Psychiatrist Appointment Win?

I saw my consultant psychiatrist, NewVCB, for the second time this morning, an appointment that I’d been dreading for days.  Even though my first encounter with her back in January had gone without any significant hitch, and even though I had established on that occasion that she was not as formidably intimidating as OldVCB, I still found myself feeling scared of her in the run-up to today.  She’d been ostensibly much nicer than her predecessor, but there had been moments where I’d found her a little condescending, and anyway I think I’ve just developed a fear of psychiatrists anyway.  Don’t ask me why.

I was fully expecting that NewVCB would keep me waiting for 23 light years before she emerged to escort me to my for-today fate, but to my astonishment she actually came to get me shortly before the appointed time.  That was quite impressive; OldVCB was never on time, never mind early.  I was also pleased to note that my file seemed to have been fully updated to reflect my name change.

She showed me into her office as usual and gestured for me to sit opposite her, before quite amicably asking me how things had been.  I was honest and told her that Quetiapine has, in general, made my life better.  I said that I had come from a point of being severely depressed when I first met her to being, now, perhaps only moderately so.  I said that whilst not perfect, this was clearly a significant improvement.  I also said that there probably wasn’t the same mad variation in my moods that there had been around Christmas and the months surrounding it.

She agreed that this was encouraging, but said she was also wondering about the status of the voices.  I said that Quetiapine had not completely eliminated them, which it hasn’t, but that they were (a) less frequently in evidence and (b) much less overwhelming.  I pointed out, with some regret, that the benevolent one (Tom) has disappeared entirely (though admittedly Olanzapine, my previous anti-psychotic, seemed to have been his murderer).

NewVCB asked me to describe the status of ‘They‘ relative to the unfortunate incident on Christmas Day, the details of which she was aware from our previous meeting.  I said that a comparison was impossible because the horror and overwhelming nature of that particular incident was almost unique.  “They have tried to get me to kill myself before,” I told her, “but since on most of those occasions suicide has been in the forefront of my mind anyway, those occasions did not seem so serious.  Christmas did, but they don’t have that hold over me at the minute.”

She nodded, apparently encouraged, and we discussed a bit more about the frequency of the hallucinations (no set pattern, but perhaps once a week on average) and how I can now…not ignore them, but tolerate the levels of their malevolence.

“Regarding Christmas,” I started, uncertainly.  “The baby involved, doing you remember me telling you about him?”

She responded in the affirmative.

“His baby brother was born yesterday.  They’re naming him after my child abuser.”

NewVCB was visibly horrified by this information.  She gasped, threw her hand over her mouth and winced.

“Oh, Pandora,” she sort of sighed, through gritted teeth, shaking her head rather despairingly.  “That must be dreadful…”

I nodded.  “It’s not the parents’ fault; they don’t know about the abuse.  And of course it’s not the baby’s fault.  But I feel irrationally angry all the same, as well as…not hurt, it’s deeper than that.  I’m horrified to the pit of my stomach.”

We discussed the fact that I have been covering really difficult material with C recently, though at this stage I didn’t specifically tell her that it was in relation to Paedo.  I said that although it was hard stuff, I nevertheless thought it was productive work, and the fact that I hadn’t completely lost my marbles as a result of it was a testament to the wonder of Quetiapine.

We moved back to talking about ithe drug, in particular with reference to the dosage.  For now, NewVCB wants to keep me on 300mg, as – according to her – that’s presently thought to be the most effective dose for those presenting with mainly depressive symptoms.

She said, “doses above 700mg or thereabouts tend, according to the recent research, to be most effective for schizophrenia or full-blown mania – and you don’t have either of those.  So for now I want you to remain at the present dose.  How do you feel about that?”

“That’s grand.  I suppose my thinking had been to maybe increase it in the long-run, but I’m happy enough to maintain the status quo for now.”

“In all probability we will have to increase it as time goes on,” she admitted.  “600mg is a future possibility, though as I said I’d be dubious about raising it much higher than that.  For now, though, I want to monitor just how much this dose helps you over a sustained period, rather than just a few months.  Thereafter, if you still feel that your depression is within the ‘moderate’ zone or the voices are still there, then yes, we can think about an increase.

“At the end of the day,” she continued, “the most important aspect of your treatment is psychological.  All medication will ever do is take the edge of your distress until you’ve worked through things psychologically.  Traumas, depression, whatever – certainly, they do change the physiology of the brain, and we can deal with that from within the medical model.  But it’s only one part of treatment in a case like yours.”

