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

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

Dear Mr MP

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Kind regards.

Yours sincerely

Me

Encs

I’ve been fairly lethargic for quite a while now but otherwise, in terms of my mood, I thought things were on the up.  Even at times I felt that perhaps I was even a wee teensy bit hypomanic, which would have been a nice bloody change.  Bipolar disorder is certainly a hateful fucking illness, but hypomania is the rare upside to the regrettable affliction.

There’s no hypomania today, though.  Not even a euthymic or ‘alright’ mood.  The weekend was pretty shit too, but not as bad as today, as today has seen me in an utterly wretched and pathetic state of narcissistic, all-consuming depression.

I want to cry but I haven’t got the energy.  I want someone to hug and take care of me and love me [FAIL!!!], but I feel nothing but empty loneliness.  I want to have some understanding of what it is like to enjoy life, or at least not feel utter ambivalence towards it (because I don’t even have the fire to hate it at the minute).  Even at the most abstract conceptual level, though, these things seem alien and unlikely.

I think Quetiapine is (at least partly) to blame for my complete and utter inertia of the last few days, but it isn’t to blame for the Black Dog of the last day or two, because it has always helped me in that respect.  It has definitely made my life better since I started taking it in January.  Perhaps nothing caused it specifically – I mean, I am an individual with a long history of largely melancholic depression…and even if I wasn’t, we all have our bad days, don’t we?

Yet it is my nature to analyse things, to search for reasons especially when reasons do not present themselves clearly and obviously.  So notwithstanding the above, I think that maybe I’m having a bit of a delayed reaction to last Tuesday’s unwanted events, and of course I am still mentally embroiled in a horrified fixation about the impending and enforced end of therapy (and have failed to review the last two sessions of same, which is ridiculous when I consider how important doing so is to me).  Surprise surprise!

I keep seeing images of my body flying off some of the high-rise buildings in the relatively near vicinity, or sometimes over the motorway flyover.  I go to put my tablets for the week into the little pill box that I carry everywhere, and I want to ingest the entire bloody lot of them.  If I can even manage to force myself to make some sorry form of rudimentary meal, I look at the knives involved and I want to stab myself all over with them.  In particular I want to stab the parts of my body that nobody likes to talk about (something about which bourach recently courageously wrote, and something that I have never confronted here or anywhere else for that matter…and which I am going to continue to avoid today).  So maybe it is about last week’s encounters with Paedo, or ongoing retraumatisation from therapy – who knows?

All I know for certain is that this is a miserable existence, and one way or another I don’t want things to continue like this.  Death or some modicum of “recovery” is required.  I am still hopeful that it will be the latter, but the journey is a hard and long one, and falling into gaping potholes – some with a seemingly infinite depth – is a sad but apparently frequent inevitability as the road is travelled.

[/pointless whinging]

(NB.  Please don’t worry, if you are kind enough to worry.  I don’t think I’m actually likely to do anything; again, I simply don’t have the motivation or even physical strength).

(Aside: I considered calling this ‘From Bleak to Batshit’, which I found pathetically amusing, but ‘Depressed to Doolally’ seemed slightly less obscure )

Q:

My symptoms, I think you’d agree, have gotten worse over – say – the last two years or so. There’s been overt psychosis, clear dissociation, significant self-harm, etc etc blah blah blah. As a result, you’ve seen stuff in that time that most ‘other halfs’ don’t see in a lifetime. Surely dealing with this stuff has been more difficult than dealing with someone who, three or four years ago, seemed ‘just’ depressed? But as noted previously, you were less tolerant and/or sympathetic then than now. Is it actually easier to deal with someone in the throes of a psychotic break than with a depressed person? If so, how is that? What has enabled you to tolerate all this stuff, when depression often drove us apart?

A:

Good question. To help you and indeed your readers understand this one, I need to refer you back to some of the ground I covered last week. My own journey towards a greater understanding of mental illness was quite long and, in its initial stages, I perceived that you had an amorphous condition known as ‘depression’ which, with time, would dissipate. At times my attitude was indeed unsympathetic, and this comes down to an view that I once had, and which I believe many of the uninformed share – that those experiencing depression ultimately still have some form of control, an ability to resist and to say “no” to the bleakness if only they could summon the willpower to do so. I label myself a hard worker, at least in the career context, and I expect others to struggle through adversity in the same way that I do. What I feel I didn’t realise was that this amorphous term “depression” referred to something very specific, requiring much more than willpower and self-control. It would not be possible to ‘pull yourself together’.

The stance I once took sounds very negative, and I’m not suggesting that I felt like this all the time, but I suppose a complete lack of understanding of your condition at times led me to think that you had more say in the direction your life took than you actually did.

I must confess to being a believer, to some extent at least, in the view that we create our own realities. I don’t want to get too philosophical here, but nothing is definitive; everything is perforce seen through the filters of our own perceptions. To take a very simple example, individuals can perceive the same photons entering their eyes, but their perception of what they are seeing is constructed through the lens of their life experiences. Everyday technology to me might be magic to someone else. If I show you a car and ask you what colour it is, we might agree that it is red; but do both of us use the abstraction “red” to mean exactly the same thing? I hope I’m making sense. Nobody really sees anything independently of their own perception. Following on from that, I take the view that it is possible, with effort, to change the way in which we perceive things, react to things, and so on. These are our perceptions and we can control them. You might call this a very CBT-ish approach, and perhaps it is. I understand your cynicism about this: if somebody said “You can change the way you feel if you just think about things differently,” I would be forced to laugh in their face (if feeling unkind) or hide my derision (if not). I do, however, believe that such change is possible with will and persistence. All this is a round-about way of saying that I thought it was possible for you, or anyone suffering from “depression”, to change things over time. I’m not saying I believed there was a magic bullet you could fire and fix everything overnight, but I did believe that time and persistence could be great healers. I still think that is not an unreasonable view.

There are several problems with this analysis in the context of your illness, though, not the least of which was my complete failure to understand what the umbrella term “depression” covered. A second problem is that I myself, while believing the above, have been completely unable to exercise such control over my own thought processes. Being mentally ‘healthy’, or fairly so, if I cannot do this myself, how can I expect others to do so, especially those suffering from conditions that I have never experienced? Self-change is possible, I don’t doubt, but I have concluded that it is very difficult without some form of external help (therapy, medication) or internal motivation (spiritual revelation, high motivation, etc).

I think another thing which perhaps drove us apart at times was my inability to understand what was wrong. My logical brain seeks an explanation for everything. If you are depressed, it figures, there must be a reason, and it is natural that I should wish to ascertain what that reason is, and to try to help in whatever way I can. Often, however, depression left you uncommunicative, leaving me with a sense of frustration, not knowing why you felt the way you did and being unable to do anything about it. At other times, you might cite some event many years ago, or some issue over which you had no control, as the reason for your low. In this case, my frustration would derive from that fact that I felt there was no point brooding excessively over something you were unable to change. Of course, that is easier said than done, but we’ve all had problems in our lives, and I wondered whether yours had been so much worse than those experienced by others. Of course, at this time, I was unaware of the full extent of some of the terrible things that actually did happen to you. You had spoken in general terms of the abuse, for example, but its long-term and systematic nature was something of which I was unaware. I think possibly you weren’t fully aware either.

So, I’ve not painted a particularly complimentary portrait of myself. So be it. We did have good times, and not every day focused on depression or related issues, so we generally got on with things, having the odd downward spiral in our relationship, but a range of good times as well. I don’t mean to suggest that I had no sympathy or made no attempts to understand, and I hope that isn’t how I came across. However, it is clear that the efforts I did make were not especially successful.

So why can I cope with much worse things now than the ‘mere’ depression of old?

I explained in my last post that my attitude changed as the concept of “depression” was happily (for me) dispelled in favour of a much clearer explanation of what you were suffering from and why you were suffering from it. Although you are much further ‘down’ than you ever were when you were ‘simply’ depressed, the fact that I now have some level of understanding is the crucial difference. Having an explanation makes it so much easier to empathise, and I’ve ceased telling myself “Well, if it was me, I would do x or y“, since I couldn’t possibly know what I would do – I’ve never been in your position. A clear diagnosis fulfils my need for a logical explanation of your state of mind. My understanding of where you are and why you are there mentally has been vastly enhanced since you entered therapy and started writing this blog. Now that I understand something of the conditions with which you are afflicted, I realise that the hole in which you find yourself is too steep-sided to climb out of on your own, or even with the assistance of those close to you. You need expert help. A sympathetic and well-meaning hand of personal friendship is not enough. A heavy duty problem requires a heavy duty solution – enter therapy and the dreaded (but seemingly essential) medication.

A second aspect of the current situation has made it easier for me. Now that you have diagnoses, I am able to see that there is scope for medically valid action plans providing a genuine ray of hope that you will eventually emerge from this in better shape. I am no longer naive enough to think that you will be ‘cured’. I may as well wish for my own permanent physical disability* to vanish. However, there are coping mechanisms, means of managing the condition and sharing your life with the demons stuck in your head.

In the end, it is the combination of increased understanding and hope with a logical basis that has enabled me to get closer to you despite the sometimes horrible situations in which you have found yourself (my least favourite of which was one night in Accident and Emergency after you had befriended a scalpel).

Easier to deal with someone in the throes of a psychotic breakdown than someone sitting on the sofa silently and broodingly?  Yes, it does seem a very strange thing to say.  I certainly do not find it at all a pleasant experience dealing with situations where you are dissociated, hallucinating, self-harming, and so on, but these are so far from being in any way associable with the common understanding of “depression” that I find it very difficult to compare the two.  I suspect the latter may be more readily faced by me because this is so clearly the outworking of a very serious medical condition.  Why that should give me some form of strength I am not sure.  Perhaps it is because I know I am not responsible for it, you are not responsible for it, neither of us have much control over it when it strikes, and we have to work together to overcome it in the long term, with the assistance of medical professionals.

I said it was difficult to compare the “depression” scenario with the psychosis one, but I will try.  In the former case, I think I have gone into some detail on that both earlier in this post and in my last one – in a word, my reaction was frustration.  In relation to psychotic episodes and the like, my reaction is one of fear, alarm, helplessness, adrenaline, confusion, worry, and other similar ‘flight’ type instincts.  Yet these conditions also force me to take some form of action.  I remember on that A&E visit, during your very long wait to be seen, you decided that you’d had enough and were going to walk out of the hospital and home.  You have told me you don’t remember this because you were in a dissociated state.  I have a very clear recollection, however.  I had to physically restrain you – block your exit from the building – for a minute or two before being able to persuade you that you must return to the waiting room.  There is a frightening adrenaline surge to events like this.  I don’t wish for it, but at least I am able to do something.  A similar occasion arose at Suzanne’s (Marcus’ mother’s) house over the Christmas period when, as your readers may recall, you went (to use your own terminology) ‘batshit mad’.  Again, a combination of my verbal and physical restraining, combined with the very last vestiges of your rational personality, prevented your condition from becoming evident to the whole gathered clan.  Once more, the need for action on my part was there.  I’m fundamentally not saying I like this – I abhor it – but perhaps there is more of a sense of satisfaction in being able to do something, however minor, than in being able to do the square root of nothing (in the case of depression).  I don’t want these situations to develop – ever – but they have been a fact of life and I’ve had to deal with them, as you have.  They are tangible in a way that ‘mere’ sofa blackness is not, and they are very clear manifestations of medical conditions, demonstrably so in a way that our old friend depression is not.

Does that explain things a little?

The above account doesn’t paint me in a particularly sympathetic light, and I don’t want to suggest that I speak for anyone else living with a ‘mental’, but it is my tuppence worth, and I hope it is at least of some interest.

* A is completely blind in one eye, and has only partial sight in the other.

I think one more thing to note is that generally my psychoses and dissociation are stress-induced and transient.  Not always, but normally.  Depressions can linger for months, with no clear end ever in sight.  I don’t know if this has any impact on A’s view of things, but I can see how it might.

For all his self-confessed cynicism, A does have a wee bit of idealism and hope inside him still  (I don’t, like, but I suppose it’s useful that one half does..!)

Next interview with A next week, all being well.

Me me me. I have this, I experience that. Me. I. Yours truly. Myself.

But it’s not just about me…is it?

For some time I’ve been thinking about ‘interviewing’ A on his experiences of living with a woman with mental illness. It’s of interest to me both intellectually and as a girlfriend, and I hope that it might be of interest to you, my dear readers, too – particularly if you are in, or are hoping to be in, a relationship. So I give you the first in a series I am going to call Perspectives from the Mentalist’s Partner (PMP): how through his relationship with me, A has developed a greater understanding of what mental ill health really is.

—

Q:

Let’s start at the very beginning. You knew I had a mental illness before we even met [I was diagnosed with severe clinical depression at the age of 14, and corresponded with A for nearly a year before we met when I was 19], but that didn’t completely manifest at first. When it did, you will recall that you viewed that mentalism fairly unsympathetically, though your mind has clearly been changed, as over the course of this present breakdown, you have been extremely supportive.

So I suppose I’m wondering – do you remember when you first saw evidence of my mental health problems, and how did/do you feel about that incident or period? Can you explain your reasoning for your evident lack of sympathy at the time – and what was it that modified your opinion into what it is today?

A:

It took me a very long time to realise what mental illness actually is. Sure, I was peripherally aware of depression as an issue, and you made it clear that you had suffered from it*. However, I probably wouldn’t have perceived it as a ‘mental illness’. I associated the term ‘mental illness’ with, well, very extreme conditions involving padded cells and the like. A very stereotypical view, for which I apologise to readers of this blog; however, I simply didn’t think much about it as it had not really affected me or others I knew. Granted, I’d experienced what I considered ‘depression’ at the age of 15-16, and I therefore assumed that what you suffered was some variant of that. Not at all a pleasant phenomenon, but something that would nevertheless gradually recede, with time. (In my teenage years, I think my own experience of ‘depression’ was one of those ‘growing up’ type problems, though I never have been and never will be a cheerful or optimistic type). Anyway, I am digressing.

When we first met, you seemed far from depressed. In a recent post [this], you talked of the dichotomy between Pandora and the ‘other’ you, the everyday person whose name I shall not utter here. The person I met was essentially Pandora; sociable; intellectually agile; opinionated (in a good way); lively; challenging; interesting – a person with aspirations and apparent self-confidence. Of course, we all package ourselves in similar ways, or try to, in order to impress those we wish to impress, especially in the first flower of a relationship. Sure, there may have been a bit of that, but it was certainly more than that, and indeed that part of you continues to exist now. When others meet that part of you in person, they are extremely taken aback to learn that you suffer from ‘depression’ (to use the generic term that most of us who are not informed might use).

