I have two therapy sessions to catch up on and, since I probably won’t write about them before tomorrow morning, a third will probably join them.  I remember the interactions pretty clearly, as I usually do – one pièce de résistance was asking C if therapy was really meant to make you feel worse, which hit a nerve ;) – but I just can’t find any motivation to record them in writing here (or anywhere else for that matter).  I think, letters to MPs notwithstanding, that as things draw to a close I’m increasingly finding our meetings to be utterly futile and to that end, perhaps, I can’t face writing about them.  To do so would maybe be to acknowledge that, this time next month, psychotherapy – my only hope of a recovery of sorts from my perpetual anguish – will in all likelihood be over.  That’s a thought that is both sobering and chilling.  CPN/SW or not, good family and friends or not, I’m not at all convinced that I can keep myself safe from the end of next month onwards.

To go from making what was really rather good progress in therapy to regressing into this barren Purgatory-like wasteland is frustrating to put it mildly.  I don’t know how to articulate my current feelings on the matter beyond that.  Grieving, hurt, depressed, anxious, angry, I suppose – but all of these with a certain degree of measured stoicism; perhaps I am simply resigned to his abandonment of me now.  Overall I feel straightforward but profound sadness and regret.  Sadness for the fact that I will miss him greatly, I suppose, and regret for what could have and should have been – a relationship that had the power, if given the requisite resources, to greatly improve my quality of life.

Even if I had the will to write up the last two sessions – even if I had it right now – I wonder to some extent what the actual point would be, because as I say our sessions are feeling increasingly pointless.  I don’t really blame him, and I don’t really blame me.  It feels inevitable that things would just sort of ‘trail off’ mid-sentence, mid-air, as D-Day approaches.  Just the nature of the beast, methinks.  Pointless, futile, dancing around things and dodging others.  Still, I suppose the reason I started writing such detailed posts on therapy in the first place was for a record…for reasons of mere posterity.  Empty discussion or not, surely it is equally important to discuss the final sessions of this process if that has been my aim.  So I should – and therefore, I have now decided, will – review them, but I can’t say when.

Because the problem is that my current apathy is not just about examining psychotherapeutic matters.  I am finding it excessively difficult to write about anything (perhaps not unlike how I felt two weeks ago and indeed a week before that).  In part (probably in large part) that’s because I have absolutely no life whatsoever.  Yeah, I sometimes go out for a drink with A or to a shop with my mother – but so what?  What’s that got to do with anything?  Who’d be interested in that?  Certainly not me, and since this blog (despite having quite a few lovely followers these days) is primarily my record of these dark times, I’m not going to blather on about stuff that bores me to death (death is more peacefully achieved by other means, thanks very much).

This failure of expression and engagement with life extends to contact with the outside world at large.  I’ve been ignoring Twitter, emails, text messages – everything.  I refuse to return my mother’s unanswered calls, and the only person I speak to is A.    I do go through phases of doing this every so often, but this feels deeper, like it’s likely to go on longer.  I’m in a rut, both in terms of social communication and in terms of the one form of communication I’ve always held so dear – writing.

I thought about taking a brief break from blogging – say a month or something – but as I stated here, my concern, justified or otherwise, is that even the most short-lived of interludes would lead to a situation where I never felt able to once more lift my metaphorical pen.  And ergo you get stupid little filler posts like this one, designed to at least be something, but which are pointless and vacuous in their story-telling and exasperating in what catalysed them.

But that’s not this blog’s fault.  I don’t hate this blog.  I do, however, despise its author.

In all seriousness I don’t really expect it to do any good, but you never know.  A friend of mine, through contacting her MP about the failures in her mental health care, did receive some very positive results, so it’s got to be worth a try.  At the very least, it’ll shake things up with C and Mr D-P

This will probably be a little repetitive if you’ve read my post on my history of therapy and if you’ve been following the Mr Director-Person series.

Dear Mr MP

Re:  Access to Mental Health Services, [My] Trust

I am writing to you as a constituent hoping that you will be able to assist me in accessing NHS services to which I am entitled for several serious mental health conditions. I am diagnosed with borderline personality disorder (BPD) and complex post-traumatic stress disorder (C-PTSD) with psychotic and dissociative features as well as clinical depression and social anxiety, and have been ricocheted around both the NHS and private systems since about 1998 when I was 14.

It is clear to me that the [My] Trust, in its approach to my mental health problems, is placing me at serious personal risk by refusing to offer me adequate treatment. In order to explain the situation, I feel that it is necessary to provide some background information and catalogue a series of NHS failures which have led to the dire situation in which I now find myself.

At about the age of 14, when I first experienced notable mental distress, I was referred to a counsellor whom I met only once. Some time later I was referred to a trainee (child) psychiatrist that I met several times; however, when she left to take another job, I was left without any support whatsoever. Several years later, after having severe difficulty pursuing my schooling, I was referred to [C's] Hospital for a psychological assessment, but was regarded by the assessor with open contempt and was not referred for any therapy or psychiatric care whatsoever.

However, with familial support I was able to somehow manage to go to university, during which time my mental health issues were relatively stable. Unfortunately, though, I had a major breakdown in 2007 during a Masters course, meaning that I had to leave my course with a diploma instead. Upon consultation with my GP, I was referred for an assessment at [Big Scary Bin]. Eventually I saw a psychiatric nurse who referred me for group Cognitive Behavioural Therapy (CBT), but given the lengthy waiting list for this, I saw both a psychologist and hypno-therapist in the private sector. Thanks in particular to the latter, I was able to return to a part-time job.

I was subsequently contacted by [Big Scary Bin] regarding the group CBT sessions, but unfortunately these clashed with my morning job. I asked the individual that had contacted me if it would be possible to arrange an alternative time, and he confirmed that afternoon sessions were available on a one-to-one basis, though the waiting list for this was much longer. I agreed to wait for these individual sessions; however, I was never again contacted by anybody in relation to this matter.

On 4 August 2008, after having battled against a major depression in my job (which had since become full-time), I broke down completely and had to go off work. I have been off work since. My condition was so bad that my GP sent out a Crisis Resolution Team (CRT) to my house, a referral only made in serious circumstances. Unfortunately I was patronised and all but openly derided by the CRT, who left claiming that they would, again, refer me to a CBT therapist.

Knowing how long the waiting lists for this were likely to be, in the interim period I consulted a CBT therapist in the private sector and saw her for several months. Although we had a good relationship, the cost of the treatment – for someone absent from work in particular – was prohibitive, and furthermore unfortunately CBT as a therapeutic modality simply did not help me at all. At this point it was considered that I was suffering from depression and anxiety ‘alone’, for which CBT is often an effective treatment. However, as was later determined, I also have BPD and C-PTSD, for which CBT is generally not empirically proven.

During a routine appointment with her Nurse Practitioner in late 2008, my mother found out that the CRT had not made any referral in my case as they had claimed they would. The Nurse Practitioner therefore referred me herself for an assessment at [C's] Hospital.

In January 2009, my GP also referred me to a psychiatrist.

On 29 February 2009, I first met [C], a clinical psychologist at [C's] Hospital. After three assessment sessions, [C] decided that an alternative approach to CBT would be appropriate and offered me the opportunity to keep seeing him specifically. I accepted this and, for the first time, I have found the relationship and the work conducted therein to have been of genuine benefit. As of the date of this letter, I have had 59 sessions with [C]; although since three of these were preparatory assessments and four are designed to facilitate the ending of the treatment, this amounts to a year’s therapy.

In May 2009, I was finally seen by a consultant psychiatrist (after a number of follow-up calls from my GP, and an additional referral from [C]). After assessment I was diagnosed with BPD (with a differential diagnosis of bipolar disorder, type II).

Research literature (and, indeed, my care team) is generally agreed that the treatment for BPD consists of long-term psychotherapy, of a minimum of 18 months – preferably twice a week (my therapy is once weekly). Medication can help manage certain symptoms such as depression and psychosis (in my case hallucinations), but therapy is considered the mainstay of treatment for this disorder. I personally know several individuals in other Trust areas that have received therapy for the same or similar ranging from two years up to over four.

Despite this, however, I was told by [C] in December 2009 (shortly after I lost my job due to my long-term absence) that he could only continue seeing me until August 2010. When I protested that longer-term therapy than what he was proposing was required, he agreed, stating that unfortunately certain constraints inhibited his ability to offer longer-term therapy, and said that he would support any complaint on my part. To that end, I wrote to the local mental health charity, Mindwise, and to the [My] Trust’s Director of Mental Health, [Mr Director-Person].

Unfortunately Mindwise dismissed my concerns, but [Mr Director-Person] did reply and I have been in correspondence with him since (copies enclosed). However, he has to date point-blank refused to allow my treatment to continue longer than the currently proposed timeframe, despite the inadequacy of the treatment the Trust is offering and the apparent postcode lottery that appears to permeate mental health care.

The Trust’s approach is in contravention of both personality disorder guidelines from the National Institute on Clinical Excellence, and the Northern Ireland Personality Disorder Strategy of June 2010. Although both recommend specific therapies for illnesses such as BPD (such as Dialectical Behavioural Therapy, Transference-Focused Therapy, and others) they also state that in the absence of facilities for same, more ‘generic’ therapy of the type I am presently receiving and finding useful should be provided.

In March 2010, my consultant psychiatrist (a different person from the one who diagnosed my BPD) felt that I was also afflicted with complex post-traumatic stress disorder (C-PTSD) as a result of significant trauma in childhood. This illness is similar to but distinct from BPD, and psychosis and dissociation are common in both. Unfortunately, exploring the traumas in therapy – something I was only able to do properly in about March 2010 owing to considerable defence mechanisms and even amnesiac elements surrounding the issues – has left me thoroughly re-traumatised (as well as strongly suicidal, depressed and anxious). Whilst I accept that this is an inevitable part of therapy, the problem is that a matter of mere months is simply not adequate to help me to deal with and get over not only the original traumas, but this level of re-traumatisation. The re-traumatisation has caused even more severe flashbacks, serious hallucinations and considerable dissociation, including but not limited to my ‘waking up’ in places without awareness of how I got there.

[C] and my psychiatrist, [NewVCB], have proposed discharging me to a community psychiatric nurse or a social worker upon the cessation of therapy, but no one has been able to tell me what these individuals do, how they could help me in resolving and managing my current difficulties and traumas, and how this can be considered an adequate substitute for continued psychotherapy. It is my belief, supported by academic literature and research, that the best person to give me any chance of recovery is a qualified therapist such as [C].

The struggle with the Trust’s uncooperative and frankly negligent approach to my condition has in fact contributed to the worsening of my mental state, exacerbating feelings of worthlessness and despair. The Trust provided a good, functional relationship with a competent therapist but is now determined to terminate that relationship unreasonably whilst providing no adequate replacement treatment.

As this letter has detailed, it took me over 12 years to meet a therapist that I felt could genuinely help me, and I feel it is not unreasonable of me to wish to continue with this helpful work, particularly in light of the problems the health service has produced in the past. Furthermore, I am all but certain if I am discharged from therapy now, that I will merely be referred – perhaps more troubled and traumatised than ever – in the future, which will not do anything to save health service costs. Finally, as I am still unable to work, the public sector is not in any way saving money by discharging me prematurely from therapy; if my work with [C] were allowed to continue, I believe that I could return to work sooner than otherwise, thus saving public sector funds in the long-term.

I am convinced that a discharge from treatment when one is in a worse state than when that treatment commenced would not happen in the realm of physical health, where conditions are treated until they are either cured/remitted or can be adequately managed by the patient alone. The lack of resources of the [My] Trust should not be translated into inadequate care for the mentally ill. It should not be forgotten that approximately one in four people will suffer from some form of mental illness, whilst only 5% (source) of NHS funds are directed towards resolving these issues.

In conclusion, I am asking you as my political representative to assist me in accessing the psychological treatment that I desperately need, and to which under the various guidelines and indeed the very ethos of the NHS I am entitled. Should you require further information on how my illnesses impact upon my everyday life, I should be happy to provide same. I am sending you this letter both in your capacity as my MP and as an MLA for my area. I am also copying this correspondence to other [my constituency] MLAs and to Michael McGimpsey in his capacity as Health Minister.

I understand that after my mother (and registered carer), [her name], contacted you regarding the provision of mental health services, you were very helpful in the matter, about which I am greatly encouraged. I would be very grateful for your prompt attention in this matter, especially as I am due to be discharged from my treatment at the end of August.

Thank you very much in advance for your time and assistance.

Kind regards.

Yours sincerely

Me

Encs

Admittedly, I went in in a bad mood to begin with. I’d actually been in a good one hitherto, thanks to waking up to this lovely comment from Seaneen (and one already made by Nick, to which I alluded at the end of that post). I’m always thrilled when people compliment my writing; although the blog is still primarily for my own benefit…well, if it’s considered to be done well by others, then that’s a very worthwhile, confidence-boosting bonus. So yes, I was in quite a decent mood, and the sun was shining, and I thought that this confluence of relative non-shitness might lend itself to actually covering something useful with C for the first time in about 300 years. Although, having said that, when I’ve been in a good mood in the past I tend to go in, ramble on a little, then seduce him into a discourse of academic psychology and intellectualism. But anyway…

I arrived at the hospital, and was outraged to see a car in ‘my’ parking space. Who the sodding hell did they think they were? I park in the same space each week. In fact, I have a ritual. I drive to the back of the carpark, turn, drive forward into the space, adjust steering until I am exactly six inches from both right and left extremities of the space, and finally reverse/go forward until I’m right in the middle relative to the front and back of the space. And it has to be that space.

Were I not so utterly in love with my little car, I would have used Him to ram the other car of unwitting evil out of the space. How very dare it steal my space?!!

(A tells me that I have to write a post about my apparent OCD-ish behaviour. Another foible that he finds consistently amusing is the fact that I will not change the radio station in the car, even if the most offensive thing I’ve ever heard is playing, unless he’s with me).

So I had to take another space – one that actually brought me a good deal closer to C’s building – but I felt soulless and destroyed inside. I cursed myself for having failed to bring Diazepam with me. And then my nose started bleeding, as if symbolically voicing its own displeasure at the sorry circumstances in which it found itself.

