envious of others that have recovered from illness, because I wonder why I have not. I can be envious when someone gets better grades than me at school. I can be envious when I see people having a great time when I am depressed. I wouldn’t say it is often though and certainly no worse than most.

I really don’t believe anyone is envious of me. There would be no reason to be. I’m depressed. My life sucks!

9. Arrogance

shows arrogant, haughty behaviors or attitudes

I hope I don’t, but I guess at times I can be a bit of a snob and I’m guilty of generalisations. I am not exactly appreciative of chavs and I can sometimes be a bit rude towards people that watch rubbish on TV, but I’m not alone on this. I don’t think I’d go as far to say that this is a major problem or that I was particularly bad at it. I certainly know people who are worse than me!

_______________________

Anyway.  I’m going to post this now. It’s not really complete. There is plenty more I could say on the matter, but I’ve been at it for hours and if I don’t post it now it may be days before I do finish it. Maybe I will edit this post, or maybe I’ll add another. We shall see. This is well over 3500 words long now and I have spent quite a few hours on it.

Does anyone have any ideas of what to do next? I just feel a bit lost and trapped. I’m worried that if I question the diagnosis, it will come across as narcissistic! That is the biggest problem with personality disorders. Questioning it is just further evidence of the disorder and can all be seen as part of the problem.

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.

Blogging Twit…

with 3 comments

Blogging seems to have been replaced by twitter lately. I can just about manage 140 characters at the moment, but proper blog posts are a little hard. Hence the fact I’m writing about twitter, rather than how I actually feel.

I don’t know how I feel about twitter.

When it first appeared on the scene a few years ago, I wasn’t sure about it and decided I spent enough time on Facebook. I didn’t need another site to absorb my time.

Then all of a sudden it was the next big thing and I wanted to avoid it because of the hype. I am generally adverse to hype. If a band is hyped to death I usually avoid them and the same applies to websites! I also got annoyed at the way it suddenly became this brand of innovation or a fashion statement. Join twitter and show how cool you are! I hated the celebrity culture that became attached to it too. All of this meant I pretty much avoided it like the plague and didn’t want anything to do with it.

But I’ve found that I often have things I want to add to this blog and I just don’t have the time. I thought about setting up some asides (a la Matt @ WordPress), so I can update when I have little time or if I am unable to find the words. In the end though it seemed easier to use Twitter with the WordPress widget. Add a small dose of peer-pressure to the mix and I capitulated. I think I signed up under this account in April. I don’t have a personal account and don’t think I ever will. I guess Facebook still serves a purpose for staying in touch with friends.

I barely used twitter at all in the first few months. I signed up whilst I was still in The Priory as I thought I might be able to keep things updated on my phone. Easier than typing full posts on the little qwerty keyboard of an E71. I kept forgetting twitter was there though and the arrival of a netbook meant I could update here instead.

Suddenly though over the past month my tweets have increased in frequency fairly rapidly and now I’m using it every day. I don’t know what brought about the change. Funny that my twitter frequency has increased inversely to my mood. Wonder if there is anything in that?

I guess you come around to most things in the end though. I resisted for a while but a surrender was always coming.

I seem to be collecting followers and readers now too, which is nice. I felt honoured yesterday that @MarkOneInFour plugged this blog on twitter and I certainly seem to have picked up some followers through that.

Anyway I don’t know where this is going really. I just started writing and before I knew it there was a post. I know I’m really writing this to avoid writing about how things are. They’re crap btw.

So if you ended up here through twitter. Hi!

Edit:
p.s. I seem to have developed a tic with the word “just”. I’ve just (argh!) edited out a million from this post. Maybe I can start a new trend and it will replace the awful use of the word “like” that teenagers seem to love so much these days.

p.p.s. The original version of this was rubbish! Full of mistakes and the aforementioned “just”s. A little editing was in order. I guess the (lack of) quality of writing shows how bad my concentration is right now.

