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).

I received a text message from my cousin SMcF early this afternoon to report that her daughter, SL, has given birth to her second son (MW’s baby brother).

Another son.  Not a daughter, as I had feared and (inexplicably) expected.  Maybe there is a God.  Paedo might not touch MW and As Yet Unnamed New Baby because they are male.  He might not have touched either of them anyway, but it’s stupidly reassuring nevertheless.  Not that I will be any less vigilant in the company of him and his two great-grandsons, having said that.  As I’ve said in the past, if I suspect he has done anything inappropriate towards them, I shall act.

Why won’t Paedo just hurry up and die?  His life sucks horse bollocks anyway, so remaining alive isn’t exactly doing the miserable old sod any favours.  I believe I said it before; death would be a mercy to him.  It wouldn’t make any difference to me from the perspective of my abuse at his hands, but it would put an end to my worries about the possibility of him trying to fuck his underage descendants, and that would be a major weight of which to be rid.

Anyhow, I bring this up as, perhaps unsurprisingly given the subject matter of recent therapeutic sessions, shit with Paedo was the main crux of what I discussed with C on Thursday past.

I don’t remember a tremendous amount of the dialogue.  I do recall that I whined and whined and whined that I was a fetid, disgusting whore and that C kept asking what evidence I had for that, and that I responded that it was a clearly ridiculous statement but that that didn’t keep me from believing it fervently anyway.

I told him that one thing I couldn’t bear people calling me was a slut, and how I had reacted very viciously on the rare occasions that anyone had done so.  “And yet,” I went on, “it’s exactly what I think of myself.”

He asked if I thought it was ever appropriate for an adult to have a sexual relationship with a child, and I responded that of course it wasn’t, but that didn’t mean that I couldn’t find (make up?) evidence justifying what Paedo had done to me.  In other words, in other cases one can never justify child sex abuse, but it is perfectly acceptable to do so in mine.  Thinking back on this statement, what hideous kind of inverted narcissism am I guilty of?!  How dare I make myself out to be such a special case, even if in a twisted sort of way?

At one point C very gently asked me if I could actually describe some of the stuff that happened.  I wanted to tell him.  In fact, I fucking longed to tell him.  But every time I went to open my mouth, a pathetic groan or muzzled whimper was all that emanated from my mouth, and absolutely nothing of any substance was forthcoming.

I am so ashamed.  So ashamed.  So dirty and filthy and vile.  I am damaged goods.  If I tell him what happened then he will know all that and he will be repelled by me, so filthy and horrible am I.  Shockingly, I told him that I thought this, and then went on to admit that although I do not agree with it in the least anymore, that I was brought up with my mother telling me that sex outside of marriage was a bad thing.  Ergo, I was a slut for having a sexual relationship wth my uncle.  I wasn’t married to him, at a time when I was told I had to be for it to be ‘right’.

What, for me, was most curious about this session was that for what was probably the first time, I felt the full force of a flashback.  I have ’seen’ images of the abuse in fleeting moments on plenty of occasions, but on Thursday, with C, I felt it physically too.  I cannot believe I am about to type this, but I felt pain and what I can only describe as a nebulous but ghastly sensation in my genital region (I just went to thesaurus.com looking for an alternative word to ‘genital’.  The very act of typing that word fails me with shame and horror).  I felt the physical sensations of his hands on me.  I heard his laboured breathing, and felt my own chest constricting as I tried not to breathe in the futile hope that what was happening might just go away.

And yet, the imagery remained largely third-person.  I saw him push me down as if I had been a bystander, and yet nevertheless I was so strongly feeling the sensations of all that had happened.  There’s a book I saw on Amazon called The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment.  Clearly my body does remember…certain things, anyway.  But, I ask myself, does my mind?

Well, the answer to that seems to be a definite “yes” and “no”.  My mind must love ambiguity; it knows I hate it and it wishes to torment me, I should imagine.  As C and I sat in his office silently with these physical sensations and third-person images battering my psyche, I was suddenly flooded with an abject barrage of other gruesome images, in tiny flashing bursts.

The concealed alley-way beside the garage.  A laybay off a road behind their house.  Beside the old dog shed, which was only there until I was about five making it especially fucking troubling.  Their living room.  The back of my wendy house at my mother’s house.  My darling grandfahter’s house and outhouses

Penetrative vaginal sex.  Forced fellatio.  Fingering.  Other touching.  My reluctant acquiescence versus my attempts to fight him off.  His ‘gentle’ attempts to get his way right up to his brutal forcefulness causing searing pain that shouldn’t be experienced by a child.

It all smothered my consciousness in a racing deluge of awfulness that, despite the considerable scope of it, could only have lasted a few seconds.

I looked up at C in horror and told him, omitting specific details, what had just happened to me.

“It’s false memory syndrome, isn’t it?” I begged him.  “Mum would certainly think it was and she would be right.  These memories can’t be true.  Can they?”

“Look at the filing cabinet,” he said, nodding in its direction.  “The memories that our minds use to build up our conscious recall, our personalities, relationships and whatnot – they’re normally filed coherently in our brains, just like files are put in there in an orderly A – Z fashion.  Trauma memories aren’t so easily categorised.  Because they’re so difficult to deal with at the time, as you know many people find themselves dissociated to a greater or lesser degree, so the memories are completely fragmented.  Even when the person doesn’t dissociate, the memories tend to fragment anyhow, in order that the mind may cope with the trauma.  So if you open trauma memories in the filing cabinet, it would be like seeing a load of files or documents just being thrown in there haphazardly, with no order to them.”

He said, “because of the fragmented way in which the mind stores these memories, recall of them is complex.  Something may just suddenly trigger them; they may simply come back over time; they may not come back at all, but still leave their impact on other areas of the person’s life.”

“So you don’t think if I told you about this stuff that I would be a fucking liar then?” I asked, appreciating what he was telling me but doubting my mind’s capacity for truth-seeking nevertheless.  I accused myself of having an overactive imagination.

C replied by saying that in a sense it didn’t entirely matter if what had invaded my consciousness was an 100% accurate depiction of the sex abuse.  “In the first instance,” he explained, “none of us remember events 100% accurately 100% of the time, whether those events are traumatic or otherwise.  And secondly, if your mind is storing this information, then it is clearly bothering you – whether at a conscious or unconscious level – and that’s the most important thing.”

I don’t think he ever said it in an outright fashion at any particular juncture, but I distinctly got the impression from him that he felt that the memories were (at least mostly) accurate.  Maybe it was his gentleness, his empathy – I don’t know.  In part I wish he’d shouted at me and said that yes, I was indeed a horrible little slut, and that my lies were unspeakable and abhorrent.

Maybe then – just maybe – it might not seem to be true.

I have this enduring and recurring image of watching, from my perspective on the chair opposite C, a (faceless) little girl climbing into C’s lap, curling up and burying her head in his chest as he puts his arms around her, strokes her hair and gently soothes her in softly spoken words that I can’t quite hear.

I assume that she’s me.

Writing this makes me cry.  I am so ashamed and horrified and disgusted about all of this stuff, and today should be a happy day because it saw the release of Final Fantasy XIII.  I’m not sure that there was a great deal more of substance in the session anyway, so I’ll try to conclude.