I had no tissues with me, so holding my nose, I dashed into the building. Before I reached the toilets, however, I almost literally ran into C. This was about 9.20am, which freaked me out because C does not exist at 9.20am. He only starts existing at 9.30am when our appointments commence.

We exchanged awkward pleasantries, and I ran to hide in the toilet, blood trickling its surreptitious way out of my nostril. I plugged it up with bog roll (unused, just in case you were wondering), and stood behind the door, listening, waiting, for him to go past so as I didn’t have to encounter him outside session-time again.

How ridiculous is this? Seriously. How can someone so obsessed with and attached to her psychotherapist be thoroughly freaked out by seeing him outside of the allocated fifty minutes, especially when it’s mere seconds beforehand? There have been times when I’ve dreamt of bumping into him in a pub, a shop, I even half-hoped I’d see him at the recent Metallica gig at which we were both in attendance. If that had actually happened, though, it would appear that I’d have gone completely doolally. What the fuck is wrong with me?

Anyway, having heard someone that I assumed was him walk past the door, I sneaked back out to the waiting room, like some silly schoolgirl bunking off class. Eventually he emerged again, this time to escort me to that week’s 50 minute doom.

It commenced in the usual silly way. We acknowledged each other. I even asked him how he was, something I haven’t done in eons. Then there was silence. He glanced at me. Our eyes met. He nodded. I made some not unfavourable facial gesture in response, and looked away.

And the silence continued.

And continued.

And continued.

Eventually, he said something along the lines of, “where would you like to begin?”, to which I responded with resigned laughter.

C replied by saying that things seemed to be frequently commencing in this silent fashion. No shit there, Sherlock. 10 out of 10 for observation.

I think he then said something to the effect that he wondered if we could use ‘the time remaining’ to tackle some of the issues that were paramount in my mind.

Thanks, C. Rub it in. Just rub it right in. Pour a barrel of salty piss right into my gaping, agonising wound. Go ahead and remind me that said wound is going to be open and raw for some time – possibly forever.

“But you’re trying to protect yourself, aren’t you?” he said. “So you’re finding it difficult to communicate these things.”

Did I shrug at this? I think I did. Whatever the case, my response was non-committal.

“What about the sexual abuse..?” he asked tentatively, tailing off.

The mention of this most un-amusing of subjects somehow did amuse me – the very notion that I would discuss this more when I am being consigned to the dark recesses of rubbish bin of psychotherapy was tragically funny. I eventually said, honestly but reluctantly, “I don’t think I’m going to talk about that anymore.”

It seemed ‘tragically funny’ then, but it doesn’t now as I sit here writing this review. It fills me with a deep, foreboding, unforgiving sort of sadness, that I can actually feel physically as well as psychologically. It feels almost like a part of me – a physical part, no less – is being surgically removed without an anaesthetic. A huge gap or a hole somewhere in my stomach, just clawed out carelessly with a rusty scalpel. It hurts. It hurts. So very, very much.

I have so much I want – need – to address, and nobody seems to care. This leads me to believe that I have always been correct in my resolute belief that I deserved everything negative that has happened to me in my life, including though not limited to the child abuse and my father’s point-blank rejection of me. This proves it, surely. Nobody wants to help me, or pay attention to me – they just want to reject me all over again, so everything that has gone before must have been deserved.

But enough childish, whinging navel-gazing. The whole ‘I won’t discuss the sex abuse with you’ led to the typical bullshit discussion about the end of therapy, the one I am perpetually desperate to avoid. I can’t address it without fighting tears, and I don’t want to give C the satisfaction of seeing me cry over it.

Instead, I heard myself telling him how annoyed I had been when he last week accused me of saying (the week before that) that the process coming to an end was ‘tragic’. I actually went on a massive rant about this, although I did try to do so whilst not attacking him directly. In retrospect, ranting about this was completely bloody stupid as my fury was ignited over one tiny word.

“Tragic,” I declared, perhaps a little pompously, “denotes something big. The Cumbrian shootings were tragic. The 2004 tsunami was tragic. The end of a relationship between two people – out of over six billion people on this planet – is not tragic.”

“I looked in my notes after you left last week,” he replied. “They said you said it was ‘sad’.”

“Sad! Yes, I said it was ‘sad’ alright. I did not say that it was ‘tragic’. Do admit that I did not say it was ‘tragic’?”

“I suppose so..,” he replied, apparently rather bewildered at my passion over this almost meaningless semantic issue. “You seem to have an air of triumphalism in that, though, and I’m wondering why it’s such a big deal to you?”

Triumphalism. I had accused him of the same here in my write-up of last week’s session, so rather than help him explore his question, I told him so.

Why did I say that, readers? Why?! I accepted myself that I was probably over-reacting to the supposedly ‘triumphant’ comment, so why did I have to insult him by telling him of my paranoid thinking?

He looked quite dutifully stunned, and then I think I stated on the ‘mechanistic’ comment he had made.

“I’m grateful to you for saying that,” I started, smiling, “because it led to one of the greatest compliments I’ve yet received about my blog; someone [Nick, referenced above] said that that proved you’d not seen my blog, because apparently no one could say that about my writing.” Carried away by this train of thought, I also started wittering on about Seaneen’s comment, and several others I have received from a surprising number of you lovely people.

C sat there looking at me in utter bafflement. I could almost see the cogs of what the fuck? turning inside his mind.

Eventually he stopped my narcissistic rambling. “So, you’ve been hugely complimented about your blog,” he iterated. “You’ve met nice people through it. Unlike this big, bad, nasty therapist…”

To be honest I’m not sure I realised just how vituperative I had been at that stage. To his continued surprise, I told him that I had “not been having a go at [him].”

I watched his face carefully. He looked…I dunno, ‘wounded’? ‘Torn up’?…and I suddenly felt guilt and self-disgust surge through my veins.

“You’re insulted now,” I murmured, lowering my eyes regretfully. “That really wasn’t my intention.” And it hadn’t been. I still don’t know why The Bitch came out to play with such intensity.

He didn’t respond to that specific comment, but instead said that he felt two things were underlining this negative form of engagement with him. Firstly, it was indubitable that I had a lot of pent-up anger – whether or not it was directed specifically at him, it was coming out aimed at him (all well and good from the analytical point of view, of course), and that it was in fact probably suitable and right that I was bringing it with me and flinging it into the poor sod’s face. Secondly, he opined, I was going on an all-out crusade to avoid talking about my heartbreak (not his word) as regards the cessation of our relationship.

All of this was fair, and my silent response was intended and, I think, taken as confirmation of it. I looked down at the floor. Shadows created by the window-blinds breaking the sunlight danced insouciantly on the carpet. For a few minutes, this strange waltz captured my attention completely.

“Where has your mind wondered to?” C’s voice finally asked, breaking into my distracted consciousness.

I ‘came to’, and told him about the dancing shadow-shapes. He raised an eyebrow curiously but said nothing.

Another silence briefly ensued, which I eventually broke by blurting out, “I want to see the notes you hold on me. Can you just give me them, or do I have to apply in writing?”

He hadn’t been expecting this, and was visibly surprised by the revelation. He admitted that he didn’t know the procedure, but said that he would consult the Head of Department and advise me accordingly at our next meeting.

Inevitably, of course, he wanted to know why I want my notes. Was it simple curiosity?

I said that it was, and advised that I would not just be asking for his notes, but also NewVCB’s and my GP’s.

“I think I’ll request my GP’s since I was about 12,” I mused thoughtfully. “You know, just before I became properly ill.”

Then I chuckled slightly, and added, “yes, 14 years of notes. That’ll really piss them off!”

The utterance of this comment was a serious error on my part. I should have known that C would jump on it and wank on and on and on about it – which of course is exactly what he did. He became convinced that I was only requesting my notes to annoy the various medical professionals with whom I am involved.

This is not true. Is there a certain element of caustic satisfaction from the amount of work that inevitably goes into the preparation of such things? Inevitably there is, yes. But it’s both incidental and innocent; I take such sadistic pleasure out of any such situation, and it has nothing to do with winding the Trust and its employees up. For example, when W – who lives in England – got married, I went to great pains to wrap his (fragile) wedding present to unbreakable standards in preparation for postage. Although it took me about two hours to do this, I took pleasure from the fact that I knew it would take him (or his then-fiancee) similarly long to unwrap it. I told him so, and he found this amusing. It’s just a silly character trait, and I wish C wouldn’t overreact like this.

I became sick of his whinging about this, so said, “look. I know you’re trained to read a lot into every single little thing I bring into this room – I get that, I do. But I swear to you; my primary motivation is not to piss the health service off. I just want to know what my notes say. OK?”

I’m not sure if he believed me, but either way he conveyed his acquiescence through a nod and added, again, that he would look into the procedural issues of the matter for me.

Another brief silence came and went. I don’t recall whether or not he instigated the conversation or if it was me, but in any event, an in-depth discussion developed about my intention to seek out alternative therapy when my time with him comes to an end.

I had been with Lovely GP the day before, hoping that he would act as an advocate against the Trust’s intentions to end my therapy as he had said to my mother he would. I told him, in about as un-detailed terms as you can possibly get, about the abuse and how I felt that therapy had re-traumatised me vis a vis same. After asking if C had the expertise to help ease my traumatised mind – and my affirmation that he had – LGP went on anyway to suggest I saw the Nexus Institute. He made no further reference to ‘making a phonecall’ to make sure the therapy continued, and as such the appointment was only of any use in that he gave me some IBS medication to try.

Anyhow, I told C about LGP’s suggestion, but then sighed. “I fully respect what they do,” I told him, “but regardless of that I have, by association, a long-held negative view of them, even though it isn’t their fault.”

I explained how, when I had seen a therapy assessment woman (at the same hospital in which I see C and NewVCB) when I was about 17 or 18, I had been treated with utter disdain – “nay,” I corrected myself, “contempt” – apparently having been considered as an angsty teenager with no legitimate mental health concerns.

“I made the most oblique of references to having some experience of sexual abuse,” I went on, “and she immediately threw Nexus’ number in my face and all but demanded I get out of her office and stop wasting her time.”

He thinks that the following us my belief: if I end up going to see them, I am accepting and agreeing with her view of me as a time-waster. This hypothesis most likely true. I kept apologising to no one in particular for forming such an unreasonable view of Nexus, but every time I hear of them I remember that woman’s palpable antipathy towards me. I didn’t deserve that.

C proceeded to make some comment about how I’m perpetually derisive of myself. “You often sit over there and say that your wasting my time, or that you should just ‘pull yourself together’ and whatnot. You feel that you were treated badly by that woman, but yet you say these same things about yourself.”

Hmm. I bollocked around this for a bit, claiming that most of my ‘time-wasting’ self-castigations related to times when I sat in C’s presence without saying anything, and this is true. However, there have certainly been plenty of self-directed rants on how my problems are infinitesimal compared to those of some others. I think I finally rationalised my position to him by stating that, whilst in the grand scheme of things my psychological issues don’t really matter, that they were still nonetheless very real to me. “In the midst of my self-hatred, I just lose sight of that sometimes,” I admitted.

We continued talking about future therapy, and I asked him if he’d have any recommendations for private therapists. He responded in the affirmative, stating that they would, however, be primarily be from the analytic school.

“Good,” I responded. “That’s what I’m looking for.”

During the ensuing conversation, it emerged that he was familiar with a group of psychoanalysts that I have also come across. He mentioned one in particular with whom I am familiar, but asked me to bring in my overall short-list to see if he recognised the names.

“Bear in mind,” C cautioned, “that these people are more likely to lean towards traditional analysis.”

“What, like I lie on the couch and babble endlessly, and they never open their mouths?” I checked.

“Hmm…well, any therapist you meet will try his or her best to tailor the therapy towards what’s best for you as an individual, so not necessarily – but still, I reckon you can expect them to be less interactive than you’re used to here. What exactly are you looking for?” he queried.

A curious question coming from someone with a doctorate in psychology to a person with a Wikipedia knowledge of the subject, but then he knows that I am very well informed.

“Analysis-ish,” I replied. “I like your integrative approach. Psychodynamic, but sufficiently bending the rules of that persuasion so as things suit me. I like that you actually respond. I don’t think I’d be completely happy with someone who never said anything, but notwithstanding that I really have much more faith in the more traditional therapeutic approaches. I don’t think that CBT or DBT or things like them are remotely helpful practices, except possibly in the hands of exceptionally skilled practitioners.”

“I think that issue is key,” C stated. “As you’re probably well aware, research consistently shows that, generally, one of the main factors in successful psychotherapy is the relationship between therapist and patient, rather than the type of therapy specifically.”

I did indeed know this, and it has always been one of the key problems in the Trust ending my therapy with C. After all these years – after all these horrible, painful years – I have finally found a psychotherapist with whom I have a proper, workable, trusting and intimate relationship. He is just about the best person I could have asked for. Through our connection – for we do have a connection – good work was being done, and could have continued to be done, had I not had this constant menace of the curtain-down of things hanging over me. Yet such an encouraging prospect is being cruelly and unfairly being stolen. All because some fat, pen-pushing bastard sitting in some overblown office somewhere thinks that C should be driven by fucking time-directed targets and not real, life-changing, meaningful results demonstrating a significant improvement in a patient’s health or well-being. Fuck the health service! What is the point of it being a ‘health service’ when it prioritises statistics over its patients?

I think C saw an opportunity here, perhaps noticing some vulnerability in my stature or body language. He (quite gently, to be fair) brought back up the issue of me ‘fighting’ my feelings of sadness/grief/abandonment/rejection/etc.

Yet again I felt tears prick my eyes, and a lump form in my throat. Why does he want to put me through such pain? Does his ego really need stroking that much? (For what it’s worth, I suppose I do see, objectively speaking, what he’s trying to achieve, and no – it’s not really about his ego. But I can’t bear it, however much I intellectualise it now).

I sensed that the session was nearing its end, so decided I could get away with answering this rather than redirecting it. He wouldn’t have enough time to probe me further.

“Yes, OK, I admit it – I admit it freely – of course it makes me feel sad. How could it not? I don’t like it and I don’t want it. I don’t want it to end, not at this juncture. Yes, I’m sad and yes, it hurts. But I’ve sat here and insulted you in copious measure this morning so I don’t suppose that sense of regret is always entirely evident, is it?”

