The Inevitable ‘Goodbye’ Post

 Blog News, Life, Moods, Recovery, Work  56 Responses »
May 042012
 

Not Dead, Just Sleeping…

Happy birthday to me
Happy birthday to me
Happy birthday, dear Confessions
Happy birthday to me!

Confessions of a Serial Insomniac began exactly three years ago today with the first incarnation of the ubiquitous About page. It seems fitting and right that it meets its pseudo-demise on its birthday. It’s a nice, round timeframe.

Those of you that are regular readers will have seen this coming for months. Indeed, I’ve discussed it with several of you over the last…I don’t know, eight or ten weeks, maybe more. My passion for this place – once overwhelming – has waned profoundly, and it would feel a disservice to the blog to simply abandon it, rather than tying up its loose ends.

There’s so much I want to say that I hardly know where to start. I’ll jump in, then, with practicalities.

  • I said in a recent post that I intended to discuss my new set of sessions with Paul on the blog. I’m not going to do that after all, for which my apologies are due. I’ll outline the primary reason for this later.
  • I never did finish my series on my aunt Maisie’s demise. Again, apologies for those of you that were mad enough to be interested. To be honest, although I could have made the further details of the funeral into an epic yet dull piece of prose, not much of note really happened. Her coffin was carried up the road a bit, the eight men underneath it bulking under its weight. I once again, inexplicably, envied my cousins’ comforting of each other. Maisie was buried, atop a hill, in the sunlight. I cried again, like the sad cunt I apparently am. We went to the tedious, oppressive wake (on which, ironically, Maisie would have completely thrived). The only real out-of-the-ordinary incident was to do with Aunt of Evil. After hours of successfully avoiding the accursed woman, she managed to catch me out whilst I was aimlessly talking to her brother-in-law, Uncle of Boredom. Long story short: although she apologised to me for “whatever it was [she] ha[d] done” (as if she didn’t fucking know!), I ended up apologising to her too! I raged with myself for weeks, because I had done nothing to the heinous witch to warrant any words of atonement, but then I remembered she’d gone back to USistan without my having seen or spoken to her again, and I settled a bit.
  • Twitter and Facebook. I’ll keep them both ‘officially’ open, I think – Twitter especially holds so much history for me – but I’m very unlikely to be updating or checking either. Don’t unfollow them, though (unless you’re sick of me, which is obviously reasonable enough); you never know where and when I may re-crop up…
  • Although I’m finishing my writing tenure here, I’m not taking the blog down; it’ll still be fully accessible. Many of the search terms over the years – and the regular readers I’ve picked up therefrom – have suggested to me that some people have actually found parts of this rubbish useful, or at least enjoyable (!). I don’t want to deny others the opportunity to explore it should they so wish, and in any case the domain name and hosting are paid up until at least January 2013, so they might as well be made use of.
  • You can still contact me, though I’ll be disabling the contact form soon and, as observed, will probably not be hanging about Twitter. Instead, email me at pandora dot urquharthuxley at gmail dot com. This arrangement will most likely not be permanent either, but it will bridge a gap at least.

Now then. I suppose I should try to outline my reasons for leaving this place, my much-loved home for three years – the place where I met so many amazing people, garnered so much support and spouted so much crap that offered a surprising amount of catharsis. As I sit here and write this, it almost feels like folly to quit; Confessions has brought me so much, and here I am rejecting it. I will mourn it, and do so profoundly; it has shaped my life beyond my wildest dreams during its course, so how could I not?

But I am not this person any more.

I think there comes a time in the lives of most mental people where they realise, or accept, that they are defined by something greater than their diagnoses. For the most part, I have seen my life since 2008 – and, to a lesser extent, since I was a teenager – as an experience which was shaped by my diseased mind and its treacherous idiosyncrasies. Of late, though, I’ve begun to think differently of myself. I’m not naive, and I’m not an idealist: I have a mental illness, and although that can potentially be managed, I will almost certainly always have it. My views have not changed so radically that I now see myself as someone who has ‘pathologised her humanity‘ or some such other patronising fucking nonsense. Nonetheless, ‘mental’ is no longer the first word jumping from my lips when someone asks me about myself.

I suppose I could adapt Confessions to reflect this – I could write about gaming, books, pubs I like, holidays I’ve been on. But it does not, in any fashion, feel right; this has always been a blog about mental health, and I feel it more apt to let it stay that way. So as I as a person move on, so must my blog.

There are wider issues than just this, of course. Logistically speaking, I don’t always have time to write here any more, at least not in the essay-ish style to which I’ve always been prone. Again, I feel it would be a disservice to the legacy of what I’ve done with this journal to modify my writing style to facilitate shorter posts; it’s just not what this all became over the course of its life. I’ve had it said to me by a few people that my longest posts – probably because they’re the ones in which I’ve become most immersed – are my best, and I’d rather be remembered for that than for something that just dribbled dry over time. At the risk of employing a vulgar cliche, as Neil Young (and, more famously, Kurt Cobain) put it, it’s better to burn out than to fade away.

Additionally, to quote one of my favourite writers who has also lately bowed out of anonymous blogging, I am tired of pretending. I’ve long-since hated the anonymity that this place affords me – not because I hate the persona that you all know as Pandora, for she has become an irrevocable part of ‘me’, and despite it all, I actually don’t hate myself (and am not sure that I ever truly did). It’s because I am not ashamed of who I am, of who I have become, of what I have, and of what I don’t. The matters discussed on this journal have actively required that I cloak myself behind a pseudonym, but, again, I no longer see myself as someone solely prescribed and designated as a victim of sexual abuse or vicious hallucinations. To that end, I presently don’t need my anonymity (at least for pursuits unconnected to this website).

The final straw was in therapy recently. Nominally, Paul and I were having a proper therapeutic conversation, though he did at the end comment that it had been a strange session. It was, because I was not properly in it. Thankfully – or not – that had nothing to do with fucking Aurora; it was me playing games with myself. To get to the bloody point, I was sitting there considering in detailed terms how I could frame our discussion in dialogue-driven, prosaic terms – did he raise an eyebrow here, did I sneer at something there? – for this blog.

That is not healthy. I knew right then that I had to stop writing here. Therapy is meant to be a life-enriching, remedial experience; it’s not fucking blogging fodder. In the sessions that followed, having made up my mind to close things down, we were able to do much more fulfilling work together.

Naturally, this has a downside; I am unable to express to A, for example, the kind of material covered in session. I regret that, but I feel that healthy psychotherapy is more important for all concerned than others having insight into the process as it happens to me. If that sounds blunt, please forgive me: my point is that if I am unwell (as, without adequate, concentrated treatment, I will be), then everyone around me is affected. That’s no more fair on them – and probably you, as a reader – than it is on me.