As we got to know one another better, and the first flush of spring faded (it always does, as I know you agree), I started to see your occasional black moods. However, as I’ve said, I have not been a stranger to such in the past. ‘Depression’ was something that I felt, with time, one could ‘get over’. That will undoubtedly seem insulting to some, but it was how I felt.

I was also very much opposed to attempts to control depression through medication, believing that the solution lay in rethinking one’s approach to life (somewhat DBT-ish, you might say). I’ve never taken many pills myself, although I’ve been fortunate in my health for the most part. You’ll recall that I was no fan of you taking medication, and eventually made the drastic error of persuading you to come off Prozac**. Bad mistake. I suppose it was at that stage, several years into our relationship, as you really began to spiral downward, that it began to dawn on me that this was not something that would go away easily, without some form of concrete assistance.

My realisation grew as time passed and a pattern started to emerge. You were unable to hold down a job. You’d start one, seem to enjoy it at first, but gradually find it more and more difficult to cope, lying awake at night worrying about what might go wrong the next day or week. Of course, you were not helped in that by some of the horrendous managers you have had the misfortune to work for; still, even somebody as insensitive as I began to notice A Problem. Nonetheless, on my more cynical days I wondered whether it was just that you needed to find ‘the right’ job, and that you needed to foster a greater sense of ambition and commitment to achieving this. I have always been somewhat driven in the work sphere, if not elsewhere in life, and I suppose I expect the same in others. So, yes, at times I still thought less about illness and more about ‘what I would do’. Obviously, I couldn’t possibly know what I would do, given that I don’t suffer from mental illness. However, I didn’t always think like that at the time.

Really, then, although my realisation was dawning, I believe that it’s only in the past two years that I have really started to grasp what mental illness is, and the extent to which you are afflicted by it. Gone now is my illusion that you simply had ‘depression’ that you would ‘get over’, or that you could will yourself to cultivate a greater personal drive.

Just as an aside, thinking about my prior attitudes, I have come to believe that ‘depression’ is a horribly overused term, as in popular usage at least it can signify anything from a bad few weeks to serious clinical illness. I am not saying that those who actually understand mental health issues talk of depression in this way, but the word has become seriously devalued by its more general societal usage, whereby it can connote practically any bad feeling a person may have for a sustained period***.

Anyway, I suppose my first lesson in the seriousness of your illness, which came long before the realisations mentioned above, came from your occasional black moods. I remember in particular one Sunday evening where you did not really wish to speak or interact. You exuded a aura of bleakness, and no matter what I tried to do or say, there appeared to be nothing I could do about it. It left me wondering things like, “What have I done? Is this my fault? How can I fix this? Why is Pan behaving like this?” I didn’t know how to handle it. Your illness seems to have changed, and your black moods are subtly different now. I’m not sure I have figured out how to deal with them, from my own point of view, but I certainly know more about what to do and what not to do than I once did.

I might add that much of the understanding I have gained of your illness has come from you. As you have educated yourself about the issues, you have educated me. In that respect, Confessions of a Serial Insomniac has been a tremendous help. You write cogent, coherent, insightful and moving accounts here that you are often unable, due to the difficulty of talking about these issues, to express to me or anyone in person. I started writing ‘real life’ there for ‘in person’, falling into the dangerous delusion that the written form is somehow less real. Far from it. In fact, it allows one to be more revealing in some ways. I suspect that the closest you come to being able to communicate as you do on here, in verbal form, is when you meet C.

Anyway, next question please…

* Through our 10 months’ email correspondence prior to meeting face to face, I had shared a lot with A, including the fact that I had depression and that I took Fluoxetine (Prozac) to treat it it.
** This was during my postgraduate course – I would have been 21 or 22. I was taking, I think, 60mg daily, and initially cut it down, before I stopped taking it altogether. It was partly because I’d been feeling fairly good and fell into the trap of thinking I was ‘better’, and it was partly due to A’s encouragement. It – in part, at least – led to my second biggest psychological collapse (after the present one) to date.
*** One thing that A hasn’t mentioned here is that he has in the past said that he felt that my receiving a proper, psychiatric diagnosis was of great benefit. As I recall (and I welcome his correction(s) if I am misreporting him), he felt that saying, “I have borderline personality disorder” as opposed to “I’m depressed,” allowed one brought up with the views he had formerly held to note the presence of a real, tangible medical condition, rather than expressing their ‘having a few bad days’ erroneously. I would point out that I feel, have always felt, and that A now feels, that depression is a ‘real, tangible medical condition’. However, we are dealing with stigmatic stereotypical societal views here (how alliterative), and I would agree that most people probably do misuse and, indeed, misunderstand the term.

—

Next interview with A to follow soon…

Dear Mr Director Person

Re: Accessing Mental Health Services

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

I note with interest your willingness to point out that NICE guidelines are not always applicable in this jurisdiction, and that a regional team is “considering” the application of the KUF. I also have taken note of the information that a plan is being “worked on” to develop services in this Trust and that a NI Strategy for PD apparently exists. I am cautiously encouraged by this information.

However, you will recall that in my letter of 11 March, I specifically requested details on what is being done at this time to adequately govern the treatment for the serious difficulties faced by people with mental health issues in Northern Ireland. I would hope that your lack of a response to this question was an oversight and, therefore, I look forward to hearing from you in this connection by return. I would ask that you also detail how the rights of such individuals are secured within the community mental health system.

In relation to my own case specifically, you may be aware that <NewVCB> considers that I am afflicted with (amongst several other conditions) a form of complex post-traumatic stress disorder. I would refer you to Trauma and Recovery by Judith Herman and The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization by Onno van der Hart (and a multitude of other literature) on this subject. As I am sure you are aware, these sources (and many others) quite definitively assert that whilst psychotherapy is a vehicle to recovery, the inadequate provision of same can lead to re-traumatisation of the patient to whom the therapy is provided. I would assume that an explanation of the potential dangers of such a scenario is not necessary.

Given your evident familiarity with my case and your contact with C, it will probably come as no surprise to you that I have become thoroughly re-traumatised as a result of recent work with him. This is, I acknowledge, often a necessary step in the therapeutic process. My dissatisfaction with the service provided by the Trust stems from the fact that the Trust is allotting me very little time, by way of further psychotherapy, to address this. In short, the Trust is effectively releasing from therapy a patient who, as a result of the therapy being cut short, is in poorer health than at the beginning of the therapeutic process. Is it the Trust’s intention to discourage healing and indeed bring about psychological damage to ill and traumatised individuals? I do not believe that it is possible for even the most gifted therapist to alleviate this trauma within a matter of weeks, and have today discussed this issue with C, a meeting wherein it was agreed that my precarious situation within the Trust is, to put it diplomatically, “less than ideal”.

The Trust may, of course, claim that it is not bringing my treatment to an end. It is, I note, proposing to refer me to a CPN or mental health social worker after my contact with C ceases. With the greatest of respect to such members of the CMHT, I feel that this is far from adequate.  Given my re-traumatisation, I would enquire as to how a CPN or SW could (on their own, at least) possibly be considered a better choice than a qualified psychologist as my primary contact within the system, particularly given that such individuals often practice the supposedly panaceatic techniques of CBT or DBT, which I have found to be extremely unhelpful and indeed counter-productive in the past. I am not entirely sure what other kind of work such individuals could help me with, and would appreciate your kind clarification on same.

If the Trust’s actions are being determined by concerns around costs and NHS targets, then I would at least appreciate an acknowledgement of this. If, alternatively, the Trust considers that my therapy should end as a result of perceived psychotherapeutic attachment or reliance, perhaps you could admit to that fact (though of course most research in the area agrees that these issues, if present, should be fully explored rather than ignored).  In short, please advise on exactly why my psychotherapy is being cut so profoundly short and why my case is being transferred to an as yet unknown individual who may lack the expertise to deal with the kind of conditions with which I am diagnosed and indeed with the severe re-traumatisation of the kind that I am now experiencing.

For the avoidance of doubt, whilst I am willing to try to engage with a CPN or SW, I would strongly prefer that my psychological therapy with C continues past the currently proposed end date (circa September; in terms of actual meetings, this contact amounts to one year). Furthermore, I would also request that said therapy continues for as long as is necessary, bearing in mind two important factors. Firstly, it took over 12 years to finally be assigned any type of useful therapy, despite my having been referred by my GP to a number of other mental health practitioners (who, for various reasons for which I am not responsible, failed to be of any assistance). Secondly, as discussed with both C and <NewVCB>, it is highly likely that in the event of my discharge now, I will, in future, merely be re-referred for psychological therapy, thus rendering pointless any supposed cost-saving efforts surrounding the current process.

I would like to emphasise that I have found the current psychotherapeutic process at least modestly useful, and believe that through further contact with C, it could continue to help me.

I am certainly well aware of the strain on resources a case like mine presents, but as stated in my original correspondence to you, I am aware of quite a number of individuals in other Trusts that (have) receive(d) psychological therapy for years, if that is or has been deemed necessary (and in my own case it is accepted that long-term treatment of this nature is what is considered the best course of action). As you may be aware, mental health care receives approximately 50% less of the health service budget in Northern Ireland than it does in other parts of the UK; nevertheless, I know individuals in other Northern Ireland Trusts that still receive(d) ongoing psychotherapy for the required time (of course, by the same token, I do appreciate that some Trusts in Britain exhibit failings in mental health care too). Do you think that this postcode lottery vis a vis treatment – not necessarily PD specific – is acceptable? If not, what does the Trust propose to do to counteract the deficiency?

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

Thank you for your time once again. It is appreciated.

Regards.

Yours sincerely etc.

Thoughts? I will detail this morning’s session with C when I have actually bothered to adequately detail the last one. As you may note from the above, I have decided to pursue therapy to the end (thanks for your advice on same), though I was completely honest with him for once and told him about my having considered cutting it short and about how re-traumatised I feel.

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

Dear Pandora

Re Accessing Mental Health Services

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

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

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

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

Yours sincerely

Mr Asshole Director-Person Cunt.

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

Anyhow, this is my proposed response.

Dear Mr Director-Person

Re: Accessing MH Services

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

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

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

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

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

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

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

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

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

Thank you for your time.

Regards

Pandora (Ms)

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

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

Thanks again lovelies.  x

Anyway, I may report on the holiday in due course, but for now I need your advice, my precious lovelies.  I’ve been thinking seriously since I last saw C – and before, for that matter – of just quitting therapy.   I will outline my reasons and the pros and cons of this, but whatever the case I would really value your advice or tales of your experiences of same.   Thanks so much to all of you on Twitter and Facebook that have already provided such counsel.

Basically, I feel that the whole situation with C is completely out of my control, and this is doing my head in.  I’m not exactly a control freak, but I know that if things are in my hands, then at least I am not in as vulnerable a position than I would be in the case where the power is firmly in the hands of others.  The therapy is ending in – what? –  seven or eight weeks anyway, so why not take control of things in one of the few ways I now can?  What are those few weeks going to actually even do, apart from fuck up my life even more?

I’m also at the stage where I believe firmly that therapy is thoroughly re-traumatising me.  I accept that a certain amount of this is inevitable – indeed, I’m sure, necessary – in trauma therapy, but the thing is in most cases the therapist continues working with the client at least until he or she has been able to overcome that re-traumatisation (or, in the worst case scenario, not be quite so hideously haunted by it).  This will not be the case with me, unless C can miraculously process all my traumatic memories – those of systematic, long-term child sexual abuse, abandonment/rejection, bullying and betrayal – in a few pathetic weeks.  He doesn’t even know about it all (not because I have deliberately withheld information, simply as some things have to take priority), so how can he?  Basically, I am completely re-traumatised and it is all but impossible that I am going to leave therapy in a different state.

Useful work is not even being done at this stage, in my view, because I’ve become terribly defensive again.  At least, I assume that it is defensiveness – it never feels exactly like that in session, it’s just that I can’t seem to talk about anything worthwhile anymore.  But of course I can rationalise that behaviour out of session: I know that I’m teetering on the precipice of being hurt with a pain unparalleled in years, so it makes sense for me to clam up in order that I can protect myself from being even more at C’s mercy than I already am.

So, pros and cons of ending therapy of my own accord.

Pros

• Regaining control of the situation.
• Earlier transition to a private (and hence more reliable) therapist, and an earlier start at interviewing those on the shortlist.
• Satisfaction of beating C at his own game.
• Reduction of further re-traumatisation.
• Reduction of further wastage of 50 minutes each week on both sides.

Cons

• The Trust will almost certainly interpret this as typical borderline behaviour and note further stigmatic bullshit all over my medical notes.
• The Trust will consider the fact that I quit therapy of my own volition in any future referrals and presumably respond with a giant ‘fuck off’.
• I might miss C and end up regretting finishing interaction with him before the last possible minute that I could have done.
• W claims that therapy seems to have been working of late, presumably owing to his objective and detailed reading of my material here.  It certainly was doing so, for a while, though I don’t really think it is at present.  But if it is, then I could be ‘blowing it’.

One thing I am going to do – to wind C and the Trust up if nothing else – is demand some material from them.  One, I want copies of the entire files that C and NewVCB hold on me.  They will be requested, respectively, tomorrow and at my psychiatric appointment next Wednesday.  Two, I intend to launch a Freedom of Information request into the minutiae of certain Trust expenditure, so as I can quote the Trust’s almost inevitable wastage in my ongoing dispute with Mr Director-Person (more on that cunt later today).

So.  In conclusion, I would really, really appreciate all your thoughts on this matter.  Any views of any persuasion are most welcome.  Should I quit therapy with C before he quits it for me, or should I ride it out to the end?

Thank you all.  x

Apparently, in the case of the Multidimensional Inventory of Dissociation, C had emailed the author of the questionnaire – Paul Dell – for a detailed manual of scoring and wanted to fully investigate that. Apparently Dell had then offered an alternative scenario; he would be willing to score my results himself, subject to my taking some further questionnaires and allowing my results to be published in future research.

“It’ll be entirely anonymised and subsumed into more widespread results,” C pointed out reassuringly, “and it’s totally up to you if that’s something that you’d like to do.”

I confirmed that I would be more than happy to participate – “subject, however, to my seeing the resultant study.”

“Of course,” C nodded. I told him, therefore, to go ahead and tell Paul Dell that I would do it.

He proceeded to remind me that this was my last session prior to a two week gap, as I am going to Turkey (again) tomorrow night. I said to C that in actuality I could have attended the session as the flight was much later than I understood, but that since I had already told him I wasn’t coming that it didn’t matter.

“The appointment’s there,” C replied. “I keep the Thursday mornings for you, I’ve got no one else coming in.”

