Yet another day with two posts. Sorry.
In short, she is better than her predecessor, though as W said to me this morning, she could hardly be much worse. In fairness to OldVCB, I had come round to her a little before our relationship was severed, but nevertheless, I am not exactly sorry to see the back of her.
NewVCB is a shorter, younger, longer-haired, less officious, more Northern Irish version of her predecessor (who was ((and presumably still is)) tall, short-haired and Scottish). It surprises me that NewVCB is old enough to be a consultant, but apparently it is indeed so. She said that she works closely with OldVCB – in fact, they job-share – so she claims that she has been fully informed about my case.
She opened the mentalist discussion by saying that she had had the opportunity to speak to C on Monday. “And,” she added, “BS [the unfortunate initials of the psychiatric liasion woman [[henceforth known as PLW]] from Saturday].”
I rolled my eyes. Having not heard from PLW (despite PLW telling me she would give me follow-up phone calls), I had hoped that maybe she had not phoned NewVCB et al after all – but clearly it was a futile desire.
NewVCB continued, in that time-honoured fashion of mental health professionals, by asking me how things had been. I said that they were (are) fucking terrible. I told her how I have been on a downward spiral since before Christmas, and that neither Venlafaxine nor Olanzapine seem to have made a blind bit of difference.
She is the only professional that I confessed to about what happened at Christmas; I didn’t want to, obviously, but what choice did I have? Risk it happening again, end up hospitalised or just tell her, and let her offer me some proper outpatient treatment? Needless to say, the latter is the least worst option…so tell her I did.
It was apparent that she and C have already had the Christmas discussion, which – thinking about it now – is actually really annoying. C never asked for my permission to reveal the finer points of my life history with NewVCB. If he had asked me could he do so, I would have happily given my permission, but he didn’t. He was too fucking busy last week psychologically battering me.
NewVCB continued by asking what had happened to precipitate the sheer forcefulness of ‘They’ at Christmas in particular, so I told her about the McFs being a freakshow of abject cuntery, and about Paedo being a paedo.
“Ah yes,” she said, knowingly. “This is something that came up in conversation the other day [evidently with C, because it is highly unlikely to have been PLW]. These kind of transient, stress-related psychoses are quite common in people who have been through that kind of trauma, so don’t be thinking…”
Don’t be thinking what, love? If you have something to say, just say it. Am I supposed to think I’m not a freak, or that because it isn’t that unusual that it’s therefore not serious? Whatever.
I don’t remember how the topic of C came up, but it inevitably did, and I told her he was discontinuing my treatment.
She sort of laughed and pointed out I still had over 20 weeks left of psychotherapy.
“Yes,” I retorted, “but all published research on borderline personality disorder recommends therapy of a much longer time frame than that.”
To be fair, she agreed that BPD therapy should be at least two years but then babbled on for a bit about there being no personality disorder service in our Trust area (so? How the fuck is that my fault?) and that therefore C was being “very kind” in treating me (um…no actually, he’s doing his job, for which he’s paid a very decent salary).
She continued that she has “a lot of respect for C” (that makes the sum total of one person I know, then) and when I protested vehemently about C’s decision to flog a dead horse every bloody week, she said that C knew what he was doing and that the issue of abandonment was part of my problem.
I am so sick of all of them assuming this is just about transference. IT IS NOT. Not entirely. I freely admit that whenever therapy ends I will be upset, as I will be sorry to lose my connection with C, because I am pathetically attached to him, however much he can be an arse. I mean, how can you not mourn the loss of a long-term relationship of any kind, never mind one in which the other party has been privy to your deepest secrets, fears and fantasies? No, I’ve never, ever denied that potential sense of loss.
However, this is also about getting that to which I am entitled and that I need. It is about the health service screwing me over for years, and then slapping me in the face by doing it again. It is about somebody finally taking responsibility for all the failures to which I have been subjected. It is, above all, about improving psychologically to a point where I am able to adequately cope without the support that is therapy.