I am a horrendously jealous person – I freely admit it. When I log on to that bloody curse that is Facebook – I really should deactivate it yet again – I see people I went to school with having brats and developing the careers they always wanted. I’m not envious of the former per se because, as you know, I’m childfree. But I am jealous of them having what they want, and of their apparent happiness with their lives.

But, you know, when I think about it all in context, when I think of all I’ve faced and all I’ve done – or at least tried to do – it doesn’t seem quite so bad.

I didn’t have the best start in life, whether through social factors, chemical ones or ones relating to my own psychology (or, in my view, a combination of all thereof). I could have let my resulting mental illness fuck me entirely – and at times it nearly has, and indeed it still might – but I fight with every weapon my arsenal allows me; I actively try to help myself get better. I engage with all services available to me – psychiatry, nursing and therapy (indeed, I had to go out of my way to secure the latter, after NHS Psychology shat on my face, rather than lying down under it like I could have done). I co-operate with them all despite the fact that they – like almost anything – are not perfect, because I don’t want this non-life any more. I want that sense of contentment that those twats on Facebook appear to have.

Although I’m still ill, I refuse to tolerate the idea that I should stay on state benefits indefinitely. That is most indubitably not to say that mentals (or anyone else with a serious and/or enduring illness) should be forced off ESA and other benefits. Fuck the Coalition and their myopic, dangerous biases; our first concern as a society should be to support individuals who are disabled, ill and/or vulnerable, rather than lowering taxes for people who can afford to fucking pay for them.

Still, I ultimately want to be self-sufficient, despite the perhaps precarious position in which I find myself. It may not happen any time soon, but I want to, when possible, try.

I’m pragmatic enough to realise that my illness can’t be cured, merely managed, and as such although in an ideal world I’d go back to a more traditional job, I realise that it may (and only ‘may’) not be possible (or at least sustainable).

So, for now at least, I write. I consider myself a writer now, regardless of whether others think the title narcissistic or grandiose. This is partly why I don’t have as much time as I once did for Confessions; it’s sad, but it’s real. As my best mate Dan (himself a full-time staff journalist) discussed the other day, I’ve made genuine in-roads into turning what was once a vague fairytale idea into a reality. I’m talking to Editors, engaging with the low-paying but still useful services of guru.com and eLance, getting my (real) name out there…and I’ve applied for a voluntary job which will involve, if I get it, writing for the local rags about mental illness. Most of my writing to date has been in relatively specialist publications and websites, so writing for the papers – a more mainstream pursuit, with wider readerships – would be a welcome challenge, and indeed a useful addition to my portfolio.

Oh, and The Book? It’s back on :) I’m also half-minded to try and novelise this blog at some point, but that would be an immense piece of work – even harder than a random piece of fiction, because it would require endless re-working of Confessions, rather than putting a bunch of ideas down on paper and formulating them into prose. If The Book ultimately has any success, I may be buoyed to work on such a monolithic task, but we’ll just have to wait and see.

My writing ‘career’ may fail…but, again, I’m trying to make something of my life. It’s very difficult right now, what with not being fully well, and there are days when it’s impossible to face. There are days when anything is impossible to face. But I’m starting, and that’s got to count for something. If it goes tits up – yes, that’ll be disappointing. That much goes without saying. But I’d rather have that potential outcome than that in which I didn’t give it a damn good go.

And I feel a little better each day. A bit less depressed, a bit less despairing, a bit more positive, a bit more hopeful. My current medication cocktail, combined with an ever-excellent psychotherapist, has brought me closer to wellness than I’ve been in a very long time, despite the truly abysmal year this has been, circumstantially, so far. As I said way up above, I no longer see myself entirely through the lens of a mentally ill kaleidoscope.

In the years since my most recent breakdown, I’ve often cursed my psychic misfortune (aside from the fact that no, I still probably wouldn’t flick the sanity switch were I offered the option). Further, I’ve cursed this blog (sometimes for valid reasons, sometimes just in rage-fuelled piques). And yet…look what both my madness and my blogging have brought me.

  • A half-credible chance to use my afflictions to facilitate a respectable career, whilst simultaneously advocating for others in the same shitty boat.
  • Most importantly, I have met some of the most wonderful people in the entire known universe – people who (God/Buddha/Allah/Flying Spaghetti Monster/Richard Dawkins willing) will be lifelong friends.

Throw in the gratifying fact that I’m in a long-term – and, more crucially, happy – relationship with a loving, accepting partner. Multiply that by the other genuinely meaningful and life-changing friendships I have managed to forge throughout my life – Dan, Brian, Aaron, lots of people that are not close friends but that are certainly more than acquaintances. Minus the disastrously dysfunctional family, but add to the list a loving mother – something that not everyone is fortunate enough to have.

When I think about things thus, when I examine my life as though it were the Bayeux Tapestry, looking at the ‘bigger picture’ (I hate that fucking term) – well, I feel privileged.

And at the risk of repeating myself, in these circumstances, I find myself sometimes thinking, “do you know what, Pan? You ultimately did well, girl. You did well.”

And, for now at least, that’s enough.

Is this completely ‘goodbye’? Not necessarily. A number of you already follow another blog I write, and I will consider requests for the URL from others (email me as per the details at the start of the post, though please do not be offended if I don’t respond with the address; I don’t write exclusively about mentalness there, and don’t want it to become what this blog has). Furthermore, I may add the odd update here once in a very occasional while. And let’s not forget that when Maisie died, despite my pre-existing intention to wind down Confessions, I immediately gravitated here and ended up writing quite a lot; as it had been so many times before, the blog was my haven and lustration. Right at the top of this entry, I used the words ‘not dead, just sleeping’. So, when things inevitably go downhill again, or when some other life event once again sends me down the figurative shitter, this place could be resurrected. So do keep me on your RSS Readers and social media profiles just in case :) I’m not offering any guarantees, and I’m certainly not saying it’s even likely. It would be folly to rule anything in, or rule anything out, though, so there you have it.

Whatever happens, thank you for sharing this madness with me. Your support, tolerance, friendship, and even love has made my life better – and literally saved me on occasion. I’m pretty convinced I’d either be dead or much more seriously ill than I presently am had it not been for the amazing people I’ve met through writing here.

In the parting words of the Ninth Doctor: you were fantastic – absolutely fantastic. And do you know what? So was I!

Farewell, my loves. Cue trite, manufactured, but tackily appropriate song from (who else but?! ;) ) Lunatica.