The long and the short of things is that I still didn’t describe any detailed aspects of things with Paedo to C, either from the stuff I recall clearly or from the ‘new memories’.  To that end I accused myself of “capably playing yet another game of avoidance.”

In actuality, even though I thought that, I still thought the session had perhaps been a step in the right direction, and when he refuted my claims of avoidance, he seemed to agree with that assessment.  He actually claimed to think that I’d been very open and that if I was unable to verbally articulate certain things, then that was really not surprising at all, and shouldn’t be something over which I beat myself up.

I said, in that laughably child-like and black and white way of which I am so often guilty, “so, is this good?  Is it good that I’ve told you what I’ve told you?  Has this session been good?”

He replied that if that was the word with which I felt most comfortable, then yes, it had been “good”.

Oh, give me a star medal!!!

He had, at the start of the session, asked me how strong the impulses to kill or harm myself had been since the last time I saw him, and I’d said that whilst I still thought about those things with great frequency, that I hadn’t felt the same compulsion that I had last year or in the earlier part of this one to act on those thoughts.  He’d been encouraged by that of course, but given how much slightly-under-the-surface-bubbling a mere reference to any of this wank had caused me before, he was concerned that such candour as I’d apparently expressed on Thursday would drive me back to hurting myself.  He practically begged me to find something to do to occupy myself in at least the immediate aftermath of the session.  I told him I had been intending to go for swim and a coffee when I got back into town.

He liked that, then asked if I could occupy myself after that until A got home with the X-Box or a walk or something.  I agreed, though in the end I went to get some groceries instead, and I was still quietly pleased that he (ostensibly, anyway) gave enough of a toss to care about what happened after I left his room.

He asked if we could “park” the sex abuse discussion until next week, and discuss a few practical matters.  Unsurprisingly, one of these was the stupid letter from the twatfaced Mental Health Director.  I was taken aback to learn that C had heard absolutely nothing more, and was merely wondering if I had.  If I were C, I would find it professionally unacceptable that he had not been apprised of the ‘progress’ of the issue.

I hadn’t read the letter in detail at that point, so outlined it in basic terms only, telling him that I found it an amusing waste of time.  He misunderstood, thinking I meant that my whole complaint had been a waste of time, and very earnestly and reassuringly said, “I don’t think it was a waste of time.”

Apparently I have flagged up just how inadequate services are in my Trust area for conditions of the ilk that I present.  He suggested that not only had it been good for the head office twatheads to learn of this, but it even aided his immediate bosses in Psychology.  He thinks I have done A Very Good Thing.

I let him think I was completely letting it drop, which was at the time my broad intention.  I will let him know this week, out of respect and courtesy, that that is no longer my intention, and I will show him the pathetic letter that I received to demonstrate why indeed it should not be.

As I left he told me to enjoy my coffee which, wretchedly, made me want to hurl my arms around him and cry.  Why am I such feeble, pitiful bitch?  To add to that sentiment, what has pervaded the forefront of my mind since seeing him has not so much been horrid flashbacks, though that is not to say that they have not been in evidence at all; they have.  But what has played out mentally most commonly, what has dominated my psyche, what just won’t go away no matter how much I try to distract myself, is that sad, prevailing image of a damaged child seeking some sort of comfort or solace in the safety and reassurance of C’s lap.

EDIT: Literally about fifteen minutes after publishing the above, SMcF sent another text message to advise that SL and her husband are calling the baby after Paedo.  This made me feel utterly physically sick and mentally horrified.  Even whenever Paedo does die, the child will always remind me of him and what he’s done.  Fuck.

Anyhow, if indeed the abuse was more sustained than I had previously supposed, I am wondering to what extent I am troubled by some version of post-traumatic stress disorder. C has bandied the term about a few times, but hitherto I’ve rejected any sense of it, as my ‘trauma’ was fuck all in comparison to that of many others of whom I’m aware. I still agree with this assessment of my experiences relative to others, but I can, in light of the apparent new memories, begin to accept that PTSD might apply. In particular, I believe I fit (at least some of) the criteria for complex-PTSD.

I have never disputed my BPD diagnosis, but I wonder to what extent the criteria for C-PTSD would also apply. Or perhaps one is more appropriate than the other? I am (rather pointlessly) going to examine the evidence.

Diagnositc Criteria for Borderline Personality Disorder

Frantic efforts to avoid real or imagined abandonment.

I do fear abandonment considerably, that is undeniable. The mere thought of it upsets and terrifies me, though I’d have to admit that that doesn’t universally apply to all individuals in my life. I have made a concerted effort to fight the imminent abandonment from C; however, I would not say that any of my abandonment-avoidant issues have involved ‘frantic efforts’. It is a fear, but not something I am wont to actually do much about.

A pattern of unstable and intense interpersonal relationships characterised by alternating between extremes of idealisation and devaluation.

I certainly don’t have unstable relationships, and they’re not ‘intense’ by comparison to some. I am certainly known to swing between idealising and devaluing individuals with whom I have interpersonal relationships, but it’s usually quite episodic and would not be a consistent thing.

Identity disturbance: markedly and persistently unstable self-image or sense of self.

I’m conflicted about this. I do have a clear sense of who I am most of the time, but my self-image is certainly unstable, as I can go from despising myself to thinking I’m really quite alright within minutes (though admittedly the former position dominates).

Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving).

I’m not at all guilty of the stereotypical borderline behaviour of promiscuous sex. However, in fairness to my ‘diagnoser’, I still do fit this criteria – I binge eat, I purge, I am known to drive recklessly, I am known to drink heavily, etc.

Recurrent suicidal behavior, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself.

Can’t really deny any of this. I haven’t attempted suicide or seriously self-harmed since January, which I suppose is good, but I still think about such things all the time and engage in the picking / scar interference behaviour mentioned.

Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days).

I don’t agree that it generally lasts less than ‘a few days’, but otherwise this is absolutely true.

Chronic feelings of emptiness.

Yes.

Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).

I have very, very rarely been involved in physical altercations, but the rest is absolutely spot on.

Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms.

Undeniable.

So, that gives a total of six symptoms out of nine, with one or two of the others being debatable. To meet the threshold for the diagnosis, one must exhibit at least five of the nine criteria (under the current incarnation of the DSM anyway). Ergo, I haz BPD innit. Fair enough. (Source for the above information: Wikipedia).

Proposed Criteria for Complex Post-Traumatic Stress Disorder

A history of subjection to totalitarian control over a prolonged period (months to years).

My instinct is to deny this…but I don’t think I really can anymore. Certainly, some of the more minor instances of the abuse were over many months, and quite probably years. The new memories suggest that more serious stuff may also have fitted this pattern, but I just cannot be sure. ‘Totalitarian control’ seems like a harsh term in my mind but, thinking (ostensibly) rationally, I suppose what else do you call it when some old cunt pushes a child forcibly to the ground or wall and sticks his fucking cock in her?

Alterations in affect regulation, including:

• persistent dysphoria
• chronic suicidal preoccupation
• self-injury
• explosive or extremely inhibited anger (may alternate)
• compulsive or extremely inhibited sexuality (may alternate)

Yes to all of these, in broad terms at least. The first three, as you know, are certainties. Furthermore, I am a very angry person and tend to ‘explode’ with certain individuals – but with others, I’m extremely submissive therefore hiding my raging anger. Consequently, I think it’s fair to say it alternates. Re: sexuality, I couldn’t say that ‘compulsive’ has ever been an especially accurate term, but it was for quite a while incredibly inhibited. It’s not so much the case now that I know sex – as in normal, consensual sex – is really not that much of a big deal (in the sense that it’s just one of many enjoyable things in which adults engage), but during my childhood and teenage years I had pretty conservative views on how I wanted to express my own sexuality.

