BEWARE: SELF-HARM TRIGGERS

EDIT TO ADD: Apparently this was originally written by a member of Recover Your Life. See here for more information. Thanks to Voluntary Madness for pointing this out in the comments section of this post. P.

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I’ve ripped this off from The Exact Science of Manic Depression, but as he himself acknowledges, it’s been doing the rounds of the Madosphere for a long time, and no one really knows who’s ultimately responsible for these wise words. Ergo, the relevant copyrights are with those who own them and not me. But the message is an important one, so here it is.

Before you make that first cut remember. You will enjoy this. You will find the blood and pain release addictive. Even though you think you can make a few tiny cuts that aren’t deep and will heal easily, they will get deeper. They will scar. They will sometimes take months to heal. And years for the scars to fade. If you think you can limit the cutting to one area of your body think again. It will spread when you run out of skin.

Be prepared to withdraw from others and live in a constant state of shame. Even if you are the most honest person ever to live you will find yourself lying to the people you love. You will jerk back from your friends when they touch you as if their hands were dipped in poison. You will be terrified that they will feel something under the cloth of your shirt, or just because it just plain hurts so much to be touched.

Be prepared to get so out of control you fear your next cut because you don’t know how bad it will be. Just wait for 10 cuts to turn into 100… Be prepared for your entire life to revolve around cutting, and thinking about cutting, cutting and covering up cutting. And just wait until that first time you cut “too deep”. And you freak because the blood won’t stop, and you are gaping, and you feel yourself shaking all over. You are having a panic attack and you are terrified but you can’t tell anyone. So you sit there alone, praying it will be okay and swearing you’ll never let it go this far again. But you will; and further. Don’t worry, you will learn how to take care of your cuts so that you can go deeper and deeper and avoid A and E.

You will lie to yourself and justify it when you find yourself spending £10, £20, £30 every time you go into a chemist. You will feel the flutter of your heart beat every time you go to the counter. Butterfly strips, 3 or 4 kinds of dressings, wound tape, antibiotic cream, medical tape, and scar reducers. You will tap your foot impatiently hoping the queue will move on and that no one will stare at you or wonder why you need all these things. And at the same time secretly hope that someone will notice… someone who is standing in line with an armful of the same supplies. Someone who understands. But of course that never happens.

Medical supplies won’t be the only thing you spend all your money on. Be prepared to buy a new wardrobe. Long sleeve shirts in summer colours, bracelets, wristbands, boots, gloves the list goes on and on.

You will start looking at every one in a different way. Scanning their bodies for any signs of SI, just hoping that you might meet someone like you so you don’t feel so terribly alone. You won’t even think about it as you eyes scan their wrists, arms, hoping, just hoping that you might meet someone like you. But they are not. You will see their clean arms and feel terribly ashamed and alone.

You will start doing alot of things alone. You will always have to wash your laundry in private so that no one sees the blood stains on your clothes and towels. You will always be cleaning up the blood. Scrubbing your bathroom floor, wiping the blood off your keyboard.

You won’t be able to make it through a day without cutting. Next thing you know you’re locked in a toilet cubical somewhere breaking open a scar with a sewing needle you keep in your purse for emergencies. When you get really desperate anything can be a cutting tool. Scissors, car keys, needles, even a pen. It doesn’t really matter what if you need to cut bad enough you’ll find something.

Say goodbye to the things you took for granted. Like wearing shorts or sandals, pedicures and sleeveless tops. A normal summer day at the beach or the swimming pool will become a far off memory to you.

And remember to be ready to itch. Because you will itch and itch so much that “you look like you have fleas or a skin disease”.

You will become an expert on your own body as you destroy it carefully. You will dream about cutting. You will dream about being exposed. It will haunt you day and night and take over your life. You will wish you never made that first cut because you will absolutely hate cutting; but at the same time you love it and cannot live without it.

You have been warned…

It is all absolutely, 100% true. I promise you, readers. Pay heed. Proceed with caution. Self-harm is a drug from which it is hard to break free, especially in times of great stress.

Plus Bye Mum! and The Obligatory ‘I Had an Appointment’ Post.

Let’s start with the first one.

Bye Mum!

One of two things has happened as regards my last post, in which I speculated that my mother was reading this infernal bollocks that I call Confessions of a Serial Insomniac.  Either I have been suffering from a paranoid psychosis (or, in less hyperbolic terms, just paranoia) regarding all the reasons that I thought she was reading it, or she has become shockingly technically savvy over the last few months.

I went to her house this morning after an appointment with Lovely GP and, when her attention was distracted, I searched her history, cookies and Temporary Internet Files on both Firefox and Internet Explorer.  There was no evidence of any visitations to this site at all, save for one single cookie which is probably from a time I wrote a post from her PC (as it had some references to an upload, to which, of course, she would not have had access.  For the record, I thought I had deleted all reference to that session, but meh).  When I say ‘searched’, I actually mean that; I used the built-in search boxes to search for terms such as ‘serial insomniac’ or ‘confessions’, rather than really rip the piss out of her privacy by wading through each single thing.

So seemingly I stand corrected on my earlier accusations.  Mother, I apologise.  Even though you aren’t reading this and don’t know about it.  Hmm.  Sorry anyway.

The Obligatory ‘I Had an Appointment’ (Part of the) Post

I saw LGP at the unGodly hour of 8.50am.  OK, so for a normal person, that’s not that bad, but I’m still registered at my mother’s old surgery, and since I live at A’s in the main, it involved a drive to the other side of town and then a hike up the motorway for a while.

I realised with horror last night that I had failed to fill in a form for the admin staff at the surgery.  Rather than do any work themselves when they receive DLA claims in from Social Security, they write out to the applicant asking them how their disability or illness affects them.  To be honest this suits me fine as they don’t really know how being mental affects me, and of course I do, but nonetheless I’d received the form the other week and had kept putting it completion of it off, despite their request to return it promptly.  I therefore sat in LGP’s car park immediately before my appointment and scribbled all the bollocks I could think of down – psychosis, dissociation, failure to engage in everyday tasks, severe anxiety, major depression, self-harm etc.  I hope I’ve covered everything.

Anyway, the main reason I went to see LGP was to scrounge Diazepam due to the now absolutely-imminent abandonment of me by C(unt).  LGP was sympathetic towards me given C/The Trust’s unprofessionalism, and seemed to understand that I have been completely retraumatised by the experience; however, the poor sod seemed unable to do anything about it.  He asked about NewVCB, and I said that she too was horrified about what C/The Trust are doing, but that she also seems uterly powerless to do anything about it (though she did try to dissuade C from cutting the process short, but the miserable git chose to refuse to listen to her).

The last time I saw LGP he had suggested going to see the Nexus Institute in the wake of the whole disaster that my therapy with C has become.  As I noted in the post in question, by psychological association I’ve developed an aversion to the Institute due to a really antiquated encounter with some NHS assessment bitch, but nonetheless I have been thinking about the suggestion and have perhaps warmed a little to it.  My concern now is that they offer, according to C anyway, a maximum of 24 sessions, which seems hideously inadequate to me.  When LGP raised the issue again this morning, I said so to him.  I pointed out that I felt that about 15 – 20 sessions was the minimum required to open up to a new person – and that was when the relationship was a good one.

He said that his experience of patients using the Institute’s services was that they had managed to actually achieve a lot in that timeframe, therefore opining that it was at least worth a shot.  He told me that they have a waiting list as they genuinely seem to be good at what they do.

Fair enough, but I bet they have never met a cynical, snide fuck like me before.

Anyway, it was left with me telling him I would, indeed, do as I was told for once and contact them for an appointment.  I am shitting myself at the mere thought of this, so how the fuck will I feel when I actually get round to the fucking meeting?!  And my concern is also this – my relationship (or, rather, the premature cessation thereof) with C has traumatised me so severely that that’s yet another thing for a new therapist to have to deal with.  It’s not all about the sexual abuse in the first place – it never was.  Now there’s just another layer of trauma-shite to add to:

• the sex abuse
• the bullying
• the whole dreadful saga with my ex that I’ve still never written about here
• the fact that I still weep for my grandfather nearly 12 years after his death
• V’s abject cuntery towards me
• V’s abject cuntery towards my mother
• V’s relatives’ abject cuntery towards me and, to a lesser extent, my mother
• an issue I’ve never discussed here pertaining to how my mother treated me when I first manifested severe depressive symptoms as a teenager
• general life disillusionment that, unresolved, simply leads to further crippling depressions.

Can a therapist trained in helping people overcome sexual abuse deal with all that bollocks as well?  And do they have any expertise in treating people fucked up the arse by the NHS and being more of a mess as a result?  (Actually, they probably do; I’m sure my situation isn’t terribly uncommon).

Of course, the long-term plan is for me to enter analysis, but at least Nexus are free (donations notwithstanding), so I shall try them first.  I just hope that the limited timeframe afforded is not going to end up with a repeat of my current therapeutic disaster…more psychotherapy-induced trauma?  Oh yes please, world – give it to me, yeah!!!

Anyway, I risk never getting to the point if I don’t stop blathering about points made a zillion times before.  I led LGP to believe* that I was having a breakdown within a breakdown over the end of things with C and begged him for Diazepam.  ”The last time I had any was May!” I pleaded.  ”Please!”

It was truly pathetic.

He checked my notes and confirmed that May was the last time I was issued with a script for the beautiful, wonderful, amazing, fabulous tablets, and noted that I am “clearly not abusing them.”  No shit, mate.  He agreed to give me some more, though I was disgusted when I left the surgery and read the prescription that he had only issued 14!  I have seven left from the previous script, so there’s 21 – that’s only a fucking week’s worth!

To be fair, he said that if I was having a really hard time, that I was to ring him and he’d let me have some more.  You can be sure that I will be “having a really hard time”.  I feel that I need to hoard them, to have a proper size of a stash – just in case.  You never know when they’ll be needed, do you?  On that note, I observed with amusement that the back of the script paper now instructs you not to heard medication, as apparently that’s stealing money from the NHS or something.  This caused me much merriment – I hoard like fuck.  Too bad.  They failed to give me what I needed, so if I’m ‘stealing’ from the fuckers (such melodrama!) then I feel like a Robin Hood character, and am glad to be involved in screwing them.  Fuck them.

LGP asked the old rote question of whether or not I would overdose on the Diazepam.  I said that I wouldn’t, and then proceeded to tell him that I’d had my stomach pumped before and had no wish to relive the heinous experience.

“But are you having suicidal thoughts?” he asked.

I laughed in his face.  ”Of course I’m having suicidal thoughts,” I chuckled.  ”My entire life revolves around suicidal ideation.  But I won’t overdose, don’t worry.  I know how to do myself in and, unless you plan really carefully, that is not an outcome facilitated by overdoses.”

He raised his eyebrows, intrigued.  ”You’ve become something of an encyclopaedia about mental health issues,” he said, smiling.

“Well, I read a suicide newsgroup, so I know a bit about suicide methods,” I admitted.

He nodded.  ”But it’s not just that,” he went on, “you’re very self-aware, aware of what’s going on with you, and you’re extremely articulate about it all.”

I couldn’t help but blush.  That was nice.  I think.

He asked if my interpersonal relationships were of a satisfactory standard, and I responded that I had the support of A, a mass group of wondrous online friends, and a number of non-online friends that were supporting me unwaveringly.  I also told him that relations with my mother are at a reasonable point, though at the time I was still paranoid about what she was or wasn’t reading.

“It’s not that I think you should be grateful for the situation you’re in,” LGP said, “of course you shouldn’t.  But at least you do have a support network, it’s better than absolutely nothing.”

I suppose it is.  I asked if I could see him in a month as support additional to NewVCB and he said that of course I could.  He then mused for a second, and when asked what he had been considering, he told me that they also have counsellors that operate in the surgery.

“However,” he said, “I don’t think it would be appropriate for you.  Firstly, your issues are clearly very complex.  And secondly, you are clearly…” he searched for the words “…at a level above that sort of therapy.”

I regarded my lovely (but, alas, ginger) doctor with interest.  Was he implying that I am more intelligent than his almost-certainly-CBT-practising staff?

Mwhahaha!

He took my blood pressure, which he felt was pretty high.  He reckons that this is generally the usual PANIC PANIC that people get themselves into when in medical appointments, as well as stress over C.  ”I suppose I should also recommend losing some weight though,” he added, clearly uncomfortably.

I advised him that in the last year I have lost over four stone (yes, those of you that met me on Saturday – that does mean that I was even more the size of a mansion a year ago) and am continuing to lose pounds.  He was beside himself with joy (!) and kept congratulating me over and over, which was in hilarious stark contrast to the battering I took from his cunt of a colleague in December.

I left with the Diazepam script, a promise to him to contact Nexus and an agreement that we would meet again in about a month.  Ah.  Sighs.  I do like LGP.

I went to the chemist next door to get my medication, and whilst waiting looked around for other bollocks to spend money on.  I chose some Rescue Remedy, to aid the workings of the Diazepam, plus some anti-IBS stuff and Pro Plus.  Then I saw Seri-Strips, bandages etc – and I jumped on them.  I don’t feel like self-harming at the minute, but who knows what tomorrow will bring?  Better to be prepared, because it could go totally tits up after my final session with C(unt).

Which leads me to…

The Final Countdown: The Eve of the End of Therapy

So.  Here we finally are.  All my efforts to fix this dire situation have been a waste.  After 10.20am tomorrow, I will never see C again.

I look through my archives on this subject and actually find myself laughing at some of the histrionics displayed therein.  Wa wa, I can’t cope without him.  Wa wa, my life is over.  Wa wa, I’m so miserable, I can’t cope, please kill me someone please!  Tonight I feel…

…

…

…

…ambivalent.  Fine.  Asi es la vida.  I don’t care.

Now don’t get me wrong.  I am still positively full of righteous anger and indignation at the appalling way I have been treated by the Trust, and I don’t intend to just lie back down under it and let the fuckers abuse me more.  However, as regards C as an individual specifically, I really don’t feel anything much about our soon-to-be-permanent-separation.  * In this sense, my “I’m having a breakdown within a breakdown” performance to LGP was perhaps slightly exaggerated in pursuit of drugs.  Maybe I should contact Narcotics Anonymous whilst I’m in the process of contacting new therapists?!

There are two probable reasons for this.

One: I have already done most of my grieving.  About a fortnight ago – after a session itself after an unpleasant meeting with NewVCB – I was in a particularly bad state, so much so that I caused a fuss on Twitter, apparently having implied I was going to do myself in.  That was a bad day, but it was one amongst many.  I have shed millions of tears over this and whined and bitched and moaned about it here so much that it will no doubt seem like another blog once I desist from such shittery.  My pain was so real, so deep, so astoundingly visceral – and now, it’s just not.  It has apparently played itself out.

Two:  a limited number of people know this, simply as I haven’t written about any of my sessions with C in five or six weeks, but in that time my view of him has shifted almost 180 degrees.  I know that the fault in this whole sorry mess is only partially his, but he has become the fall-person for my disdain and derision.  I used to respect him greatly and I was very fond of him, and that was on top of my issues of transference and attachment.  Now, I kind of feel like he’s…I don’t know…a fly or something.  He’s there and he’s actually rather irritating and frustrating, and you feel like swiping him – but, ultimately, he’s something of an irrelevance, his existence little more than a passing inconvenience.  And that existence, in terms of my life anyhow, will cease to be in 13 or so hours.

It should have been different.  Of course it should have been different.  There is a small part of me that feels sad that I have come to view him thus, and as stated I know that it’s mostly not his fault.  But this is the reality of things as they stand; he is the figurehead for every failure I’ve ever experienced thanks to his employers.  Poor C.  But not poor C too.  Who cares?

Is this a defence mechanism?  Probably.  And it could unravel completely in the morning and I might be a suicidal, dissociated, agitated mess.  For now, though, for this one important evening, I am OK.  Surprisingly but genuinely OK.

Now.  Who likes my new logo?!

Pan x

*** STANDARD TRIGGER WARNING: POSSIBLY TRIGGERING MATERIAL IS UPCOMING; I HEREBY ADVISE YOU AGAINST READING IT IF YOU FEEL THAT IT MAY SET YOU OFF…BUT I KNOW YOU’RE GOING TO READ IT ANYWAY, SO THAT’S A BIT POINTLESS, BUT I PROBABLY LIKE YOU BECAUSE I LIKE EVERYONE THAT I KNOW READS THIS DRIVEL, SO PLEASE DON’T HURT YOURSELF.  NOT BECAUSE OF INADEQUATE LITTLE ME ANYWAY.  IF YOU DO SO I WILL HAVE TO COME ROUND TO YOUR HOUSE AND SHOUT AT YOU AND/OR KILL KITTENS AND/OR CLUB BABY SEALS AND/OR SLEEP WITH RICK MAYALL.  NOW YOU WOULDN’T WANT THAT WOULD YOU, SO EITHER DON’T READ THIS SHIT OR A LEAST MAKE SURE YOU ARE NOT COMPLETELY MENTAL AT THE TIME OF DOING SO.  OK?  OK.  THNXBAI. ***

I’m sure that most of you are familiar with what I did on Friday night(well, technically, Saturday morning) given my bizarre running commentary on same on Twitter.  Of course, not everyone who reads this blog uses Twitter, but nevertheless, you can derive the basics from the title of this post.

It wasn’t a “cry for help” or some sort of silly borderline strop.  It was an absolutely pathetic attempt, I will admit that, but it was a nonetheless serious attempt.  I genuinely wanted to die.  I did.  No bullshit, straight up – death, not attention, was what I sought.

Nothing especially bad had happened on Friday – I was just miserable for most of the day.  I met A for dinner and a few drinks, which was pleasant actually, and when we got home, we listened to some music and were generally rather contented.  But I kept thinking how much easier things would be if I wasn’t in existence.  Not just for me – although I admit that was a major motivating factor – but for everyone.  I add nothing to anyone’s life.  A million people could tell me otherwise, but I’d never believe them.  I am a worthless, useless slut of sheer, unadulterated and fetid disgustingness.  Or at least that’s what I thought then.

So when A went to bed, circa 1.15am, I laid into myself with the scalpel.  Few parts of my body are unaffected – self-harm is strongly in evidence on ankles, arms, abdomen (there words there, just slashes elsewhere), elbows – the works really.  As I was doing it, I thought that I might as well go one step further and slit my wrists, the hopeful and intended result being my bleeding to death.

Now, people could say, “but a serious suicide attempt requires planning, and this was an impulsive act.”  I do accept that, and can see why it looks like nothing more than a pathetic gesture.  All I can say to convince people otherwise is that it felt absolutely and completely genuine at the time.  I wanted to die.  I really did.  I always remember (or rather don’t) the nothing that I experienced under general anaesthesia when I had an operation a while back.  I longed so fervently for that nothing again – and for it to be a permanent state.

So, I took a few minutes to write a note to my mother and A, with acknowledgements of a few friends, then went in search of an analgesic spray that I keep for sprains and the like.  An attempted suicide is not like self-harm; it’s not performed in the pursuit of pain.  No, pain was not a commodity that I lacked, so I sought to minimise more of it.

I’ve read this on the suicide newsgroups, but I was nevertheless surprised (or at least I am retrospectively) by how calm and contented I felt having made the decision to kill myself.  It was reassuring and comforting to know that I would not have to continue with this sorry excuse for a life, that there would soon be nothing.  Nothing was all I wanted.

I cut my left wrist first.  I tried to cut deep, but my skin was ungraciously unco-operative, refusing to slit to any meaningful degree.  This irritated me considerably, but I let it pass and decided to return to it.  So off I moved to my right wrist, which curiously proved considerably easier.  I’m generally right handed, so wielding a scalpel with my left hand would not be the most obviously effective way to garner a major life-threatening wound.  But initially, I thought I’d spotted success.

I was captivated by the blood.  It was the most blood I have ever seen from a deliberate act of self-harm.  Dark, and think, and oozing, and beautiful.  It completely mesmerised me, and I could almost feel my life ebbing away with it.  That was an eminent comfort to me, and I felt moved and calmed, yet slightly euphoric.  God, what a beautiful and welcoming thing death seemed to be!

But wait.  The blood was oozing, not spurting.  That meant that I had failed to sever a major artery, and rationality came flooding back: if one is going to off themselves by cutting, they really should cut vertically on their arms, not horizontally as I had done.  Vein cuts generally won’t lead to a successful suicide, and indeed artery ones don’t always either. Plus such wounds can lead to nerve damage in one’s hands if they fail to bring about death.  This was the shittest suicide attempt in the world!

I was filled with self-disgust, but even more than that, irri-fucking-tation.  Not anger or fury, but irritation.  I was irritated that my peaceful comfort in an imminent death had been shattered.  For fuck’s sake, I can’t even kill myself with any fucking gusto!

I sought advice on Twitter (that well-known bastion of medical knowledge), still watching the blood ooze heavily from my wrist.  The consensus was that it wouldn’t off me, but that I should go to Accident and Emergency nevertheless and get the thing stitched.

I considered this.  The thing wasn’t going to kill me, self-evidently, but it may have led to nerve damage.  If I was, however unfortunately, going to remain alive, then I might as well do so with a functioning right hand.  I rang a taxi to take me to the hospital, which is less than five minutes’ drive away.

Whilst waiting for it, I cleaned both wounds up a bit (although superficial, the left one was bleeding satisfactorily) and bandaged the right one as best I could.  The bleeding was still very heavy though, and before the taxi even arrived, it needed changed.

I called up the stairs to A to tell him that I had been advised to go to Casualty.  He got up and told me that he was coming with me, a suggestion against which I protested, though admittedly rather mildly.

I don’t remember the taxi trip at all, and have only the vaguest recollection of checking in at the A and E reception.  I remember telling the woman that my suicide attempt was one of the most pathetic in history, and being surprised by how much data she was able to access on me from her computer (1984 is with us, readers).  I also recall that the waiting time was estimated at seven hours, but for some reason I allowed myself to believe that it would never come to that.  How absolutely and completely wrong this assumption proved to be.

To be fair to them, I was very quickly seen by a triage nurse, who opined that the slit on my right wrist probably needed stitches.  She put steri-strips on it to close it as much as possible until such times as I was seen by a doctor.  She was a young girl – I’d guess younger than I am – and was remarkably sympathetic.  I was bawling my eyes out like a bloody baby by this stage, but this girl did not try and rush me, nor patronise nor judge me.  She simply listened and tried her best to be supportive.  Alas, though, eventually I had to go back to the waiting room.

And so it began.  The mind-numbing, seemingly endless, hideously interminable wait.  It is, I imagine, exactly what the final wait on death row is like – though at least if you’re a suicidal, schizo bitch you can expect a satisfactory outcome at the end of that particular interim period.  I had no idea what to expect at the end of this one.

Wait.  Wait.  Wait.

Heat.  Heat.  Heat.

Atrophying mind.  Atrophying mind.  Atrophying mind.

If swear to God that if one wasn’t suicidal to begin with, it was enough to make them so.  I can’t describe why it was so bad, but it was.  It really was.  Thank God for Twitter (on which I will remark later) on my mobile, though of course the bloody thing’s battery packed in on me eventually, leaving me once more to the doom and nothingness that was Casualty.  Well, I know earlier I was extolling the virtues of nothingness, but that particular brand of nothingness has the decency to lack consciousness.  The A and E version does not demonstrate such wonder.

After the seven hour mark had passed, I went back to the desk and asked was I going to get seen.  By this point it was after 9am.  The woman consulted with a doctor and, interestingly, he almost immediately proceeded to take me through the double doors of doom.  I’ve said it before, but I’ve wondered are there gas chambers through there.  I felt like I was walking the plank.

I was led to a room that, aside from the lack of bars, did a wonderfully accurate impersonation of a prison cell.  It, like the waiting room, was painted (if you could call it that) in one of those bland non-colours that are designed to half-sedate people into compliance.  Just like they have in customs halls at airports.  I was utterly exhausted, mentally and physically, yet my agitation just increased more on arrival in this room.  I found myself barely able to even speak to the doctor, though he seemed like an amicable enough man.

Amicable…but competent?  I’m not sure.  He asked a few questions then went to call the liaison team from the bin, without examining my wrist.  I called him back and asked him did it not require stitches.  He looked at it, in a horribly cursory sort of way (without even removing the steri-strips), then declared that that with which it was already dressed was “quite adequate”.

Again, I’m not sure.  The cut was pretty deep and the resulting blood loss, whilst not life-threatening, had been relatively considerable.  It wasn’t as deep as the (accidental) cut to my finger a few months ago, but it wasn’t that far off it.  Lovely GP told me that I should have had that injury stitched, so I was surprised at this doctor’s belief that this one didn’t such treatment.  I was especially surprised that he didn’t remove the steri-strips to check.

Surprised, yes, but at the time I was so indescribably fed up and so unbearably consumed by exhaustion that I didn’t care.  I just wanted to go home (so any attempt to admit me to the bin would not have gone down well, not that I’m sure I’d have had the energy to fight the bastards).  I said so to the doctor, who said that he wanted the psychiatric liaison woman to see me.  I asked how soon that was anticipated.

“Oh, she’ll be over shortly,” he said nonchalantly but apparently genuinely.  Based on that premise, I agreed to stay and meet the woman in question.  I went to get A and brought him back to the cell, where at least he was able to sit in a slightly more comfortable chair.  I used much of the time between the departure of the doctor and the arrival of the mental woman to apologise to A.  I was horrified that I had put him through such trauma.  From my own perspective, I didn’t – and frankly don’t – give a toss about my suicide attempt, but I absolutely abhor myself for putting him through it.  I kept telling him that his life was better before he met me, which as far as I can tell it indubitably was.  He denied it, claiming that he had been lonely prior to the crossing of our paths.  But surely loneliness is preferable to having to tolerate a borderline freak with a scalpel fetish on a daily basis?

There was plenty of time for such apologies.  Plenty indeed.  The doctor left my cell about 9.15am, and the woman from psychiatry finally arrived just before 1pm, after three enquiries from A to staff about her whereabouts.  If anything this waiting was even worse than the seven hour one of earlier; perhaps it was because we were so completely brain-dead exhausted by then, or perhaps it was simply because the ‘examining’ physician had strongly suggested that the wait for this woman would be pretty short.  It must be that, in A and E, anything under three years is short.  Absolute fucking shit.

Anyway, eventually she did arrive, just as I had finally persuaded A to leave.  I figured there was no point in both of us losing even more of our wills to live (not that I had any in the first place, but you know what I mean), and in any case the poor cats needed fed.  So as I went to a “more private” room with the woman, off A went.

She was a nice woman, but perhaps unsurprisingly was about as useful as a rolled-up election manifesto being shoved up my arse.  We discussed what has stressed me of late (Christmas, C’s dickery, just general mentalism), self-harm in general, the history of my mentalism, my physical health, my weight (“it’s not uncommon in people who’ve been sexually abused to deliberately but unconsciously become overweight, so as they make themselves – in their eyes – less attractive to potential abusers”, apparently) and current eating habits (don’t eat – binge – throw up), and other related wank that I don’t really remember.  She did keep asking if I still wanted to die, and I kept being very careful with my response.  On the one hand, I didn’t want to lie to this woman who was being understanding and down-to-Earth with me, but on the other I didn’t want to say ‘yes’, and find myself sectioned.  I doubt that I would have been, given the low level of resources that this Trust seems to have devoted to mental health difficulties (this isn’t my usual Trust, for the record, as this all took place at A’s house and my normal Trust is based on my address at my mother’s house), but it was always a horrible possibility.  So I just said that I didn’t know.