She said that C sees something in me that he feels he can work with and that that “isn’t the case with all people”. I’m keen to work with C, apparently, C’s keen to work with me, apparently, and therefore there’s a lot that can be done in 20 weeks (and apparently I need to “get some perspective” on the timeframe. Cheers for that.). I’m sure that’s in part true – if C will allow me to discuss the fucking issues for which I am in therapy in the first place, rather than endless bollocks about him rejecting me. But what do I know. He and NewVCB have it all worked out amongst themselves and Heaven forbid the stupid mental might have a differing view.
I said that I was feeling no better whatsoever after months of C’s involvement, and in fact that I was feeling distinctly worse. I admitted that I had always expected to feel worse before feeling better, but that I hadn’t expected to be actively suicidal all the time.
NewVCB said, “but you’re feeling these things now – you’ve repressed and dissociated so much in the past and are now learning to feel.”
I’m sorry, but if this is what experiencing emotion is like then I’d rather stay a repressed, dissociated mental freak forever. And anyway, that’s bollocks. I’ve felt like this before many, many times; it’s just the worst it has been during this current breakdown. I saw this quote today – “[I've reached a] new level of worst.” That sounds about right. A new level of worst for the past breakdown. I haven’t felt this low since I was about 16, but back then it was basically perpetual.
Anyhow, NewVCB eventually moved on and asked me about manias, making the connection that OldVCB never did that some of the mixed and manic episodes were considerably exacerbated by Venlafaxine. I was unable to describe a (hypo)mania to her, as frankly I’ve been on the downside of the cycle for quite a while now, though admittedly I’ve had quite a few delightful mixed states thrown in too. Things are, however, looking very cyclical to me – I rarely have hypomanias lasting any amount of time, but I do experience long-ish-term mixed episodes and depressions. I told her so.
She said that she is still uncertain about a bipolar diagnosis, but that it’s a distinct possibility, and in any case with or without it, my moods are very changeable. To that end, given that the Olanzapine hasn’t really worked as either a mood stabiliser nor as an anti-psychotic, she has decided to change it to Quetiapine. Apparently, there is a lot of research coming in that, at 300mg (the dose that she has prescribed – very high for a starting dose), this drug stabilises moods considerably. I see that it is indicated for both mania and depression in bipolar I, and depression in bipolar II, as well as schizophrenia.
NewVCB therefore wants to wean me off the hateful Venlafaxine, about which I am both encouraged and horrified. On the one hand, I think it is an evil, insidious medication and would prefer to have it out of my system. On the other, I’m petrified of not being on anti-depressants specifically, given as I have been on them in one form or another for 12 years. On the third hand which I’ve just grown, I know that Venlafaxine is particularly difficult to withdraw from, and I am not sure that my head will be in a space to cope with that in the next 12 or 14 weeks, which seems to be her rough timetable for doing this.
On that note, that’s one thing I liked about her. She probably sounds like a condescending bitch from most of this post and, regarding C at least, at times she was. However, she did tell me how she foresees things developing and what her plan of action is; basically, as things stand now, she would plan to keep me on the Quetiapine for quite some time, as it can take a while to fully get into one’s system. However, if it doesn’t work after about two months, she’ll just take me off it and try again. She did speak to me as if I had half a brain for the most part, and assumed that I had prior knowledge of that of which she spoke. I appreciated that a lot, though I am sure it would be a reason for some other people to dislike her.
She says she will see me again in “four to six weeks”. In the Psychiatrists’ Dictionary, that means 18 months or something. Meh. To be fair to her, I actually think she might see me again in the timeframe specified, because I really don’t think she’s as bad as OldVCB. I had made a polite dig to her about OldVCB failing to see me as promised in December, so I hope she has taken the hint.
One final point she made on C, although she said it almost in passing – apparently if work still needs to be done after the 20-whatever weeks, she is sure that he will “carry on.” I wonder if someone has told him that?
