Livin’ La Vida Lamictal

 Life, Medications, Mental Health Diagnoses, Moods, NewVCB, Psychiatry  10 Responses »
Nov 112011
 

Good afternoon my beauties.

Yes, I remain on this plane of existence. I simply have no idea what to write here – well, actually, that isn’t true; I have quite a few ideas floating around in my head, but in terms of actually recording them on this blog, I’ve failed to do anything with them. Never mind. Maybe next week I will feel more amenable to blogging? I have one piece of (unpaid but) professional writing to get done which will take priority, but perhaps the mere act of getting some words out of my system will help motivate me into putting more here.

I don’t know where this apathy has come from; I want to write, but I just cannot work up some sort of inclination to do so. I’m not particularly depressed in the traditional mood sense, and in fact have at times found myself quite hyper of late, but this week has been a frustratingly busy one and let’s not forget that it’s November – a month that I detest. How the fuck did it get to be November? My life is passing me quickly by in a haze of malaise and anhedonia, and it reminds me acutely of how much I’ve wasted my fucking 20s and failed to achieve anything of any notable worth.

Still, this was not meant to be a post in which I complain about my failure at life; there’s plenty of material there for another post entirely! Instead, let’s have a brief, dull look at my appointment on Wednesday with my consultant psychiatrist, NewVCB.

Incidentally, I feel guilty for continuing to apply the moniker of ‘NewVCB’ to the woman, because it was borne out of my distrust and dislike for her predecessor and the implicit hatred does not apply to NewVCB. Let me use this as a disclaimer, then: I do not think that NewVCB is a vingear cunted bitch. I actuall quite like her. Nevertheless, that has become the term by which people are used to knowing her, so I will maintain it for that reason alone.

She was running late on Wednesday, which is fairly unusual for her. I was mildly irked – not at her specifically, but more at her previous patients for taking up her time – because, carless as I was at the time, I’d had to get a combination of a taxi and a bus to get to the outbin, and had unnecessarily rushed like blazes. Waiting for her produced further frustration in the form of an elderly couple making whispered judgements on other patients wandering in and out of the building.

“Anorexia,” the man murmured, nodding to a girl walking out the main door.

“No, no,” replied the woman. “That girl looks haggard. Some form of anxiety, I think. Nothing too serious.”

What the fuck?! Firstly, what gives these two wankers the right to talk about personal issues pertaining to other patients? Secondly, anorexia and anxiety frequently co-occur, do they not, and either way, is it any surprise that the girl looked “haggard”? Many mentals do! And three – how the fuck can anxiety not be “too serious”? Many forms of anxiety can be fucking life-threatening!

Grr. Normally I love elderly people but these two old gits thoroughly deserved a slap. Anyway, their presumptuous pseudo-speculation was cut mercifully short by NewVCB – but she was there for the two of them at that juncture, and not for me. Ballbags. I sought refuge on Twitter, as usual moaning about the nature of the situation.

Shortly thereafter, my mother appeared. She was collecting me from the outbin owning to the absence of my beautiful car, which was with the mechanic in preparation for his MOT. Mum assumed I was in the waiting room waiting for her, rather than NewVCB and was annoyed to find that she, too, would now have to wait. Sigh. Así es la vida, ¿no?

Anyhow, when I eventually did see her, I couldn’t have been in with her for more than 10 minutes. I told her a highly redacted version of my recent possible episode of hypomania. Christine, my CPN, had advised me that she would discuss the issue with NewVCB in advance of this appointment, and it must have indeed been the case because despite my discussion of it lasting little more than 30 seconds, she said, “it does sound like a period of elation.”

My brow furrowed slightly, so she continued, “well, you know what I mean; yeah, I understand that with it came irritation and uncomfortable racing thoughts, but nevertheless…”

I nodded, seeing what she meant.

She went on to say that she was very conscious of my dosage of Venlafaxine being pretty high. As she noted, she has no problem with my continuing on said dose, but thinks it is something which “we need to keep an eye on.” This kind of confirmed to me that she is now definitely thinking that I have some form of manic depression, though I didn’t ask her directly as I had intended to do. The thing is, she’s never even thought twice about how much Venlafaxine I take in the past, so this seemed significant. Venlafaxine is, of course (in common with SSRIs and other SNRIs), capable of inducing manic or hypomanic behaviour in susceptible individuals.

To be honest, I’ve been taking 300mg for so long without any madness of this particular flavour that I genuinely doubt it’s related, but that said, it is reasonable and sensible to monitor it nonetheless.

Anyhow, I reminded her that the last time we’d met we had discussed reducing my daily intake of Seroquel because of the preposterous amount of weight 600mg of it has caused me to gain. At that appointment, NewVCB had suggested that I continue to take the Seroquel at a reduced dose (to maintain its anti-psychotic properties) and then, to mitigate the loss of its mood-stabilising effects, add in…well, a mood stabiliser. You may recall at that appointment she had alluded to Lithium and Depakote, but the excellent discussion in the comments of the relevant post had put me off them somewhat (particularly the latter). Furthermore, a number of you asked in that thread (and elsewhere) if Lamotrigine (AKA Lamictal) would not be better for me, as although it is used in the general maintenance of bipolar disorder, it is considered particularly good for depression.

I therefore told NewVCB that I had been researching the drug, and that I’d like to try it. “Despite that episode last week,” I told her, “as you know, my symptoms are primarily depressive – so Lamotrigine seems, to me at least, like a good call. What do you think?”

She sort of waved her arms about in a gesture of agreement. “Yes, it is especially good for depression, so yeah, I have absolutely no problem prescribing that for you,” she replied. “My ideal combination for you would be sodium valproate [Depakote] along with the Venlafaxine, but as I told you…well, it’s not considered ideal for women of your age.” She looked up sort of sheepishly at me. I think she was non-verbally intimating to me that she understood my decision to remain childfree, but that that might not go down terribly well with other whitecoats and fuckwit-managerial types that might find out about it.

For different reasons, this suits me perfectly well. I was horribly put off Depakote by some of my readers’ experiences with it – for example, I think it was tai that said in the afore-linked comments that she gained a lot of weight whilst taking this medication. Since that is precisely the reason I wish to reduce my intake of Seroquel, which has otherwise been a wonderfully successful drug for me, moving to Depakote with its potential weight issues would complete miss the point!

So, she got out her prescription pad, consulted her medication guidebook, and scribbled out a script for the Lamictal for me. I am to take 25mg daily for a fortnight, then move up to 50mg until I next see her (in about six weeks, she says, which should give the new stuff some time to start working). She said that she wanted to maintain the Seroquel at 600mg for now until the Lamictal has built up in my system, but that she’ll whack it down to 400mg the next time I see her (assuming the Lamictal seems to be working, of course).

I got the inevitable but important warning about the dreaded Lamictal rash, but that was pretty much it, and off I trotted to my GPs’ practice to hand in the script.

One thing I completely forgot to mention to NewVCB was that I take the contraceptive mini-pill. A little bit of research has suggested that since this pill is proestrogen only, that it and the Lamictal should not interact. Apparently, Lamictal can reduce the effects of the normal, ie. oestrogen, pill - and said pill can, in turn, reduce the effects of the Lamictal! It does not seem to be an issue with the minipill, but I’ve put on an appointment with Lovely GP just to check. In the meantime, if any of you have any information about this, I’d be very grateful to hear about it :)

Shockingly, Fat Pharmacist did have my new prescription when I went to get it yesterday afternoon (of course, he didn’t have the Seroquel, Venlafaxine, Cetirizine and Zopiclone that I had requested, but why quibble about such mere niceties with the useless ginger twat? It is only my fucking health we’re concerned with here, after all…), so I took the first dose of it last night. I took a Zopiclone just in case I’d draw the predictable straw of insomnia that can potentially come with the stuff, and I was squinting a wee bit more than normal when I went to the shop (another potential side effect), but overall nothing seemed amiss – though, to be fair, it’s a bit early to tell.

So. I currently take the following medications:

  • Venlafaxine/Effexor, 300mg daily
  • Quetiapine/Seroquel, 600mg daily
  • Lamotrigine/Lamictal, 25mg daily (to be raised)
  • Cetirizine, 10 mg daily
  • Cerazette, 75 mg daily
  • Multi-vitamin, whatever-it-may-be daily
  • Zopiclone, 7.5mg as needed
  • Diazepam/Valium, 5 – 15mg as needed

Jesus fucking Christ. At this rate I could be a drug dealer. Still, I’m feeling positive about the new introduction to my daily pharmaceutical routine, and about losing some bloody weight when the Seroquel is reduced. But we’ll just have to wait and see.

Anyhow, I’ll try and write on those issues wafting around in my head in the next week or so. Have a great weekend in the meantime, lovely people.

(I’m in a rush so can’t be arsed proof-reading this. Sorry for the probable multitude of errors herein).

Change of Diagnosis

 Christine, CPN, Mental Health Diagnoses, Psychiatry  5 Responses »
Oct 042011
 

I finally saw my CPN, Christine, this morning. I say ‘finally’ as I had been meant to see her about – what? A month ago? Three weeks past? Something like that. I turned up on that occasion, early as usual, and reported to the CMHT/outpatients reception in the normal fashion. The bloke seemed a bit unsettled to see me, which should have been a warning sign that things were afoot, but then he told me to have a seat, as normal, in the waiting room. I dutifully did so.

And thus began the wait for which the term ‘waiting room’ was invented. To be honest, as soon as the allocated appointment time had been and gone, I somehow knew that she wasn’t coming – but rather than approach the reception bloke again and enquire as to Christine’s status on this plane, I just sat there rocking back and forth like the oversized bodybag of insanity that I am. Someone sat opposite me, curled up in her seat in a ball. Someone else sat to my right, shuddering and ‘ticcing’ with a remarkable frequency, as if afflicted by tardive dyskinesia (not such an improbable scenario in this realm, of course). I was struck by the obvious mental illnesses of all three of us: you might think that comes as no surprise in a psychiatric outpatients waiting room, but you’d be wrong.

In my two-plus years of attending the outbin, I’ve always been a little taken aback by how completely sane and normal most of the people looked – and then this makes me feel like a right stigmatising bitch. Mental health problems really aren’t that abnormal, and societal stereotypes on how people with such issues should look (foaming at the mouth, constantly existing in states of 1,000 yard-staring catatonia, running around wielding knives) are dated, inaccurate and sickeningly discriminatory. Madness can affect anyone – any age, any race, any gender, any religion, any sexuality, any class. It does not discriminate, and it can be well disguised. So why would I, someone who should have known better, have assumed that there must be a certain ‘look’ a mental must have, or particular behaviours he or she must present? Why does the the complete ordinariness of most mental health outpatients surprise me so? Because I’m a bigoted bitch, no better than the majority of the supposedly sane community who generally live in a similar ignorance – that’s why.

But I digress, as I am often wont to do. I knew Christine wasn’t going to turn up on this occasion because of the confluence of events in which (a) reception bloke had regarded me with an odd disposition; and (b) there had been a missed call from an unknown number on my phone earlier that day. No one had left a fucking message, though, so I did not consider it important.

Of course, it turned out that it had been the outbin calling me to alert me to the fact that some shit was hitting some fans in Shite Town, one of poor Christine’s unfortunate ‘community’-based stomping grounds, as poor reception bloke was forced to eventually admit to me. Not that I displayed it to him, but I was fucking irritated. Not with Christine – I fully recognise and accept that shit hits fans sometimes (especially in Shite Town…God, I hate that bastardhole with a passion) – but with her colleagues back at the bin for letting me drive all the way there when a simple fucking message could have saved me the petrol.

A secondary issue, of course, was that I was right in the midst of a major depression at the time, but meh. I was completely pissed about by (Old)VCB, but NewVCB and Christine have generally been very good in terms of seeing me, and have even afforded me the opportunity to contact them if I am in a non-crisis-team crisis – which, in de facto terms, means any serious (but sub-A&E) crisis, because it will be over my dead body when I ever deal with the bloody crisis team again.

Anyway, so it came to pass that this morning’s appointment was organised, and subsequently attended by both Christine and me. I was with her for about half an hour, which is relatively short by previous standards, but there wasn’t a huge amount of things to discuss. The poor cat had died since I last saw her, which was obviously rather a rather shit stabbing of fate, and it had come at a time when I was very mentally fragile anyway. Christine expressed what appeared to be sincere apologies for our loss, which I appreciated. Some folks say the words alright, but you can almost see them thinking, “but it’s just an animal..!” Others, of whom I’m guessing she must be one, realise that pets become your friends and family.

The odd thing is, apart from the first weekend after Ms Cat’s death, I think things have been stabilising ever so slightly. Obviously, one might reasonably assume that if one had atypical (AKA reactive) depressive symptoms, that such a horrible and untimely occurrence would have paved the way straight back into the depths of the abyss – yet in my case, it did not. It’s not because I’m cold or some sort of unfeeling droid – truly, I miss Ms Cat horribly and am horrified when I think about her being hit by that fucking car, her dying all alone in the middle of the road – but overall, putting a quite normal reaction to bereavement aside (and if viewed from an entirely pathological perspective), things seem to be ever so slightly moving upwards. This makes me feel smug. Why? Because I’ve been trying to tell the quacks for ages now that my moods are not reactive, and that my major depressions are clearly melancholic. What has happened in the wake of Ms Cat’s death exemplifies that well, to my mind.

Lack of a reactive mood suggests a lack of borderline personality disorder. I’ve discussed the fact that I don’t feel the diagnosis is relevant to me any more both here and here, in the latter case having made brief allusion to the issue with Christine herself. Today, I just came out and asked her: what the fuck actually is my current diagnosis?

The question was borne out of a discussion about mood stabilisers. As I had asked you lovely lot here, I so asked her about the pros and cons of Depakote and Lithium, both of which she actually seemed quite positive about. She must have seen some scepticism in my expression, because she asked me to articulate what it was that I didn’t like about them. I presented a redacted version of some of your responses to the aforelinked post.

“I know that’s a tiny amount of people compared to all of those that take these drugs, but still, I’m dubious,” I admitted. “What about Lamotrigine? I heard from various sources that it’s particularly good for depression.”

“Lithium and Depakote are the ones we most frequently use here,” she told me, “but yeah, Lamotrigine and [some other anti-convulsant-cum-mood-stabiliser whose name I have forgotten] are also used, and yes – Lamotrigine does tend to be good for depression. I know that [NewVCB] does recognise the severity of your depressive features. Would you say that they’re the most troublesome part of your illness?”

I thought about it for a moment, and then said they were certainly the most pervasive, which is undoubtedly correct. I kind of screwed up my face, though, because – although depression is a hell beyond the comprehension of those who have never truly experienced it – other symptoms I’ve experienced have been pretty ghastly too. ‘They‘ (especially on a bad day). The particular anti-delight that is the psychiatric mixed state. Insomnia. Fake Paedo and night-time peccaries. Dissociation. They all suck donkey balls that are bigger than I know how to quantify, but despite it all, I think that depression probably is still the worst of the whole sorry lot. It’s inutterably abominable.