I told her about C’s intention to cut my psychotherapy short and about VCB constantly fucking me about.  I also told her that I now have a new VCB, a woman who I am to meet for the first time on Wednesday.  The liaison woman reckoned she knows NewVCB, and says if it is indeed the same woman that she is “lovely – really bubbly and friendly.”  That’s better than her predecessor I agree, but ‘bubbly’?  How does a mental who’s just tried to catch the bus deal with someone chirping about and loving life?  Fuck.

The long and the short of it is that she is going to ring LGP, NewVCB and, crucially for me, C, tomorrow morning to report on Friday’s occurrences.  I say ‘crucially’ regarding C as I profoundly do not want him to know about this.  A and A’s best mate W (who A was keeping in touch with during this whole episode via text message) both place the blame for my suicide attempt solely at C’s door.  Naturally I have been trying to defend C.  I have my own psychological agency; he is not responsible for my actions.  A agrees, but still strongly believes that what he feels is C’s ineptitude has at least “precipitated” this.  I don’t know what I think.  I just don’t know how I am going to face the man after this.  I don’t see why I should be so mortified – after all, A, W, all my Twitter friends and now all my blog readers have been party to the most minor of details in relation to this, and C will know a mere few (unless I confide further in him, which as of this writing does not seem likely).  I suppose that I am worried that he too will think that I did what I did solely because of him, and I don’t want him thinking (knowing?) that he has that level of power over me.

Anyway, the woman told me that when I got home I was to give the scalpel and its associated blades to A.  I protested most vehemently against this.

“If I want to kill myself, I’ll find a way,” I said.  “Removing the scalpel will not prevent that, but it will prevent the only real outlet I have for calming my mentalism when it’s at its worst; non-suicidal self-harm.”

She said, “have you ever been referred to a self-harm team?”

I responded in the negative, and she said that she would, therefore, try and refer me to one.  It is difficult because I officially live with my mother, and therefore in a different Trust area – my Trust, surprise surprise, doesn’t have a self-harm team (one thing I ranted about in the advocacy letter, at C’s suggestion).  Nevertheless, she said, she will try.  So I suppose that was one positive to come out of the whole awful experience.  As I said to her, I actually don’t want to stop self-harming as things presently stand; it is the only way to cope sometimes.  What I do want, though, is to want to want to stop it.  I don’t put much faith in these self-harm team people really, but it is at least an avenue to explore.

She once again asked if I had any thoughts of going home and trying again to kill myself, and once again I made some sort of ambiguous noise.  However, she took this as a ‘yes’, and to that end took me back to the doctors’ station to seek my discharge, which was instantly given without any further examination or questioning.  I left, and walked home alone.  I had been there 12 hours, and not a thing of any use – save for the possible self-harm team referral – had occurred.

When I got home I found evidence of what happened all over the living room floor.  Mercifully, there were no blood stains on the carpet, but there were maybe eight tissues that were absolutely saturated.  Blades lay scattered everywhere, though the scalpel itself was curiously absent and has remained elusive (A swears he didn’t find it).  I tidied the place up, grateful that A had been seemingly oblivious to it all.  He had had enough trauma.

I found him in bed listening to the radio.  I crawled in beside him and begged for his forgiveness, and I am very lucky to be able to report that it was granted, on the proviso that I don’t do this again.  I promised I wouldn’t, though A wonders if that is a promise that can be kept given how strong the compulsion to die can be at times.

All I can say is that I will try my best.  I really will try my best.  To look at it from a cynical perspective, I really don’t want to have to go through 12 hours of unmitigated hospital shite like that again.  The inadequacy and comical inefficiency of the NHS never ceases to amaze me.  I mean, OK – had there been some big emergency in, I could have understood the waiting there like complete numpties for 28 years – but there wasn’t.  There were a handful of other minor injuries, so it was just complete and utter shit.

How do I feel now, about 30 hours after getting home?  I feel remarkably not-too-shit, though there seems to be a permanent, cynical sneer across my face (though that was quite possibly there long before Friday night).  I still think the world is a shithole and that my life is a mess, but I am simultaneously touched by the generosity of some people, both out there in the ether and here, in ‘real life’.  See here and here for just some examples of individuals that prove that Twitter is very, very far from the facile, meaningless shite that many in the media present it as.  I fully believe that were it not for Twitter, I may well have successfully killed myself in the last nine months – not on Friday probably, admittedly, but at some juncture.  It is the best support group that I can imagine.

W and of course, in a beyond-words sort of way, A, also prove that maybe, in the midst of all the darkness, there are some people who make this existence less shit.  I am grateful that people care.  I hate my life, very profoundly do I hate it, but in terms of having people to give a shit, I am glad to declare myself a fortunate individual.

Wasn’t it 1992 that the Queen said was her annus horribilis?  Well, let’s fast forward 17 years to now, New Year’s Eve, 2009. This year has turned out to be the annus horribilis of your humble narrator – mostly. I’ve been on the brink of sectioning on a number of occasions, the brink of suicide on others, I’ve developed serious psychoses, I’ve been twatted by the system and I lost my job.  Yet, there are a few glimmers of non-shit somewhere in there.

To that end, here, for your dubious delectation, is the good, the bad and the ugly (well, the bad and good anyway) of the last 12 months in the world of this PsychoFreakBitch…

THE BAD

Being Mental

Perhaps rather obvious, but yeah, being mental hasn’t been a great deal of fun.  I know I’ve argued that if I could flick that figurative switch to the sanity setting I wouldn’t do so, and I still hold to that, but nevertheless, the panics, depressions, mixed states, psychoses and frantic states are not exactly things that I enjoy.

As you know, faithful, darling readers, I have been mental for many years – my first diagnosis was in 1998, but in reality I did have some manifestations of madness well before that juncture.  However, 2009 was by far the worst year for it, as I think most of those close to me would attest.  The dysphorias, the exceptional levels of anxiety and the psychoses, all having existed before, have been exacerbated so considerably during the last 12 months.  I’m not sure why; maybe it is the intensity of psychotherapy, maybe it’s medication, maybe it’s simply the ‘proper’ development of BPD and/or bipolar disorder, given as they tend to manifest most strongly in one’s 20s, maybe it’s another psychiatric illness altogether.  Maybe it’s nothing more than coincidence.  Either way, it is.

Specific Issues on Mentalism

–> Psychoses

Tom was alright, but ‘They’ have been a hideous bloody curse.  Even with the anti-psychotic, ‘They’ are almost ever-present, though their severity was mostly reduced with said medication.  The worst manifestations of ‘They’ were when they tried to get me to kill myself and, worse again, when they wanted me to kill Marcus on Christmas Day.

Of course, the psychotic symptoms were not limited to hearing voices.  The shapes continued amok throughout 2009, though in retrospect I think I can say that I maybe noticed some abatement of their severity when I started taking Olanzapine.  However, I also developed new hallucinations, such as music, knocking and whimpering.  And I hallucinated my erstwhile stalker once.  Fuckin’ A.

Oh, and let’s not forget the delusions – A was in collusion with GCHQ, the sun and signs were watching and/or communicating with me, ‘They’ steal the thoughts from my mind, my cousin ScumFan was a drug dealer, A was not A but A’s sister, yadda yadda.

–> Dissociation

This has been pretty fucking annoying and at times highly disturbing.  There have been a number of times that I have found myself in dissociative fugue states – being in random places some distance from home, having no idea how or why I got there.  I need not explain the potential implications of these (admittedly relatively minor) fugues to my readership.

Of course, it does not take a fugue to make a dissociative episode.  Despite my ability to write 3,000 or more words on my sessions with C, my psychotherapist, it is not infrequent for me to dissociate parts of these meetings, particularly (unsurprisingly) when we are tackling something difficult together.  Several of the fugues have been in the wake of sessions with C.

I’ve also found myself in amnesiac states during or after arguments or highly stressful events, and of course I have the standard BPD features of depersonalisation and derealisation – forms of dissociation, I believe – on a frequent basis.

Although I’ve experienced depersonalisation and derealisation for years, I’ve only knowingly experienced full dissociative episodes – ie. proper periods of amnesia, losing time – in the last year.  Well…maybe it began in 2008, but it would mostly have been in 2009.

However, I only remember the rape and other parts of the sexual abuse in flashbacks, for example, and in discussion with C we have found that I have many ‘symptoms’ characteristic of someone who dissociated something traumatic in childhood.  The suggestion has been that, given the strength and quantity of these symptoms, there may be more than I don’t consciously remember.  I hate the idea for its own sake, obviously, but I hate it even more by virtue of the fact that it is not recalled (if indeed it did happen); it leaves me with a distinct lack of control over how I now react to triggers.  Perhaps that can be addressed in therapy over time (if therapy even fucking continues over time).

–>  Self-Harm

Is self-harm even bad?  Sometimes I really do wonder.  As a way to cope, it works.  As a way to fascinate (by virtue of watching the beautiful krovvy), it works.  As a way to seek absolution, it works (albeit temporarily).

Still, it serves as a permanent record of a very horrible year of my life, and I suppose in that way it could be considered a bad thing.  It’s something that, as of this writing, I feel quite nonchalantly about, but who’s to say in 10 years or something, I won’t look at my scars and feel triggered back into mentalism from which I may have found some relief?

I’m classing this as a bad thing of this year because, prior to 2009, I hadn’t engaged in any serious self-harm for years.  2009 saw it return on a relatively frequent basis.

Losing My Job

In reality, I was nowhere near as upset about this as I should have been, but one thing I really do detest is being in the hateful position of being dependent on the state for my living.  I had always dreamed of a career (not just a job) and the opportunity to use my intellect in a meaningful fashion.  I did not want to end up being a dolescum, and this is still something that I am hoping to change in seeking treatment for my madness.

So I suppose that is the worst part of losing my job; I now am officially everything that I never wanted to be in my adult life.  It’s also awkward from the perspective of my developing my career; having to explain a gap in employment of whatever length and an incapability dismissal will not be a lot of fun.

Trouble with the NHS

It all started with all the trouble with getting an appointment with, and then sustaining appointments with, the VCB.  Then C waded into the quagmire with his ‘I can only offer you 24 more sessions’ bullshit.  As you know, of course, I am fighting this.

Then there was Dr Arsehole just before Christmas (about whom I will write in the next ‘C’ installment), and the latest is that I have an appointment with Psychiatry on 20 January (more than a month after I was meant to have my most recent review appointment)…but not with VCB!  No, readers, apparently I am seeing ‘Dr M’.  What in the fuck..?  I might not like VCB, but at least I had got to know her to some extent.  But now they’re fucking me about again.  Arsecunt.

Christmas

It was fucking God-awful dreadful.  Enough said.

C

Not C himself; of course I don’t know the man in any realistic way, but my sense of him is positive.  OK, he does wind me up sometimes, and it is not at all unknown for him to actually anger me, but generally I am very fond of the man, regardless of whether or not that is simply a case of transference.  However, psychotherapy is not a fun process.  It’s not fun at all.  In fact, I believe firmly that it has made me more mental than I already was.

It therefore seems ridiculous to continue with it, but there’s method in the madness…

THE GOOD

C

‘Him again?  You just said he was a bad thing in this year!’

Yeah, I did, but he’s also been one of the most fabulous things.  Aside from my absolutely obsessive attachment to him, which I am pretty sure I wouldn’t have were I not very fond of him in a non-transferential sense, I believe the therapy is good for me, and is working.  Yes, it has made me more mental, but I believe this is a temporary state.

In being forced to (re)live some of the most horrible things about my past and, to a lesser extent, my present and potential future, it seems inevitable to me that my conditions would be exacerbated.  I had to get worse before I get better.  That was what I expected well before I commenced therapy with C, and that is still my belief.

Additionally, and this is probably related to the transference issues, C is the only person to whom I will talk completely openly.  For a long time, I would literally discuss many (not all) things with him, but it is only in the last couple of months that I really have stopped abstracting things.  I’ve now let my guard down and allow myself to be vulnerable around him, and I trust him.  That kind of relationship, however strangely asymmetrical, is a big achievement for me, and I think if it is allowed to continue as it should that it will pay dividends in terms of my mental health.

Diagnoses

Some people hate them.  There are a number of other mental health bloggers for whom I have the utmost respect that consider diagnoses ‘diagnonsense’.  I do get where they’re coming from, but I am grateful for mine.

It helps me to be able to attribute certain symptoms to an actual illness.  Now I’m not saying I use the conditions as excuses, but they do explain some erratic and bizarre behaviour, and I find that rather comforting.  Furthermore, in saying I have certain illnesses, it makes my range of symptoms part of something, rather than just a nebulous bunch of ‘things’; quantifying it in this way makes it seem more real, I am convinced, to others.  Just throwing the term ‘depression’ out makes it sound like a cop-out (NB. please note that this is not my view of real depression at all – I just think that some people, ignorant of mental health issues, view the word this way.  They believe that “I have depression” equals “I’m depressed,”, which of course those of us who have been there know to be a fallacy).

One further positive I’d add about the diagnoses is that they have enabled me to connect with others that have the same (or similar) disorders.  I will be eternally grateful for that, and for the support and kinship those individuals have given me (see more on this below).

Turkey

Our holiday to Turkey back in September was probably the happiest time of this year.  As I wrote at the time, I felt entirely contented throughout our stay, and indeed we enjoyed it so much that we are returning to a resort close to the one from 2009 again in May 2010.  I will never forget the crystal clear waters, the warmth of the locals and the sheer relaxation of lying about in secluded coves.  Whilst reading Social Factors in the Personality Disorders: A Biopsychosocial Approach to Etiology and Treatment, of course.  I mean, obviously!!!

This Blog

I will always be thankful that I started writing this blog, and indeed that I kept writing this blog.  My initial hope was that it might help me to identify triggers, but to be honest in that regard it hasn’t been as successful as I might have liked.  It has, however, given me a focus – writing is an activity that, despite the sometime difficulty of it, is something that I enjoy, and can direct my energy towards.  It also serves as a chronicle of what has been an extremely difficult period in my life, but one that is also likely to be a highly formative one too, if I don’t end up offing myself.  I’ve found it fascinating to rediscover diaries I kept in the past, and no doubt I shall find the same with this – though I hope that I will still be maintaining this journal well into the future.

I’ve been ever so grateful for the wonderful feedback I’ve been given on this blog too.  Some people find my writing style engaging, which is a huge compliment; others find solace in the fact that they are not alone, as what I’ve written correlates with their experiences and/or feelings; yet others seem to be grateful to learn directly what everyday life, therapy or whatever with my various diagnoses is like.

On a similar note, the blog has enabled me to meet so many people with whom I have found affinity.

Twitter

By far the best thing I have done this year was join Twitter (I’ve met many brilliant people through the account allied to this blog, but even more again through my ‘main’, slightly less anonymous, account).  I have met so many wonderful people – both mentals and non-mentals – through this service that I could not possibly thank them all here, much as I’d like to.  The support, friendship, empathy and, frankly, in some cases love that I have been shown has been a source of immeasurable help, more than the personnel concerned will ever know.

–>  Thank Yous – Twitter

CVM*
K*
@bourach
@woundedgenius / @behindthecouch
@notbovvered
@fromthesamesky
@error505
@an_other
@kimshannon
@helentaustin
@benpolar

* Both of whom I now consider ‘real life’ friends – I have met K and communicate with her most days; I haven’t met CVM, but again communicate with her most days and certainly will meet her when finances and circumstances allow the travel.  I love them both.

The above is far from an exhaustive list, but there are others that I cannot mention to protect either their or my anonymity.  Some to whom I am incredibly grateful are not even aware of the fact that I write this blog.  That does not mean I value them less, however.

–> Thank Yous – Blogging Buddies

Some of the above-named individuals of course keep blogs, but they are not people I met originally through this medium.  The following are.  Thank you to:

Alix Rites
Crazy Mermaid
Borderline Case
The Prozac Queen
Pumpkin
Vanessa
NiroZ (no longer blogging, alas)

Again this is not an exhaustive list.

It is my honestly held belief that were it not for the aforementioned individuals – both the Twitter friends and blogging mates – I would either have killed myself or been horribly sectioned this year.  So thank you to all of you listed, to many not listed, and extra special thanks to a select few – I hope you know who you are.

Friends

Of course, real life friends have been of immense value to me this year too.  I haven’t been fortunate enough to see my best friend D an awful lot, but we’ve have corresponded via email and communicated via the hated telephonic device, so of course I am very grateful for his support.  In spite of an acrimonious break-up of a serious relationship, not to mention other problems, D has still been there for me through all of this sorry year, and for that I am significantly in his debt.

B has also been very supportive.  It’s not that we tend to go into great detail about issues of concern, but he’s just there, and that means a lot.  In particular, like D, his ability to provide a metaphorical shoulder to cry on whilst dealing with significant difficulties in his own personal life is testament to his integrity and the strength of his friendship.

AC has also been great; as well as actually giving a shit and supporting me through mental illness, AC has also been there just for those ordinary, everyday things that friends do together – the theatre, lunch, whatever.  I also must hat-tip DL for this too.

Honourable mentions to A’s friends and family too.  Even though they’re (mostly) not conversant with the finer points of my mentalism, they nonetheless have been a source of fun and comfort.

And of course a re-acknowledgement of CVM and K

A

Saving the best for last.  He’s seen it all, and it all ain’t pretty.  Yet he is still there.  Still loving, still comforting, still supporting, still protecting, still fighting the corner, still providing, still entertaining, still staying sane.

There are no words.  ‘Thank you’ seems so woefully inadequate, but it is all I have.  I just want to make it publically known that I will always owe a debt of gratitude to A for everything he has put up with this year.

AND FINALLY…

This post might lead you to believe that there was more good than bad this year, and I suppose in the most objective of senses that may be true.  This is why something like CBT will never work therapy-wise for me; it doesn’t matter how much evidence there is or is not for a belief – the belief is still held.  The reasons for the belief need to be explored fully and processed.  But I digress.  My point: 2009 was an absolutely fucking shit year, and I will be glad to see the end of it.

But I have hope.  A small glimmer thereof, but a glimmer nonetheless.  Not of a miraculous cure, but of some stability maybe.  With the help of C (I hope) and the love and support of my fabulous friends, both those in the physical world and those online, there might just be a path to stability somewhere down the line.

Happy New Year folks.  If ‘happy’ is ambitious, then at least I wish you peace and something approaching sanity in 2010.

Yours ever

SI x

First Signs are a UK-based charitable organisation devoted to the prevention, or at least the minimisation of, self-harm.  Whilst as regular readers of this blog will know, I don’t really see the big issue with (controlled) self-harm, I can and do admire the work that FS are undertaking.  If nothing else, at least they’re raising awareness on the issue – why people self-harm, that most people who do it aren’t dangerous to normals and so on.

However, as you can see from the title this isn’t a post espousing the worthwhile cause of this user-led charity.  I am writing in response to this supposed distraction technique.  Yes, folks, they are arguing that bringing yourself off is a viable alternative to cutting or burning yourself.  Riiiiight.

I read a lot of articles on psychiatry and psychology, much to the detriment of my Twitter followers (not so much on the account allied to this blog), but I rarely feel the need to respond to them.  However, I just find this article so ridiculous that in this case I felt compelled to do so.

The first thing that struck me about the piece was that FS had devoted the entire thing to masturbation.  I mean, even if you do accept that wanking is a credible alternative to self-harm, it’s not the only distraction technique that exists out there.  When C and I first discussed the stupid DBT bullshit way back in week 12 of our therapy, some of the stuff in the material he gave me was devoted to distracting oneself – and, as it happens, masturbation was mentioned (to which I responded with an ‘LOL’ which I know is really rather puerile)…but the difference was, it was only mentioned in passing, as one technique amongst dozens available.  No 1,300 word article on this topic per se was deemed to be required.

Personally, I think distraction techniques are all bollocks, but that’s not really the point.  The point is, to what extent is masturbation really a viable alternative to self-injury?

FS pose this question:

When you’re urging to hurt yourself, aren’t you looking for a release, and some relief from the emotional distress you’re having trouble coping with?

This basically forms the central tenet of their entire argument as far as I can see.  In fact, looking again at the article, it seems to be their only tenet.  What a convincing argument they must have if they only have one major thread to their point.

That said, OK – successfully orgasming undoubtedly does relieve tension, and no doubt endorphins are released upon climax just as they are in cutting.  But for goodness sake, how obvious is it that it is an entirely different type of release?!

I wrote about the satisfaction, if that’s the correct term, that I get from self-harm in this post a few weeks ago.  I suppose my main point was that bloodletting is beautiful because one feels, temporarily, that they are watching their own evil flow away along with their blood.

Which, to be objective, is the only point I really made – but it feeds into the idea that many people will injure themselves as some sort of ritualistic punishment for their perceived inherent evil, or for the self-disgust they feel.  I know I have been known to cut for this reason.

Why, then, would I allow myself the satisfaction of a pleasurable activity?  If I am a bad person, I need some obvious form of punishment, not a reward, whether that’s sexual or otherwise.  Now, satisfaction is undoubtedly garnered from the ‘punishment’ of cutting – but it’s not a premeditated satisfaction (masturbation is in my view, even if a sexual urge comes on one quickly, because it usually has a clear objective that one is trying to meet).  And in any case, the satisfaction is, primarily, mental, not physical (which is all masturbation, unless conducted mutually with a partner, can ever be).  You are satisfied because you have done what needed to be done to this bad individual; you have hurt them.

Of course, that’s only one aspect of self-harm.  One other major function of it is to reorientate oneself when going doolally or, as FS admit, to release some psychic pain in the same circumstances.

Now let me get this straight.  When I am going off my head in a mixed state or panic attack, am I seriously going to sit down and analyse distraction techniques (this is why I think they are all complete arse, as discussed here, for example, or there’s always this epic rant specifically about methods of distraction)?!  In particular, am I going to think, “Christ, life is so fucking terrible right now…an orgasm would make it better”?  Well, maybe it would actually, in an ephemeral sort of way, but would that really be forefront in my mind?  The idea, as any one who’s experienced such a state will appreciate, is ludicrous.

All one can think about when going mental is the mentalism.  The ‘decision’ to harm, if it can be termed that as it is not always conscious, is almost innate.  OK, so sexuality is innate too, but there the comparisons end.  Perhaps the reason for the visceral nature of self-harm in these circumstances is simply that its effects are instantaneous (my mantra to C: “it’s quick and it works”).  Even if we (erroneously) were to agree that an orgasm can have exactly the same physiological effects as self-harm, time (for most women but I reckon to some extent blokes too) is required.  One does not feel like they have time when one is going mental.

Another issue that escapes them, and my aforementioned post on blood being beautiful ties in with this, is that cutting isn’t always about pain or distraction; sometimes it’s about blood.  Personally speaking, I love watching the blood.  Occasionally I cut only to watch the blood and how it flows.  Again, if we make the false assumption that orgasm release = cutting release, where is anything tactile or tangible from that?  FS do state that “…masturbation doesn’t cause any physical problems..,” and in doing so of course acknowledge that cutting can and does of course have physical consequences – but, as I said, they miss the point that that can be exactly why it is done in the first place.

Above all, what antagonises me most about this article is how it trivialises the issue of self-injury.  Now, I don’t think it’s a big deal if done under controlled circumstances, but neither do I think it can simply be equated as having similar physical and mental properties as something that most people have done in their lives and that is seen, rightly or wrongly, as something to be sniggered about at the back of a classroom.

FS state several times in the article that they fully recognise that self-harm is a serious issue, and to be fair they wouldn’t exist in the first place if they didn’t think so.  Nevertheless, singling out masturbation as a distraction technique in this fashion strikes me as counting it as some sort of panacea in a path to recovery from self-harm.  That probably wasn’t their aim, and what they have written was clearly with the best of intentions, but it has sadly worked out as over-simplified and utterly ineffective.

It may seem like I’m saying, “fuck distraction techniques, self-harm for the win!” in this and other posts – I am not.  This may be what I think for myself, but I would not advocate such for anyone else.  One thing FS got right in this article was to remember that everyone is different, and so other cutters / burners / whateverers may find a range of distractions, including this one, effective.  To that end may I reiterate that I admire the work that First Signs do; I applaud their very existence.

But wanking is never going to be a viable alternative to the scalpel for me.  Sorry folks.

Thursday was fucking traumatic, a state of affairs of which you are probably aware given my citation of the disturbing imagery of Metallica’s Until It Sleeps that evening. You’ll have seen on that post that my iPod was reading my mind again in playing it – and other songs on similarly dark themes – but what is most interesting about this is that this strange form of electronic ESP took place as I was driving home from an utterly pointless dissociative trip to a coastal town about 20 miles from home.

My first proper awareness of going to said town was when I realised I was in the centre of it. I do have a very vague recollection of noticing my normal turn off and thinking that the traffic was heavy, but at no time did I think, “why the fuck are you not in that heavy traffic?” I don’t remember deciding to drive on, and I don’t remember the journey. Another small-scale fugue-like episode. Sweet.

I had been quite good on the self-harm front of late, but the good spell has been broken. ‘Bitch’ and ‘grief’ are the latest, though I don’t remember doing the former (it must have bled like fuck though as I had seemingly used a towel to stem the bloodflow). Grief. Am I grieving for myself, or for what I should have been? If so, is that good? Presumably one is meant to say, “well, the self-harm bit isn’t good,” but you know me folks – not really one to listen to that sort of argument. A is raging with C; in A’s eyes, it is C’s fault that I have taken to cutting myself again. But it isn’t. It really isn’t. All C has done is facilitate triggering discussions, and been someone to whom I am hopelessly attached, which is hardly his fault. We can’t avoid matters of this importance simply because there is a risk it may act as a trigger; the entire psychotherapeutic process would then be pointless, and I’d be left as mental as I ever was.

I’m unsure as to what exactly this entry will amount to, as I remember surprisingly little of the session – perhaps unsurprisingly. But let’s start at the very beginning and see what happens.

C pointed out that he’d been looking through his diary and saw that our current contract was due to end shortly (he thought there were two sessions remaining after Thursday; I thought one, but as it turns out it will not matter). This was something of which I was horribly well aware. Having only begun to open up to C properly in the last few weeks, I was convinced that he’d see me as a manipulative bitch – it looked, to my cynical mind, like I was trying to wrangle more time out of him by leaving the avalanche of confessions until this point. Given that my primary diagnosis is borderline personality disorder, it reasonably follows (in my eyes) that he could believe me to be manipulative, as the psychiatric establishment still seems to think that about those who have BPD more than any other psychiatric problem.

Of course, he didn’t like either the idea that he would find me manipulative, nor in particular that he would think this because I have BPD – that fixates on labels, don’t you know. Actually, it doesn’t, because it’s what I think he should think anyway – the fact that BPD is the only psychiatric diagnosis to still be treated with open contempt by mental health professionals just reinforces that point – though to be fair, I have not experienced that disdain personally, thank God.

I honestly don’t think I was being manipulative – not consciously, anyhow – but it did look like it, and that had been my worry all week. Of course, C refused to concede that this was the case in his eyes. Did he point blank deny it? I think he may well have done, but I don’t remember clearly enough to say for certain. What he was willing to admit to was that I may, consciously or otherwise, fear the end of the relationship, and act accordingly to preserve it. Which is apparently not manipulative. Hmm.

The issue of the end of therapy raised its ugly head a couple of times during the meeting. What he said at this juncture was that we should “…continue seeing each other until Christmas, at which point [he'll] be off for a fortnight, and then we’ll review the situation in January.”