Of course, armchair-psychologist-Me realises that sitting there insulting him in copious measure that morning made it all the more evident, but I wasn’t feeling at my most intellectual at the time.

“I don’t feel insulted,” he reassured. “Things were rather adversarial for the first 30 or 40 minutes, I think, but no – I don’t feel insulted.”

“‘Adversarial’,” I repeated wistfully. “[submissively] I’m sorry, C. I was in a bad mood when I came in here. Someone parked in my parking space.” I threw him a weak smile at that, which thankfully he returned.

One thing I deliberately kept from him during these whole shenanigans was the fact that I had finally posted the most recent letter to Mr Director-Person the day before (it didn’t go exactly as detailed in the relevant post, but it was close enough). To recap briefly, said letter specifically requests (for the first time) that my treatment with C continue beyond the current allocated time, citing issues of re-traumatisation and the fact that a CPN or social worker – however good they may generally be – are under-qualified to deal with something quite so complex.

I don’t know why I didn’t tell C. Probably because I know Mr Director-Person is going to blab all anyway, and they can laugh together at my pathetic, desperate begging. Still, when I decided to respond to Mr Director-Person’s first stupid and borderline-offensive letter, I vowed to myself that I would see this fight through to the bitter end. And one way or another, we’re approaching that point now.

I just wish part of me didn’t seem so hell-bent on offending C before we get there. He may claim he wasn’t insulted – but I’m not stupid; I could see that he was effected by my words, and in fact I think he was hurt. At the end of the day, I actually think he’s rather fond of me (as I am of him), and listening to a constant barrage of criticism from someone you hate is hard enough, nevermind when it’s from someone you don’t mind. It’s part of his job, I know, but I feel hideously guilty anyway, and have resolved to try and be nice to him this week.

Maybe I’ll even allow him to see some real vulnerability.

Anyway, I’m going to put a few of them up on this post for no other reason than I can.  Beware of unlikely, but possible, triggers.

This…ahem…”gem” was one I’ve just drawn on the Facebook Graffiti application.  Don’t worry, I’m not about to off myself.  It’s just a silly doodle depicting a set of thoughts that never stray too far from my mind.

(If you don’t have Flash enabled, here is a .jpg of the above).

This shite was some scribbling I did in relation to the internal conflicts I feel regarding psychotherapeutic transference:

The blackness of abject depression:

This is another scribble regarding therapy. Not so much about attachment and transference in this case, though I suppose such difficulties feature, but more about the depths of despair and nefariousness that the process brings up:

I’m not sure that the physics of this one are remotely on the acceptable side of accuracy, but the symbolism at least should be quite obvious (assuming you can make out what it is, like…):

Finally for now, a particularly un-artistic, talentless piece, but something that represents strongly how I feel about therapy and recovery:

I don’t know why I’ve really done any of these things, nor why I’ve shared them, but there you go. Things that are hard to describe in prose, despite my verbosity, seem to find their own way into the Paint programme, even if the artistry involved is dreadful

Anyway, after the lively discussion in the comments section of the ‘To Quit or Not to Quit’ post, I had determined that I would attempt to be honest with C about what I had been thinking and about the disillusionment I was feeling with the process. To my own considerable surprise, I did all this and more. It was a productive session, if rather – what’s the word? Saddening? Full of regret for what will be lost? Yes. It was productive, if rather [insert mournful word of your choice here].

When I rather arrogantly arrived in the waiting room, which I have come to regard as my own exclusive, personal space, I was horrified to see another woman sitting there. There is never anyone there. A curiosity of the building – indeed, this specific corridor – is that it houses both Psychology and Audiology, so occasionally one will see an elderly person there to have his or her hearing tested sitting on the other side of the corridor, in the ‘other’ waiting room, which is just an extension of the Psychology one really. But no one except me is ever in the one quite subtly, but paradoxically ostentatiously (due to its stigmatic nature), marked ‘Psychological Therapies’.

Another point of note is that the corridor is almost always deathly silent, save for the creaking of the door on the rare occasion that it is opened. I’ve gotten used to it now, but for a number of weeks I found it strangely ethereal and disconcerting – the opposite, surely, of the kind of place in which people with mental health problems should find myself. The phrase “as quiet as the grave” often comes to mind (perfect for suicidal types). On the other hand, busy, noisy waiting rooms, such as NewVCB’s (which was also C’s way back at the start of our relationship) freak me out too.

Anyway, it was probably evident to the woman that I was slightly freaked out by her presence, but we politely acknowledged each other then mutually pretended to think about something other than the fact that we were sitting there together. When the bloody door started creaking, the woman passed remark on this irritating feature. This led to a desultory conversation deriding the waiting room, but it eventually developed into a discussion that tangentially referenced why we were both there. It transpired that the woman was there for the first time. By this point, I had convinced myself that I’d got my dates/days/times/life wrong, and that this person was one of C’s other non-existent patients, but when I asked her who she was seeing, it was indeed someone else.

Which led me to another silly internal dilemma. I have never seen anyone from Psychology apart from C and his secretary. The person who has the opposite office from C is some audiology person. It’s like C is the entire department. Or maybe he and his department exist in some alternative plane of dimension, who knows – the former creepiness of the waiting room might lend itself to that fantastical theory. Maybe the waiting room is purgatory and C is its gate-keeper.

OK, I’m babbling and infinitely regressing – the point was, it was bizarre to learn that there really are others working there, including (as in this case) other doctors of clinical psychology. I knew it rationally, of course, but when there is no physical evidence available to you for something, well – the mind is a funny thing. Or at least it is when you are a nutjob.

I tried to reassure the woman, but possibly the admission that I was still in attendance after an entire year merely served to intimidate her. Either way, I never got to see her fabled psychologist, because C arrived to escort me to my weekly doom before him/her/it.

Point of note: my formerly dark hair (the photo on the right is…er…not accurate. It is me, but it doesn’t really represent me. Which is exactly why it’s there) is now bright pink. I bleached it to fuck then slapped some purple muck-rubbish over it on the Tuesday of last week, and even though I failed to obtain the intended purple result, the resulting pink was drastic and eminently satisfactory.

So out came C, expecting to be greeted by a dull-looking fat woman with slightly-off-red-brunette-ish-thing coloured hair, to instead be confronted by a dull looking fat woman with flourescent pink hair. He was visibly taken aback. He started. He stared. Very good. Very good indeed

I wished the other woman luck and followed C to the office. I always hate walking past the secretary’s room. She knows who I am and why I’m there and for some hateful reason, that makes me feel mortified and shamed. The thing is, in general, I do not feel shame for my mental illnesses. Why should I? They are what they are, and they are a part of me. For the most part I am open and easy going about disclosure, sometimes even actual discussion, of same. So why the secretary’s probably-uninterested knowledge in me freaks me out is beyond me.

Well over 900 words and the session hasn’t even begun. That is surely a record even for me.

So. I went in and sat down; he joined me and said, “you’ve dyed your hair.”

Readers, why – why – do people make such inane, asinine statements? Why?! I know that I have dyed my hair, C – I dyed it (or in other cases, I allowed someone else to do so). It wasn’t done when I was dissociated to fuck or anything – and even if it had been, might I not have noticed the change by now? I mean, I’m not at all criticising him for commenting on the change – it was all but unavoidable – but the pointlessness of the actual statement he did offer both irritated and amused me.

“Um…yes, I have…” I said slowly, as if speaking to a child, making a hand gesture intended to convey a WTF? sort of message

“It looks well,” he said, nodding slightly as if self-referentially agreeing.

“Thank you,” I responded.

Two weeks hitherto I would have dissected that small three-word statement of his to death with something along the lines of:

OMFG did he just compliment me? Oh wow! Does that mean he likes me? Does he care about me? Does he genuinely think I look OK? Or is it some sort of psychotherapeutic trick? But hang on, is he even allowed to say that? Isn’t that treading into countertransferential territory that he should be having out with his supervisor? Isn’t that dangerous…? Does he…will he…what if..?

Blah blah blah

Yadda yadda yadda

La la la

Etc etc etc ad infinitum

The fact that I have written that at all, of course, suggests that I am dissecting the living fuck out of what he said, but at the time of his comment, I just nonchalantly accepted the remark as I would nonchalantly accept similar from anyone. That is not my default position around C at all, as you will probably be well aware.

Anyway, we discussed a few boring housekeeping issues for a few minutes, culminating in my telling him that I had an appointment with NewVCB scheduled for Wednesday 2 June. For some reason, this prompted him to ask about the status of my ongoing war with Mr Director-Person.

I advised C that I was finding each response from Mr D-P to be increasingly pathetically amusing. I ranted a bit about how Mr D-P clearly didn’t know the answer to some of my questions, and about how if I were in his position and receiving his salary that I “would damn well know how to do my job.”

(Interesting aside – Detective Inspector Google advises me that Mr D-P does not have a background in mental health at all. He comes from fucking management! Well chosen, Trust…).

Anyhow, given Mr D-P’s closing statement in his latest letter about the assignment of a CPN or SW instead of C to my case, I told C that I thought this was a load of wank because, apart occasionally from shite therapies that don’t work, such members of the CMHT don’t seem – to me – to actually do an awful lot. I know some of you disagree with that – it’s just my observations at this stage really.

He denied that there was a major likelihood of any of them bollocking on about CBT and other such nonsense, but when asked what they would actually do instead, he said something like, “well, you see them at the CMHT, sometimes in your own home, and they support you.”

I laughed in his face. He’d been expecting such a reaction, to be fair – it seems he’s not entirely sure what the rest of the CMHT do either. I suppose I can understand that – back when I was still at work, I didn’t know what some staff in other departments did either. At any rate, I don’t remember the full details of the conversation, but I recollect that I agreed to meet the designated person a few times to see if there could be any value in such liasion. Then something struck me.

“Are they all women?” I asked.

“Well…about 90% are, yeah.”

“Oh no no no, that won’t work at all. I don’t get on well with women at all.” Pause. “At least not here, not in the real world. [Philosophically] If this is even the real world…”

It’s not just that I don’t get on with other women, aside from exchanging the time of day with them or whatever. I’m actually moderately afraid of them. I’m wildly different from any stereotype of a woman, but then so are plenty of people of this gender, so what makes me so bloody special? This is something I will have to think about, but not now, because in whatever way C responded, we didn’t dwell on my woman-fear. What is especially weird about this is that the majority of my online friends are women, including two (K and Annie) that I’ve met. I don’t fear or not get on with any of these ladies – very much the opposite. Well. Who said I was anything other than a walking contradiction of abject strangeness?

During the anti-SW/CPN thread of conversation, I had thrown in a “that’s something else about which I must inform you,” in reference to my ending therapy proposition. He picked up on that, and asked me what the ‘something else’ was.

I was completely honest for once and just told him that I had been seriously considering coming in there that morning, thanking him for all he’d done, and then shaking his hand and leaving. Permanently.

The instantaneous surprise that suddenly permeated the room was palpable. His eyes widened, his brows furled. Again, he actually physically started. In fact, it was more than that – in an apparently instinctive move, he almost defensively sat back, as if wishing to create a distance between us. The expression on his face was not one I’d seen before – the closest it had come to that previously was only about 15 minutes ago, when he’d been taken aback by my dramatic change in appearance. ‘Taken aback’ is too small a phrase for his behaviour this second time round, despite the post title. He was stunned. Absolutely astonished.

This gave me no pleasure, despite my sometime sense of misanthropic sadism. I like C. I feel like I know him, even though I don’t. I don’t want to hurt him or inadvertently question his practice or professionalism, which it felt like I was doing. I felt like an evil bitch that had just stabbed her best mate quite royally and deeply in the back.

I tried to make him feel better by telling him that I had changed my mind, but when he asked why I had done so, I was – once again – entirely honest, and admitted that it was for logistical rather than therapeutic reasons.

“I am certain that as things stand that I will have to be re-referred for therapy in the future,” I told him. “I don’t want the Trust to have ammunition against me – ‘oh, that one’s just a borderline, ignore her – she walked out last time she was in the system, so she can’t have any more treatment”. I know that’s exactly what would happen and I can’t take that chance. So you’re stuck with me for now.”

“We’re going to have to have a conversation on why you were even considering this,” he responded, not unreasonably. “But in terms of actual practical matters, I don’t think that that would be the case at all. You attend appointments as scheduled and are always on time. You can work psychologically and you commit to that work. In my view, you’d be perfectly eligible to have any future referral considered as normal, regardless of whether you previously left therapy by your own choosing.”

“For the avoidance of doubt,” I pressed, “you are telling me that leaving therapy now would not in any way impact negatively upon my position within the CMHT and mental health system in general in the future?”

“I really don’t think it would, no.”

“OK.”

And so began the ‘why?’ conversation. Preamble: I don’t remember all of this. It was a week ago and it was a stressful topic to cover.

My first point was that if I was going to seek private psychotherapy when things with C end – and I am – that it would just be preferable to start to interview potential analysts/therapists now, rather than dither in the pointlessness that I expected to be the remaining time with C.

Why did I suppose said time would be pointless?

I told him that I thought therapy had been generally useless of late, not through any fault of his but entirely through mine, and that ergo it was my expectation that I could expect more of the same. “I come in here every week, and I stare at you or at points in your room, and I say fuck all. We dance around important material because I am not willing or able to discuss it, and the whole thing just becomes an exercise in futility. It’s a waste of your time and mine. It’s not doing anything at the minute, except maintaining (or perhaps even worsening) my sense of re-traumatisation.”

For some reason, he raised his eyebrows and asked me if I felt re-traumatised – I would have thought the answer to that would have been quite obvious given things like this and this.

I was very frank with him and said that I believed, intellectually at least, that I was trying to protect myself from further re-traumatisation. “The most gifted therapist in the world cannot change this state of being in a couple of months,” I told him (an honestly held belief). “I believe that it can, ultimately, be changed – but not in the timeframe you and I have remaining together. So I think that, unconsciously, I’ve shut down and won’t talk about anything important, because I know that’s going to cause me much hurt, and there will in the end be no outlet for that pain.”

I hate talking about the end of therapy. I always direct the conversation away from it when it comes up, in part as it is presently the only thing that makes me cry, and I don’t want to cry. I don’t want to cry because I fucking hate expressions of emotions, but moreover, I don’t want him to know of the strength of my feeling for him. Why? Because it’s so asymmetrical, so quintessentially patient-therapist, so un-returnable, so needy and pathetic. It is A Very Bad Thing.