Alterations in consciousness, including:

• amnesia or hyperamnesia for traumatic events
• transient dissociative episodes
• depersonalisation/derealisation
• reliving experiences, either in the form of intrusive post-traumatic stress disorder symptoms or in the form of ruminative preoccupation

You see, my instinct is to absolutely refute any suggestion of amnesia – but then, if I’m ’suffering’ from it, I’m not exactly going to know I’m suffering from it, am I? That’s kind of the point of amnesia. All one can do is look at the other evidence available. The new flashbacks and other symptoms I present do seem to hint strongly at it, so I will reluctantly accept it as at least a possibility.

The rest of these all absolutely apply. I can’t say that I experience flashbacks with considerable frequency, but they do happen and I do ruminate on events a lot.

Alterations in self-perception, including:

• sense of helplessness or paralysis of initiative
• shame, guilt, and self-blame
• sense of defilement or stigma
• sense of complete difference from others (may include sense of specialness, utter aloneness, belief no other person can understand, or nonhuman identity)

All of the first three apply absolutely, especially the shame / self-blame bit. I do feel different from other people in many ways, though in more nebulous terms than this criterion suggests. I’m not entirely sure how to describe it, but it applies in some inexplicable way.

Alterations in perception of perpetrator, including:

• preoccupation with relationship with perpetrator (includes preoccupation with revenge)
• unrealistic attribution of total power to perpetrator (caution: victim’s assessment of power realities may be more realistic than clinician’s)
• idealisation or paradoxical gratitude
• sense of special or supernatural relationship
• acceptance of belief system or rationalisations of perpetrator

This is really the main area in which I feel that I deviate from this diagnosis. None of these strongly apply to me; I don’t think he’s that powerful, we don’t have a special relationship and I don’t idealise him at all. However, I don’t dislike him particularly, and have been known to defend him despite what he’s done. I also rationalise his behaviour towards me on the grounds that I’m a slag who led him on. Whilst ridiculous, this is of course a genuinely held belief.

Alterations in relations with others, including:

• isolation and withdrawal
• disruption in intimate relationships
• repeated search for rescuer (may alternate with isolation and withdrawal)
• persistent distrust
• repeated failures of self-protection

All of these apply, to varying degrees. I withdraw so considerably from society at times that I might as well be a hermit, and I trust absolutely no one until they have all but definitively proven themselves over a period of months. I wouldn’t say that I experience or cause disruption in my interpersonal relationships a lot – but I suppose in small ways it can be true (losing my rag with Mum or A, for example, some discussion of which has already been featured on this blog). I’ve been looking for a rescuer for years, and think my obsessive desire for C to protect and take care of me currently exemplifies this. And I can’t say that I’m especially successful in protecting myself, now can I?

Alterations in systems of meaning:

• loss of sustaining faith
• sense of hopelessness and despair

To be honest I’m not sure what the first one even means, but “yes, definitely” to the second one.

So, let’s say there are seven broad diagnostic criteria for this disorder. I’m not sure how many one would have to meet to be considered to be suffering from it, but I think I can say that six of the seven generally apply to me, which sounds like pretty categorical to me. (Source for the above information: Sasian. Oddly, C-PTSD doesn’t yet seem to be included in either the DSM or the ICD, though it is certainly recognised by the discipline of psychiatry, as this leaflet from the Royal College of Psychiatrists attests).

The more general syndrome of PTSD additionally includes traits such as hypervigilance, avoidance of anything that may trigger memories, distrust of authority, cynicism, sleep disturbances and psychic or emotional numbing – all things highly evident in the mentalness of yours truly. And, as stated, I sometimes have flashbacks too; in fact, Thursday’s session with C was almost characterised by them at points.

I’m not really sure why I’m writing this. If I were disputing the BPD diagnosis, it would make more sense – but I’m not. Part of me would love to get rid of it, given the unfair but deeply entrenched stigma attached to the illness; on the other hand, how can one meaningfully fight against that unreasonable stigma if one is not from within the bracket of people to whom it is applied?

I think what I’m trying to do is make clear to myself that there actually has been trauma in my life. Every time C (or anyone else) speaks the word I wince, because I find it difficult to accept on anything but an intellectual level that there actually was any trauma. If I fit the criteria for post-traumatic stress disorder, even if it’s only via a silly self-diagnosis, then perhaps somehow I can allow myself to actually believe that I am traumatised. Although often also (in part) caused by ‘trauma’, BPD doesn’t immediately convey that potential causation through its name in the way PTSD does.

At the end of the day it doesn’t really matter; it’s ultimately a semantic debate that doesn’t really mean anything, and psychiatric diagnoses are often a pile of old crap anyway. But I know that sooner or later I need to properly realise that I was not to blame for the sexual violence levied against me, and if I can advance that realisation in any way then I suppose that is to be welcomed. Alas, though, it is still a pipedream for now.

—

Dear Pandora

Advocacy in Accessing Mental Health Services

Thank you for your letter dated 17 December 2009 about accessing our mental health services.  I am glad to note that you have developed a good therapeutic relationship with the clinical psychologist involved in your treatment[,] but am sorry that our services have not met your expectations.  [My "expectations"?  My "expec-fucking-tations"?  No, you miserable old bellend, they are not my "expectations".  They are my fucking needs and requirements!]

I have received feedback from Dr C J confirming that he saw you for the first [time] on the 19 February 2009 and [that] after three assessment interviews an agreed treatment plan was drawn up that offered weekly treatment appointments and also an assurance that an end to therapy would be identified well in advance of a contracted completion.  Dr J [he is not Dr fucking J!  He is C!  I don't care if this is an official fucking letter.  He is fucking C!] agreed with your view that some modest gains had been made during your contact with psychological services [aren't I the fucking lucky one].  He also recognised the complexity of your difficulties and so sought additional input in the form of a referral in May 2009 to [Old]VCB, Consultant Psychiatrist [that should have gone through months beforehand, after a referral from my fucking GP.  Useless twats].  I understand that you continue to be seen by the psychiatric team [yes, after more upheaval, and when they can be bothered, which is really rather infrequently].

At the time of your letter Dr J [FUCK] had made the offer of 24 additional appointments, which would bring your contact with him to an end at about the first week in June 2010, a treatment duration of about 16 months [actually, that is incorrect.  There will be 59 sessions, three of which were assessments, and four of which will be to end the process.  This gives an exact total of 52 therapy-specific sessions, which surely even in your clearly deficient brain equals a total of 12 months.  Fuck you.]. Dr J [fuck fuck fuck] expressed the hope that within these sessions, which would span approximately six months [my God, I would never have realised], [that] further work could be done that would help towards resolving, dealing with or managing your ongoing mental health difficulties.