Review the situation in January. You can take a wild guess as to what I think about that. He is going to throw me out with the dirty water in cunting January. Just over a month away, after the most stressful time of the year for me (ah yes, I’m sure you’ll be treated to a delicious rant about fucking Christmas in the near future, dearest readers). A tells me that this is not what C meant; apparently, he literally meant that we shall review the situation, and if further therapy is required (as if it won’t be), then that is what the case shall be. Well, Ms Rationality of course says, “yeah, right” to that. He is going to abandon me.

I honesty don’t remember how I reacted in session to the comment about ‘reviewing things in January’. I think I simply agreed and didn’t voice the aforementioned rejection worries, but I wouldn’t swear to it. As I said, it did indeed come up again, but I don’t remember under what circumstances. I can and do appreciate that the relationship can’t be permanent – in the most rational of ways, I don’t want it to be. I want to live an independent life, free of a need for a surrogate daddy. But can C realistically expect to change 13+ years of misery and being fucked about by the NHS in seven-ish months, particularly when I have such a strong neurotic attachment to him? Trying to be objective about it, I cannot honestly fathom that as reasonable, except in especially productive scenarios (which are about as applicable to me as…um…er…something that is very un-applicable to me). This is a personality disorder. It is ingrained into every metaphorical fibre of my self, the conscious, the unconscious, whatever – and it is causing me to self-destruct. Can something of such enormity and longevity honestly be treated adequately in just over half a year?

In any case, eventually the discussion – predictably enough – returned to the eminently delightful subject matter of the preceeding week. Eugh. It was me that raised it, though not exactly through choice; we were talking about something else (no idea what now) which triggered some sort of memory – it’s a shame I’ve forgotten what that subject was, as it would be useful to know these triggers, especially in cases where there is no obvious correlation, as I think the case was in this instance.

I became rather agitated and told C that I wasn’t “going there”. I hid.

Despite my telling him to leave it, he continued to probe me – but gently and quite subtly, to be fair. I eventually admitted that I was thinking about the Pandora’s Box.

My memory is even more fragmented from here on in, though some things do stick out in my mind very clearly. I was very, very careful not to verbally articulate much at all; at one point I desperately begged, “look, don’t you see where I’m going with this?” But it appears that he believes that I need to say the words. I still have not used the word ‘rape’, and strictly speaking he could still be under the impression that it was something other than rape – but he’s not that stupid.

He must have asked what was so troubling about verbalising this material, because I remember then telling him that I am fairly tolerant of articulating the gruesome information on this blog.

“Which is odd,” I mused, “given that it is all the more real when it is written down, even more so than if I verbally discuss it. It’s there, on the blog, in black and white.” (See here, for example).

I went on to postulate the idea that perhaps it is easier to deal with in writing because I can rationalise everything; life events become something that is seen in the third person, by a narrator, an observer with at least a modicum of theoretical knowledge of that about which she writes. If I have to talk about it, I have to feel it. I am there, in the midst of it, with the rawness, the vileness, the trauma of it all.

He agreed. He didn’t say so, but a sense that he wants me to feel that repressed pain was very palpable. Maybe that is why he was such a cock when I put this, and other shit, in writing for him – in fact, I’m certain it is. What kind of profession capitalises on other people’s grief? If I asked him why he became a clinical psychologist, I’m sure he’d respond along the lines of that old cliché, “I want to help people.” What, by making them relive their darkest memories, by making them suffer through them all again? Does that not take a special kind of sadism?

I am, of course, being a little facetious; I don’t believe C to be a sadist in the least, and I do believe he is in his job for the right reasons. But the human mind, and the sciences that arise therefrom, are odd things indeed. It strikes me as strange that it is an apparent psychological necessity to directly face that which you most revile in your past, before you can heal from the wounds it inflicted.

But this is not a post about the curious concept of psychology as an academic discipline, nor is it a post about the mindsets of those practising this form of figurative alchemy; it is a post about a session I had with my therapist. So…was it at this point that I lost it? I’m not sure, but anyway, in my next clear memory, all I could see in my head was the INCIDENT, or more specifically, the moments during which I was pushed to the floor of the outhouse in which it took place and served up as tasty piece of young meat for the delectation of my uncle. I recall very strongly that (in C’s office, not in my mind) I had my head in my lap and was pelting my skull with both fists with as much strength as I could muster. I have never done anything of this ilk in C’s company before.

And so he too did something that he has never done before; he raised his voice to me. He didn’t shout, but he did raise his voice just enough to try and penetrate through the mentalism that had tenaciously gripped my mind.

“SI!” he called. Well, he didn’t of course – perhaps it will surprise some of you to learn that I have a name, a normal, very ordinary name, and he used that instead – but you know what I mean. One thing I’ll not forget about this session was that he actually used my name three times, and at one point I used his too – these things are unheard of in the whole time we’ve known each other. Does it mean something? Why do I attach such importance to something so apparently normal and trivial? Is it because using names is personal, and that I want to see him as a person, not a canvas? Who knows. I certainly don’t, but I do know that that memory sticks with me.

I think he must have somehow brought me back from this mental place, but I don’t remember the specifics. The next part of the conversation that I recall was when he asked me how I felt about myself and that I told him that I felt like a “dirty, fetid little slut.” I then rationalised things for a bit, proclaiming that I am in actuality not a slut. Unfortunately, I still felt (feel) like one.

Then I lost it again. “I’m a filthy whore,” I spat, hiding from him again with my hands.

I think he actually went as far as to tell me that I am not a whore, but that could be a phantom memory. I mean, how the fuck would he know? I could have sold sex in 28 European capitals for all he knows. One thing he definitely did do was try and help me regain my composure. I sat up and pretended to be fine, sticking out my hand to measure how much it was shaking. I have used an incident when I was about 15 as a yardstick to measure anxiety; the day after I found out about an incredibly twisted lie from my first real boyfriend (a long story that I will have to detail some day), I went into school and, in English, happened to notice how much my hand was shaking. That denotes severe anxiety and/or anger. If the shaking is less than that, things could be worse.

I told C about this. However, a brief reference to the lying cunt of an ex must have touched on the self-disgust I was already feeling over my own lying to C about the INCIDENT (when we first met I told him it was ‘mere’ touching, but that was only part of it, obviously. More on this shortly). I told him this – still without using that word – and went into a major self-invective of utter disgust and abhorrence. It was filled with ranting about how much of a shameful, lying, grotesque, hateful slag I am, lying to the one person that might be able to bring me back a little hope in this sorry mental battle, and about how guilty and sorry I am, blah blah de blah.

When I took a second to draw breath, he jumped in to try and (a) reassure me that I had nothing to feel guilty about and (b) establish exactly what it was that I felt I’d lied about.

I answered (b) first, at least to the best of my recollection. He’d specifically asked in our initial assessment sessions what form the sexual abuse took. As is my wont, I had avoided articulating myself properly, and instead managed to answer the question merely by his probing. I think, though I am not certain, that he asked if I was raped, and that I said ‘no’. I am sure that when he asked if it was inappropriate touching that I said ‘yes’, and that I led him to believe that that was all. In my defence – and I told him this in the session to which this post refers – I have dissociated a lot of the INCIDENT. I remember ghastly, loathsome pieces of it in fleeting glimpses, like looking at still pictures in an album or, sometimes, short video clips. I remember the sensations of pain and terror in these moments too. I am grateful that the memories are so brief, but also resentful of it too, as it feels like it removes my power to understand the INCIDENT and my reactions to it. Furthermore, obviously part of me does remember it, and that part is mentally fucked – perhaps it would be easier to address were it all consciously there at the front of my mind.

Anyhow, I then proceeded to respond C’s (a) point. “I lied to you,” I said simply. “Aren’t you angry with me?”

“No, of course I’m not angry with you.”

“Why not? You should be.”

He sort of laughed (he mustn’t have realised I was serious), but seeing the look on my face, he desisted from doing so abruptly.

“SI,” he said again, firmly, looking straight at me. “Do you seriously think that I should be angry with you?” His tone was a more compassionate version of ‘incredulous’.

“Yes,” I began, “fucking dirty, lying, grotesque little bitch, fucking…”

“One,” he interrupted, rather dramatically, leaning forward and counting on his fingers as he did. “We had only just met and you can’t honestly have expected yourself to deeply discuss such sensitive matters with someone you didn’t know. Two, you didn’t lie, you omitted some information…”

“But then that’s a lie of omission…” I began.

“Three!” he went on, raising his eyebrow in a surprisingly authoritative fashion, signaling that I was to let him finish, “three, this is hard for you to talk about, so it is not surprising you withheld it. What is there to be angry with?! I am not angry with you, and neither should I be.”

Well, that was me told, then. I was quite taken aback by the forcefulness of his tone. Actually, ‘forcefulness’ is a horrid word to use as it has negative connotations – let’s say ‘emphatic’ instead. He was incredibly emphatic. I gaped at him in a sort of stupefied disorientation for a minute or two.

He sat back in his chair, recovered his blank canvas and either asked me how I felt, or signalled for me to speak.

“Um…” I muddled. “That’s reassuring. I do feel reassured. But it also confuses me; you have a completely different attitude to it from me.”

He seemed to understand that in fairness, which not an awful lot of people would. He was able to see the black-and-white chain of logic that I was following in believing that he ought to be angry, but luckily for C things in his world do not seem to be as black and white as they are in mine.

I don’t remember how things ended. I know that I was battered and bruised psychologically (and physically to boot what with punching my head). At no point had I been tearful, but one does not need to weep to mentally suffer. I went and sat in the car and phoned A for catharsis and reorientation purposes. Although the trauma of reliving the INCIDENT had been the most awful aspect of the session, the fact that I fixatedly whined to A that C ‘wants to abandon me’ before I even touched on the rest of things is very telling.

In later discussions A urged me to tell C about this abject fear. What’s the point? C already knows I’m terrified of him abandoning me. Perhaps the real question is ‘is my attachment to him healthy?’ There have been mixed views on this from the readership of this blog. cbtish, for example, thinks it puts me in an intolerable position (cbtish is a therapist). Vanessa from eTransference, a clinical psychologist in training who has a particular interest in the phenomenon of transference, thinks it ought to be encouraged in many ways. Others undergoing therapy – bourach and thesamesky (who’s also a counsellor) for example – have their own struggles with the therapeutic dyad (bourach in particular will understand why I thought C should be angry with me, given this post of her’s).

I don’t know what the answer is; just that the attachment is very real. Just that I feel guilty for withholding information and for lying (though he wants me to stop that – and I’ve just remembered that the session ended with him asking me, again, to try and not post-mortem things in therapy. Oops. He was also worried, after what happened with VCB’s SHO in September, that his actions or words could have a…er…detrimental effect on me. Double oops. All I can say is that I think our current dialogue is progress, regardless of any self-harm that follows). And at least I am far from alone in withholding, and even lying.

But it’s still all a bit of a quagmire, yes?

I’ve been avoiding writing this entry, in part due to a continuing malaise with being arsed to do anything, never mind soul-searching and expunging myself across the internet. But it’s not just been that. There’s nothing that I am going to say that is unknown amongst the circles that read this blog, but talking about this shite in therapy and then making it a concrete black-and-white reality in a journal make it real, and it is not allowed to be real, not by me at any rate. So I have been avoiding it. You should note that I am deliberately going to refrain from putting some details here, due to their personal nature, but I am sure you can forgive me.

Thursday’s session with C was one of the most frank and revelatory that I’ve experienced to date. It was a strange meeting, because initially I thought it was going to be one of those useless, ‘let’s both stare at the floor’ encounters, but if anything it ended up becoming one of the more useful (if difficult) sessions I’ve had in psychotherapy, because we finally began to face some of the stuff I’ve been so strategically avoiding in the last six months (and, frankly, for much of my life).

I was greeted with that usual opening gambit of, “so where would you like to start?” I know why he does this (“the dyad is a co-construction but you have to help inform it by raising issues of concern” or some such, no doubt) but seriously, is it really so much to ask for him to just ask me a question about something he thinks is worth discussing? Although I wasn’t in the same agitated mood that I was last week, I sort of shrugged off the question and we looked at each other.

Two points of interest arise for me here. One – why do I have such trouble just telling him where I would like to begin? Let me try to articulate how I feel in the moments immediately subsequent to his opening question. I suppose the closest I can really get to it is to say that it just feels inappropriate. Is this a boundaries thing? Is it something to do with a possible perception on my part that he is an authority figure? It just feels like I’d be breaking a rule, that it is something of inherent embarrassment to me, like I’d be showing myself up like a child humiliated by her teacher or parent.

Two, regular readers will know that C has directly confronted me – if I may use artistic licence with the term ‘confront’, for want of a better one – about the fact that I hide from him. I mean that I literally hide, not (just) metaphorically: I have fairly long hair, and I either wear it loose in his office and hide behind it, or I take it down from a ponytail in his office, and hide behind it. I also put my hands over my face to avoid him. How, then, is it that I can stare him out at other times (note that above I stated that we stared at each other for a bit)? In fact, I do the stare with such intensity at times that I think I unsettle him – whether or not that’s correct, at the very least I usually win ‘stare-outs’ with him. I stare and stare and stare, confrontationally, challengingly, defiantly even, all in a strange dance of intellectual seduction, no doubt designed to avoid actual exploratory psychotherapeutic work, which is no doubt exactly what this o’er weighty prose is also designed to do, so I shall forthwith desist from it. To try and answer the question, though, my suspicion is that the ‘hiding’ occurs when I am vulnerable or open with C, and the staring when I feel confident or (probably erroneously) believe myself to have the upper hand in the dyad. I am a walking Freudian stereotype.

The beginning of the discussion – and in fact the first 30 or so minutes – were really pretty innocuous. One thing that completed cracked me up was that he made enquiries as to the nature of my finger injury. Initially I was slightly taken aback by this – why the fuck would he show friendly concern over a cut finger? That is at most a medical problem, surely? However, I explained the circumstances in deliberately pedantic detail.

He nodded and smiled slightly in that irritating ‘oh-right-that’s-nice way’ that he does when I have said something that he deems irrelevant (which was most frustrating in this case, as he instigated the discussion), seeming apparently satisfied with my response. I wasn’t going to let him off with it though (more avoidance?) and said, “you thought I did it deliberately, didn’t you?”

He hesitated; I think he was reluctant to answer that, but for once he did give me a straight response, stating that, “that had been [his] thinking.”

For some reason I found this preposterously hilarious, and laughed and laughed. Although he tried to humour me, C was clearly puzzled by this amused lunacy, and retrospectively speaking, so am I. OK, so trying to severe my finger hasn’t exactly been my self-harm MO to date, but then this is the girl that recently bought, for the purposes of cutting herself, a surgical scalpel from eBay, and as a young child tried to amputate her foot. His supposition was not that terribly unreasonable when you think about it.

By whatever means of progression, we ended up engaging in a fairly length discussion about ‘They’ and the VCB’s prescription for an anti-psychotic to combat ‘They’. C, correctly, kept calling ‘They’ ‘them’ when ‘They’ were the objects of his sentences. He then went about correcting himself and apologising to me, apparently believing his ‘incorrect’ term was some sort of invalidation of me (because throwing a whole ream of hard work back in my face isn’t, but whatever), but I honestly couldn’t care less. It doesn’t matter what C calls ‘They’ – it’s not exactly going to rid me of their malice, is it? And his ‘mistake’ isn’t a mistake – he’s correct. Allow me to honour Dr Freud again; does my refusal to name ‘They’ in correct grammatical terms hark back to childhood trauma, when such niceties of the English language were only beginning to be understood? No, it probably doesn’t, so let’s move on.

The discussion of ‘They’ led on to further perusal of my recent psychoses (as detailed in the ‘They’ post and in this tweet); namely, the knocking, whimpering and music. I told C how I sinister I found them all, in particular the heinous music, but that in some odd, vaguely altruistic way, the whimpering was the worst. My desire has been to help the whimpering creature, to rid it of its obvious pain, but of course I cannot do that as, oddly enough, it isn’t fucking there because it doesn’t fucking exist. On the other hand, I explained, even if I could find the source of the whimpering, my pathological fear is that it is a trap laid by ‘They’ to somehow torture my mind further…or indeed worse (if you can euphemistically call taking me out ‘worse’, and I am not convinced that you can).

Anyhow, so far so tame. Well, not so for a normal, but yeah – let’s stick with ‘tame’ anyway. Unfortunately I walked into a trap at this juncture. Well, that’s unfair; C didn’t mean to dig into something right at this point (or at least I don’t think he did), and even if it had been a probing question, it would not be fair to consider that entrapment. He merely asked how I experience these sounds.

I won’t go into my answer nor the next 10 minutes of conversation, as this is the personal information to which I alluded in the opening paragraph. This remains private, between C and me, and no one else; all I’m willing to say is that it relates to me protecting myself. I’ll make only two other points about it. Firstly, this particular subject could have been horribly uncomfortable and awkward – and with the wrong person, it indubitably would have been. But I felt at ease with C, relatively speaking, and thought he dealt with it with tact and sensitivity. Secondly, this part of the session ultimately led to one of the topics I have been dreading to face in detail.

“You’re opening a Pandora’s Box here,” I cautioned at this point.

“Do you want to tell me what’s in the box?” C responded on cue.

I very deliberately turned round to look at the clock, noting only 10 minutes remained of the session.

“What a shame we don’t have time for that,” I smiled, probably patronisingly.

He took another route. “Can you even tell me the name of the box then, or give some details as to its contents?”

I took a deep breath. “You are aware of what happened with my uncle.”

He nodded, and what followed was some slightly circular discussion about my continuing worries about Marcus and his soon-to-be sibling (my cousins twice removed, or third cousins if you prefer the more common, yet inaccurate, assessment), and how that’s diminished a little of late*. Another point was regarding Maisie’s husband’s exact relationship with me – ie. that he is my uncle by marriage. There was subtle reference as to what extent the incident (lovely word) has consciously impacted upon my life in the last 16-ish years.

Finally he said it. I don’t remember his exact words, but it was something like, “you haven’t told me it all, have you?”

That sounds like he phrased it in a sort of blaming fashion, but honestly, he didn’t. I just remember that it wasn’t something like, “there’s more to this”, because I’d have said ‘yes’ to that, whereas the correct answer to the question above was ‘no’.

I didn’t feel like a child, or at least I don’t think I did. I did, however, bow my head, look up at C from this submissive position and shake my head slowly, sadly and in a horribly resigned sort of manner – just like a child does when faced with a similarly awkward position. Submit submit submit. You lied to him, you little bitch, you lied.

I would reiterate that this is my thinking and that I got no sense of blame or recrimination whatsoever from him. Still, I hate the fact that I actually outright lied to C about this matter in our early discussions. I hate it. I hate it almost as much as confronting this bollocks itself.

We didn’t talk about the whole shame issue I mentioned in the sex abuse post, simply as there wasn’t time. We did spend the few minutes that were left exploring who else was privy to the information – A is one of only two ‘real life’ person to whom I’ve actually spoken the word ‘rape’ in this context, though a few others will have now found out thanks to reading the material I’ve written on the blog.

The other person who heard me use the word was my mother. Her reaction to the whole thing is a subject for several sessions with C as, to be honest, her way of handling it wasn’t exactly in my best interests. I gave C the brief version, which is what follows, though of course it will be revisited I’m sure. When I first confessed to my mother that anything happened, she said that I had misinterpreted McMF’s husband’s actions, as “he loves children” and would touch them in innocent, companionable sorts of ways – that must have been what happened, SI, you silly girl! Mum still holds to that position, on the very rare occasion that there is some sort of reference to the INCIDENT. When I told her, on a separate occasion, the full extent of the INCIDENT, she – knowing I am not a fan of the McF dynasty – said I made it up to avoid going to their house. Cheers mother.

Of course it was not just the INCIDENT that permeated this period in my ‘relationship’ with McMF’s husband, though that was always the worst bit – well, obviously, I suppose. The fact that I mainly have flashback-like recollections of the worst part – ie. my wriggling under him as he pushed me down and did what he wanted – is presumably suggestive of dissociation from there onwards, for which I am both grateful and resentful. There was more to it than just than one day too, and God forgive me, I played up to it. I did. I played up to it. I would wear short skirts in front of him and make suggestive comments to him – not because I wanted him to touch me ever again, but because I wanted him to suffer (the rationale being, “oh, you want me, do you fuckhead? Well, you can’t have me!”). When he did later touch me again (once in a room full of other children – thanks for that memory, mind), I would seize up and eliminate myself from the situation with as much speed as possible. It makes my skin crawl to think of this.

Yes, it makes my skin crawl, and my reaction to it makes my skin crawl. I know I was a child, and I know flirtatious and sexualised behaviour is a common response to child sex abuse, but I feel like a grotesque little slut nevertheless.

Readers, I cannot do this. I cannot face the enormity of not just this hideous link to the past, but also that of the first boyfriend saga, and that of the desolation of grammar school, amongst others. How can I face this all with C? How? I can’t even face it with me! I am not strong enough. I am weak. The word flows through my blood and inhabits every cell and fibre of my being. Weak, so, so horribly, pathetically weak.

OK, I have totally digressed. This post was about a session with C, and I have turned it into a mini discussion on child sex abuse and my failure as a human being. Sorry. To return to the point, C and I had to finish the session after the talk about my Mum not believing what I had told her about her brother-in-law. A Pandora’s Box indeed. I should have kept my mouth shut – the next few weeks are, I suspect, going to be tough.

And yet I should not have kept my mouth shut because it needs to be confronted, and in this way I am heartened too. Even though I don’t think I can do it, it is a real development. It’s only taken six months, but what’s half a year between therapist and client!

The session ended with C advising me that both offices on either side of him are being renovated shortly and that as “we can’t do work of this nature with such noise”, we’ll have to have an office change. It will be the second, which is a completely cuntified state of affairs – but there is an upside to it. The building work, which is starting in two or three weeks or so, is due to last for 12 weeks. Our current therapy contract is due to end on 26 November which would mean only two more sessions, which from my point of view simply cannot happen or I’ll be straight into the bin (or the ground – who’s discriminating). But C said something like, “so we’ll have to move out during that time…”, which is an excellent statement, as it strongly infers a continuation of treatment for the foreseeable future. Certainly, he once told me before that there would be a minimum of a four-week preparation period prior to any cessation of therapy, and very clearly that has not come to pass, but whatever way he phrased his words it sounded like he still expects to see me back in the current office when the work is over, so that’s a decent extension to the current timeframe.

What I expected to be a reasonably short post has turned into my usual 2,800 word bullshit. I see, reading back, a lot of pontificating about words and language. More avoidance?! Anyway, I’m going to bed. Goodnight, dearest readers.

* I’ll blog on this in a future post. Suffice to say, I saw Maisie’s husband the other week and he really is a pathetic shadow of his former self which, for the benefit of his great-grandchildren at least, is a most beneficial state of affairs.

I have been incredibly good recently and haven’t self-harmed for about a fortnight. That’s good going for me since May.

That does not mean it isn’t on my mind, though. I think about it almost all the time – well, either self-harm or suicide. As things stand right now, it isn’t about feeling pain, or distracting myself from the mental agony of a severe mixed state or whatever. It is about a desire to watch the blood. The beautiful, dark, flowing krovvy.

A lot of other cutters get this, but I’m not sure normals do, or frankly ever will. At least in part that’s probably because it’s so difficult to articulate why watching your own self-inflicted wounds bleed has such ethereal beauty.

One argument is that it’s like watching the psychological pain flow away, however temporarily. However, when that pain can be contained (as in my present case), I’m not sure to what extent that point of view is applicable.

I think – for me, at present – it’s symbolic in a different sort of way. It’s such a perfect delight at the time because, by average societal standards, it is a dark and forbidden pursuit in which to engage. Enjoying it, wanting it – nay, needing it, at times – that’s “bad”, right? Yet it isn’t when you’re me.

It is beautiful because it’s representative of the darkness that inhabits me, and becomes a temporary acceptance that it might just be OK to be so internally flawed. That my ‘real’ being, with all her twisted, gruesome little thoughts, might just be, in some sense, a beautiful persona.

Of course the effect is, as stated, temporary, and the endorphins that (presumably) create this illusion leave after a short while, and you feel all the more fetid and grotesque looking at the scars that scatter your body.

But in that one glorious moment, it seems worth it.

Well, fuck me, but didn’t the VCB actually manage to bother her arse seeing me today.  Will wonders ever cease?!

I took my Mum with me to the horrible, dilapidated, thoroughly depressing place as I wanted VCB to see that I was nervous about seeing her.  And was I nervous, oh yes.

I had had about half an hour’s miserable sleep on the sofa so was completely mentally fucked in any case.  This made the drive to my mother’s somewhat interesting, but anyway, she drove onward from there.

I began to regret requesting my mother’s company within minutes of sitting in the waiting room.  In my attempt to not appear mental and hyperventilating, I was a bit mental and hyperventilating.  I was rocking back and forth in the chair and covering my face with my hands.  The other nutters that were there had the courtesy to pretend they didn’t notice – initially, anyway.  When my bloody mother started going on that I didn’t “look OK” (10 out of 10 for observation, Mum), then they all turned round, as if her opening her mouth gave them a Licence to Gawk.  One of them looked like a bit of a freak.  The other one looked surprisingly normal.  I didn’t.  My hair was a mess, I was wearing the same trousers that I’ve worn on and off since about Wednesday and I was deathly pale, with big black circles under my eyes.  Not to mention the odd psychomotor movements.  Yeah.  A loon.

VCB kept me waiting, as well I suspected she might do.  Every time I heard the door open, I took a deep breath and got ready to face her, yet it wasn’t her.  Needless to say, this didn’t help my levels of anxiety.

Some rough-sounding bitch came in with what was, I presume, her father.  She had evidently already been seen by someone and was waiting for them to come back, but she was bloody raging.  She called the staff “dickheads” and said that her situation was “not fucking funny at all” and that her social worker was a bitch and that she was not taking any more of her crap.

Generally, I hope I don’t behave like this in public places, though I know I do here.  Nevertheless, I couldn’t help but feel the woman’s pain; these people are arseholes, and consistently seem to let patients down.  I also envied the girl’s ballsiness, if only temporarily.  I just knew I’d end up submitting to the VCB and I so desperately didn’t want to.  I wanted to stand my ground, demand answers and get help.

Another thing – the rough bint, as stated, referred to her social worker.  You may have read my rants on Twitter on Friday (here, here and here) that there are actually two Community Mental Health Teams (CMHTs) at the hospital in which the VCB and C are both based.  C and VCB will, in some way, be part of those teams, but as I understand it, CMHTs also include social workers, occupational therapists, CPNs, the stupid crisis teams and ‘duty’ teams who are there when your psychologist or psychiatrist isn’t.  The social workers, CPNs etc are, as far as I understand it, there for use alongside the professionals you normally see.

I’m not going to sit here and tell you that my mental health problems are the most serious in the whole vicinity.  They aren’t.  Mind you, I’m fairly sure that I’m not a million steps from sectionable behaviour, so they aren’t entirely innocuous either, are they?  So I’m wondering why it’s left to C to do all non-medical work with me.  As discussed in the comments of this post, it seems kind of odd that C is practicing psychodynamic therapy along with stupid DBT.  He is always banging on that whilst we need to tackle the underlying issues of madness, I also need practical measures to help me when I actually go mental.  I agree with him.  I just find it confusing to go from one to the other potentially several times during one 50-minute session.  bourach said to me that I should request a CPN to do all of the practical crap with me, leaving the actual ‘deep’ therapy to the psychologist.

In all honesty, I reckon a CPN or an OT or whatever would probably be shite; nevertheless, I think DBT itself is shite, so if it’s going to be insisted upon in my treatment, surely it is best served by someone specifically dealing with practical issues.