Result! I can maintain my illusion of being his only patient for another few weeks.

Or can I..? I confirmed that, if he was willing, I would in fact take tomorrow’s appointment after all, and he reached out for his diary to write me in. And…and…I saw something vile and horrible and despicable. I saw writing, writing that denoted a meeting of some sorts, scribbled in C’s dreadful handwriting for about midday.

Fuck fuck fuck fuck. No no no no no no.  That is not allowed.  But wait, it’s OK. It was just an appointment with a colleague, or perhaps it was group therapy. He’s allowed to conduct group therapy, just not individual therapy with others. So it was something like that. It was not another individual client.  No.  No!

The next week’s meeting agreed, he asked me where I wanted to start. I shrugged and commenced the usual silence that I seem to be so stunningly good at. I said to him, “and here begins the customary dance of idiotic silence.”

He smiled, and went to say something, but it was the day of the General Election here, so something compelled me to talk to him about that.  I told him that I was excited and agitated in equal measure.

C asked me if I was going to vote.

“Of course,” I replied, aghast that he could harbour the smallest doubt that I would do so.   Without thinking, I added, “are you?”

This made him laugh quite a lot, presumably as I am not meant to ask questions about his private life.  Nevertheless, I refused to take my eyes off him until he answered.

He stopped laughing and eventually said, “yes, I am actually.”

“Good,” I responded. “I was about to lecture you if you’d said ‘no’, and I don’t care how much it is not my place [he laughs, perhaps in a slightly bemused fashion]. It is an abdication of adult responsibility not to vote, so I am very glad to hear that you are going to do so.”

A brief discussion followed during which we discussed which coverage would be better for the sit-up-all-night-election-party that A and I were holding just for the two of us.  I said that we would, in all probability, watch the BBC – Sky newsreaders are cunts, and ITV is sensationalist, tabloid bollocks. C suggested that I try Channel 4 who were running a sardonic alternative to the usual coverage, with people such as Charlie Brooker.

It was odd to have something vaguely approaching a normal conversation with C. It is not the first time that it’s happened, but it’s always strangely pleasing when it does. I have this mentality, presumably some sort of attachment-related coping mechanism, that he only exists for the time that I am with him each week, and in a sense hearing or learning that he has ordinary, outside knowledge reminds me that this is not the case.  Well, of course I know that it’s not the case – but I also don’t know it at the same time, if you know what I mean.  It’s good to think of him as a real person, but that understanding inevitably comes with certain caveats: he’s allowed to exist outside my therapy as long as he has similar interests to me, is single, not a father, is fixated with psychology and his job, not treating anyone else, and not particularly popular.

Hmmm.  Not a lot to ask there or anything.

The ‘normal’ conversation continued with me bragging about my blog having been online for a year, and he asked me if I celebrated.  I admitted to having blown some money on a new laptop, concluding that evidently, yes, I had celebrated.  I went on to tell him, in relation to this and the previous topic of conversation, that I had just finished writing a series of posts on the mental health pledges of the Northern Ireland political parties.

“They ranged from very encouraging to totally abysmal,” I told him, which prompted him to request details.

I told him that the best policy was from the Alliance Party, and I have to admit that there was an underlying motive involved in this line of discussion.  A reading of the Alliance’s (and some of the others) manifestos on mental health makes clear that sustained and long-term psychotherapy is considered a crucial element of treatment for most serious mental illnesses. That does not, self-evidently, tally with C’s decision to end the therapy in nine weeks’ time.  I wanted to try and make the point, but subtly (as of course when we fixate on that topic it wastes time that should be devoted to other issues).  In the end, though, I don’t think the point really came across – or if it did, he didn’t comment in any meaningful fashion.

Onward. At this point I told him that bringing the topic of politics to a therapy session was an utterly preposterous pursuit. The horrible, infuriating silence followed, and unsurprisingly I was shortly laying into myself for being a time-wasting tosspot.

I asked why he had told me the previous week that the silences or, more accurately, my self-critical reactions to them, were insightful for him.

“You already know that I start into an endless barrage of self-castigation at these points.  Why do you need to see further examples of it?”

“It’s about how we resolve that together,” he replied.  “It may seem useless to you, but I think work is being done during these periods.”

There was a pause, and then he continued, by saying, “I think part of your frustrations are related to the fact that our time together is finite [no no no no no, denial denial denial denial denial], but I think it’s more than that.  It’s a deeply instilled issue of self-blame and self-disgust.”

This inescapably led on to a roundabout discussion of the child abuse issues, given that one of my biggest examples of self-blame and hatred is that.  There was a lot of stuff in my head about it that I wanted somehow to convey to him, but I knew that it was almost impossible that I would do it verbally. I tried to project it to him psychically, but that was, of course, a thoroughly pointless endeavour.  C may be one of the most insightful men I’ve ever met, but he is not a mind-reader.

I kept fidgeting with my hair, my ring, my scabs and scars.  He commented that I was obviously in a dilemma.

He said, “I can see you’re scared, and being scared is OK.  You have to allow yourself to experience that kind of feeling in a safe environment.

“Furthermore,” he continued, “I know one of your concerns about all this stuff is your belief that you’re some sort of ‘whore’; I know you worry about what I’ll think of you.”

I wanted to avoid questioning along those lines, as it would probably have led to a discussion as to why I give a toss about what he thinks of me.  Fuck you, attachment – fuck you so very, very much. We’ll leave you until another time.

Instead, I said, “I don’t feel this particularly, but intellectually it seems to me if I don’t voice stuff to you in this regard then I can pretend that it is not real.”

He agreed and said that doing so would bring up strange and frightening emotions – shame, disgust, sadness, fear etc – and said that he thought that I was terrified of experiencing these kinds of feelings. “Obviously you don’t want those emotions to be real, just as you don’t want what happened to you to be real,” he added.

We briefly talked about how writing about stuff here was considerably easier than even attempting to talk about it, which culminated in my haughty query, “how does talking about it make any bloody difference anyway?!  How can that actually help to make me feel better?”

He saw this as some sort of critique of the effectiveness of therapy, and asked me if I thought that the process had helped. I thought about it, and concluded that it had – in subtle ways.

“But nevertheless,” I pressed, “doesn’t it seem bizarre that just talking about something changes brain chemistry and neural pathways and make you feel better? I read somewhere recently that therapy does induce such brain changes.  But how?”

Out came the whiteboard for some visual depiction of what he felt the process was:

The auditory accompaniment to this was that in simple PTSD the trauma memories are outside the autobiographical memories of the sufferer, and present themselves in normal consciousness, therefore, as intrusive, distressing flashbacks. In the case of complex or repetitive trauma, all this is still the case - but the flashbacked, unconscious memories present in a particularly difficult fashion, and strong dissociative and sometimes psychotic symptoms can enter the consciousness also.  Therapy seeks to reintegrate the unconscious, repressed trauma memories and one’s normal, autobiographical ones. This means that, although the memories will still inevitably be painful, they will not be experienced in the same horribly flashback-y, uncontrollably stressful ways.  In doing so, C assumes, this helps correct broken neural pathways – though I have to bear in mind that he is “not an expert in neurobiology,” apparently.

“Successful reintegration is possible,” he assured me.

I was aware that I had seduced him once more into an intellectual dialogue, but I felt captivated by the material on the whiteboard in a different kind of way too, and felt that it was relevant to our discussion.  It (and he) was postulating something that to me seemed utterly inconceivable and impossible.

I just stared at the thing.  It is possible to experience this stuff as part of your normal life timeline?  That’s ridiculous.  It cannot be.

For some reason I was overcome with sadness and regret.  What he was proposing – reintegration of the traumatised self along with the ‘everyday’ me – was too massive to contemplate.  I started battering myself around the head (literally) to cope with the hideous enormity of it all.

He said he could see that I had been really sad, and that I was playing my usual game of trying to avoid experiencing that.

“You had to suppress emotions when you were a child just to survive,” he said gently.  “When you tried to express to others what was going on – your mother, for example – you effectively had it thrown back in your face, and had to suppress those emotions too, again just to survive.  This is a defence mechanism that you’ve always known, always had to use, but it is safe here to show that pain.  Suppressing it then was a necessity, but doing so now leads to all sorts of problems.  So experiencing it now is also a necessity.”

After a brief pause designed to let me take this information in, he continued and referred back to our regular discussions on schemas in BPD. “The healthy adult tries to protect the abused child by suppressing this,” he said.  “It’s always been the way she has handled it, but it’s no longer effective.”

Eventually I told him that experiencing and expressing emotions was the ultimate sign of weakness in a human being.

“Again,” he responded, “maybe then – for reasons of survival – it was ‘weak’ to feel emotions or to show them.  You were effectively alone, after all.  But I would reiterate that that was then – you need to feel this now.”

There was a silence during which I fought to control myself, my head bowed, my lips quivering.  The timing of this was horribly unfortunate; he cleared his throat guiltily and said, “we’re going to have to leave it there for today, Pandora.”

I gave in and allowed myself some tears.  “I can’t leave in this state, I’m sorry,” I whimpered.

He was so nice.  “It’s OK,” he said in that sweet, gentle tone that he employs in these situations.  “There’s no rush.” [EPIC WIN!!!]

Indicating the whiteboard, I said, “it’s too much. I can’t even begin to conceive of what you’re talking about. I don’t have a frame of reference before this, I don’t know how to do it, I don’t know what it’s like.”

“Of course you don’t,” he affirmed. “It’s all you’ve ever known.”

For some reason this made me even sadder. There’s something overwhelmingly tragic about your life being ruined at an age so young that you haven’t even had the chance to experience ‘normal’ formative memories.

C said a little bit more about experiencing and expressing emotions, but to be honest I can’t remember the minutiae of his soliloquy.  Eventually I once again castigated myself for showing weakness in his presence.

He reiterated once more that he felt that it was not weakness.

“Do you want a tissue?” he asked.

“No!” I spat defiantly.  Then, sheepishly, “yes.”

He chuckled lightly and pushed the box towards me.

“Did you tell me last week that you’re going to a Metallica concert on Tuesday [11 May, yesterday]?” he questioned.

I responded in the affirmative.

“OK,” he said, “if you see me there, don’t worry – I’m not a hallucination [wry, but comforting, smile].”

I had wondered if he was attending; I know he has an interest in decent music. “You’re going then?” I checked, rather pointlessly.

“Yes.”

“Are you standing?”

“Yes.”

“Me too. Very good.”

Very good. Hahaha. Mistress of the Understatement, me. What I really meant was that there was joy joy deep in my heart.

By this point I had mostly recovered myself, so I said, “well, I suppose I’ll see you under the next government then.”

“Yes,” he replied, “and we’ll have seen Metallica!” I detected slight enthusiasm.

“I hope you enjoy it,” I said.

“You too,” he replied, as he opened the door for me. “Take care of yourself.”

And so it ended for another week, with a pathetic nine sessions – including tomorrow morning’s – remaining.

In the end I didn’t see him at the concert, but it was a strange feeling to know that I could have done. Part of me was hugely excited by seeing him in a vaguely normal social situation, yet part of me was horrified and terrified.  I mean, he doesn’t exist outside therapy.  He just doesn’t.

I had tried to organise an appointment with Lovely GP this week, but due to the holiday, C and the anticipated hangover from the gig, I didn’t get a chance. Instead, I persuaded my mother to go in my place and either request Diazepam for me, or pretend she needed it herself. As it happens, my mother has a rather worrying…um…thing? sore? Gash?…on her ear, so she wanted to see LGP about this anyway. So she went this morning.

Regarding her ear, it is with considerable uneasiness that I have to report that LGP was worried.  He’s given her antibiotic cream, but has instructed her to be back with him in exactly two weeks, at which point – if the thing has not cleared up – LGP intends to refer her to a specialist.  My mother and I have been feigning nonchalance around each other all day, but the ‘c’ word floats palpably in the air despite it. My only comfort is that, with LGP, she will be in good hands.

I almost feel guilty writing about the appointment’s direct effects on me, but hey. Without question, LGP wrote a script for me for Diazepam and apparently went on to compliment me as “incredibly articulate”.  He asked how I was in general, and my mother opined that she felt that perhaps things were slightly better, but that she was worried and extremely disappointed that C was cutting the therapy short.

LGP asked if she (and I) felt that the process was or had been helpful, and she said that we both did.

“In that case,” he said, “I’ll make a few phone calls.”

He did go on to warn that he could make no guarantees, and that sometimes therapists concern themselves about a client being too reliant on them and thus try to make the client cope on their own.  I really do get that, but surely they should first explore that reliance?  Anyhow, LGP said that if we felt the psychotherapy had been useful then he would do his best to make a difference.  I’ve put on an appointment to see him myself when I get back from Turkey, because I want to make it clear that this is a critical time with C.  I am prepared to tell him about the sexual abuse – he is so delightfully kind and gentle that I trust him with that information implicitly.  C can’t tell him, of course, as that would breach confidence – but…hang on.  Since C doesn’t work at the hospital on Wednesdays, LGP won’t have been able to speak to him yet.  I can tell C in the morning that he is welcome to share any and all details with LGP.

LGP was fantastic last year when Psychiatry were being complete tossers, so one never knows. I’m trying not to get my hopes raised here, but I have to cling on to something, because the idea that I will have to face the world alone within a few months is too terrible to contemplate.

Anyway, it’s the eve of the election and I’m simultaneously excited and anxious. I’m excited because I’m a total politics nerd, and I always get a thrill out of exercising my democratic right to vote. I’m anxious because I am worried that Gordon Brown will end up back in 10 Downing Street; I pathologically detest the man. I hate Cameron too, mind you, but nowhere near as much as Brown. Like so many people, I now am a fervent supporter of a Liberal Democrat win. I don’t think we’ll get it – not this election – but fingers crossed for the future.

Anyway, it’s kind of moot because I can’t vote for any of those three parties (unless you count the strange alliance between the Tories and the Ulster Unionists). We’ve already looked at both the Unionist and Nationalist parties…but are there any other options, and if so, what do they offer to the Mental Vote?

Well, the answer is that there are other options: here we are with the ‘Others’, the parties often forgotten in coverage of Northern Irish politics. Two of them – the Alliance and the Green Party – are not along the normal Northern Irish sectarian lines. The third – The Traditional Unionist Voice – clearly is. Of course, there are a number of other smaller parties in existence in our wee country; however, mostly they are not running in this general election. Some are – mostly independents – and you can see their details here. However, I am not exploring their positions on mental health provisions, for the simple reason that they are unlikely to have any, being mainly one person parties. Even if they do have something to say on the subject, their chances of election are minimal*, and even if they were elected, as single candidates in Westminster they would need to vote with bigger parties to have any influence whatsoever.