It is clear that you have a good knowledge of the NICE guideline[s] on the treatment and management of borderline personality disorder [Hmm.  You are telling me that I know something that I know.  That was a productive use of your secretary's typing time].  Overall as the guidance states, the evidence base for individual psychological therapies in the treatment of borderline personality disorder is “relatively poor”.  Specifically, however[,] it recommends that brief therapies (under three months) should not be used.  Much of the guidance relates to provision within a specialist Personality Disorder Service.  The availability of twice weekly sessions, group psychotherapies and integrated team treatments [what the fuck?] are [sic] largely to be found within those highly specialist services [oh really, I had no idea Mr Director Important Person, thanks for clarifying].

The <Trust in question> does not have such a service [aha, and that's clearly the fault of the patient.  Nevermind the NICE guidelines saying in the absence of such a "service" that adequate generic therapy should be used.  Fuck you again], although we, along with all other local Trusts, are involved in the development of a regional approach to Personality Disorder services across Northern Ireland [wowee, I'm so profoundly impressed] and have recently interviewed for two specialist workers [two?  A whole TWO?  That's extraordinary!  Congratulations sir!].  Therefore we are planning to develop our services to people with personality disorders [I therefore assume that I can take this letter as confirmation that these "services" will be fully accessible by me...?].

As you state it is important that clients have access to a full range of mental health services appropriate to their needs.  We try [and fail] to ensure that needs are assessed in a collaborative way [hahahahahahahahahaha!!!!!] that involves both clients and mental health professionals [well, then.  That has been an epic fail!].  I would encourage you [who the fuck do you think you are, my father?  Fuck you in triplicate] to discuss these matters with the two professionals that you currently attend [yeah, because I haven't done that already.  Fuck you x4].  The Crisis Team provides mental health assessment and support outside 9am to 5pm hours in the working week, and can be accessed if appropriate through the out of hours primary care service [well, fuck me sideways with a broomstick.  I had no idea what the Crisis Team did, thanks for providing me with a lit pathway to therapeutic enlightenment.  Fuck you mark five].

Dr J [FUUUUUCK!!!] has confirmed that you have continued to attend his sessions following the writing of your letter [what was I meant to do?  Fuck a goat?  Oh wait, that's exactly what I was meant to do, right?  "The bitch is borderline, so she must be non-compliant with treatment and will instead go out and fuck anything to temporarily fulfill her emotional voids"]. I would hope [oh would you really?] that despite their finite nature you could still use the upcoming sessions to make progress.

Yours sincerely

Abject Twatfeatured Spetum-Faced Tosspot
Director of Mental Health and Disability Services

—

So.  He has succeeded in providing me with:

1. A chronology of events.  Woohoo.  Obviously the stupid mental couldn’t possibly know that she saw these individuals, nevermind know in which order she saw them, even less what they said!  Particularly when she’s an immature, manipulative borderline freak. So thank you, Mr Important Director Person, you have made my life and mental health treatment complete!
2. A commentary on the fact that I know what I know.  A tremendously useful and productive use of his time and mine; after all, I couldn’t know what I already know unless he told me, could I?
3. Um…that’s about it.

Altogether an epic success, I’m sure you’ll agree.

The letter is dated 17 February (how it took him two months to compose the above I’ll never know) and it actually arrived at Mum’s house a good while ago.  I made her read it down the phone to me, so I was aware of its content, but I only collected it the other day, and had (until now) refused to look at it.  I thought that due to its high degree of pointlessness and its utter failure to assuage my concerns, that it would upset me considerably.  After all, this is about the cessation of my relationship with C, which is an incredibly traumatic thing to contemplate.

However, when C asked about it this morning (blog to follow – big update on the beard!), I somewhat surprisingly found myself wryly amused as I reported a redacted version of its contents to him.  Therefore I’ve come home and written it up and am pleased to say that I still find it amusing rather than upsetting, probably because it doesn’t actually say anything.  OK, there’s maybe six or seven hundred words there, but it doesn’t actually – at any juncture – make any salient points at all.  It is a vacuum of a letter.  It is a nothing.  Empty space seems full relative to this page of black and white nonsense.  I’m glad it was printed on both sides of the sheet as I would have hated to see any more wood senselessly wasted on something so fruitless and silly.

Given the amount of money this moron is paid, I should really be rather angry, as well as disappointed and lost as to what to do next.  Instead, fair play to him, as he’s given me a laugh…and, in fact, some hope.  If someone with such poor (written) oratorical skills and an intellect clearly directly comparable to that of an earthworm can rise to such a lofty position within a large organisation, then my dream job is surely still within my reach.

In conclusion…FUCK YOU ONCE MORE, Mr Director Wankface Important Daft Person!

This article is fairly straightforward, but more than adequately covers all the salient points: violence and mental illness are not correlated; alcohol and drug abuse are, in the ill and ‘well’ alike, associated with higher rates of violence; the NHS is far from faultless in the care of those with severe mental illness; that sad cases such as those of Phillip Hendy represent only a tiny number of recorded murders per year (though the author of course acknowledges that any death is one too many).

She ended the article with what I thought was a very good point:

How many viewers watching this film will realise they’re in more danger from their partner beside them on the sofa than from a stranger with schizophrenia in the street?

Since the documentary, this piece has done the rounds on Twitter and probably Facebook et al as well, but if you haven’t happened upon it yet, it’s worth a read.  There’s some lively debate and interesting points made in the comments section too (though there are a few inevitable naysayers criticising the author).

Violence is Not a Symptom of Mental Illness

I came across the following article whilst Wiki-surfing the other day.  As Bippidee has discussed, the San Francisco authorities are planning to erect huge nets under the Golden Gate Bridge to deter potential suicides from jumping off it.  Which is a shame, as the bridge is beautiful (I’ve seen it with my own eyes, and have been on it), and it’s at an extortionate cost that would be better spent, surely, in mental health services.  Anyhow, as things presently stand, the Golden Gate is still the most popular suicide site in the world.

The New Yorker goes into fascinating, if morbid detail, as to why this may be.  It discusses in detail the perceived romanticism of jumping from the bridge and the experiences of the few survivors.  Apparently, some that survived the immense, four second jump have claimed afterwards that as soon as they fell, they realised that they didn’t, in fact, want to die after all.  The article also states that these survivors almost exclusively entered the water feet-down and at an angle; most others were probably killed instantly, as hitting water from that height has been demonstrated to be equivalent to hitting concrete.  The rare few that did survive the fall but later died usually drowned, as they ‘dived’ so deeply into San Francisco Bay.

There is a discussion of previous attempts to erect anti-suicide measures, and reasoning for their failures (usually cost or aesthetics).  One of the most intriguing, if horrific, parts of the article details exactly the kind of injuries a person can expect to sustain should they choose to jump from the Golden Gate – and it ain’t pretty at all.  Apparently it’s as if “someone took an eggbeater to the organs of the body.”

Random fact of which I was completely unaware: the most common phobia amongst the San Francisco populace is the fear of crossing bridges.  Who knew?

This is long and morbid, and really rather outdated too coming as it does from 2003, but it’s still a compelling and engaging read.

Jumpers: The Fatal Grandeur of the Golden Gate Bridge

If you’re feeling particularly interested in investigating popular suicide spots (!), you might ‘enjoy’ the following article discussing the macabre popularity of the Aokigahara forest at the bottom of Mount Fuji, Japan.  The article, at the Providentia blog, claims that this forest is the world’s third most popular place to kill oneself, with Toronto’s Prince Edward Viaduct taking second.  However, Wikipedia claims that since the viaduct has erected its “luminous veil” (essentially a high barrier preventing jumps), Aokigahara has overtaken it.