For some reason, though, we ended up talking in some detail about my psychotic symptoms; Christine noted that whilst the psychosis had actually been pretty serious at times, that on most occasions it hadn’t been particularly prolonged (save for my ongoing GCHQ obsession, but then I don’t think that that is delusional. Those nosy pricks honourable men and women watch all of us: it’s simply a fact). This is true – in the past I’ve even suggested that my psychotic symptoms were perhaps transient and/or stress-induced, though as I continue walking this darkened path of lunacy and reflect on times gone by, I’m less and less convinced that any of it was (is) as simple as that. Either way, though, it has been uncommon for me to be verbally persecuted or delusional or whatever for long periods of time, as is traditional in the likes of schizophrenia.

One thing I told her, that I haven’t mentioned here for a long time, was that I missed Tom. Not all hallucinatory voices are malicious, y’know. Christine empathised; she says she has one particular patient that has an extremely settled and successful life now (hope, perchance?), but who really misses her voices which (like Tom) were killed by the anti-psychotics that, all things considered, the woman had little choice but to take.

Anyhow, that’s by the by, apart from my worry about reducing the Seroquel to 300mg and adding a mood stabiliser. This concern, as I observed in the appointment, was that even with a slow titration back down to the half-dose of the stuff, I would become psychotic again. Christine reminded me that when I had tried a self-inflicted hand at living on 300mg, that I had only had one day of psychotic mentalness – that the rest of those few weeks, whilst they appeared to have fucked with my mood, had not rekindled voices, paranoia, thought disorder and so forth. True enough, to be fair to her.

“So, maybe 300mg can work to prevent psychosis for you,” she said. “But yeah – I think the introduction of a mood stabiliser is a good idea to make up for the loss of such properties if you lower your dose of Seroquel.”

I nodded, also expressing my willingness to “just deal with the weight gain” if indeed it turned out, after all, that 600mg of the stuff was what I needed. She said that it was good that I had such a philosophical attitude to the whole thing.

“I suppose so,” I adventured, “but I’m going to be taking 300mg of Venlafaxine, 300mg of Seroquel and God knows what dose of a mood stabiliser. That’s a bit…well, mad.”

She shrugged, but not in a dismissive fashion. “If you had a broken leg you you’d put it in as big a cast as it required…”

“Oh don’t get me wrong,” I said, “I agree. I’m not at all one of those anti-medication apologists; the stuff has saved my life many times. It’s just a lot of medicine to be taking when…well, when supposedly dealing with a disorder for which NICE don’t recommend medication…”

Christine made some remark that seemed derisive of NICE, which left me feeling all warm and fuzzy inside. Then she continued by saying that, if I was referring to BPD, then NewVCB was seriously doubtful about my having it.

Good! (Though let’s be clear: I do believe that I did have borderline personality disorder, though I never met the stereotypes so nefariously associated with same – but then, very few people actually do. So here I am – proof that it can be recovered from). But if BPD is no longer applicable, what are we all dealing with, then?

“[NewVCB] doesn’t like to discuss diagnoses with me,” I complained forlornly. “But I’d like to know.”

Christine nodded and said, “I’d say she’s about 90% going with – predominantly depressive, bear in mind – bipolar affective disorder with psychotic features.”

Of course, bipolar type II was always my differential diagnosis, but it now seems that they’re looking at type I. In a way, it’s curious as I’m pretty sure I’ve never intimately danced with a euphoric mania – indeed, (Old)VCB (who met me about four times and was therefore the consummate expert on the idiosyncratic nature of my personal psycho-neurology) stated that I definitely didn’t have bipolar I. However, if I have had mixed episodes – and I certainly have – then clearly, by very definition under the current editions of the ICD and the DSM, it must be bipolar I. I’d always shrugged that reality off: these things exist on a spectrum. I haven’t changed my view on that, but an elevation from II to I is not exactly a non-issue for me, partly because specific diagnoses may (or may not) affect one’s treatment. In that regard – and it’s as unfair as fuck, because the popular, sensationalised images of it are not accurate – not being seen as having BPD any more is a positive development, even though it’ll obviously never leave my files entirely.

Anyhow, there is a window of doubt in this apparent bipolar diagnosis. It is, to no surprise of mine whatsoever, potentially filled with schizoaffective disorder. Essentially, the difference between it and psychotic bipolar disorder is that the psychosis can occur outside mood episodes in schizoaffective disorder, whereas in bipolar (or psychotic depression), such symptoms are exclusive to either depressed or “manic” states (I use the scare quotes* here ((which I normally loathe loathe LOATHE)) because I feel the term denotes euphoria, whereas clearly in my case – if I do have this – then my “mania” is of the dysphoric variety). Given my inability to properly rise from bed in the mornings, it will come as no surprise to you to learn that trying to keep track of my exact state of mood relative to other symptomatology isn’t entirely easy. My sense is that I have hallucinated when fairly euthymic, but then euthymic by my standards could be a mild to moderate depression by those of another, and thus I feel unqualified to judge this objectively.

Oh yeah, and let’s not forget that I still have a number of elements of C-PTSD, regardless of whichever one of the other two conditions is predominant.

I rattle when I walk sometimes, what with all the tablets I have to carry about with me. And that’s going to get even worse! And lo, my poor brain must rattle now, with all these diagnoses in place to form description of it. But, although I know the terms aren’t important and that the actual treatment is, I still see value in diagnoses. I read recently – I can’t remember where, sorry – that the point of diagnostic psychiatry is communication. Without at least some guidance – to be taken with a pinch of salt certainly, but which can act as something of a sign post – surely all branches of medicine, even those in which spectra and classification-overlaps predominate, would end up jargonistic free-for-alls.

Diagnoses may not help diagnosees, but I still can’t see how not having them does either.

* On the point of scare quotes, actually. The verb ‘to label’ and its nominal, adjectival and qualifying derivatives are unlikely to be used synonymously with ‘to diagnose’ on this blog – but if they are, they are the only terms I will always put in scare quotes. I cannot express how much I completely abhor this usage of the word ‘label’. I hate it. I despise it. I feel repugnance and disdain and derision and other derogatory d words towards it (though, it must be noted, not those that use it!).

It’s not a rational objection, but please don’t kick me – we all have foibles, do we not, and this, sweet readers, is one of mine ;)

—

Random real life aside – in the wake of Ms Cat’s death, we decided to get a new kitty quite quickly. This was a pragmatic decision based on Mr Cat’s future wellbeing. It became quickly apparent that he really missed Ms Cat; so did we, obviously, but human mourning takes time – does the same apply to felids? We know not. Had it been about us, we’d have waited at least a few months before getting another female cat, but on balance, we reckoned it would be better for Mr Cat if a new adoptive sisterbling came sooner rather than later.

So here she is! ShHe shall henceforth be known as Señoritao (Srtao) Gatao on this blog :) [EDIT: As you can perhaps deduce from all the strikethroughs, we thought the bloody cat was a female when we got it, but alas it's a bloke. We never intended to get another male; the possibility of territorial disputes was too unsavoury. But although Srto Gato annoys Mr Cat with his kitten ways, they actually seem to get on reasonably well. Thank Christ.]

Srta Gata

I Lied – The Mentalism is ‘Back’

 Christine, CPN, Medications, Moods, Triggers  14 Responses »
Aug 242011
 

Didn’t I sound so positive on Friday?

All that positivity about The Book, the proposed voluntary position, blah de blah. Although I seemed like (and am) a work in progress – a person notoriously uncompleted, perhaps – my apparent optimism last week did not seem to represent the words of a person in regression. It didn’t seem to be the commentary of someone whose outward skins of positivity were being painfully sliced off, little by little.

But that’s the truth of the matter.

I didn’t mean to lie. I wasn’t even truly aware at the time that I was lying. I mean, when I wrote “I might be slightly depressed…but given all that has been going on, that’s actually quite good”, I did sort of raise an eye-brow in self-referential suspicion, but I think the crux here is that if I was trying to fool anyone, it was primarily myself.

Things are not continuing to get better, as they had been for some months – and I’ve been very firmly in denial about this. The signs have been very strongly, and at times starkly acutely, in evidence for a couple of weeks now, but until Monday I was in complete denial about them. I ignored them: not consciously, but nevertheless, I believe, deliberately. When they couldn’t be ignored, I attempted to dismiss them as circumstantially appropriate, or nominally sane in some other respect, rather than doing the fucking adult thing and recognising them for what they are – clear, indubitable, glaringly-obvious-with-hindsight signs of an impending serious depression. It isn’t fully that yet, but without action and intervention now, that’s what it will become. I know (and should have known) from bitter experience that that is how this hand plays out.

Why the denial? The short answer is that I don’t really know; in the past, I’ve recognised and accepted going mental when I’ve seen it coming, so it’s hard to determine exactly why I deviated from that pattern this time around. I would hypothesise that, having tasted the pseudo-heady heights of pseudo-recovery, I didn’t want to ‘fail’ myself, to go back on all that I had seemed to have ‘achieved’, by knowing I was slowly becoming ill again. Also, and I know this is hatefully egotistical, but I often feel a sense of responsibility to others, mainly because of the relative success of this blog. I got better – -ish – and wrote about it to the world. It doesn’t look good to suddenly come back one day and say, “sorry, folks, scratch that,” does it?

Also, in this case, the problem is very likely to be attributable to my own stupid decisions. I’ll come back to that later.

I only realised how fucked I was when I spoke to Christine, my CPN, on Monday. I really can’t be bothered going into this in any detail, but essentially I told her I was experiencing the following symptoms:

  • the usual paranoia (still convinced I have schizoaffective disorder, but now also of the view that I have schizoid and/or schizotypal personality disorder, on top of the clinical depression and complex PTSD) – no better nor worse than it was the last time I saw her;
  • agoraphobia – won’t leave the house alone, don’t really want to leave it at all during the day anyway, not always at night, either (though at least then I have A to join me);
  • hideous insomnia;
  • ergo, hideous fatigue – but the levels of it are even greater than I’d expect to correlate with the level of insomnia I’m currently experiencing. I mean, I’m not exactly unused to insomnia;
  • complete and utter apathy and malaise;
  • probably some old other bollocks that I’ve forgotten.

I said to her initially that things hadn’t really changed since our last session together, and I really didn’t think that they had. The above ‘symptoms’ strike me as being part and parcel of everyday existence (to a greater or lesser extent, anyway), and it was not thinking about nor discussing them out loud that made me realise that a major depressive episode is a-callin’. It was Christine’s response to me – to what I detailed, certainly, but mostly towards me specifically.

I seemed different, apparently. I seemed ‘flat’ and disinterested. She said that the absolute confirmation of that assessment came when she asked me about writing; apparently, I spoke of this blog, and even some of my other writing ventures, with complete impassivity and detachment. In the past, she claims, there has always been a ‘spark’ about me when I’ve conversed on these matters, but in this case, I just didn’t care.

I hadn’t realised that I’d previously spoken about the blog with such enthusiasm to Christine, but what I did notice when she asked about it was how much I felt that I just didn’t care. This makes me feel guilty; there are hundreds of thousands (possibly millions?) of words chronicling a huge and important chunk of my life here. There are thousands of (mostly!) supportive and interesting comments. There are dozens of links in the blogroll to the writings of others that I really appreciate. It’s a big deal. I cannot reasonably be apathetic about this, yet I am. That was not the case a few weeks ago.

In talking to her, I also realised how ridiculously irritable I’ve become of late. Don’t worry – I didn’t fly off the handle at her (although when she kept looking at her watch I silently seethed), but she did ask a lot of questions and when I thought about the answers, I realised how narky I have actually been over the last few weeks. I’ve kept that to myself pretty well, but the feeling has certainly been there. I’ve been internally going completely batshit barmy over every single little bloody thing, and though I’ve always been easily irritated to some extent, the sheer intensity and frequency recently experienced is something that is only every present when I’m clinically doolally.

Other things I noticed in the course of the discussion were that I was even more hypervigilant than normal and that I’d behaved really strangely this weekend past. Christine asked me if I was getting out at all, and I said that A and I had gone out on Friday and Saturday night (though of course I advised her that I refuse to go out alone and am still petrified of crowds, and thus spend all day sitting in the house, cowering from the outside world. This concerned her because at points I had been trying to go some places, such as shops, by myself. I haven’t done that for ages). She was pleased that I’d gone out at all, but the weird thing is, on Saturday night when A went to bed, I sat up until 5am watching YouTube videos and smoking.

That might seem like a normal thing to anyone else in the world, but it’s odd behaviour for me. There are occasions when I stay up later than A, but they’re usually to write because in a cruel twist of fate, most of my ‘inspiration’ seems to come around the witching hour. This was different – I don’t know why it’s so odd that I would remain up whilst he went to bed, I don’t know why it’s so odd to listen to music videos whilst alone…but it is. It’s just not me at all.

She asked me if I had even enjoyed my late night pursuit. I laughed, and said that I’d taken no pleasure from it at all, but that I couldn’t seem to tear myself away from it. I said I was taking pleasure from almost nothing (save for writing the first chapter of The Book, not that I told her about that), all over again. A different tact, then; what about motivation for anything? Don’t be daft, Christine love, it simply doesn’t exist. Have I any social contact? Meh, occasionally I check Twitter. No, no, she meant in real life. Of course – A is there. But A is only there in the evenings, is he not? Well…yeah. What about my mother? Yes, my mother is there, I can go up to her house again now that AoE and The Everythinger are gone. Good, right?

But…I don’t want to talk. I don’t want to use my vocal chords at all: it is so much effort. Whilst I can get away with this in A’s company, it’s not possible in Mum’s; A can entertain himself quite easily with computer games or whatever, whereas my mother, at least when I’m with her, seems to need verbal social interaction in order to even breathe. Yet I’m too tired to speak. Speaking a few words seems akin to remastering the theory of relativity right now, so I dread the idea of having an entire conversation.

So, Christine mused, if I don’t want to (or literally can’t, at times) talk to anyone, am I willing to even see anyone? Well, Mum and A, yes – despite the communication problems inherent in seeing anybody. But beyond that, no. I’d rather gouge out my eyeballs with a rusty fork and stick them so far up my anus they come out in next year’s vomit than see anyone right now. I did force myself to have lunch with my oldest friend Brian about a fortnight ago, because I’d essentially ignored his text messages and Facebastard comments and so forth for ages, and knew I was being a shit friend. However, if I could have gotten out of it with any ounce of integrity left intact, I would have done so in a heartbeat. The meeting was awful; Brian is a lovely bloke, and we’ve known each other for so long that there will always be something to say, but I couldn’t feel anything other than selfish frustration that I had to be out of the house (fortunately, as ever, I think I hid it well).

And that brings me to another point. I felt hideously guilty for not enjoying lunch with Brian; I feel hideously guilty for not wanting to speak, especially to Mum because she’s so nice and she’s so lonely oftentimes; I felt guilty for complaining to Christine about not wanting to speak, because in doing so I was speaking, so she probably thought I was angry with her for ‘making’ me engage in that; I felt guilty for being irritable; I felt guilty for not being more respectful and appreciative of this blog; I then felt guilty for being narcissistic enough to think that people actually care about it; I felt guilty for thinking that almost everyone is out to get me; I felt guilty for my general issues of anhedonia and avolition, because when you think about it, life hasn’t really been too cruel to me, and I should be bloody grateful for what I have.