So, in short, I was very annoyed that LCP, C and VCB had failed to advise me of these CMHTs.  I did fantasise about ranting to VCB about it, but I reckoned that she’d only say it was nothing to do with her, which to be fair it isn’t especially as she is dealing with the medical side of things and fucking DBT and suchlike isn’t that by any means.  I do think I’ll have it out with C, though.  Was it his place to tell me?  I don’t know, but I do know that at least I can ask questions like this of him, whereas I’m way too scared of VCB to confront her, even if it were her domain.

OK, so that was a digression.  Sorry.  Eventually, VCB stuck her head around the door and summoned me.

Basically, the appointment was alright, but very little has changed.  Despite telling her about Tom, the voice, the delusions and paranoia, the increased mania and the stupid things I do whilst therein, and a full account of what happened on Friday, she is still not prepared to give me mood stabilisers and/or anti-psychotics (though thank Merciful Christ, she is not willing to section me either.  I think she realises that’s just about the worst thing that could happen right now).

In fairness, she has a fair rationale for not prescribing such drugs just right now.  Somewhere in this post, I outlined some of the mad things that have been happening to me since I started taking Venlafaxine – but I also drew attention to the fact that I thought it had made a very subtle improvement to my ‘base’ mood.

Encouraged by this, and at my own suggestion in fact, VCB wanted to double the dose to 150mg daily.  I begged her not to take it off me, as whilst it has a string of hideous side effects, at least it looks moderately encouraging as regards the depression side of things.

So, there are two things to consider in light of this.  The first was that she said that if I thought Venlafaxine had side-effects, then I should wait until I experienced mood stabilisers.  In fairness, she appreciated that I was probably quite aware of this, as she seems quite aware of how well informed I am about many psychiatric issues, including medication (C must have discussed this with her).  Secondly, and more pertinently from my point of view, she said that she would “never” make two medication changes at once (and by increasing the dosage of the anti-depressant, she is already making one).  She would – quite obviously, when you think about it – be unable to see what particular tablet was causing side effects or any changes in my mood if she made more than one change at the same time.

That’s fair enough, but the difficulty of this for me is that – given my original reactions to Venlafaxine – doubling the dose will probably send me utterly batshit again.  Even if it doesn’t cause me to react in such an extreme fashion, increasing the dose of this notorious drug is desperately unlikely to, in itself, stabilise my up-down moods and episodes of psychoses, is it?!  If she sees me again in six weeks, that’s probably bearable…but will she?

I actually specifically asked her this, and she said she would.  It fucking better be the case.

I also asked her, for the avoidance of doubt, if she would consider both anti-psychotics and mood stabilisers if things don’t change (which they won’t).  She said ‘yes’ to both.  I clarified that I actually quite like Tom, but that I recognised that hearing him was not normal (Obviously.  I mean…obviously!).  She agreed, but I think her greater concern (like mine) was regarding the other hallucinations, the delusions and paranoia.  Tom is benign (so far); they are not.  (Quotes to A – “why the fuck are you taking notes on me?  Are you in collusion with GCHQ?” //  “why is that sign trying to tell me something?”  //  “he [my stalker] is there, he’s fucking everywhere [he wasn't there]“).

She did give me some fairly useful advice on dealing with the stalker. It’s nothing I didn’t really think of myself, but nevertheless it sometimes helps to have it verbalised by someone else.  I don’t think I have the balls to confront the bloke in the way she mentioned, unless I’m once more manic, and she did acknowledge that it’s easy for her to say.  Still, I have to do something about the fuckhead.  VCB said, “I’m not encouraging you to drink per se, but I do think it’s important that you retain the normal routine and do things you enjoy, such as going to your local.”  So I have to face up to him in some way.

Sensing disappointment regarding her unwillingness to prescribe additional medication, she said, “medication is not a cure, you know [no, I had no fucking idea given that I've been on it for 12 years.  If it was a cure I'd be cured by now, you old horse!].  The best route to recovery is via psychotherapy.  I know there’s nothing immediate happening in yours, but I spoke to C and he thinks there’s good work being done there.”

I laughed in her face.  I don’t know why; I’ve stated time and time again that I do think there’s hope with C, and my hopeless attachment to him is almost a textbook reaction to a functional therapeutic relationship.  I think I’m angry with C for fucking off for a fornight…again.  Additionally, I remember that when I told him about my planned discussion with VCB that he’d suggested an improved mood was down to him, not medication.  This is funny.  I don’t know why, but it is.

I told VCB about it.  “I’m terribly fond of him,” I admitted, “but really – any positive change like this is strongly attributable to the medication, I think.”

She didn’t seem sure about that, not entirely anyhow, but she didn’t argue either.  Her contention though was that, even though we are pretty agreed I have bipolar disorder as well as BPD, that that illness also requires psychotherapy.

Now she’s a psychiatrist and I’m not, but I always understood that any psychotherapy in bipolar was about trying to recognise triggers, managing mania and mixed states, etc.  I didn’t think there was any exploratory psychodynamnic-esque stuff within it (unless it is co-morbid, as in my case), mainly as it’s largely an organic illness, rather than one supposedly created in large part by traumatic events like BPD.

When I relayed this part of the conversation to A, he said it sounded like she hadn’t a clue what she is doing.  Hmm.  I don’t know.  I suppose research into causation of mental illness, including bipolar disorder, is still ongoing.

So, anyway, it wasn’t the most productive meeting ever, but assuming I actually do get to see her in six weeks as promised, it could have been worse.  If I don’t, well – the shit hits the fan for her crappy department.

Despite the relative non-shitness of it though, I am feeling remarkably low and unmotivated and sad today.  I didn’t get much sleep as already discussed, and even though I appreciate VCB’s reasons for not prescribing me some cocktail, I must confess to some level of disappointment in it.

I was also irrationally angry last night when A told me of a discussion he had with his friend, in which A told him I was diagnosed with clinical depression.  That’s so last decade lol!  A told him that because he (very much a layperson) wouldn’t understand the terms BPD or bipolar, but I’d have thought he’d have understood the old term ‘manic depression’ at least.  This annoyed me as any time any of that lot see me, I’m in pretty good form; thus if he believes I have ‘clinical’ depression, it looks like I’m faking this whole damn thing (plus I’ve developed a crackpot identity beyond just depression since I first realised last year that it was more than that).  This potential belief was exemplified the other day when the bloke in question asked me how work was.  I told him I’d been off and said I was dealing with some “mental health issues.”

He said, “in other words, you don’t like work.”

Jesus fucking Christ, such willful bloody ignorance.  If it were about hating work then I’d have gone and got myself another fucking job.

My annoyance was compounded by the fact that the bloke’s father has suffered from depression but hasn’t responded to treatment.  Yer man therefore opines that it could well be that his “dad is just a dick”.  This, as I saw it, is a refutation that there is anything wrong with me or anyone else that has difficulty responding to treatment.  It is also suggestive that he believes depressed people are ‘dicks’.  Maybe it isn’t, maybe that’s just paranoia, but one thing it definitely is is ignorant.  It’s not entirely his fault; it is, of course, a greater problem in society than just one man.  But this in itself makes me despair.

If this is what someone that knows and seems to like me thinks, what does the world at large believe?

So: (stress of VCB) + (complete exhaustion) + (societal denial that my illness is as real as anything physical) + (other things that I don’t want to write about that really upset me) + (worry about OH on Thursday) = NOT FUCKING HAPPY.

Still, VCB didn’t section me.  I really convinced myself during the night that she would, given some recent events, but she doesn’t think it’s at that point, so I suppose I ought to be grateful.

Of course, almost by definition, being on holiday is not normality.  It is a break from it, a break from the humdrum everyday mundanity that is the rat-race in which most of us here in the West have to engage (or not if you’re a dolescum like me, but anyhow), not an experience we can hope to replicate as part of our ‘normal’ existence.

But I don’t actually mean the overall experience of having a break from it all, I mean the general emotions, behaviour and state of being whilst one is on said break.  I think, during my ten nights in the Turkish Republic, that I found something as close to “normality” in terms of these matters as I can ever remember.

I’d written here and here that I was manic the day we left, and the evening before that.  I’ve already offered my reasons as to how that differs from ‘excitement’, and it was certainly profoundly different from most of what I experienced whilst we were actually away.

I don’t particularly believe in ‘happiness’, not as a distinct emotional entity from mania, or at least genuinely-felt cheer, anyway.  This is not just cynicism; I really believe that the best any of us – mentals, normals, in-betweeners – can hope for is contentment in our lives.  If nothing else, the state of contentment conveys much greater connotations of relaxation to me.  ‘Happiness’ denotes a mood of elevation and excitement, which surely requires energy, and I believe that that can only be sustained for brief periods – ‘contentment’ suggests relaxed acceptance of life, the ability to contend with and combat any negativity in it, and that, I believe, can be (broadly) sustained over time – circumstances permitting.

So, I won’t say I was ‘happy’ whilst on holiday, with the exception of one manic episode (as A saw it anyhow), where I was randomly talking to the bar staff in a friendly pub we liked, and having my pictures taken with them.  This isn’t behaviour consistent with my everyday character, only my manic one, which is why A found it odd, but he let me continue experiencing it, as “normal people do it” and I was “having fun”.

By the same token, neither was I in a negative mood for the most part.  There was only one brief episode wherein I went mental – I broke a glass in our apartment which sent me into an insane rage at myself – but it was relatively minor and short-lived.  On the last day, I found myself quite emotional (I still hate that fucking evil word) and in tears quite a bit, as I didn’t want to leave.

The rest of the time, I felt nothing other than contentment.  I found myself constantly wondering, “is this what it’s like for ‘normal’ people, in the general course of their lives?” (of course whilst recognising we all have ups and downs, but you know what I mean).  Contentment and relaxation.  Both are so far removed from my version of normality that, despite the positivity of them, I found it all quite alien and perplexing.  But in a good way, I assure you.

Is this normal?  I’ve already questioned what the sodding hell ‘normality’ is anyway, and why I reject it, at least in part.  But if that’s it, then actually, I’d quite like some more, thank you very much.  Controlled madness, with this as my default mood, would be quite nice.  But maybe this is ludicrous idealism; perhaps my default cynic is right – ‘normality’, even for normals, is simply existence.  Achieving contentment, something akin to proper living, maybe – probably – takes a lot more work.  Maybe I’m wrong above and contentment isn’t a broadly sustainable state of being – perhaps a better way of describing a life that isn’t mental or shit in the long-term is to, paradoxically, say that one is “content with not-particularly-content”.  Content with mere existence.

Well, it may not be quite as enjoyable as what my perception of contentment in Turkey was, but it’s better than what I usually know.  Things have been shit (normal) since I came back, and it’s not just a case of the post-holiday blues.  Those of you that read the password-protected post will know the reasons, but in brief summary to the rest of you, the psychoses (auditory and visual hallucinations, severe paranoia and delusions) have been worse, I’ve got a fucking stalker through no one’s fault but my own and my mood cycles between depressed and mixed states.  I’m also experiencing the hallmark BPD traits of severe derealisation and depersonalisation at times.  I never like hypomania, because I know it ends (sometimes abruptly), at which which point you can crash and burn – but I’d rather have it than this.  Even more than that, I’d like to have my contentment back.

This week is not going to make things any better, I fear; it all starts when I have to see the VCB in the morning.  She has it in her power to change my mood right round, but she has let me down so many times that I simply do not trust her nor expect that.  I would not be surprised in the least if she actually exacerbates things – but if that’s the case, she better be prepared for some extra attention from the media, the voluntary sector advocacy services and high-ups in the NHS – I’ll write to the Minister and Permanent Secretary of DHSSPS (essentially, the NI Department of Health) if I have to.  But it’s all too stressful to think about now.  I hate thinking about it.  I hate thinking about her.  I hate thinking about that building, her office, the other mentals, the car park – and the fact that there’s a bin and a day-bin right beside it.  Bleugh.

Then I have to go to occupational health on Thursday, which is especially shit as even though it seems to be with the nice OH doctor, things simply haven’t changed since I last saw him.  That’s largely because VCB has neglected to see me, so I don’t have anything/anyone other than C (and frankly, not at the moment him either) to help me to control my all-over-the-place moods, other than stupid practices of ‘mindfulness’.  So yeah, I have to go there and say, “well, aside from the wonderful further development of psychoses [most notably Tom, the voice], things are exactly the same, so this meeting is fucking pointless and you should just tell them to fucking sack me and stop this silly little dance of procedural ass-covering.”  Meh.

Sorry again for whinging.  I seem to have been doing quite a bit of that this last week.  On a brighter (?) note, I said that I might share a picture with you from the holiday.  I have decided to do so, though obviously you won’t be able to identify me from it (or if you can, please let me know as that would be unacceptable!).  Below is SI…but what is that she reads?!  She lies on the beach of a remote, idyllic, tiny and largely empty cove, on the shore of the clearest water she has ever seen, basking in the beautiful warm sunshine…

…and she is passing her time reading Social Factors in the Personality Disorders: A Biopsychosocial Approach to Etiology and Treatment.

This picture was not a set-up.  I really did spend most of my time at the beach reading it.

Well, as if you needed it, there is proof that I’m a freak.  It’s a really interesting book though, so thanks to beautifulstones, one of my blog readers, for suggesting it.  It came on a great journey with me

Things are, indeed, bad.  I seem to have got myself a stalker.  Did I write here that a few weeks ago whilst manic I went up to some bloke in the pub and started talking to him?  Well, if I didn’t chronicle it, then there you go.

A was with me, and it was all totally innocent – the man in question is a grey-haired biker git, 20 years my senior.  Not that age matters a fuck to me, but really – there was nothing sexual or romantic about this liaison in any way.  He seemed fairly genuine too, and the three of us got on well, with shared interest in music and whatnot.

Unfortunately, I shortly realised my mistake and tried to get away; I’d nothing against having a pint with this man, but I didn’t want to spend all night with him.  But it wasn’t that simple, and to my horror I found myself agreeing to exchange phone numbers with him.

He harassed me on and off a few times but whilst it was bothersome, as I despise the fucking phone, it was little more than a nuisance.  However, just before we went on holiday, he rang me and was on the bloody phone for about an hour.  Towards the end of the conversation, he made a number of sexual comments that I don’t want to even think about.  I listened in horror, unable to hang up, though I eventually managed to ‘politely’ get away.

In consequence of this conversation, I have ignored the little contact he has recently directed at me.  He seemed to have got the message.

So, A and I went to the local after dinner last night.  We scouted it out for Blokey Bloke, and he wasn’t there, so we sat down and began to engage in conversation.  After about 20 minutes, though, to my horror, I saw Fuckhead cross the path of my peripheral vision.  I pretended not to notice him at first, but he’d clearly seen us and basically pushed me out of the way to sit down with us.

I wouldn’t say that A and I encouraged the conversation particularly, but what we didn’t do was tell the miserable son of a bitch to fuck the fuck off.  No, we both chickened out.  Pathetic, miserable wusses.  Me especially, as it was my fucking irresponsibility that had got me into the damn mess in the first place.

We pretended that we had only intended to come in for one drink and promptly left, and went to the other pub in the vicinity.  But by then I was so freaked out I kept seeing yer man.  He was there, in the bar – yet he wasn’t.  Then the bloody voice started wittering on.  Then I really lost it and was crying and panicking and begging A to protect me from everything and my skull was splitting and frankly, had A been a psychiatrist I think I’d have been sent to the bin right then and there.

Perhaps needless to say, A took me home.  I think I was able to feign having calmed down to some extent, but when he fell asleep I tried to sever the arteries in my ankles.  I momentarily tried my wrists too, but decided against that as the blood would be much more visible to me, what with one’s hands being much closer to one’s eyes.  I do like watching the blood from cutting, but I understand that severed wrists when done properly are actually pretty gruesome; you can see much more than just blood.  So I abandoned that.

As you can see, this pathetic suicide attempt failed.  The agony of trying to slit my ankles was indescribable, and the cuts that are there are little more superficial than any non-suicidal self-harm cuts.

I bandaged my feet and went to bed and did sleep briefly, but only for a couple of hours.  I woke at maybe 2am and have essentially been awake since.  The cat threw up on the landing and I used the bandages of my by-that-point dry wounds to clear up the vomit – how strange and surreal.

Today I can feel a migraine coming on, and I feel guilty about the cuts because I know it’s not fair to put A through this crap, and I’ve got to see the in-laws tonight (not that that’s a bad thing, however).  I’m also aware that I can hardly ever go for a quiet drink again without whatshisface harassing me, as he frequents both our locals.  I suck so utterly profoundly.  How irresponsible and stupid!  So, life could be better.

A wants me to tell VCB about last night but I think she needs to hear the redacted version.  I really don’t think being binned would help my fragile mental health; psychiatric wards sound like places of great evil to me (group therapy?  Fuck off.  Other mentals wanting to talk to you?  Fuck off.  NHS neglect, food and general wastage?  Fuck off).  I am seeing VCB on Tuesday and am terrified, then on Thursday I’ve got to go to occupational shitting health.  So another great week awaits.

Sorry for whinging.

As you know, I’ve been on holiday, and as you also know, I promised I would go into more detail about the three mental health appointments I had in the days that preceded my departure. I had started this post well before going to Turkey, but despite my claim that I’d finish it on the plane, of course I didn’t; even flight-safe phones such as the iPhone were not allowed to be used onboard. Obviously in Turkey I was trying to enjoy myself, though as you will see in a later post that did indeed involve some forays into psychiatry. Anyway, I’ve finally got round to the post in question, so here it is.

—

Tuesday: The Psychiatrist

I said I’d go into more detail about how I responded to the psychiatric SHO on Tuesday 8th. Basically, I said I couldn’t deal things any more (I’m sick of my up-down moods and am worried about the effect some of my psychoses are having not just on me but the others around me). I said I’d been pushed from pillar to post by Dr C’s department – due to the ridiculous saga to be seen by them in the first place, then their cancelling an important appointment in July – and that I thought it was unacceptable.

The thing was, I was in a complete state and it sounded more than I was pleading with her than that I was angry with her. I was begging, effectively. My first reaction to her refusal to do anything was one of panicked desperation, and I half broke down, but she merely apologised and said she was too inexperienced to deal with a case like mine. She blamed the department’s failure to have me sitting there with Dr C on a “secretarial error”.

She said, “if you need help in the meantime, you can always get the Crisis Team to…”

Regular readers will know what I think of the CRT. See about three-quarters of the way down here, for example. So you can imagine my response.

“No,” I shrieked. “No, I can’t – they’re useless, they’re crap!”

“Well, they’re always there for you,” she started, but she seemed to realise the futility of continuing in this vein, so she changed tactics and continued by saying, “or your GP.”

She said, “Dr C will talk to your psychologist right away and see you as soon as possible – unfortunately she’s just doesn’t have a window today.”

Seems to be her curtains are always fucking pulled, but anyway – I told Dr A I would be on holiday until 21st September inclusive, so she agreed to organise a new appointment for sometime after the 22nd. I got up then, mumbled some sort of goodbye, and almost literally stumbled out of the building. Some other (male) mental sitting near the door tried to grope me on my way out (the “appointment” was in the psychiatric day hospital, rather than the usual outpatients clinic, so obviously he was ((erroneously?)) recently released from the actual bin).

As I was telling C the following Thursday, another thing of note was the physical environment of the “appointment”. As stated it was in the day hospital, which has much smaller one-to-one consultation rooms than outpatients. This was a problem as there was a window in the door, and I could see the other mentals looking in from time to time. Even worse than this was the fact that the room was near the entrance, meaning that all the others waiting for their cunty day therapy and other patronising OT-esque wank were directly outside the room smoking. Not a problem in itself – except that Dr A neglected to close the window, meaning that everyone else could hear the conversation.

I could have (reluctantly) lived with all of this imbecility if they had done something, but obviously they didn’t.

So anyhow, I went and sat in my car. Recognising that I was unfit to drive, I decided to ring A for cathartic discussion. I cried down the phone to him for about 20 minutes. He was absolutely livid with Dr C and her people. He authoritatively told me not to drive until I’d calmed down considerably, but said when I got back to my mother’s house that I should get her to phone them and kick up a fuss and demand answers – not to mention an actual definite date to see Dr C.

After a while I thought I’d calmed down and left, but I remember bawling my eyes out at times on the way home and practically fell through the door to my mother’s. Initially I was incapable of even rudimentary speech, but eventually I managed to convey a basic version of Dr C’s neglect to my mother.

My mother tried to calm me and I suppose she partially succeeded, because she managed to eventually tear herself away from me for long enough to phone Dr C’s admin department (a suggestion unsolicited by me), who emphatically denied a “secretarial error” but did say they would try and find out what had happened. Apparently the girl Mum spoke to was very nice and she said she would phone back with information later.

Then Mum contacted the GP; the one on call was the (only) one I hate in the ‘surgery’ (I’m indifferent to the others, mostly), because on more than one occasion she has blamed my mental health issues on being overweight. Sure, luv; wouldn’t be anything to do with personal pathology, rape, abandonment, bullying, lies or bereavement. Obviously not. As it happens, I think a lot of my excess weight is caused by depression rather than the other way about; partly because of comfort eating, partly as an annoying side effect of antidepressants. But that’s another issue.

Anyway, let’s call this woman Horrible GP, in contrast to her colleague, Lovely GP, with whom I was due to have a review appointment the next day. My ma outlined the issues involved and Horrible GP asked to speak to me. I refused, but she pushed my mother to get me to talk and thus I started to go mental, screaming that there was no way in hell that I was going to pick up the phone.

Mum said to HGP, “she’s panicking now.”

Query: is “going mental” the same as having a panic attack? I’ve certainly had the latter; for me, a panic attack is much more of a physical problem. Not that that doesn’t affect one mentally, of course, but going mental is almost a reverse course of action. It’s the shit in my mind, racing around in a whirlpool splitting my skull, that causes physical distress, rather than the other way about.

Whatever the case, the long and the short of it was that HGP agreed to provide emergency Valium, as I had left my main stash from my last meeting with LGP at A’s house, on the other side of town.

This agreed, Mum sat down with me again and ranted about Dr C and her negligent behaviour and about how she was thinking of going to the media. About this time, A sent me a text message saying that he was “so angry with these abject cunts” and also suggesting contacting a popular local consumer affairs programme.

Handbags at dawn, dearest readers!

Mum eventually went to get the Diazepam from the pharmacy, at which point I inflicted the self-harm that I posted a photo of, perhaps irresponsibly, here. It’s no big deal, self-mutilation is not uncommon for me as many of you know. It helps. I did it as I perceived the situation as Dr C hating me. Therefore, I was a hateful person. Therefore, that had to be acknowledged somewhere. That’s a logical(-ish) train of thought that wasn’t exactly present at the time, but it was at least the sense of my reasoning.

I bled and bled and bled and then worried that I wouldn’t be able to try and hide the injury from Mum, who has been mostly unaware of my cutting. I managed to bandage myself up, though, and the bleeding was adequately hidden just in time for her return.

I took the Diazepam, and the rest of the day was mostly uneventful. A was good enough to go back to our house, feed the cats and get my tablets, then come and stay with me at Mum’s (I wasn’t allowed to drive due to the Valium). He and Mum spent some time scathing about the morning’s occurrence, and the words “criminal negligence” were used. My mother queried what would actually happen if someone were seriously suicidal, little knowing of course that a few weeks ago, I tried to hang myself. Mind you, I hadn’t told Dr A that either. To be perfectly honest, I didn’t tell her because I had forgotten that I’d tried to hang myself. Who forgets trying to hang themselves?! It’s a good thing I did, though, as there’s always the possibility they’d have sectioned me. I am, after all, a danger to myself at times.

Wednesday: The General Practitioner

The next day I had a very long discussion with LGP (his colleague having related the previous day’s fun and games to him). Appointments are meant to be 10 minutes long, so if you’re the poor sod that was waiting at least 15 minutes after your appointment time, then I apologise. At least it shows LGP cares about his patients, unlike others I can fucking think of.

LGP asked to see the self-harm of the previous day, so I showed him, and in fact gave him the guided tour of the words and slashes that litter the flabby rolls of my abdomen. He appeared to be genuinely affected by this; not freaking out like normals do over this sort of thing, nor angry, but sorry that I was in the position where cutting seemed my best course of action (which I maintain it often is, to be honest). He wasn’t judgemental nor overly worried – he’s obviously aware this is quite normal in mental illness, certainly in BPD and very definitely for me on and off over the years – but just fucking caring. Just nice, supportive and caring.

He showed me the letter Dr C had sent him re: my diagnoses and medication change. I was interested to observe that whilst she wanked on and on about BPD, she had then said that “a differential diagnosis” was bipolar II. I thought a “differential diagnosis” was a diagnosis based on the elimination of most other illnesses based on symptoms presented? If correct, that would suggest to me that bipolar is considered my primary diagnosis, but contextually the letter presented it – as Dr C had done to me in June – as if BPD was my primary pathology. Her whinging about NICE’s mood stabilisers and anti-psychotics in BPD to both LGP and me would seem to confirm that. Can anyone, therefore, clarify the meaning of “differential diagnosis”?

One thing it did say that was moderately encouraging was that she was not totally against the use of mood stabilisers in future. She didn’t make further mention of anti-psychotics, but with regret I am beginning to wonder if I really should have them. (Incidentally, Maisie’s husband was put on an anti-psychotic a few years ago to combat his very severe paranoia. It changed his life for the better almost instantly. You can take a guess as to what I think about that).

LGP wasn’t happy with Dr C as well he might not be. He believes that additional medication (though he didn’t say which) seems appropriate, and furthermore that the dose of Venlafaxine is very low, despite its dodgy side effects. However, he said that he was in an awkward position. He certainly has knowledge of psychiatric illnesses, but he’s no expert, whereas Dr C (supposedly) is. He virtually said that in an ideal world after her lax approach he’d refer me to an alternative specialist, but after all the trouble we had had getting me to one in the first place, he didn’t really see that as a viable option.

That’s fair enough I suppose, although it didn’t help me much. Regardless, LGP has been the only one out of the three main health professionals with which I deal that has been a constant source of support, rather than frustration, so I’ll forgive his reluctance to interfere with the psychiatrist’s domain. We discussed sleeping pills and he suggested I return to Zopiclone over the holiday at least, as it worked for me before and I wouldn’t have to drive on the holiday (prolonged use of it has affected my vision in the past, though not on every occasion on which I’ve taken it). I remembered that he’d given me an inhaler when I was about 14 to help with panic attacks and asked if, in conjunction with the Valium, this would help me when I start to go mental. LGP agreed to provide this inhaler and as I left, after wishing me an enjoyable holiday, he said that if I hadn’t heard from Dr Cunt within the next few weeks, to phone him and he’d get slabbering.

Thursday: The Clinical Psychologist

So the next day’s measure of insanity was with twatting C. We had agreed to spend most of that day’s session discussing coping methods of mentalism on the holiday, and he reiterated that point at the start of the session.

However, he firstly wanted to discuss a few housekeeping issues. The selfish prick chose to take leave the week I came back from Turkey (ie. what would have been today’s session), rather than taking it the same bloody week that I was away.

Is this annoyance on my part unreasonable? Probably, but sometimes I really wonder if mental health professionals, including C, realise the positions of responsibility, authority and trust in which they are placed by their patients. Anyway, at least he’d given me notice of this unfortunate absence before; I sat seething in silent rage as he then explained that the week after that, he’d be on a training course. This means three missed sessions, as opposed to the original expected one.

Fuck. Fuck. FUUUUUCCCKKK!!! Fuck you, C!!! [As it happens, so far I have hardly missed him at all, but (a) there's still two weeks until the next session so Christ knows what'll happen between now and then, (b) I'm trying to replicate my frustrations from then rather than my feelings now and (c) whether or not I miss him is not the point. The fact that I am essentially entirely devoid of mental health support for nearly an entire month is the fucking point].