So for me to almost direct the conversation that way was really rather unusual. OK, so there was an inevitability about it ending up at that juncture, I suppose, but it was the fact that I actually brought it there that was odd.

C sat back in his chair and sighed deeply. Eventually, he sat forward again, and began to reward my candour with some of his own.

“I’ve been in a difficult position,” he admitted. “I’ve said to them [there's always An Enigmatic 'Them', isn't there?], ‘look, this person needs long-term psychotherapy,’ but there’s always issues of targets, or of costs, or of whatever. And we’re trained to mostly only provide short-term therapies.”

Oh. So when you said that curtailing things was your decision, and not the Trust’s, I was right in supposing that that was accurate in only the most technical of senses, was I?

Basically, yes. Apparently, “I could have kept it under the radar. They wouldn’t know how long I have been seeing you for, but I decided the end point on the grounds that I did declare how long we’d been seeing each other to them.”

Dun-dun-DUN! I feckin’ knew it. I feckin’, feckin’ knew it. I resisted the urge to smile a smug smile.

I appreciated his better-late-than-never honesty and told him so. Would it have been nice for him to have kept this apparently most sensitive material ‘under the radar’? Yes, of course it would. But even I don’t expect him to all but lie for me. If he gets in trouble, my continued psychotherapy is not exactly going to be assured.

Anyway, there developed a discussion about part of my thinking about quitting therapy being about punishing him, or finding him less competent that one should be given to expect. I vehemently denied the latter point and demanded that he disabuse himself of the idea were that his belief. As for punishing him, apparently I want him to feel the same sense of loss that I feel as regards the termination of the relationship.

Time for me to be pathetic. “No [looking meek and helpless]. I don’t…I don’t want you to feel bad.”

‘Bad’ and ‘nice’ should be fucking banned from the English language, at least if you are above the age of nine. Fuck’s sake. How child-like and grotesquely piteous can one be?

He made some gesture of acceptance, but continued by saying, “but I think you’re very often angry with me – you blame me for the end of this, you’re angry about the way I sometimes speak to you, content shared between us can infuriate you.”

I denied this once again. “You make t sound like I’m permanently angry with you, and I’m not,” I protested. “Do I get angry with you? Of course I do. That’s to be expected in any interpersonal relationships, and I know there are times when I piss you off too. But I don’t think there’s some big transferential thing here for you to hook on – it’s just normal, surely?”

He claimed that I was angry in that moment (which perhaps I was, I don’t remember) and I started ranting about being furious with the system, which I perpetually am. If he wants to examine a permanent anger, then it’s with The Enigmatic ‘Them’, not him.

I remember saying, “I just wonder how many people end up dead because of something like this. People that could have been helped, but because silly targets and other bureaucratic faff and unlucky postcodes and grubby pieces of shite like that get in the way, they end up at the mercy of their illnesses, are completely fucked and alone, and they see no way out and they top themselves. It’s tragic, C. Tragic.”

My passionate, warrior-like micro-soliloquy was laden with what he would call emotion, and I got the usual, “you look like you want to cry” crap.

This perennial phrase of C’s pisses me off. No, C, of course I do not want to cry. I hate expressing these feelings, let’s not forget. If I am looking or sounding tearful, then that is because it’s visceral and un-chosen. Automatic. Unavoidable. I do not want it! I know I’m playing a silly semantics game here, but it does piss me off.

I continued to try and fight against these Christ-forsaken tears, but I think that they probably won in the end. I didn’t end up breaking down exactly, but I did let a few of the monstrous droplets of salty water pass from my traitorous eyes to my cheeks and fingertips.

Whether it was solicited by him or not, I don’t recall, but I have some memory of, through these tears, admitting to the sense of loss – the sense of grief – that I feel about the cessation of my relationship with him. Eugh. How gruesome an admission that was, and will always be. A Very Bad Thing. A Very Bad Thing, indeed.

And then…

“We’re going to have to leave it there, Pandora.” At least he had the grace to sound apologetic.

One thing we briefly discussed in a housekeeping capacity was to continue things until – if memory serves me correctly – the start of September, rather than have a set number of weeks remaining. He is taking two weeks’ leave over the summer, and it will therefore work out at approximately the same number of sessions as he had previously offered, but I think I might be wrangling one or two extra out of it. Very-tiny-win. Maybe.

I hate these discussions. I was particularly vexed by them in and around Christmas, where it felt like it was all C wanted to talk about. That seemed endlessly circular and futile to me, as if we were avoiding the very issues for which I sought psychotherapy in the first place. And in the main that’s very much still my view. Still and withall, though, it’s hard to deny that a lot of my attempts to avoid the topic lie in the very obvious points that I simply don’t want, or feel unable, to ever be without him.

Anyway, here is the latest letter from Mr Director-Person, in response to my correspondence of 11 March.  I am very impressed with his wonderfully speedy return on this.

Dear Pandora

Re Accessing Mental Health Services

Thank you for your letter of 11 March 2010 and I apologise for the delay in replying.  As we have acknowledged previously you are correct in your interpretation of the NICE Guidelines in relation to personality disorders.  However NICE does not apply automatically in Northern Ireland.  Currently a Regional Personality Disorder Group, brought together by the Department of Health, Social Services and Public Safety is considering the Knowledge and Understanding Framework (KUF) as a way forward to developing better services in Northern Ireland.

Locally, a group run by <Mr Twathead>, Head of Mental Health Nursing in our Trust, is working on a plan to improve services for people with personality disorders.  This service will support the objectives of the Northern Ireland Strategy for Personality Disorder.  The Trust is also in the process of recruiting Personality Disorder Practitioners who will work with community teams to provide a more locally responsive service.

As a Trust we are committed [hahaha!] to user involvement in the planning, delivery and monitoring of our services so we would be grateful if you could get back to us with an expression of interest in helping us develop better services for people with personality disorders – please contact <BitchBrain>, Assistant Director Mental Health Services, <Big Bin>, <phone number blah blah>.

In relation to your own treatment and care, <C> has spoken to <NewVCB> about follow-up sessions.  It was agreed that there would be a seamless [*explodes laughing*] transition at that time [<pedantry>at what time?  What point of your letter are you referring back to?</pedantry>] to the provision of support from either a community psychiatric nurse or a social worker from the community mental health team.  The details of who this will be and the extent of the contact will be negotiated closer to the time of transfer.

Yours sincerely

Mr Asshole Director-Person Cunt.

One thing that really annoyed me that has no relation to that actual content of the letter was that he addressed me as ‘Mrs <my new surname>’, assuming that any female changing their name must be doing so owing to marriage.  My cunting bank did this as well, which send me into a spiralling fury of ranty anti-capitalist rage.  What a pile of outdated, presumptuous, misogynistic crap.

Anyhow, this is my proposed response.

Dear Mr Director-Person

Re: Accessing MH Services

Previous correspondence refers.  Thank you for your eventual response of 12 May 2010.

I note with interest your willingness to point out that NICE guidelines are not always applicable in this jurisdiction, and that a regional team is “considering” the application of the KUF.  I also have taken note of the information that a plan is being “worked on” to develop services in this Trust and that a NI Strategy for PD apparent exists.  However, you will recall that in my letter of 11 March, I specifically requested details on how the treatment of the very real challenges faced by Northern Ireland individuals with mental health difficulties (not just personality disorders) is being adequately governed and protected now.  I am disappointed to note that you have failed to provide this information.

You may be aware that <NewVCB>, whilst reluctant to continue the tradition inherent in the system of providing stigmatic diagnoses, felt that I am afflicted with a form of complex post-traumatic stress disorder.  I would refer you to Trauma and Recovery by Judith Herman and The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization by Onno van der Hart on this subject.  As I am sure you are aware, these sources (and many others) quite definitively feel that whilst psychotherapy is a vehicle to recovery, the inadequate provision of same can lead to re-traumatisation.  Given your apparent familiarity with my case, I believe that I can fairly reasonably conclude that you will be aware that I am thoroughly re-traumatised thanks to recent work with C.

To that end, I should be grateful if you could clarify the mandate of mental health services within your Trust.  Is it your actual goal to discourage healing and indeed bring about psychological damage to ill and traumatised individuals?

In particular, I must question the decision to refer me to a CPN or mental health social worker after my contact with C ceases.  I must confess to being amused at your contention that the transition from C to this person would be “seamless” – aside from the fact that it is impossible for you to predict the level of “seamlessness”, and the fact that I am well acquainted with C without any knowledge of his “successor” (and bearing in mind social anxiety is one of my many diagnoses), as yet no one has been able to tell me exactly what such individuals do other than to attempt to encourage their charges to complete day to day activities.  C-PTSD and BPD, as you know, require significant psychotherapy, not reminders to undertake simple tasks (which, I might add, are often impossible regardless of external encouragement).  Whilst there is arguably a place for such professionals as adjunctive workers involved in a person’s treatment, at present I utterly fail to see how assigning them as the primary contact can be of significant benefit, at least to someone someone such as myself.

On the other hand, I am also aware that certain individuals of these specialisms practice the supposedly panaceatic techniques of cognitive and dialectical behavioural therapy.  After my 12 years of being richocheted around your system – and of being forced into the private sector thanks to its failings – I have experience of these “therapies” and feel strongly that not only are they ineffective and patronising, they are indeed offensive.  Their practice is in keeping with the victim-blaming culture that seems inherent in psychiatry and allied professions in reference to BPD.

Whilst I accept that the above view is personal and not held by everyone, and that these techniques can have at least temporary usefulness for some sufferers of mental illness, it has been accepted by those involved in my own case that this would not be appropriate for me.  I would therefore hope and expect that it is not suggested.

I would, ergo, again enquire as to the relevance of a CPN or SW as opposed to a qualified psychotherapist as my primary case worker.

I would like to convey my sincere thanks to you for inviting me to express interest in your user involvement scheme.  I shall be writing to your AD, <BitchBrain>, with said expression forthwith, and look forward to hopefully making a worthwhile contribution to personality disorder services within our Trust.

Thank you for your time.

Regards

Pandora (Ms)

I whacked this response out on a secluded beach on the Turkish Mediterranean.  My God, what a sad, pointless life I lead!

I’m seeking advice on this one because, although I feel my letter is fairly good, it doesn’t ask many direct questions, meaning that Mr D-P can cleverly wriggle out of answers yet again.  To this end, I wonder if any of you would like to suggest amendments, additions or direct questions that I could use when writing back to him.  As with the last post, all views are most welcome.

Thanks again lovelies.  x

I am going on holiday this evening. Ergo, I will be (mostly) in absentia until at least 24 May.

Unlike the preceeding hours before the last time I went on holiday, I am not in a good mood. I am, in fact, muderously livid. C is to blame (surprise surprise), even though it’s not his fault.

So, the latest on the wanky questionnaires is that either I have DID or I’m exaggerating my dissociative symptoms. He tried to dress it up, but that’s what it comes down to whatever he says.

So typical of borderlines, yes? Neurotic, attention-seeking, self-obsessed, manipulative narcissists.

Beyond that the session was thouroughly pointless. It was just more of me slagging myself off endlessly. He didn’t even bother to defend me this time, like he has been known to do, because apparently I am trying to manipulate him into doing so or something.

Some gems:

I’m a five year old fantasist trapped in a womans’ body. A pretty smart five year old, but a five year old nonetheless.

I’m an immature, pathetic, stupid waste of space. Well…not stupid. But stupid all the same. Just not stupid-stupid. But the stupid kind of stupid. Except not actually stupid, just…stupid.

[On seeing Trust headed paper being used, as intended, for rough notes] You do realise that I’m internally raging, don’t you? That exemplifies your pathetic public sector inefficiency. No wonder the Trust has no money. Such wastage. [Genuinely seething inside - proper, murderous anger].

I’m sure there was more but I can’t recall it all and anyway, I’ll write about this session properly when I get back from my travels.

My mother had called me during the session so I called her back to see what she wanted when I left. Mr Director-Person had finally responded.

My analysis of the NICE guidelines etc is apparently quite correct, but – it now emerges – the NICE guidelines don’t automatically apply in Northern Ireland. Well, that’s brilliant, isn’t it? Great job. How eminently rea-fucking-surring to know that we are safeguarded in this country as well as the rest of the UK. OUT-FUCKING-STANDING.

Blah blah blah…we are developing a PD service…we welcome “service user” (I fucking hate that term) involvement…please register your interest with this tosser at this hospital…

Readers, I will. In fact, if they do indeed accept me on board, I will turn it into a personal crusade. I will twat the system from inside the bastarding system.

Blah de blah…[C] and [NewVCB] have agreed to put you under the care of either a CPN or a mental health social worker…details to be worked out closer to the time…

Go and fuck yourselves. What is some CPN going to fucking do? Remind me it might be a good idea if I fucking washed occasionally? Attempt to patronise me with CBfuckingT?! No. No. I need psychotherapy. If I am not to receive psychotherapy, then you can all just go and die, you supercilious, self-interested bunch of despicable cunts from hell.

So that, dearest readers, is the latest. I am sure I’ll calm down a bit – but probably only when we finally reach our apartments tonight, as hanging around airports is supremely frustrating, and flying is supremely boring.

I have got a data abroad package on my phone so will probably be about occasionally on Twitter – I might even post here if you’re (un)lucky. Otherwise, thank you all for reading and thank you for your unwavering support and friendship.

Much love

Pandora x

“Well and contented” would be a laughably optimistic description of my current physical and mental status, at least in some ways – but we’ll start with the good things, shall we?  I’ve had the pleasure these last few days of connecting and re-connecting with friends whilst I was on a short break.

TEH GOOD STUFFZ

I have already mentioned K on this blog; it was with great pleasure that A and I saw her (again, in my case) on Monday night, along with her boyfriend N.  We spent several hours discussing BPD, cats, our obsessive attachments to our respective therapists, K and N’s work (both together and independent of one another), the sheer inadequacy of mental health services on the NHS, politics, how K’s and my BPD impacts on N and A, and general life.