The Suicide Forest

I always have to get an article about psychotherapy into these posts, don’t I?  This is from Psych Central, and discusses what side-effects one might expect from the therapeutic process.  It isn’t a very long article – though there’s a couple of interesting comments following it – and it focuses on a few specific types of disorders, but it still makes for interesting reading.

One point of interest is that when practicing exposure-based therapy with an agoraphobic client, relaxation techniques and breathing exercises can actually lead to a worsening of a panic.  The study discussed is not denigrating the use of such techniques in general, however; it is merely suggesting that they should not be taught simultaneously with exposure exercises.

Harmful Side Effects of Psychotherapy

—

As ever, there were half a million other articles that I found interesting, but for this week these were either my favourites, or the ones I felt most pertinent to other parts of my blog.

Enjoy…if you have the same sinister, grim capacity I do to enjoy stuff like this.

I was one of, as far as I know, hundreds that wrote to complain.  In fairness, I got a fairly reasonable response from the Deputy Editor who afforded me the opportunity to speak directly to him about my concerns if I thought it would be of use.  I didn’t, so I didn’t phone him, but I did think that perhaps the furore about the program may have made the BBC think twice before putting out such biased and unprofessional tripe again.

How wrong I was.

Last night, BBC2 screened a documentary entitled, Why Did You Kill My Dad?, presented by filmmaker Julian Hendy.  In 2007 his father Phillip was brutally murdered by an individual with mental health trouble.

The tragedy saw Mr Hendy set out to “investigate” the true rate of violent crime committed by the mentally ill, in particular those with psychotic illness, in the UK.

Cue mournful, vaguely sinister music, accompanying pictures of crazed looking nutters or images of catatonic freaks showing off their thousand-yard stares.

TEH MENTALS HAZ EV1L IN THEM INNIT

I feel bad criticising Julian Hendy, as I can’t imagine how horrific it must be to lose someone you love in such circumstances.  Nevertheless, this was a hideously biased, completely unbalanced program, full of very little more than gross generalisations.

OK, so perhaps it didn’t specifically come out and say, “people suffering from psychosis are more likely to be murderers,” but it might as well have done.  Those suffering from mental ill health were depicted as axe-wielding maniacs who have no hope of managing their conditions whatsoever.  TEH NHS FAILS COS IT HAZN’T LOCKED ‘EM ALL UP INNIT.

I’m the first to admit that the NHS is bullshit when it comes to mental health.  Christ knows, I rant about every day or two on this journal!  And maybe in the case of Phillip Hendy’s assailant, the NHS should have realised there was a risk to others.

But that is one case.  Hendy ergo tried to counter that by speaking to other families that have lost people in similar ways, but when you compare this small number of people to the amount of people that have suffered psychosis the percentage risk of a psychosis-violence link is so much beyond negligible that it is in fact almost infinitesimal.

The documentary conveniently failed to acknowledge the fact that community based individuals with schizophrenia, obviously the best known of psychotic illness, are much more likely to be victims of violent crime than they are to be perpetrators (source: any of these dozens of Google results).  Those not based in the community are usually imprisoned in locked bins with draconian rules on release, so their risk to the general public – if there even is one in the first place – is clearly quite low.

What complete bollocks. Psychosis simply does not equal violence.  For God’s sake, my voices once told me to harm my baby cousin – it doesn’t mean it actually fucking happens in all but the smallest minority of cases.

The film, whether it intended to do so or not, has only succeeded in presenting the mentally ill as dangerous and deranged, despite the fact that it is well known (and highly demonstrable) that psychosis as well as other forms of mental disorders can be well managed with minimum danger to others.  All this documentary has done is to reinforce the false stereotypes and dangerous, unfair stigmas that surround mental ill health in the UK today.

BBC, you fail.  Again.

It accounts for some of my motivation for anonymous writing, but it isn’t really the crux of it, to be honest. There are a few people in my real life that I allow access to this blog, which kind of disallows exploration of some of the most intimate stuff – but then, I’m not sure I’d want to share the most intimate stuff with anyone anyway, anonymously or otherwise, so that doesn’t really matter. Furthermore, I’ve been known to password protect certain posts to ‘hide’ them from real-life voyeurs who might otherwise become party to information to which they are not entitled.

In an ideal world my writing wouldn’t be anonymous at all. I don’t think anonymity adds to the stigma attached to mental illness, but I do think that complete openness about one’s experiences can only help to reduce it (if you can appreciate the subtle, but definite, distinction). I have a lot of respect for what Seaneen (the author of The Secret Life of a Manic Depressive), and Alison (of Genius Gone Wrong) are doing on their blogs, which are almost entirely identifiable with them.

However, such openness – in certain circumstances – can be profoundly inhibiting. Regardless of whether or not we all should be more open, on certain themes it can be desperately difficult to actually do so. I think one of the key things I’m thinking of here is sexual abuse.

Anyone who’s read the archives or followed the blog for a while will know that I’m quite open on the general points of what Paedo did to me when I was a child – but if you look closely, I’ve never gone into the specifics, the hideous minutiae of the various incidents. I would like to do so, but I’m too weighed down by a disgusting overwhelment (spot the made-up word) of shame and responsibility for it. I know rationally that I am not to blame, but in some ways this is the point I made above; I know that discussing specifics is maybe something that I should do, but it’s just so fucking hard. If it’s hard without you knowing who I am, how much worse would it be if you did?

Anyhow, metaphorical blocks to openness and honesty are not the main crux of my need for anonymity. The choice to write under a pseudonym is predicated upon the need for protection. Not self-protection, oh no. It’s about protecting the myriad of people that would find themselves mentioned here.

In reality, if any of the relevant personnel somehow happened upon this blog, they would know the identity of the author instantaneously. However, fortunately for them (and me), most of them (with one possible exception) are very, very unlikely to come across the online home of yours truly. Were I using my real name, though, it would be thousands of times more likely that this would happen.

It is essentially an agreed part of my psychotherapy that I anonymise references to it and specifically to C here, after this debacle. I could reveal my own identity and not reveal his, of course, given that there’s only a few in my ‘real life’ that actually even know his full name – it’s just never really come up with anyone else. For the record, C is the only person that I’m protecting here that I think could easily find the blog.

The anonymity also protects A in a sense; although I’ve allowed two of his close friends (W and G) to read it, as they are people to whom I am relatively close myself, I fear that some of his other mates and, in particular, his family coming across this site would be disastrous. Everyone knows by now that I’m mental, but it’s a small few that know about the self-harm, the dissociative episodes and the psychoses. I don’t care if A’s parents know…well, no, wait. Who am I trying to kid?! It would be mortifying if A’s parents knew the seriousness of my conditions. I know that’s something I shouldn’t think, given that I don’t (shouldn’t?) feel shame about my illnesses, but there you go; that’s the way it is. But allow me to at least retain a fickle veil of altruism: out of tact, A’s family / friends may say very little to me about the more ‘difficult’ facets of my madness, but I fear that he would have to tolerate a lot of earache, and he gets enough of that from me!