So anyway, C asked was there anything I wanted to bring to the table before we discussed preventing and coping with madness whilst on holiday. I decided to refrain from coming right out and asking him directly if he had spoken to Dr C, and instead enigmatically replied, “has anyone spoken to you about me?”

He furrowed his brow a little and said, “not since I spoke to your psychiatrist, Dr…Dr..,” he searched for her name.

I reminded him, and asked when the conversation to which he was referring took place. It was clear he couldn’t remember exactly, and he eventually replied with something vague like, “a few months ago.”

Great work, Dr C. You and your SHO claim you want to speak to C and see me as soon as possible thereafter. Clearly it was right the fuck up there in your list of priorities.

I nodded at C, feigning casual indifference, eventually cracking under the pressure of his piercing stare of curiosity a few minutes later.

“You won’t be aware of the events of Tuesday, then?”

“It was Tuesday you saw her, wasn’t it?” he asked in all sincerity.

I laughed bitterly and made some vicious snipe about how useful “seeing” her was.

I went on to detail the circumstances in full. Those have all already been reported here so I can omit that part of the discussion from this summary of the meeting. Basically, two issues arose.

Firstly and of foremost interest was that C seemed utterly perplexed by the fact that I had cut myself in the wake of his colleague’s fuck up. Well, aside from the fact that’s a fucking hallmark trait of my illness, you twat, I was going totally up the walls and self-harm – as I have told about 496,960 times – is a quick, simple and effective tool to suppress such spiralling insanity.

OK, SI. Why the need for something so elaborate, then. Perception at time: Dr C hates me. I am hateful. That needs to be acknowledged.

Entirely predictably, C droned on for about 40 years on methods of “distraction” and “grounding myself in the moment”, all this bollocks we visit in a circular motion time and time again. I don’t remember my response to him. I just remember my metaphorical eye-rolling and desire that he’d move the fuck on from this DBT nonsense, because in its simplest form anyway, it doesn’t fucking work.

Anyhow, the second issue arising from the Dr C conversation was what he thought of the treatment meted out to me by Psychiatry. He seemed surprised by the strength of the reactions of A, Mum and (obviously) me, and his expressions and body language suggested, to me, something akin to nonchalance about the situation. Well – maybe ‘nonchalance’ is an unfair word. But I certainly did not get a vibe of overt concern like I had from LGP.

So, I set him a challenge. “If I ask you a straight question,” I began, “will you please give me a straight answer?”

This, of course, garnered a slight non-verbal reaction, because it was a strong inference that he often doesn’t answer straight questions. Well, he doesn’t. If he doesn’t like my directness about that on this occasion, that’s just too bloody bad.

“If I can,” he responded.

Ha! What you mean, C, is if you’re willing. Do you think I’m stupid? Can’t you even plan the answer in a straight fashion?!

I asked him if he thought I was being unreasonable in expecting better from the Health Service. I reminded him that I had been fucked about by Psychiatry from January to May, then fucked about again in July after a serious medication change to a seemingly effective but nonetheless insidious, potentially mind-altering, drug, then fucked about again in September. Was that fair? Was it fair, also, that such carelessness was exhibited vis a vis my privacy in my meeting with Dr A? Whilst acknowledging that to some extent the NHS is ‘free’ to use, was it fair that I had worked since I was 16 (insofar as my illnesses permitted) and will hopefully return to and continue to work until my 60s, thus facilitating the salaries of Dr C and her team via national insurance – only to be treated in this fashion? Was any of that actually fair? Was I being unreasonable?

When he didn’t immediately respond, I pointed out that my enquiry was serious. I genuinely wanted to know if something about my fury, and that of Mum and A, was somehow unjustified.

He eventually started wittering on about it being fair to expect certain standards from a service, regardless of what that service is, and certain frustrations were bound to be evident were those standards – or, more accurately, the expectations of standards (my distinction, based however on what I inferred from what he said) – were not met.

Exasperated, I said, “yes or no – do you think my anger is unreasonable?”

He sort of sighed, then said, “you talked about your main GP as being a good doctor, but the on-call one on Tuesday as being someone you strongly dislike. Dr C is, presently, in your mind, a second ‘bad’ doctor. If I answer ‘no’, I am just another ‘good’ doctor, affirming your present mindset. If I say ‘yes’, then I become a ‘bad’ doctor.”

He was obviously accusing me of black and white thinking, which is generally not a particularly unreasonable view for him to take, but nonetheless I resented every syllable of this fuck. Is what he said not profoundly black and white? Can’t he understand that if he can coherently and reasonably defend his position on the matter that I might have some insight, that if he disagrees with me that I might be able to derive some perspective from that? Oh no. Even in someone with an IQ of 148, it’s apparently as simple as a childlike concept of good v bad, with no room for relativism at all. I might have BPD, but I’m not completely colour-blind to shades of grey.

Rather than lose it with him, I tried to rationally explain my reasoning for my views on the GPs, the subject of his comments that had especially irritated me. My views on both have been developed over years. I first met LGP over 12 years ago. I first met HGP maybe six or seven years ago. I just didn’t meet either of them once or twice and form a view of them. My views on them, and on all other GPs and health professionals I’ve met, are based over time. They can change dramatically or quickly, I’ll admit, but not without very good reason.

In general, that is.

He conceded that perhaps there was more to it than good-doctor-bad-doctor, but pressed, “why self-harm though?”

This was irritating, as I’d already outlined my reasons. I sighed and said something like I wasn’t sure we’d ever see eye to eye on this.

He said, “I wouldn’t be sitting here with you if I didn’t believe you had other coping methods.”

Seeing my eyebrows raise, he added, “…or at least if I didn’t believe that you could develop them. What would be the point in that?”

I don’t recall my thinking now, but I looked him straight in the eye with what I think was some sort of oddly demanding expression and asked in a dark monotone, “are you going to leave me then? You’re going to abandon me?”

Poor C. The man was genuinely stunned. Reflecting on it now, so am I. Talk about adding two and two and getting half a million. There was absolutely no tangible link between expressing that he had hope for me and a suggestion he was going to desist from seeing me. None.

“Where did that come from?!” he exclaimed, mystified.

I honestly don’t remember my answer; I am writing this a fortnight later. I must have said one of two things; either I tried to justify my ridiculous belief that C had suggested he was going to ‘dump’ me, or I immediately apologised and submitted to him. Either way, we ended up in the submissive position, with me predictably following my Attack-Defend-Submit pattern. I said that my comments were clearly bullshit, that I was being daft and he should forget it.

“But it’s obviously something you’re bringing to this room,” C pointed out. “Why is that?”

As can be my won’t at times, I began playing psychologist. Interesting that I refuted any suggestion above that I was childlike, because I remember telling C that that’s exactly what I was. When he asked me why I thought this, I sardonically replied that I wasn’t allowed to intellectualise matters so I couldn’t answer his question.

He laughed and said, with a kind of amused defeatism, “go on then.”

Of course, I couldn’t. This was a PhD qualified clinical psychologist I was talking to. I’m a Wikipedia qualified psychologist. (Actually, I’m underselling myself, as I do have some knowledge of the subject, but it is from some time ago and was not even half as in-depth as a full undergraduate degree, nevermind a doctoral one). For the record, I was thinking of attachment and object relations theories and their roles in transference.

Anyway, my paranoid whining led to a monologue from C about ending therapy. Obviously I’m aware it’s not indefinite, it’s not a permanent fixture in neither his nor my life, aren’t I? But he’d like to assure me – again – that it will never just abruptly end. He envisions a minimum of four sessions of preparation before discharge, probably more, blah de blah.

I just sat there and looked at the floor, struggling to not burst into tears like a bloody newborn, struggling not to get down on my knees and beg him not to leave me to try and make some sense of insanity, my past, my future – my entire damn life – alone. I know I sit here and spout bile about the man and slag him off and call him names – but I do like him despite it all, and I need him and see hope with him and I can’t do it without him – not yet anyhow.

I was utterly overwhelmed by how much I don’t want him to abandon me and how inadequate and feeble I felt because of that. How sad and ridiculous that an intelligent woman of 26 wants a man she doesn’t even know to take the place of her missing father, grandfather and, frankly, friends, given that she only has a few close ones. How pathetic that she is vulnerable like a girl 20+ years her junior, and that she wants this unknown figure to scoop her up and take care of her. It’s so wretched that it’s almost kind of darkly amusing.

He interrupted this self-indulgent and piteous stream of consciousness by asking, “how are you feeling now, in this moment?”

I can return to ranting now. I swear to fucking God that I am sick to death of that phrase. He must surely use it as his meditation mantra. Is there some cadence in it that I’ve missed that makes it an attractive thing to say all the time?

I cleared my throat and said I was fine. He looked at my cynically, but decided against pressing the issue, presumably as there was very little time remaining in the session.

“When Dr C contacts me,” he began, “I can tell her nothing if you want. What we discuss here is confidential. Some people might not be at all comfortable with the idea of a discussion about them behind their back. Others may find it helpful. What’s your take on that? What do you want me to tell her?”

“It is weird to think of the two of you discussing me whilst I’m in absentia,” I admitted. “However, I don’t think that makes it unhelpful.”

I shrugged. “Use your discretion, I suppose. Answer her questions, give her any information you feel is relevant.”

He nodded, and I saw him look at the clock, which to my annoyance he’s moved to behind ‘my’ chair so (I presume) that it’s less obvious to the patient when he checks the time. Which it’s not as you can see his eyes shift above your head. And in any case it was pointless to hide it on this occasion, as he said, “we’ve left very little time to talk about your holiday.”

Oh really, I had no idea, I thought we had six hours. To be honest, I was glad. The preceding minutes had been pretty intense for me and I was tired.

We did conduct a quick and fairly basic discussion on coping if I were to go mental in Turkey, but beyond talking about getting A involved in the techniques, there was nothing new in what was discussed. I did talk about the inhaler from LGP and the Valium, but C kept whinging that these were external sources (oh really? I thought I had them sewn into my oesophagus) and that I needed to develop internal responses. To be honest, I just sat there and nodded, not really agreeing, not really even thinking about what he said, because I just wanted to leave. Not a good thing probably, but there you have it.

As I left, he said, “I hope the holiday goes OK.”

I ranted to A about this later. OK? You hope it is OK?! No “have a nice break” or “I hope you have a great time”?

To my surprise, A defended C. A contends that C had to be careful; had he said he hoped it was “great” or whatever, I would have been too cynical to really believe that he meant it, or that I expected it was possible that the trip could be great. I actually don’t agree that that would have been my view, but in fairness I can see why C might have thought that. So I can forgive his lack of enthusiasm to some extent. I suppose.

Friday: The Flight

OK, the title says ‘three’ days and this is a fourth day, but it doesn’t involve professionals attending to my madness, and in any case I’m not going into too much detail. You can probably tell from the style of writing here and here that I was (hypo)manic on Thursday night. This carried on right into Friday.

I suppose there is an argument that I could simply have been excited about going on holiday, but I don’t think that is the case. Forms of mania are, to me (and as far as I know to diagnostic manuals), different from contentment or excitement, in subtle ways at least. I understand that bipolar II in particular often goes undiagnosed because the hypomania therein often presents simply as an especially good mood. Maybe I seemed in an especially good mood on the Friday of that week, and I probably was, but I was also behaving oddly and saying really stupid shit.

I don’t have the best recollection of it, I’ll admit. I do remember sitting at the departure gate at the airport, delayed, babbling incoherently and in a racing fashion to A. I remember dropping my bag and having some sort of hysterical fit of laughter and more racing speech about this ludicrously uninteresting event. People around me were looking at me as if I was mad (which clearly I was). A found it amusing, and I can understand why it might have been to some – but it is also not ‘normal’; certainly, it was not appropriate behaviour for a public place.

And it very certainly, profoundly and completely wasn’t appropriate for a plane, and luckily I had enough cognisance to realise this. So, for the first and to my credit (?) only time from then to now, I took Valium to space me out and slow me down. It worked, to A’s self-proclaimed disappointment, but obviously it is not a long-term solution to episodes of mania.

Thus began our holiday. I will write in more detail about that shortly; it’s a separate issue from most of this post’s material. However, don’t worry; I’m not going to bore you to death by telling you what we did, what we ate etc etc etc – even if you actually know who I am, such things become dull very quickly. Of course, I keep this diary primarily for my own reasons – but more in relation to my mental health, not ‘normal’ stuff, if there even is any of that presently in my life. No, I want to think about how I felt on the holiday, how I behaved – whether there was an overt exhibition of madness thereon, or whether I actually managed to acquit myself well. I hope to write this tomorrow, but if not hopefully early next week.

Meh

When A and I were waiting for the plane, I received a message from my mother stating that a letter had arrived from Psychiatry offering an appointment on Tuesday 15th. LOLOLOLOL. Can’t they get anything right? I clearly told Dr A I would be away until the 21st. Mum rang them for me and whinged some more, pointing out they had not explained the situation as promised to her on the phone on Tuesday. They promptly and without question rearranged the meeting for Tuesday 29th. I am now terrified of it. It’s not great timing either as I have another bloody OH appointment on Thursday 1st October as well, but there’s not much I can do.

So, finally, you’re probably wondering what the reference to ‘genital vinegar’ in the title of this post relates to. It relates to Dr C. In ranting on Twitter, someone responded to me that Dr C was a “vinegar cunted bitch” – or so I thought. It turned out he was actually referring to some bint spreading more “Obama is a Nazi” bollocks in the US, but never mind – the title as one for my psychiatrist stuck.

Obviously there are a lot of ‘C’s in my life anyway. The actual C, CVM, Dr C…I’m sure there are more. Therefore, to avoid confusion and to reflect my current position on Dr C, I shall henceforth refer to her as the Vinegar Cunted Bitch, or VCB. I know I have a terrible penchant for acronyms, and when combined with usage of terms such as ‘BPD’ etc it is bound to get confusing – but I’m not going to start calling C ‘John’ or VCB ‘Dr Alfonso-Smythe-Hetherington VI’ just to anonymise them, so you’ll just have to bear with me. I have to bear with myself, after all.

Saw a new Senior House Officer, Dr A, who listened to how things had been and asked me to explain various specifics. After 20 minutes, she summarised things – missing a lot of points in my view, but I couldn’t be arsed arguing – then went to see Dr C. Dr A said either she or Dr C would come back. Whilst in the waiting room, I saw Dr C calling someone else. As I am scared of her, I was in part pleased she wasn’t going to see me – but I was also outraged that she was abdicating responsibility again.

However, the people she’d be seeing left before anyone came to get me again, so it looked like she might get involved. Alas, Dr A turned up again. After I’d been waiting another half hour.

She said that there had been a “secretarial error” and that Dr C would need to see me, but couldn’t today, how unfortunate, she’d send me out an appointment as soon as possible, things must remain as they are for now, Dr A isn’t experienced enough to deal with a case like mine, Dr C needs to speak to C (um, didn’t you have three months to do that, luv?), must away now SI, we’ll be in touch soon. Byeeeee!

I could go into detail about my response to Dr A, and I will, but for now I think how I feel about the whole thing and how I think they feel about me and indeed how I feel about me is best expressed by a graphic rather than words. It ‘speaks’ louder.

My mother had to phone the GP’s office to get me Valium, as my main ‘stash’ is at A’s. Hey ho, ho fucking hum.

As any of you who have read this blog since I began it in May will know, it has long since been my intention to write about each of the different therapists of one description or another that I’ve seen over the years. The idea was inspired by the same type of post by Introspective at Conversations with my Head, so hat-tip and thanks to you my dear.

It’s now September, so you can see how successful I’ve been to date in getting around to this. But here I am, finally, with all the fascinating (!) details.

Be warned; this is very, very long. I’d suggest you don’t even bother reading it if you wish to remain awake (possibly alive). If you really want to, try it in two parts or be prepared to be sitting at your screen for a while.

—

I was about 12 or 13 when I began to think that I had mental health problems. With the benefit of that wonderful thing called hindsight, I can see that I might have been a bit batty even as a child – I was a complete narcissist even then, and once tried to amputate my foot. I was an insomniac and experienced nightly hallucinations. I thought it was normal at the time.

But with the onset of adolescence (though not puberty, for I experienced that mostly in its entirety a bit earlier than most), I began to feel increasingly depressed. I felt hopeless, like my life was worthless, that the future was bleak and dark, that everything was utterly futile. Even I had the sense to recognise this as a bit unusual.

The realisation that I was depressed came one day when we were visiting my grandfather in hospital. In the corridor, there was a sign detailing the diagnostic criteria for a depressive episode. I hadn’t had five of the criteria for a few weeks; I’d had them all for several months.

I remember going back and looking at the poster over and over again, in the hope that my mother would notice that there was something on it that was piquing my interest. I never succeeded in that endeavour, but sooner or later she did, somehow, realise that my marked change in behaviour was quite long term, and off she marched me to the GP. Thus commenced about 12 years, to date, of on-off psychotherapy.

The GPs

Not therapists obviously, but it was of course one of my GPs that initially made the diagnosis of clinical depression; I was aged 14 at the time. To be honest, I think they just gave me a diagnosis and medication just to get rid of me. I am still of the view that I was initially seen as an angsty adolescent that they wanted off their hands. Best to give me Prozac, then say toodle-oo. Except it wasn’t so simple. Mum had me up at the practice more times than enough and eventually they sought the involvement of…

The Counselling Bloke

In all honesty, I remember very little of this guy. I don’t remember his name, and I don’t remember the precise point at which I saw him. I remember that he was a counsellor, of course, but I can’t recall whether he felt I needed more specialist help than he could give me, or whether we just closed the meeting and mutually agreed there was no point in continuing the brief alliance. Whatever the case, I’m fairly sure that I only saw him once, and I found the meeting utterly fruitless.

I do remember what he looked like; he was a short, thin, dark haired bloke, and actually reminds me a bit of C. It’s not beyond the realms of possibility that he in fact was C; although I’m not sure of C’s age, I’m guessing he’s in his mid-thirties. That would make this meeting just on the side of possible; he could have been an undergraduate or new graduate gaining some work experience. Perhaps I am creating a phantom memory, but it doesn’t really matter either way. The meeting was still useless.

The Trainee Child Psychiatrist – Anna

I’m not sure how I ended up with Anna, but it could have been one of two ways. Either the Counselling Bloke referred me, realising I needed more help than he could give, or Mum and I went back whining to the GPs and they eventually referred me. I don’t remember, but it doesn’t matter.

According to Anna herself, so my mother says anyhow, people under the age of 18 aren’t allowed to see psychiatrists. This seems ridiculous and unlikely to me, especially given that Anna – by her own admission – was a “medical doctor” (Mum asked her one day if she had a PhD in psychology), so surely the only mental health specialism of medicine is psychiatry?

Anyway. Whatever the case, she was based at a Child and Adolescent Mental Health Unit and I saw her for quite a few months. I liked her, and despite the bizarre situation and the fact that we never really made any headway, she liked me too (more on that in a minute).

I remember few of the specifics of the psychotherapy. I do remember her giving me stupid, patronising little sheets to fill in. You had to complete the end of the sentence, eg. “I secretly…” or “I really hate…” or whatever. Though in thinking about it, this maybe only happened a couple of times.

I think she was trying some sort of cognitive behavioural approach with me, because I remember thinking at the time that whilst she was well intentioned, her methods were unintentionally condescending (even though she herself wasn’t) and I just knew they were never going to work. I did apply myself to the therapy, though, and tried to work with her, but I never let my guard down and was always very careful in what I said to her. She knew I was bright and I think she actually found me quite entertaining; I remember one incident where I had the woman doubled-over laughing (thanks to some scathing remark I’d made about someone that was intended to be amusing, but I hadn’t predicted just how funny she’d find it).

I don’t remember the exact reason that my sessions with Anna came to a close. We must have agreed to have a break, though I don’t remember that happening exactly. All I do remember is that, whilst I hadn’t seen her for a week or two, I was expecting to see her again, when a little card arrived in the post from her, explaining that she’d been offered a new job on the other side of Northern Ireland and would not be able to see me again. The letter was kind, stating that she’d enjoyed working with me and wished me all the best for the future.

I wished her well and fully understood her reasons for moving on. Our therapy hadn’t much worked anyway, but nevertheless here I was left high and dry again.

The Education and Welfare Officer – Elaine

Actually, I’m not sure whether it was Elaine or Lorraine, but I’m going to go with Elaine as it’s quicker to type.

Elaine wasn’t a traditional psychotherapist; she was actually a social worker attached to the local education board, and was involved in my situation as – owing to my mental health problems – I missed a lot of school. Nevertheless, our relationship became one that more closely resembled a therapeutic one; she was more like a counsellor than someone involved to keep tabs on me. I would meet her each week on a Thursday – it was during GCSE Maths which of course was especially gratifying

As is the wont of social workers, especially (though not limited to) those not directly trained in managing mental health issues (or so I’d imagine), Elaine’s discussions with me would centre around practical measures I could take to help myself, rather than an psychoanalytical exploration.

Although she wasn’t much like Anna in her actual therapeutic approach, she was to some extent in her reaction to me: I distinctly got the impression she recognised that I was not being deliberately awkward as some of my teachers believed, and that she believed that I was a bright, not unpleasant kid, with some genuine difficulties. She liked me. I would take her in photographs of events I’d been at the odd time and she’d always compliment me on how well I looked in them. She took me out to lunch a couple of times as well. She was the only one (other than my best friend D) to whom I would show my prolific self-inflicted injuries (which were more than just silly little cuts, but long, occasionally complex words all over my body). I don’t remember whether Anna ever asked to see them or whether I just avoided it with her, but I’m pretty sure she never saw any of it.

I don’t remember, again, the exact reason why this relationship came to a close. I don’t think Elaine left her position; I think it must’ve been something to do with me taking my GCSEs and therefore potentially leaving school, and ergo, her remit. As it happens, despite my previous intentions, in the end I elected to return to school for sixth form, but by the time I got to that stage, things were more (not entirely, but more) settled anyway.

It was during my time with Elaine that I seriously tried to kill myself (the first attempt, a gesture in retrospect, had been about a year beforehand, catalysed by a break-up with a boyfriend). On this occasion, although I decided upon doing it on a whim, it was something I had been thinking about for a long time and I really intended to die. I took a massive overdose of everything I could find in the house – paracetamol, ibroprufen, various prescription medicines of my mother’s, my Prozac etc etc – thinking it would be enough to off me (I know better now, but I genuinely believed it would kill me then).

I am reminded that my time with Anna and Elaine must’ve overlapped, because I now recall Anna coming to see me the next day in hospital, after I’d had my stomach pumped. When I went back to school the next week, Elaine took me out for lunch. I remember asking her why she was rewarding my behaviour; she responded that she didn’t feel that she was ‘rewarding’ it, but she was upset that I had felt so desperate that I’d seriously tried to kill myself, and she wanted to do something to cheer me up. Well, as anyone who’s been there knows, it takes more than skiving off school for lunch – but I appreciated the gesture, as well as the rest of her tenure as my EWO.

It actually pains me to write about Elaine, because it reminds me very acutely of what was probably the bleakest period to date in my life. It was only through thinking about what I was going to write about on this post that so much came flooding back to me; clearly I had compartmentalised much of it (I was whinging about this to bourach here recently). In a way, one could argue that this past year of my life (ie. 2008 – 2009) has been even worse in the sense that I have experienced a lot more than ‘just’ depression, and that would most assuredly be true. But now, at least, I have a support network, and a network that understands this whole mess is not something of my choosing. I very distinctly didn’t have such support when I was 15/16. I had a few friends, yes, but with the best will in the world it was hard for them, not having been there, to understand a disease so often (and often unfairly) solely associated with adults (I’m not even sure they’d understand it then, but anyway). Although she recognised that I was mentally ill, my mother couldn’t fully grasp the enormity of my despair either, and reacted aggressively to my illness at times, although in fairness she did champion me a lot with the GPs/counsellors etc. I was picked on by a couple of teachers too, though in fairness there were a few good ones. All in all, it was a horribly dark period in my life, and rather than discuss the specifics thereof, I think I’ll just leave it be. Maybe another day.

—

After doing my GCSEs I existed in a relatively sane frame of mind for a while. My dosage of Prozac had been upped, and a lot of the wankers that had made my life so miserable at school had either left or had grown up a bit. Additionally, I was only having to do subjects I liked and was good at for A Level, so things were a lot more settled for a while. Things were far from perfect; I continued to miss a lot of school, and didn’t do as well in my A Levels as I could have done – but things were certainly better in those two years than they had been in the previous five. In fact, it is only through writing the above about Elaine that I am shown how much I wear rose-tinted glasses regarding school. I tend to be quite defensive of the place should anyone slag it off, and when I think back upon my time there in an abstract sense, I am sometimes overcome with fond nostalgia – this is based almost entirely on not absolutely hating those two years of sixth form. Clearly at least part of me blocks out the unbearable misery that were the preceding five years.

But anyway, that obviously didn’t spell the end to the madness…

—

The First Assessment Woman

I’m not sure when this was. After sitting my GCSEs, the next time I really remember losing it big style was when I was doing my postgraduate course, but I’m fairly sure the First Assessment Woman was earlier than that. Perhaps I had been feeling low for a while in sixth form (or whilst I was an undergraduate) and had yet again been at the GPs’ ‘surgery’; given my history, they might have referred me to the Psychological Therapies people. Who knows. Whatever the case, I went to see this woman at the same hospital in which I now see C and Dr C.

I believe the meeting was intended to assess what the most appropriate psychological treatment would be for me given my history. It was, short of the Crisis Response Team (see below), the most useless and frustrating mental health-related meeting I have ever had. The woman quite openly sneered at me as I tried to relate some very difficult information to her. I think it was because I expressed everything with a distinct absence of emotion and she therefore didn’t think there was actually much wrong with me (or such was my impression, anyway).

When I related a very abstruse outline of the sexual abuse, she decided that that alone must be the entire cause of my problems and gave me the number of the local Nexus Institute. I remember protesting that I didn’t want to phone someone (so clearly the phone phobia has been ongoing for a good while then) but she dismissively said it could be in confidence “if I wished” (thus totally missing the point) or that I could see them in person, if I preferred, and that that was all, I was to run along now. I didn’t have the energy to argue with her and that was that.

—

I had a major breakdown whilst undertaking my postgraduate degree. I had, at this point, only the dissertation left to write and had finished the taught part of the Masters programme, so took a full-time job which looked to be like a very good opportunity, and which was, unlike my previous and subsequent jobs, directly related to my academic background.

Unfortunately, I had been in a slow, but with hindsight obvious, downward spiral, largely thanks to my own doing. I had been feeling pretty good during my postgraduate year, so cut back on my Prozac without medical approval. DO NOT EVER DO THIS!!! By the time I realised I needed to remain on the dose I’d been at, the spiral had already taken its grip and the return to the full dose didn’t make a difference.

In fairness to myself, it would probably have happened sooner or later anyway, because at no point had I seriously tackled the underlying causes of my mental health difficulties – surely a recipe for disaster. It’s one thing to be aware of what they are, but it’s different to fully face them and be aware of all the subtleties therein. To mitigate their effects, or at least begin to reverse them, in my view I need to do this. Of course it had been my choice to never get into this detail, as I’d already seen a number of different ‘therapists’ by this point and had failed to utilise the opportunities presented. On the other hand, until you’ve been there, it’s impossible to understand how difficult this is, and how skilled a therapist needs to be to get it out of someone with so many defensive walls built around them, like me.