Christine cocked her head, and lifted her eyes to me. “Excessive guilt,” she said simply. An explanation of the term was not necessary. I am well aware that it is a symptom of a major depressive episode. Not that I felt or feel that the guilt is excessive, but she apparently did.

“OK,” she finally continued. “Your mood, your general demeanour, has definitely changed since I saw you last.” As noted, I’m not sure how, but then I can only observe myself from within. “You’re just…” …she searched for the correct terminology… “…not yourself, not the person I’m used to meeting.”

I thought about this for a moment. How can she know what ‘myself’ truly is? I see her for an hour every fortnight or three weeks, for Christ’s sake! But I forced myself to try to see things from her perspective, and realised that if my demeanour had indeed changed, then in fact surely it is her of all people that would notice. A sees me every day, Mum once a week. Any changes to them would be subtle, and only clearly observable retrospectively. An analogy would be when we got our cats as kittens. We didn’t notice them aging day to day, but when my sister-in-law – who was with us the day we took them home – saw them several months later, she very clearly noticed how much they’d grown. I suppose observable shifts in mood are a bit like that.

Indeed, I remember when I got my accursed medical notes (yes, those things that I didn’t bother doing anything useful with – fail fail fail fail fail), the letters from Psychiatry to Lovely GP would detail my mood self-reports and then their ‘objective’ assessments. Now don’t get me wrong, I certainly don’t always (or even often) agree with their alleged ‘objectivity’; however, unlike many within this discipline, Christine is a no-bullshitter, and the more we talked about how things were, the more I grew to see that she was right. Things are Heading South.

So, then. What caused it?

I tried to blame it on insomnia. If I can’t sleep, then it’s inevitable that my mood is going to drop. She accepted that, to a point, but asked if I was still feeling so apathetic and (sometimes willfully) disconnected from the world when I had taken Zopiclone and ergo had had at least some sleep. I was forced to admit that I was. In all honesty, sleeping hadn’t really affected that at all.

“Ah well,” I sighed. “These things do go in circles, don’t they? I’ve never been stupid enough to believe that I wouldn’t go through another major depression. It’s always going to be a part of my life in some fashion.”

“Hmm,” she replied, uncertainly. “Maybe. But I’m just wondering…how long has it been since you sliced your Seroquel dosage in half?”

“About five weeks…” I began.

“And how long has this…this downward slide been going on? About three?”

“Um…yes, I suppose so. But it can’t be anything to do with the Seroquel, can it? I mean, I know it’s used as an anti-depressant, but I thought that was at lower doses. [NewVCB] told me that the maintenance dosage of it for depressive features is 300mg.”

“As a general rule, it is,” Christine replied. “But it doesn’t mean that the mood stabilising and anti-depressant properties aren’t applicable in higher doses – and anyhow, you seem to have a high tolerance to medication to begin with. Everyone responds differently to different doses of medication, as you know.”

I had to concede those points to her, and after debating it in my head for a couple of minutes, I was forced to recognise that the timing of my apparent descent back into madness relative to my idiotic decision to reduce my daily intake of Seroquel was highly coincidental.

“And I don’t believe in coincidences,” I added softly.

She nodded. “Neither do I. I don’t know if you know this, but in the XR version of Seroquel [the one I take], the anti-depressant properties are more potent than in the standard version [no, I didn't know this. I thought extended release was just that - so why does that have an impact on mood more so than getting the hit all at once?], so I think that further evidences the fact that there’s a connection here.”

“But,” I protested, “I have had no hallucinations at all since I reduced the dose, and that day of heightened paranoia last month was when I was still taking 600mg.”

“Even so,” she shrugged. “The depressive and anhedonic symptoms still strike me as being related.”

Maybe the psychosis remits. Maybe it only occurs in times of stress (so maybe I don’t have schizoaffective disorder, as I posited at the beginning of this post. Though I still think I do). Maybe it simply can’t be bothered right now, and will return down the line a bit along with some other nefarious attacks on my psyche, such as the hateful mental prison that is the psychiatric mixed state. Maybe it only comes at all when I’m in the midst of a full-blown mood episode (therefore, again, possibly ruling out schizoaffective disorder, and suggesting psychotic depression or bipolar disorder). I mean, when you’re terrified by hallucinations, it isn’t your first priority to start assessing what your general mood state has been at the time, so I really don’t know.

Who cares. Whatever the case, psychosis or no psychosis, I was forced to agree that it looked very likely that the reduction in Seroquel had dramatically affected my psychological well-being.

“If I were you, I’d very seriously consider going back on to the 600mg,” Christine told me.

“What, tonight?” I checked.

“Yes. And if you find that you still want to reduce it after that, discuss it with [NewVCB] in your appointment on 7th September, and she can maybe consider tapering it down or something. But for now, I really think you should go back on it until you see her. I know it’s only a fortnight, but…”

“…that’s a long time when you’re going mental,” I finished despondently, and she nodded her agreement.

“What do you think about that?” she asked.

“I reduced the Seroquel because I was sick of not being able to get up in the mornings. and then experiencing this repulsive, zombified hangover when I did. But I’d rather both of those than be mental – particularly ‘mental’ in the form of ‘depressed’. I’m just worried about the weight gain. It makes me need chocolate, which is contrary to my nature. I’ve never really had a sweet tooth, but as soon as I started taking 600mg of this stuff, I developed one that is surely unparalleled across space and time.”

“We can discuss that, if it continues,” she said. “If you can get back your interest in things, then maybe you can start taking occasional trips to the swimming pool, for example, and build it up from there. If your mood is better to begin with, things like that will seem less daunting.”

I inhaled deeply. “OK. I’ll increase it again. If this is the start of a black treacle of depression, I want to nip it in the bud before it gets out of hand. If I can. Maybe it’s already too late?”

“Possibly, but by no means definitely,” Christine replied. “You may well be able to stop this before it becomes significantly worse. And at least you have a psychiatric appointment soon, and that will help guide us from there.”

I have been back on the 600mg of Seroquel for two nights now. Obviously two nights isn’t going to make a difference, but let’s just see where we are with the depression thing. I don’t feel depressed as such – Christine, when I said that to her, once again used the adjective ‘flat’ to describe my disposition – but the curious thing about depressive episodes is that they’re not always characterised by raw despair itself; many other things can mould themselves into that horrible, amorphous shape. So, as I did in February, I’m going to use those amazingly accurate, wonderfully telling and obviously entirely diagnostically valid depression scales to see what the craic is.

Goldberg – 68
Beck – 53
Hamilton – 37
Burns – 89

Look at the fucking score on the Beck Inventory! All the others are slightly better than February, but it is a fuckload worse. By fucking miles! Either I inaccurately recorded my Beck scores when I previously did this test, or things have really fucked up, because I think I’ve been honest in my answers today. Perhaps the thing with it is that it places a lot more emphasis on behaviour and thoughts, rather than depressed feelings alone, than some of the other assessments do. But whatever the case, that isn’t good.

Perhaps one of the biggest indicators that things are not good is the fact that I collapsed on Monday night. I just blanked out – presumably I fainted – and fell, with the next thing I knew being my lying on the floor. Mum, who is trying to buy a new car, kept asking me to stand behind her at the computer as she looked up endless reams of automotive specifications, and I was so fucking exhausted that even that was an effort akin to climbing Mount Kiliman-fucking-jaro. So I apparently responded somatically, and passed out. Don’t worry; I wasn’t hurt or anything. But I do think that all factors, when detailed here together, suggest that until things start to demonstrably improve, I have to be very, very careful.

My concentration isn’t as bad as it normally is when I’m off my head, so maybe I can seek some solace in writing The Book. Yet even that seems like it has to be treated with kid-gloves, because writing can very quickly wear even the sanest person out (I’ve been writing this fucking post on and off since Monday afternoon!). Take it easy, The Eagles once sang. Good advice, that.

Those of you that read TWIM will know that on Saturday I featured, as one of the wildcards, a blog denouncing the inappropriate use of quotation marks. You might very well attempt to protest at my use of said marks in the title of this blog post, but you can’t put me on trial for hypocritical punctuation abuse just yet (at least, not for that. I’m sure there’s a multitude of errors within this post, but I’m typing on my mother’s netbook which makes things difficult and, furthermore, I’m a bit mental and can’t be arsed to proof-read this. So suck it). I put the word ‘back’ in quotes because it isn’t back; it can’t be, because it was never away. It was, and is, always there – just to greater or lesser extents that can or can’t be easily managed. ‘Back’ seemed like the most appropriate word given the apparent change in intensity, however, so there you go.

—

I’m really, really not a fan of BBC3 in the least, but BBC1 happened to repeat this programme originally broadcast on the former last night. It’s a surprisingly sensitive and interesting look at how caring for a parent with mental illness can affect a young person. If your country allows you access to the BBC iPlayer, do check it out :)

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How Do You Work Full-Time When You’re a Mentally Ill Seroquel-Gobbler?

 Life, Medications, Random Mental Health Related Philosophising, Work  25 Responses »
Jul 262011
 

Seroquel has tended to dictate that I sleep until at least 10.30am each day, and often much later. When I say ‘sleep’, I don’t necessarily mean that literally, because of course Seroquel regrettably loses its soporific effects over time, and I have an apparent predisposition to insomnia anyway; however, one way or another, the hangover effects of the drug leave me in a zombified stupor the whole of each morning.

Seroquel may dictate that I don’t do anything at all in its wake, but unfortunately of late circumstance has demanded the polar opposite. You may recall that A and I were burgled (for the second time) about a month ago. Two requirements arose out of this: one was the need to urgently repair the damage caused by the tossbags responsible (that being the broken back gate and the door between the kitchen and living room) and the second was, in respect of our probable desire to move, to get the house into some sort of cosmetic order. A and I live in perpetual mess and don’t really give a shit what the house looks like ordinarily. Of course maintenance of a house is a general chore to anybody, but I appear to have a specific phobia of it. Not that I’m using that as an excuse to get out of it, mind you, because I wouldn’t fucking do it whether I had said fear or not. (At least I’m honest, yes?).

Anyway, A’s father and step-mother have a mate who’s good around the house. He paints, tiles, joins, does minor structural work, blah blah de blah fucking blah blah. He’s trusted, being a family friend, and he charges reasonable rates. Excellent. Brilliant. Amazing.

Does that sound sarcastic? It is, to an extent, but seriously – we’re very lucky to have this connection, because of course it would be just our luck, were we to seek out a similar sort of individual via classified ads or something, that the person contacted would be an unscrupulous wanker with a criminal record the length of one of my more…um…exploratory posts on this blog (that’s c. 4,000 – 5,000 words, for current readers fortunate enough to be uninitiated). Furthermore, the bloke in question is a nice bloke; he’s fairly easy to chat to and seems to do a good job.

However. Fuck me but I’ll be glad to see the back of him.

I have a routine. An inane and, perhaps paradoxically, fairly un-regimented one, admittedly, but something that suits me nevertheless. I get up when Seroquel allows me to get up. Then I write, read or occasionally watch the pointless but inexplicably addictive rolling *ahem* news (read: sensationalised bullwank) on BBC News 24. I sound like a work-shy fucker, I know, but even in these not-so-heady days of pseudo-”recovery”, this is genuinely all I am capable of. I don’t like lying in half the day, and I don’t do it through choice. I do it because the medication forces me to do it. In turn, the threat of potentially dangerous psychosis forces me to take the medication.

Our builder-joiner-decorater-Everythinger, and his penchant for showing up at eight in the bloody morning, has screwed up this seemingly idle but oddly workable routine on an epic scale. I haven’t felt this chronically and soul-destroyingly fatigued since I was plagued with literally months on end of insomnia. In fact, I’d go so far as to say that it takes me back to when I was still at work full-time and plagued with literally months on end of insomnia (God, that’s a vile memory. I would lie in bed, awake, all night – every night, for months. I’d get up at 7am and almost throw coffee beans down my throat. Then I’d go to work for 8am, stay there to 6pm in a futile effort to wear myself out, come home, stare blindly at the TV for a few hours, then repeat the whole hideous cycle for another day, and another day, and another day. And this was before my 2008 breakdown came a-callin’. How the fuck did I do that every day?).

It’s the Seroquel’s fault, of course. I would probably be tired if I wasn’t taking it, but I don’t think I’d be so completely devoid of any atom of energy whatsoever. It’s the drug that demands that I rest (if you can call existing in a stupefied Seroquel hangover ‘rest’) so much, and when I don’t do its bidding, it punishes me, like some embittered monarch lashing out at a traitor.

Anyway, whilst I’m on the themes of Seroquel and working both, herein lies a huge issue. Last month, Differently left the following comment on my rant about knobend MP Philip Davies (who, incidentally, was one of the ones to question the Murdochs and Rebecca Rebecka Rebeckah Rebekah Wade Grant-Mitchell Brooks over the News of the Screws phone-hacking allegations – how the hell did Parliament let him on that committee?):

…realistically I’m unsure that I’ll ever be able to work full time, since a combination of my experiences and the meds I take mean that managing 2 weeks at 10-4 left me looking physically unwell, pale and tired and feeling horrendous, thereby meaning that I hope to work part-time…

Seaneen, who is presently working full-time, has also alluded recently to how much Seroquel has inhibited her at work in the mornings (and she has, as a consequence, withdrawn from it).

I had been thinking, much to my chagrin, that part-time employment was becoming my own only realistic option as far as future return to work goes, but I kept trying to tell myself that eventually that wouldn’t be the case, that eventually I could back to working full-time. But this exhaustion-debacle with the Everythinger has left me seriously questioning that feigned optimism.

I cannot function without devoting most of the morning to a complete state of bleugh. I just can’t. Not whilst 600 daily milligrams of Quetiapine addles my entire system. So, if I continue to take the stuff – certainly at this dosage – there is no way in hell that I could work full-time. It is simply impossible.

I keep looking at other people (especially, to my personal feminist frustration, other women) – randoms in the pub, the street, whatever – and I silently ask them, how – how?! - can you possibly work eight hours a day, five days a week? How is that even remotely physically feasible? And then I remember that I too did this – for years, some of it whilst doing a sodding postgraduate degree – and I shake my head in stunned disbelief. How did I do that? How was that even approaching possible? Was I an imposter in my own body? (I do love a bit of ((self-directed)) Capgras). I am certainly not that person now. Was I ever that person, really? Who was I then? Who am I now? How did it all change? (And, you might ask, who fucking cares, Pan?).

Those that are masochistic enough to regularly read this blog may be remember that, at my last psychiatric review, I asked NewVCB if I could consider reducing my dosage of Quetiapine. You may also recall that she was potentially amenable to this, citing a maintenance dose of 300mg.

This could help, and I might notice the difference more markedly after coming down from such a high dose, but my recollection of taking 300mg in the past was that it was still very – if not quite, as currently, absolutely and unequivocally - debilitating the next morning. Besides, I’m not convinced that 300mg adequately functioned on the psychotic features of my illness. It sated some of the voices a little I suppose, but it was only when I started ingesting a daily whack of 400mg upwards that they actually shut the fuck up (and random, probably stress-related delusions are notwithstanding).