Written by intothesystem

Monday, 7th December 2009 at 5:47 pm

The ECT Experience…

with 3 comments

Whilst I was having ECT I never really wrote about it. I was in hospital with only mobile access to the Internet. I was exhausted, often in pain and not really in the mood for writing. Recently though I’ve been inspired by this blog and Seaneen’s appeal for ECT info to document my experience. I’m worried that if I don’t do it now, I’ll forget what happened all together.

Ultimately my experience with ECT was a failure. I had 11 treatments, some unilateral and some bilateral. I barely responded at all and in the end we gave up.

ECT was seen as the last resort. I was about as severely depressed as you can get and no one knew what else to do. I wasn’t sure about having it, but at the time I wrote that anything was worth a try. I think I was so depressed I didn’t really care what happened to me. I know I secretly wished it would go horribly wrong, so overwhelming were the thoughts about death.

I went into the treatment with a smidgen of hope as at least we were trying something. I felt little, but I knew my family wanted it to work. We had to believe it would work, as the alternative was too horrible to comprehend. Other patients at The Priory had been through ECT and come out the other end much improved. ECT had been lifesaving for them and I hoped it would be the same for me.

The procedure was a lot less scary than I had feared. We were woken early by the nurses, our blood pressure and temperature taken, then we were bundled into a taxi with the nurses over to Cheadle Royal. The Priory doesn’t have an ECT suite any more, so treatments were taken there.

There was a waiting room, where we’d sit waiting our turn. There was usually three or four of us being treated at the same time. Three from The Priory and a day patient from elsewhere. Eventually we’d be called into a prep room, where a girl would wash our forehead and neck and attach EEG stickers. Next we entered the treatment room. We’d climb onto a bed and Dr Shock would ask us how we felt. We would be attached to the monitors and then the anaesthetist would take my hand and try to insert a cannula.  This was where it got difficult to me. My veins are small and deep and finding one proved near impossible at times. Multiple attempts, hands like colanders and a number of bent needles later and we would be ready to go. After a few treatments like this, the anaesthetist ordered some microwave lavender bags, which I’d be given to warm my hands. ECT quickly became associated with the smell of lavender.

I’d never had a general anaesthetic before my first treatment and I didn’t know how I’d feel. I soon got used to the feeling. Twice a week for nearly 6 weeks, you have little choice. The liquid would ooze into my veins. I could feel the cold liquid flowing in my hand and then I’d drift off into a blissful sleep. When I was ill I’ve never had any other sleep as nice as that. Next thing I knew I was in the recovery area, oblivious to what went on whilst I was asleep.

Throughout my treatment and since, I’ve always been curious to see what happens in between those moments. I often wondered about asking if I could watch someone else go first, but was certain I’d be turned down. I know they apply a current to my brain and I have a fit, but what does it actually look like? Who does what?

A few times I awoke covered in blood. The cannula would slip out during the fit and I’d be left with a red tshirt. The first time it was a bit of a shock and slightly scary, but once I knew what had happened it was okay.

As we woke up, our vitals were taken regularly. Each of us would have a nurse, who would keep a close eye on us, administering pain relief if required. It was always required. An hour after our treatment we would be allowed up and given tea and toast, or water and toast in my case. Then we were bundled back into the taxi and taken back to the ward, where we usually went straight to bed.

At the time, the side effects weren’t so bad. I usually had a thumping headache, more so after the bilateral treatments. Sometimes I would ache all over. My jaw was often painful. My appetite was normally dodgy and I felt queasy from the anaesthetic. My memory seemed to be pretty much in tact. I’d written all my passwords and things down before I went, but I don’t think I ever needed to refer back.

I didn’t really mind the treatments, but I was frustrated at the lack of response. The night before each treatment we’d be given the BDI and would tick the boxes and I couldn’t see any improvement. I know my scores did improve a little, but one or two points is nothing when it is scored out of 60-something and the miracle I was hoping for never materialised. There were a couple of days after one of the early sessions where I became quite hyper and agitated for a short while, but that didn’t last either and could have been down to something else.