Anyhow, as ever, I digress. The breakdown meant I lasted a sum total of one week in my new job, and eventually had to leave my course with a postgraduate diploma rather than a Masters degree.

I returned to my GP. LGP had joined the practice by this point, but I didn’t see him consistently until more recently; it’s dog eat dog in our practice, and you take who you get unless you’ve planned the appointment for weeks. So I went to another one, who simply told me to “fight against it”. Unsatisfied with this, I went to the practice’s Nurse Practitioner, who prescribed me a new anti-depressant – Mirtazapine (in part because it’s good for insomnia) – and referred me for wanky CBT. I saw ‘wanky’ now, but I was hopeful at the time.

—

The Second Assessment Woman

She was a CBT Nurse at the main bin in Northern Ireland, Holywell. She was certainly better than the first bint of her ilk (see above), although I disagreed with her ultimate conclusion. I remember that she asked me the one question that every single one of them has consistently asked me: “don’t you have any female friends?”

I said that I didn’t like other women, adding, remembering her gender, that I meant “no offence” to her. (To qualify this a bit, I generally don’t get on well with other women in real life, though I felt more harsh about this at the time than I now do. Online, this isn’t the case at all – most of my online friends are women. I do have one real life female friend at the minute, so maybe I’m making progress! It all goes back to a terrible case of black and white thinking; because many women express emotion, want children and dream of white weddings, stuff I hate, I behave like I think they all do. Rationally of course I don’t think that at all, but then rationality and I are not always the best of friends, regardless of my desires to the contrary).

Anyway, Assessment Woman Two listened to me and, in fairness, seemed non-judgemental and accepting of the fact that there was something wrong. She did seem puzzled by my customary lack of emotion and even apparent amusement at some stuff, but she let it pass. Her conclusion was to refer me for group CBT. I protested vehemently against this – I was terrified of the group thing. The woman said, though, that she felt it would be beneficial in two ways: (1) the waiting list was shorter for group therapy than individual therapy and (2) it would help me confront my fear of group situations face-on. I reluctantly agreed.

The Psychoanalyst – Ian

As the waiting list for even the group CBT was six months, I went back to my GP’s ‘surgery’ and asked for a recommendation for a private therapist in the meantime. The physician I saw that day suggested Ian.

Ian was a very well regarded psychologist who’d even practiced as a forensic psychologist. Without detailing my academic background too much, this appealed to me strongly at an intellectual level and although he charged £70 per hour, I was happy to ‘try’ him.

I liked Ian. In a way, he reminds of me of C, the psychologist I now see; he was qualified to PhD level in his discipline, was clearly intelligent and astute, and seemed to be able to read my mind.

It was he who first suggested to me that my narcissism was an elaborate defence mechanism, built up over the years to disguise inherent and strong self-dislike. I remember arguing, “but I genuinely do think I’m better than some people,” and him responding by saying, “you genuinely think that you think you do, yes.”

We did discuss some of the stuff that effected me as a youngster, but although this was closer to psychoanalysis than any other therapeutic situation in which I’ve been, he was still primarily interested in here-and-now of my psychology. I believe that this was not because he wasn’t intending to explore everything else in more depth, but because if he had an understanding of what was now the case, it would allow him to work backwards. C did something similar, but has a more structured approach.

Again, though, my whole ‘lack of emotion’ thing was pronounced and perhaps he therefore didn’t realise how serious the situation was, or at least was becoming. Furthermore, if I am entirely honest the whole thing was kind of like an extended intellectual discussion between two parties interested in the way people’s minds work. To this end, I don’t feel that it was necessarily a particularly helpful relationship, even if it was an interesting one.

I think Ian could perhaps have helped me had I allowed him to break down more barriers, but then again, just because we liked each other at an intellectual level doesn’t mean that we ‘clicked’ especially; I don’t think we did, and there is increasing evidence suggesting that the dynamic of the therapeutic relationship is what allows the most useful and effective type of work to be done (see here or here, for example).

I went maybe five or six times, approximately every fortnight, though it became progressively less frequent as time went on. Aware that I wasn’t working, Ian suggested that I do some reading and practical things, and suggested I came back in a couple of months to save myself some money. In fairness, he did genuinely seem to want to provide me with a value for money service.

I didn’t go back, but not because I just gave up.

The Hypnotherapist – Edith

Having heard that I was paying out £70 per hour, the McF dynasty decided to get involved, recommending a hypnotherapist that S and her daughter Suzanne had both gone to, finding her effective and more reasonably priced than Ian at £70 for two hours. I must confess that I was cynical, but my mother offered to pay for the treatment so I thought, “what the hell?” My intention was to have it compliment the work with Ian, rather than replace it, and for a short while nearing the end of my contact with Ian, the two did overlap.

Edith was the sweetest, most gentle woman you’re ever likely to meet. She oozed empathy and sympathy and absolutely tried her level best.

For my part, I did open up to her, but still in a pretty detached sort of way. For instance, I remember one discussion in which I was supposedly hypnotised where she was “regressing” me to my childhood. She asked if I could see the little SI in my mind’s eye, and I said that I could. There was a conversation about the kid’s actions, behaviours – I don’t remember it fully, but in any case, despite outward appearances, it became apparent that Child Me was probably not very happy. Big SI was very bad and said that she didn’t care that her mini-me was somehow unhappy. Edith said, “doesn’t she need to play? Shouldn’t she be enjoying these years of her life?”

I can’t remember my exact response, but it was certainly a definitive no. She kept pressing the issue – “but can’t you empathise with that little girl, that innocent child” blah blah blah – but no matter what way she tweaked it, or however she phrased it, I didn’t like Child Me and did not empathise with her. Edith kept trying and trying to instill empathy in my unconscious, but it never worked.

I’ve always wondered if I was completely hypnotised anyway. Whilst I obviously recognise that hypnosis is generally not like you see on the Paul McKenna show or whatever, but that it is rather just a heightened state of relaxation, my experience in Edith’s was distinctly different to both that of S and Suzanne. S in particular had found that her body took on the characteristics of her abusive ex-husband – she spoke in his voice, she lashed out a couple of times and emulated his stature. Suzanne hadn’t quite such an intense experience, but more so than I had, and neither remember much of it, whereas I remember a lot of it quite clearly (and anything I don’t recall is more to do with the passing of time rather than the hypnosis bit, I think).

I’m not faulting Edith; if I wasn’t hypnotised, then it is probably because I resisted it. I don’t know about the accuracy of the claim that some people can’t be hypnotised – maybe that’s part of it? But still, once more, I wasn’t fully willing to confront everything in detail. Again, yes, this is arguably stupid, but I still utterly despised the notion of expressing emotions (I still do) and was incredibly defensive.

One issue of difficulty was that I had to point blank lie about McMF-paedo-fuck to Edith. This is because she lives close to the McFs, and of course she treated Maisie’s husband’s daughter and granddaughter. Although I have more than one uncle that is still alive (and did then too), it would just have been too awkward to admit that it was an uncle. She did directly ask me who was responsible, so had I said, “my uncle,” there was nothing to stop her from asking which one. I therefore had to lie and say it was the husband of a friend of my Mum’s. This meant having to remain on guard about this issue a lot, which no doubt didn’t help the hypnotherapuetic process.

Having said all that, Edith must have done me some good. One thing she did do was set anchors, though as far as I know this is as much about neurolinguistic programming (NLP) as hypnosis. Occasionally I’ll still grab my wrist in a certain way to try and calm myself – that was one of the anchors.

Whether it was partly this, or partly expunging myself each week to her in general, even if still in a detached way, something must have helped in some way, because it was after seeing Edith for a few months that I started looking for work again.

—

(For the record – when I got a job, thinking I was back on track, I didn’t return to Ian. I did eventually receive a notification to attend a CBT session back at Holywell, but it was in the mornings, and that clashed with work, though as I was part-time back then, afternoons were ‘do-able’. I let Holywell know this, but was told that the group sessions only took place in the mornings and that therefore I’d have to wait another while for individual therapy. I never heard from them again).

A initially advised me against going to the four interviews I got at this point, as I would totally lose it each morning before the interview of that day. But I somehow forced myself to go to them all, and in the end was offered two of the four positions (I had temped briefly at the full-time one, and had other experience in the area, so no doubt that helped). Ultimately, I took the part-time one, because (a) I felt really encouraged by the staff I’d met at my interview, (b) it was in part working with animals and (c) I felt that a part-time position would be a better way to ease myself back into work.

Unfortunately, it didn’t entirely work out well, as despite appearances some of the staff weren’t quite so nice – but that’s another story. I did keep in touch with two of my colleagues from there (AC and DL), and thus am still grateful for the experience. Anyhow, I applied for another part-time job, got it, then a few months later got promoted to a more senior and full-time job. This is my ‘current’ job.

Things were fine for about a year, though the year had many stresses – V’s death and the will fiasco, a change of manager, a lot of stresses in the job itself that really shouldn’t have happened. Eventually, I was becoming increasingly agitated and depressed, and even dreading going to meetings as I knew I would only have a pile of extra work laid at my door, when it wasn’t possible to do any more. I was becoming increasingly neurotic and disillusioned with life in general, and one day I cracked and rang my mother in tears, begging her to put an appointment on with the bloody GPs the next day.

This she did, and that was the last day I was in work.

—

The Crisis Response Team (CRT)

I initially saw the Nurse Practitioner that day but when she heard I wanted to die and I couldn’t see a future for myself (amongst other things), she said, “you know, you’re really ill,” and decided to involve one of the partners in the practice.

He, in turn, decided that I needed to urgently see specialist mental health professionals and arranged for someone to come out to my house that day.

I am not sure that I have enough pejorative terms for the two women that turned up. Whilst the first one was friendly enough, when the other (apparently the more senior) one took over, she was incredibly passive and didn’t stand up for me, so I hold her as well as her colleague culpable for my annoyance.

Despite outlining how unbearably bad I felt, despite trying to tell them why, despite all the efforts I made to convey the longevity and seriousness of my condition to them, the more senior woman said I should “perhaps try meditation”. I actually laughed, thinking this was some sort of twisted piss-take, but her facial expression conveyed the information adequately that she was not joking. For the record, I have no problem with meditation, but don’t believe it’s a substitute for proven medical intervention.

She continued by asking me to analyse a scenario. Bloke A is in the park with his six brats running around screaming and doing my head in. What’s my reaction? “That Bloke A should die.”

“Alright,” she said, “now assume you approach Bloke A and tell him to shut his children up, and he apologises to you and says it’s just that his wife died that morning. What’s your reaction now?”

“My reaction is that while I am sorry for his loss, Bloke A should die.”

She looked puzzled and said, “but don’t you see that there are different ways of looking at things?”

“Yes,” I said, “I’m not stupid. What is your point?”

Apparently I was not recognising that there was an alternative viewpoint to the behaviour of Bloke A’s children and his inability (or unwillingness) to discipline them.

“That is incorrect,” I protested. “I do accept that there’s an alternative viewpoint. I still think he should die as his grief isn’t my problem. In fact, I’m offended on behalf of his wife. Shouldn’t he be taking his kids to see her parents or something? Or, in an alternative viewpoint, let’s assume the wife’s parents are dead – surely she has some family? Shouldn’t he be engaging with them and sharing grief? Or if he needed to be alone, why isn’t he alone? I appreciate that it’s possible that neither he nor his wife have any friends, family nor colleagues, but I think even you’d agree that that’s unlikely.”

But apparently I still missed the point.

After a long and protracted argument, about the above scenario, meditation and other issues, I admitted defeat and told the two of them that I was disgusted that my national insurance went towards their salaries.

This comment was ignored and they agreed to refer me to a…take a guess…wow-ee, a CBT therapist! Deja vu, anyone?

As they left, they told me it was “lovely” to have met me (so they’re liars as well as morons). Perhaps needless to say, I didn’t return the ‘compliment’.

The Cognitive Behavioural Therapist – Margaret

Given my previous experience of CBT therapists twatting about, I knew if the dumb bints from the CRT even did refer me (which it turned out they hadn’t), that I’d be waiting a while for it, so back I went to one of the GPs, and again asked for advice on a private therapist, though this time I specified that I wanted to try CBT rather than psychoanalysis.

Enter Margaret, at £90 an hour.

Although I liked her as a person, it was Margaret that gave me my intensely negative view of CBT. Initially, I was cautiously optimistic, but it didn’t last. As is apparently typical in CBT, now that I’ve read about the process more in-depth, she would have me analyse the likelihood of a perceived negative event. As a very rudimentary example, someone I know walks past me in the street without speaking to me. I can (a) assume (s)he hates me or (b) rationalise it – maybe (s)he didn’t have her glasses on, maybe (s)he was on his/her mobile, maybe they’re depressed.

Um…so? I know there are a million other explanations and I know that it is almost certainly not about me unless there has been a very clear reason for that, such as an argument. I already fucking know all that, I don’t need anyone to patronise me about it. The question is how does one really believe it? When I asked Margaret that, she said you just have to have an evidential base for the belief, which tallies with the literature on the subject, but that’s bullshit in my view as it’s already been recognised as utterly irrational by me; I already see and recognise that evidential base, but it’s doesn’t stop me from believing that the worst case scenario is the case, even if I don’t rationally believe it. If that makes any sense.

Another technique would be to directly face that which is most feared. As an example of this, I told her that I was freaking out about an interview for a job for which I’d applied, and she said I must go, as exposure to the event would be helpful.

I ended up in LGP’s office having gone totally batshit, and he gave me Diazepam for the first time.

In fact, I actually did go to this interview, and of course it didn’t go badly (in the sense that the panel weren’t Satan Incarnate; it did go badly in the sense that they were looking for someone much more qualified than me). But I already knew it would never be as bad as my panic was making it out to be. This happened another few times – I would utterly and completely lose it, even though I knew it could almost certainly not be as bad as my losing it would suggest. It doesn’t matter than I’m rationally aware of probable realities. It doesn’t matter that I know the worst that can happen is that the interview panel don’t like me or that I don’t get the job, and it doesn’t matter that neither of these things are likely to matter in the grand scheme of things.

I still fucking go mental when I’m under stress, or sometimes (mostly, actually) ‘just because’. Furthermore, in the case of the latter, I am not losing it because of any specific reason – as such, how can I rationalise what I fear? I mean, I don’t (consciously) know what the fear is in those moments. Even if I did, I already know anything a CBT-like approach could teach me.

Although I liked Margaret, I became increasingly disillusioned with the CBT approach, not to mention the fact that I was beginning to get into horrific debt – meaning that her employer’s ludicrously high charges were too much for me to pay. So that was the end of that.

—

My mother happened to be seeing the Nurse Practitioner at the GPs’ ‘surgery’ on an unrelated matter. The Nurse asked how I was getting on, and my mother said that things were not good. Upon a brief glance at my records, the Nurse saw that no referral had been made for me by the CRT for psychotherapy (I knew they were incompetent).

The Nurse therefore took it upon herself to make a referral. Fortunately for me, though, she cocked it up and didn’t make it specifically for CBT, like it was meant to have been when the bitches from CRT decided upon it.

I was really struggling during this period, and at my behest, had my medication changed to 40mg of Citalopram daily, which is the highest dose they were prepared to give me. It was at this juncture that the GP I saw decided to refer me to a psychiatrist, on top of the Nurse Practitioner’s referal to a psychologist. I finally saw her about five months later, despite the fact the waiting list was less than three months at the time. Contextual links follow later.

It was somewhere after my CBT with Margaret than I began to believe I probably had more than ‘just’ clinical depression and anxiety. I didn’t really investigate anything further at the time, but I recognised that for a while I’d been experiencing a wider set of symptoms. I assumed, rightly as it turned out, that seeing a psychiatrist would shed some light on this.

A relatively short period after my mother’s appointment with the Nurse Practitioner, I received a questionnaire through the post asking me to outline my psychological difficulties to help cut waiting times for a psychologist. I was prompt and, I hope, thorough in my completion of this document.

Some weeks later, I received a letter from the same hospital in which I’d seen the first assessment woman, asking me to attend an assessment with Dr C J, a clinical psychologist. Mum and I were both raging, as we wondered how many more fucking assessments it would take before they actually offered treatment? In both of my previous assessments, I then was simply moved to a waiting list for whatever the treatment deemed appropriate was. Still, I went along, because one has to do things the way the NHS wants.

—

The Multi-Disciplinary Psychologist – C

I’m not giving his first name. I’ve already told him I’ll keep all references to him here anonymous, and even though his first name wouldn’t give away his identity exactly, there’s always the chance that someone who doesn’t already know may find out who I am and work it out from there.

The ‘assessment’ session with C ended up turning into three assessment sessions, because he actually took the fucking time to discuss each of the points raised in the aforementioned questionnaire in detail with me. Surely he must have been breaking NHS protocol by actually taking his time over it?

I didn’t know what to make of him at first. His intellect was obvious, and I respected that, but there was something indefinable about him that I found quite irritating. Nonetheless, when I told him I thought CBT was a load of crap, even though I wasn’t a psychological expert, he accepted that and said that I was certainly the expert in myself, and that if that didn’t work for me, then it didn’t.

By the end of the three sessions, whatever it was that irritated me about the man was beginning to abate, and when he said that he would continue to treat me, rather than someone else, I was glad. We initially agreed to six weeks (his optimistic suggestion), shockingly commencing the following week! Progress at last. He did warn that although it might be mutually attractive, we couldn’t let our sessions become some sort of intellectual endeavour (as had been the case with Ian, though C is not entirely familiar with all that). I did stress that I couldn’t abide being talked down to, nor could I bear to not communicate comfortably because I had to ‘dumb down’ what I was saying. C accepted that and stated that he would be glad to have an intelligent dialogue with me, but it wasn’t to become a discussion of my issues as a psychological abstract; it still had to be directly about me. Given my narcissism, I was happy enough to acquiesce to this.

During those first six weeks, I began to grow from being pretty indifferent to him, to becoming really rather fond of him. He seemed to have got the mix right between employing intelligence and empathy in his approach – this is a position I still maintain about him. At the end of those first six weeks, I burst into tears in his office and begged him not to abandon me, as he was the first therapist to really ‘get’ me out of the many I’ve seen. We agreed to another 10 weeks at that stage, and when those came to an end, another 12 (of which we have presently had two sessions, with the third tomorrow). I see him once a week, first thing on Thursday mornings.

Perhaps because of his balance between intellect and empathy, rather than just one of them being in evidence, I have opened up considerably to him and have even shown the dreaded emotion, though I still curb it to some extent a lot of the time. I’ve told him stuff I’ve told no other living being.

In essence the therapy is mainly psychodynamic, though he has tried – usually to my annoyance – to bring stuff like DBT into the mix. His rationale is fair; psychodynamnic exploration is important, but when I lose it I need practical help too. I’m still dubious about DBT, but at least it has an ancient philosophical background which CBT doesn’t.

The main thing I’d say about my relationship with C is that there is a bond between us now. I am horribly attached to him, and whilst I won’t delude myself into pretending that he returns that attachment, I do think he likes and gives a damn about me. He is the first of all of these people that I have actually experienced transference towards, which is demonstrative of the fact that my psychotherapy with him just might be the vehicle I need to a recovery of sorts, as of course the phenomenon is generally expected to manifest if the therapy is to have any hope. Transference does cause me to get annoyed with him over very little at times. He causes me to get annoyed with him at times; the way he’ll avoid a question infuriates me, but this is him trying to avoid getting into a intellectual discourse with me, for the most part.

But all this transference, bonding etc is not to say that the process is fun; quite the opposite. It’s intense, overwhelmingly so at times. It often (ironically) depresses or angers me, saddens me, has made me lose it a couple of times. Even though I’ve opened up to him on many issues, I am still incredibly defensive and tend to (figuratively) run away if he hits a nerve. Yet somehow he manages to get most of it out of me eventually, showing his subtle but evident skill. I always crack up though. But then I always expected that things would get worse before they got better, because I have not faced any of my ‘baggage’ in any real depth before.

Overall, it’s possibly the most difficult sustained experience I have ever been through, but nonetheless, I think the relationship is a very good one, and despite the regression in my condition since I met him, in conjunction with his colleagues in Psychiatry, I have a glimmer of hope that, over time, C may be able to help me get some control back over my life.

The Psychiatrist – Dr C

Again, no names. In this case I don’t even know their first names anyway.

Obviously she’s not a psychotherapist and exists mainly to monitor my illnesses from a medical point of view. But I want to hat-tip her anyway, for providing my diagnoses back in June. Dr C also changed my medication to Venlafaxine on that occasion, but was open to the possibility of adding further medication to the cocktail should it prove necessary.

Unfortunately it took a hell of a lot of trouble to finally get to see her (it was only in discussing self-harm and suicide ideation with C that I was ever seen by them) and now that I have met her, it apparently takes a lot to continue to be seen on a regular basis. Basically, I feel fucked over by her, just like I have been by the NHS on several occasions, but meh. I ought to be used to it.

At least, though, when she does bother to show up, she seems to be willing to tackle my case in a straight-up fashion and to do something that might actually have something like a positive effect, so in conjunction with C, I have my fingers cautiously crossed.

—

So there you have it. The life of the Serial Insomniac through therapy. I realise that I have whinged an awful lot in the early part of this post that people kept attributing my madness to teenage angst. For what it’s worth, I do understand why this was thought to be the case, for the laypeople anyway, and I am working towards letting go of my anger in that regard, though it’s not easy.

It is only now, about 14 years after first really feeling that there was something psychologically wrong with me and about 13 after seeing someone about it, that I feel I might actually be finally moving in the right direction.

I expect it to be a slow process, but I’d rather have that than have no hope of regaining control at all.

Apparently BPD has a decent prognosis in the right circumstances, though I certainly won’t hold my breath. Bipolar disorder has no known cure. Either way, I’m not asking for ‘cures’. I accepted years ago that I will probably be on medication for the rest of my life; I am fine with that, and I am not against some sort of semi-regular ‘top-up’ psychotherapy after completing my main course, if that is what is required. Cures are not what I seek, as discussed in more detail here and here.

But I do want to be able to at least be functional, and I do hope that with C’s help, maybe – just maybe – I might be able to regain enough control to achieve that. I don’t know. The journey will continue to play out on this blog.

Lucky you, dear reader. If you’re still reading this post, then I’m amazed and don’t understand how you’ve not passed out or even died of boredom. Even by my verbose standards, this is fucking long. So, until ‘C: Week 23′, so long.

I had what I felt was a really good session with C on Thursday.  That, to me, seems like an odd thing to say, as the best I’ve had to say upon departure in the past is that it ‘wasn’t bad’ or some such, but I actually left the other day feeling very positive about the whole thing.

I’m not entirely sure why; I felt reassured and taken seriously, and felt the dynamic between the two of us was good. Not that it isn’t normally, but it seemed to ‘flow’ particularly well and naturally on Thursday morning.

Apart from the very start, that is; he always wants me to start the session, and I almost never know where to begin unless something has been very definitely playing on my mind.  Plus I hadn’t slept all night and had missed a dose of the dreaded Venlafaxine, so I was kind of two seconds behind him intellectually.

Eventually, with my inability to articulate myself, C decided he would draw attention to my starting arguments with A over nothing (see here, and latter part of here), as we had discussed to some extent last week.  I didn’t really have much to add to that, to be honest, mainly as I don’t remember the circumstances on many of the occasions.

So began a discussion regarding disassociation.  He thinks that I have amnesia as regards the stupid arguments because then I completely freak out that I am going to be abandoned, so in order to cope with the enormity of that in my mind, I have to disassociate from myself and the world.  He went on to lead a dconversation on what can be done to “ground myself in the moment” when I first start to notice negative feelings that could cause me to lose it and ultimately disassociate.

He asked me what I thought I could do in such a situation.

I laughed and said, “you don’t honestly want me to answer that with sincerity, do you?”

C pretended to be perplexed by this apparently cryptic comment but he knew as well as I did that it was a reference to self-harm.  I said, “what I think I can do in such a situation is carry a knife about with me.”

He muddled his face, but laughed when I admitted this was probably not the best idea in light of the police crackdown on knives thanks to so much knife crime doing the rounds in the UK and Ireland of late.

But I continued, asking him what the problem with self-harm was – he made some comment to the effect that it was potentially dangerous, but I waved my hands dismissively at him and pointed out that any cuts I made were superficial.

“Look at me,” I challenged.  “Apart from where I’ve picked the spots on my face, can you see any scars?”

He looked me up and down, and eventually concluded that he couldn’t.

Excellent.  “In that case, what’s the problem?” I asked.

He thought about it for a minute or two, then said something like, “don’t you think it can have negative consequences?”

I complained that because my entire abdomen is covered in stuff like ‘hate’, ‘death’, ‘vile’ etc, that it would certainly make it difficult to get a cut-price* full-body massage from A’s sister, a beautician, but beyond that minor disability, I didn’t really see any negative consequences.  As stated a million times here, cutting is quick, and it works.

(* Perhaps a poor choice of term given the subject matter?!).

“Other people vilify self-harm,” I whinged.  “I don’t get it.  What’s the big deal?  It’s effective, and if it’s superficial – ie. not life threatening, and none of these scars would have been – then I really fail to see the problem.  What is it?”

“If I define a problem, you’ll see me as someone who wants to defy or contradict you,” he replied.  “If I don’t, then you’ll take that as carte blanche to inflict self-harm on yourself, as the perceived need arises.”

I don’t consciously think that would have been the case, personally.  I was asking him to explain what, objectively, the problem with self-inflicted injury is, given that it’s a speedy and effective antidote to severe agitation.  But to be fair to him, I can’t tell you what my unconscious might have thought if he’d answered the question directly, and knowing this, I let it pass.

I noticed that he was trying to avoid making me aware of any judgement he may have had on self-harm, but predictably he did reiterate that there are other methods I can use to “ground myself” rather than merely grabbing the nearest sharp object and slashing myself.  We discussed briefly the DBT methods such as breathing techniques, using rubber bands and/or ice cubes to hurt myself.

He said that he thinks I can appreciate that there are times when they can be effective distractions, but that maybe I do not garner the same satisfaction from them.

I affirmed this.  I told him that even the simple cuts I’d inflicted to my arm this night didn’t have anything like the satisfaction of a big, angry ‘HATE‘, which I kept going back to and looking at in awe.  If that is the case, how can breathing or whatever possibly offer an appropriate level of satisfaction?

However, I continued by telling him that whilst I certainly didn’t necessarily dismiss these techniques completely, I saw this whole coping method as being on a “sliding scale”.  I can’t remember how I expressed it, but I think I was suggesting to C that if I try these DBT methods and they don’t work to calm me, I can then give myself permission to cut myself, if it is the only thing remaining that will ease my distress.  I mean, it’s better than taking myself out, right?  …Right?!

I was astonished when C didn’t argue with this.  He didn’t agree with it, but he didn’t argue.  It reminds me a little of a recent documentary I saw on self-harm, hosted by author and comedian Meera Syal.  It told of a controversial treatment employed in some psychiatric hospitals (the featured one was Bethlam – still Bedlam to me – in London) in which the staff allow the patients to self-harm, as long as they document the incident in detail afterwards.  The young woman interviewed said that when she had been stopped from cutting, she simply found more inventive ways to harm – eating lightbulbs, throwing herself at the wall etc.  Obviously my example is considerably less extreme, but rightly or wrongly I felt that C was meeting me half way; if I was willing to try his methods, and they failed, he would reluctantly tolerate my methods, as long as they were implemented in a controlled and non-dangerous fashion.  Perhaps I read too much into this though – perhaps his decision not to argue was based around the aforementioned notion of my feeling (in his mind) that he was judging me, whatever way he responded.