I do protect my friends through my anonymity here, in a tangential sense at least. For example, my best friend D is a very well respected business journalist – I can’t imagine that in his cut-throat industry and sector of employment being the best friend of a known and certified nutjob would go down that well. My second closest friend B, when afforded the opportunity, turned down the opportunity to read the material here, as I suspect he was worried about how much of it would disturb him (bloody normals!).

But most of all, those that I need to protect are my family. As you probably know by now, I really don’t hold that many of them in particularly high regard, but that’s mostly irrelevant as, despite our significant differences over the years, I love my mother very much. Her family – her illusions about certain members of her family – are all she really has left in this sorry world. OK, she has me, and of course she has a wide circle of friends too – but she, unlike me, strongly subscribes to the idea that blood is thicker than water, and to that end my aunts and uncles and their various descendants are of supreme importance to her.

My mother is mostly unaware of how serious things have been, and I want to keep it that way whilst still being able to discuss them openly in some sort of supportive arena. She knows I’ve heard voices / seen things, she knows that I’ve cut myself and she knows that I experience periods of dissociation – but she has no idea as to how serious these incidents have actually been. Why not tell her? She’s my mother after all, she’s meant to be the most supportive person in the world to me. That matters not, because she would worry. It is as simple as that. I suppose it’s self-evident to say that she worries as things are – how could she not – but she does not need the additional and profound concern that would be caused were I to divulge exactly how grave things can often be.

There’s a few further strands to this, of course. Mum is well aware of some of my disdain for my family, especially her sister in America (GA) and to a lesser extent, the McFs. However, with the exception of GA, I maintain a pretence of relative tolerance towards the rest of them, as I have no wish to argue with my mother over their respective characters. Here on the blog I can bitch and whine and rant about the bastards all I like, with almost absolute impunity. In this sense, my reasoning for anonymity does more closely align with that of some other bloggers – ie. that one’s deepest, most disturbing thought processes can be discussed with no comeuppance.

Finally, of course, is the issue of Paedo. Partly I don’t want my mother to read about him because she is happy in her illusion that he is a decent person, even though she has been made well aware of that of which he is guilty. Moreover, though, if my name were connected with the revelations on this blog – well, the implications for Paedo are enormous. I don’t want him to be prosecuted, as I don’t believe it would achieve anything whatsoever. Even if I did, I simply cannot ruin the family unit to which he belongs. They may piss me off, but they don’t deserve such a hideous, life-ruining shock as this would be. Certainly my mother doesn’t, and despite all that she has done (or perhaps not done), I believe that she would take my side in any battle with the McFs; even if my revelations ruined their lives, I do not believe that they, in a hundred-million years, would ever believe the truth.

So there you go. I cannot be ‘me’ here, because I cannot ruin my family, a family that I mostly don’t even like especially. Hey-ho. What I can be made to be, however, is a more personal entity than someone who writes under the handle of ‘Serial Insomniac’. I am a serial insomniac, and I do ‘confess’ on this blog, but I am more than just that; I’m a person. A real, living, breathing person.

Thanks to the 45 of you that voted in the poll that was at the link in the last paragraph. Here are the results.

As you can (hopefully) see, the single most popular vote at 31% was to keep the moniker of “SI” despite the fact that, as alluded to by Differently, Lost and Sanity, quite often that acronym is linked with “suicidal ideation” or, more frequently, “self-injury” (though to be honest I quite enjoyed that inherent ambiguity). However, that means that the majority – 69% – voted for something other than “SI”.

As I said in the original post pertaining to this, the title of the blog is, was and will continue to be Confessions of a Serial Insomniac. However, if you’d like, you can now refer to the specific author of it as Pandora.

It was the most popular choice amongst the suggested names (at 24%), and while I like the metaphor of my evil insidiousness being released on the world as in the allegory of ‘Pandora’s Box’, allow me a rare moment of sentimentality – as Fatally Doubting and Faithful Reader pointed out, at the end of all the horrors Pandora released, that most fabled of concepts, of human emotions – hope – also finally emerged from the ether.

He is off this week, which is why I’m writing about last week’s session on what would normally be my Therapy Thursday.  I miss him.  I miss him very much.  On Tuesday I had a moment (read: quite a long time) of utter desolation pertaining to his absence, accompanied by my old friends of depression, self-loathing and suicidal ideation.  If my inability to cope without him is so acute and all-consuming after a matter of days without seeing him, what – in all seriousness – are things going to be like when the 59th session has been and gone?  I can already see myself falling into an abyss of, at a minimum, abject depression.  I have contingency plans, of course, but can they ever be the same?  I’ve seen something like nine therapists over the past decade.  C was/is the first and only one with whom I really connected.  How long will I have to wait, how many more people will I have to see, before I can find a relationship with someone else that even approaches the quality of this one?

A doesn’t think attachment to a therapist is good.  I know some others, including mental health professionals, don’t either.  Personally, I don’t think it is ‘good’ either (in the sense that it is a difficult position for the client to be in), but as a somewhat-proponent of the psychodynamic school of psychotherapy, I believe that some form of transference – and, if it is vaguely positive, therefore attachment also – is necessary.  As research consistently finds, the most important aspect of successful psychotherapy is the therapeutic relationship.  I have a good one, and yet it is on the verge of being brutally severed.

But enough with my pointlessly whiny ruminations.  42 is the answer to life, the universe and everything, apparently.  I’m not sure that C: Week 42 was necessarily the answer to my life, my universe and my everything, but then – just like in the Hitchhiker’s Guide – I’ve never been entirely sure what the precipitating question was or is.  I merely have had and do have the awareness that many things have been afoot in my world.

Anyway.  The first thing that struck me was, once again, the beard.  It is still there.  I have nothing against beards – on people who suit them.  C suited his erstwhile goatee reasonably well (he looked a bit like Derren Brown), but this full beard makes him look like a walking statue of Christ.  What was of particular note last week was that it was perfectly trimmed.  It was so exact that it must have some mathematical or scientific use – perhaps it could be used to plot planetary movement around stars or something.  I longed to leave, drive to the nearest petrol station, buy some fuel, return, douse the beard in said fuel, and light a match.  I don’t want to cause him any pain, but really.  The beard needs to go.

As ever he tried to find out where I wanted to start our discussion, and as ever I stubbornly shrugged and claimed not to know.  Luckily – in a sense, at least – he had planned for this, and reminded me that in the previous session, we had agreed that we would spend some time talking about the various incidents that took place with Paedo when I was a kid.

In all honesty, I don’t remember a great deal of what we discussed.  In fact, in the end a lot of what we covered was related to my mother’s reaction to my revelations to her about the sexual abuse (see bottom of the page of the link in the previous paragraph).  I do remember telling him that I was absolutely able to be open and frank about what happened in writing (namely, here, on this blog), but that I simply couldn’t manage to get the words out to him.

Of course he wanted to know what I thought he would think about me if I did say what needed to be said.  I couldn’t think of the word at the time, but what I think I was trying to articulate is that he would be ashamed of me.  My own shame, my anxiety about uttering the word ‘rape’ to him and my utter inability to actually eventually do so would seem to confirm that.  It was like there was a metaphorical stopper in my mouth; every time my lips tried to form the word, or my vocal chords tried to convey it, something stopped it from being enunciated.  Maybe some ethereal presence put its hand over my mouth and silenced me.  Utterance of that word, and the specifics of the incidents, was impossible.

Without putting it in so many words, I basically conveyed to C that I had a supreme difficulty in verbally declaring some of the stuff that I should be discussing with him.