I always seem to leave Psychiatry in a bad mood, and today was no exception. However, he appointment really wasn’t that bad; I have got a decent dose of what I hope will be both a mood stabilising and voice-reducing medicine, and someone overseeing it all who seems like she may take more interest than her colleague did. Time will tell.
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So sounds not so bad, if we’re reading correctly here. We hav been on your new thing the quetiapine (Seroquel on this side of the pond) for many years. Up to 1600 a day at one point when we were in and out of the nutward. Wouldn’t recommend that much. Anyway, we’re on 400 mg/day now and it continues to be helpful to us. Above 500 mg we start having issues with short-term memory so be on the watch for that. Heart palpitations occasionally when we were on 800/day. Which we were for several years. Watch for possible weight gain too.
We have found that it has really helped with the flashbacks and hypervigilance. When we switched to new shrink last October, he being a specialist who works with trauma and DID people, this was the first thing we wanted him to change. It had been such a constant for ao long we wer sick of it.
Now we are on Xanax XR, Zoloft, and the Seroquel and haven’t had a panic attack in months. It’s good stuff. Also beware of sleepiness at first.
Glad that things weren’t horrific at least. It would freak us out completely to have our care being decided by somebody or somebody’s else. We don’t care enough about our citizens here enough to ensure that everybody has access to health care. So it’s up to the individual to find and pay for their own care. We are very very fortunTe in that we have insurance to cover a part of our mental health bills and can pay for the rest. Good side of that however is that it’s a buyer’s mRket foe the most part.
We are so sorry that you have to go thru this.
Thanks so much for the information on Seroquel, that’s great. I was wondering if anyone else had any experience of it, and side effects aside, it sounds like it’s really worked for you, which is great. I was on Zyprexa before which is the absolute worst for weight gain so I’m hoping the Seroquel won’t be quite as bad in that regard, but then again the Seroquel dose is much, much higher relative to the Zyprexa.
Private therapy and medicine does exist here, but since I can’t work at the minute it would be prohibitively expensive for me. I looked into the possibility of insurance myself, but either they don’t cover psychiatry or psychology at all, or you have to be in the plan for at least two years, with no history of mental health trouble. I’m pretty screwed that way then
But anyway, tanks for your words of comfort too
It’s much appreciated and does help, I love our Twitter support group! Take care of yourself x
I have been on Seroquel for some time now. I am on 300mg right before I go to bed and an additional 100 at supper. It works well for putting me to sleep but try to go without it and I’d be up for days without sleep.
Thanks for that info – much appreciated. I’ll do my best to make sure I don’t miss any doses of it then! Given the title of this blog, you’ll know that I appreciate the sedation
Thanks again.
I’m also on Seroquel. I don’t sleep either if I don’t take it. It works very well, but can be really expensive! Unfortunately there isn’t a generic form out yet (that I know of)…I’m told that it can raise blood sugar, but that’s actually a good thing for me since mine stays low…
Hope it works out for you…
Hoping the withdrawal from V will be not adverse. After more than a decade on anti-depressants, three months is not an insignificant portion of time.
Psychiatrists (and perhaps their allied health ilk) do seem to have a different sense of time from the rest of the population.
“Get some perspective”. Those are three of the most aggravating words in the English language.
I have never been on an anti-depressant, Seroquel neither.
Perhaps it was out of “interprofessional respect” that C told the things about Paedo and Christmas. They are/were going to affect your treatment big time. My own warned me about that sort of thing. I think it is mandatory to report any sort of abuse going on. It is true that they were not ‘his’ things to tell.
Pilgrim wrote a really great list of things therapists shouldn’t do. No, her friend Katie had it:
Things Therapists Shouldn’t Do from Health Diaries
Number 10 describes very very well. It is about confronting the issues for which you went into therapy; not the relationship with the therapist.