He went on to state that he was “concerned that there’s two sides of you in conflict with each other – during a previous self-harm incident, you spoke of being in a trance-like state, saying, ‘it’s beautiful, it’s beautiful’ [this incident is discussed here] and finding that your mood dramatically improved after inflicting the cuts.  One side ‘hates’ the other and whenever she feels that side is getting out – for example, when she’s feeling depressed or lonely or anything that she perceives as weak, she has to be punished.  This then affirms her position as strong, and makes her feel better.  In suppressing the other her, though, she is ultimately repressing stuff and in the long-term is going to feel worse because of it.”

Two things strike me about this.  The first was that he spoke in the third rather than second person for so much of this particular part of the session.  I didn’t think about it at the time, but now I wonder if he thinks I have Disassociative Identity Disorder?  For what it’s worth, I don’t really actually think he thinks that, as it’s certainly not uncommon for a myriad of mental health issues to feature disassociative symptoms in some way.  But his choice of phraseology was interesting.

Secondly, I became completely fixated with the fact that he’d said he was “concerned”.  The word ‘concerned’!!!  He actually used it!  Any reference to him giving anything that vaguely resembles a shit about me in the past has been along the lines of, “…but if I do x, you’ll think I don’t care about you,” or whatever.  In this session, unsolicited, he actually outright stated that he was concerned for me.  I literally had to bite my bottom lip for some time to prevent a delighted smile.  This is a pathetic over-reaction and I think I need to die.  (Sorry, not allowed to say that.  Bad Side is suppressing Nice Side again.  Bad Girl.  I am not empathising with nor showing compassion to myself.  More on this later).

C said that I need to start recognising triggers for negative experiences.  He didn’t phrase it like that, but that’s what he meant I think.  He then went into a monologue about how humans do so many things on autopilot – cycling (“you’d probably fall off the bike if you started thinking about how you do it, actually”), opening doors, driving, breathing, whatever.  Such revelations nearly floored me, of course, who would ever have thought it, eh? [/sarcasm]  But his point was, if we do that for these innocuous processes, sometimes we can let an autopilot take over for more important matters.  In my case, he is of the view that I ‘automatically’ respond in an inappropriate (not that he used that word) fashion to (relatively) minor things.

He said, “imagine someone or something pisses you off, whether or not it was intended.  Stop a second.  Try breathing before you respond.  I know your reaction is an impulse but try and control it by remembering this discussion.  Then think about what’s going through your mind – identify the thoughts, emotions you experience, how you want to respond in light of that.”

Although that sounded way too easy to be true, the latter part of the instruction was interesting, as I had read very recently somewhere that it was important for individuals diagnosed with BPD to try and recognise the exact nature of their emotion; for example, rather than feeling ‘miserable’ or ‘low’, you’re ‘sad’, or you’re ‘depressed’, or you’re ‘scared’ or whatever.  I have to say that by and large I think I can identify these different experiences, though not necessarily when I’m in the middle of them, which is the issue I think C was driving at.

Back-referencing a little, he said the side that inflicts harm on herself experiences triumphalism in its wake, because she has won.  He said that in learning what’s going through my head and what I am actually experiencing, I could begin to develop some sort of sense of empathy for myself (or Bad Side could do so for Nice Side, whatever).

You can imagine my reaction to that, of course.  “We’ve been here before, C – I can’t imagine ever wanting to or being able to experience this empathy thing.”

“What’s the worst that can happen if you empathise with yourself?” he queried.

That took me aback somewhat, and I had to think about it.  Eventually, I said, “OK, I’m in the middle of an abject depression, feeling sorry for myself, so I stuff my face with chocolate and red wine (or maybe red wine isn’t the best idea when you’re already depressed, but you know what I mean).  How does that look?  ‘Oh, look at that lazy bitch, lounging around in her self-indulgence whilst nothing is wrong with her’.”

I paused then, my words reminding me of an earlier discussion with C in which he concluded that I was pathologically terrified of being scrutinised (negatively, at least) by others.  “What I’ve just said relates back to that, doesn’t it?” I mused, as an aside, and mostly rhetorically.

“Whatever the case,” he said, “what is clear is that you aren’t allowing any room for middle ground.  You can only be intensely self-critical or self-indulgent.  Is there any potential to reach a half-way point?”

I babbled on a bit incoherently about this for a minute.  C summed my position up better than I had by saying that whilst I could objectively appreciate there may be more of a grey area than my previous comments suggested, I didn’t really feel it.  Indeed.

“But what’s the point of empathy anyway?” I asked cynically.  “How is it going to make me feel less shit?”

I don’t remember exactly how he put it, but his response was something along the lines of if you fail to empathise with yourself, you fail to empathise with others, that can alienate others, thus making the self feel worse, etc etc.  (I knew altruism was about selfishness, really).

I said to C, “are you saying I’m a sociopath?”

“No!” he exclaimed instantaneously.  “No, no, no!”  He shook his head vigourosly and sort of put his hands out as if to stop me saying stuff like that.

“I’m sorry,” I said, “I was joking – I just did so much about psychopathy at university that I found it funny how closely what you just said matched the description of that condition.”

He sort of laughed, and yet again he insisted emphatically that no, he does not think I am a sociopath.  Well, that’s one less thing to worry about, then.

As if to prove his point, he went on to say that in fact I am more than capable of expressing empathy; the thing is I tend to express it towards inanimate objects, such as Disraeli, my car.  (Case in point: on Thursday night I ended up in tears thinking that I had ‘offended’ a lamp.  Yes, folks; a lamp.  Repeat after me: SI is not a loon, SI is not a loon – keep repeating it and we might CBT ourselves into believing it, right?).

Having read over parts of this blog for something to do during the particularly painful bout of insomnia the night before this meeting with C, I remembered another set of ‘objects’ (in the psychological and philosophical, not physical, sense) for whom I do feel empathy: my online friends.

C’s assertion on that occasion was that, perhaps, online relationships are, for me, ‘safe’, just like inanimate objects.  I had dismissed it at the time as even though I’ve not met any of my current online friends in person, I still do see them as very real.  However, I thought about it on Wednesday night / Thursday morning and concluded that he might have a point, as long as he accepted that the personnel concerned were still ‘real’ to me.

I raised it with him.  Did he still think that?

He sort of shrugged without shrugging, if that makes any sense; whatever the gesture was, the implication was that it was something to which he was open, without necessarily feeling that it is fact.  Indeed, he said, “it’s an idea.”

I told him that I now thought he had a point, and he went on to voluntarily tell me that if we accepted that this was possibly indeed the case, that I was definitely not to think that it diminished the importance of my internet friends in my life, nor was the implication that I – nor he, for that matter – saw them as ‘unreal’ figures.  (Though what is real anyway?  Sometimes I wonder about the validity of solipsism.  An aside – in Googling ‘solipsism’ to double check the spelling, I came across Solipsism Syndrome – what a cool psychiatric diagnosis to have!  I wonder if I can try and get it.  I would probably have to fulfill my childhood dream of becoming a professional space-based cosmologist, however, and that’s not fucking likely).

Anyway.  What was I saying?  Right, so C said t’folks on t’internet are still very real and important friends.  “But,” he continued, “online relationships are…” – he searched for appropriate words – “…less complex than ‘real life’ ones.”

I accepted this, but did want to make it clear to C that I wasn’t engaging in the “less complex” relationships to avoid dealing with the “more complex” ones.  “My real life friendships are stable,” I said, “even if there are fairly few of them.  I haven’t sought out new ones for a very long time, but I’m not sure that’s related.  I’m socially inept, I’m a misanthrope, I just can’t deal with people.”  Certainly, I admitted, I don’t trust people and fear being hurt, but there are other factors.  They’re probably related via some electron cunt thing in my brain somewhere, but they aren’t consciously so.

“But then,” I continued, “it’s funny being me.  If I’m in some sort of hyper or manic mood then I tend to be exceptionally good with people, if over-talkative and arrogant at times.”  As a relevant example, I related having met A’s parents the other weekend, when I was pretty manic and apparently good craic (for those uninitiated to Northern Ireland Speak, ‘craic’ is pronounced ‘crack’, though does not denote drugs ((well, beyond dopamine and/or serotonin, I suppose)).  It means ‘fun’, ‘entertaining’, ‘a laugh’, etc).  And about how A’s mother had cross-examined him on the phone afterwards wondering (in not so many words, to be fair to her) how I could possibly be mentally ill in any way when that was the behaviour I exhibited in front of her.  I can see her point.

“This annoys me,” I continued.  “I cannot stand ambiguity or unpredictability.  I used to work with a woman who was terribly moody.  One day you’d go in and she’d call you all the names of the day.  The next she’d throw her arms round you and practically declare undying love.  It infuriated me.  Either always be nice, or always be a bitch; don’t fuck about.  I don’t know how to deal with you if you fuck about.  Point being, I don’t know how to deal with me if I fuck about.  I want certainty.”

I paused, and asked C if I was rambling.

“If I say that you are, you will perceive me as being critical, but if I say that you aren’t, you’ll feel I didn’t really take an interest in what you said.”

I tilted my head and stared at him enigmatically.

“What?” he asked.  “What do you think?”

“I think if you answered the question you’d be someone who answered a question.”

He smiled in an odd sort of way, almost as if he was embarrassed.  I’m not sure what his exact response but he was basically asking if he thought I thought he avoided answering questions a lot.

Well, dear readers, you will know that this is indeed the case.  His ability to bullshit around a question is akin, at times, to that of a politician.  I know that there are probably fair reasons for this – “NHS Guideline 1,090,073.233.642 – Thou must patronise the stupid mental to avoid said stupid mental having a clear or definitive idea of the service thou hast provided or that thou willst provide, thus ensuring the NHS is not taken under the ludicrous claim culture of the 21st Century” – but it still winds me the fuck up.  I actually feel bad even writing something remotely critical, because me likes C today.  And thus was the case at the time too; in fact, it was almost a reversal of previous situations, as I became the one who avoided the question.  I can’t remember exactly what I told him but it was something like my conscious mind at least would not pass judgement on him answering the question honestly.  I deliberately refrained from referring to whether or not there was a reflection of him anywhere in there.

“OK,” he said, “I think we maybe need to trackback a bit.”

Which means he did think I was rambling, and I wondered that when I was evidently going to realise that, why he didn’t just answer my original question, but I forgave him and let him continue.  To be honest, my memory is not 100% clear on what it was to which he actually did backtrack, but it was something to do with the whole empathy crap.  Presumably I am meant to allow myself to be hyper or whatever and not berate myself for it.

He asked me if I had heard of a bloke called Paul Gilbert.  I had.  I read his Overcoming Depression when I was about 16.  It wasn’t the most patronising self-help book I’ve ever read, even if it employed a bit of CBTish nonsense, but nonetheless, here I am about 10 years later and I’m completely off-my-head mental, so it didn’t exactly fucking cure me, did it?

C said, “there are two books of his that could be useful; they both have ‘compassion’ in the title…” He trailed off, I am convinced in order to gauge my reaction to this.

I actually laughed out loud.  Naturally, he wasn’t surprised by this and in fact laughed a little himself.

“…one is an academic book,” he continued, “the other is…” He paused again.

“Self-help,” I said, finishing his sentence with evident disdain.

“Quite.  I know you’d prefer the more intellectual style of the first one, but…”

“Let me stop you there,” I interrupted.  “If you’re asking me to read one of these, it’s going to have to be the first one.  There are a few things I can’t tolerate in life, and being patronised is one of them.  That’s what self-help books do, sorry.”

“Isn’t that like saying that all works of fiction are shit?” he asked.

“Well…OK, it’s a gross generalisation, but I can only speak from my own experience, and my own experience of self-help books is that they’re universally shit.”

To be fair to him, C admitted that a lot of them are rubbish.  He described the ones like that as having a “new-agey American* love-in tone”, which he appreciated I would hate, and for which he didn’t have much time either.  But he was keen to make clear that in his view they’re not all like that.

(* Sorry American readers – his words, not mine.  I did laugh though, I admit, and he did acknowledge that there are plenty of British knobs writing the same wank.  I’m sure cynical readers will appreciate what was meant; the whole “you can change your life by thinking happy thoughts about your inner rainbow flying out of your arse [ass, if it's Transatlantic, presumably].  Remember, I – who do not even know who you are because I am merely  writing this bollocks and not spying on everyone who buys it [hopefully] – love you, and so does everyone else despite the fact that in your life you’re likely to meet maybe 0.0000000000000014% of the world’s population, some of whom will actually hate you, except that they don’t because everyone loves you, because that’s the way it works in my world which is as black and fucking white as yours, except I pretend it is white whereas you think it is black.  Remember, the only person that doesn’t love you is you, except for all the world’s population that are indifferent to you because they don’t know you exist, not to mention the ones that do know you exist and think you’re a prick!  Smile, it can change your day and help you love yourself, not to mention the added bonus of a punch in the face because people think you are a smug, condescending piece of shit!  You are worth loving, for now at least because if you feel worthwhile you will feel inspired to recommend me to your wrist-slashing friends and I will earn even more undeserved money! Etc etc, blah blah, yadda yadda, now fuck off cos I’ve got my royalties from your purchase you despicable, self-indulgent, psycho piece of shit that I’m exploiting by writing this jism” thing).

Ahem…*clears throat*.  Again, where was I?  Yes, C was keen to reinforce his point to me that not all self-help books are of the ilk of the preceding paragraph.  He went over to his desk and looked both books up on Amazon.  I joined him, and he showed me that – slightly unusually for Amazon UK – they had the ‘Read Inside’ feature.  He turned to me and asked if I would look up the self-help one, read inside it, read the reviews of it and at least consider getting it (or, “if I must”, the academic one).

We sat down again, and I agreed to at least look into it.  “If I buy it, though, and it’s rubbish,” I wryly told him, “I’m sending you the invoice.”

To wind C up, I told him that I was reading a very analytical and academic book at present called Social Factors in the Personality Disorders: A Biopsychosocial Approach to Etiology and Treatment.  The effect of this attempt to tease him was rather lost because I couldn’t remember the name in its entireity.  FAIL!  He said, “that sounds interesting.”  It wasn’t meant to sound interesting; it was meant to underline the point that I need something ‘proper’ to read.  But the fault is mine for not remembering the name properly.  (For some reason, I never can.  I have to go back and search through my previous posts here if I don’t have it to hand, as the book in question was very kindly recommended to me by one of my commentators, beautifulstones).

To compensate for not having the intended effect, I decided to be critical of Lost in the Mirror, which I recently finished, reviewing it as having “interesting psychological points, and being empathetic towards this hateful borderline condition, but not being helpful because of its extraordinarily childish and ergo patronising prose.”

I was interested to note that the above was the first time since I related my diagnoses to C that I have used the term ‘borderline’ in front of him.  Hitherto the very thought of doing so has made me cringe.  I still avoided looking at him when I said it, but say it I did.  This is progress.  As anyone who read the end of this post will know, I was convinced C would no longer wish to treat me, given the intense dislike of BPD that still permeates many mental health professionals.  Thankfully, it does not at all seem to be the case.  (Incidentally, regarding the diganosis of BPD, there has been an interesting discussion on the comments of my last post regarding its validity.  I had hitherto had little doubt that it was correct, but some interesting points against it were raised).

To get back to the books C had recommended, I asked if ‘compassion’ referred to extending same to the self, or to others.  He contended that they go in tandem; one feeds off the other.  I wondered to what extent I agree with that, as whilst feeling I am a complete piece of crap I don’t necessarily that think others are (not that the concept of compassion is as simple as that, but you know what I mean).  On reflection, though, I do think it makes some sort of sense.  I am incapable, or at the very least unwilling, to demonstrably extend compassion to others in my life who clearly deserve it at times.  When my Mum’s partner died when I was 11, my way of comforting her was to say something like, “um…right…sorry?”  When her brother died when we were on holiday in 1996, I couldn’t deal with her grief and started an argument with her!  (For the record I am citing these examples only here; I didn’t relate them to C at the time because I didn’t think of them).

After he’d stated his position on compassion, I must’ve looked contemplative because he asked me to articulate my thoughts.  I said, “I’m not for one second going to sit here and tell you I don’t need practical help for being mad; clearly I do.  However, I am keen that we also establish the causal roots of my mental health problems – I don’t want to just have the symptoms treated, you know?”

He jumped in quickly to that, emphatically denying that providing practical treatment alone was what he intended.

“I think, intellectually, you’d much prefer something like psychoanalysis…”

I interjected stating that I didn’t want to still be sitting in his office every Thursday morning in ten years’ time, but let’s face it – as of now that is a lie.  I would be quite happy for that to be the case.  Or at least I would at the minute – there are times when I don’t want to see C ever again for as long as I live, but now isn’t one of them.

“…but,” he went on, acknowledging my comment only with a subtle grin, “you present a number of symptoms that are proven to be treatable by practical methods, so I think it’s important we do some work in that regard.  Having said that, it’s only one dimension to what we should be doing here – I do agree that we need to delve deeper and explore causes.”

“A dual approach,” I murmured.

He nodded, then looked directly at me, smiling reassuringly.  “Don’t worry,” he said.  “We’ll get there.”

I am not sure I will ever forget the profound feeling of reassurance I took from those five words.  Anyone can say something like that, of course, but I felt that he really believes we can get ‘there’, wherever ‘there’ is.  Not only that, but he wants to get me ‘there’, not (just, anyway) because he has to meet some stupid Health Service quota or because he’s scared of getting in trouble because I have topped myself or ended up in the bin, but because he actually gives something of a fuck.

This was the end of the session.  As I was walking out the door, he said, “all the best,” which is not something he’s said to me in ages – perhaps not since our initial assessment meetings back in February or March.  It’s a stupid thing to feel pleased about, of course, but it just adds to my general feeling about the session.  The whole thing, however temporarily, set my perpetually troubled mind at ease, at least as regards psychotherapy, which can be a difficult and murky process.  I felt there was a clear rapport in the dynamic, perhaps even a sense of camaraderie insofar as that’s permissible in the circumstances and the relationship, and moreover, C seemed to me to make a real effort to try and alleviate a number of concerns I expressed.  ‘Reassure’ is a word I’ve used a lot on this post, and whilst it’s still the most appropriate one I can find, it doesn’t even seem to grasp the safety I felt.

In terms of my current thinking, almost two days later, I hesitate to use the word ‘hope’, because I’m way too cynical to even believe in that concept anymore, in its most abstract sense anyway.  But let me put it this way; for now, for this week at least, and even if it never happens again, I feel a very slight tingle of cautious optimism that there may be some light somewhere down the tunnel, that is for once not a train hurtling towards me.

The below is a list of symptoms that I have experienced since starting to take Venlafaxine (75mg) from 15 June.  It is redacted in places, for either personal reasons or to help the ‘flow’ of this post, but essentially this is from a list I have been maintaining with the intention of showing Dr C when I finally see her again on 8 September.

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• Significant increase in (hypo?)mania – I am very much the ‘life of the party’, very confident (at times to the point of arrogance, or being very over-talkative)
• Significant increase in mixed episodes.
• In both of the above obviously fragmentation, pace and disorder of thoughts are of increased severity.
• Rapid cycling between (hypo?)mania and depression at times (ie – changes once or twice a week – occasionally more often, occasionally less so).
• Significant increase in compulsion to (and execution of) self-harm. Execution of ‘creative’ cutting reduced a little after the initial six or so weeks, but is still sometimes happening and I still feel the compulsion strongly and with great frequency.   Any lack of execution of cutting is mainly due to environmental factors or preventative measures I have previously taken (eg. hiding knife). Head-banging, hair pulling, scratching at self all still very frequent.
• Severe restlessness – compulsion to head-bang, to pace, get up, sit down, get up, sit down – noticed usually in tandem with severe anxiety and/or mixed states, but not necessarily limited to this (this was present before Venlafaxine but it was much less frequent and much less severe).
• Psychosis – Increased and more severe delusions (frequency – circa once a week? Though hard to say) – eg sun (watching me), signs (sending me messages), iPod (reading my mind/mood), severe paranoia (trust issues even worse – everyone is out to get me).  Some hallucinations are of similar frequency as before, but are more vivid – shapes especially clear.  Now also hearing voices/whispers which are very audible – as opposed to nebulous – at times (obviously unaccounted for).  The frequency of the voices – there are no hard and fast rules, some weeks this is frequent, some weeks there are none at all.  No specific time. Content is not ‘demanding’, it just says stuff like saying my name, asking what I’m doing – it is meaningless ‘small talk’. The shapes are there most (but not all) nights as before, same nebulous form as previously, except sometimes with greater clarity.
• Amnesia – eg. ending up in places with no idea how I got there or forgetting long discussions usually related to being mental.  Frequency of this is hard to determine – at a guess once a week? It depends – sometimes no such amnesia one week, sometimes several instances thereof.
• Increased mood swings, independent of mania-depression-mixed states – eg. extreme and uncontrollable irritability, anger, frustration, lethargy, anxiousness (again, these mood swings have been strongly present long since taking Venlafaxine but seem to have increased since taking it).
• Constantly exhausted – even more so than previously – except when I’m in a ‘manic’ state during which high energy levels are present.
• Fantasy world is still there but seems less intense than previously – not sure whether this is a result of tablets or psychotherapy though?
• Terrible forgetfulness – I go to do something and literally five seconds later I’ve forgotten what it was or what I went to do.  As with anyone this happened the odd time in the past but  for me it is now several times daily.
• Horrible, vivid nightmares when I do manage to sleep. Once or twice a fortnight.  I very rarely had such dreams before taking this tablet (approximately once every few years). They focus mainly around my being attacked (physically or sexually) or painfully trying to kill myself – despite suicide ideation this is not pleasant at the time!
• Suicide ideation seems increased to others (though not necessarily to me).
• Others say ‘default’ mood is slightly improved but not still not to extent they would have hoped.  My own view is mixed.   I still feel profoundly depressed most of the time, but perhaps the intensity of that profundity is very slightly reduced (not always – but I think in the main). Furthermore, given the substantial increase in (hypo)mania, depression occurs less frequently – but is felt very strongly when it does due to the strong divergence in mood. Mixed states, which are now very common, are probably the worst state as when I am very depressed I don’t have enough energy to self-harm or seriously consider suicide, etc – in a mixed episode I do.
• Others describe lows / mixed states as being of considerably worse severity.

Symptoms with No Change Since Taking It

• Still feel depressed though as stated others comment that I seem to them to be less depressed during ‘normal’ periods and own view is that it may be very marginally improved at times.
• Insomnia in a similar state, though general exhaustion and lethargy increased. Difficulty falling asleep – if and when I do, wake up frequently, even with medication (without sleep is usually non-existent beyond maybe half an hour or so).
• Dependency / abandonment issues unchanged.
• Narcissism, entitlement – though self-hate has definitely manifested more significantly since onset of psychotherapy (apparently unrelated to medication).
• Misanthropy.  Mistrust of people.  Abject terror of work, work-related issues, going to unfamiliar places – I fall about in a mess even thinking about this stuff. This is all the same as before.  Despite all this, I experience a lot of paradoxical loneliness.
• General levels and frequency of inappropriate anger is similar to before, though outbursts seem to be increased (as stated above).
• Self-analysis, overthinking.
• Dissociative symptoms – depersonalisation and derealisation seem mostly unchanged (apart from the development of amnesiac occurrences – presume this is related to dissassociation in some way?).
• Continued personification of inanimate objects, feeling sorry for such things – no such sympathy or empathy for people (in general).
• Fixation with death (as distinct from specific suicidal thoughts) is ‘stable’.
• Complete and utter lack of motivation – no interest in everyday activities eg tidying, dressing,cooking etc.  Same as before.
• Utter inability to concentrate or focus for anything more than a few minutes, except when mood is strongly elevated (and certainly not always then either). Very easily distracted, little ever gets done (applicable at all times).Memory rubbish too. Need to sit and plan things to have any grasp on them.
• Eating problems similar to before.
• Obsessional behaviour continues.
• Black and white thinking and behaviour.
• Post-morteming behaviour.
• Other issues that I can’t think of.

—

In short, I think Venlafaxine could, potentially, help me with my depression – but the dosage would have to be increased, as the small improvements made in that regard are simply not sufficient to keep me sane.  More importantly, though, Venlafaxine is not only not helping all my other symptoms, but either it is making no difference or, more commonly, it is in fact increasing them.  I have described some of the horrors elsewhere on this blog.  The past few months have been fucking horrendous, by and large.  This is particularly the case, of course, as regards the bipolar symptoms.

As you can see from the link at the top of the page, Dr C refused to give me mood stabilisers when I last saw her as she believes that BPD is my primary diagnosis, and NICE advise against the use of them and anti-psychotics in BPD (though this seems to be the mainstay of treatment for borderline in other countries!).  That’s all well and good, but of course Venlafaxine is notorious for increasing or inducing manias and mixed states to those predisposed to them.  Given that circumstance, you would have thought that she would either have had the decency to listen to my plea for mood stabilisers at the time, or at the very least had her SHO keep the fucking July appointment that they cancelled.  If I, a complete psychiatric novice beyond my explorations on the internet, am aware of Venlfafaxine’s notoriety in this regard, surely a consultant psychiatrist, who herself diagnosed me with an illness on the bipolar spectrum, should have taken some bloody consideration of this?

In any case, I have forgotten to bring all my medications, including the bloody Venlafaxine, with me to an overnight visit to my mother’s house.  I am well aware of how hardcore missing doses of Venlafaxine can be, plus I also don’t have my sleeping pill so no doubt insomnia calls.  I’m sure, ergo, that tomorrow morning’s session with C will prove interesting…

For a variety of reasons I simply haven’t had the opportunity to blog about my most recent session with C to date, so, with it now being the septiversary of our last meeting, it seems appropriate to try and do it now before my memory of the meeting dwindles further.

Last week was weird, because for once he actually opened the conversation, rather than just fucking staring at me for 140,618 years, waiting with futility for me to express my thoughts. He wanted to know how I had coped the previous week without him, and what plans we were going to put in place in case (or rather when) I go batshit mad during his annual leave which will be ongoing until 20 August (might as well be 2079 to me right now for all the closer it seems).

I was encouraged by this: I thought he was going to explain the procedures that the CMHTs have in place to deal with attached-to-shrink mentals in the absence of said shrink.  Which of his colleagues should I contact in an emergency, who should I get it touch with should I need general advice, blah blah.

Was he fuck!  The exercise, and frankly most of the session, was a load of naval-gazing, useless dross.

“We need to formulate a plan,” he declared.  It seems his idea of a plan has four progressively mental points in the key of D:

1. Mental: DBT Distraction Plan
2. Quite mental:  Discussion About Being Mental
3. Very mental:  Doctor – Either LGP or Out of Hours
4. Suicidally mental:  Death Avoidance – Casualty

He didn’t use this stupid ‘D’ thing; that’s of my doing, because it’s equally fucking patronising to the whole bloody ‘plan’.  I actually laughed in his face about the discussion bit.

“Who the fuck am I going to discuss this with?” I asked.  He reminded me that the first time he’d been unavailable for a session I called D, my best mate, to expunge myself.  I don’t think I was keeping this blog then.  Not sure.  It was a while back anyway.

This is true, but whilst D is mostly aware of the issues that have given rise to my mental health issues, I really don’t want to discuss them in detail with him.  He reads this blog from time to time, but I’m quite analytical here, not off-my-head mental, so even though the material here may well be disturbing to normals, they don’t get to hear or actually witness what it’s really like. I need to protect people from it.

I said so to C, who by virtue of his chosen career has de facto committed himself to hearing about and witnessing disturbing behaviour.