[youtube=http://www.youtube.com/watch?v=j1ntfvsS_gU]

…And the NHS Cocks It Up Again

 Christine, CPN, NewVCB, Psychiatry, Triggers  14 Responses »
Feb 102012
 

I had a psychiatric appointment on Wednesday morning. In terms of interaction with NewVCB regarding myself, it was fairly unremarkable. I apprised her of the various events that had occurred since I’d last seen her – Maisie’s death; seeing Paedo; the fact that the doctor’s bloody “surgery” screwed up my Lamictal script for several weeks; the kitten, Srto Gato, had temporarily (yet stressfully) disappeared (the latter two being stuff I’ve not ((yet)) discussed here); and that I saw Paul again.

Essentially, although she had intended to decrease my dosage of Seroquel at this appointment, she decided against it because of the fuckery of the last few weeks. She wants me to get back on some sort of even keel that involves a minimum of external stressors before pissing about with the stuff, an assessment with which I agreed wholeheartedly. I said, “in light of particularly stressful events that previously occurred with various personnel from [Hotel California], I was very, very glad to be taking anti-psychotics over the last few months.”

NewVCB understood. Although 400mg, the dose to which we are intending to reduce the Seroquel (at least in the short-term), had at one point prevented some of my psychotic symptoms, given that the last six weeks or so have been really shit, it would be ill advised to take any chances at the minute.

I did ask about increasing the Lamictal, however. I’m currently taking 100mg, and my internet readings have suggested the therapeutic dose is generally between 150 – 200mg. NewVCB disputed this, though; she said that 100mg is the usual standard in the (admittedly uncommon) circumstances in which she prescribes it.

“I’d prefer to keep it at 100mg for now,” she advised, “in part because you had a break in it enforced upon you, so it’ll take some time for you to entirely re-adjust to it. Thus it’ll take a few weeks to see its full effects again. Then, we can see.”

That seemed fair enough. In terms of the Seroquel, I said to her that I’d lost a lot of my appetite in the last, say, eight to 10 weeks, so at least in terms of weight gain, reducing the dose wasn’t as ‘urgent’ as it had once seemed. I told her that I’d read that Lamictal could sometimes cause weight loss, or at least a reduction in appetite, and she confirmed that this was indeed the case from time to time. She said she was pleased that this had been the case for me, not because she dared to opine that I had a plenitude of blubber surrounding all corners of my body (though clearly I do), but because she knew how annoying my weight gain had been for me especially when I’d been losing so much of my pre-existing fat until I started taking 600mg of this heinous drug.

And that was pretty much that.

Except that it wasn’t.

“Um…now, Pandora, there’s, er, something I need to discuss with you,” she said ominously.

Oh my fucking God. She’s leaving. Oh fuck! Fuck! Just when I thought things with the NHS were actually getting me somewhere! The incipient dread I felt as soon as each word of the sentence left her lips grew overwhelming very quickly.

“The NHS are changing things again,” NewVCB sighed.

Again?! [I can't find any posts on this, aside from my review of my first appointment with NewVCB, but it was due to NHS changes that my consultant was changed from (Old)VCB to her in the first place, and that was only two years ago. What the fuck? More bureaucratic - and no doubt costly - bullshit from the fucking NHS. What a sack of shite!].

She saw my face, and shot me a sympathetic glance. “I’m moving to [Big Scary Hospital],” she said. “Until recently, it was just assumed that I’d take all my patients from your GP’s surgery with me – but…God, this drives me to distraction! They’re re-drawing geographical boundaries, so right now I don’t know what’s going to happen. I may or may not be taking all such patients. I really have no idea at the minute.”

She was clearly frustrated by this fuckwank herself.

I drew a breath, then ventured, “Obviously – and I know you can’t do anything about it – I’d prefer to ‘stay with you’ if I possibly can.”

“I know. I know. I wish I could give you something more concrete at this stage, but I can’t unfortunately.” She shook her head and twisted her mouth in obvious vexation.

She continued by asking me exactly where my address was in the area, but although I could see her trying to mentally calculate whether or not the house was affected by the boundary change, she came up with nothing but a blank.

“When is this taking place?” I asked. “I mean, if I don’t move with you, will I see you again?”

“Oh, yes, yes – I’ll see you again in six weeks or so. This shouldn’t be happening until two to six months hence.”

I nodded, but something else occurred to me then. “Assuming for a minute that I do move with you. What about Christine?”

“Well. In the long-term, they’re planning on moving the whole team – whatever ‘long-term’ means. But it certainly won’t be any time soon, so if you come with me, you’ll have to get another CPN.”

FUCK!

“And if I don’t go with you..?”

“Then you’ll still have Christine, here, but you’ll be moved to a new consultant.”

FUCK!

This is so fucking unfair. Just when things were going so well with my psychiatric team. Having both a CPN and a consultant that you really like, both seeming to genuinely want to help you – that’s not at all common, especially in this bloody Health Service. And now, regardless of what happens, I’m going to lose 50% of that to a quantity entirely unknown. For all I know, the replacement for either the psychiatrist or the nurse could be fucking amazing – but my longer-term experience of the Psychiatric Service does not lend me to having a great deal of hope about that. Furthermore, even if the person were brilliant, I’m happy with things as they are. I like them! I like NewVCB and Christine! I want to stay with them both!

Don’t cuntwits like Mr Director-Person – who, as the head of mental health at the Trust, is at least partially responsible for this idiocy – realise that this kind of upheaval is likely to only increase illness, and therefore increase costs? That, as a mental, it takes long enough to become settled with members of staff – and that breaking that confidence and trust is likely to lead to breakdowns, misery and crippling anxiety?

Well, of course Mr D-P doesn’t realise that. He doesn’t realise anything about mental health, because he’s nothing more than a general manager, and always has been – he comes from a business-y private sector perspective, that isn’t even remotely tangential to mentalism. So no, despite all the fucking risk assessments they’ve no doubt claimed to have undertaken, he and his cronies have no idea what it’s like on the fucking ground, in the fucking real world, of someone with (a) mental health condition(s). It’s alright for him to sit in his inviolable ivory tower of an office, and play about with geographical lines on a computer (or, more likely, ‘getting his secretary to play about with geographical lines on a computer’ whilst he plays that little mini-golf game you always see executives figuratively masturbating over). It’s not alright when the ramifications of that feed back down to patients who are, as a direct result, going to suffer like fuck.

And nobody can do a damn thing about it. Fuck the Trust. I can’t for the life of me work out what it is that they care about, but it certainly isn’t their patients ‘service users’. Bastards.