The day prior to that A and I met Annie for the first time.  I would have called her ‘A’, but that would seriously confuse issues!  Annie and I have known each other online for quite a few months now so it was great to finally meet her.  We spent a great afternoon chatting about her kids, her pets, our pets, mentalism (Annie has bipolar disorder; her aunt to whom she is close also does, as well as possible BPD), Doctor Who (does anyone else think Matt Smith is fucking awesome?  Pertwee and Baker are still my favourites, but Smith is already vying for third place with McCoy) and Postman Pat (don’t ask).

I consider myself a highly fortunate person to have met such wonderful folks online such as these two.  And I’m meeting CVM next month too.  And then there’s all the lovelies I haven’t met, primarily but not exclusively from Twitter.  <3 you all.

TEH SHITE STUFFZ

Following on from that point, last week a situation emerged wherein the support of such people as aforementioned was so profoundly welcomed.  As soon as I made others aware of the problem emerging, I received lots of supportive comments, tweets and emails, for which I am eternally grateful.

It made one thing brutally clear to me: this blog, and the people I’ve met through it in one way or another, mean more to me than nearly all of my entire family.  Family-orientated individuals may find that an outrageous and utterly callous statement, but I don’t care.  It’s true.

What happened was entirely my own fault.  I didn’t do anything consciously if that in any way mitigates my actions, but I was remiss – even reckless – in my accidental use of this online persona, one that is meant to be almost entirely disconnected from my offline one.

I had a couple of pictures on my iPhone that I wanted to share with my mother, so I simply emailed them to her using the built-in mechanism on the phone.  For those of you unfamiliar with the device, it lets you send photographs without the need to actually open your email client.  Unbeknownst to me, though, when you do this, it defaults to a particular email address of which I have three.

If you don’t know already, you can guess the rest.  When I checked my emails the next day I was horrified beyond description to see a response from my mother to the aforementioned email in my serialinsomniac.com accoount.  F.U.C.K.

A and I were due to head away for a few days that day, but I decided to call with my mother under the pretence that I needed to borrow something.  The plan was to get A to distract her whilst I went in to the PC and permanently deleted the email from her computer.  She’s not especially technical, so we reckoned we could just blame its absence (if she even queried it) on the fact that Microsoft is a pile of steaming horse manure (I’m a Linux girl ).

It was straightforward to accomplish this mission, and for a few minutes A and I breathed a mutual sigh of relief.  As if on cue, though, my mother then declared that she had forwarded the email on – to two of my cousins in the McFaul (McF) dynasty.

FF UU CC KK ad infinitum

This rendered the matter completely out of my hands.  Fuck fuck fuck.  I wasn’t so worried about one of the recipients – her being an internet novice even more than my mother – but the second person would have the potential lack of stupidity to Google the term ‘serial insomniac’ had she noticed it or cared about its relation to me.

So, my first instinct was to password the entire blog, as you can do with blogs hosted at wordpress.com (as I used to be).  However, since I now run the blog myself, this option does not exist; I assume that WP’s supposition is that you would not pay for a domain and hosting if you didn’t want people to read that which was on the domain and hosting.  Instead I looked for a plug-in (a third party application that adds further functionality to WP) that would permit passwording of the entire site, found one, and installed it straightaway.  A and I left to head to our destination, feeling that the problem was temporarily solved; all my regular readers could visit essentially as normal, random voyeurs who might be my family could not.

When I arrived I was distraught to note that the blog was totally inaccessible; the plug-in had completely fucked it up.  It wouldn’t allow you to get to a page where you could enter the password and I couldn’t even get into the administrative pages, so I couldn’t delete the damn thing.  It was stuck on an endless loop of blank-screeniness.  My original concern of having been ‘found’ was replaced with a new one – that of having lost everything.

The first few hours of our break were therefore devoted to looking for a wireless network so as A could download an iPhone FTP program and access the site directly, independently of WordPress.  I was crawling up the walls with crazy.  I don’t know how many words I’ve written during my time on this blog, but I have something like 125 posts – of up to 8,000 words each (as seen here) – chronicling, so far, one of the most difficult years of my life.  Not to mention over a thousand comments of wonderful feedback and support.

In those few hours I made the realisation that I cared more about the preservation of the blog than I did about the potential discovery of it by my family.  If all hell broke loose – well, it just did.  I didn’t (and don’t) want it to, but that is actually preferable to being silenced or hidden.

The long and the short of the story is that Lovely A rescued the blog, and I password-protected certain key posts rather than the entire thing (I’ve since removed all passwording except the original four and the family tree).  Over the next few days, I monitored closely search terms that were getting here (after initially revoking search engine access, I later asked myself why the bloody hell I should do so.  Those few days have adversely affected my stats, but onwards and upwards, eh?) and what posts were being read, to see if there were any suspect or anomalous referrals.

TEH OUTCOMEZ

In my view, some of the search terms leading here and some of the reading patterns were kind of unusual.  Disproportionate numbers seemed to be searching for “serialinsomniac.com” or “serialinsomniac”, rather than “serial insomniac” – in others words, it looked to me like someone was Googling the actual URL rather than the blog name (as if having seen the URL in an email).  This isn’t unknown in the past, but it’s not been terribly common.  In all probability, I’m being over-sensitive, but one never knows.

I’ve started making an effort to change some names.  You can see some of the key ones on this page, and others are already changed in the archives which you can look at it if you need context.  I’m abandoning many of the old initials completely so if you need clarification on who a new name refers to, you’ll need to contact me.  I’ll try to add to the ‘Emsemble’ or family tree page with names that weren’t previously included as soon as I can.

I’m also monitoring the geographical location of people finding their way here.  I’d like to assure you that if you are outside a very tiny geographical triangle of Northern Ireland that I will pay no attention whatsoever to where you are, what your IP is, etc – so normal, genuine readers should not feel discouraged from reading.  Please, please don’t stop reading and commenting!

TEH AFTERMATHZ

To the Family:  If you’re from the McFaul family (or any other part of it for that matter), with the IP tracking site I will see you and I will block your IP addresses, rendering you unable to access this website.  I don’t care if I have to pay a fortune to maintain that; you have no place here.

If you are concerned that you recognise yourself, then grow the fuck up.  Everything has been, and will continue to be, anonymised.  The lengths that I have gone to to protect you should be appreciated, not condemned.  And if you don’t want to become aware of matters about which I write then don’t fucking read what I write.  Think I’m lying about Paedo?  I don’t give a shit; what I’ve had to go through thouroughly and utterly trumps any disgust you may feel at what I’ve revealed.  Think I’m being unreasonable about how manipulate and oppressive Paedo’s missus is?  Then you’re deluding yourselves.

In short, I won’t go into a closest for you people, and I don’t care if you don’t like it.  Try and read if you want to, but I will stop you; I’m not going to be in the position where I have to try and pay lip service to you here, on my own fucking diary, as well as in ‘real life’.  This journal is my pride and joy, my own little corner to bitch and whine with impunity about my illnesses, to rant and cry about what all of my family have done to me at various points in my life, to explore the weird dynamics of therapy.  And everything else in between.  And it’s staying as it is.

To everyone else:  So I’ve joined the ranks of mentalist bloggers that have been found by real life.  I know I’m in a long-line of such people…how did you handle it?

There’s a good bit more to report than that which has been detailed, mainly in reference to the aftermath of recent discussions with C, but I’ll leave that for another post.

I’ve been absolutely shite at replying to comments, emails and even tweets recently.  I am genuinely sorry for this, and hope you don’t think it means I value each and every one of you less, because I love you people.  I do.  I know I haven’t met most of you, and I don’t even know most of your ‘real’ identities – but it doesn’t matter.  Your feedback, empathy, advice and wonderful support has meant so much to me over the last 11 and a half months.  Here’s to the next 11 and a half years.

—

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!

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.

Alas.  These evil bastarding illnesses don’t disappear because one has a few less shit days.  I had a very productive session with C on Thursday (blog to follow, mais oui), but it left me thinking about some shit that I don’t really want to think about, mainly about the stupid fucking sex abuse (like that’s the only difficulty I’ve ever faced in my life.  Why the hell am I fixating on it?).  Moreover, my mother – I am not unconvinced deliberately – made a particularly insulting comment vis a vis same a mere few hours later (details in the forthcoming C post).  Consequently, this stuff has been swirling around in my psyche for a few days, though I thought I was handling it quite well, as my mood remained on the less-shit-than-completely-and-utterly-shit level.

Or, more accurately, it did ostensibly.  However, beneath the surface the madness bubbles smugly in its little cauldron of neurons and silly levels of dopamine and eventually, when you least expect it, it attacks.

I made the stupid decision to go on a drinking bender yesterday.  Well, I say ‘bender’, but by comparison to some piss-ups I’ve frequented, it was actually relatively subdued.  Nevertheless, one should not be consuming alcohol when taking anti-psychotics.  I’ve always ignored rules on alcohol and medication, and have never encountered any noticeable side-effects, but then all of these tablets are different in how they interact with one’s personal physiology.

Anyway, all was going well up until the point at which A and I met G, our friend about whom I blogged on the DBT philosophy post.  Not that there’s anything wrong with G; he doesn’t act as some sort of intellectual trigger or something.  No, the reason it went wrong at this point was that it is the last point of which I have any recollection.

I woke up this morning in my own bed, fully clothed.  I must confess that I wondered at the time if I’d done anything mad…but I didn’t think it would be quite as bad as it turned out to be.

My party piece had apparently been to pass flat out in the disabled toilet.  Classy, SI.  A had begun to think I’d slit my wrists in there, and ergo G asked the barwoman if she would check the toilets to see if I remained in this plane of existence.  Unfortunately I did, but was lying there, flat-out unconscious.

I have to admit that in retrospect, this seems amusing – albeit in a twisted sort of way.  Stupid cow had too much to drink and fell asleep in the pisser, chortle chortle!  But it’s really not so funny when I actually think about it.  I have never passed out owing to alcohol before – and as I say, some days gone by make yesterday look fairly tame.  What’s more, I’ve never experienced such long-term memory loss like some people do as the result of pissing it up.  A few details get lost amongst all the murdered brain cells, certainly, but not hours of material.  It’s like an entire chapter has been ripped from a book, and the only thing that I really feel I can compare it to is the amnesia from a severe dissociative episode, like some of the fugues that have been my absolute joy to behold.

The story continues.  A brought me home, not unreasonably.  And there I really, really lost it.  He doesn’t recall most of the specifics exactly, but whatever the case I lodged a barrage of completely ridiculous and unfair allegations and insults at him.  Subsequent to which I levied them at myself – I’m a fetid, disgusting slutty whore, apparently.  Well, at least I got something right during this epic rant of stupidity and vicious pointlessness.

I am reminded somewhat of the behaviour that gave rise to this post, though at least my mind has the common courtesy to allow me to remember what happened in that incident.  Last night’s events were not as serious as that, and as far as I know there was no overt psychosis involved, but nionetheless – the stream of abuse that came out of my grotesque little mouth is simply unacceptable.  More lines crossed.  More boundaries of common fucking decency transgressed.

My current self-view is that I am a evil, utterly vile, indescribably despicable bitch of Satan.  Not, as a committed atheist, that I believe in Satan’s existence, but you take my point.  Oh yeah, and the fetid whore thing still rings true.  A said that my apparently unwavering belief that I am a slut is something that needs to be discussed with C in therapy.  Well.  Quite.

Perhaps the most bizarre thing about all this is that despite my complete self-disgust and total horror at what I’ve done, I’m actually still in a (relatively) favourable frame of mind.  I’ve gone about punching myself as punishment, but I don’t feel that overwhelming need to self-harm that one does when the strength of one’s depression is crippling.  I’ve actually managed to have a relatively non-shite day with A despite his revelations about what a complete twat I was.

So anyhow, I apologised to him and then started deriding myself a la the last-but-one paragraph.  He accepted my apology and refuted my blather of self-disgust, though I am clueless as to how he can hold me in any positive regard whatsoever.  And then…this is the best of it…my appalling behaviour was rewarded with breakfast in fucking bed.  I am a lucky girl.

My assessment as to the causation of the blackout is that it must have been attributable mainly to the combination of alcohol and Quetiapine, though I do think I must have been unconsciously harbouring some major stress.  Certainly, the outbust thereafter would indicate that – the actual catalyst might have been booze, but the content of the rant strongly speaks to me of underlying and unprocessed psychological bullshit.

However, that simply isn’t an excuse.  A may defend me on the grounds that I’m “mental”, but I don’t think that – or anything else – is a valid defence.  Being mental does not give one carte blanche to scapegoat the most important people in one’s life for things in which they were and are absolutely uninvolved.  No, the only human characteristic that deems that permissible is one that is strongly in evidence in my personality: that of being an abject cunt.

Fuck, fuck, fuck, fuck, fuck it all,
My fucking life.
Suck, suck, suck, suck, suck it all,
My fucking dick.

Here is my apparent equivalent in prose. Hilarious.

—

Fuck my existence.

Fuck therapy.

Fuck C.

Fuck (New)VCB.

Fuck the NHS in general.

Fuck V.

Fuck Paedo.

Fuck my entire famly except my mother.

Fuck my ex.

Fuck the school bullies.

Fuck the school fucking teachers.

Fuck university.

Fuck the Troubles.

Fuck politicans.

Fuck the Social Security Agency.

Fuck the government.

Fuck religion.

Fuck secularism.

Fuck human relationships.

Fuck feeling.

Fuck heat.

Fuck cold.

Fuck the UK and Ireland.

Fuck Earth.

Fuck the solar system, galaxy, local cluster, universe and multiverse, should the latter exist.

Fuck medication.

Fuck getting washed and dressed.

Fuck getting out of bed.

Fuck prejudice and bigotry.

Fuck the beautiful people (forgive irony vis a vis last point).

Fuck this blog.

Fuck my “life”.

Fuck everything.

That is all.

I don’t want to stop writing. I really don’t. I want this blog to chronicle all my future negotiating of NHS (and possibly private) mental health services, all my thoughts, emotions, psychoses, episodes of all descriptions – the works vis a vis my mental illnesses. I want it for my own benefit, and I want it for others. I wish blogging had been in existence when I was a teenager, as I don’t think I would have felt quite so horribly alone back then had I been able to read that others were in exactly the same boat.