So, herein lies my dilemma. You all know I don’t buy into anti-psychiatry ideals and (conspiracy?) theories. Seroquel works. I know I whinge about weight gain and have launched a virtual diatribe against the stuff in this post, but it has truly made my life better. As long as I have my get-over-the-hangover routine, I am fine. Venlafaxine at a high dose has worked wonders – well, quasi-wonders, anyway – in terms of my mood; Quetiapine has probably aided in that too, but the key issue with it is that I am almost entirely without psychosis at the minute, and have been (bar that one episode the other week, as linked to in the previous paragraph) for aaaaaaaaaaages.

But, much as I don’t want to be normal in what seems to be the standard, societally accepted version of the word, I want to be able to do the things I always wanted to do. In other words, I want to work. A career – not a job, a career - was all I ever really wanted. Thus far, mentalism has denied me a career, but has periodically at least allowed me to have jobs, which may have – in another place and time – led to careers. Is being mental now going to rob me of both possibilities? Will I be a dolescum forever? Are part-time workers actually commonly sought by employers? Besides which, why is it fair that A works full-time (fuck knows how he does it) and I don’t?

Bah. I don’t know. It looks to me like I have a choice between relative sanity and full-time work. Please don’t tell me to kick the Seroquel, by the way. It isn’t going to happen, at least not in the short to medium term. I’d rather not live with a bunch of nefarious fucktards telling me to kill myself (or, worse, others); I’d rather not live with Paedo following me about the place; I’d rather not have to make sense of contemptuously vicious peccaries and stupid fucking gnomes randomly harassing me; I’d rather not live convinced that cameras are watching my every bloody move. Waaah waah waah, whinge whinge whinge, ad infinitum.

We could argue the toss about the true roots of psychosis all we might like – Paul of course held (and, presumably, holds) that psychosis is an entirely logical response to severe trauma, and he may well have a point – but I don’t think I’m ever going to go all R D Laing/Robert Whitaker on this. At the risk of being infuriatingly repetitive, Seroquel, for me at least, works. It does exactly what it’s indicated to do. (Or, as I mistyped, tindicated to do. Geddit?!!!?1?!!!?11????!!eleven?!?! It does exactly what it says on the tin? Tindicate? No? Meh. Sorry. Humour ain’t my strong point).

So, sanity or full-time work. Full-time work or sanity. Why is nothing ever simple or easy in this enforced existence that the fabled they (not my ’They’ ;) ) smugly refer to as ‘life’? Why do we always have to make choices, to compromise, to ‘make do’?

Am I an immature little brat for being irate that mutual exclusivity exists in this context? (Actually, don’t answer that).

Anyway, enough.

(And yeah, by the way, I have sold out and stuck PayPal begging buttons on some posts and on the sidebar. What can I say? I’m a slave to a capitalist world, a traitor to my fellow benefit claimants, a betrayer of my lefty principles, a self-serving money-whore of evil, a rabiator of [insert hated multi-national conglomerate of your choice here] proportions, a twat, a dick, a __________, a &%$(“($, a…yeah, you get the idea. A few of you also did ask about it, in my defence ;) ).

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Agoraphobic Persecutory Delusions of Familial Evil and Seroquel. Etc.

 Christine, CPN, Life, NewVCB, Psychiatry  11 Responses »
Jul 082011
 

In the absence of Paul – I know I’m still catching up on writing about my final few sessions with him, but they did in fact finish about three weeks ago – I’ve been seeing Christine at fortnightly intervals. The last appointment was last week.

Although things have been generally going OK, as testified by this blog throughout recent months, over the last week or so they’ve taken a slight downwards turn. As things stand, I can manage it;I suppose it could perhaps be a mild depression (by my standards – I think that probably equates to moderate by official scales? [EDIT: I am correct, apparently. I just took this test again and scored 52, which is within the bracket of 'moderate to severe' depression. Well, it's better than having gotten 82 back in February, I suppose..!]), but we’ll see.

I guessed that the whitecoats would claim that my mood dip was reactive, for the following reasons:

  1. the cessation of the treatment with Paul;
  2. the burglary; and
  3. the fact (as yet unmentioned on this journal) that FuckBitch Queen of All Levels of Hell Aunt of Evil arrived in the country on Wednesday morning (more on this anon).

Appointment With Christine

I guessed correctly. It didn’t come as massive shock to the system when Christine carefully opined that it was “hardly surprising” that I “wasn’t at” myself. In my view, my moods are, by and large, non-reactive (I’ve always maintained, and I continue to maintain, that my particular blend of clinical depression is melancholic rather than atypical), but I can see why she came to the conclusion she did. I’m not saying the above has not affected my mental status at all, but I think this goes in cycles too. Interestingly, NewVCB seemed to primarily agree with me, but I’ll get to her later.

I was with Christine for quite a while, though not quite as long as the last time I saw her. In a supposedly surreptitious fashion, she kept glancing at her watch, which mildly irritated me, but I do appreciate that she has other people to see. Anyhow. We discussed how I’m feeling in the wake of the end of therapy (fine, though I’m not sure she was convinced of that, given that she kept bleating on what a “big deal” it apparently was for me), how I’d dealt with the burglary (relatively well) and medication.

Seroquel has been a wonderful drug for me. It really has made my life a lot better. However, predictably for an anti-psychotic, it has sent my appetite completely out of control, and a lot of weight I’d lost has piled right back on. It wasn’t always like this, though; I’ve been taking Seroquel for about a year and a half now, and it’s only since the dosage was increased to 600mg daily that this has happened. I did a fair bit of whinging about it to Christine.

The long and the short of it was that I should discuss the issue with NewVCB (well, I’d never have thought of that…), but – reasonably enough – Christine thinks that this would be the wrong time to reduce my dose of the stuff. I agreed that I’d like to retain this level of relative stability for several more months before I’d seriously consider reducing it, particularly if there are likely to be stressful events hovering about.

She kept emphasising how important it was that I remained free from psychosis. In light of our last meeting, where she said that NewVCB was reconsidering my previous diagnosis of BPD, I am now wondering if they think that I actually have some sort of specifically psychotic illness – Christine, at least, puts very heavy emphasis on that side of things. She’s worried that if I started reducing my intake of Seroquel that all the voices and visions would come flooding back. Her concern troubles me, because when she heard that I had suffered from command hallucinations and hadn’t been sectioned (or voluntarily admitted) at any point in my life, she was utterly stunned. So if I go mental again, if ‘They‘ come back or some other(s) turn up, will she recommend the bin for me?

Am I Still Proper Mental?

She asked me if I was still free from the voices, and I was pleased to respond in the affirmative. But then she asked me about possible delusional thinking. I denied any, but I must have shifted my eyes suspiciously because she kept probing me about it. I admitted, then, that yeah – I might just have a little bit of paranoia hovering about. Might. Just maybe. Perhaps.

In an admission of narcissism that shocks even me, I blathered on about how GCHQ read this blog, and about how people still have cameras up watching me. The funny thing about the cameras is that they go wherever I go. Yeah, I am really that important!

Naturally, Christine enquired as to the strength of these alleged delusions. I said that I rationally knew they were a load of bollocks, but that…well, that I still had the fear that the “paranoia” was grounded in at least some truth. For example, I have a friend, William, who’s a policeman. None of us know exactly what it is that he does, because it’s some shady, cloak-and-dagger, national security-esque thing that requires his utmost discretion and a solemn vow never to speak about it in detail to anyone. What he has told us, though, is that the amount the security services know about people, their movements, their online habits, etc is truly shocking. He also confirmed that yes, they probably are scouring insignificant online bullshit like this blog – though he contends that it’s probably based on keyword searches, patterns and the like, rather than some agent sitting in a dimly-lit room in Cheltenham reading every word that people like me are typing.

You see? As the old adage goes, just because you’re paranoid doesn’t mean they’re not watching you.

I told Christine about all this, and of course she pointed out that, given that this is a public blog, it probably could be read by GCHQ and their kin. However, she picked up on William’s point that it’s unlikely to be in any detail, unless something suspect comes up. She laughingly asked if I had somehow threatened national security in my writing of this blog, and I had to concede that I haven’t. She sorted of tilted her head as if to say “I told you so,” and then started quizzing me about the cameras.

“I know the cameras aren’t there,” I said, exasperated with myself, “but I just can’t shake off this stupid irrational belief that they are.” I’m a walking conta-fucking-diction.

As I said to her, in a way having this kind of insight is almost worse than being completely under the control of a delusion. Not that I’m saying the latter is nice – far fucking from it. But when you know that your beliefs are (potentially) psychotic (is it even psychotic at all in that case?), then you have the added pressure of arguing with yourself about the damn thing all the time. You might as well have one of those tossers that doesn’t believe in mental illness with you at all times, telling you to “wise up” and “pull yourself together”. The rational, ‘well’ side of my mind isn’t particularly sympathetic to the sicker part.

The upshot of the conversation, though, was that the “paranoia” isn’t too intrusive. It doesn’t stop me from doing things I want to do (no, anhedonia, avolition and agoraphobia are the culprits there), and most of the time it’s operating at a fairly peripheral level rather than being right in the middle of my conscious mind. Christine seemed mostly satisfied with this, though I suspect she’ll be coming back to this issue at each session for the next foreseeable future.

Rant: Aunt of Evil is on this Landmass!

We then moved on to an issue about which I was, according to her, “very angry”. I thought I’d been speaking perfectly reasonably and rationally, but Christine did not concur. The topic in question was the arrival of Aunt of Evil in this country. Those of you that have been reading this in the long term may realise that this means that this is the third time the stupid fucking bitch has been here in less than two and a half years. If you’re not so intimately acquainted with this blog, or indeed if you’re a normal human being who doesn’t have a photographic memory for bullshit, I have a long running dispute with the woman and her immediate family. They reside in the USA, and frankly their existence in Ireland makes me wish that air travel had never been invented (other than for the flight that sent them across the pond in the first place, that is).

The story of my feud with Aunt of Evil, Georgie, is a protracted and convoluted one that I’ve never discussed fully here – not because I have a problem with any of you knowing about it, but simply because other people’s familial dramas are really not that interesting. Indeed, most of it is not that interesting even to me, so I’m not going to waste my time or bandwidth or put myself at even greater risk of repetitive strain injury by detailing it all. You can see contextual posts here, here, here and here. There’s probably more, but those links should give enough information, and I can’t be arsed going through any more archives.

Now, of course given my history with Aunt of Evil and her spawn, I am not going anywhere near any of them. In that way, their presence doesn’t particularly bother me – but what does is that I know that (a) Aunt of Evil (AoE) has a skewed perception of why it is that I loathe her, and have no time for her family and (b) I will be talked about between them all, behind my back, despite my express fucking instructions to my mother – and to AoE herself – that I am not a suitable subject for their conversation.

My ma told me the other week that AoE has been going around whinging that V, the deceased lump of shite that forcefully donated his sperm in order to facilitate my conception, “has achieved something in death that he didn’t in life – the breaking up of the family.”

This fucking enraged me. AoE has always been a wanker, and I’ve never liked her. However, given that she purports to be a Christian and should therefore have a corresponding set of morals, I did expect her to at least behave honourably when V snuffed it. I did not expect V himself to behave thus, in life or in death, so her contention is completely erroneous. V was a cunt. I expected him to behave like a cunt. I did not expect her, her offspring and her offspring’s mate, to be have like cunts. And they did.

What is so fucking difficult to understand about that? It’s not fucking about V. It’s about them. Simple.

I advised my mother in no uncertain terms to appraise AoE of the above – but I don’t think that she will. My mother is lovely, but she is, in this instance, also a hypocrite. She agrees with my position on AoE and her twatpack, yet she has quite happily arranged to see them, have them stay with her, etc etc. In fairness to her, she has this idea that [cue best EastEnders-esque put-on accent] faaaahhhmmmlaayyy is one of the most important things that an individual can have on this Earth. I respect her view, but I fundamentally disagree with it. One of our friends, G (of intellectual fame, waaaaaaaay back in 2009), put it best:

Family is genetics; friendship is earned.

Quite. I don’t get this societal obsession with family for its own sake. If the people concerned are nice, if you have something in common with them, if they’re a laugh, whatever – fine. If not, why bother? Seriously. I don’t understand it. What ties do you have to such people other than DNA?

I so wish I could show you my cousin’s wife’s blog, so that you could have a laugh (or, indeed, recoil in repulsion) at her utterly nauseating nice-middle-class-ism, and pictures of the nice house that they bought with the money that should have gone to my mother and me (tangential point of amusement: she has 23 blog ‘fans’ on Fuckbook. I’m not exactly some bigshot on the hateful service myself, but at least I have over 670. Mwhahahahaha! :D ). I see from said blog that she’s up the duff again. I wonder how they’re funding that brat Gift from God?

No, no, no – I’m not bitter or anything ;)

Aaaaaaaanyway, I gave Christine a redacted version of the story, and as I said, I thought I’d been fairly calm and reasonable in my narration thereof. It certainly wasn’t a rant like the last few paragraphs here were! However, when I’d finished, she said, “you’re clearly angry about this.”

Well…yeah. I sort of am. I then proceeded to rant a good bit about V, justifying my view that he was a knobend of Rupert Murdoch proportions by referencing his actions towards my mother during the joke that was their marriage. I said that I was furious with AoE for believing that my problem with her and her family was about him because, as noted, no one expected V not to be a dick.

She was curious as to why I care about what someone I can’t stand thinks of me, which was a fair question. The answer is that it’s not so much about what AoE thinks of me – she still “loves” me according to My Mother the Messenger, but I really couldn’t care less whether she adored or despised me – but, rather, about her consistent and unwavering failure to accept responsibility for her actions. She still thinks that what she and her family did is right. It was legally permissible, I’ll give her that. It was, however, ethically repugnant.

None of this, of course, even acknowledges my more general, more long-lasting disdain for AoE. She is self-righteous, patronising and a Queen proselythiser (she’s one of the key reasons that I had such a profound and blanket hatred of Christians until I met lovely people like Phil Groom and bourach). Once, when she asked Mum why I didn’t like her, my mother – bless her – was honest, and told her exactly that. AoE affected to be shocked by this information, but honestly – on this side of the Atlantic there is no one in this shittily sprawling dynasty of mine, including my mother and the other Bible bashers like Suzanne, that strongly disagrees with my stance on that.

Back to the Fucking Point, Pan…

To get back to the original point of this post, Christine feels that it is a positive thing that I am avoiding these people; I know my limits, apparently, and “not everybody does, you know.” Nevertheless, given my levels of resentment, anger and general frustration towards them, she also thinks that this is a massive stressor for me. Perhaps it must seem that way – the rant above would appear to be clear and present testament to that – but I actually don’t think it is. I’m staying out of their way, and as long as my mother does not provide me with a running commentary on all the inevitable back-biting, I am happy to sit here at A’s in my blissful ignorance until they all sod away off again.

The appointment was basically left with her saying that if my mood dips any further before I see her again (next Friday), I can contact her, presumably to arrange an emergency appointment. NewVCB (after this week) is off for about 408 years – Christine says that all the consultants just disappear over the summer – so it’s good to at least have some professional support, especially when I don’t have Paul to bleat to. I better not go really mental though, because if it were to come to the bit and some SHO or other had to assess me, he or she would inevitably take advice from Christine as the only present person within the CMHT that knows me. And as I noted above, Christine is stunned I’ve never been binned.