He asked could I not speak to A, then.

Yes, I can, as it happens; he bears witness to many of the worst moments and is certainly aware of the others.  In fact, of late, I’ve noticed many of our conversations have been about my being mental – I think I’m trying to forge some sense of identity by being obsessed with my madness, but that’s an entire other post.  The point is talking to A doesn’t always alleviate the problems; not that it’s specific to A though, talking to anyone doesn’t make a difference, at least depending on the type of episode anyway.

Yet still C wanked on about it.  The Samaritans then.  Lifeline.  Some such 24 hour crisis line.

This was winding me up to fuck, so at this point I expressed my annoyance yet again through a cynical laugh.  This didn’t go down too well – not that he criticised me, but just because he’s the one trained to be perceptive doesn’t mean that he is the only one that actually is perceptive.  I could sense an annoyance, or at least a confusion, at my reaction to his suggestion.

I explained that whilst I had every admiration for the volunteers operating these services, recognised their well-meaningness, and in principle fully supported them, that I had not found them helpful in the past.  To be fair, I was overplaying my use of them, letting C believe I’d called them a number of times when in actuality it was only once or twice.  But when you know something isn’t helpful (or indeed is), then you do.

He hides it well, you know, but I sensed exasperation.  I said the point was that I cannot talk to anyone other than him, and to a lesser extent LGP and Dr C, about the darkest things.  Even then the discussions are abstracted, formalised or structured by me so that I can avoid talking about those things that I wish not to discuss (or at least discuss them in a ‘safe’ way).  In front of them, I don’t behave in the angry, frenzied, self-destructive way that I often do otherwise, and that I frankly long to do in front of them at times.  I try not to express emotion, and when I do I either force myself to desist from it or end up apologising for half an hour for my failure to control myself.

Simply put – it’s hard to talk to anyone.

Anyway, C said this was about my inability to ‘do’ empathy.  I asked what the hell ‘empathy’ had to do with it.

He said, “you despise the emotional side of yourself so much that you don’t allow yourself, or feel unable, to empathise with others, would you agree?”

“Not entirely,” I replied, “but in the main, I suppose the answer would be affirmative.  Why?”

“You can’t empathise with others because you can’t empathise with yourself.  I think that has to be one of our goals here, to allow you to gain, or regain, that sense of empathy.”

I protested that I didn’t want it, I don’t do emotions, I like to be rational, this arse shouldn’t come into my life, thank you very much, the end.

C wanked on and on about emotions for a while.  I do do them, of course, he contended.  He didn’t say this, because labels are so evil and unhelpful, don’t you know, but of course the cornerstone of a diagnosis of BPD is an inability to regulate emotions properly, thus you go mental.

So, he concluded, my emotions are clearly very strong, and my lack of empathy for myself is profound.  “For example,” he said, “you carved ‘hate’ into your body.  Don’t you think this is a way of expressing a strong emotion, without expressing it in a ‘normal’ fashion?”

Once more I laughed in his face.  “You think ‘hate’ is bad?” I sneered.  “You want to see some of the stuff that’s been added since!”

He raised his eyebrow and said, “you say that with almost a sense of glee.”

“Yeah.  So?”

“Well, I’m getting the sense that you delight in self-harm – it’s a further, and outer, manifestation of your self-hatred.  You mask ithe hatred well outwardly, for the most part, but you need to confront it eventually, in ways that aren’t self-destructive, in order to get over it.  Thus, you need to be able to empathise with yourself.” He also stated that carving things such as ‘hate’ into myself was a form of punishment for feeling emotions. He seems to think that’s at least partly why my mood improves after self-harm; I am sated because I am punished and have got what I deserve. Probably fair, admittedly.

“Yeah, whatever,” I said, “but the point is, cutting is quick, and it works.”

“Maybe so, but it is self-destructive.”

I shrugged.  I mean, he’s probably right in the sense that it is an outer manifestation of something I don’t generally express in other outward ways, such as through talking.  It certainly is self-destructive, though I don’t really see how that matters, but still, how could I argue?  I simply told him that I genuinely cannot foresee him being able to get me to ‘empathise properly’ – not in the manner that he means, anyhow.

An interesting side-note is that I’ve observed from re-reading parts of this blog that I’ve (unconsciously) stopped putting words like ‘emotion’ and ‘feelings’ in quote marks (except in circumstances like the immeadiate foregoing where they are necessary to denote they’re not active nouns in the sentence). I told C this, laughing that he must have made some progress with me in this particular area. Interestingly, he did seem mildly encouraged by this.

Anyway. We discussed suicide ideation for a bit, in relation to the stupid plan of action for when I go doolally in his absence.  He said something like, “…if you start thinking about suicide…” at which point I interrupted him, yet again with a sneering laugh, stating that I thought about suicide every hour of every day.

He asked why.

I said because I want to not exist.

He replied, in my view rather confrontationally, “so why have you not done it then?”

“Cowardice,” I responded instantly, without a mere second’s hesitation.  I’m fairly sure he was expecting some humming-and-ha-ing, but I’m already well aware of the answer.  I’m too fucking pathetically scared.

I did concede that not all shreds of altruism are lost amongst my endless waves of narcissism; in part, I haven’t topped myself because I know it would annoy A, Mum and my friends (plus – in my view, oddly – the family, but who cares about them).  But the main reason, selfish or otherwise, is simple cowardice.

He didn’t quite seem to know how to respond.  I think this was one of many points where he irritated me intensely by silently staring at the floor for what seemed like eons, with his index finger ensconsced thoughtfully over his mouth.  Eventually, this pissed me off so much that I said, “you do realise, don’t you, that I’m trying to work out what you’re thinking?  Isn’t that a role reversal?”

“Do you mean,” he enquired, “that you think you feel like the therapist?”

“That’s patently ridiculous,” I said, but in quite a nice way.  “I suppose I’m asking if you think I play mind games with you.”

“Do you?” he asked.

“I think so, yes.”  I told him I felt there were times when I challenged him, whether overt- or covertly, to work me out, or answer difficult questions, or respond to deliberately provocative statements.

“‘Mind games’ isn’t the terminology I’d use,” he said, “but if you want to call it that, fair enough.  I think you’re testing me, is all.  You want or need me to prove my competence, understanding, whatever – basically that I’m worthy of your trust or time.”

I agreed with this.  I told him that he would, of course, have worked out by now that I had very strong defences built up and thus have big problems trusting people until they’d proven themselves trust-worthy.

“Consider yourself lucky,” I smiled.  “I do trust you – yet I don’t know you at all.”

He asked how I felt about not knowing him; I responded by stating that “this relationship is asymmetrical of necessity.”

“Perhaps,” C said, “but that doesn’t mean you don’t find it strange.”

“Of course it’s strange,” I replied, waving my hand dismissively.  “But I can deal with strange.  I’m strange.  My life is strange.  Strange is normal to me.”  Fair is foul, and foul is fair, hover through fog and filthy air… [Macbeth, Act I, Scene I, if memory serves].

I don’t remember really what that led to, so the next few issues I remember raising were my ongoing problems with my cunt office, although that rant was brief, though I then launched into a major invective regarding the situation with Dr C.  Well, I say it was ‘major’ – it was, but it was also very measured.  I did say to C that I was extremely angry but I couldn’t go on about it too much as I risked behaving in a “psychotic pacing ranting fashion” and that I didn’t want to do that “in front of him.”  I did say that I was sick of the pillar-to-posting I’d experienced under the care of the NHS for over a decade, and that it was particularly frustrating that when things actually looked like they might be moving forwards, I was yet again rejected.  I whinged that when I needed Dr C most, due to the problems with my medication causing serious and frequent mixed episodes, it was the time she chose to abandon me the most.

[Alas.  It is now Friday 7th, thus I didn't get this published on Thursday 6th, the septiversary of my last meeting with C, as I had planned.  Apologies.]

The truth is, I was hoping C would contact Psychiatry and tell them that my self-harm is getting worse and my suicide ideation is out of control, which I think it is, given that most people don’t seem to think about suicide and death all day, even if they are rather batty.  I mean, he had most of Thursday and all day on Friday to contact them before he went off on his stupid fucking leave.  But he made no such offer, and a week has now passed without my having heard from them, so it’s evident he made no such contact.

What do you have to do?  What the fuck do you have to do?  Do I need to run into a busy shopping area pointing a shotgun at my head or climb, very publicly, to the top of a tall building with the threat of jumping, to convince them that this is fucking serious and that I need help?  Nobody gives a fuck.  No one.  I’m sure most of C’s silences during this session were him fantasising about 5pm on the Friday when he’d be free for over two weeks.

Anyway, before the end of the meeting, he returned to the wanky Four-D Perfect FoolProof Anti-Suicide Plan.

“Look,” I said.  “I promise not to be dead in three weeks, OK?!”

He looked over his glasses at me in that strange enigmatic way he sometimes does.  “But you’re promising me, not yourself,” he mused.

“So what?  The effect is the same, isn’t it?”

Essentially this relates back to my lack of self-empathy or some such bollocks.  Whatever, who cares.  He asked me to definitively agree a plan of action with him before I left.  I should have tried a new mind-game and pretended (or, more accurately, admitted) that I didn’t agree with anything he was saying so as I could have made the session overrun, just to see what he did or said.

I did say, and in fact although I didn’t mention it above I had said it earlier, that the problem with any of this stuff is that by the time you’ve gone mad enough to need it, you’re far too mad to do it.  Fairly simple concept, yes?

“In advance,” C said, “write it down.  You’ll then have something tangible to which to refer.”

“It doesn’t matter,” I protested.  “The entire house could be wallpapered with plans for what I should do when I go mental, but when I am mental none of it matters.”

I tried, with absolutely no success whatsoever, to describe what it’s like when I’m psychotic, or panicking, or experiencing a mixed episode.  I couldn’t put it into words, but the point was that even though I may maintain some small awareness of rational issues that exist outside my head, that I did not have the cognitive functions to actually put any such things into practice.

“What do you think the answer is then?” he asked, again in what I felt was a confrontational manner (though I could just have been paranoid – who fucking knows).

“Valium and sleeping pills,” I declared.

His concern was instantly piqued and he went to protest, but I pre-empted it by saying I wasn’t talking about overdosing on them (I know from the suicide newsgroup that there’s practically no chance it would fucking work even if I tried), but rather about knocking myself out for a few hours in the hope that by the time I woke I’d have returned to my default state of quasi-sanity,or at least vague rationality.

He seemed cynical of this.  I don’t remember what if anything he actually said, but I got the distinct message from him that drugs were only part of the answer, if even that.

We were running out of time, and he kept pressing me to work with him to formulate the stupid plan.  In exasperation and to just fucking pacify him I finally said, “right – distraction, discussion, GP and casualty, OK?”

“Yes,” C replied – relieved, I think – “but you may want to add layers in between.  Remember the breathing exercises as well, for example, or specific distractions of your own.”

Well, as it happens I don’t fucking want to add ‘layers in between’, because I don’t think the bloody thing is of any adequate use anyway, unless someone is acting on my behalf (in stages three and four anyway).  But fuck it, I just nodded.

He said, “our next appointment is 20 August.  Do you want an appointment card?”

I said yes, as I would be wont to forget that, as each day runs into another when one is a dolescum.  He wrote it out and handed it to me.  I was irritated in the extreme to observe that he’d written “Dr C. J.” on the front of it.

I have been seeing you for twenty weeks, C.  That’s about five months.  I FUCKING KNOW YOUR FUCKING NAME.

I got up and wished him a pleasant holiday (though part of me was secretly hoping he spent it in mild misery with ((non-fatal)) swine flu or something – but only part of me ), and he thanked me.  As I left, I said, “take care.”  I was offended by the fact he merely said, “bye” and didn’t reciprocate.  Funny how silly, meaningless little things take on such importance in the therapeutic setting.

This post has made it sound like I am absolutely raging with C and that our last session was a confrontational battle of wills.  Neither of these are really true; it comes across differently on ‘paper’ than it really was, and of course I use this blog as a sort of secondary therapy where I can rant and rave all I like with (mostly) anonymous impunity.  I can castigate C to the high heavens here; even though my annoyance at him can be real, it’s also somewhat tongue-in-cheek and in any case my feelings towards him vary from day to day, maybe even more frequently than that.  Stupid transference.

I’ve managed relatively well without him thus far.  I’ve not been in good form by any means, but when am I (except when hypomanic)?  My only real major episodes were last night and part of today, but there were precipitating causes – the McFs, perhaps unsurprisingly – and that’s a story for another day, for it is now 1.40am in the UK and I must draw myself away from the computer.  It’s my first night of the tri-weekly sleeper-fast and I need to try and relax somehow in a perhaps futile attempt to get some rest.  Due to the almost certain insomnia of the next week, I have a horrible feeling that the coming seven days will not be much fun, but we’ll see.

This week has sucked, and I am glad it is nearing its completion.  I’m actually in a fairly good mood now as I write this, but it’s the first day that I have actually felt that right from getting up.

As you will know from Monday’s post, I’d been in bad form regarding the fucked-up status of my relationship with the psychiatrist.  However, no sooner had I published that post than an email arrived from the Horse that put me in an even worse mood.  My first reaction was of panic, but it was shortly replaced by anger.

Prior to Monday, the latest in the work saga had been that Horse had asked me to yet again outline any “aggravating factors” that had occurred in the workplace prior to my absence.  I had already done this back in March, and received a reply that was nothing but an unconstructive and condescending refutation of my comments.  So, when this second request came, I had simply outlined a few management issues that needed to be addressed.

They have agreed to increased supervision in the immediate aftermath of any return to work, as well as a phased returned facilitated by payment commensurate with hours of work rather than by use of annual leave to cover the out of office hours.  Yet again, though, everything else was refuted.  Frankly, it seems to me that the Horse is actually too braindead to even understand what I was saying.  I would have given my boss, with whom the Horse seems to be working closely, more credit, but I think that this is her first experience of managing an absence of this length and as such she seems to be delegating most of the responsibility to Personnel.

Work have picked the wrong person to fuck with.  A’s job is writing employment law.  His brother, DI, is an CAB advisor.  His best friend, W, is involved at a senior level with a charity law unit in a well-regarded university (my employers are a charity).  My mother is a former Personnel Officer.  My best friend, D, is a Personnel journalist.  One of my Twitter friends and regular commentators here, bourach, is a union rep.  I know where the fuck I stand, and if I don’t, I can soon fucking find out.

In exploring the relevant legislation, A has commented that I would probably need to put up more of a fight in regards to what would be considered reasonable by the ‘reasonable man on the street’, especially under the Disability Discrimination Act, if I were seriously to take them on.  Initially, I had not wanted to fuck the office over so hadn’t bothered to argue with them.  However, the more I hear from the Horse, and the more my boss doesn’t bother to stand up for me, the less I care.  I know things are over now.  I will almost certainly not be returning.  It’s illegal for them to give me a shit reference on the grounds of my disability, and I will be seeking assurances from the fuckstains that this does not happen.  The point I’m making is that I no longer feel I have much to lose by fucking back with them.

To demonstrate that she speaks in Fuckwit rather than English, I am including a few excerpts from her email.  Except for my [] points, these extracts are exactly as they appeared in the email, though I have bolded the especially hilarious bits.  Sigh.  I thought they still taught grammar in schools?

SI, as explained in previous correspondence, a priority system would be introduced so that [managers] and [others]  to adhered too (however there may be exceptions to this)

As you can understand that we wish to cause least distribution to the team, we would appreciate if GP appointments were made at the start of the day as I am lead to believe that your GP is based in [some distance away].

[Re:my request that work was clearly delineated between my assistant an me] Unfortunately we can not adhered too at all time.

Well, no, you can’t ‘adhered to’, you stupid bitch.  Your contention that the organisation wishes to make ‘reasonable adjustments’ to accommodate my illness is frankly amusing given your continuous refutations of my comments.

Her constant use of my name at the beginning of sentences (if you could even call them that) is infuriating.  How dare she patronise me in this fashion?  How dare she?  I can almost guarantee that my intellect is about double hers.  I am also willing to bet substantially that my qualifications are more significant than hers.  Even if not, I think the pathetic construction of her correspondence just proves that she is a dumb, fuckwitted moron.  I would have thought that it was key in a Personnel job to be able to communicate effectively.  Apparently not in my organisation.  It doesn’t matter that my dismissal is imminent anymore, as I was wasted on the cockheads anyway, it seems.

She also demanded written evidence regarding Dr C.  She failed to specify the nature of the written evidence she requires.  I am now of the belief that they don’t believe I have seen her or that I have been diagnosed as I have.  A says this is paranoia and that it is standard practice to ask for written evidence for everything.  Maybe so, but they have not asked for anything of this nature previously.  In A’s view, this exemplifies the incompetence of the Personnel function in the organisation.  Which is probably fair in relation to some of its members, most notably the Horse.

Anyway, this email arrived on Monday, which was 20th July.  As per the Horse’s previous email a few weeks ago, I understood that I was due to attend Occupational Health the following day, ie. Tuesday 21st.  The Horse then said in the email referenced above that the appointment was on Thursday 23rd.  Great work, Horse.  You’re obviously competent enough to keep track of your own emails.  It turned out it was Tuesday, but I had to call OHS themselves to determine this.

I emailed her back and was frankly just on the borderline of civil.  Well, that’s not true; I am always very careful in my correspondence with them not to be a cunt, as they would indubitably use it against me, so it was still polite and professional.  However, there was a sneering, cynical tone to it that adequately if subtlety conveyed just how fucked off I am with the whole bloody thing.  AC told me it was a bit “cheeky” (but justifiably so); Mum and A said it wasn’t cheeky exactly, but it did make clear that I was sick of the way they were treating me.  Good.  That is what was intended.

It is the tip of the iceberg, anyway.  A and I are going to work on an email to the Horse outlining exactly why her shite contentions fail, and why what she perceives as “reasonable” is in actual fact not at all reasonable.  We are going to do this before she contacts me again to eliminate the risk of a knee-jerk emotional response to her inevitable imbecility, and it’s going to be fucking brilliant.

Anyhow, despite my anger, Monday evening / night was relatively OK.  Without the sleeping pill (it was my week off them until last night), I didn’t sleep, as ever, but I didn’t go mental either.

This was not the case on Tuesday afternoon.  I worked myself into a major panic regarding the impending OHS appointment, which culminated in some fun with a knife.  There are at least 10 random slashes across my arms, legs, breasts and stomach, not to mention the delightful words of “vile”, “fail” and “die” across my lower abdomen.  In keeping with previous incidences of self-harm, I then calmed down.  For a while anyway.

I was laughably early for the appointment, so sat in my car playing games on my phone for a while.  I was fine until I actually got into the building and then I just lost it.  I took a Valium, but to be honest by the time it started having any effect, I was out of there – not that one Valium tends to make any difference anyway.

I was, fairly quickly, approached by a tall, fairly good-looking middle-aged bloke with grey hair.  This exacerbated my panic as I was expecting the woman that I’d seen the last time I was at occupational health; at least I was familiar with her.

He introduced himself as the doctor I was to be seeing.  I could barely speak and when he held out his hand I could barely shake it.  I was shaking, stuttering, rocking back and forth and generally behaving like a loon.  I even burst into tears at one point, for which I then found myself apologising.

It was telling that the only notes the bloke actually took were regarding my current medications.  He literally wrote nothing else, as I recall – why would he bother?  It was self-evident that I am mad, why bother noting that information?  I don’t really remember a great deal of the conversation, but I do recall telling him that work didn’t believe me about the BPD / bipolar diagnosis and that they were out to get me.  I also recall him asking if I had been to university, and my telling him that I ended up having to leave my Masters degree with a post-graduate diploma because I had a previous breakdown at that point.  He said quietly, and with evident sincerity, that he was “sorry to hear that”.  In fact, he seemed so genuine and sympathetic in saying so, that I thought he was going to come around the desk and put his arms around me.  I also admitted to the self-harm, some of which I even showed him,and the recent hilarious mini-suicide attempt. I told him about the trouble with the shrinks that is causing such extreme fuckuppery at present.

I have to say he was lovely.  I felt that not only did he understand the nature of the diagnoses and the symptoms thereof, he actually seemed genuinely sorry that I was experiencing them and, reading between the lines (although he didn’t actually say so), I did get the impression that he wasn’t overly impressed with the behaviour office.

Although he was nice, the meeting was essentially a waste of my petrol.  I was there less than 10 minutes, with his view being very clear; there is no way I am well enough to return at the minute.  He didn’t put a timeframe on it the way his colleague had done the last time I was there, but did say he would probably see me again.

It’ll be interesting to see what Horse and friends make of what he says.

I was fine on Tuesday evening, but after going to bed I became progressively mental.  Well, I say ‘mental’, but that’s probably not true; it was more real, hard-core depression (is it the same thing?).

I admitted defeat.  Work had won.  Georgie had won.  V had won.  Maisie’s husband had won.  The school bullies had won.  My ex had won.  I had failed, epically.

I ceased to care.  Let C section me.  Let him not section me.  Let the shrinks abandon me.  Let them not abandon me.  Let me die, let me live, I don’t care.  I just didn’t care.  Whatever became of me, I didn’t give a fuck.  My life is over; all I can look forward to is existence.  If that’s my future, then it doesn’t matter what form it specifically takes.

A started babbling at me in his sleep, which is not something he can help, but it annoyed me and I started crying and came downstairs.  I lay on the sofa and curled up with the cats, rocking back and forth, and remaining there, awake, for the rest of the night.  I thought about adding to the body art, but to be honest I simply didn’t have the energy or motivation.  Interestingly, I have read in several places that depressed people are at the most risk of suicide and/or self-harm when they start to make small improvements, for instance when anti-depressants or psychotherapy first start to be successful; when they are in the depths of despair, they simply cannot get motivated to undertake the acts, but when they are still depressed, just a little less so, they begin to get back enough energy to go ahead and do it.

Wednesday was alright, if boring.  However, after I went to bed on Wednesday night, A found some of the cuts from Tuesday afternoon and was upset by them (I had been successful in hiding them until then).  I freaked out at him at one point then started crying and apologising to him.  I kept wailing that he was angry with me, and he would either not answer or he would say that he was not angry with “my rational mind”, which means he is angry with me because my irrational mind is in control of me so much of the time.

But he ended up being nice to me and so I got over it and, although I was fairly depressed yesterday during the day, I improved last night have been in fairly good form since.  Strange how the moods swing.

So, this is kind of a pointless post, but then they all are, except for my own reference, and of course that is the main point of this blog.  So I suppose in that sense it does have some point.

So, after my grovelling apology and new-found respect for Dr C back in June, the current behaviour of her and her team has reinforced to me why I thought they were shit in the first place.

I was supposed to be seeing Dr C next Tuesday, so as she could review how the change to Venlafaxine was affecting me.  Regular readers will know that I’ve gone completely fucking mental since I changed to them, as demonstrated in just about all my posts in the last few weeks, but especially here and here.  Dr C, or perhaps more accurately her bint secretary, had already changed my appointment time several times.  This was irritating, but meh; as long as they were to see me, I could live with it.

Well, a letter arrived on Friday from their office stating that whilst they “apologised for the inconvenience”, the outpatient clinic had been cancelled and that an appointment had been rearranged for 8 September.  September.  What the fucking fuck?

I went to ring them but instead of being able to type their number into my phone I just ended up panicking and ultimately throwing it across the room.  Eventually I got my mother to phone the bint secretary for me.

The bint told her that the clinic wouldn’t have even been with Dr C in the first place.  My mother didn’t get the name, but it sounded like it was Dr N, the SHO I met the first time I went to psychiatric outpatients.  That wouldn’t have been ideal, but I could have lived with it.  But anyway, Dr N has cancelled her clinic.  Just like that, apparently, and no more reason was given.

Alright, my ma went on.  But SI is climbing the walls and would really need to speak to Dr C.

But that isn’t possible, apparently, since Dr C is on holiday.  For “quite a while”.

And in the meantime?

September is literally the first appointment available, so that’s too bad really, oh how regrettable, but that’s the way it is.  If there are any cancellations, they’ll apparently phone me.  Yeah, right.

FUCK FUCK FUCK FUCK FUCK FUCK FUCK FUCK FUCK

Go fuck yourselves, one and all in psychiatry on the NHS.  Fucking bastarding cuntflapped bollockheads.

No wonder I don’t want to be hospitalised, if this is the standard of care one can expect.  Mental health professionals don’t care about mentals, clearly.

I got off the phone with my ma and threw my head at the wall with such force that I literally fell backwards, and very nearly knocked myself out.  I sat down again, got back up, sat down, got up, paced, sat down, paced some more and eventually ended up in the kitchen looking for the knife.  I then went and re-carved the word ‘HATE’ across my tummy, about which I wrote here.

That action having been completed, I sat on the sofa with the knife for a while wailing and sobbing in utter desolation.  (For what it’s worth, after a fairly short while I felt a lot better, proving that self-harm does indeed work).

It’s like the conversation I had with C on Thursday.  I don’t think I’m being taken seriously by the NHS.  I really don’t.  I would love to have the nerve to make a suicidal gesture and that would fucking show them.  Even better, I’d love to actually be successful in catching the bus and then the cunts would face a potential lawsuit and be forced to apologise to my family and friends and shit.  But as of right now, obviously, I don’t have the nerve.

Everyone is commenting that these tablets don’t seem to be good for me.  As I detailed here, if they are creating mixed episodes (which they are), then the apparent way of treating this is to add mood stabilisers to the medication cocktail.

How the fuck am I meant to get these if the psychiatrist refuses to fucking see me for months?  My GP can, theoretically, prescribe them, but of course he’s not the expert that Dr C supposedly is.  She would know if the mixed episodes are caused directly by the Venlafaxine, or whether it’s something else.  She would know whether she should change me to another anti-depressant, or whether adding mood stabilisers on top of Venlafaxine would be the best answer.  I am not sure that Lovely GP has this in-depth knowledge.  As CVM (a registered nurse) said to me, he went to university for five years and then trained as a GP thereafter, so he damn well should be able to know – but, simply, he doesn’t have the same knowledge and specialist experience than Dr C and her ilk are reputed to have.  Still, I may go and see him anyway.

I am convinced that C could get them to take notice (it turned out that it was him rather than Lovely GP that did in the first place), but of course there is no C this week   I will have to rant about it to him next week before he then goes away for two weeks

Additional worries:

• Georgie is on this landmass.  In fact, she is – until her departure next week – never more than about 40 miles away.  I feel violated.  I wonder, despite my request for her not to, how much back-chat she has engaged in about me?
• Fucking occupational health tomorrow   Panic panic panic panic panic panic
• Because of the shrinks wanking about, it is almost certain that I will lose my job now.  If they’d see me as planned next week then I might have been able to get a solution to my present situation fairly quickly.  Given that I am now likely to continue feeling this fucked up until at least September, about the time work are expecting me back, I really cannot see how the situation can be resolved.  I didn’t realistically think it could have been anyway, but it was possible, and now the chances of not getting dismissed are low to infinitesimal.
• The effects of my mentalism on poor A (I went mental again on Saturday, though it was remarkably less severe than the previous couple of weeks).
• The fact that some people are still unwilling to try and understand that this is not something that I can help, that I could end being mental by “changing my thoughts” (ha!), and decide to tell me what I should and shouldn’t do about it and how I should count my blessings.  Never thought of that or anything, thanks.

I’m not totally losing it today, but things do seem pointless and bleak.  Nevertheless, that’s a fairly default position for me, so I suppose it’s progress from going totally off my head.

Well, I will report back on the occupational health tomorrow.  Can’t wait…!