The problem is this. I am right in the midst of a major depression. I want to die. I have no energy, I have no focus, I hardly even have any thoughts beyond how much I don’t want to exist. I am consumed by my complete and utter misery. Typing a fucking Twitter message at 140 characters or less is a desperate effort, so you can imagine how profoundly difficult blogging is.

I am forcing myself to write this – and it is genuinely a physical effort that feels on a par with the gym on a bad day – because I know if I don’t write it, that the blog will progressively fall by the wayside, and that is the last thing I want. But I am not sure how much longer I can sustain any writing. Part of my all-consuming lethargy is probably attributable to the introduction of Quetiapine into my medication cocktail, but the cycle of depression had started before I started taking it, so it’s not entirely to blame. Ergo, in short, I’m concerned that even if the sedative effects of my new medication do pass soon, that I’ll still be finding it hard to write this blog.

I am not the first person to be afflicted by a major depressive episode that has a blog. How do the rest of you sustain your writing when your mood is at its lowest? Any advice would be appreciated.

A often tells me that I should describe how I feel whilst in the middle of an episode, so let me see how well I can do that:

• Suicidal ideation. I’ll not act on it in this state though – I simply do not have the energy to try to kill myself. Nevertheless, I’m completely pre-occupied with my death and how I can bring it about.
• Distracted, unmotivated. I can’t concentrate on anything. This post has been written in bits and pieces, has taken ages and is probably still disjointed and figuratively illegible.
• Emptiness. I don’t know how to describe this any better
• Worthless, listless. I have no function. I am pointless and (justifiably) disenfranchised and useless.
• Apathy. I don’t care about anything, and that includes feeling better. I can’t explain this; I feel so indescribably low and miserable, but I couldn’t care less about feeling less low and miserable. I just don’t care. I can only assume that that is because it seems like too much effort.
• Self-hate. Not as strong as it could be, though; I don’t have the energy to hate myself as much as I sometimes do. But I still do feel self-disgust. I feel worthless and horrid and fetid and disgusting.
• Lack of interest in anything. I don’t want to engage in anything that ordinarily gives me pleasure, including this writing. It has taken me absolutely ages to get to this point, and it is still requiring every last ounce of willpower that I have (which isn’t very much).
• Lethargy, exhaustion. I am utterly buggered. All I want to do is sleep. Despite my moniker on this blog, insomnia has been less of an issue (presumably) thanks to my new medication (I’m still waking at random times and finding it hard to get back to sleep, but that’s better than no sleep at all). I’m oversleeping at the moment, actually – maybe 10 or 12 hours on and off – but I am still absolutely shattered. All I want to do is sleep.
• Inability to concentrate. So forgive me if this is a bizarre entry.
• Psychotic. ‘They’ are hassling me. Not in the all-consuming way that they did in October and December, but they’re babbling on and on and on at the back of my head, with their usual ‘slut’, ‘whore’, ‘bitch’ mantras. I don’t have the energy to ignore or rail against them.
• Don’t want to talk to anyone. Self-explanatory.
• Sick of do-gooding. Ah yes, well-meaning interference…

This is going to make me sound like a miserable sod, perhaps with good reason, but I am so sick of peoples’ good intentions. I am not sick of good people’s support for me of course, but there are certain misguided manifestations of that that are driving me up the walls.

Telling me that I should remain in existence because I am intelligent or kind or whatever positive adjective you find appropriate does not make a blind bit of difference to how I feel. I still want to die. Wittering on about how I should have a course of CBT because getting better “can be that simple” denies the truth that CBT is a patronising load of wank, touted as a mental illness panacea by a government hell-bent on reducing costs, whatever they may say to the contrary. I still want to die. Telling me I have to “think more positively” serves frankly only to make me want to punch you in the face. I still want to die. It is not that simple.

I have a mental illness. I am not just having a bad few days; I am mentally fucking ill. Yes, I’m lucky that people care, but there are limits to that in terms of how they present their concern. Some of those that are engaging in this well-intentioned but horribly intrusive do-gooding I don’t even know well. How can they consider it appropriate to get involved in discussion of my (poor) health at all, let alone express such profound failures of understanding about the diseases with which I am afflicted?

Right now I don’t care if I get better. I just crave the comfort of unconsciousness, whether that is death or whether it is more bloody sleep. I am grateful for people’s simple understanding, and their offers to be there for me should I wish to avail of them, but their well-meaning pursuit of dialogue that goes beyond that merely serves to irritate.

I know I’m selfish and nasty and horrible for even thinking these things, and I know I should be grateful and to that end I’m sorry, but I’m so fucking miserable that I don’t care. It took me all my time to write this shit so I’m going to publish it anyway. At least it chronicles one of the bad days in an accurate, if intensely negative, fashion. Let’s see if I can manage to write up last week’s C session whilst continuing to endure this abject psychological torture. Hedge your bets now, my dears!

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FAIL

On 17 December, I wrote to two mental health advocacy groups (Mindwise and the Northern Ireland Association for Mental Health) regarding the whole ‘you can only have 24 more sessions’ bullshit with C.  Both have now responded, and both have represented something of an epic fail.

Mindwise simply told me to discuss the matter with my consultant psychiatrist, as “they would be the ones making the decision”.  Well, I will, when I see my (new!) consultant on 20 January (over a month late, might I add).  However, as regular readers will know, Psychiatry have been one of the problems I’ve been having with the NHS during this most recent breakdown (though to be fair, this was not outlined in the letter).

Talk about passing the fucking buck.  It was simply a case of pushing responsibility onto someone else, and not wanting to tackle my case themselves.  Is it because I is borderline?  Everyone hates a borderline, innit.

Should the meeting with the psychiatrist not yield results, though, I am going to write pompously back to these tossers and demand their assistance.  Either that or the media will be learning of their incompetence and unwillingness to help a mentally ill individual, which is exactly what they exist for.

I heard from NIAMH yesterday.  Apparently, their advocacy service does not operate in my Trust area.

Forgive me, but is it not the NORTHERN FUCKING IRELAND Association for Mental Health?!  At no point does the name of the charity remotely infer that it is not operational across the entire country.  How, then, can they not operate in my Trust area?  Is it because I is borderline?  Everyone hates a borderline, innit.

In fairness, at least they did suggest some sort of action I could take.  They said I should try the Trust’s Patient Council service, who apparently deal with matters like this.

I will heed their advice, especially given that a Twitter friend had some results via the Patient Council in his area, but not until I have heard back from the Trust, who were copied in on the original letter.

POSSIBLE WIN

As you know, the advocacy letter was copied to the Chief Executive of the Trust.  Not wanting to be arsed himself, the individual in question passed my letter to the Director of Mental Health services.

This bloke wrote back to me a few weeks ago, telling me that he had requested more information and that he would be in touch once he had received same.  I have not heard more from him yet, but am hopeful that the mere act of kicking up a fuss like this and threatening to contact the politicians and the media might be enough to get some action from him.

I won’t hold my breath, of course, but I will cross my fingers.

WIN

HAHAHAHAHAHAHA!  Asshole GP has backed down!

Apparently, Dr Bellend/Twatbag/Arsehole/whatever-else-I-called-him “would like to apologise” and accepts that his attitude fell short of “desirable [surely 'necessary'?] professional standards”.  Ha!  Muah-ha-ha-ha-ha-ha!

The letter went so far as to offer me the opportunity to meet the Practice Manager and Dr Knobjockey to further discuss the matter.  I will not accept the invitation, but I suppose it was good of them to offer it.

As I have generally been well supported by the practice (recently, at least), I won’t be a dick over this.  I’ll write back and accept Dr Fuckwit’s apology, and just hope that I won’t have to see him again.

MEH

And that, folks, is the latest news on that front.  I feel smugly satisfied about the GP letter result, but of course am rather disappointed that the advocacy charities are not actually doing anything that remotely resembles advocacy.  But we shall see how this continues to play out over the next few weeks.

This post shouldn’t be overly detailed, as a lot of it was repetitive bullshit regarding the annoyances of the previous week. Nevertheless, here we go.

Upon leaving C’s company the previous week, we had agreed that we would use week 35, the last week before a break of three weeks owing to Christmas, as a session to discuss how I would manage the so-called festive season.  In reality, that bit ended up taking approximately five minutes at the end, and although it was ever so slightly more helpful than some of the nonsense he’s come off with at other breaks (“breathe!”), it was still not entirely helpful.  But then again, he’s not my guardian, is he?  Much as I would like it that way.

I say we were flogging a dead horse because the majority of the discussion centred around the same crap we had discussed over the previous week (leave a comment or get in touch if you need the password) and the week before that, ie. my anger and distress about his decision to cut short my treatment, and my general disgust about the NHS’s abject failure to adequately treat me since I first sought help for my mental health problems.  I do understand that in some ways maybe C sees exploring my reactions to this as a form of projection or transference, and maybe in some ways it is: perhaps I feel so rejected and aggrieved because that’s how I was meant to feel about my father, uncle, ex, etc etc.

However, it endlessly frustrates me that I cannot just simply be angry because I have been so horribly fucked about by the health service.  Again, in this session, C reiterated that the 24 week limit (starting from tomorrow) was his decision; he said he was “not a robot” controlled by the NHS.

It completely contradicts all the stuff he says about my right to be annoyed and about how BPD should really be treated, and we went round and round in circles on how I could not reconcile his two contrasting views, and about how he either couldn’t or wouldn’t explain it properly.

I also, having decided as a result of the preceding week that he hated me, went to find out whether or not this was indeed the case.

I said, “if I ask you a question, will you promise not to answer with a question?”

He shifted uncomfortably, then admitted that he was unsure as to whether or not this was achievable.

I asked him anyway, on the proviso that if I thought he was “blagging” his way through his answer I would pull him up on it.

He did come off with the form bullshit such as, “why is it important for you to know that?” and whatnot, but I was pleased when he finally admitted that he too had found the preceding week “frustrating”.  So he is a human after all!

He said that I had been “very angry” with him, which I thought was unfair.  I told him that I genuinely hadn’t been angry with him, merely the system, until he confessed to having been the one that decided on the time limit.

“But you were angry with me then,” he pointed out.

“Yes,” I said.  “You had seemed so supportive of me prior to that; you agreed that my situation was wholly unfair.  Then you completely contradicted that by admitting to this arbitrary limit crap.”

And so back we went to flagellating that deceased equine.  More questioning demands from me, more bullet-dodging from him, no progress from either of us.

He had asked me in week 34 to seriously consider whether or not to continue with therapy, as I “had” to agree to the time limit as part of the contract (which strikes me as being quite unreasonable, as contracts are meant to be negotiated rather than forced in this type of setting).  Apparently if I don’t accept the limit, I cannot continue treatment.

“On that note,” I told him, “I am prepared to accept it, but only if you accept – because this works both ways – that I am going to fight it.”

He asked what I meant by ‘fighting’ it, prompting me to withdraw a copy of the letter to the advocacy groups out of my pocket.

“It’s only fair that you read that, given that you’re going to be involved,” I told him, handing the document over.  He took it and began reading.

I sat there and watched him reading it for a minute or two, then stood up and walked to the window, knowing perfectly well that he would almost certainly comment on this, as he had done two weeks previously.  Indeed, he didn’t disappoint.

“I’m wondering why you got up, SI…” he pondered, as he continued reading the letter.

“It’s not reflective of anything,” I spat cynically.  “I’m not denying my hurt or failing to face up to my problems.  I’m simply looking out the window whilst you are occupied with reading that.  Am I not allowed to get up, C?”

He shrugged and muttered something along the lines of that I was, in fact, allowed to get up, then continued reading in silence.

He eventually looked up and said, encouragingly, “it’s a good letter.  Who all are you going to send it to?”

I told him about the advocacy groups, Mindwise and the NI Association for Mental Health.

I was astonished – and delighted – when he then proceeded to actively encourage me to also send it to both the Chief Executive of my Trust, and the head of the mental health directorate of same.  In the end, he forgot to give me the person’s name, but as it turns out it’s been passed to him anyway (more details on how the letter has progressed in a future post).

C said, “you’ve also made reference there to people I think are in England – perhaps it would also be worth adding information about provision for personality disorders in other Northern Ireland Trusts.”

I asked him what such provision existed, knowing that people with the most serious PDs are in fact sent to specialist units in England as there are no facilities to treat them here at all.

C said a self-harm team exists in one of the other Trusts here.  “Although not everyone who self-harms has BPD, and not everyone with BPD self-harms, they would probably see a disproportionately high rate of people with your diagnosis,” he said.  “No such team exists in this Trust at the minute.  There’s discussion ongoing about making the existing team a regional, cross-Trust one, but it hasn’t yet come to anything.”

He talked on for a few minutes about plans our Trust has for action on personality disorders, and how they don’t seem to much be coming to fruition.  But the best part of the session was when he asked me if he could have a copy of the letter.

“I think it would be good for my line managers to know how you feel about all this,” he said.  He went on to say something (I don’t recall what) indicating that there might be some benefit to me in this, but was very quick to point out that it was my choice as to whether or not he did take a copy for them.  I readily agreed, of course, delighting in his apparent desire to act as my advocate to the bureaucrats above him.

Now, of course, I am convinced that he took the letter so he and his twatfaced bosses of evil can formulate some plan of self-defence in advance of hearing from the advocacy groups.  It was not in my interest at all – merely their own.  No doubt over the next few weeks we’ll see which way it actually is.

Eventually – I don’t remember how – I said that he must get sick of his job, what with all the whinging he would have to listen to.  “I accused you of being a sadist a few weeks back,” I said.  “Now I think you’re a mashochist.”

He accused me (sympathetically, to be fair to him) of splitting, which on reflection makes me slightly irritated, but at the time I agreed and called myself all the names of the day for employing this “silly psychological process.”

C leapt to my defence.  He said he knew that I had long since known I was guilty of splitting, but that it’s now “emotional for [me]“, not just something I recognise intellectually.  And it is OK, I do not need to berate myself for it, because I have suffered serious traumas, apparently, that have caused this defence mechanism (which is not silly, he contends) to develop.

On that note, as I recall it anyhow, we moved on to the discussion about the dreaded Christmas.

C’s advice was basically to get the fuck out if I felt anxious or overwhelmed.  I said that was easy to say, but he didn’t have to listen to my mother’s wrath if I did so.