He reminded me that a few months back I had put together a range of material, largely garnered from my writings here, that I had wanted him to read.  He had refused, to my considerable disgust.

“What of it?” I inquired.

“I’m not sure exactly what that stuff consisted of,” C acknowledged, “but I believe that you were trying to reach out to me in preparing it, that you were trying somehow to tell me about this stuff.  But…[thoughtful pause]…but I think we need to get you to say it.  To say it out loud.”

I’d always suspected that at least part of his reasoning for refusing to take the myriad of pages I’d printed that day was related to the fact that he wanted to hear me actually verbalise this shit.  I still fervently believe that it was mostly about his refusal to have anything to do with me beyond my allocated 50 pathetic minutes, of course, but I did and do believe that his secondary motivation was to get me to actually speak.  I just wish he’d bothered to have told me that at the fucking time.  I would not have been so out-and-out furious had he done so.

Back to what I thought he’d think of me if I did speak of these experiences: I told C that I felt like a filthy whore and to that end provided him with the details of my complete knobbery from a fortnight ago, where I endlessly castigated myself as a slut of evil (we both agreed that I need to take care vis a vis alcohol whilst taking Quetiapine).  I also confided in him that in huge, angry letters the word ‘SLUT’ is etched, permanently, across my lower abdomen (along with its kindreds of ‘HATE’ ((the second incarnation thereof)) and ‘DIE BITCH’).  ‘SLUT’ is the most dramatic, however, and seems to have been the deepest of the various mutilations (all garnered, if memory serves me correctly, on the night I tried to kill myself last month).

“It’s ridiculous,” I admitted, finally.  “Of course I’m nearly as far from a slut as it is possible to be [not quite perhaps, but largely]; I see that rationally.  But I still believe that I am one, whilst at the same time believing that I am not.”

He referred back to schema models, about which we have talked on several occasions now.  He said that the part of me that felt that my belief that I’m a slag is ridiculous was, in many ways, an example of a healthy adult; she is rational, and can see things in a sensible, evidential sort of way.

“However,” he went on, “your healthy adult seems to have become rather merged with your punitive parent.  You can be very logical and whatnot, but when you do so, you’re very critical of the more child-like, emotional sides of yourself – not that you’d use the word ‘emotional’ [he added dryly] – in this case, you use the word ‘ridiculous’, but on other occasions you’ve been even more disparaging.  You would agree that that’s punitive, I take it?”

“Yes, I suppose so.”

“So there is hope there, in the expression of the healthy adult,” he said, “but we need to separate that punitive side from her…”

“Well, as you know,” I interjected, “I don’t ‘do’ self-compassion especially well.”  He has consistently told me that having some genuine compassion for myself would be a major breakthrough.  I have to say that in all honesty, this still seems as unlikely to me as it did when he first mentioned it months ago.  I feel sorry for myself at times, I think some of what I’ve gone through is unfair at times – but I never feel what I would call ‘compassion’, and frankly that applies to others as well as myself.  I have tried to develop some sense of it – I’ve read the stupid books and I’ve cried (admittedly rarely) under C’s watchful gaze.  But it still isn’t happening.  I don’t think years of psychotherapy can induce this supposed quality in me.

Somehow the dialogue progressed to an analysis of my mother’s response to matters with Paedo.  In particular, I told him how outraged I had been with her comments to the McFs in the immediate aftermath of my last therapy session (see the last few paragraphs of here).  Cue much questioning along the lines of the inveterate “how did that make you feel?” type.

I felt physically sick, not something common in my mentalness.  Struggled not to throw up.  Despondency followed.  Which was later subsumed by a raging inferno of anger.

I’m sure I’ve told him before (well, I know I have), but I felt compelled to outline again that my mother had initially said that I had “misinterpreted” Paedo’s actions, which – when I stupidly admitted the true extent of things – was later replaced by an accusation of outright lies, which were apparently fuelled by my desire not to see my family.

I didn’t get particularly angry in relaying this information, but nevertheless, the picture I painted of my mother to C was wholly negative, and at some point or another, I became acutely aware of that.

“I make it sound as if she’s a terrible person,” I sighed.  “She isn’t.  It’s just…this.”

(Actually, it’s not just ‘this’; I’ll have to introduce C to the tales of how she would viciously beat me up, leaving temporary but significant bruising, almost daily during periods of ((my)) intense depression when I was a teenager.  But I’ll leave that for another time…not that I have that many ‘other times’ remaining).

He responded by saying that he was well aware that, broadly speaking, I presently have a good relationship with my mother and that I didn’t see her as a ‘bad person’.  He shrugged.  “We all have different facets to our characters, as well you know.  She’s made mistakes in this regard, but just because you’re highlighting them to me doesn’t mean that I necessarily think that that’s representative of her entire personality.”

“I wrote a rant about her behaviour last week on my blog,” I murmured, absent-mindedly.  He asked about the content of it, and I said that it largely mirrored the information that I had just relayed to him, except that it was furious and bitter.

He nodded thoughtfully for a minute, then asked about my audience here.  Was the blog open for everyone to read?  How many read it?  Who, broadly speaking, might my readership be?

I told him that I do password protect the odd post, though if I am honest I probably gave him the impression that I do it much more than I actually do (this is my 121st post; out of all those 121, only three are password protected.  Two of those three are about C, if that reveals any deep psychological insights).  I said that the majority of my audience seemed to be others involved in various mental health systems, mainly but not exclusively from my side of the couch.  And that there were, at that point, in the region of 20,000 hits.

“But it’s all anonymous?” he checked, which irritated the fuck out of me, as we already had this conversation, leading to a particularly fraught interaction between us and a horrible few post-therapy hours for me.

“Yes.”

“And no one in your “real-life” reads it?”

“Not ‘no one’.  There’s a few, but they’re a select few.  It’s definitely not for my mother’s eyes.”

“And maybe you think it’s not for my eyes either?  Maybe you’d feel uncomfortable about me reading it?”

Oh for God’s sake, C.  Not this crap again.  “Why, have you?” I challenged, looking him straight in the eye.

He too had been looking directly at me, but as he replied, “No, I haven’t,” he tellingly lowered his eyes.

I don’t believe he is lying, but I do believe the statement was a half-truth.  It would be hard for C not to find this blog, given some of the Google terms he is likely to be searching for in his line of work; therefore I believe that he’s probably come across it.  He would have recognised me after having read a mere few lines though, and in his defence he is a professional, so is unlikely to have read any further.

I told him I didn’t care if he’d read it or not, as there was nothing contained within these pages that I wouldn’t say to his face.  He was about to respond when I interrupted, saying that technically that wasn’t entirely true, as I was fully able to discuss the issues of child sexual abuse on the blog, but not with him. (Specifically, I can write ‘rape’, but not say it, at least not to him.  Look, see: RAPE RAPE RAPE RAPE RAPE RAPE RAPE RAPE.  The day I do that in therapy with particular allusion to myself is the day I eat the contents of a 14th century latrine).

“But you know what I mean, I hope,” I continued, and he confirmed that he did.

There was a lull for a few minutes, then C noticed that I was laughing softly.  Naturally he asked why.