(* With the possible exception of Sylvia Hermon, as she is also the outgoing MP for South Down and has been considered fairly popular in her constituency).

So we’re left with the Alliance, the Greens and the TUV. what if anything do they have to say on mental health services provision?

The Alliance Party and Mental Health Service Provision

Ideologically, the Alliance Party are my preferred party, as they were the first Northern Ireland-specific party to embrace cross-community unity, rather than organising themselves along the usual tribal lines. It turns out, too, that there’s a lot to be grateful about in terms of their mental health policies.

Navigate your way over to here, a page on the Alliance’s website. An entire policy on mental health issues, rivalled only in my investigations by the DUP’s (which was shockingly comprehensive, and about which I wrote the other day).

Unfortunately the page presents some alarming statistics; apparently, there are 20% more mentally ill individuals in Northern Ireland than in the rest of the United Kingdom (which tallies with other material I’ve read attributing this greater incidence to Troubles-related PTSD and depression), yet simultaneously we are the least resourced region to tackle this group of health conditions. Well, what a surprise.

The Alliance Party propose to tackle this sorry state of affairs in the following ways:

• [by] tackling segregation – addressing the exclusion of those with mental health and mental health issues;
• [by] re-balancing the economy – addressing the costs to businesses and the loss of GDP that arises from mental health and learning disability, and allowing people to develop to their full potential; and
• [by] providing of sustainable public services – delivery of a modern system of properly funded services.

All sounds grand to me. Of course, the difficulty with this is that it means fiscal resources will have to be allocated to mental health service provision instead of other areas of importance. I’m only speaking for myself here, but I would genuinely be happy to be more highly taxed/National Insurance-d if psychological and psychiatric resources were improved and developed. Furthermore, if some capital has to be removed from other (non-urgent) areas of the health service to accommodate the Alliance’s proposals, then I could quite easily live with that too. I admit that I am seriously biased here, but don’t forget the old statistic that at least one in four people will be directly affected by mental or emotional illness at some point in their lives. Some lobbyists are arguing now that the figure is one in three. The Alliance also point out that:

Over 19% of the total burden of disease in Western European Countries is attributable to mental illness compared to 17% for cardiovascular disease and 16% for cancer (WHO 2004)

It is sobering to know that mental illness affects more people than the openly-discussed ailments of heart disease and cancer in Western Europe – yet how often have you seen it mentioned in the media, at least without Sun-style sensationalism of ‘Schizo Freak Murders Fluffy Kitten!!!1!1!!!!eleven!!!’?

Moving on from what could easily become a rant, the Alliance Party at least do move on to tackle the fundamental issue of funding. One of the primary failing of political pledges, in my view, is that there is endless rhetorical sentiments expressed, without any substantive explanations of how the pledges can be achieved. At least here we have an awareness that achieving what is desirable will not an automatic development; it’s something that requires compromise and hard bloody work.

The party then move on to discuss what they term ‘Key Issues and Principles’, which (conveniently, a cynic might say) are right in line with the perennial Bamford Review.

The lines that interested me most was these ones: ‘Services should be needs-led‘ and ‘[we need] increased access [to] psychological therapies‘. Sounds obvious, doesn’t it? Yet as my own case underlines, that’s not the way it is in the current NHS in this region (and in the country in general in many cases), oh no. Access to psychological therapy and services in general are resources-led:

Therapist: I’m dealing with a really mental bird at the minute, she has about 403 different diagnoses and she needs long-term psychotherapy.

Manager: Throw a few weeks more at her, then kick her out, we can’t afford her.

Therapist: But what if she’s not better?

Manager: Oh my poor dear man, you’re new here, aren’t you? That’s not how it works!

The above was, of course, an entirely hypothetical scenario. *whistles innocently*

The Alliance also draw attention to the need to tackle stigma head on, and in a particularly commendable move address the issue of greater focus on the needs of carers for the mentally ill. They are the only party that have also pointed out that the recommendations of Bamford are not always fully transparent and, indeed, fully achievable.

Finally, they point out that the current situation regarding the Mental Health Act in Northern Ireland. Apparently, two major revisions were due to this legislation as it applies here in both 2011 and again in 2014. Sound fucking stupid to have two modifications? Well, the Alliance concur. In a demonstration of the fact that they can make a difference in this policy area, after their lobbying of Michael McGimpsey, the Health Minister, it has been agreed that – in principle at least – one modification will incorporate all the proposed statutory changes.

Result.

The Northern Ireland Green Party and Mental Health Service Provision

I’ve been wittering on in this series of posts about how we in Northern Ireland are not afforded the right to vote for the ‘mainland’ parties, but I suppose this kind of contradicts that a little. The Green Party are, of course, a national force – national in both the sense of the UK and Ireland.

Their widespread nature means that someone, somewhere, will inevitably have had to bring up the issue of mental health. In Northern Ireland, it seems primarily to be student Karly Green. Ms Green is heavily involved in developing a cross-party youth initiative on mental health, and that’s not to mention her considerable involvement in lobbying current politicians for better care for mental illness in our wee country.

(An aside – Ms Green’s hard work makes me wish I’d taken a more active role in politics at university. I was involved heavily in student politics – the running and management of the Students’ Union – but never in actual, meaningful party politics. I feel like I wasted my youth when I could have been out there making a fucking difference).

To get more details on the Greens’ position on this matter, however, we need to look at their policy South of the border. This has, quite obviously, questionable relevance to a Westminster election, but their UK health policy is surprisingly and disappointingly silent on the issue of mental illness.

As with the Alliance, the Greens argue that mental health is an area that is ‘greatly neglected,’ and interestingly, they’re the only party of the lot that I’ve looked at that has made more than a passing reference to preventative medicine and its relation to mental illness, which is to be applauded.

Of course, with this document focusing so heavily on the Republic, the contents are not always 100% applicable to those of us in the North; for example, they discuss how many patents with mental health difficulties are seen only under their GP. This is actually true up here too – the CMHTs generally only manage more serious cases – but in the Republic, the whole system is different, meaning that some people do not even have the primary care of a GP (something that is rarely true in Northern Ireland). Clearly this is an appalling state of affairs, and I would hope that the main parties down South are looking at this deficit too.

One point that applies to this jurisdiction is that they want to emphasis the need for psychological treatments, rather than an over-reliance on drugs. Remember this moment, readers, because it is possibly the only time you will see the Green Party agree with the DUP (see somewhere or other in the Unionist post).

Alarmingly, the Greens point out in this policy that apparently Irish mental health spending is less than half what it was 20 years ago. I suppose the rationale was along the usual lines that people were severely traumatised by the violence of the Troubles (any flippancy is to do with the fact that the Troubles existed at all; I don’t for a second see how anyone could not be traumatised by so much of what happened). Whatever the case, the fact that this party want to see at least 12% of the health budget devoted to this area is a worthwhile aim.

I particularly like their pledge to offer more post-graduate positions for the training of clinical psychologists. It rather seems to me that we could do with some of that up here too.

A few of the parties I’ve looked at in the course of this series have alluded very briefly to the human rights of the mentally ill (the UUP were the main ones that I mentioned, if memory serves me correctly). The Greens, however, have their own page as part of their general mental health policy devoted to this. Although their point is indeed commendable, unfortunately they miss the opportunity to fully address what could and should actually be done about the difficulties faced by many individuals on involuntary detentions. At least the UUP had the clear viewpoint that they would support amendment to legislation that shifted the legal onus on hospital release from the patient to their assessing tribunal.

In essence, in the area of mental health provision, the Green Party want to see greater staffing, greater funding and greater community, non-institutional care. I don’t think any of us would agree with these fundamental aims, but the approach sadly feels a little lacking in substance and discussion in how these aims could be achieved.

The Traditional Unionist Voice and Mental Health Service Provision

Hahahahahahahaha. I’m not even going to waste the energy it takes to type anything vaguely related to this non-entity of a vicious, nasty little scumfuck of a so-called political party. Well, except this rant of course. Just read their manifestoss (no spelling error). Nothing on mental health, scant on health in general, scant on education except their hate-filled bile, scant on sanity. I guess I’ll see Jim Allister in the bin.

Conclusion – Alliance, Greens or TUV

I don’t think you’ll be stunned to hear that the TUV are very instantly ruled out, and indeed it wouldn’t be a huge leap of faith for you to think I’m siding with Alliance as the victorious party amongst the so-called ‘Others’. The aims of the Green Party are certainly admirable, but they fail to fully articulate how they hope to achieve them, and cannot exemplify any occasions in which they’ve made a difference in this arena in the past. Furthermore, there is very little information on their exact position in this specific region.

The Alliance Party, on the other hand, have set out a number of very clear mental health objectives, and fully recognise the challenges of achieving these – yet they can articulate with some authority how they would achieve them. They can even cite an example of when their lobbying of a minister has previously made a difference to mental health issues.

I was not surprised to find that they had a mental health policy, but I was most gratified by its comprehensiveness and the fact that their aims are not all pie-in-the-sky-ness, but real, obtainable goals.

OVERALL CONCLUSION

So, here we find ourselves at 11pm on the eve of the election, having investigated the policies on mental health of the main UK parties, the NI Unionists, the NI Nationalists and, finally, this, the NI nebulously-named ‘Others’. Who’s getting my vote?

It’s important to note that I am not, nor should I be, a single issue voter. I have a view on the economy, on Iraq, on crime, education, etc etc etc.

Most of all I have a view on the tribalism that Northern Irish politics has traditionally presented. To that end, I have almost always supported the Alliance Party, and my enthusiasm about their mental health manifesto above was surely palpable. I was undecided as to whether to vote tactically tomorrow but this has been the final deciding factor: the Alliance Party will, once more, get my vote tomorrow. They won’t win, but I aim to be a conscience voter, and the things that they strive for (not just in terms of mental health) are things that, for the most part, I want.

In terms of this series of posts, I still think Alliance have trumped the other parties, but the mental health policies of Sinn Fein and the DUP were actually surprisingly impressive, even if I don’t trust either of those parties as far as I spit out my own shite. I was very disappointed by the UUP and the SDLP, parties that I otherwise don’t mind. It was hard work finding anything on the UUP at all, and whilst the SDLP had a little more substance, ultimately they seemed to be trying to echo points already laid out by SF.

It’s time mental health was an issue taken seriously by all political parties; just like I did at the bottom of the first post, I would again urge you to sign Rethink’s petition for the next government.

In conclusion – please, whatever you do, don’t be apathetic tomorrow. In some ways it doesn’t matter who you vote for, as long as you give enough of a shit to go out and put one ‘x’ on one bit of paper. This is a democracy. We have the right to vote here. Not everyone has that right, so please exercise yours.

Happy voting, darling readers.

My first piece of writing here was the ‘About‘ page, which still retains the same basic structure as it did on 4 May 2009, but has been modified in terms of content as circumstances have changed. My first actual post was written on 5 May, and can be found here (it’s also since become the subject of another page, as I thought it gave a lot of useful contextual information).

Confessions began life at serialinsomniac.wordpress.com. I moved to the self-hosted domain of www.serialinsomniac.com in January this year, as I wanted more control over the aesthetics of the blog. I still have a redirect from the old WP hosted blog, which will run until January 2011.

SIGNIFICANT EVENTS AND POSTS

A lot has happened in these 12 months.

2009

I started self-harming again in May (though I’ve been ‘clean’ since January this year) and was subsequently diagnosed with BPD and bipolar disorder in June (at which point my medication was changed from Citalopram to Venlafaxine). I started hearing a (benign) voice in September, whilst in October the hallucinations became malicious, in the form of ‘They’. It was also in October that I lost my job, owing to my lengthy mental illness-related absence. I completely lost my sanity over Christmas, leaving me in not quite the best frame of mind in which to see the new year. The problems were mainly related to being forced into seeing Paedo, but C’s revelations that he would be offering a curtailed number of sessions in 2010 didn’t help either.

2010

In January, I bit the bullet and did something that I’d been intent on doing for about two years – I changed my (sur)name, thus dissociating myself entirely from my aunt and uncle, Georgie and Merv, not to mention my deceased father V. The new year also saw me receive my first blog award, from the wonderful Mental Nurse, who have also been kind enough to feature me in their weekly round-up of mental health blogging (TWIM) a number of times. Despite these positive developments, I spent the entire month in a depression of epic proportions, and I tried to kill myself in the early hours of the 16th. However, shortly after that, I was allocated a new psychiatrist (Dr M, mostly known as NewVCB) who prescribed the anti-psychotic Quetiapine (brand name Seroquel) on top of Venlafaxine to curb the voices and hallucinations, and also to act as a mood stabiliser. It has really been a force for good in my life. NewVCB later agreed with my self-diagnosis of complex post-traumatic stress disorder, so I was able to add that to my arsenal of diagnoses. The C-PTSD was mostly in relation to the sexual abuse I went through as a child, the full memories of which came back to me through discussion in therapy, the extent of which I finally admitted to C some weeks later. It is an ongoing psychotherapeutic topic.

A year on from commencement of writing, the importance that this blog now has in my life was underlined by an incident in which it initially looked like my family had found my online home (which would have been a huge disaster for all concerned). I now do not think they have, but my conclusion whatever the case is that I will not be silenced.

ACKNOWLEDGEMENTS

As you might expect, there are far too many to list. I would like to thank all that read here, and in particular those of you that leave comments – your interest and support make this project worthwhile (though of course I still maintain the journal primarily for my own benefit). There are a few people that I have to single out though.

Obviously A has been a source of immeasurable support and I’m fairly convinced I’d have done myself in were it not for him throughout the past year. There are no words great enough to convey my appreciation of his unwavering tolerance and care – I can only say that he is treasured and loved very much. CVM, K and Annie (internet friends that I have met or will meet) and my close friends Aaron, Daniel and Brian also deserve my gratitude.

In terms of my online friends, I owe particular thanks to Alix, Splintered Ones, Tiger, Lola, Kim, Wounded Genius, The Same Sky, Bippidee and Phil. I’d like to especially single out bourach, as it was her blog that inspired me to start this one. Thanks also to the aforementioned Mental Nurse for featuring my blather in TWIM from time to time, and for yesterday devoting a whole post (albeit a short one) to my crap

SOME STATISTICS AND TRIVIA

At the time of this writing Confessions has had 48,213 hits. The counter is only updated twice a day, so if you see any disparities (eg. the counter not updating despite you visiting several times), then that is probably why.