He advised me to talk to her in advance, but I protested against this as well.  “When I told her about what happened with my uncle, she said I made it up to avoid going to his house,” I reminded C.  “So how can I justify my anxiety?”

“Blame your crowd phobia,” C said.  “She can’t be critical of that, can she?  There will be a crowd there, won’t there?

“Yes,” I replied.  “And they’re all part of the problem – it’s not all about my history with my uncle.  I have nothing in common with them and it’s a weird matriarchal set-up, where about 18 different generations all live under the same roof.  They’re freaks.”

He said, “are there children living there?”

I was horrified.  He was obviously wondering if anyone else is presently at risk from Paedo.

“Now you’re angry with me for putting the baby and all the other generations in danger.  I’m sorry,” I raced, in a bizarre panic.

C looked at me, his eyes wide-open.  “Where did that come from?” he enquired, surprised.

“Oh, you’re not angry with me?  Then I’m using you as a board for my anger at myself, am I?”

“OK, you’ve lost me,” he admitted.  “Just…just remember – get out.  Talk to your mother in advance, blame your crowd phobia if you have to, but if you feel yourself becoming tense, get out of there, even if only for a few minutes.  Allow yourself to be anxious about this.  How could you not be?”

And that, folks, was really that.  Of course, you know how ridiculously awful Christmas turned out to be, but I did remove myself from the others when I went so horribly mental, so I suppose I did at least follow the advice given.

As I was leaving, I wished him a Merry Christmas.  He said, admittedly cautiously, “you too,” causing me to laugh bitterly.  I think he knew that it was inevitable that the season would be utterly shite.

So, the three week gap is due to be over tomorrow.  Of course, I am convinced that C is dead again; either that or therapy will be cancelled due to the stupid, horrible, pointless fucking snow, and I need him so desperately at the minute.  Though I have not heard anything about a cancellation today, and I suppose I would have expected an advanced notification were the snow to fuck everything up on the monumental scale that it has in Britain.

The last time he was on holiday, in August, I didn’t miss him that much.  But this time I have, and I need him to help me pick up the pieces of the last few weeks.

—

Dear Sir or Madam

Re:? Complaint

It is with regret that I am writing to you in order to make a complaint about an appointment that I had with Dr Arsehole on Friday 18 December 2009 at 8.40am. In particular, I wish to make my views known about Dr Twatbag’s dismissive and patronising approach in relation to my health issues.

The appointment was primarily scheduled to discuss a physical health problem. I had been told previously by a colleague of Dr Shithead’s that medication was available to assist in the management of this condition, a fact that Dr Wanker confirmed. However, he then refused to prescribe me anything to alleviate the severity of my symptoms, citing my age without providing any substantive reasoning. I am baffled as to the relevance of an individual’s age to their need or otherwise for medication, and was not offered an explanation. Furthermore, Dr Knobjockey chose to fixate on my weight at this juncture. I do recognise that I am overweight, but as intimated to the doctor, have recently been dieting and exercising, resulting in the loss of over three stones. Despite my attempts to make this clear, the physician continued to speak condescendingly to me about the strain on resources that the “obesity epidemic” is causing.

However, it was a discussion around my mental health that caused the most offence and which, in my view, demonstrated not only a lack of sympathy for mental illness, but in fact ignorance surrounding this group of health conditions. When I asked for medication to help combat insomnia and anxiety, Dr Bollockfist refused, in an irritable and frankly almost hostile fashion. In the past I have been refused these medications, and would certainly not issue a complaint on those grounds alone. However, I do not think it is unreasonable for me to have expected this request to have been denied respectfully and sympathetically, with an explanation of the reasoning.

Regarding my chronic sleep deprivation, Dr Cuntfeatures unhelpfully told me that a lack of sleep, no matter how long-term, “won’t kill [me]”, failing utterly to offer any practical help or advice on the matter. Perhaps this is, literally speaking, true, but this denies the extremely serious effects a lack of sleep can have on normal daily functioning. I am also fairly sure that this does not constitute professional advice nor assistance. I should not have to point out that forced sleep deprivation is used as a form of torture.

Dr Bastardface discussed insomnia that he had experienced following a personal bereavement; whilst obviously I have the greatest sympathy for his loss, I fail to see the relevance of the example, and indeed believe that the implied suggestion was that because my insomnia is not necessarily circumstantial that it is therefore somehow less real or less deserving of attention than a lack of sleep caused by a distinct traumatic event. He then, to my astonishment, point blank denied a connection between psychotic symptoms and insomnia. Might I be so bold as to suggest that Dr Dickhead researches this more fully; insomnia is, in fact, well known to cause or increase psychosis and the symptoms of psychiatric illness (source).

In discussion of the illnesses that (at least in part) contribute to the aforesaid, I was dismayed by the allegation that I was simply trying to “medicalise” my conditions. I do not believe this to be fair at all – I am presently undergoing intense psychotherapy and merely wish to try and manage my symptoms until it has reached a satisfactory conclusion (incidentally, please see the enclosed letter to Mindwise regarding the disturbing possibility of a premature cessation of this necessary process. If I cannot receive psychotherapy to sort through my illnesses psychologically, I fail to see what choice I have but to seek medical intervention). I would add, also, that even if I were ‘medicalising’ my illnesses that they are, indeed, at least partly biological. Borderline Personality Disorder is thought to exist in individuals with a biological predisposition (sources) and bipolar disorder is considered primarily a medical illness (sources). Both are, of course, considered serious mental illnesses, having disproportionate rates of psychosis, suicide and self-harm (sources).

Incidentally, I noted with interest that my file does not reflect these diagnoses, still stating that I suffer from depression and anxiety. Whilst these co-morbidities do exist, my primary diagnosis is BPD (with psychotic features) with a differential diagnosis of bipolar disorder, type II.

Overall, it was not so much what was said that upset me (though I felt that to be lacking too) as the manner and tone in which it was said. Although I felt Dr Bellend’s response to my physical complaint was inadequate, it was at least presented fairly amicably by him. His attitude to my mental illness was, however, dismissive, unsympathetic and thoroughly unhelpful – I would say it bordered on disdainful, indeed.

Whilst I appreciate the subjectivity of this judgement, I would hope that the fact I have never made a complaint about [the practice] in my life until now would indicate that I am not wont to take things out of context. Unfortunately I got the distinct impression that the physician was dubious as to the sincerity of my illnesses and that it was felt that I did not have ‘real problems’ (though should he require a list of traumatic events that have helped to contribute to my psychiatric illnesses, I should be happy to provide same). It is sad that such stigma is not only present in society, but apparently in the medical professional also. Dr Cockhead, like anyone, has a perfect entitlement to hold such a view privately, but given his chosen career should not allow it to impinge on his professional practice.

I would like to make clear that, in general, I have felt very much supported by the professionals at the practice – in particular, I would like to thank [LGP], [the Nurse Practitioner] and all the nursing staff for the support, respect and professionalism that they have shown me. I have also had the pleasure of having positive interactions with Dr Ballbag in the past, and would therefore hope that this incident merely represents a ‘blip’ in the professionalism of his practice. However, given the distress it caused me and the apparent lack of awareness that it represents, I felt that it was imperative to bring it to your attention.

Thank you for your time.

Best regards.

Yours etc.

Enc (of the letter to the advocacy service).

Re: Advocacy in Accessing Mental Health Services

I am writing to enquire as to my rights and to what extent you can assist me in accessing the services to which I am entitled.  I am diagnosed with borderline personality disorder with psychotic features with a possible co-morbidity of bipolar disorder, type II.  I take anti-depressant and anti-psychotic medication, and although I only received the diagnoses in June 2009, I have been utilising mental health services both on the NHS and  in the private sector since 1998 (having originally been diagnosed with clinical depression and social anxiety).  The care that the NHS has provided has always been wholly inadequate; until recently, any therapy I have been offered has either not come to fruition, has ended abruptly or, in one incident, has seen me being regarded with outright hostility.

Since 29 February 2009 I have been seeing a clinical psychologist on a weekly basis for psychotherapy broadly of a psychodynamic nature (though the  approach is integrative).  As of today’s date, we have had 35 sessions in total. It has taken me some time to fully open up to and to trust this psychotherapist, but now that I have, I feel that progress is being made, albeit slowly.  I believe that further progress can be made through this relationship.

Unfortunately, my psychologist has informed me that he can only continue to offer me therapy for 24 further weeks (starting from the next session).  This would, of course, equal 59 total weeks of therapy (including three assessment sessions at the start, and four sessions to end the therapy).

As you will be aware, all published research on borderline personality disorder strongly recommends long-term therapy for the condition. Indeed, NHS and NICE guidelines on this illness and on personality disorders in general completely contradict the view that one year’s worth of psychotherapy is remotely adequate treatment.  I believe that the New Horizons consultation recently undertaken by the health service would not support this situation either.  I strongly believe that not only is long-term treatment advisable, it is in fact necessary to deal effectively with my condition and therefore I feel that it is my entitlement.

Whilst I appreciate that resources are limited, I am frankly disgusted by the postcode lottery that seems to be in operation.  For example, I am aware that there is a specific self-harm team within the <other NI area> Trust – whilst self-harm is not, of course, by any means the only symptom of BPD, I am sure that this team would work frequently with individuals with this diagnosis and would thus understand it well.  Furthermore, I am familiar with several other individuals that have this (and other) disorders – in most cases less severe than mine – that have received guarantees of treatment lasting at least two years (in some cases) and three years (in one).  I have yet to encounter a single other individual who has received only a year’s guaranteed treatment.  My psychologist himself admits that ideally BPD should be treated twice a week for a minimum of 18 months.

I believe that if therapy comes to an end as proposed that I will in fact undergo a significant regression, and probably end up utilising yet more NHS resources.  I am unable to work, and am in the regrettable position of being dependant on state benefits – a situation that I abhor.  Any saving of government resources in cutting short my treatment is, therefore, a false economy.  I also feel that the worry of treatment coming to a close will overshadow my relationship with my therapist thus preventing us from tackling more substantive issues together in the relatively short period we have remaining.

Additionally, I understand from the various guidelines from the health service that multi-disciplinary approaches are considered desirable and indeed necessary for personality disorders.  To that end, I am surprised that I have never been offered access to the CMHT’s social workers, CPNs or occupational therapists, despite presenting symptoms perhaps best dealt with by such individuals in conjunction with my psychologist.  Although I have had one experience of the Crisis Response Team (which, I might add, was an utterly appalling meeting), I have never been advised on how to contact them again in an emergency, of which I have had several in the past year.

I am not prepared for the NHS to once again treat me as a second class service user and am prepared to contact MLAs, MPs, the relevant Minister and Permanent Secretary, and indeed the media in order to obtain the treatment to which I am entitled.  I would therefore be strongly grateful for your advice and assistance on (a) ensuring that I obtain a guarantee of continued psychotherapy, in line with NHS guidelines on the longevity of same; (b) ensuring that said psychotherapy can preferably continue with the therapist I presently see, as of course issues of trust and abandonment are a big part of this illness; and (c) ensuring that I can have access to the full range of services from the CMHT and the Crisis Team in an emergency.

As you know, borderline personality disorder, especially when psychosis is involved, is a severe mental illness and in this case has not been taken seriously.  I feel that this matter is urgent and desperate, and to that end would be very grateful for your help and advice.  Should you require further details, or if you would simply prefer to correspond via another medium, please do not hesitate to contact me via email on <my email address>.  I look forward to hearing from you.

Thank you in advance.

Yours etc.

Copy to: Chief Executive of my Trust

CVM is very much in my thoughts and I wish I could do something to ease the pain of her and her family. I am publicly sending my sincere condolences here. <3 xxx

—

I know that I have an annoying tendency to open these posts on C with, "today was weird," or some such. Well, Thursday really was strange. It was totally bizarre. C was evidently puzzled by certain directions it took, and when I told him at the end that it had been “weird,” he actually responded by saying that it had, indeed, been “different” (for what it’s worth I feel reassured rather than invalidated by this).

I’m not sure if the written word can adequately convey the oddness of the session, because although it can look disjointed, it would take a better writer than I to convey the sudden and sharp shifts in mood, the nuances of the spoken tones, the randomness and subtlety of the non-verbal communication that took place. Nevertheless, as ever, I shall try.

It was very much a meeting of three parts. During the first – I dunno? – maybe 10 or 15 minutes I sat there petulantly, stubbornly avoiding his gaze and giving one word answers (at best) to any questions he posed. For once he had the decency to open proceedings, and not piss about waiting for me to do so. He said he was aware that part of me was attached to “here” (this annoyed me, though I did not say anything to him – I am not attached to his fucking office for Christ’s sake, I am attached to him!) and that I was concerned about the cessation of therapy. Wow, insightful. I’m absolutely profoundly impressed, Dr fucking Freud-Einstein-Mary Poppins.

I’m ranting about him now for stating the obvious, but I also got really pissed off when he strode into the territory of conjecture. He said he was also aware that I was unhappy that I only had 50 minutes of his time each week and that I was annoyed that I couldn’t just turn up or phone him or whatever outside that time.

This sent me into a rage. At no point have I ever said such a thing. Struggling to control my anger, I snarled that his comment was unfair, and that he was putting words in my mouth. I asked him to exemplify exactly when I had made these assertions to him.

He admitted that I hadn’t, and moved on, but I think I now realise where he got this from. Some months ago – I can’t find the relevant post offhand, sorry – I had asked him who I was meant to contact in an urgent situation (because if my life depends on it I still want to avoid the fucking Crisis Team). Could I have a CPN, a social worker – anyone at the two CMHTs based at C’s hospital? I don’t remember his answer but it was some nonsense about ringing Lifeline or the Samaritans. Yeah, thanks C. So he had obviously read this request – a reasonable one, in my view, given that CMHTs are meant to be multi-disciplinary and he is only one tiny part of them – as a demand for his attention outside of our sessions. This was profoundly irritating. If he had failed to understand my question, then he should have asked for fucking clarification.

Anyway. To follow on from the uncertainty of the last couple of weeks, he brought up the matter of how long he can continue to act as my psychotherapist. Apparently, he can offer 10 week blocks, with four weeks at the end to deal with the closing of the relationship. Fair enough? Well, no, not really; he can only offer me two of these blocks – ie. 24 further weeks (beginning on Thursday 10 December) in total. Now, that will amount to something like 57 total sessions (including the three assessment sessions at the beginning and the four ‘leaving’ sessions at the end) which ostensibly sounds fair enough. Unfortunately for me, BPD is well known to take a very minimum of a year to treat properly, and usually three or four.