I had been thinking about the fact I have an entire alter-ego here through this blog.  My material is searingly honest and intensely personal at times, and yet it’s a very tiny fraction of my readers that know to whom this intimate information really belongs.  As things stand now, that’s an unfortunate necessity, but it doesn’t keep it from being ever-so-slightly odd, and hence vaguely comical (at least to me).

We had a brief conversation about how the cloak of the internet allows one to accentuate particular parts of one’s personality.  In my case, in this guise at least, the accentuated part has been my madness.  I’ve had other guises related to other specific parts of my personality, of course, but relatively few that have been about ‘me’ as a whole, whoever she even is.  Anyhow, this was part of the reason why I felt that I should consider giving myself an actual name on this blog, even if it’s still not the ‘real’ one.

This saw the end of the session.  C said that we have a lot of material to work with over the coming weeks – well, my friend, isn’t that a shocking surprise! We still won’t grasp it all, though; we can’t in the time we have remaining together. As I departed, he wished me all the best.  Little things like that make me feel pathetically good about our relationship, perhaps because it gives me the impression that he cares about me, however tangentially.

So, no strong revelations as to my life, my universe and my everything in week 42, but as he says, there’s material to work with for a while.  Can we find the ultimate question?  Moreover, can we find it in the small window of time that remains?

The author, Kimberley, discusses an article on the phenomenon from Pandora’s Project, which is a support site for those effected by sexual abuse (interestingly, ‘Pandora’ is the name currently leading my poll on what I should be ‘called’).  Firstly, Kimberley discusses the symptoms that are commonly seen in this illness, such as hypervigilance, flashbacks, severe anxiety and dissociation, though she then moves on to outline the biological research undertaken into PTSD.

The bottom line is this: PTSD is not just a psychological illness, but a physical one too.  Trauma does not just damage our psyche, it can actually change the physiology of our brains.  In particular, traumatic events seem to affect the hippocampus (a part of the brain that has responsibility for a lot of memory functions) and the medial prefrontal cortex (responsible for cognitive functions such as personality expression and decision-making).

I have come across information like this before, but Kimberley’s analysis of the Pandora article is worthy of particular note for her eloquence and understanding of this subject.

PTSD and Your Brain

Now, this I like.  Anyone who has followed this blog in the long-term knows about my complete disdain about all forms of cognitive behavioural therapy.  I think it’s the biggest pile of toss in the history of psychology, at least for people like me.  To say that I have faith in the psychodynamic and analytical schools of therapy would be false, because I am not sure that I really believe any form of psychotherapy works entirely.  Nevertheless, I hold the latter in much higher regard than the ‘newer’, in-vogue, supposedly cost-efficient therapies.

The problem in this position in the last few years has been that the psychodynamic schools have lacked empirically-based evidence for their effectiveness, whereas (surprisingly for me) CBT and its kindreds are backed by a myriad of studies supposedly supporting their effectiveness in treating various forms of mental illness and distress.

Well, finally it seems the psychoanalyst types have sought to prove the efficiency of their practice.  This article from Scientific American (reported prolifically elsewhere too) discusses a recently published journal article apparently demonstrating that psychoanalysis and psychodynamic therapy not only work, but keep working after cessation of treatment.

The piece claims that psychodynamic therapy has been shown in controlled trials to effectively treat anxiety, depression, eating disorders and, crucially for yours truly who is in psychodynamic therapy, personality disorders.  According to the author of the original journal article, this type of therapy enables patients to develop tools to better function in the “real world”, increases self-confidence and decreases the symptoms of their illness(es).  A key ingredient in achieving this is, of course, the therapeutic relationship.

Like the preceding article above on PTSD, there’s a wee bit of neuroscience thrown in here; current research seemingly suggests that psychodynamic therapy can produce changes in the prefrontal cortex of the brain, as patients begin regulate emotional health.

Naturally this isn’t a faultless paper; for one thing, the studies therein simply aren’t numerous enough in number.  But, not unsurprisingly in my view, most of the main detractors of the article’s findings are CBT devotees, who complain that this study is across various mental disorders, rather than focusing on just one.  Fair enough, but the analytic schools had to start somewhere (and admittedly should have done so sooner), and ’somewhere’ is proving to be a promising start.

Talk Therapy: Off the Couch and Into the Lab

A few other articles of interest came up this week, but I think I’ve drivelled on enough.  Enjoy.  *coughs*

C is off tomorrow   So I shall report on last week’s session then, hopefully.

To both ends I wonder if the moniker of “SI” isn’t too impersonal. For reasons I will go into in more detail on another occasion, I have to blog anonymously, at least for the foreseeable future. Nevertheless, I wondered if I could invent a more personal sounding journalling identity.

My intention is not exactly to abandon the handle of Serial Insomniac of course; that’s still and always will be the name of the blog. But the writer could be called something different, perhaps – Lola Snow, for example, is the author of the Marine Snow blog, Ophelia is the author of Writing Myself Sane. Their names are distinct from the names of their blogs, whereas at present mine is not. On the other hand, changing my name as an author may simply confuse issues; after all, I’ve been known as SI to my readership for over nine months. But then I was known by my original surname for over 26 years, and am now trying to get used to my new one. What do you think?

Anyway, I’ve done a little short-list of possible pseudonyms:

Clara – simply because I quite like it. But it means ‘bright’ which would be laughably ironic.

Elora – again, I quite like it. Used it for a role-playing character in Call of Cthulhu once. Means ’silent’, which by virtue of this blog I most certainly am not – but where it actually counts, I do often feel as if I am. The whole C-cessation of therapy saga, the whole maternal denial of the sexual abuse. I am indeed voiceless.

Elysia – from Greek and Roman mythology. Refers to elysium, which is the realm of the dead, and specifically means ‘blissful’. Your humble narrator is not ‘blissful’, clearly. However, that realm of the dead most assuredly could be so in her dark and suicidal eyes. The name reminds me slightly of the Dylan Thomas poem, Do Not Go Gentle into that Good Night (see here), the ‘good night’ of course being death. The blissful elysium. The good night. Yes indeedy.

Lorena (or Lorina) – ’sorrowful’. ‘Mournful’. Who knew first names for such beautiful misery existed? This provides me with much pleasure. I find this one nicely evocative too.

Pandora – I can’t easily dissociate it from the Adrian Mole books, but then I loved them, so that’s OK. Everyone else will probably be familiar with the Pandora whose curiosity led her to open a box, thus unleashing evil across the world. I feel like I do this everyday, with every word I speak or type, and it is ultimately my own selfishness that drives it.

Perdita – invented by Shakespeare. I don’t like its diminutive, Perdy, but Perdita itself is fine with me (though A claims to hate it). It means ‘lost’ or ‘forgotten’. I am certainly ‘lost’ in the metaphorical sense; I have no idea where I’ve come from in life and even less of where I’m going. I feel ‘forgotten’ by the system, and even to some extent by a few people that ought to care more than they apparently do.

So that’s the short-list. I don’t have a strong preference, so I’m going to let you, my dearest readers, vote for your preferred choice of pseudonym. I can’t guarantee that I’ll end up following your advice, though I’ll at least strongly consider it as you lot can be decisive, a characteristic that is wholly absent in me.

The realm of SI has temporarily become a democracy. Exercise your egalitarian right to be heard! It will make your life better to do so, yeah! Oh look, a flying pig…

EDIT: The poll has now closed. Stay tuned for the results!