Initial Side Effects of Lamictal…and a Long Overdue Rant

 Life, Medications, Moods, Psychiatry  16 Responses »
Nov 182011
 

If you follow me on Twitter, you may have been the unfortunate recipient of a number of tweets yesterday evening that contained almost epic levels of ranting. I had written an entire post for this blog on A’s iPad, which, whilst better for typing than our iPhones, is not as conducive to creating lengthy prosaic lamentations as a proper keyboard. Unfortunately for me, I’m in my laptop-phobia zone this week, and to that end only the iPad and the iPhone are safe for use (don’t ask for an explanation of this fatuity, because I don’t have one. Maybe I’ve simply grown to hate Windross so much that I fear even seeing it. Time to put Debian on the laptop, perchance).

Anyhow, I was a complete moron and decided to use the Blogpress iOS app to aid me in this ignoble endeavour. Just as I had finished, with the usual laughably stupid length of post completed, and went to save the entry – the cunting, fucking, shitting bastard of an application died on me. I lost every single word. I tried all the usual wank in an attempt to save it – close the app, turn device off and back on, etc – but circa 2,000 words and just over an hour of my time were lost to the dark realms of the e-ther (geddit?!) and try as I might to continue the rescue effort, the bloody thing just crashed, crashed and crashed a-fucking-gain. Shitting fuckery hell and bollocks.

So, iOS V users – don’t use Blogpress, OK? Not, at least, it’s been thoroughly updated and tested. It used to be a great wee app – it is, ostensibly, a much more fully featured blogging program than WordPress’s own. But at least (eventually) the latter fucking works. So that is where I find myself as I type this attempt at a re-write.

First though…

JESUS FUCKING CHRIST BUT I AM SO ANGRY. THE POST WAS ACTUALLY NOT BAD, UNLIKE FUCKING EVERYTHING I’VE WRITTEN FOR MONTHS. I WOULD HAVE BEEN FUCKING CUNTED THE FUCK OFF IF THE BASTARDING PIECE OF FUCKWITTAGE LOST A MORE CHARACTERISTIC LOAD OF FUCKING SHITEY CUNTFLAPPED BELLENDERY, BUT THE FACT IT LOST SOMETHING VAGUELY NOT COMPLETELY BLOODY AWFUL MAKES ME WANT TO SMASH THE LIVING BECHRIST OUT OF EVERYTHING. YOU CAN NEVER BASTARDING WELL REWRITE SOMETHING TOLERABLY BLOODY PASSABLE TO THE SAME PSEUDO-ALRIGHT LEVEL AS IT WAS THE FIRST SHITHEAD OF A TIME YOU FIRST BLOODY WROTE THE BOLLOCKFIST OF A FUCKING THING, SO WHAT FOLLOWS HERE WILL BE BACK TO MY USUAL DICKHEAD STANDARD OF UTTER COCK. FUCK TO THE ENDS OF ALL THE KNOWN BALLWIPED DIMENSIONS. FUCK. FUCK. FUCK.

Well, it’s been a while since there was a proper rant here, hasn’t it? And lo, I used to be the Queen of Rants in the Madosophere. But anyway, now that we’ve got that out of the way…

I’m having some difficulty adjusting to Lamictal. Don’t worry, if you’re one of those odd people that may in some way give a flying arse about my existence, there’s no “FUCK I’M DYING” rash or anything. But the drug has brought me an insane level of fatigue (for example, I nearly fell asleep yesterday afternoon whilst playing Saints Row: The Third, which had delightfully arrived here early. I mean seriously, what the actual fuck? No one with even five per cent of a pulse falls asleep whilst playing Saints fucking Row!!!), my eyes have gone cross-eyed, my levels of forgetfulness that began with Venlafaxine (curse it) are amplified to objectively hilarious points of pseudo-dementia (cf. in people’s company a few days ago: “A, what’s my name again? Oh yeah. And, old chap, should you be so obliging as to advise me on the word one uses to intimate the device used to take a crap? Yes! ‘Toilet’. That’s it.”) and my regular migraine-level headaches are now even more frequent. The last point is especially irritating as, in off-label indications at least, Lamictal is used to treat headaches. Go figure, eh?

The exhaustion is not simply that frustrating but familiar kind of languorous weariness to which we are all often slaves – oh no, this is hardcore stuff, even by my own insomniac standards. It’s that kind of exhaustion that is like an gaping vault of oppressive darkness, sucking you in, dominating you entirely, screwing with your mind until it hurts but rendering you useless to do anything about it. It’s that kind of interminable, preponderant bleak tiredness normally wedded to the very worst of depressions – you know the ones I mean. That old familiar hangdog horror in which rising from your bed is not just a difficulty, but an impossibility. The old foe that leaves you helplessly staring at the wall, willing it with whatever mental faculties you have remaining to somehow show you some mercy and let you die. The old knocking on the door of the mind that reminds you that you have no escape, because you are utterly devoid of enough motivation to even end things yourself. The old living hell that seems unresolvable.

Normally such exhaustion and a depressive hell are thus united – but not in this case. It would be a lie to say that the tiredness does not impact upon my mood in some fashion, but for someone whose mental agility and body alike are so heavily enervated, I actually feel pretty stable in this regard. Indeed, Null thinks I’m high. As I was trying to write the original of this post last night (RIP), I must confess that I did wonder that myself; the style of my prose, whilst slightly better than my shitty norm, did have something of a manic quality to it (perhaps that’s exactly why it was slightly less rubbish than as is typical!).

Allow me to exemplify how OK I am, despite Lamictal’s nefarious side effects. I have exactly £1.06 to my name right now, and even that’s part of my overdraft – yet I am not panicking like an old lady denied her copy of her all-important Bella magazine like I normally would; instead, I’m tolerably riding the wave of patience until I get paid next week. It’s November, and I don’t want to run out and throw myself off the nearest bridge or towerblock. Indeed, even bastarding, fuckwitted, hateful, cunting Shitmas has been surprisingly kind to me this year: the hackneyed and improbably dainty ads for the accursed capitalist nonsense only began registering on my radar about six weeks in advance of 25 December, rather than the 12 or 13 weeks to which I am normally frustratingly used. And, next week, off I go to London, where I am short-listed for a Mind Media Award. I am excited, rather than entirely petrified, by this. I mean, of course I should be excited – but as someone with social anxiety issues which are, at times, very severe, it’s a surprisingly gratifying thing that being faced with being in such a busy venue with – dun-dun-DUN! – famous people does not scare the living bejesus out of me right now.