I didn’t tell him this as, in the past, every time I’ve made reference to my diagnoses he’s come off with (or at least inferred) some crap about fixating on labels. Heard it all before, C. So instead I asked what I was supposed to do if things weren’t adequately improved by that point.

He said, “I would expect you to have made progress by then – I feel you have made progress.”

Great – I’m so glad one of us does. Most reassuring. I pressed on. “But what if I haven’t?”

He said something suggesting that I shouldn’t be expecting cures from psychotherapy, at which point I interrupted him by telling him I didn’t even believe in cures and, in fact, didn’t especially want them. My question, I insisted, was in the context of alleviating the worst of the psychological pain and providing me with coping mechanisms and greater understanding that I could take onward in life. What if that had not been achieved within his stated timeframe?

I honestly don’t recall his answer, but there was a strong inference in whatever it was that if we were unable to progress by then that there was effectively nothing he could do for me (an assertion with which I do not agree, but what do I know – I’m just the stupid mental that sits opposite him).

No arguing with that, then. That’ll be it. The end. Finito. Fuck you, SI. In response, I just sat there looking at the ground for a while. It’s difficult to articulate how I was feeling. It was a veritable cocktail of fear, dread, hurt, anger, bitterness and depression. I fought, ironically using the breathing exercises that C had so fervently espoused, against tears and rants. I fought them because I didn’t want to give him the satisfaction of knowing that this abject rejection completely fucking cut me to the core. But he knew. Of course he did.

After a minute or two, he proceeded with that usual question of ultimate annoyance, “how do you feel about that?”

One thing I’ll say in his defence was that at least he was completely straight for once. Often he dodges and dives from material that he doesn’t really want to bring up with me for fear of setting me off (or such is my supposition for why he avoids it), but on this occasion he was upfront and honest, and through my anger and hurt, I felt appreciation for that. I told him so.

He told me to think about this over the next week (“but not so much that you end up ruminating on it” – as if that wouldn’t happen!) and bring all of my thoughts and feelings on the matter to him in the next session. He said, “you’ll probably feel anger, frustration…”

Once again, I got really mad at him for putting words in my mouth, so he desisted from that angle of probing. Whilst it will indubitably be the case that I am angry – I already fucking am – and whilst it was indubitably the case that, in an ideal world, I could phone and/or meet him outside of scheduled sessions, how dare he presume any of that. If he wants to know my thinking on these matters he should fucking well ask me – it’s not like he’s never asked before. He shouldn’t just assume that his suspicions are gospel, regardless of the probability of their accuracy.

During the silence that ensued, I fought a mental battle with myself. One side was crying out, “but that’s another six months! You should be grateful!”

The other responded, “the NHS has failed you yet again, SI. They are ignoring all research on your diagnoses.”

For once, the negative side was, I am convinced, the more rational. BPD takes a long time to properly treat. It is as simple as that.

Finally I said to him, “why do you do this job?”

I knew he would respond with a question, and indeed he didn’t disappoint.

“Can you tell me why it is it important for you to know that?”

“I’m curious.”

Once more, I knew he would fail to answer, and instead question me again. Once more, I was correct.

“But what is it that gives rise to that curiosity?”

I laughed cynically in his face. “Just answer the fucking question,” I demanded. “Please.”

He looked away and appeared thoughtful for a minute. Eventually he said, “because I think it is of value.”

I nodded non-committally and waited for the backlash.

Well, apparently my questioning his decision to practice clinical psychology ties in with my intense rage towards him / the health service (because that couldn’t possibly be fucking justified could it? Oh wait, it could!) and my assertions last week that he was a ‘headfucking sadist’.

I winced. “Yes, sorry about that,” I muttered awkwardly.

“No, no,” he insisted. “You should bring that anger with you.”

I ignored him and said that it must be something of a nightmare to spend an hour with me every week.

He sort of laughed and said that I have to spend all the time with myself. (This could be read as an invalidating statement, which it shouldn’t be – there was more to it than this, but I don’t recall the specifics. Whatever the case, the point was actually made more sympathetically than I’ve made it sound).

“Yes, that is a disability,” I mused. “But honestly – I’ve been such an angry child here recently, it must be shit for you.”

I saw his eyebrow quiver slightly at my use of the term ‘angry child’. Excellent. It had been intended to pique his interest.

“I’ve been reading about schema models recently,” I proclaimed, triumphantly.

This is where part two of the discussion began. Let’s call it Intellectualise my Mentalism.

The other week, when I was convinced my therapy with C was coming to a dramatic and premature halt in January, I rushed to the Yellow Pages looking for suitable therapists. I was looking primarily for practitioners of psychodynamic therapy, as I have been receiving from C, because it’s the only type that I have found remotely effective to date. However, I was open to exploring both schema and gestalt therapy, having read quite a bit on both, and found practitioners of both in the vicinity. As two major studies have demonstrated its effectiveness for all symptoms of BPD (unlike stupid DBT), I have more faith in schema therapy, even though it does involve some wanky (if apparently advanced) CBT, for which (as you know) I have no time, so – convinced I was in imminent danger of abandonment from C – I Googled “Schema therapy borderline personality disorder” and came up with this book. On a whim, I bought it.

The book contends that people with BPD have five main strands to their character:

• The healthy adult (the authors admit this seems an unlikely component, but make the reasonably fair point that many with BPD are not always going mental. Not that they put it quite like that, of course).
• Detached protector – this mode sees the patient protecting the harmed brats that form part of her consciousness.
• Punitive parent – “everything is my fault” mode. Must punish myself. I am usually pretty good at this, especially in session.
• Angry or impulsive child – furious, mainly as a defence mechanism. It is convinced it will be fucked over. It is also angry that its needs / rights are not met. (I am a walking stereotype).
• Abandoned or abused child – alone, no one cares about it, whinges, cries, blah de blah.

I told C that today I was the protector. I was avoiding his questions, getting irritated when he probed me – classic protector traits, according to the book.

We had a discussion around the whole concept of schemas, schema therapy and its development, which to my amazement resulted in him bringing up the term ‘borderline personality disorder’ in a completely unsolicited way. He went on to explain the schemas seen in BPD in more detail, to the absolute delight of my ears and my mind.

Feeling that we were on something of a discursive roll, I presented him with a print-out of this post from Kathy Broady’s blog. I had analysed the piece bit by bit in terms of its applicability to me.

I pointed out that it was written by a DID therapist, however, and that therefore it might not all apply directly to me.

He sort of shook his head and said, “there’s a debate in psychiatry and psychology as to whether or not DID and BPD exist on a continuum. At the very least, there’s often an overlap of symptoms. So therefore I’m sure some of this stuff can apply.”

(For the record I think I’d identified about 18 of the 20 signs Kathy listed as being applicable to me to one extent or another. Fuck! Is there more I don’t know about?!).

Satisfied with this response, I gestured for C to go ahead and read the list. Not wanting to sit there like a numpty whilst he read it, I stood up and looked out the window.

I could see out of the corner of my eye that he was looking at me, puzzled. I turned to him.

“What, am I not allowed to stand up now?”

“Well, yeaa-ahhh, you are,” he began, doubtfully, “but I’m just wondering why you’re standing up.”

“You’re reading that, so I’m going to look out the window,” I replied.

“I think you’re trying to distance yourself from the material in this article,” he told me. “It would be better if you sat down and faced it.”

So, the mere gesture of looking out the window is reflective of an entrenched tendency to avoid confronting one’s problems, is it? Well, fuck me, I’ve heard it all now. I was going to argue, but decided against it, not really seeing any point. I made an arm gesture of “you win” and sat down, internally laughing at how absurd I felt his deep reading of my meaningless action had been.

C read the list – to my annoyance, he read a lot of it out loud – then paused on one particular point. I don’t remember which one it was, but I’d provided an ‘analysis’ at the end along the lines of, “I do this, I do that, blah de blah.”

“Blah de blah?” he queried. “What does that mean?”

“I don’t know,” I said. “It’s just flippancy.”

“Yeah,” he agreed, “but where does that flippancy come from?”

“It’s stylistic,” I argued (I’m sure most readers of this blog will agree that I have a penchant for flippant remarks). “It’s just my writing style. You haven’t read any of my writing…”

“But…” he went on.

Enter stage three of the session – the mad, maniacal bit.

“Right,” I said authoritatively. “You don’t believe me that that’s how I write? Well, let me show you.”

From my bag I pulled out a print out of this post, my (latest) rant on the NHS. I began randomly reading some of the more colourful parts of the rants, in a deliberately exaggerated and dramatic voice. When I finally drew breath at the part where I talked about reading Grey’s Anatomy at the age of five, the completely befuzzled C interrupted me, exclaiming, “what’s happening here today?!”

He looked completely bemused, and on reflection I can’t say I blame him. It was a bit of a random tangent.

I defended myself on the grounds that I wanted to demonstrate to him that the flippant comments he’d seen on the trauma list were sod all in comparison to the flippant comments made by me elsewhere.

“But,” he said, metaphorically stroking his chin, “we’ve been all over the place today [I'm not sure that he phrased it quite like that]. For the first while I thought you were quite upset, quite agitated…now I’m not sure what you are…angry? And in the middle we perhaps intellectualised matters a little.”

“Oh fuck, I’m sorry!” I cried. “I led you into that.”

“These meetings are a co-construction,” he insisted. “I’m just as culpable for any straying off course as you are – we just have to be careful not to head into intellectual territory too much.”

He pondered for a minute and, referencing point 10 on Kathy’s list of trauma signs, said, “your rush to apologise just now ties in with that.” He noted that I had commented on the list that my self-blame wasn’t excessive because that for which I blame myself is, in fact, my fault.

“You do realise, objectively, that it is excessive, don’t you?” C asked.

“No no no, it’s my fault. It’s my fault,” I contended. “Just now I seduced you into that discussion on academic psychology. It was my fault, I’m sorry.”

Readers, why – WHY?! – did I have to use the word ‘seduce’? Why? A dozen other words would have sufficed. It just rolled off my tongue, as hyperbolic metaphors often seem to do.

He raised his eyebrow and narrowed his eye slightly. “Seduced?” he enquired.

Fuck. FUCK. FUCK FUCK FUCK! Now he thinks I want to fucking fuck him. Fuck fuck fuck.

I felt my cheeks turn red in utter mortification and in my rush to defend my use of the term, on the grounds that it was figurative, probably made an utter tit of myself – thus reinforcing any belief he might have that my transference is of an erotic nature.

Fucky fuck, shit and damn. I did try my best to explain what I’d meant, but I was flustered, and in any case it probably looked like a case of the lady doth protest too much. So eventually I gave up, looked down and gestured for him to continue to read the trauma list.

Thankfully for once he had the grace to do as he was told and not press me. He read on in silence this time, and when he’d finished I asked him if he thought the points included were applicable to me.

He said that he thought they were, and indeed that a lot of it had already come out in therapy and that we were beginning to address those issues.

He handed me the list back, and I read over it. For some reason I then went into a dysphoric but energetic rant against myself, telling C that I was “nothing but histrionic” for thinking any of the list was applicable to me, and indeed for bringing it to him.

He listened to and watched me in a kind of bewildered way. Perhaps he’s not that familiar with mixed states.

“Well, this has been weird,” I declared.

He cleared his throat, as if for dramatic effect. “It’s certainly been…” – he searched for the word – “…different,” he acknowledged finally, with a slight wryness I thought, which I found bizarrely reassuring.

“I was nervous about telling you about the schema book,” I admitted to him, rather randomly. “I’ve always got the feeling from you that you think to so much as mention a diagnosis is to fixate on a label.”

“Not necessarily,” he began. “It’s very important not to fixate on it, indeed. You mustn’t allow yourself to be ‘built’ around a diagnosis. But it can have benefits, yes.”

“I’ve found it helpful,” I said. “For one thing it’s enabled me to connect with a range of people who have been a great support network.”

“Good,” he declared. “No, I have no problem with diagnoses. It’s just important that you know that it’s not ‘borderline personality disorder’ that comes into this room, it’s [my name].”

I nodded. I think I do keep a sense of perspective on the diagnoses; if someone asks me about myself, unless it has been directly in the context of mental illness, I’ll usually tell them I’m a rock bird with a love for reading, writing, pubs, sci-fi and Newcastle United. The illnesses are part of me, and I am not ashamed of having them, but they’re certainly not the whole story.

As I was about to leave, C asked me to think over the prospect of there being a maximum of 24 weeks of the process left in order for us to discuss it at the next session. He all but begged me to “bring the anger with [me].” I protested that I couldn’t do so with absolute impunity, as I couldn’t face being heard screaming at him by those in the offices adjoining his.

He looked extremely taken aback at this, which I still don’t fully understand. I have social anxiety for Christ’s sake, does he honestly expect that I can allow anyone but him to be party to my rants? In any case, his secretary phoned today. Having convinced myself at the weekend that he was dead (whilst simultaneously reckoning that he wasn’t dead, but nevertheless believing that he was), I was horrified about what she had to say. Mercifully, so far C is not dead and will see me on Thursday at the normal time – just not in the normal place, due to building work. He is temporarily moving back to VCB’s stomping ground.

In a way, it’s worse to lose it with him there than in his own office. The office in which I suspect I will meet him is next door to the one VCB shares with other psychiatrists. These cunts all have it in their power to section me should I really lose it, which is hopefully unlikely but frankly not impossible, especially with ‘They’ still hovering about from time to time (though wouldn’t you know it, the anti-psychotic has seemingly killed Tom. Just my luck to lose the ‘good’ psychosis and retain the ‘bad’). On the other hand, an advantage of this location is that the building is attached to the day bin and adjacent to the actual bin, so hopefully they’ll be used to having crazies losing it on them fairly often.

As for now, I don’t know what I think. The argument is still ongoing in my head – More NHS Fuckovery, I’m Calling an Advocacy Service vs. Well, It’s Another Potential Six Months, Be Grateful. The truth is I feel both at the same time. A little bit positive, but more than a little bit lost.