One of the others having ECT with me improved fairly rapidly, which was great news for her, but I remember feeling a little jealous. She was discharged from hospital before I’d even finished the treatment, although I think she had a couple of sessions whilst she was an outpatient. The other person improved gradually, but she did improve. She would have a boost for the first day or two after the treatment and the improvement would ebb away, but over time it seemed to ebb away a little slower. ECT definitely helped her to get better, although I don’t know how she is these days. I seemed to stay the same regardless. ECT wasn’t working for me.

Dr Shock would ask me each time how I felt and I never knew what to say. She would tell me I looked brighter, but it felt like she was only saying that to convince herself it was doing some good, not because she really believed it.

Towards the end, I knew we were running out of steam. I could see the medics were giving up. When the decision was finally made I wasn’t surprised but I was disappointed. I felt like a failure and I felt annoyed that it hadn’t worked. It was meant to be the cure and it failed. I felt like I should have tried harder to make it work. I worried it was my fault and that everyone thought it was my fault and that I just didn’t want to get better.

There is something to be said for it. It may not have actually lifted me out of my depression, but I think it did help keep me safe whilst I was at my worst. I suspect my insurance wouldn’t have renewed the funding if I didn’t need to be kept in hospital to have the ECT and at least whilst I was having the treatment I was often too exhausted and unwell to act upon the suicidal thoughts that were so strong at the time. Maybe if I wasn’t being told to wait and see if it worked, then perhaps I’d have been more determined to kill myself. I don’t know. I guess you never can know. Maybe I’d have been even worse if I hadn’t have had it, although I don’t know how much lower I could have got.

After the failure, came the assessment from Dr P and the diagnosis of Bipolar II Disorder. It was suggested that my lack of response to “traditional methods of treating depression”, showed that I wasn’t suffering from “straight” depression. I had suspected that for a long while before, but I don’t know why it took ECT to decide this as I know ECT can be used to treat Bipolar Disorder too. I am grateful for the ECT for accelerating this diagnosis, but it seems an awful lot to go through just to get another assessment.

The long term effects of ECT have only been showing themselves over the last few months. I didn’t think the memory loss was significant, but as you go through life there are reminders of what is missing. People mention things that happened and I have no recollection of them at all. Silly things like ordering a meal in a restaurant commenting that “I’ve not had this before”, only to be told that I did back in April when I went there with my parents. Not only had I forgotten my order, but I’d forgotten I’d even been there with my parents.

It’s not just from the treatment period either, but before too. A lot of last year has disappeared and I only have my blog and my family’s memories to remind me. Distant memories that were once clear are now fuzzy or gone completely. I have lost a lot more than I’d realised at first. They say that the memories will come back with time, but I seem to be forgetting more, not less. I don’t know if it’s just because as time goes on I find out about more of what is missing.

I don’t think my short term memory is that bad. I am forgetful, but I’ve always been a little. For most people it is the short term memory that is worst, but I seem to have got off fairly lightly on that front. I guess this is something.

I’ve alluded to this at other times, but I think ECT has had an effect on my thinking ability too. It’s hard to know for certain, as depression can stunt your cognitive abilities too, but I am not as sharp as I used to be. My partner often says that I’m slow. I am not very quick on the uptake at times. I find it harder to think and harder to solve problems. My arithmetic seems worse than before.My concentration is poor. Even when I’ve been a little high, I don’t feel as capable as I did before. Things I used to find easy can be a challenge. I feel like I’m a little blunted. I pride myself on my intelligence, yet I don’t feel as bright. I wonder if I’ll ever regain what I used to have and if this will improve.

Along with the memory and cognitive effects, there is a physical side effect. The right-hand side of my jaw has been problematic ever since. It locks and it grinds. Sometimes I can’t open my mouth at all. Other times I get shooting pain right through the side of my head, where my jaw is stuck or out of place. I don’t know if there is a solution, but I suspect I will be stuck with this for ever now. It may not be anything major, but it can hurt and is annoying.

I don’t think I’d mind these effects at all if ECT had worked. If I was now stable and free of depression these issues would be worth it. It’s just that for it all to be in vain, it seems a lot to go through for no gain.