So. I must retain a modicum of sanity at least until NewVCB is back from her summer gallivanting.

Speaking of her…

Appointment with NewVCB

This is Friday (albeit only into its early hours). I saw NewVCB first thing on Wednesday morning (9.30am) and felt that the appointment went fairly well. I told her that things weren’t quite as positive as the last time I’d seen her (which I didn’t record here at all, because I was in and out within minutes, and all was deemed to be well), but also said that I was happy to leave my medication as it was, and that if the downer got worse or, indeed, if it lengthily prevailed, then we could possibly reconsider this at a future appointment. She seemed to think this was a fairly sensible course of action.

I did raise the weight gain on my current dosage of Seroquel issue with her however, whilst stressing that I didn’t want to reduce the dose right now. She agreed that this was something we could think about over the coming months; according to her, a standard maintenance dose of the stuff is usually 300mg. That said, I wouldn’t like to whack the dose in half at any point, even if life was absolutely fucking amazing, so if that’s where we ultimately want to return to, then I’d have to insist that we slowly taper it down. She’s not stupid, though, so I’m sure she’d agree with that.

I told her that I was worried that, if we go ahead and do this at some point, the voices would return. “At the end of the day,” I said, “I’d rather carry some extra weight that be persecuted by ‘They’.” She nodded her assent to this, and added that in a case like mine – where the mental illness may remit at times, but usually returns in some fashion – it would be fine to have xmg as a maintenance dose, but that it would at times be necessary to whack it back up.

It sounds odd, but I was quite pleased by this statement. I took it as recognition on NewVCB’s part that my mental health problems are chronic and recurrent, and not necessarily the reactive issues that Christine had perhaps suggested (though I’d add that I don’t think that Christine thinks it’s all reactive – just that that, to her, is probably part of it, and maybe it is). This isn’t me saying, “yay, it’s all biological,” because clearly it isn’t (even if it was then that would be pretty shit – therapy would be an utter waste of time, would it not?); would I be so fucked up were it not for the ‘trauma’ I experienced? Probably not to this degree. But I’ve always maintained that I hold to a biopsychosocial model of mentalism, and she seems to concur with that.

Of course, therapy has helped me a lot, hence the ‘psychosocial’ bit. But, as I am forever banging on, I don’t believe in cures. Therapy – and medication for that matter – may help to reduce both the severity and frequency of episodes, but that doesn’t mean that the whole sorry business is dead and buried.

Anyhow, this led onto a conversation about suicidal ideation. Christine is usually concerned when I say something like, “but of course I still have suicidal thoughts, how could I not?” NewVCB, on the other hand, says she wouldn’t even believe me if I went in one day and said that I absolutely wasn’t suicidal in the least. As she says, the horrific intensity of my preoccupation with ending my life that I’ve often experienced will not always be present, but she believes – in the short to medium term, at least – that there will be probably always be some level of it.

That’s a pretty poor prognosis, I suppose, but I’d rather she was honest with me. I’ve always respected her for her candour, and even if she’s not painting the rosiest picture in creation, better that than false hope and lies.

She said that I should use this period of relative stability to think about what I can do when things go tits up again. Well, I’ve thought about it, and I haven’t a fucking clue. One thing NewVCB suggested was that I should keep the idea with me, for the next time I’m standing on the edge of some cliff with a bottle of gin and 20 packets of Zopiclone, that I have come back from the absolute brink (remember the 4th October plan, anyone?) and that therefore I don’t need to take the jump. “Use this period as a reminder when you’re that low again,” she instructed. “You can, and you have, recovered from very severe suicidality.”

Spot on: I have. However, I know from bitter experience that the mind of a person at that kind of hideously low ebb does not think like this. Well, the omni-present rational narrator in my head would certainly say, “but look, remember how well you did in mid-2011?” but the depressed side is always going to dominate that with responses such as, “yeah, but that was then, this is different. I can’t recover this time,” or even “so what? I don’t want to recover anyway.” You might very well think that both of these (and other possible) responses are thoroughly illogical, but that’s how severe depression works I’m afraid. Indeed, continuing my standing-at-the-abyss scenario, I could look down over the cliff, knowing that The Rational Narrator was right and that everything else was a crock of shit. And it wouldn’t make an iota of bloody difference.

Still, she has a point, and I’ll try to do as she says. One thing I have now that I didn’t have when I had a major crash-and-burn in the past is this blog; one crucial thing about it is that for the first time I have a proper record of something that approximates recovery, or at least a road to relative wellness. Perhaps those positive words, penned (typed) by my very own hand, could make a difference? I’m not convinced of it, but you never know.

We spent some time discussing this journal actually. NewVCB alluded to it in the context of it being one of the things that had helped me when I felt at my worst, but was careful to remind me of the dangers of becoming too immersed in the online and mentalist world, rather than in the supposedly real and sane one.

I laughed, and told her that since I’ve been feeling better, the amount of visitors here has gone way down. I still get about 200 hits on days on which I don’t post and often over double that when I do. This is far more than I ever could have expected when I embarked on this narcissistic but cathartic pursuit, and don’t get me wrong – I’m grateful to and for every person that takes an interest in this bollocks. Compared to my hits when I was posting my most morbid, morose material, though, things are definitely much less popular. I don’t mind that – I just thing it’s an interesting statistic.

In any case, I assured her that I think I’ve achieved a good balance between being here, being Pandora, and being there, being me, in the “real world”. She asked me if I was getting out much.

Ha! As if. I’ll go out alone for little errands, such as buying milk or something, if I’m feeling game. Otherwise I won’t leave the house without A, or at least without the promise of meeting someone I know well. Even then, there’s some difficulties.

I was due to meet Brian, one of my close friends, on Monday evening. Realising, however, that I would actually have to go out and, shock horror, talk to Brian, I backed out and made a frankly idiotic excuse to avoid him. (Contrast this with my intended meeting with Aaron on Wednesday, which I was going to until fate intervened. I bring this up because never, never, never ever ever ever, have Aaron and I been able meet based on our original arrangements. Something always comes up. Famine or feast, eh?).

I admitted to NewVCB that I’m sometimes genuinely scared of seeing my/our friends. Naturally she asked why, and naturally I said that I didn’t know.

She said, to paraphrase, that I need to really take some time to work out the specifics of this social and agoraphobia. I agree that the roots of it need to be uncovered, but I thought that was what therapy was for. Oh, wait. The NHS won’t fucking give me therapy, and Nexus deals with sexual abuse issues rather than this sort of fuckwittery. So basically I’m screwed.

Maybe I’ll try and look at this through writing in a future post here. I can’t seem to get the thoughts that need to be…er…thought…into my my head with any modicum of coherence, and sometimes writing about thoughts can be more revelatory than thoughts in themselves.

And that was pretty much it. Since NewVCB is on holiday now for a good while, she said she’d see me again towards the end of August or start of September. That’s a little longer a gap than I usually have between my appointments with her, but not too much so. And it’s still a fuck of a lot better than the erratic scheduling her predecessor afforded me.

Meh and Blah and Yadda and Etc and Such

If you’re still reading this, you really must have a strong interest in self-flagellatory pursuits  - but seriously, thank you. I don’t know if anyone has the lack of wit to care about me, but if you are thus afflicted, please don’t worry. I’m OK. Really, I’m mostly OK. People have downers, whether they’re mental or not. It could be a mild ‘episode’, it could be the start of something more serious, or it could be just one of those things that happens from time to time. Indeed, I’m feeling a good bit better than I was on, say, Wednesday, so it’s probably nothing much – I mentioned it to Christine and NewVCB on a ‘just in case’ basis, I suppose. I’ll be fine.

As you might imagine, sleep is an issue for someone whose blog is entitled Confessions of a Serial Insomniac. Generally, one of the most positive side effects of Seroquel has been its soporific effects, but the downside of same is the hangover the stuff gives you the following day.

The fact, therefore, that I’d been up really early from Monday to Thursday inclusive is probably not insignificant. After the burglary, we had to replace the two doors that the robbing cunts smashed through; one was in a room that has a second (undamaged) door that we also decided to change for the sake of aesthetic consistency. The bloke we got to to do the work arrived each morning bright and early, and I had to be up to greet him, make the obligatory cups of tea and share the obligatory cigarettes. It hasn’t been a particularly unpleasant effort – he’s a nice man – but it has resulted in severe fatigue. That, in turn, can be a major issue vis a vis mentalism.

Next week sees Northern Ireland’s Lovely Loyalist Love-in, the Twelfth (or, as one council is trying to politically correctly re-market it, “Orangefest”), come to pass. I have nothing particularly against the occasion despite my unionist-nationalist ambivalence (although, of course, I do loathe the contingent of wankers that set about causing trouble around this time of year – utter cunts), but neither do I care for it either. There are two days’ holidays, though, which from a practical point of view means that our door-hanger – soon-to-be our painter and decorator – can’t come out next week. So, in this way, Orangeism has done me a favour. It will allow me and my Seroquel-addled mind to rest.

Anyway, this is the abrupt end of this stupidly but predictably long post. Cheerio.

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The Wrong Side of the Road

 Life, Random Mental Health Related Philosophising, Recovery  18 Responses »
Jun 152011
 

I think this entry will function adequately for my contribution to this month’s Blog Carnival of Mental Health, which is on the theme of hope and despair.

As you probably know, I was on holiday recently. For those that care, yes – we did have a lovely time, thank you. We relaxed, ate and drank – but on several days we…you know, did stuff. We were in Fuerteventura, so one day we took the ferry across to Lanzarote (where we’ve been before, although we visited a different town from where we’d previously stayed). Another day, we took a different ferry and went to La Isla de Los Lobos, which is a small nature reserve island located just north of Fuertaventura. It was very hot, and Los Lobos is very exposed to the sun, but we still walked around the entire place, rewarding ourselves with a dip in the idyllic little lagoon at the end of the hike.

On a third day, we hired out a car. Oh yes. WE HIRED A CAR.

What do you mean, such a benign few sentences don’t deserve their own paragraph, their own capitalisation? Yeah, I know everyone hires cars on holiday – but everyone is not me. Hear me out here, folks.

A does not drive, owing to being partially sighted (and, indeed, completely blind in one eye). This hardly bothers me at all (the fact that he can’t drive, that is – obviously, I deeply regret the reasons for that) as I actively enjoy driving – in my darkest days, it was one of the few things that kept me from falling off a precipice into a deep abyss of uttely chaotic, poorly prognosticated madness. I suppose it’s the freedom of it, the thrill of speed, the sensation of motion that’s accompanied by appropriate music – it all adds up to being one pretty cathartic way to spend one’s time.

Today, driving still exhilarates me. Even in these days of pseudo-recovery, anhedonia may still reign supreme over me at times – driving, however, is something in which I still take genuine pleasure. Whilst out on the free and open road, I find the practice completely invigorating.

Anyway. I had never driven on the wrong side of the road before (and yes, before most of the rest of the world says it, it is actually the wrong side of the road despite it being far more common to drive on the right – or, more accurately perhaps, left-hand drive cars should be considered dangerous aberrations. Consider it from a pluralistic or utilitarian point of view. Go on. Think about it.). It may not seem to be a big deal, but when you’re a mentalist freak who has driven the same car without exception for the last three years, it becomes a greater issue.

So, I present to you The Car Story.

We picked the car up in the morning and, after a few minutes of it stuttering at me and generally refusing to be particularly co-operative, I managed to get the thing to run smoothly away from the hireship. A good start? No, as it turns out; here, just seconds from where the car had sat waiting for us, we hit our first snag. An alarm started bleating on and on, and Christ, was it irritating – all the more so because neither of us had the first clue as to what it was trying to tell us. I did some brief checks – we both had our seatbelts on, it wasn’t the air conditioning, blah blah blah. More out of annoyance than sense, we decided to pull over at an appropriate place and investigate more extensively.

I parked down a quiet street and looked for clues as to the source of the alarm. Obviously when the car was switched off, the alarm ceased its incessant call too, but I was gratified when I turned the ignition back on to see (hear) that the alarm had stopped. Had it been an anomaly, perhaps? I decided to drive a bit further on to see if it revisited us, and that if it did, to look out for signs as to what had triggered its screeching.

Before we got the opportunity to put this plan into action, however, we hit our second problem. I was parked such that I needed to reverse out of the space – but I could not find, for all the life of me, how to engage the fucking reverse gear. I looked at the stick in detail, and was satisfied that I was following the paths clearly marked out on it. I looked in the glove box for a manual, but there was none. Eventually, A (as he, unlike me, had more than -£800 in his bank account) turned on roaming 3G on his iPhone to see if Detective Inspector Google was willing to help us solve this frustrating case.

Initially, DI Google’s investigative skills proved to be poor. I got out of the car and walked about a bit, smoking as I went (I can try to pretend that it helps me to think, see). The incident was certainly frustrating as hiring out this car (a VW Beetle Cabriolet) wasn’t particularly cheap, and it felt we were wasting the time for which we had paid. Yet, despite this, I couldn’t help smile at the funny side of it too. Something so bloody daft could only happen to Yours Truly.

Just as A was about to advise that we embarrassingly ring the car hire company to beg for help, DI Google brought us an exhibit. Not a verdict (well, a DI is not a jury, so it would have been a bit odd if (s)he had I suppose), but a piece of guidance. Some website or other referred to pulling your gear-stick up.

“This one already seems to be ‘up’,” I observed.

“Have you tried pushing it down?” A queried.

I hadn’t, so I did. And it worked.

(Incidentally, my mother tells me that most modern cars are built like this. WHY? It’s heart-stoppingly stupid. There are enough slots for all six or seven gears in a standard gearbox, surely?).

So, smug and satisfied, off we headed.

I drove well, overall. In the end the main problem was not steering with my left hand as I had predicted (that’s a clue to the bemused Americans and Europeans who can’t understand why I’m definitively asserting that left-hand drive cars suck, by the way), nor even changing gears with my right, but my confusion over pedals. That’s especially strange because, relative to my feet, the pedals were roughly in the same position as they are in my own car, unlike everything fucking else. In any case, the problems were minor, and sailing through this beautiful, arid, mountainous terrain in an open-top car with the sun shining and the wind flowing through our hair gave that exhilaration I find from driving an even harder edge. It was great.

I noticed the alarm a couple of times on the trip. I never did decipher exactly what it was moaning about, but it was something to do with engaging the hand-brake when the car came to a stop. Once I’d figured out this part-of-the-story, I was able to successfully play an ad hoc game of Shut the Fuck Up, Alarm with the car.

We hit snag three when we arrived in a sleepy little town on the west coast of the island. We wanted to leave the car for lunch (and later the beach), but – despite what drivers of roofless cars seem to do as standard – we wanted to put the hood up, to make the vehicle as secure as possible. The bloke in the hire place had shown me how to do this – but would it co-operate? Would it fuck! A and I both fought with it for ages, before once again resorting to our expensive old friend, roaming 3G, and the YouTube video that DI Google uncovered for us. In the end, we’d been doing almost exactly the right thing – we’d just been a little less heavy-handed than we needed to be, a caution borne out of, I think, quite reasonable worry that we’d break the bastard.