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Lest anyone think I’m in the midst of a narcissistic delusion of grandeur regarding the awards ceremony, no, I do not – not for half a second – entertain the notion that I could possibly win the award. No way. But it doesn’t matter; what matters is being there. It is enough to have the opportunity to meet some incredibly interesting and highly influential individuals operating in the arena of mental health; it is enough that someone, somewhere has considered this silly blog even worthy of mentioning in the same breath as some truly excellent anti-stigma and exploratory material; it is enough that I dare to see my name listed in honour of the late Mark Hanson, a stalwart of the social media world who suffered from horrendous depression; and it is enough that I have the opportunity to see some of my wonderful old friends and, indeed, to meet one of my oldest and most supportive online friends for the first time (so excited, bourach! :D ). Although it would be beyond absolutely incredible to win, to be in the position I already am is more than enough.

So, although I’m fighting medication side effects from every angle, I’m doing relatively well. As for the side effects themselves – well, according to most of the literature on Lamictal, they will pass. Indeed, I already feel them abate, ever so slightly. As the days pass, my eyes will blur things a little less, my energy levels will increase a little more, and my headaches will revert to the mediocre but liveable standards to which I’ve long been accustomed. Maybe the current drug cocktail will, in the end, work for me after all.

What’s that you say, fair reader? “Oh dear God, Pan’s defining characteristic of cynicism has been lost?” No, fear not – I have not become so washed away by some sort of bright absolution that I have become an optimist. Christmas still sucks, the world is still a cunthole, I’m still an infernal misanthrope and I still can’t stand the sight of happy couples frolicking around the shops like some sort of silly vapid bunnies. I’m just a misanthrope that can’t stand the sight of happy couples frolicking around the shops like some sort of silly vapid bunnies who happens not to feel opprobriously atrocious for once.

If you don’t like that…suck it up ;)

(NB. I haven’t proof-read the above folks, sorry. I humbly beg your forgiveness for any poor turn of phrase, grammar, spelling etc, and I shall endeavour to correct such issues at my next available opportunity. Toodle-pip!).

Livin’ La Vida Lamictal

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

Good afternoon my beauties.

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

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

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

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

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

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

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

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

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

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

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

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

I nodded, seeing what she meant.

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

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

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

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

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

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

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

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

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

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

So. I currently take the following medications:

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

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

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

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

Hypomanic Hogwash (and Seeing the CPN)

 Christine, CPN, Life, Moods  6 Responses »
Nov 022011
 

Having finished my posts on the first stint of therapy that I had with Paul, I’ve been left feeling surprisingly disenfranchised as regards my writing here. By that I mean that I have no idea whatsoever about what I should write. I mean, when I hadn’t finished the stuff on Paul, I procrastinated and procrastinated, and avoided having to tackle those posts by thinking of other inane stuff to throw at these pages. Now, in stark contrast, I can think of nothing. This is what might be known as a ‘fail’.

So, then. Let’s go with an obligatory ‘I had an appointment’ post. This one was with Christine, my CPN, on Tuesday.

The weekend had been an odd one. If you follow me on Twitter, on Friday night you might have seen why. I was behaving in a completely out-of-character fashion: gushing about how much I loved everyone, ravingly extolling the virtues of random Babylon 5 YouTube videos to people whose names I failed to correctly spell, wittering on (admittedly with my tongue firmly planted in my cheek) about how fucking awesome I supposedly was, asking people to participate in C(o)untdown contests (what the fuck?!) and generally going about screaming (or whatever the equivalent is on Twitter) “WAH!” and “WOOOOO!” and suchlike. What. A. Freak.

Saturday was better, but marginally so. The in-laws, who are selling their house, were throwing a party – ostensibly for no reason, but it felt like a ‘goodbye to Nice House in Shite Town’ kind of event (though, that said, as far as I know there have been no offers or any meaningful inquiries about the sale). Anyway, after visiting A’s father and step-mother who live relatively close to his mother and step-father, off we headed to the abode of the latter. And, although I was conscious enough of how mental I’d been behaving on Friday night and sought to curb the obvious signs of same on Saturday, I generally behaved like a twat then too. My sister-in-law, very drunk at one stage, welcomed what she appeared to see as my enthusiasm (ha!), as my mother-in-law seemed to do also. My own mother, however, was less impressed. (I forget the expression she used, but it was probably something along the lines of “catch yourself on,” a Northern Irish colloquialism that I have always loathed due to the unavoidable fact that it makes absolutely no sense in terms of syntax).

At one point my mother particularly riled me by throwing a blithe back-handed insult in my general direction. I can’t be arsed to go into the specifics, but Clarissa has cogently written about her own mother’s infuriatingly similar behaviour here, so read that if you want to get a feel for what I’m on about. This remark ignited an underlying irritability, masked by my ostensibly great mood, and I called Mum up on it, but of course we ended up getting sucked into the usual pointless circle of blame: “I’m always to blame”, “No, I’m always to blame,” yadda yadda yadda. So rather than fight it out with her, I sat down silently beside her, then suddenly started telling her why Anthony Burgess had decided to write A Clockwork Orange. My mother eyed me with bewildered suspicion, and after listening to 10 minutes of myself rabbiting on, I felt compelled to join her. A Clockwork Orange is an incredible book – one of my favourites ever written – but seriously, what the fuck? My pseudo-scholarly analysis of the background leading up to it was one of the best examples of a personally acted-out randomness that I can remember since my school days with Daniel (one such recollection: my mother was out at golf one evening, so Daniel and I ended up playing the fools by wearing cushions on our head, grabbing an abandoned curtain pole, and running up and down the quiet street squeaking, “weeeeeeeeeeeeeee! WEEEEEEEEEEEEEE!”, all whilst each holding one side of the pole. And that’s just one such example).

So yeah. I was mad. Someone’s going to come on here and ask if I had been drinking; well, that’s in the affirmative, but honestly – this was notlunacy fueled by alcohol consumption. If anything, knowing things were a bit weird, I was more measured in my imbibing that I otherwise might have been. And alcohol, even mixed with the current medications that I take, has not in and of itself ever affected me like this. Other people’s mileage may vary, but that is mine.

On Sunday and Monday, although I behaved apparently fairly normally, my brain was certainly hyper, and thoughts seemed to race through it faster than the speed of light. Until Monday evening, that is, when I promptly and suddenly fell about 80,000 figurative parsecs, and was paralysed by a deep – but mercifully brief – depression.