I am still disappointed. ECT had been that final resort and was something I could hold in my mind as a possibility for change. For me, I always need to know that there is another option and this was just another one that we have exhausted. When I have run out of options then I will really give up. I don’t think I’d go through it again, even though for some it can work a second time when it had not the first.

All that said, even though ECT didn’t work for me, I still wouldn’t discourage people from trying it. You have to weigh up the potential benefit with the possible effects, but if it works, I think it is worth it. It is usually only used when all else has failed and in that case what else do you have to lose? I have seen it work for others, I am just jealous it didn’t for me.

Stream of Conciousness…

with 10 comments

I started this post on Monday, but didn’t get time to finish it. It’s now Sunday! I don’t know where my weeks are going. I keep snatching five, ten minutes or so to write, but it takes me half that time to work out where I was before. I keep wishing I could write more, but other things get in the way. I guess more accurately I could say another person gets in the way. My bloke is still not too keen on me spending time on here and that means I usually have to fit it in when he’s not around.

At Creative Remedies on Monday we were asked to write. To write and to keep writing whatever came into our heads for three minutes. I wrote something private, something which I had thought about writing on here for a while. My thoughts were about how I come across at Creative Remedies. I behave like I used to at work and at uni. Friendly, helpful, bright, but hiding how I actually feel. There is a front there that hides the illness. An act. I feel like I have two halves. One outgoing and intelligent, the other ill and flawed. One bright, one dark.

I soon wished I hadn’t have written this. The next step of the exercise was to place our work in a pile on the table. Each one would be passed onto someone else who would then highlight the bits they most liked. The idea was to give us suggestions of how we could turn our stream of conciousness into something a little more creative. I didn’t want to share these inner thoughts. I didn’t want to let anyone in and break down the front. It was made even worse because my notebook is distinctive so whoever got it would know it was mine.

I felt almost sick as I handed over my book. I was given someone else’s piece. Theirs was fairly personal too, but completely anonymous and it gave me no real idea of the context. It didn’t let me in like mine would let someone else in. I was jealous of the guarded nature of their writing.

I could see who had mine. They were writing fervently on my piece. I worried about what they thought. They hesitated to pass it back still writing away. She glanced over at me and mouthed the words “is this yours?”. I had to reluctantly nod as she brought it over to me. Everyone else was scrabbling away at the pile trying to find their own.

I looked at her words. They were kind and expressive, but I still felt a little violated. She had liked my writing, yet I still felt uneasy. She was worried for me. She could feel the sadness and emotion in my words and wanted to comfort me. She later asked me if I was okay. It felt strange and I wasn’t comfortable with her concern. I don’t know that I deserve it.

I know she will never see me in the same light. She is the one person that knows the façade isn’t real. She will look at me with suspicion wondering what is behind the act. Wondering how I really am. I feel like I’ve been found out.

It’s weird how I can write here, knowing anyone could read this, yet I am so uncomfortable. It’s weird how I’m actually considering dropping my anonymity on this blog, yet I didn’t want to drop the act with one person. How would I feel if the same person came along and read all of this? I don’t know.

I don’t know how I really feel about these two sides. I guess in some ways the act shows I am making progress. I can hold myself together in front of people now. I can portray a sense of capability and confidence.  I can actually do things and at times I even enjoy them. There have been times in the past year or so when there was no way I could hide anything and enjoyment was a foreign concept. I was a mess, unwell and visibly so. That’s not true any more.

Yet, I am not sure it’s a good thing. I wasn’t well a year ago when I was first admitted to The Priory and I behaved the same in therapy. I was the sensible, level headed, friendly one. I spent more time giving others advice than I did talking about myself. I was the helpful, confident person. People even wondered why I was there. I seemed fine. I wasn’t.

I don’t really like the act. I don’t like its return. I have worked so hard in therapy to break it down. To be more open and honest about how I feel. To be more true to myself. For the therapists at The Priory, I was making progress when I started to talk about myself. I was chastised when I went into helpful, clever mode. I wonder if I should chastise myself when I act like this now.