After that, we had a lovely day walking around the town, mucking about on its beach with its amazing waves, and driving through the Fuerteventuran dunes in the early evening. Later, we left the car outside our apartments and walked into town as normal.

The next day, I returned the car to to hire place. To cut a long story short, there was apparently a small mark on the back of it that hadn’t been there when I took it away the previous day, and this could have seen me lose my E100 deposit very easily. I calmly told the man involved that I had definitely not breached the terms of the contract and that ergo, I had no idea how the mark had got there. He thought about it for a moment, then handed me back my deposit and told me not to worry about it.

So. Thus endeth The Car Story.

Also whilst on holiday, I actually bothered to use my knowledge of Spanish in order to communicate with locals. I was pleasantly surprised when the majority of them respected this enough to actually respond in Spanish, at least until I got confused by something (this is an odd situation, I have to say – I have been known to, and probably still could, talk at some length about world politics or the intricacies of the works of Gabriel García Márquez in Spanish, but if you want to hold a boring, average conversation with me, generally you’ll be met with a blank stare of oh fuck, I wish I’d listened in third year and not just sixth form). I had been quite pleased with myself that I was able to speak vaguely meaningful Spanish at all to people, but it was a particular boost to have them consider me capable of understanding their responses.

I swam in the sea and did not imagine phantom sting-rays underneath me waiting to pierce me through the heart, as if I were an oversized, female Steve Irwin. I drank a bit but became neither maudlin nor manic. I came back here to my dull life and didn’t want to slit my wrists.

Do you see where I’m going with this? It’s not just a boring story about driving a car, nor about speaking a language I’m actually meant to fucking speak. It all serves as an allegory for the state of my mental health.

Remember how I was in February? I was such a mess, so enthralled with the idea of ending my life, that NewVCB considered putting me in the day bin (though of course she didn’t, knowing that it would only make things worse. I don’t really have a lot of interest in sewing or whatever one does in day bins, and the interaction with other people was only likely to have served to encourage me to purchase my helium in disgust). My point is, I was in no fit state to do anything. Lifting my head off the pillow was a genuine and concerted effort; getting downstairs was a fucking good achievement.

I wouldn’t even have been able to go on holiday in the first place, never mind committing to driving in a strange land, in a fashion diametrically opposed to that to which I am used.

And if I had got to that point, I’d have had a complete, full-blown panic attack at the first sign of trouble with the car. Having the various mishaps we did have would have probably sent me jumping into the nearby quarry. Having been told that I’d marked the vehicle and was liable to pay for it would have seen me collapse in the street, begging the bloke to forgive me for my (non-existent) carelessness.

I wouldn’t have dared speak anything other than the occasional “hola” or “gracías” in Spanish, and even that would have been delivered with a head-bowed meekness.

Instead, I behaved methodically, calmly and generally confidently throughout.

I am home now, and have had the opportunity to consider this and other issues. Things with Paul ended on Monday (I won’t go into much detail on this as I will write a proper post pertaining to the final appointment and my resulting future plans in the coming weeks) and I didn’t end up going completely batshit. I had a pile of crap thrown in my face on Sunday past, which was compounded that evening by the news of the death of a good friend’s father – and rather than throw a mental fit, I merely swept the metaphorical dust off myself and got on with things. I’ve really started reading properly again, to the point where A recently described me as a “vociferous reader”. I’m currently reading – and have managed to properly follow the really excellent TV series – of the very intricate A Game of Thrones. Furthermore, I’m actually doing writing that does not pertain to this blog, even on occasion to this identity, and I am doing bits and pieces of (admittedly at-home-in-front-of-the-computer) voluntary work.

I know that I’m not ready to return to a ‘proper’ job, that yardstick by which I so strongly measure myself, but I am progressing towards it. I am hoping – cross your fingers, please – that by the start of 2012, I may actually have started looking into proper ‘in-office’ voluntary work, and perhaps I can even upgrade myself back to part-time paid employment by the end of that year. These aren’t hard and fast timeframes, fear not; they are hopes, but if I don’t meet them, I’ll not bee too hard on myself.

It could all go tits up. All of this could turn into nothing – or, rather, it could turn into an unmitigated disaster in the form of a serious relapse. But I have hope. Only four months ago, all I could see was death and despair. And now I have hope! It’s curious – an unknown quantity to me, almost – but it’s here, and I welcome it.

So I’ll continue to hope – hope for the best, be prepared for the worst, and take what comes.

—

I’ve only received one entry and one enquiry (reply on the way after this) about the aforementioned Blog Carnival of Mental Health. I’m sure more of you than that want to contribute? It’s a giant themed TWIM, folks – it’s awesome! Leave your links on the page linked on this paragraph (or here if you must, lazy-bones), or email me if you’d prefer. Thank you and enjoy! <3 xxx

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Illness

 Life, Moods  16 Responses »
Apr 192011
 

I am sick – again! This week’s misery makes last week’s, horrible as it was at the time, seem like a walk in the bloody park. There are many symptoms, but the most pressing ones are the horrifically frequent diarrhoea bouts and an agonising pain in my tail bone. Secondarily, I have a lot of abdominal, joints and muscle pain, nausea and occasional vomiting. I can’t get comfortable no matter what I do and, of course, I can’t get any fucking sleep. I lay awake all night last night just living with this misery. It sucks.

I mean, I know it isn’t serious, but it is draining me of every possible resource – activity, cognition, ability to eat and drink (thus perpetuating the drainage cycle), psychomotor function, etc etc etc. I’m still managing to read bits and pieces here and there, but my concentration is royally screwed as well, as you might expect.

Unlike last week, when the onset of whatever it is took place early on Monday thus ruining my plans for the day, this week I did go to my session with Paul (nearly having a serious car accident in the process, but that’s for another day) – but afterwards, the illness hit me with a bloody vengeance. The session had been fairly intense (posts on the last three sessions to come – yes, I know, I know), but I seriously doubt that this is psychosomatic. My body just hates me, and wants to punish my consciousness with a crappy immune system.

I’m also riddled with a non-specific, low-level anxiety. I don’t have any particular reason to be anxious, but I’m petrified of leaving the house (not that I could do so if I wanted to anyway) or seeing anyone or even hearing from anyone at present. I don’t know whether it’s that agitation or the physical malady that is making me shake and shiver so much. Indeed, I don’t know whether it’s related to the physical malady or whether it’s just there because it wants to punish my consciousness too.

When I was at school, probably between my second and fifth years (ages c. 13 – 16), every day I went into school with moderate level nausea and anxiety. It wasn’t all-pervasive, I suppose, but it was always enough to bother me. In that case, the physical issues probably were psychosomatic owing to my general misery and isolation at the time, but that doesn’t make them any less physically real. When I get sick now, I wonder how I did that for all those years. I missed a lot of school, but even when I was there, I was still ill. Up and down those infernal staircases, struggling desperately not because I was overweight, but because I was wholly encumbered with exhaustion and anxiety-laced breathlessness. Always wondering if I could make it to the next landing in case I needed to throw my guts up – better to do it in a toilet, if I can find one, than in a busy corridor. Forcing a smile as a walked past a peer, or a face full of indifference as I walked past a bully, when in reality I was petrified and wanted to run into the toilet, curl up in a ball and if not die, then at least not be there (I’d now use the term ‘dissociate’, but I was only peripherally aware of then, and didn’t understand its function as a psychological phenomenon).

And the tailbone thing that’s troubling me now – there was some of that when I was in sixth form too (though I suspect this is not the same as that was). As I stood up or sat down, it felt like my skeleton was literally being pulled apart, like you might expect to experience when ensconced on an iron maiden. It was horrendous, and yet I pulled myself up with all my might without giving anything away, always wearing that omniscient fake smile.

How did I do that? I can barely make it out of bed now with lesser complaints (this week’s illness is greater in magnitude overall than that ever-present dull misery of my teenage years, but some of the specific symptoms are not as great). If I can’t do it as an adult, how did I do it as an extremely troubled adolescent, who – although she had a couple of wonderful and close friends – was, in wide terms, pretty much consigned to a life of enforced acting and disturbed, lonely silence?

I feel sorry for my teenage self. She shouldn’t have had to endure such chronic hardship and torment, both in physical and psychological terms. And I feel sorry for her predecessor – myself, the child – who shouldn’t have had to endure the various circumstances that led, in part, to the teenager’s distress.

Frankly, right now I feel sorry for my-now-self – but that’s because I’m sick. It doesn’t do much for my mood, of course, but when this illness passes I’ll be back on the up – or at least that’s the hope. My former selves didn’t have the assurances and comfort of such relative immediacy.

—

Side note: at least I can now be fairly sure than taking Venlafaxine at 300mg hasn’t started to induce a hypomania in me. I was worried about that. No, if it had, I doubt I’d be so fucking shattered; one needs much less sleep to feel rested when hypomanic, even when ill. I have had maybe an hour or two’s sleep in the past 24 hours and I sure as fuck needed more for any sort of even normal-by-my-dire-standards normal functioning.

—

Side note II: this stupid fucking disease or virus or whatever it is could hardly have come at a worse time, because (a) it’s going to be A’s and my eighth anniversary in a few days and (b) we have friends coming home at the end of the week from England and the USA. People we don’t see often, as you may imagine. I just hope to fuck it clears itself up in time.

—

Side note III: we booked a holiday to Fuerteventura this evening :D We’re going for 10 days at the end of May. The timing is highly fortuitous, as it means we can get out of ScumFan McFaul’s 21st birthday. I like ScumFan, as it happens, but both Paul and NewVCB (and, I’m guessing, Christine too, should it come up with her) have forbidden me from seeing Paedo. Even under such orders, I would still have gone to the event if we had not been going away at the time. Practical advantages aside, though, I’m just genuinely looking forward to it anyway. A is very stressed at work at the minute, and needs to get away and I can always do with a bit of hopefully-non-mentalist time that is purely devoted to relaxation.

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Side note IV: in case I don’t write anything more this week, whether due to apathy or sickness or other factors: HAPPY ANNIVERSARY, A :D It’s been an honour and a privilege to spend the last eight years with you. Seven years ago we were in San Francisco celebrating our first anniversary. I have such happy memories of that fortnight, and it only seems like yesterday – how time flies. I have so many happy memories of times since too, and just regret that my issues have indirectly but inevitably affected you. Your support, though, has been amazing. Eternal thanks and love <3 xxxxx

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Side note V: I can’t be arsed to proofread this owing to the fucking disease, so sorry for the probable errors strewn throughout this self-indulgent and pointless prose.

Bye, Bye Borderline!

 Mental Health Diagnoses  21 Responses »
Apr 132011
 

These are the criteria, at least five of which are required to be met, in order to be diagnosed with borderline personality disorder. Apologies if this is too much of an echo of my year-old post called ‘BPD vs C-PTSD‘ – but there’s method in the madness, I promise :)

But what is that method?

I realised something last night, when I commented on Frankie’s blog, The Sunshine Diaries. I was saying to Frankie (who has both schizophrenia and BPD, the former being an illness that she is managing well, the latter being something she still struggles with at times) that I had felt so much better lately, showing that (contrary to a lot of uninformed but sadly popular opinion) there is hope for people with the disorder. As I typed, the following words seemed to roll of my fingers

I’m not sure I meet the required five criteria any more and if so, only just.

I hit the ‘reply’ button largely without thinking…then I realised what I had said, and the possibly enormity of it. Could that possibly be true? Honestly, literally true? That I might no longer meet the criteria for BPD? Really?! Surely not!

Well – this is not official in any way, but stilll…as it turns out; yes, it could be true. I no longer meet the diagnostic criteria for BPD!

:D *does a happy dance* :D

Let’s examine it one by one.

[BPD is a]… pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-injuring behaviour covered in Criterion Five). Me? NO. I’m not even that anxious in terms of abandonment issues any more, never mind going to extreme measures to avoid it. I don’t suppose I ever really went out of my way to prevent rejection, other than to make the complaint against the Trust about the end of matters with C – but really, that was more about morality and rights within the system than it was about me and him per se (not that that wasn’t part of it, admittedly. It just wasn’t the whole story).
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealisation and devaluation. Me? NO, and this has never been true. I have had issues with splitting in fairness (although this is increasingly less true as time goes on), but it’s very rarely been the case in the context of my close relationships. A and I will have been together for eight years this month. My two best friends from school are still my two best friends. Aside from the normal ups and downs any lengthy connections go through, all of these relationships have been pretty stable.
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self. Me? NO. Not significantly more than anyone else anyway, I think. In the last few months my self-perceptions have been stable, or at least consistent with an ongoing mood. When severely depressed, I don’t like myself – who does?! When I’m feeling euthymic – as I think I am at present – I am reasonably content with myself. So yeah, it changes occasionally – but it’s not some sort of yo-yo disparity at all.
  4. Impulsivity in at least two areas that are potentially self-damaging (eg. promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). (Note: Do not include suicidal or self-injuring behavior covered in Criterion Five). Me? MAYBE. The binge eating thing still applies, though in fairness that’s only really gone out of control since I started taking such a high dosage of Seroquel. Even if we can assume that it is a BPD symptom, is there (at least) a second such trait? It’s hard to say. I used to do a lot of stupid shit when I was driving, like seriously exceeding the speed limit. In the past few months, I’ve actually noticed myself being exceedingly boring whilst ensconced behind the wheel. I haven’t even gone beyond 60mph on the motorway in the last few months. *zzzzzzzz* Oh, and - assuming we’re talking in terms of consent (*coughs*), then I’m about as far from promiscuous as you can get without being one of those no-sex-before-marriage people. Yeah. I should vote Conservative.
  5. Recurrent suicidal behaviour, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself. Me? YES. Not threats and gestures; I’ve actually never been guilty of that. And I haven’t attempted suicide in well over a year, though I have seriously toyed with the idea since. Suicidal ideation is still a very big part of my life, and I can’t see it ever going away. However, it’s about degrees; right now, it’s fairly low by the standards to which I am used. As for self-harm, I’m perennially guilty of the whole ‘interfering with scabs and picking at self’ thing, and I do self-injure with my old friend the scalpel from time to time. 18 months ago, though, I was doing that at least once a week. I find it hard to average out its frequency in terms of today, but it would be less than once a month anyway – perhaps not as often even as that.
  6. Affective instability due to a marked reactivity of mood (eg. intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days). Me? YES, but also NO – not in terms of the specific criteria detailed here. The DSM says that people with BPD have reactive moods, and that said moods last a few hours or days, and only ‘rarely’ longer. This is not me at all. My mood ‘episodes’ last for weeks, quite often months actually, and – in an opposite to the DSM criteria – only rarely last for shorter periods than these. In this way, any affective ‘instability’ is much more consistent with major depressive disorder and/or an anxiety-related difficulty.
  7. Chronic feelings of emptiness. Me? NO. No! I don’t feel empty at all. One can feel hugely depressed, anxious, traumatised or whatever without feeling empty. I have all those issues and more, but no – no emptiness. Not any more.
  8. Inappropriate anger or difficulty controlling anger (eg. frequent displays of temper, constant anger, recurrent physical fights). Me? NO. I rant and rave on this blog all the time, but as I discussed somewhere else (I can’t be arsed looking for the link, sorry), that’s often because I’m really pretty submissive in ‘real life’. I have occasional tiffs with my mother and with A, but – shock! horror! – that happens in such relationships. Big wow! All that said, my types of ire can alternate – but even when it’s internally explosive, my old skills at acting allow me to behave, mostly, in a measured fashion. I am not constantly angry, and the one, solitary physical fight I’ve ever been in was when I was being bullied at school and had no choice but to defend myself.
  9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptoms. Me? YES. This is still the main criterion that applies to me, though things are a lot less severe in this regard than they used to be. They could also be explained by other illnesses with which I am diagnosed, but I accept that they could certainly still be BPD ‘traits’ too. NewVCB has told me on a couple of occasions that, in her observations, there are two main strands of people with BPD: you have one bracket of folks who are (to use her phrase) “classically emotionally unstable”, then another who tend more towards dissociation and psychosis (which is much more in keeping with Stern’s original observation of the phenomenon, ie. that it was on the ‘borderline’ between psychosis and neurosis).