Essentially, the above tale characterised my meeting with Christine on Tuesday morning. She asked a lot of questions about my behaviour and mentality over the weekend, to the point where I was beginning to wonder if I was in some sort of bizarre Capgras situation wherein she’d been replaced by a GCHQ operative quizzing me about whatever act of criminality or terrorism they might like to pin on me (not really, by the way. That was a demonstrative hyperbole, not my actual thought process):

  • Had I been irritable (yes)
  • Had I been sleeping normally (no – if ‘normally’ means well, that is)
  • Had I slept at all (not to any meaningful extent – a couple of hours here and there maybe, were I blessed with a lucky night)
  • But had I not needed any extra sleep (apparently not – highly unusual)
  • What had my energy levels been like (jumping around the place like a twatting hyena on crack)
  • Had I dominated conversation (it varied from person to person, but in most cases I must have seemed like a self-obsessed bastardface – so yes)
  • Was I able to curb any compulsion to talk (no, fucking babbled endlessly on about every piece of meaningless minutiae pertaining to any given subject)
  • Had I been afflicted with racing thoughts (yes, to the point where it felt like a cognitive kaleidoscope was exploding over and over and over again in my head)

You get the picture. She had started her analysis by saying that it may be difficult to distinguish whether this wankery had been a simple good mood or an episode of hypomania, but as I answered the questions put to me one by sorry one, she noddingly came to the conclusion that it was, in all probability, the latter.

The distinction is one I find hard to make myself especially as, as Christine noted, a genuine good mood is a very, very rare thing in my life. On this occasion, however, my behaviour had been so horribly out of character that I had to agree with her final assessment: I was probably mental.

I got myself into quite a tizzy about it. Firstly, I tried to claim that it could not have been a hypomanic episode, because it only lasted a few days. She refuted that, stating predictably and reasonably enough that there was great variance in the duration of such moods across everyone afflicted by them.

OK then, but the last time I remember being hypomanic to any notable degree was – fuck me, it must have been 18 months or more ago. (There have been very minor instances of it since, in the sense that they’ve only lasted for one evening – and, curiously, seem to be the exclusive…er…privilege (ha) of my visually impaired friends. I cannot stop talking when I see them, and I’m restless and jump about and make too much noise and pace and flit from topic A to topic B to topic fucking Z). I’ve certainly had what I believe to be mixed episodes in that time – those have been a sorry staple of my life for quite a few years now, though I only realised they had a name after I started writing this blog – but hypomania has been relatively and curiously elusive (and, indeed, its big brother – the full-blown euphoric mania – has been more or less non-existent).

Given the good mood that accompanies episodes like this, I was, on Twitter, heard (seen?) to express a murmur of regret about the paucity of them in my life. However, La-Reve promptly and correctly reminded me that hypomania – whilst better than actual mania (which she has experienced, even if I haven’t) – is actually rather shit. This is true, for two key reasons. One: the higher you are, the lower you fall. Two: actions have consequences.

By the latter point, I mean that, when I had calmed down, I was absolutely and completely fucking affronted by my behaviour. I am not like that. I am known in certain company, that of my in-laws for example, as someone who enjoys a laugh and a bit of craic – but not as someone who jumps around elated, squealing in wide-eyed delight because someone suggested putting a fucking CD into the presiding hi-fi. I am, I hope, known on Twitter as someone who really does care about the people with whom she’s developed genuine friendships – but (I hope) not as someone who wastes bandwidth CAPITALISING EVERYTHING SHE FUCKING TYPES TO TRY TO MAKE THE POINT THAT SHE LOVES EVERYONE SHE’S EVER SPOKEN TO (BECAUSE, WHEEEEE, ISN’T SHE JUST SUCH AN AWESOME PERSON) EVEN MORE CLEARLY THAN SHE ALREADY HAD (or, in greater likelihood, quite the opposite).

So yes, I was (and am) embarrassed, and I told Christine so. She shrugged it off a little; whilst she feels that this was a hypomanic intrusion, she also thinks that I behaved as some more extroverted people might generally act as standard. The assertion irritated me slightly; it is, indubitably, true – but it is not true for me. If I were a natural extrovert, laden heavy with an arrogance that blinded me, then of course it wouldn’t matter – but I’m not. I’m me, and the person I was last weekend didn’t correspond to my self-perceptions at all. Other people’s norms do not matter in this equation.

Christine asked me when I was next seeing NewVCB, and I responded by stating that it was next week (Wednesday, I think). She appeared glad to hear this, and asked me if I was still OK with possibly going down the mood stabiliser path. I confirmed that I was, especially in light of all this shite. She acknowledged that she had some concern in that regard too.

We talked about Lithium versus Lamotragine. Reading between the lines, she seems to favour the former, but my preference is distinctly for the latter. Despite the contents of this post, as most of you will be aware, my symptoms – if I even have a form of manic depression at all – are very predominantly depressive. Secondarily, I’ve heard of people putting on weight on Lithium – and since that’s the primary reason that I want to reduce my Seroquel intake, it feels like taking it to mitigate Seroquel’s lost mood-altering effects could be a false economy. Lamotrogine, by contrast, seems to carry a greatly reduced risk of weight gain; indeed, I’ve read that in some cases it actually seems to reduce the bulge.

Not that I’m unwilling to experiment, mind you. It’s just that my first preference is for Lamotragine – if, for whatever reason, that fails to function as I hope, then I’d be ready to at least try Lithium.

At my mention of depression, Christine asked had that more generally characterised my mood since I’d last seen her. The answer to this was ‘not really’ – but, when a greater timeframe is applied to the question, it would have to become ‘yes’. In June, say, I was feeling pretty positive, and felt that my outstretched fingers were within mere inches of grasping the branch that is recovery. Now, although I don’t feel hideously awful, that former optimism has become a shattered reality, unobtainable and out of reach.

I exemplified it to her thus. A has observed over the last four or five months that things with me have been on a slow but definite downwards slope; apparently, at increasingly frequent intervals, I have exhibited a general aura of malaise and despondency, I have all but completely lost interest in leaving the house alone, and I’m really avoiding things that have traditionally given me pleasure. Although of course A cannot be said to be entirely objective – he is, after all, emotionally invested in me and my well-being – he sees things without the internal bias that the mind of a mental (or of anyone, in relation to themselves) inevitably creates. I might have said that I was plodding along with relative ease; his testimony highlights a more truthful version of reality.

Christine said that she would discuss what came up in our appointment with NewVCB before my meeting with the latter. She went on to ask about psychosis (nothing much), dissociation (nul points) and then, to my consternation, therapy. It wasn’t her fault that I was slightly dismayed – it’s Nexus’. I reapplied to see Paul again about five weeks ago, and although they confirmed I’d go back on his waiting list, I’ve heard absolutely nothing from them since. This is, as you might imagine, frustrating.

Christine asked if it were possible that my decline in spirits was related to the absence of therapy. Although I believe that I have melancholic (as opposed to reactive) depressive moods, it would be churlish of me not to entertain this as at least a possibility. Indeed, I think A has noticed a slight correlation, and I told her so.