The overall most read post is ‘Suicide Attempt Epic Fail‘, which has presently been read 402 times. At the old URL, the most read post was ‘Signs of Childhood Sexual Abuse‘, which is still the second most read overall post with 332 hits. In both incarnations, ‘About the Author‘ has been the most popular static page, with a total hit count of 771.

The post most frequently reached through Google searches is ‘BPD vs C-PTSD‘, which with 329 hits is currently just short of being the second most read post overall.

The longest post, with over 8,000 words, is ‘A (Half-)Life in Therapy‘.

The busiest day on the blog to date was Friday 16 April 2010, when there were 614 visits. The quietest days were, unsurprisingly, last May when the blog was shiny-new. Since then my quietest period was about a week in April 2010 when the aforementioned worries about my family possibly reading the site surfaced. This was due to my efforts to hide the blog from their eyes, but of course had the knock-on effect of preventing others from reading too.

The busiest month so far was March 2010, when Confessions received a total of 10,529 hits. The quietest month was, unsurprisingly, way back in the beginning in May 2009 when there were 824 visits. Interesting point of comparison: this May is only just into its fourth day, and the hit count for it is 1,082 – half as much again in four days than were received in the whole month of May last year.

On the other hand, May 2009 was (ostensibly) my most prolific month of writing, as 23 posts were published during that period. I say ‘ostensibly’ as, as my writing here has developed, my verbosity has similarly developed and increased notably, so in reality even though I may have been writing less posts in other months, I was probably writing more words. The month with the least posts published was August 2009, where I only wrote a total of seven.

The sites that send me the most traffic are BlogSurfer, StumbleUpon and, of course, Twitter. The actual blog that refers folks here most frequently is Bippidee‘s

The most commented-on post was, perhaps slightly ironically, a password-protected post: ‘Things I Know That I Should Not Know‘ has 47 comments.

The most common search terms are variations on the blog’s title, ‘confessions of a serial insomniac‘. ‘C-PTSD‘ (and variants thereof) is currently the second most popular, with ‘i hate my therapist‘ (presumably for this), ‘letter to my therapist‘ (this) and ‘Julian Hendy‘ (this) also featuring prominently.

Some of my favourite search terms are ‘hallucinating gnomes‘ (referencing this), ‘dr bellend‘ (this), ‘dbt is patronising‘ (too many possible posts to list), ‘fuck you therapist i hate our relationship‘ (this again, I assume) and ‘arsecunt‘ (apparently this, which was otherwise fairly innocuous!). There are also a variety of searches ranging from fairly dull to outright weird that incorporate variations on the word ‘wank’ (because of this).

Including this, there are a total of 154 published posts. Including track- and pingbacks, there are 1,572 comments.

A POINTLESS YOUTUBE VIDEO TO PROVE THAT I CAN EMBED THE DAMN THINGS…AND MEH

The following song quite adequately sums up how my life has been in the year chronicled on this blog (and well before it at that)…

Click here to view the embedded video.

…not especially cheerful, I know. It hasn’t been an especially cheerful year. But still, something positive has come out of it; Confessions of a Serial Insomniac is my pride and joy. It might not be the best written blog, nor the most popular, nor useful nor helpful nor politically cor-bloody-rect in any way. But it’s mine – all mine – and I love it, follies and all.

There is a certain curiosity in the potential influence of both of these parties. SF, perhaps unsurprisingly, may take a certain amount of interest in the politics of the Irish Republic, discussed mainly in its Parliament, the Dáil. In that regard, their policies might not necessarily fit a similar pattern to those of the other Northern Ireland parties, which are more likely to be influenced by their colleagues in Westminster. More surprising is the fact that, despite their status as supporters of a United Ireland, it’s quite possible that the SDLP are influenced similarly to the Unionist parties. They are, in fact, Northern Ireland pseudo-surrogates of the UK Labour party.

There has often been arguments from many voters here, me included, that because we don’t have any of the three main UK parties (or, indeed, Dáil parties) that our voice is not heard in Westminster (or Dublin). The Labour party try to get around this by citing their loose association with the SDLP – but, at least as far as many unionists perhaps unfairly see it, the SDLP only represent the nationalist side of the community, and therefore are not a party that can convey their needs and views. Of course, the Ulster Unionist Party are now allied with the UK Conservatives – but the SDLP shoe still fits, simply in a different way; not many nationalists see the UUP as a party that can represent them. The Liberal Democrats briefly mooted the possibility of setting up their own branch here, but to the best of my knowledge, that never came to proper fruition.

To that frustrating end, it might seem favourable that the SDLP have some alliance in London; the problem often is, however, that they seem to take the Labour whip without due regard for their actual constituents (to be fair, this is a problem in many, if not all, seats). I’d always thought of them as a good constituency party until last week when I watched the Northern Ireland party leaders’ debate, and Margaret Ritchie of the SDLP admitted that her MPs voted with the Labour party more often than not.

Still, they take their seats, unlike SF. To be fair, the SF rationale is that – as Irish Republicans – they do not wish to swear allegiance to the UK monarch. I really do understand that issue of principle, but the difficulty is that it complicates the party’s ability to lobby the Westminster executive. SF contend that Westminster is becoming decreasingly relevant to Northern Ireland, what with our devolved government at Stormont. In some ways that is true, as we decide on the allocation of fiscal resources. On the other hand, the overall source of those fiscal resources is, ultimately, still London.

So, how would each of these two parties allocate this capital? Will they consider mntal health provision as a priority?

Sinn Fein (SF) and Mental Health Service Provision

My first reaction to what I see of SF’s mental health policies is one of encouragement. I suppose one should expect reasonable discussion on matters like these from a party that is, broadly speaking, socialist in nature, but it’s still nice to see it in black and white.

The first article of interest to me was this one from the West Tyrone branch of the party. Here SF discuss the provisions – or, maybe more accurately, the lack thereof – for forensic patients.

Anyone who knows me will know that crime is one issue on which I am relatively right-of-centre. I believe in retribution, and public protection, at least for the most serious crimes. However, I do make an excepton for individuals with serious mental ilnesses who are clearly not fully cognisant of the folly or danger of their actions. I resent people simply claiming mental illnss as some sort of excuse, but in genuine cases, the personnel concerned need to be treated as patients to be rehabilitated and treated, and not as criminals. I don’t have the statistics to hand, but I understand that in most prisons in the UK and Ireland, at least a significant minority of prisoners have serious mental health trouble. Would these people really present a danger to society if their illnesses were adequately managed and treated? How can incarceration lead to their recovery?

SF clearly concur that services for forensic patients are wholly inadequate. As councilor Declan McAleer says:

Rather than treating these people as patients in need of care and support, they are frequently treated as ‘felons’ and find themselves being shuffled between court appearances, case conferences and confinement.

This lack of a proper joined up approach… prolongs the day when they are restored to full health.

Councillor McAleer then points out that, with the recent devolution of justice and policing to the Northern Ireland assembly, hopefully there will be increased communication between the health service and criminal justice service here. Since the devolution only took place last month (April) it is of course far too soon to say whether or not there has been much progress in this regard, but it is a situation that I will continue to monitor.

The document further contends that a high security unit is a necessity here in the province; it is claimed that 78% of males and 50% of females in our prisons have personality disorders. We only have one medium security unit; any patients/prisoners requiring high security are presently sent to Great Britian. I should imagine that sending them to a unit far from their home, friends and family would be a serious inhibition to their recovery.

Moving on from forensic matters, SF have what I feel is a very positive message about mental health service provision, as published in this page of Republican newspaper An Phoblacht. They detail four key mental health issues that they intend to address, specifically as part of their 2010 General Election manifesto:

• Implement proposals of the Bamford Review and raise awareness about mental health issues
• Pursue implementation of an all-Ireland suicide prevention strategy
• Support the ‘card before you leave’ system to provide vulnerable patients at Accident and Emergency units with advice, contact numbers and follow up appointment details
• A new system to provide dedicated perinatal mental health services on an all-Ireland basis, ensuring that pre-natal and post-natal patients can be cared for with their new-borns when this is required

Four objectives don’t sound like an awful lot – but (a) they are four sensible, achievable goals and (b) although other parties do have positions on mental health service provision, as far as I have seen none of them have directly detailed their policies in this area for the 2010 election.

Finally on Sinn Fein, I’d like to draw your attention to this article. This relates specifically to the Republic of Ireland, but is nevertheless relevant to voters in Northern Ireland, as it shows SF’s position on mental illness and privisions for same. In essence, this piece discusses “savage” cuts from the local health Trust, meaning the closure of an acute unit and a day unit. The SF Dáil leader and spokesman on health in Eire, Caoimhghín Ó Caoláin, expresses his concern and anger at the prospect in this article, and details how he has lobbied the Republic’s health minister to seek assurances that the closures will not take place as planned. In particular, Ó Caoláin is concerned with the closure of the day unit in question, as it helps to prevent institutionalisation, something the Republic has sought to minimise through various initiatives. All in all, SF’s protests at these cuts seem encouraging.

The Social Democratic and Labour Party (SDLP) and Mental Health Service Provision

Apparently

The SDLP believes that good mental health is imperative to an individual’s general well being.

Such insight!

To be fair, like SF, they do lay out objectives which, whilst small in number, are potentially achieveable and not some sort of spin doctored pipedream. This booklet was written as their manifesto for the 2007 Northern Ireland Assembly elections, but I cannot imagine that the points therein are no longer normative; particularly with the ongoing discussion of the Bamford Review in mental health, these points are surely still relevant. The positive message of them is unlikely to be something on which the party would renege.

Essentially the SDLP would also seek to deliver an all-Ireland suicide prevention strategy, seek to build a cross-border forum on mental health issues and address “as a matter of urgency” what they call the chronic lack of services in both child and adult psychiatry and mental health in general. In part this would be achieved through full implementation of the recommendations by Bamford. I note that their comments here are essentially an elaboration of their 2005 General Election manifesto, thus giving further weight to the idea that their policies will remain broadly similar now. For what it’s worth, here is their 2010 manifesto – but it is disappointly sparse in its discussion of mental health issues.

The document also fixates on human rights for those that are mentally unwell. Although it does not specifiy the current infringements, we all know that this is a big issue for the mentally ill – in particular in regards to involuntary hospitalisation. The party also note that mental health service provision for adolescents is particularly crap, and claim that this would be a key point for them to address.

On that note, I was really pleased to see this piece on the SDLP Youth site discussing how a delegation of young people from not only the SDLP but all the other main parties plus the Alliance and the Greens launched their very own mental health strategy in Belfast in April last year. It makes a wonderful change to see the typical boundaries transgressed in the name of unity on such an important issue, and is to the credit of all the youth branches, not just that of the SDLP.

And…well, that’s about it really.

Conclusion – SF or the SDLP?

Although their siding with Labour at Westminster does annoy me (despite my earlier whinging that we need representatives from here in the main UK parties), I have always had respect for the SDLP. I don’t agree with them on every issue, of course, but their relative lack of fixation on the whole Ireland/UK debate was refreshesing from a party who were still intrinsically linked to that mode of thinking.

However, I must report that I am rather underwhelmed by their policies on mental health service provision. I’m not a one-issue voter by any means, but this is clearly an arena of much importance to me, and I would have thought a socialist party who would seem to be all for the NHS system would have had more to say on conditions that will, at any given time, affect one in four of us.

I’ve never been Sinn Fein’s biggest fan because their primary aim has always been the unification of this island. I don’t object to that per se, but it’s similar to the beef I have with their unionist counterparts, the DUP – there are so many more important issues than where the fucking border lies. However, I must admit that I am really rather impressed with the time they’ve taken to outline their position on mental health issues and, in particular, that the goals that they’ve set are not just there to look good – I believe that their manifesto aims in this area are actually quite obtainable, and they have given more space to writing about mental illness and provision therefore than any of the other parties other than, shockingly, the DUP.

But having said that, as with all articles from political parties, one has to ask oneself how much of it is rhetorical and how much of it they would really implement. My current thinking is that they are probably fairly well-intentioned in making all these pledges – but how much of it gets lost in the big pile of bureacratic shite that our politicans have to deal with? It remains to be seen.

Based on the literature, though, as far as the provision of mental health services goes, SF beat their nationalist rivals hands down.

—

Next time: a look at the Alliance Party and some of the smaller parties that are running for office, plus my conclusions on which party is offering the most to us Norn Iron mentalists.

I come from a unionist background, but am a very disaffected member of the breed.  I prefer Sinn Fein to the Democratic Unionists, even though it must be said that I don’t like Sinn Fein that terribly much.  I don’t particularly dislike either the Social and Democratic Labour Party nor the Ulster Unionist Party, who are more moderate parties still built on the nationalist/unionist issue, but I find it sad that politicans who have a serious chance of making a difference here still have to be ‘on one side or the other’.

Arguably, it’s not that different in Britain: Labour, working class / Tories, middle and upper classes.  It’s still a case of ‘sides’.  Except that it’s not, because both of those parties essentially stand for the same things now, what with the coming of New Labour and the so-called third way, and a subtle Tory shift to the centre-left.  Whilst there are, of course, still plenty of left-wing Labour MPs, and plenty of right-wing Tories, the two partys’ front benches – and other areas in which political difference is mad – consist of a bunch of sychophantic, power-hungry irritants who mirror each other in significant numbers of ways.

The folks on the hill at Stormont are also ‘sycophantic, power-hungry irritants’ (perhaps in some cases more so than the Brits) – but each side is still very different.  Aside from the obvious UK/Ireland debate, the DUP, for example, are religious (Free Presbyterian, mainly) reactionaries, whereas their power-sharing partners Sinn Fein are socialists who supposedly do not let religion impact upon their politics (though they are almost exclusively Catholics, whether that’s just in name or in actual practice).

Anyway, this is turning into a rant about the status of politics here, and that’s not what it’s intended to be.  I want to see what the various parties have to say on mental health.  In true Norn Iron style, let’s look at it along divisive lines.  Today I bring you TEH UNIONISTZ.

The Democratic Unionist Party (DUP) and Mental Health Provision

The DUP should have a view on this issue, as recently one of their former MPs/MLAs and the wife of the leader – after revelations about her financial dealings and private life – was undergoing intensive psychiatric treatment.  Iris Robinson had also claimed, well before the private life issues were made public, that she struggled with mental illness.  But…can we really expect some tolerance and compassion from a party like this?

Well, I have to say – on the face of it at least, they are taking this issue rather more seriously than I expected.  They have an entire agenda on Northern Irish mental health provision published here.  (Perhaps rather regrettably for the DUP, a few pictures of an apparently sane Iris are splattered all over the document, harking back to the days when she was ((publically)) just a bigoted wingnut, rather than a mental, bigoted wingnut).