So! There you go. I have two of the main symptoms, and a couple of others remain arguably applicable. That’s probably still enough to see me considered to have ‘borderline traits’, but by the definition of the full-blown disorder, I can no longer have its ‘complete’ version.

It’s weird to write this, you know: in a way, it even feels uncomfortable. Waaaaaay back just after I started writing Confessions, I debated the issue of whether or not if, if given the option, I would flick the fabled switch to bring me to sanity. I said that I wouldn’t, and I still hold to that largely. Yet here I am, effectively devoid of an entire set of insane-ish personality characteristics that seemed such a normal part of my apparently abnormal life for so long. Someone once accused me of being obsessed with the diagnosis, which I don’t think I ever was; I did, however, embrace it in many ways – in terms of learning how to be able to manage it, of interacting with others in similar boats, of advocating and trying to fight that ridiculous stigma that permeates it.

I am not ashamed to have been diagnosed with borderline personality disorder; the stigma is unfair, and the histrionic, manipulative stereotypes are blown out of all proportion and are in no way representative of the majority of people that have the illness. You can’t base everything on what you see in an A and E department on a Saturday night, and if you’re stupid enough to think that you can, then you’re not worthy of further words on the subject from me – aside from screw you.

So no, I’m not ashamed, but at the same time, I’m relieved that it’s seemingly no longer with me too. The diagnosis will never leave my medical notes so it’s not about that aspect of things; no, it’s about progress. If I can no longer be diagnosed with BPD, then I have moved forward considerably – and, maybe, returning to work is not a million miles down the road. That is still my ultimate benchmark of ‘wellness’ and ‘recovery’.

All that said, perhaps oddly I still meet the criteria for the similar psychiatric problem of complex post-traumatic stress disorder. I won’t bother to go through the whole thing with it like I did with BPD, but perhaps the reason that it could still be applied is that it puts more emphasis on dissociation than the BPD definition does, or that some of the more specific sub-criteria are applicable to me in a way that the BPD symptomatology is not. Since NewVCB first told me that I “couldn’t not have” complex PTSD, I’ve tried to embrace that diagnosis much more than borderline – not because I was ashamed of the latter, as I’ve noted, but because it seemed politic, wise and even affirming to acknowledge the trauma partly associated with my illnesses.

Furthermore, it’s evident that I still have major depressive disorder, (social?) anxiety, psychotic and dissociative episodes (potentially part of C-PTSD or a BPD trait, but possibly independent thereof too), plus arguable issues with agoraphobia, panic disorder, yadda yadda. But still. It’s progress. I’ll never be rid of everything. I don’t believe that for a second, as well you know, good readers. But if I can manage some of it, eliminate other bits – then maybe I can go back to work and stop wasting my life like this.

How did we get here, this point of non-borderline-ness? Intense, in-depth therapy, with a competent, vaguely integrative (but non-behavioural!), caring and demanding therapist. Someone with whom you’re comfortable – but not obsessed. Someone who cares about you and not targets or looking good to his or her colleagues. Someone who asks a lot of you but is willing to give a lot back in return.

However, therapy is only one part of the equation. I have to say that Quetiapine and, in its higher dose, Venlafaxine, have both worked wonders. It pisses me off that NICE strongly recommend against the use on medication in BPD – the right combination, under the supervision of a good psychiatrist, has made my life better. Simple as, end of. I don’t think therapy would have improved things so much on its own – not in less than six months, anyway. And would I have been able to even have undertaken such intensive work without the relative stability the medication gave me in the first place? Probably not.

In fact, although I think therapy with Paul has been incredibly useful (and will continue to be), the timing of my positivity* is consistent with starting to take the higher dose of Venlafaxine. Placebo? Given that I formally thought it was a useless pile of wank before and had no expectations of it, higher dose or otherwise, whatsoever? Placebo my fucking arse.

* Well. There we go, readers. I’m bored with the newfound positivity of this blog. This is not me, is it? I mean – don’t get me wrong – life is still shite and everything…but it’s a little less shite. Tolerable. Acceptable and passable. This is new and different, and is less bollocks than it is normally. That’s good, but I feel like I’m becoming some sort of saccharine fucking cherub here, and that makes me want to vomit all over this screen.

So…

As I said to my CPN yesterday (blog on her tomorrow, I hope), it’s all going to go tits up again before long. This is probably a calm before a gargantuan cunt of a storm.

Random rant to prove I still can: the human race is an out-of-control fucking virus of much disgusting-ness and David Cameron and friends are cunts who need to have their smug, wanky faces beaten in by ASBO yobs. And, whilst I wish both concerned parties well, who in the name of all that is HOrwell (geddit?! Holy Orwell! HOrwell?!!!1!!!1!!11! No? Sigh :( ) gives a damn about the Royal Wedding? And this fucking post has taken me about three hours, not because the content is so amazingly refined – it certainly isn’t – but because WordPress is shit. gah. I feel sorry for WordPress now; I didn’t mean that, I’m sorry. I do actually love Wordperss, but honestly – they really, truly, honestly need to revise the user’s ability to create bullet points and so on. This has been eminently frustrating to format.

Bla. Blafuck. Fuckblah. Fuck. FUCK! FUCK!

There’s more to say and more to rant about, but I have a more general update planned for tomorrow so it’ll go there.

I’ll sign off with this. tai has been creating some collages based on her perceptions of her blog readers and commentators. I was pretty chuffed when she did this one of me:

Pan by tai

Isn’t that class, and isn’t it a brilliant idea? I love tai’s creativity, both in her art and in her prose, and feel very privileged to have been part of this project – so thank you, tai, very much indeed! :D

‘Night everybody. x

Missing a Dose of Venlafaxine, and Inevitable Post-Consultant Blah

 Medications, NewVCB, Psychiatry  16 Responses »
Apr 082011
 

When I first started writing this blog nearly two years ago, I was – as the title suggests – plagued by almost continuous insomnia. It is a truly dreadful affliction, but it’s surprising how much the human body and, to a lesser extent, the mind, learn to adapt to it. I remember when I was still at work, about three years ago maybe; I would lie awake all night, often for a number of respective daily cycles, getting a maximum of ten minutes’ sleep if I was lucky – and then I’d get up early, frustrated, and be in the office before 8am. Very often I stayed until after 6pm, sometimes without a lunch hour or even a tea break. It fucked with my head undoubtedly, but I still managed to undertake the duties of my position competently and courteously.

However, since I was prescribed Seroquel* last January, sleep has been much less elusive, to the point where I partly regret naming the blog what I did – though it’s established under this moniker, so I have no intention of changing it. Seroquel does tend to lose its soporific effects over time, but as my dose has increased on several occasions, I’ve been more immune to that than many that take it. I’m presently taking 600mg daily, and have been since October-ish. It’s a pretty hefty dose by UK standards, and so far although I often have difficulty in falling asleep, I usually get there eventually. The trade-off for both the management of psychosis and getting some rest is that one has a horrible, drowsy drug-induced hangover the next day, but it’s a balance I’m prepared to accept.

[* Please note that I use the terms Seroquel and Effexor interchangeably with Quetiapine and Venlafaxine in this post. For some reason, I've got into the habit of calling the former by its brand name, despite more typically using the generic medication terms, as I do with the latter in this case.]

So when, on Tuesday night/Wednesday morning, I was still wide awake at 3am, I was puzzled. I was at my mother’s house, and mused briefly on whether it was being out of my normal bed, but I dismissed this fairly quickly as I usually stay with her one night a week, and am therefore not exactly unfamiliar with the sleeping quarters to which I am allocated.

Then it dawned on me: I had forgotten to take my medication.

I was beyond furious with myself. After this bizarre incident last year, I know what missing both Venlafaxine and Quetiapine means, and it is not fucking good. I mean, on that particular day I ended up quite hypomanic, but it wasn’t all so pleasant; I have this gruesome memory of lying in a toilet cubicle in Newcastle, shaking my tits off, struggling to breathe, alternating between hot and cold flushes, desperately trying to throw up and being so consumed by ‘head-zaps’ and dizziness that I thought I might die. Even though I thought I was already dead. So yeah. I’ve had better times.

At about 6am I got up, still not having slept, and took the Venlafaxine. I decided to omit the Quetiapine in case its sedative properties caused me to end up passing out, especially as I knew I had to see NewVCB at 9.30am.

I sat with a coffee and watched the sun rise. As I did, it began to start. I could have blamed it ‘merely’ on insomnia at first, but as time wore on, it became clear that it was to do with missing the tablets. Not for the first nor last time that day, I cursed my idiocy in forgetting to take the damn things.

At 8.30am, I went to my mother’s room, where fortunately she lay awake. I explained that I was mental and did not feel in enough control of myself to be able to drive to the hospital, and asked if she would take me. She agreed and duly arose.

All the time it was getting progressively worse. I nearly fell over with the unquantifiable dizziness at one point and several times I was surprised that I didn’t faint. I was shivering. I was hypervigilant, jumping out of my own skin at even the most subtle noises. I was restless and agitated. Suspicious and ‘zappy’. Nauseated and sore.

By the time we got to the hospital I could hardly stand. In fact, when NewVCB came to get me from the waiting room, I had to drag myself along the wall all the way as I followed her to her office (getting a few looks as I went – but what do they expect? It’s a psychiatric service for God’s sake!). As I sat down, I just went completelybluegh at her. “I’m fine, really I’m fine – just not today. I forgot the tablets last night, and I’m going out of my mind.”

She swung into action, telling me how to manage having missed the stuff. Apparently I was to go home and take 150mg straight away (I neglected to mention that I had already taken the full 300mg. For some reason, I am still scared of doing something even remotely opposed to her advice, even though I know that she’s nice). Then I was to take a Diazpeam or two, as required, before taking the second 150mg as usual. I was not to take any of the Seroquel until the normal time.

As the minutes passed, I was feeling worse and worse. I hadn’t noticed I was clawing constantly and fervently at my skin until NewVCB pointed it out to me. She said she was reminded of a man she’d see a few years ago who’d been stable when she’d last seen him, but was literally clawing off his face the next time she met him. He had missed three doses of Venlafaxine.

She asked about the symptoms I was experiencing, and I told her it was beyond description. She asked me to try anyway, so I did. I said I felt like I was being attacked from the inside. My muscles felt as if they were on fire; I needed to pace or hop about to mitigate this, but as soon as I tried to my head was overwrought with dizziness and I felt faint. I said that I was incredibly cold one second, but sweating my arse off the next. I tried to describe the head-zaps but couldn’t – the best I could do was to say that it felt like a million minuscule guns were shooting something toxic into my brain, from inside my brain. I tingled. I shook. I was agitated. I felt sick. In terms of mentalism, I was paranoid and filled with a feeling of unspecific dread. Reading that back, and remembering what yesterday was actually  like, it actually reminds me a good bit of akathasia. How odd that one can feel that as a side-effect of not taking a drug…as well as a side effect of taking said drug! (It’s normally seen as a side-effect to anti-psychotics, but has apparently been observed in some that take Venlafaxine).

“It’s the Effexor, not the Seroquel,” NewVCB said, certainty lacing her tone. I have just checked it out, and indeed I must have seemed like a textbook case to her yesterday. I had almost every symptom of it in remarkable abundance. She reiterated the need to go home and “straight away” take half of the missed dose. Since I’d already taken the full dose, albeit 10 hours too fucking late, I hoped that this would indeed lead to a reduction fairly quickly in the horror story that I was living through. It took its time as it turned out, but I’ll come to that.

NewVCB said she realised that given the circumstances it would be difficult to discuss the general state of things, but I’m generally OK at seeing what some arsehole manager somewhere would call ‘the bigger picture’, so despite my physical discomfort, I instigated a conversation with her on how matters had been since our previous meeting.

Firstly, given her intention to ultimately increase my dosage of Venlafaxine to 375mg daily (God forbid I ever miss a dose of that), I have been ‘invited’ (yeah, it’s going to be such a laugh, isn’t it? RSVPiss off) for an ECG on Wednesday 13th April. Other than that, I didn’t really have much on which to update her – other than that matters with Paul are due to come to (a hopefully temporary) end in less than six weeks.

I told her that luckily Paul had advised me that I could simply return to Nexus a few months after last seeing him, and that he would intend to simply pick up my file when my second application had gone through the system. “However,” I said, “that means – I don’t know – eight, ten weeks with no therapist, so I was wondering if I could continue to see Christine during that time? I know we’d both intended for her intervention to be pretty short-term, but I really think it would be helpful to have some support during those months.”

NewVCB was nodding her head vigorously. “Yes, absolutely,” she assured me. “I’ll talk to her about that this week.”

She paused, then continued by telling me that she wanted Christine to discuss practical matters with me. The term ‘practical matters’ reignited a subtle fear somewhere in my mind – it always reminds me of those types of therapy that I utterly despise, such as C- and DBT. However, NewVCB surely knows me better than that; she would know that I cannot abide anything that I even vaguely perceive as patronising, and to that end, I (hope that) I can trust her not to make the ‘practical matters’ with Christine to be some wank of this ilk.

She asked me how things had been with Paul in general, and I advised that I thought the work had been very productive overall. I tried to explain what we’d been doing but it’s hard to put it into succinct terms, so I ended up saying that he was basically trying to convince me that everything that’s happened wasn’t my fault.

“Despite working for who he does, though, he doesn’t just focus on sex abuse, which is good,” I said. “Certainly, that is a big issue, but it isn’t the only one.”

“And that’s part of the reason why 26 weeks is often enough for Nexus clients,” she opined. “You get a lot of people there that have maybe one or two incidents of abuse, or have much fewer defensive mechanisms or complex issues than you, and so in a relatively short period you’ll often find that they can resolve many of their difficulties. Unfortunately that’s not the case with you – but then, as they’re essentially a self-referral organisation, it means that as Paul says, you can return.

“How have the last few weeks been with him?” she continued.

“Introspective,” I replied. “I don’t think it’s been useless, but I’ve found myself sitting there in silence a lot, thinking about things rather than verbalising them.”