Thanks for that link, Adelaide. You are absolutely right about point 10 on that list. I confronted him this morning about it and he says he does not want to ignore that issue, but he is willing to meet me half way. Round one (sort of) to me.
He claims he didn’t tell the NewVCB about my history with Paedo, so it could only have been PLW. I had forgotten that I had mentioned the issue briefly to her, so it seems that I’m falsely accusing him :-/
Thanks as ever for your thoughts – and you’re absolutely right about “get some perspective”!
Future possibilities; just turned 50, almost completely detoxed. So, provided I have been physically active and am physically relaxed will usually sleep 12 to 6. Alarm clock set at 6, rise no matter what 365 days a year (took agonising months to learn positive habit) Stopped napping during day. Once every few weeks can’t sleep, but just 5mg sleeping tablet enough to flip me into sleep! I retain crises supply of anti-psychotic (although not used for 3 years) but timing is everything – small dosages can take up to a week to start working. Emergency meditation technique ‘mind awake, body asleep’ but that’s another story and sod all to do with Mindfulness or DPT.
Wow – you should be very proud of yourself Nick. It must have taken so much time and effort to get into that sleeping pattern, and it’s great that you can avoid medication most of the time. It would be my long-term hope to get to where you’re at, but unfortunately I think it really is long-term! But it is always encouraging to hear from people like you who’ve managed it
I’m glad she seems to be thinking positively about the way forward although, I like you, would be bricking at the thought of coming off the Venlafaxine – tis a horrible toxic evil drug. I hate the way they all talk about you behind your back. It makes me feel incredibly paranoid and freaked out.
Lots of hugs for youxxx
C denies telling NewVCB about Paedo et al. I think I believe him. But you’re absolutely right, one becomes helplessly paranoid about these things.
I hope this Quetiapine shit works, because coming off Venlafaxine even if it does will be a nightmare
Take care babes, hugs to you too xxx
I’ve had a good response to quetiapine. Side effects – sedation initially, though now I’m on the extended release that’s not a problem. Had some fairly severe postural hypotension, and had to be very careful standing up, but that passed. Occasionally get an itchy twitch in my foot.
Had a friend who went through venlafaxine withdrawal, and it was not nice, so good luck with that.
The therapy timelimit sounds frustrating. While yes I’m sure a lot can be done in 20 weeks, and i have heard arguments that a timelimt can make therapy more effective in that it pushes people to confront what they need to, in my experience it can also work the other way, in that you become reluctant to really open up and unpack things because you know there’s a good chance you’re going to be left alone still dealing with the fallout. And of course the more therapy becomes about therapy the less time there is to address the real stuff.
Take care
(Btw would you consider letting me have your password? No worries if not)
1/ generally speaking doctors don’t appreciate that small changes in dosage can have a big impact on side effects (good and bad) – people end up staying on too much, to long.
2/ just as the same drug will effect every individual differently – so coming of them is easy for some, less so for others.
3/ prescribed drugs are a ‘habit’ like any other – you replace it with a more effective one (hopefully not one that puts more shit in your body!)
4/ the test of therapy is to ask yourself after each session, have I come away with something practical I can do differently to break-out of those routines of thought and behaviour which no longer work for me.
I was on Seroquel for quite a while about four years ago. As a mood stabiliser, it worked wonders, but I did gain 40 pounds (which I eventually lost after I was weaned at my insistence). Already having a poor self-image, having that added weight only fuelled my depression.
New VCB appears to be making an honest attempt to establish a rapport with you; however, her being privy to your sessions with C would make me feel compromised. If it were me, I would question how much of an influence C will ultimately have over NewVCB as she continues to see you.
She may very well keep her work about seeing you in four-to-six weeks, if for no other reason than to monitor the efficacy of the Seroquel. Keep us posted as your system acclimates to the drug. Expect it to be a full operation in four-to-six weeks, although you will feel the side effects, most notably the sleepiness, right away. {{Hugs}} Alix xx