Overall the document is surprisingly encouraging.  They consistently press the need for larger and more specialist community services, crucially (in my case) including the necessity for services for personality disorders (which as regular readers will know is something with which I have recently taken much issue).  They point out that research is needed to establish just how prevalent personality disorders are in the province, something I would welcome as currently the Trusts seem to get away with saying they won’t treat you as they don’t have the facilities.  Demonstrating the levels of PD would surely put an end to this – or at least would allow services to be developed in the geographical areas in which PD is most prevalent.

Other areas requiring more developed services here, according to this document, are eating disorders, addictions, learning disability and autism, and CAHMS services.  I cannot disagree with any of this.

In terms of therapy, they slam the current waiting times, though recognise that changing this could take years.  I note with interest that they feel “sustained” therapy changes lives.  Perhaps I should ask C if he votes for them.

One thing that irritated me was that they are very critical of medication and hospitalisation.  In terms of medication, I take their point that treating PTSD and depression related to the Troubles would generally be best managed by psychological treatment; however, this belies the truth – in my mind, anyway – that the medical model is really not that bad.  Yes, therapy should be offered and sustained – however, if drugs ease suffering thus helping to enable productive discussion in therapy, then I fail to see what is so wrong with them.

As far as hospital goes, the DUP have put great emphasis on community services.  That’s fine; no one wants to have to go to the bin, and if the remit of the various CMHTs can be increased, then bring it on.  However, there are times when hospitalisation is a necessary evil – and I know of no one who liked it exactly, but I do know of people whose lives it saved and, furthermore, whose lives it ultimately improved (though, for the sake of balance, I do know of individuals whose lives it ruined too).

At one point the DUP assert that beds are being used ‘inefficiently’ in both acute and long-term psychiatric wards; I have no idea as to the accuracy of this statement, but surely that judgement should be in the hands of a consultant, and not a politican?  They contend that in these cases patients are more than capable of living in the community – but, again, I question how they can reach that conclusion.  From what I understand, if someone is well enough to leave hospital, then they leave hospital.  The DUP’s fixation with discharging people seems at best misguided, at worst dangerous.

Overall – ostensibly speaking, I’m more impressed than I expected to be.  I expected to have to wade through dozens of articles just to get a snippet of information, and yet here they have a reasonable sized policy devoted to this niche area.  It’s not faultness, and as ever the danger is that it’s founded entirely upon rhetoric, but it’s a start.  Can we say the same for the Ulster Unionist Party?

The Ulster Unionist Party (UUP) and Mental Health Provision

The UUP have become the little surrogates of the British Conservative party in recent months.  Originally calling themselves ‘Unionists and Conservatives – New Force’ (WTF?), they have now mostly downgraded this simply to ‘Conservatives and Unionists’.  Theoretically, therefore, were the UUP the main NI party in Westminster, we (as constituents represented in Parliament) might expect to have more political influence than we presently do.  However, even if the UUP won every NI seat (which would clearly never happen), it would only be in the tightest of votes in which 18 people could make a difference.  And in any case, I bet they have policies that diverge from that of their new parent party.

Like the DUP, you’d expect the Ulster Unionists to have something significant to say about mental health; Michael McGimpsey, one of their MLAs, is the Health Minister at Stormont.  Yet I can find surprisingly little information on their outlook on this subject.  There are plenty of search results, and a number of news stories and whatnot, yet there does not appear to be a specific policy or mental health agenda developed by the party.

One of the first results that seems of interest is, hilariously, from the DUP (and more hilariously again, it’s specifically from good ol’ Iris, who before her political demise served on a health committee at Stormont).  But let’s just try to ignore the source for a minute and see what is said.

The most alarming assertion in the article is that, during Mr McGimpsey’s time as Minister, only 5% of health service spending has been devoted to mental health.  Given the severity of many mental illnesses and, in particular given that it will affect 25% of people at some point, this is an incredible statistic.  Five per cent.  Five.  5% to deal with, potentially, 25% of people.

Mrs Robbo continues by pointing out that the DHSSPS is “committed to” the development of community mental health services, but notes that this will require a fundamental overhaul of services as they presently exist.  She contends that little effort has been made in this regard.

Regardless of her view that nothing of worth is happening vis a vis this ‘overhaul’, I would query how such changes could possibly be made when mental health services are allocated such a meagre income from the Department, if the 5% statistic quoted is in fact correct.  I wonder how it is even possible to take care of the most severely ill people on such a figure.  OK, so I can’t comment on the actual figure – 5% of what, exactly? – but I know that the entire NHS both here and in Britian struggles on the billions it’s allocated, so throwing such a tiny minority of money into this necessary sector of it suggests to me that financial management is inevitably going to present difficulties.

A second link describes how Mr McGimpsey attended the opening of a new inpatient facility for adolescents in South Belfast in February this year.  £9million was invested in this ward, and a children’s ward is due to open next month.

It is difficult to say whether or not these two wards were impacted to any significant degree by the UUP’s own policies.  Given that they both opened/will open in the first half of 2010, it’s probable that they were planned well in advance of the current Assembly, which has been in place since 2007.  Ergo McGimpsey and the UUP could well have little to nothing to do with this.

Additionally, the creation of two hospital wards for those under 18 seems at odds with the Departmental policy of promoting community care.  Of course they will and indeed ought to still accept that there are occasions during which hospitalisations are necessary, but millions of pounds spent on new ones when others exist does strike me as somewhat curious.  Why not use those funds in developing a better CAHMS service and improving already-existing in-patient facilities?

And what about us adults?

A more encouraing perspective comes from a transcript of Hansard from the House of Lords, which chronicles a debate on an amendment to the Mental Health (NI) Order 2004.  During the debate, it is noted by a number of NI Lords that mental health services here are, even in comparison to the rest of the UK, pretty shit.  Lord Rogan, representing the Ulster Unionists, proclaims that he welcomes the Order, which – in essence – deals with human rights during involuntary detentions.  Specifically, the Order seeks to move the burden of proof from the patient having to prove they are well enough to be released, to the tribunal having to prove that the patient is ill enough to remain sectioned.

Lord Rogan, of course, throws a bit of a spanner in the works in that he raises a number of questions as to how this legal change would operate in practice.  However, far from being outraged by this, I think this is a sensible course of action.  It seems evident that Rogan and other Lords agree in principle with the Order, but it would be remiss not to consider certain legal and logistical practicalities that accompany such a profound modification to mental health law.  Asking for clarification on the potential issues suggests to me a considered approach to the implementation of the Order, hopefully meaning that it would be a more secure law when finally passed.  Ignoring potential difficulties and then having to deal with them as they arose would have been irresponsible.

Finally, although there is little detail here, an interesting meeting was recently had between the sectarian-neutral Alliance Party and the UUP.  Alliance leader David Ford commented that his party’s stance on mental health provision was broadly similar to that of the UUP.  Both parties were apparently alarmed at cuts to the health budget from the DUP (thanks to the Department of Finance and Personnel’s budgetry allocations), and (as above) note that mental health services here are inadequate in comparison to those in Great Britain.  Having found “common ground”, the UUP and Alliance want to work together (and with other parties, too) to improve matters.

Conclusion – DUP or UUP?

Ostensibly the DUP seem to have more directly immersed themselves in a policy for mental health services than the UUP.  I was surprised to find their document directly discussing the issue, and was subsequently disappointed to not find similar from the UUP.  On the face of it, the DUP’s position seems considerably more favourable, and – rhetoric or otherwise – I was impressed by the time they invested in their document.

However.  The DUP are, in my view, an insidious party.  They might be very good as constituency MPs (and to be fair I understand that, for all sides of the community, they are), but my instinct is not to trust them on basically anything that happens in a wider arena, including NHS provisions.  If, as the Alliance and UUP claim, Peter Robinson (formerly the Finance Minister) has made health budget cuts – then we should be alarmed, regardless of what his party says in some nice little booklet.  Plus – there’s no way I could bring myself to vote for these people, unless they gave me a personal, written guarantee of indefinitely continued mental health care.  I’d vote for anyone who did that, but it ain’t going to happen.

But the UUP aren’t exactly wonderful in this subject either.  The broad support of and assurance-seeking on the Mental Health Order was vaguely encouraging, but I was incredibly troubled by the 5% statistic.  OK, OK – that came from a press release from Iris fucking Robinson.  Salt and pinches of it, I know.  But I doubt even Iris would have the balls to make up such a statistic; having served as the Chair of the Stormont Health Committee, she would have been bound to have been able to back this up with evidence.

In short – I don’t believe in the DUP, and I’m underwhelmed by the UUP who could have done so much more, and didn’t.  So something of a fail all round.

—–

Next time: we meet the nationalist parties.  Do Sinn Fein and the SDLP care about our mental health?

I’m addicted to politics.  It drives me round the bend, but I’m addicted to it nevertheless.  I received an ‘A’ in my ‘A’ Level in it, and very, very nearly studied at university (the subject that I ended up studying is strongly impacted by it too).  I watch Question Time (and scream at the TV) and This Week most weeks, and now that I am a dolescum tend to be hooked on The Daily Politics as well.  I watch about three news programmes in a row, at least twice a day, mainly to see what the twats in Westminster, the Dáil and that Godforsaken shithole that is Stormont are doing.  I invariably find myself enraged, but always strangely excited at the same time.

Anyway, I’m not going to subject you to a full discussion of the parties and the rhetoric and lies that we can expect from each of them; there’s hundreds of blogs and websites (probably thousands) that will do that for you much more ably than I can.  Nevertheless, I’d like to zoom in on a couple of things – specifically, party policies on mental health provision and in particular views from Northern Ireland on same.  I was going to do it all in one post, but to my surprise it turns out that it would too big for that.  Therefore, today I will bring you…

Mental Health Provision in the Manifestos of Parties in Great Britain

Note that the heading says ‘Great Britain’, and not ‘the UK’.  The two are distinct, and (annoyingly for me) that is reflected in the division of political parties.  For those not conversant with the bizarre and uncodified constitution of the United Kingdom, ‘Great Britain’ refers to England, Scotland and Wales.  These countries – and, let’s face it, in particular England – house the ‘main’ parties of the Liberal Democrats, Conservatives and Labour.  Scotland also have the Scottish Nationalist Party, and Wales have Plaid Cymru.

I’m not going to get into a major discussion of any of these parties, mainly as it’s been done elsewhere.  Moreover, in some ways what happens in Westminster only tangentially affects us in Northern Ireland – on the other hand, though, they’re still responsible for how much money our Department of Finance receives to spend in whatever way, so in that sense they still have a lot of political clout.

Anyway, Mental Nurse have run a very entertaining and interesting series, known as This Election in Mentalists, exploring the mental health policies (or lack thereof) of the main parties (the title of which as you can see I have stolen).  You may notice that I’ve not commented at all in any of the posts, despite being a relative regular over at Mental Nurse; I was scared that I’d get into a fight, to be honest, as I tend to be quite…ahem…’direct’ in my expression of political views.  Nothing gets heads rolling more than politics.

So that’s the first article I’d like to mention, but on a similar theme, I was highly dismayed to note in Thursday’s electoral debate between the leaders of the three main parties that – in discussion of the NHS – not one of the three mentioned services for mental illness.  Two things struck me about this.  Firstly, to ignore this group of conditions in such a blatant and public way is to further distance it from physical illness, which in turn surely adds further fuel to the cruel fire of stigma.  Secondly, stigmatised or not, mental illness will affect at least one in four people at some point in their lifetime.  That is bound to have a lot of impact on NHS spending and other resources, and on other macro issues such as the economy (owing to days lost to sick leave and whatnot).  The parties must surely have a view on this matter.

Well, mercifully, one of them does – and it seems to be a more encouraging outlook than the apparent silence of the others.  Unfortunately, despite his current surge in popularity, this man is still the one least likely to end up as the occupant of Number 10 on 7 May.  He is Nick Clegg, leader of the Liberal Democrats.

Now, this article, from politics.co.uk, is slightly out of date, being published as it was in September last year.  Nevertheless, everyone knew at that point that a General Election would be called for early May, so it seems reasonable to assume that this information can be included as part of Clegg’s policy concern in the unlikely event that his party forms the next government.  (Side note: as things stand, there is a very real possibility of a hung parliament, meaning that although Clegg is unlikely to become PM, the Lib Dems could still form a coalition government with one of the other two parties.  That may mean their policies having more weight in Westminster after all, even if still not quite up to the level of a single governing party).

Anyhow, to get to the point (finally), Clegg has pledged to protect mental health services on the NHS from budget cuts specifically related to the recession.  It’s a shame that the pledge carries that caveat – shouldn’t we be protecting mental health services from all budget cuts – but nevertheless, it’s a public act of solidarity for those of us using these services, which to the best of my knowledge is a lot more than can be said for David Cameron and Gordon Brown.

As this article points out:

[The NHS area of] Mental health receives only a fraction of the funding awarded to other health conditions such as cancer, even though one in four people will experience mental health problems at some point in their lives.

I find this reality unsurprising, of course, but utterly outrageous all the same.  One could argue that cancer is, or at least can be, a fatal disease.  Mental illness, in and of itself they might say, is not thus deadly.  But is that really true?  I don’t have any statistics to hand, but I know the suicide rate in this country is not as low as it should be.  If left untreated – or if inadequately treated – suicide is often the natural progression of some of the more severe mental illnesses.  So yes, my dears, mental illness certainly is oftentimes deadly.

What is most troubling to my mind is that many suicides could probably have been prevented had there been adequate intervention and/or treatment (as to whether or not suicide is a right, and I actually happen to believe that it is – well, that’s a post for another day).  Oh, but the person didn’t seek that help! Quite often this is true, but (a) seeking treatment for mental illness is still horribly and unfairly stigmatised, something that I would like to expect the next government would seek to eradicate through proper investment and (b) I know from bitter experience, and know from the bitter experiences of others, that asking for help – no matter how desperately – does not always (or even often) get you it.  Surely these issues are directly correlated with resources invested (or rather not) in mental health services.

As Nick Clegg comments, “It is a false economy not to invest in mental health services.”

Finally for now, I’d like to draw your attention to Rethink’s General Election Campaign.  As you may know, Rethink is one of Britain’s largest mental health related charities (sadly they recently demerged from their Northern Ireland branch, now known as Mindwise, but they are probably still the most influential lobby group for this demographic in Westminster and therefore still deserve the attention of those of us over here).  The election campaign includes a petition that they intend to forward to the next government, that demands better access to services, the tackling of stigma and discrimination, and fairer treatment to prisoners with mental health difficulties.  Please go and sign the petition; we really need the new government to take notice.