Of course, I was very well aware of that, but I didn’t press it.  Her point was valid: leave the Quetiapine as it is until it has had several months to work its magic, just as she had planned from my introduction to the drug in January.  (Interestingly, and gratifyingly from my point of view, she didn’t mention Venlafaxine at all.  In the previous meeting she’d expressed the desire to wean me off it, which I don’t want her to do.  I admit that my reluctance is partly to do with the horrendous potential discontinuation syndrome, but it’s mainly because the current cocktail is making a difference, and I don’t want to interfere with that).

We discussed concentration and focus, and I said that it was still abominable.  “I pick up a book and find myself reading the same sentence 20 different times,” I told her, “which is incredibly frustrating, as I’ve always loved reading and have a thirst for knowledge.”

New VCB asked me to describe a typical day.

“I get up late, go to the sofa, watch TV.  I don’t make food beyond Pot Noodles.  I just sit there.  And I hate that, because I’m actually quite an intelligent person who is capable of so much more.”

She nodded in agreement (yay) and said that she did honestly understand my frustrations, but that concentration was one of the last things to return in the ‘recovery process’, so I therefore shouldn’t feel too discouraged.

She suggested that I make a pact with A to once a day do something other than sit in the living room – a walk, a coffee, whatever.  “It’s easier to be motivated when someone else is doing it with you,” she said.  “And if you start doing something like that in the evenings with your partner, after a while you can start setting yourself small goals to do such things yourself during the day.”

Eventually she asked if there was anything else I wanted to discuss with her, and I said I had read up on and discussed PTSD with a number of others, with many thinking the diagnosis was more apt for me than BPD.

She asked why I felt that my symptomatology was consistent with that diagnosis so I told her about what happened with C last week, then gave her a brief run-down of the other symptoms, a la the other day’s BPD v C-PTSD post. However, I purposely refrained from mentioning complex-PTSD in order to see if she would bring it up unsolicited.

She did not disappoint.  She said, “well, PTSD tends to be most applicable after a single traumatic event – an earthquake, a bombing, those sorts of things.  When there is repeated trauma, things become more complicated, and we call that complex-PTSD.  I think it actually goes without saying that you have C-PTSD – how could you not after the traumas you’ve gone through?”

I felt smugly pleased at the success of my latest self-diagnosis (the original, in which I correctly diagnosed myself with BPD and bipolar disorder, is here).

“Having said that,” NewVCB went on, “your case is not a simple one.  You’re not really classically borderline.  You’re not classically bipolar.  You aren’t entirely a classical example of C-PTSD, and your psychotic features don’t classically fit any specific psychotic disorder.  I could diagnose you with this, with that, with the other – but you’re a mix of all of these things.  They all apply, but in a convoluted mishmash.”

I said that I understood and agreed with that, but I had – in part at least – been seeking recognition of C-PTSD as unlike borderline, it emphasised trauma, thus contesting my default “it was all my fault” position.

“It is helps you to deal with things, then yes absolutely, that’s great.  You can’t not have it anyway, at least to some extent,” she said.

She remarked that I’d mentioned experiencing flashbacks in session with C and asked me how things had been with him, noting that last time she’d seen me I was very concerned about the cessation of psychotherapy.

“Well, I still am,” I confessed, “but we’ve agreed to sort of put discussion of that on hold for now and tackle this sex abuse stuff, which I think is important.  I think the key thing to report is that, although this material is difficult and triggering, C and I are working very well together at the minute.”

“Good,” she said, again pointing out that limited as it may be, psychotherapy is still the crux of my treatment.  “And I think that hits on an important point.  I feel that your prognosis is quite encouraging, because (a) you’re bright, and your ability towards insight and your hunger to learn about your conditions make a huge difference and (b) you can work psychologically.  Not everyone has even one of those, never mind both.  Having said all that, you’re not ‘uncommon’ either, in the sense that you cross diagnostic criteria, so please be reassured by that.”

I’m not particularly, as I quite like being unique.  Nevertheless, I suppose I should be glad that my prognosis is apparently quite positive.  Since I don’t believe in cures I’m dubious, but I suppose a prognosis suggestive of an ability to manage my mentalness is quite a good thing.

As I left, she said that she did actually notice a change in me from the last time she’d seen me, echoing A’s sentiments on my recent mood.  I don’t for half a second expect it to continue indefinitely, but it’s nice not to have to fight the urge to throw myself under a bus at every single opportunity.  Let’s just see how much upcoming therapy sessions will conspire against me in that regard.

(PS.  No ‘Article of the Week’ this week, for which my apologies.  I simply haven’t come across much that I found worth sharing.  Normal service will hopefully be resumed next week).

Related posts:

1. First Appointment with NewVCB
2. What’s Annoying Me Today, and Ruminations on Seeing the Psychiatrist
3. Pathological Dissociation? C: Week 48