At times I wonder if the act was what broke me in the first place. The act was a problem before, back when I was at work. I kept going, working harder and harder to hide how I felt. At times fuelled by unidentified hypomania, at other times fuelled by denied depression. I didn’t want to admit I couldn’t cope. I didn’t want to fail. I wanted to be confident and capable and not at mercy of emotions or illness. I drove myself into the ground until I snapped and my world fell apart.

I am worried I will do that again. I have been doing new things and taking on new projects over the past few weeks. I have ideas, I want to do things, I want to be successful. It’s a familiar feeling. My life has been full of periods where I take on new things and projects, but more often than not I take on too much and cannot cope. With hindsight some of these periods can be clearly attributed to hypomania, but others I am less sure. I wonder if it is just my personality. I don’t want to immediately see everything as something to be pathologised, yet I also want to learn from the past. I need to recognise the patterns and change them. I don’t want to keep crashing head first.

I don’t know what my mood is doing at the moment. People ask me how I am and I don’t know how to answer. I’m depressed, yet am I? Yes, the signs of depression are there. I feel numb, empty, suicidal. Negative thoughts, anxiety, paranoia too. The physical signs are out as well. Headaches, insomnia, tiredness. It all points to depression, but it’s not the whole picture. I am excited about new projects, interested in things (albeit not everything), doing stuff. Where is the anhedonia? I don’t think it’s a mixed state either though. Not in a classic way. I am not really sleeping, but I am tired with it. My thoughts race, but no more than is really usual for me. I am a little on the snappy, agitated, quick-to-anger side, but not physically agitated or excessively so. I don’t feel like things are going too fast. yet. I wish my mind would make it’s mind up. I feel almost lost within my mood.

Going back to the topic of anonymity and this blog. I don’t really want to be anonymous any more. I am not ashamed of my illness and I think it’s so important people are open and honest about these things. We can’t break down stigma if we’re too afraid to talk openly about mental health.

I am not even worried about employers googling me. I have no intention to leave my company any time soon. Even if I was looking for a new job, if a company didn’t want to employ me after reading this then I wouldn’t want to work for them anyway. This may limit my career in future, but it’s something I’m willing to take the risk on.

There is a problem though and it’s my family. I am not sure I am willing for them to know how I really feel. I don’t want them to worry. I know my partner reads this already, but with my parents I am even more economical with the truth. I have never been open with them and I’m not sure I’m ready to start. I guess it is doubtful they will ever google me and find this anyway, but it is still a risk.

I realised though recently it’s not even that which is the main problem. It’s actually the stuff about my sexuality I’m most scared about. I thought I was comfortable with it. I thought I’d worked through everything a few years ago when I really went through a crisis of identity. I haven’t. I am fine with coming out knowing the people I am talking to are open minded, but I am not so sure about the rest of the world. More specific I’m not so sure about those closer to me. It doesn’t hurt if some stranger says something horrible, but if it’s someone I know it’s different. I know my mother can be quite homophobic and I suspect her opinions on bisexuality are even worse. I don’t want her to find out. I have always said that she doesn’t need to know and what she doesn’t know won’t hurt her. I suspect other members of my family would be even worse. I just don’t think I can face it.

I realised the other day that I’m not as comfortable as I’d like with my sexuality in general. The other night I was at the pub with a friend and somehow we ended up talking about gay couples. I mentioned a girl I know who used to be in a gay couple and she now goes out with a bloke. She made some comment about him “turning her” and I pointed out that she could be bisexual. She seemed a little taken aback by that and I didn’t know what to say really. It could have been the time to be honest myself, yet I was uneasy with her reaction. I wish I was comfortable enough to be completely “out”, but I guess I’m still not there.

I guess I could always go back and censor myself. I could make any mention of my sexuality private and I’d be safe, yet I don’t want to. I guess I could throw caution to the wind, face my fears and all of that, but I’m not sure I can do. I don’t know what to do.

Discharge…

with 3 comments

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.

Written by intothesystem

Wednesday, 30th September 2009 at 8:13 pm

ESA Medical…

with 9 comments

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.