An excellent suggestion that Rethink make is that if you are ‘doorstepped’ by your local candidates, please ask them what their party’s (and indeed their own individual) policy on mental health provision is.

—–

Tomorrow we move into the murky realms of Northern Ireland politics and ask what the the Unionist parties – the Democratic Unionists and Ulster Unionists – are doing for the mental vote.

Anyone with any knowledge of mental illness that has read Seaneen’s blog knows that it is 100% fucking clear that she has manic depression. It doesn’t take the abject wankery of a psychiatric qualification. She has never had a manic episode? WHAT THE FUCKING FUCK? I don’t know Seaneen, and I don’t profess to be some sort of guru on mental illness, but her descriptions of what sound strongly like mixed states with psychosis are nothing like BPD. OK, so agitation and psychosis are common in BPD – I have both, myself – but the sheer extent of her symptoms strikes me as different.

I have never objected to my borderline diagnosis. If anything, I almost encouraged it; I knew I met the majority of the symptoms, and reading I Hate You, Don’t Leave Me was like reading an autobiography. However, since the diagnosis, I’ve learnt so much more about how people with this diagnosis are generally treated in the system.

I contend that borderline personality disorder, at least in many cases, is a sexist, demeaning diagnosis given to women who:

• are intelligent and self-aware, and therefore capable of challenging psychiatrists, which pisses their sanctimonious sense of intellectual superiority right off
• are “difficult,” which is a pejorative term acting essentially as code for shrinks being too fuckwitted to fully investigate your diagnosis (presumably because it might keep them from their lunchtime Vanilla Frappes)
• have issues of trauma (not in all cases). Way to go, psychiatry; re-traumatise people with this stigmatic bollocks after all they’ve already been through.
• seem mildly irritated once, because this clearly represents significant anger issues.

I am, of course, bring slightly facestious here – but you get my drift. I do not object to BPD as a concept, and unlike most people I don’t object to the name of the illness (because, at the end of the day, the concept, not so much the semantics, is what is stigmatised).

What I object to is the fact this is a wastebasket diagnosis oftentimes thrown about by psychiatrists who either don’t give a shit about their patients or can’t be arsed to understand them. What I object to is the way people with (or diagnosed with) BPD are often treated by the mental health system – “oh, fucking hell, not a borderline!” – which totally demeans the very real psychological distress and sheer fucking mental agony that the person is in and, most often, has gone through. In essence, what I object to is not this diagnosis per se, but the way it seems to be so frequently applied.

For people like me, who quite clearly do have BPD, fair enough – give us the diagnosis if you must. Just don’t treat us like shit as seems to be your pathetic little wont. For others that you just fancy throwing it at – stick your stigmatic, defiling diagnosis right up your supercilious arses.

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

TEH GOOD STUFFZ

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

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

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

TEH SHITE STUFFZ

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

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

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

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

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

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

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

FF UU CC KK ad infinitum

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

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

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

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

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

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

TEH OUTCOMEZ

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

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

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

TEH AFTERMATHZ

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

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

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

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

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

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

The meeting started as they all do. He looks at me, I look at him in the hope that he’ll ask or tell me something, then I shift my glance to the safety of the floor. Except on this occasion, he said, “at this point, I usually ask you where you’d like to begin…”

He trailed off, and I made some mutterance of agreement.

“…and you usually seem a bit agitated and unsure…”

Flippin’ ‘eck, guv, you’re quick, ain’tcha?

“…and then we sit in silence for a bit…”

Fail, Pandora, fail fail fail…

“…and finally you end up completely berating yourself as being a ‘stupid time-wasting bitch’, if I’m not mistaken.” He rather drolly raised an eyebrow.

Well, that about sums it up C, yes. I nodded in agreement, and in his aforementioned time-honoured fashion, looked silently away.

Eventually, against his better judgment I think, he asked me how things had been in the fortnight since I’d last seen him.

I genuinely considered this for a few minutes, but in the end was surprised to report that things had been mostly fairly stable. I’m finding my trademark insomnia returning somewhat (thanks Quetiapine, you wonderful, dreadful drug), but beyond that I’ve been moderately sane.

“OK,” he said. “And how do you feel about things here – in the sense that we didn’t meet last week, won’t meet next week and so only have this one week together for now?”

Of course, the truthful answer to that was, “it fucking sucks, how dare you not prioritise me above your bloody personal life, you cruel bastard.” But I was hardly going to admit that to him, was I?

Shrug a bit, avoid his gaze. “I suppose it’s not ideal really – it’s a bit disjointed, isn’t it?” I stammered, finally.

He nodded, and admitted that that had been his feeling also. I suppose that begged the question in my mind of why we’d even bothered to have this ‘in-between’ session – but having said that, I was glad of it, as I am always so glad to see him after some sort of disruption in our shared little dance of therapeutic strangeness.

Perhaps my best bet in proceeding with this story is just to detail what I remember as it emerges from the tips of my fingers onto the page. I don’t remember why some things were brought up, and I don’t remember properly the order in which some conversations developed. So here we go…

I remember being pissed off about some stuff he’d brought up in the previous session. That is to say, I wasn’t pissed off particularly at the time of the session, but upon later consideration, I became so. The whole shite that I “played a tug of war” was especially irritating. I told him I felt that that analysis had been unreasonable and unfair.

He claimed that he hadn’t meant to suggest that I deliberately fight against him, but just that both sides can sometimes become defensive over some topics (in my experience, usually the competence or otherwise of the NHS).

To me, there doesn’t seem to be a great deal of difference between a suggestion that I’m ‘fighting’ him and what he said, but I let it pass, and just looked at him.

It led to silence. He watched me. I watched him. Eventually I lost it with myself and said, “yes, you see I am a fucking time-wasting bitch, this exemplifies it!”

C asked if there were “alternative ways” of looking silences in therapy.

“Of course there are,” I spat. “It’s irrelevant, because I don’t and won’t think them to be true representations of it.”

“Still,” he insisted, “what are those alternatives?”

“One is that silence gives us time to reflect on recently discussed matters,” I started uncertainly. “A second is that it surely must be reflective of some psychological process, musn’t it?”

I noticed a smirk cross his face, and realised the potential connotations of what I’d just said.

“Did I just make a slight on your entire profession?” I asked, smiling sheepishly.

He laughed. “I suppose something can be read into silences though, don’t you think?”

I assume this was the part where I was on the verge of being accused of ‘withholding’, which is no doubt exactly what I was doing.

Silence, not speech. To withhold information is to deny its existence. Then it is not real, Pandora.

“Well, I don’t know, C,” I smiled. “I’m not the psychotherapist!”

He thought about that for a minute, but before he could respond, he was somewhat taken aback to see me laughing. He asked what it was that amused me so.

“The very notion of me as a psychotherapist,” I howled. “It’s utterly ludicrous. I’m so devoid of sympathy and empathy for people that I’d fuc the poor sods up even more!” Dreadful (though, I must confess, vaguely amusing) images of therapist-me landing into a pub blabbling all my clients’ secrets to the assembled punters danced happily through my visual consciousness.

I laughed on, then heard the sounds of my amusement rather quickly fading, as I realised the territory into which I’d just unwittingly walked. Empathy. C’s favourite subject. Specifically, my (alleged) need to empathise with and show compassion to myself.

I tried to avoid it. I said, “do you remember when we first met – I couldn’t have cared less if people were lying about the place dead or in pain, but if I saw a mere scratch on a car, I’d break down and bawl my eyes out for hours?”

He nodded in response.

“That’s projection, right?”

“Well…”

Don’t let her intellectualise…

“Well, whatever – I don’t think it’s as bad as it was,” I pronounced triumphantly. I exemplified by informing C that one of the cats had recently, for the first time, presented us with a dead mouse as a ‘present’.

“I didn’t end up cradling the mouse and weeping for its lost life,” I said smugly. “I was angry with the cat, but I didn’t lose it really; I just quite calmly asked A to dispose of the cadaver.”

“Um…OK..,” he said. “And in what way are you now able to demonstrate the sympathy or compassion you’d have previously had for the mouse?”

I can’t remember what way I reacted to this, but C stopped me before I could speak and said, “I suspect when I say that word [compassion] you’re thinking, ‘oh, for fuck’s sake’, aren’t you?”

“I certainly wince every time I hear it, yes.”

He nodded. “I really do think that developing self-compassion is a major necessity in our work.”

“I am trying,” I told him, thinking back to the discussion we’d had about a self-soothing book I’m reading. Or read. Or read a little bit of. Hmm…

I said, “my current reading material is Judith Herman’s Trauma and Recovery, have you read it?”

“No,” he replied (to my surprise). “That’s the book about complex PTSD, right?”

I nodded.

“That was quite controversial when it was released, wasn’t it?”

Well, given that I wasn’t taking the most profound interest in psychiatry in 1991 when I was seven, C, it may not surprise you to learn that I don’t actually know. (Incidentally, a quick Google search does suggest some controversy upon the book’s publication, but I’ve yet to come across its exact nature).

My response was to say that Herman wrote from what I felt was a feminist perspective. “I know 1991 was a good few years after second-wave feminism,” I sighed, “but sadly that takes us into the era of what I believe to be a form of post-feminism, so I suppose yes – it could indeed have been rather controversial in that sense.”

(He seemed quite impressed with my crude knowledge of feminist chronologies.)

He asked how I was finding the book, and I said, simply, “good.”

I was perplexed to see C smiling at this (lack of) analysis. He kept smiling and looking at me, which although oddly nice in a way, kind of freaked me out at the same time.

I said, “why are you smiling at me like that, C?”

“Your perpetual detachment, your avoidance. There’s a lot of…relevant…material in that book, and rather than discuss that, you merely pronounce it to be ‘good’.”

“Oh, OK, I hadn’t realised you wanted the London Review of Books,” I sneered. “I’m reading the child abuse chapter at the minute. It’s like reading an autobiography penned by me. Do you see?”

And so it begins.

Subject shift, even if only subtly.

“You asked earlier if anything had happened since I last saw you,” I began, tentatively. “I forgot to mention some sort of somatic symptoms I’ve been experiencing. I haven’t experienced this kind of thing since I was a child – I don’t think I could have been more than about six the last time I remember it happening.”

“What sort of somatic symptoms?” he asked.

I stared at the floor and kept my mouth firmly shut.

“OK,” he said, reaching his arm out as if extending an olive branch, “stop me if this makes you too uncomfortable. These sensations – are they in your vagina?”

Wince. Why is that such a horrible, vile word?

“Sort of,” I began, quietly, unsure of myself. It’s a desperately uncomfortable sensation during which I feel like I need to go to the toilet, even though I don’t.”

“As in urinate?” he checked.

“It’s like I need to micturate, yes,” I confirmed. I briefly raised my eyes from their default floor-staring position, to see more accurately his innate response to the word ‘micturate’. He clearly wanted to laugh, but I’m not sure that a lesser reader of people than I would have spotted the tells indicating same. He is clearly skilled in hiding his body language when he wants to do so.

“So is the bad sensation in your entire groin area?” he probed some more.

Eyes dart back to the ground.

“Between my legs,” I replied quietly. “The entire vulval region.”

“And why do you think this is happening to you again now?” he asked gently.

“I think material that we have been covering in therapy during the last few weeks has reignited old physical memories and sensations that I experienced as a child,” I answered simply.

“I would think so,” he agreed. “I’m no anatomist, but it sounds like your muscles are tensing in that region and perhaps that has an impact on your bladder – maybe they press on it to some extent, leading to this sensation where you feel you need to go to the toilet.”

Nod. Look away.

I don’t remember exactly all of what he then said, but he talked a little about the abuse for a few minutes, a soliloquy in which he admitted that he had his suspicions that penetration was involved, contrary to what I had allowed myself to reveal in the beginning of our therapy (and frankly to myself also, at least until fairly recently).

I looked at the clock. About seven minutes remained.

He interpreted this as a sign of my desire to escape, but it was almost exactly the opposite. “If we’re going to get involved in a deep-and-meaningful on this, I need to feel we have a fair amount of time to do so,” I told him. He nodded understandingly.

Tension filled the room. He knew I was going to talk. I knew. But how much was I going to say? C seemed to literally be on the edge of his seat. He’d angled his entire body towards me and was looking at me quite intensely.

I didn’t feel anything. Nothing. I don’t remember what I looked at; I just kind of stared somewhere blankly as if I was seeking catatonia, or perhaps another dimension. I felt C’s eyes burning into me but I didn’t care. I felt nothing.

I said, quite clearly, calmly and coherently, “he raped me, again and again and again. He forced me to perform oral sex on him. He performed oral sex on me. He touched me in any number of inappropriate ways. It started when I was maybe about five and it went on regularly for several years.”

Still perched on the edge of his seat, still with his head angled demonstrably towards me, C looked me in the eye and said, rather definitely, “what an awful thing for you to have gone through.”

I nodded wistfully and lowered my eyes from his once more.

My memory becomes a little skewed here again. I don’t remember exactly the order in which what followed came, so I’ll try and follow it as I feels it flows.

We talked for a few minutes about how he felt making these admissions was “a big step,” as he put it. We agreed, though, that whilst it’s a good start, using words like ‘rape’ and suchlike don’t convey the physical agony, the terror and bewilderment, nor the psychological horror of the situation (as I tried to discuss here).

He shook his head at one point and said something like, “I myself can look for words here in these moments, but none seem to quite cut it.”

I asked for clarification on what he meant.

“I can say what you went through is ‘awful’ or ‘terrible’ – and it is – but there are no words that sort of even come close to describing how dreadful it must actually have been.”

For some reason, that comment touched me. He believed me, and he cared enough to think it was too bad to adequately be put into words. I don’t believe that there was any sudden change in my demeanor, but I was moved nevertheless.

“Thanks,” I finally murmured, only just audibly.

He said, “you look like you want to cry now.” He was actually correct, though I’m not sure if he was aware that it was more to do with his compassion towards my situation (he’s allowed to have it for me) than it was about the rapes.

I was well aware our time was all but up, so no tears were allowed to be forthcoming. I shook my head at him and eventually started muttering, “no, no, no,” over and over again.

He asked what it was about crying that I so feared.

In this case, it was nothing more than a pragmatic matter of logistics. “I can’t walk out of here in tears,” I said incredulously. “People will see!”

He seemed a bit mystified by that for some reason, but let it pass and instead asked what I planned to do for the rest of the day. He has been worried in recent weeks that exploring the abuse in therapy will fuck with my head out of therapy, and he wants me to engage in activities that minimise rumination on the matter in question.