“Do you think you shut down when you know there’s an ending coming?”

It did sound that way, certainly. However, unless it’s very unconscious, it hasn’t been the reason for my recent long silences – all that has happened is that a lot of strong shit has been brought into the room, and I’ve been sitting there experiencing it, rather than talking about it. I’ll try and write about these sessions shortly.

“At an unconscious level, maybe a bit,” I ventured, finally. “However, I don’t think that’s really the case. I still expect the next six weeks with Paul to be productive, unlike the last six months with C were.”

To my amazement, she said, “therapy on the NHS can be pretty questionable.”

Obviously I know this, but I did not expect a consultant psychiatrist to say it to a patient’s face. I cocked my head in query at her.

“Well, you know…” she shrugged. “Finances, bureaucracy, targets. Sometimes voluntary and private sector organisations provide a much better service.” She laughed lightly. “You of all people know what we’re like..!”

Still clawing away at myself, I managed to laugh a little myself. Oh yes, NewVCB. I know what you’re like alright. Except that I don’t like including ‘you’ in my general derisive view, because you’re alright. It’s the sprawling mass of red tape and management-speak bollocks that you’re part of that I hate.

She went on to question me on things more generally. Mood? Awful at the time, thanks to the Venlafaxine withdrawal, but overall actually fairly reasonable. Anxious and stressed at times, but not completely pre-occupied with bringing about my own demise nor unable to get out of bed. Trying to live a little, rather than just hanging on to mere survival by a thin thread of second-by-second-ness.

Voices? Nothing much. Whispers occasionally, but no real commands and comparably little hassle. Delusions? It’s not a delusion but GCHQ and related organisations are still reading my blog, Twitter and Facebook messages. Why is it not a delusional? Because I know people who are involved in such agencies and am aware that they do this. But do they actively do it to you? Yes. Well, does it stop you from writing what you want to write? No, I stick to fingers up at their unseen faces and think, ‘if you don’t like it, you can sod off’.

She laughed. “OK. I think that you’re maybe reading a little too much into their motives, if they have any, but it doesn’t seem to be bothering you unduly.”

“Not really.” Pause. “Seroquel really is a wonderful drug, you know.”

“It certainly seems to have worked for you.”

“Paul’s not a believer in the medical model. He thinks mental illnesses are social issues. I don’t agree; medication has been instrumental in making me feel a bit better.”

She shrugged. “Whatever works is what’s important. Medication, therapy, no medication, no therapy, whatever. A combination of both seems to have made a real difference in your case.”

At this point, she turned and looked me straight in the eye. “Compared to the girl I met here last January,” she said, “you’re almost a different person. I know progress is slow, but take it from me – it’s evident. There will be times when things are bad again – it’s the nature of the beast – but overall, I really think you’re moving forward.”

I found myself smiling slightly, and I agreed. “I don’t know whether it’s a combination of the therapy and the drugs, or just the latter,” I told her, “but one way or another, I think things have improved, yes.”

There was little remaining to be said. Yet again, she advised me to go off and dose up on my missed dose. I apologised for “being stupid enough to forget it,” but she said that it happens to everyone from time to time, and that at least it might encourage me not to do it again! As I was walking out the door, she said – surprising me again – “bye, Pandora, it was nice to see you.”

NewVCB has generally been a pleasant and helpful woman to work with, but she’s never before actually given me any compliments, however vague that one may have been. It was a weird but nonetheless appreciated gesture.

Not that my body cared. I stumbled back to where I’d come from to collect my waiting mother, then went into a spin of dizziness and fell out the front door. Fortunately, the rail for wheelchair users prevented me falling flat on the concrete and splitting my face into 22 pieces.

The journey from the hospital to my mother’s house is a short one, but the motion of the car sent my withdrawal symptoms out of control. When we got back to the house I retched several times (being unsuccessful in my attempts to vomit, given that I had a completely empty stomach), then stood at the back door smoking and jumping about in an attempt to curb the physical agitation. Apparently I was also babbling endlessly on about some stupid nonsense with barely a pause for breath; I remember a little of that, but not a lot. My mother, who was going to the doctor’s surgery to have her monthly blood checks, decided that she had better take me with her. Originally she had instructed me to return to bed after seeing NewVCB, but upon seeing me so mental, she decided that it wasn’t a good idea to leave me alone.

I went with her without complaint, but it just got worse and worse. I didn’t go into the surgery, as I feared that if one of the GPs came out and saw me, they’d see how mad I was and try to bin me (realistically, I know now that that was highly unlikely, but it’s still a good thing I didn’t go in as I’m fairly sure I could have upset other patients with my evident insanity. I was even fucking drooling by this stage.). I sat in the car, audibly moaning from time to time, dissociating in some places, being miserable in all.

When my mother returned, she offered to take me home again, but I demurred. I didn’t want to stay out, but I didn’t want to go home either. I didn’t want anything. I didn’t even want the paradisical escape of unconsciousness – just nothing. I know that makes absolutely no sense at all, but there aren’t words to describe what I’m discussing (or if there are, they – like so many wonderful concepts – are foreign terms that are not at all easily translatable to English). I only existed in the moment, and anything beyond it was out of reach.

My mother had to go to the bloody golf club, so I accompanied her. I was scared of running into some of the pretentious fuckwits that permeate the place, thus mortifying my mother, but fortunately she has a tendency to hide in deserted offices when there anyway. I sat. I tilted my head to the left, I tilted it to the right. I stood and paced a bit. I sat again. I stretched. I moaned. I spaced out. I shook. I flushed. I sweated. I froze. I stood. Sat. Moved. Wiggled my fingers and toes, stretched my leg muscles. I banged my head off the wall once in an attempt to stop the ‘zaps’. My mother asked me to desist. I did. I sat. I felt my eyes dart from left to right. Up and down. I scrunched up my face and shook my head speedily. I clawed at myself. I punched my muscles. I bit my lip.

And so on and so on and so on.

However, towards the end of my mother’s tenure behind the golf club computer, it subsided a little. Encouraged, I dared to look at my iPhone; I’ve got quite into geocaching recently (assuming someone’s with me, obviously, as I can still hardly go outside alone) and wondered were there any caches in the near vicinity. As it turned out, there was one right across the road. I said so to my mother, prompting her to ask if I wanted to look for it. Had it not been across the road, given my fucked-up state there was no way I’d have bothered, but I figured since I was already there…

The fresh air seemed to have some positive impact upon my condition – or maybe the medicine was simply starting to makes its mark by that point, who knows. In the end, I was able to have lunch with my mother in the town, although I picked through a lot of it.

The hot/cold flushes remained with me all day. I wrapped myself in a blanket on the sofa, but the next minute I’d throw it off again. Only to pull it back 10 seconds later. The zapping significantly reduced as time went on, but didn’t go away entirely – the same was true of the agitation and akathasia-like restlessness. I didn’t have to get up/sit down every five minutes, but I would have to alternate between lying down and sitting up. Overall, although I felt better than I had, the afternoon and evening were still quite wretched; however, I determined that I would stick things out and go to bed at 11pm, a fairly normal time, rather than oversleep.

I did so, and passed out within minutes – with one of the most peaceful night’s slumber I’ve had in ages (though not before I found a fucking packet of fucking Zopiclone sitting on the fucking bedside table that I had failed to fucking spot the previous fucking evening. In a furious rage at the sod’s law involved I threw them at the wall, but upon getting into bed I was able to roll my eyes a little and see the humourous side of this frustrating turn of events). I suppose I had been awake without a single second’s interruption for about 40 hours, so a good sleep was deserved.

When I woke up today, I was still exhausted – but I felt half-human again. Thank Christ. Of course, being half-human leads to half-human thoughts, or at least the thoughts of a half-human who’s a mental anyway. I mulled over NewVCB’s positive words about my mental health progress, and started panicking that this meant that she was imminently planning to discharge me. Here we go again: rationally, I doubt that this is likely, but since it’s actually physically possible, I am now convinced it’s going to happen.

Rather than sit and obsess about this all day, though, I let my tiredness consume me, and went back to sleep. Having been unable to drive yesterday due to being mad, I finally came back to A’s this evening, where I was distracted firstly by taking him out for a coffee and, secondly, by writing this post.

Both last night and tonight, as soon as my phone alarm went off, I dutifully whipped the pillbox out of my bag and knocked the fucking tablets back right away. I have no intention of letting yesterday’s awfulness happen ever again.

I’m tired again now, and have written over 3,700 words for a post that could have been done in 10% of that. So I shall bid you good evening, lovely people. For those of you that do – keep taking your tablets! x

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Venlafaxine 300mg and Seeing the Good

 Blog News, Medications, Moods, Psychiatry, Triggers  30 Responses »
Mar 022011
 

I’ve been taking 300mg of Venlafaxine for a week now. A week is damn all in the context of anti-depressant medication, I know, but I’m actually feeling cautiously optimistic about it. A and I had a really good weekend; I’m not saying that most weekends are shit per se, but experiencing raw fun and pleasure is, as you can imagine, rather rare for your Not-So-Humble Narrator.

Also, last night we saw a very professional and wonderfully authentic production of King Lear. I was actually proud that I was able to go, even though on paper I would always have been keen to do so; last week I’m pretty sure it would have been impossible, and even if I could have dragged myself to it, I wouldn’t have been able to concentrate for any more than about three seconds. When you’re watching an intense Shakespearean tragedy, concentration is clearly a pre-requisite, so that would have been a fucking disaster. As it was, I was actually able to both follow and even enjoy the play, which surprised and gratified me greatly.

I’ve felt fairly level over the last few days (as my Moodscope results, unscientific as they are, would appear to attest – currently they’re about 20% each day, which is much better than the standard 1% or 2%), but I (unlike NewVCB, apparently, in the context of our last appointment at least) am well aware that I have a secondary or at least differential diagnosis of bipolar disorder, type II. All anti-depressants carry with them the risk of (hypo)mania, and that presents a slight concern. It’s particularly noteworthy for me as I genuinely have no conception of what is ‘normal’ contentment/happiness, and what is psychiatric pathology; I simply do not have a proper frame of reference from before mentalism. Arguably, if you hold to the medical model at least, the mentalism was always – to a greater or lesser extent – there anyway, thus rendering a frame of reference devoid of it impossible.

I’m reminded of Freud’s old dictum about the transition from ‘hysterical misery to common unhappiness’, or whatever way it was that he put it. Let me make this clear: I am still strongly depressed, still suffering the usual intrusions of PTSD and occasional psychosis and dissociation, and am still terrified of leaving the house (particularly alone – although I went to a non-Paul appointment by myself yesterday, about which I was very pleased). Drugs don’t cure people – actually, as you know, I don’t believe that anything actually cures people – but maybe I was too quick to condemn Venlafaxine. Maybe, to use the old phrase employed by myself, both VCBs and doubtless countless others, medication can at least take the edge off the ‘hysterical misery’.

So, so far, so acceptable. In other news, I’m on a diet again and, again, am cautiously hopeful that I can stick to it. Since I’ve been taking 600mg of Seroquel, my cravings for sweet stuff have spiralled out of control. A few weeks ago I ate six bars of chocolate and three Creme fucking Eggs in one day! Unsurprisingly, I’ve gained 11 lbs since the last time I weighed myself, which was a fucking year ago (I know I have a dangerous personality, so I keep away from the scales. There’s no danger of any imminent eating disorder given my humongous size, but I don’t want to step onto a slippery slope and become obsessed with my weight). To that end, yesterday, I procured some Slimfast, and have found that the Cafe Latte flavour can (again) take the edge off my craving for such ridiculous amounts of crap. This is all weird to me, because savoury rubbish rather than sweet stuff has always been my weakness. This is why I opine that Seroquel, not just me, is to blame. Anyhow, if it fails, it fails. I’m also planning to re-quit smoking next month, but again – if I don’t, then I don’t. There’s no point in self-vituperating about it (that’s easy to fucking say, mind you…). I want to lose weight and get back off cigarettes, but if my mental illnesses don’t like that, then I am a slave to them. All I can say is that I’ll try.

For all my positivity in the last 600 words, though, there has been a lot troubling me in the last few days too – I mean, yes, the usual pervades my mind (abuse, fear, therapy, blah de blah). But it’s not just that. A lot has been afoot in parts of the mental health blogosphere of late, and it has left me feeling very disillusioned. I’ve been angry and frustrated on behalf of the personnel in question, and furthermore it left me questioning why the fuck I even write what I do here. I was actually asked this question by a third party fairly recently (respectfully, I’d add), and defended myself on the grounds that this blog is nothing more than a personal journal.

Is it though? When I sat and thought about it, I’m not really sure any more. It’s not meant to be anything more, but to my surprise it’s morphed into something more popular than I could ever have expected when I started writing it in May 2009. The thing is, sometimes I feel pressurised to write, to the extent that I get irritated by my ‘need’ to blog. This is especially true of my reviews of therapy sessions, which are by their nature very long. I mean, I could reduce them to abstracts rather than specifics, but then all the minutiae would all be lost and forgotten to time, and I don’t want that. I want all I can possibly remember here, for me, for posterity, for recollection of the healing points made, and for help in avoidance of the bad. But, perhaps paradoxically, the more I have felt under pressure to sit down and write said posts, the less I have been able to do it. My motivation, minuscule as it was in the first place, erodes completely. I find excuses to avoid writing. I feel anxiety rising from the pit of my stomach – not because of the content I wish to record, but because of the recording itself. It’s pathetic, I know.

What all this culminated in was this: I wrote two posts that I haven’t published. Both declared that I was taking a (possibly lengthy) break from writing here (at least publicly); one entry was bitter and angry, one more measured and considered. I sought advice from another blogger and from A, and decided to wait before I published either.

Cue today. I went out the back to smoke and sat down and just thought about it for a long while. For all the negative sides to it, and for all the unpleasantness of the last few weeks in parts of the Madosphere, I think I have done something worthwhile in writing this blog. For myself. If it is somehow worthwhile for others as ‘entertainment’, a form of advocacy or whatever, then that is a very beneficial side effect – but with no disrespect intended at all, I don’t write it for you. The blog is public merely because I value feedback, support or advice for myself, but if commentators/readers derive catharsis from it, then that’s an excellent and gratifying incidental.

So I will not be taking any sort of extended break. I’m not sure how I’ll catch up on all the psychotherapy stuff, but I’ll work it out sooner or later.

To be clear, if people don’t like the realities they read in the mental health blogs out there (regardless of who the author may be), then – as I’ve said a million times before – then DON’T FUCKING READ the mental health blogs out there. Just click the ‘x’ on the top right (a variable location if you’re a Linux user, that said), and go the fuck away. S.I.M.P.L.E.

Otherwise, readers, Twitter friends, etc, you do (I hope) know that I value you all very, very deeply. Without social media, and without this blog, I wouldn’t have made so many wonderful, gentle, kind, genuine and supportive people – in fact, not just ‘people’, but ‘friends‘ - and for me that actuality easily trumps the negatives associated with what I do here. Thank you all for continuing to follow the life and times of Yours Truly, and for all your amazing encouragement, friendship and kinship.

Onwards and upwards.

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