It was therefore agreed that if I haven’t heard from Nexus by the end of this week (ie. tomorrow, since I’ve heard fuck all in the time between seeing Christine and now), that I would send a polite and brief follow-up email asking what the craic was. I kind of feel uncomfortable about doing so, as it seems to me that I’m making demands on the charity’s time – but in rational terms, I suppose a quick email is hardly the work of a servant of Satan. At the end of the day, I’d rather know what was going on than not.

The session (with Christine) drew to a close with a conversation about the awards ceremony, and my going to London at the end of the month in general. I shared with her that although this crappy blog being short-listed for something so prestigious, something so fucking big, is an honour of the like I cannot adequately hope to express, that I have a certain amount of anxiety about the ceremony itself. It’s a big deal; there will be a lot of people there, and many of them are household names (that said, that will probably mean damn all to A and me. We know nothing about most celebrity types). Let’s not forget that I have social anxiety on top of everything else!

She amiably and empathetically acknowledged this issue. “But,” she added, “you have as much right to be there as they do!”

Well, because of the appalling taste* of the short-listers, apparently I do ;) [* Comment applies to this entry alone, and not the other four in my category, nor nominees in other categories either. The short-listers have great taste in some of those!]. I mean, yeah, I’m nervous – how could I not be? – but although I honestly don’t think I have a cat’s chance in hell of winning anything, I still see much opportunity in going to the event. So I’ll be shitting a brick, but I’m still excited.

Also, I seem to have organised a fuck of a lot of things during our sojourn, meaning that I’m not actually 100% sure if I can ‘do’ a mini-Mad Up or not :( I’m finally meeting the wonderful bourach for the first time, I’m seeing my best mate Daniel, plus another lovely friend, CVM – and, when you take the ceremony into consideration, that leaves me with very little free time. Christine provided wise counsel on this; it is not a good idea to over-exert myself on the trip, especially when I’ll probably be an anxiety-ridden mess anyway. I’m not completely ruling it out, you understand, and even if I am, I’ll be back in England’s green and pleasant land in the not-too-distant future anyway. Let us see, yes? Please forgive me in advance, if it doesn’t happen? *begs like a puppy*

Christine and I parted after arranging another appointment just before A and I head off to the mainland. To her credit, she realises the magnitude in my life of this trip, and accordingly wants to offer extra support where she can. Not everything about NHS mental health services is completely shit.

Anyway, things are mostly back to normal here. I’m aggrieved that I’ve had so little time to hermit this week because of the aforementioned appointment, having to get new tyres on the car and, tomorrow, having to take the car to my mechanic in preparation for his MOT (‘his’ in that clause is not a typo. I do anthropomorphise my car). Next week is even worse, and I crave solitude and social tolerance of my agoraphobia. But I don’t seem to be even remotely manic, which is good, and I’m not overtly particularly depressed, which is even better.

If you notice anything out of the ordinary on Twitter this weekend, I want you all to beat me with a big stick. OK? OK. Good.

Good night, lovers. <3 xxx

Any Thoughts on Depakote or Lithium? ***¡Advice Please!***

 Medications, NewVCB, Psychiatry  53 Responses »
Sep 132011
 

Saw NewVCB last Wednesday morning.

Not much to report, really, and even if there was, as you’ll be able to tell from the appalling calibre of the following, I’m still not really in the form needed to competently review it.

She asked how things were and told her everything was fucked, thanks to my idiotic decision to reduce my Seroquel dosage. She checked that I was had gone back up to the 600mg dose, and I confirmed that I had, and had been doing so for about a fortnight.

Long and the short of it is that she claims it’ll take up to six weeks back on the high dose for things to start to improve. Wonderful. Well done, Pandora. It would be less annoying if it wasn’t my own fault. She encouraged me not to berate myself – she says patients do it all the time, and that if nothing else, it demonstrates to me what I do and don’t need. Well, maybe so – but I did this years ago when taking Fluoxetine, and should have learnt from that experience to leave such things to the quacks. But nooooooo. I know better, don’t I? Twat.

Anyhow, naturally she asked why I’d decided I’d half the dose. I explained about the horribleness of the hangover effects and the preposterous weight gain. I said that I’d be willing to tolerate the former for now (and as she noted, if and when I go back to work, I am more likely to get a ((post-hangover)) afternoon part-time job anyway, since most part-timers prefer mornings), but that I hated the weight gain issue because I was down to a size 16ish at one point (I hadn’t been that size since I was 16), and that having put most of it back on was pretty soul-destroying.

Her plan, then, is to wait until my mood has re-stabilised on my current medications (which seems unlikely to ever happen to me right now, but she opines to the contrary), and then we can look at how to play this in the long-term. She does, to be fair, acknowledge that even ignoring the physical issues surrounding my gargantuan size, it’s not good for my mental health to see 14 rolls lopping down around my knees, hiding even the briefest glimpse of my toes and their ingrowing nails. What she has suggested is reducing, though not eliminating, the Seroquel – and then adding in a mood stabiliser to make up for the loss of those same properties from said drug.

She specifically named Lithium and Depakote, though she expressed a mild reluctance regarding the latter; she laughed and said that she knew I was filled with abhorrence at the mere mention of breeding, but that nevertheless, she had to be very, very careful about the prescription of the thing to ‘fertile females’ on a ‘just in case’ basis. Apparently it can seriously fuck up a foetus/embryo.

I really don’t give a fuck about that, as – as she rightly noted, though I’m not sure how she figured it out as I don’t recall ever discussing it with her – I fully intend to never become pregnant. However, I think I read somewhere that it can interfere with the mini-pill, which I take as a contraceptive and fuck-off-menstruation-and-related-pain medication. A quick look just now has suggested that it doesn’t stop it working, but could increase levels of hormones in one’s body. Which could be a bit wank as I’m not unconvinced that oestrogen has an effect on mentalism, specifically depression (sometimes of the particularly vile variety known as ‘agitated’).

She did say, though, that she would prescribe it (regardless of my presumed ability to conceive) if she thought it best, on the balance of the foetus issue versus its active psychiatric indications. I was initially quite encouraged by this, because I’m not sure how I feel about Lithium: I’ve heard of others gaining weight on it (and one friend was constantly ill whilst taking it), so what would be the point in cutting the Seroquel (which I know works)? So, I thought, bring on the Depakote. Except that, since then, I’ve read the article on it on Net Doctor and see that it too can cause weight gain!

So, maybe either it or Lithium would mitigate the undeniably shitty hangover effects of Seroquel, but it’s quite possible my main concern would not be assuaged in any way. So what would be the point in modifying my current cocktail which, whilst problematic, has shown itself to work very well in terms of its indicated usages, only to find myself at the mercy of the same cunty side effects I’d hoped to avoid anyway?