I was concerned that he was concerned, and fervently sought to tell him that I was alright; however, he interrupted me and said that he actually wasn’t especially anxious, due to this being, again, “a very big step.” I think he knew that, perverse as the subject matter is, that I felt a sense of achievement in finally telling him what had happened. And he was right. I did.

By the time I finally left his office, he’d let me overrun by nearly 10 minutes, about which I was felt very warm and fuzzy inside. He told me to take care of myself as I left too, which is always a nice and considerably appreciated touch.

I really rather suspected that finally admitted the extent of the abuse would leave me a triggered, tattered mess of angst and mentalness between sessions, but I actually still feel really quite pleased with myself for admitting to how much went on, and I am pleased with his reaction of reassurance and gentleness.

The hard work is still to come. The first step is taken, but the hard work awaits. Will it be rushed and erratic? I hope not, but one thing of which I am certain is that it will be bloody horrific. But…I trust C, and I feel reassured by him. So my hope is that he can, somehow, guide me through the worst of it.

NB. I’m going to be in absentia for a few days – probably for the next week. Don’t call the men in white coats, lovelies, I haven’t disappeared to search for a suicide spot. I’m just having a few days away

Love ya lovely people x

Since then, I’ve managed to whack up a few accolade-y type things to my name, which you can see narcissistically plastered down the right sidebar if you scroll down far enough.  One of them is a health blogging award nomination, a second sees Confessions listed as a top BPD blog, another sees me as a vetted member of a mental health blogging community, and the final one is a listing in a ‘top blogs’ site (though to be honest I’m not sure how much credence I give to The Daily Reviewer, as it is called.  I’m still arrogant enough to take their badge, though).

All of these things are nice, but the award from Mental Nurse is still the one that has most touched me – that’s partly because it was the first award I received, but mainly because unlike some of the ones listed above, the blog was voted for by my peers here in the madosphere.

Anyway, the point of all this self-indulgent bollocks is that it seems I’ve been awarded something else.  I did report the award from Mental Nurse in January, but haven’t acknowledged the others in posts – so why this, then?

Serotonin Seeker, who has just started blogging, left a comment yesterday directing me to this post that he’d written, in which he discussed his empathy with my recent discussions of child sexual abuse.  He – in apparent conjunction with fellow sometime commentator Kate, who is responsible for two of the other nominations – has, ergo, awarded me a “Couregous Blogger” award!

I had to mention it because I was so touched by Serotonin Seeker’s generous words about this blog and indeed by his very belief that I deserved such a thing.  In fact, his kindness brought a tear to my cynical little eye.

I am constantly amazed that anyone cares what I have to say, and I certainly don’t think that I’m remotely courageous.  I don’t even think I’m a particularly good writer.  All I do is whinge, bitch, rant and moan.  But despite this, I’ve received some truly wonderful feedback from readers and am continually humbled and moved by the support and encouragement that you all give me.

So, I would particularly like to thank Serotonin Seeker, but I’d also like to extend that thanks to all of you that frequent this site.  You’ve all been fabulous and have turned what was intended to be nothing more than a daft mental diary into one of the most worthwhile things I’ve done in my life.  Apologies if that sounds histrionic, but there you go.  Thank you all.

One thing I like about this award is that the person that originally conceived it encourages recipients to award it to five other people, as she details here.  The award options are not limited to ‘courageous’ blogging, but also include categories for ‘inspirational’, ‘charity’, ‘thoughtful’ or ‘creative’ bloggers.

Narrowing down the amount of excellent blogs I read to a mere worthy five is pretty impossible, but here goes…

I’d like to award this to both bourach at Conversations with my Head and to Splintered Ones.  I know neither of them particularly think that they face what has happened to them with courage, but I think they do – very much so.  I also think that both their blogs are very well written and engaging, even if a lot of the material therein is very difficult.

Incidentally, I don’t think Confessions would ever have existed but for bourach’s blog; her discussions of her mental health difficulties inspired me to start writing about my own, so I owe her a lot in that regard.  I also owe both her and Splint a lot for their perpetual support through some difficult times. <3

This is for On the Borderline, the blog of a non-profit organisation that seeks to support individuals with BPD and their friends and family.  It was fairly recently founded by Lauren Maynard, who formerly had BPD but no longer meets the DSM diagnostic criteria for same (which is fabulous!).

OTB works hard to raise awareness on the realities of life with a borderline personality, and on beating down the inherent stigma of the illness.  I have a lot of respect for Lauren and the work that she is doing with the organisation.

The awards page says that the recipients of this award are:

…those who answer blog comments, emails, and make their visitors feel at home on their blogs. [The Award is f]or the people who take others’ feelings into consideration before speaking out and who are kind and courteous…

To me this sounds like a very good description of The Same Sky to me, and this is therefore for her

For poetry that makes the hair on the back of one’s neck stand up, and for evocative, jealousy-inducing photography – as well as his own unique, achingly intelligent writing style – I believe Abysmal Musings is a worthy winner of this.

I’ve actually only been reading his blog for a few months, but in that time I’ve found it extraordinary.  It’s a rare writer who has me running to the dictionary, but Abysmal is one such person!  His prose is excellent, his poetry sublime.

So there you go.  I feel ridiculously soppy and sentimental doing this, but I do think these folks deserve it.

They’re not the only ones, of course, but I will write a blogoversary post next month and single out some more of you lovely people for whom I have a lot of respect and fondness.

In the meantime – again – thank you.  To Serotonin Seeker for the award and lovely words, and to all the rest of you reading this for your feedback, kindness and unwavering support.  YOU RULE.

If the police are ever involved in my psychiatric life, then all hell will break loose. I will be fucked. A – and possibly a range of others too – may well be forced to give out information about this blog and the history of my mentalness. If that happens, not only will the peelers (Northern Ireland colloquialism for the cops) probably have to instigate a historical enquiry vis a vis Padeo, but they will have no choice but to contact social services about him, given his access to Marcus, Marcus’s baby brother and a couple of teenage grandchildren that hover about in his life from time to time.

It’s bad enough to have gone through sexual abuse as a child and to have to relive it all so vividly and painfully now. But now I have to be responsible for not losing my mind, when my mind dangles so precariously on a precipice somewhere between semi-sanity and complete insanity. That is not fair. Haven’t I gone through enough? How am I meant to control that which almost by definition is uncontrollable? And yet, the ramifications of not doing so are way too big – life-ruining and terrifying. I am holding it together now, but I know it is by a mere fickle thread.

And, mais oui, I’m effectively being re-traumitised with all this abuse bollocks by psychotherapy, during the middle of which C will just up sticks. How unfair can you get? I know this stuff needs to be psychologically addressed, but it can’t just be done in a few short weeks; it won’t just be OK or even vaguely manageable just like that. Of course, that assumes that I can even talk about it at some point between now and June, and that’s a very big ‘if’. I know from others – bourach and Splintered Ones, most notably – that if specific discussion of these matters comes at all, then it simply cannot be forced. So how am I meant to ever do this with C, given the short timeframe that remains of our relationship? I resent the notion of going private, even though I recognise it as all but inevitable, because I have done (or at the very least have tried to do) my duty to the stupid, hateful Trust by working since I was 16, and happily paying my national insurance to its governing Department during that time. Fuck them. It would serve them right if I never worked again simply so as I could avoid paying them a penny more.

I’m not even going to bother giving discussion of my last session with C its own post as I normally do. It was a complete waste of time; if he wants to play psychological academics, then he should have gone into full-time research, not clinical practice. Not that I mind the psychological academics per se – but I do hate an inordinate amount of time being devoted thereto when there are very real and serious matters that must be addressed now. Otherwise they never will be.

Apparently, I cling to “a tyranny of ‘shoulds’”, particularly regarding the sex abuse, meaning that I am convinced I should discuss the specifics of said rapes etc, I should resolve it in my own mind, blah blah blah blah de fucking blah blah. He thinks I hinder myself by demanding so much of myself in this way, which is probably true – but the alternative is surely even worse. As I told him, if I do not openly share this information with him, then it will remain unprocessed and unresolved. It will only continue to haunt me should that be the case.

I told him that I pretty desperately wanted to talk to him, and he said that that was encouraging – but is it? 14 weeks (or 10, if you account for the four sessions to deal with the cessation of the process) is not enough time to resolve several years of systematic child sexual abuse of almost every conceivable description, not to mention all the other issues – the bullying, the ex, and the continued unresolved shite about my father – and even mother for that matter. How can I be expected to continue to trust him in such circumstances? I mean – I do trust him, but that’s because I am deliberately trying to fool myself into not realising the relative imminence of our last sessions.

C said, to my considerable annoyance, that some people enter therapy expecting to be cured and that that’s not necessarily what it’s about (or words to that effect). I found this patronising in the extreme, especially because I have consistently told him that I don’t want or even believe in cures. What I want, and I do not think this unreasonable, is to fully explore my considerable wealth of issues with someone I trust implicitly and that is trained to explore them with me. This is in the hope that I can adequately process and in part resolve said issues, thus leading to an ability to fucking manage being mental in an everyday, vaguely normal-ish life. Oh, and this can not be achieved using the abject fuckery of either DBT or CBT, which DON’T FUCKING WORK (for me) and are not the panaceatic solutions that the NHbloodyS likes to pretend they are. So if Mr Director-Person tries fobbing me off with that old dog-dirt-coloured chestnut, he’d better be ready for the ongoing fight to step up yet another notch.

C also accused me of playing a game of mental “tug of war” with him, all because I responded to him in some really rather subtlely pass-remarkable fashion. It was a throwaway comment, but it’s not allowed to be throwaway in a psychotherapy session, is it? Everything you say, do, even bloody think (so it sometimes seems) is subject to deep analysis by the alleged science of psychology. Actually, I’m being unfair in being so bitter about that – the dark arts of psychology have helped me a little through C to date, and I do think he is skilled in them.

However, it is a character trait of mine to be unnecessarily – and quite possibly inappropriately – flippant at times. Maybe that means something in the grand scheme of things – I don’t know. But I didn’t think it fair for one particular instance of it to be singled out, especially given that I really didn’t feel I was playing any sort of games with or fighting against C that day.

And that’s really all that happened. A pointless session, just like the one prior to it had been, except on this occasion it was mainly his fault, not mine.

What else? I’m feeling alright – not great, but I’m managing. Thank you, Seroquel, my favourite drug in the entire universe (even though I simultaneously hate it too, because rather like Venlafaxine it fucks with your head if you miss or come off it). The recollections of the abuse prey on my mind, and the sense of yet another imminent abanodonment haunts my consciousness when I allow myself to think of C. IBS troubles me, as do headaches. I’m getting through Trauma and Recovery by Judith Herman quite well considering my poor concentration span, and find myself nodding with her analyses at most junctures. Despite taking the drugs at the fairly tame time of 9pm, I’m rarely asleep before 2am, and rarely awake before midday as a consequence.

But for the meantime at least, I’m surviving, if only capriciously. It’s the calm before another storm, I’m sure, but I’ll take the little I get.

Designed using Wordle.

Not the best evening I’ve had.  Cannot stop ruminating, as the above probably attests.

Alas.

I rather think I win. You – in conjunction with your unwitting co-conspirators of my father, my bullies, my ex et al – may have made me mental. Nevertheless, I still win.

I may be mental, but then so are you. At least I am young enough to have a fair prognosis, even if I have been bandied about the system unproductively for over a decade. How long do you have left to recover? What years you do have left aren’t exactly destined for great things, are they?

I don’t assume that you have a conscience, but in the improbable event that you do, those remaining years are years during which you will have to continue to live with the knowledge of what you have done, of the heinous acts of which you are guilty. Moreover, what kind of existence can you expect in social and familial terms? You have a wife that hates you, four children that are either indifferent or resentful towards you and a string of grandchildren that will mourn your passing but not do much to enrich your existence during the (most likely short) period through which it will continue. You may have a great-grandkid named after you now, but you’re old and ill and won’t live to see him and his older brother grow up. Unnatural circumstances expected, I will. Hahaha!

I’m the one with the IQ of 148 and 8 / 12 (depending on whether or not you include the ‘Hons’ bit) letters after my name. That is compared to your IQ of…hmm, circa 80? And your sum total of no qualifications whatsoever. I may not have worked for a year, but I have the intellect, capability and hopefully in future the opportunities to develop a successful working life for myself. You never achieved that, did you? What’s more, you never had the capacity to do so. And now you never will

I don’t profess to be the world’s most popular person, but I have a loving, satisfying relationship with my partner – something that you can hardly say about your dealings with your wife – and I have good and close friends that give a shit about my welfare and with whom I have had, and will have, many many laughs. Do you? No, thought not.

I may not be capable of doing much at the minute, but I have interests and will have opportunities to enjoy myself. Your existence consists of sitting about mournfully in your oppressive, Hotel California-esque* domicile and acting as an unpaid taxi driver to ungrateful, demanding offspring – though with your health as it is, you will soon lose your driving licence, meaning you’ll hardly ever leave the house. Oh well. My heart hardly bleeds.

What you maybe don’t realise is that I have the power to fuck up your miserable life even more. The chances of me doing it aren’t high, but I have that within my capability all the same. It doesn’t matter whether or not I prosecute you, not really. As your granddaughter recently observed in relation to similar allegations, mud sticks, Paedo. I now know so much more about what you have done than I formerly did, and I can completely twat you with that knowledge. One word from me and your inoffensive reputation is totally down the shitter. Hahaha!

On a similar note, although they don’t know your specific identity, many, many people sit in awareness of your paedophilia. I have the quiet satisfaction of knowing that every time I look at you

Above all, Paedo, what kind of sad, miserable bastard gets his sexual kicks from fucking children? It is truly a terrible thing to think that your life was so devoid of any sense of love, purpose and empathy that you felt that the violation of the most vulnerable known to you was an acceptable way to excite and prove yourself. How utterly, utterly pathetic you are.

Anyway, I’m an adult now and you can no longer touch me; I think you know that would be a very bad idea, that would land you in a lot of trouble. Boohoo! I may be overweight, severely mentally ill and live on the verge of social sequestration, but I have one thing you really, completely and utterly don’t – some semblance of hope. I’m intelligent, at times interesting, occasionally witty, relatively attractive and nigh on always determined. Though you may be in part responsible for the bad in my life, you are not at all responsible for conceiving the positive therein. All you have done in that regard is to act as a catalyst for me to begin to discover strength that I have always had, strength that your actions towards me most assuredly did not create.

You are nothing. Nothing. Just an all-but-lifeless, useless, sad old man. So I win, Paedo. I win. Fuck you very much indeed

Best

Pandora

* Remember The Eagles’ song, Hotel California?  There’s a line that says You can check out, but you can never leave. That’s exactly the environment in which Paedo lives.