All that said, I have known people to take mood stabilisers (Lithium in particular) who’ve found that it completely changed their life. Indeed, the Net Doctor article on it states that it’s a very good medication to take to boost the effects of pre-existing anti-depressants. So if I could get my depression and its related anhedonia/lethargy/etc to sod off (it’s never really gone away – it’s only got a bit less shit), then I might be more willing to leave the house and get some exercise to combat any extra weight anyway. But that’s a bit of a punt, really.

Have any of you any experience of Lithium and/or Depakote, and if so, what’s your view on it/them – both in terms of how they help (or don’t) psychologically, and on what the side effects are? If you take an alternative mood stabiliser (whether a ‘true’ mood stabiliser or an anti-convulsant) and you’ve found it useful and/or lacking in side effects, could you tell me a bit about it too please?

NewVCB also mentioned other anti-psychotics such as Risperidone, which typically have lesser weight issues than Seroquel. However, as a form of anti-compensation for that, you lose the mood stabilisation, so one such medication would again presumably be needed in that circumstance.

Despite my dreadful mood, I managed to crack a joke during the appointment, and was pleased to make her laugh. She asked me about suicidal ideation, and I told her all I could think about was my body flying off the Golden Gate Bridge or the high-rise apartment blocks close to my house.

“But don’t worry,” I added drolly. “I suffer from vertigo*, so…”

(* And it is ((usually, though not always, height-triggered)) vertigo, as opposed to acrophobia. I don’t really have the latter, bizarrely).

She laughed out loud, caught herself on and apologised, then started laughing (almost hysterically) again. I told her it was meant to be humourous and to laugh away. I like humour in this arena. I remember once ages ago that C cracked a joke (oh look – it was my very first therapy post. How quaint) about how my footballing allegiances were not at all good for my mental health (especially true that fucking season) – a comment made viscerally, for which he then apologised. Fuck that. Don’t apologise! Joke away. I mean, if you didn’t laugh, you’d have to fucking cry.

Anyway, medication issues aside, I handed NewVCB a copy of my last post, and that coupled with her usual questioning determined that I am “very clearly” in the midst of a major depressive episode. However, at least A and Mum are usually about somewhere, and my suicidality is operating “at fantasy level”, so there is unlikely to be any “danger”. I’d say that the lack of danger comes more from avolition and apathy rather than anything else, but there you have it. I shall, most likely, remain alive for the next while.

As I left the appointment (having managed to blag myself a script for Diazepam – which frankly I don’t particularly need, but insurance is always good) she said, for the second time since I first met her, “nice to see you, Pandora.”

Incidentally, the first time she gave me a complimentary goodbye of this nature, I was also similarly mental to last week (and both occasions were caused by fluctuations in medication, rather than being distinct ‘episodes’ in their own right). Why do I find that probably coincidental and innocuous fact so intriguing and revealing?

In other news – I haven’t written anything in the last week…BUT! I’ve had this laptop completely closed – it’s literally not been open once – since…fuck, I don’t know, last weekend? Although I have tweeted some articles and suchlike, I haven’t checked Twitter at all (ditto G+ and the odious Facebook). In this complete abandon of social media, I’ve been working on The Book. I’ve not written anything, as noted, but I have been studying the distance learning writing course I enrolled on when I first went off work a few years ago, and have been especially concentrating on the modules on novel composition. Much of it seems obvious – although this blog is factual and autobiographical, sometimes the narrative of posts takes on a tone similar to fiction, so I feel I have some pre-existing understanding of the idea. However, there has also been a lot of benefit in what I’ve studied to date, and I feel cautiously confident about The Book and its plot at the minute.

Furthermore, in my absence from internet sociability, for some reason I’ve been internally bombarded with quite a number of creative fictional ideas that I think I can turn into short stories, novellas, or perhaps a second The Book. There’s one about which I’m especially hopeful, which was garnered from a disturbed, haunting dream this very morning. At least nightmares have some purpose!

On Thursday, Wendy Perriam, whose excellent book Broken Places I reviewed for Mind, emailed me to thank me for said review. This was a wonderful buoyancy both for my own sake and for that of my writing (which Wendy was kind enough to compliment, which was incredibly flattering coming not just from a published author, but also from a published author who I hold in high regard). I asked her for a few tips, which she kindly gave me, and it’s added to my sense of ‘I can do this and it won’t be completely crap’. I’m not undaunted by any means, but neither am I totally petrified of my own potential incapacity.

The weekend was quite good. I’d been apathetic about going to one of our regularly organised poker nights on Friday because that meant fucking seeing people, but in the end it was fairly good craic – and guess what? Muggins won :D It’s my first win in a long time but it sees me atop the leader board. I’m the only woman in the whole group, yet the stats show me as the best player. Suck it up, gents!

On Saturday we met W, A’s best friend who was back in Norn Iron from England for the weekend, and ended up spending all day talking complete and utter bollocks and laughing at puerile nonsense. It was good. In keeping with what’s been occupying my own life lately, I suggested a writing challenge to W and A, an idea that both seemed to embrace for their own reasons of escapism and intellect. As well as just being fun (what even is that?), I think this could be useful in terms of my self-imposed deadlines – if A and W are in competition, I am going to be more driven to compete within this cause myself.

So, all in all, ostensibly things are good – but the reality, of course, is far from as black and white as that. I’m back into a firm agoraphobic, hide-in-the-house-and-brood-with-the-blinds-closed mode. But I’m keeping up with the studying element of my (hopefully) soon-to-be The Book, so there’s a sliver of a silver lining (try saying that after six pints of pale ale).

I’m seeing Christine tomorrow. She asked me, the last time I saw her, to do two things before tomorrow’s appointment: (a) ask Daniel to write me a reference for the voluntary position I was considering applying for and (b) get in touch with Nexus again to organise my second stint of therapy with Paul. Re: (a)…well, I have asked Daniel for the reference, to which he has agreed. However, I’ve not filled in anything of the application form, which therefore renders the request redundant. As for (b)…no chance.

Normally speaking, it seems like an uphill battle (at a bloody 85° slant) to acknowledge the mere existence of others, which both of Christine’s challenges require. I simply can’t face any communication without A holding my hand (literally and metaphorically). Beyond reading, I can’t really do anything off my own bat, and even if I could, I wouldn’t enjoy a milisecond of it. I haven’t had a bath in about a month. I keep trying to rewatch Babylon 5, but I can’t concentrate on it. I’m scared, I’m low, and I’m so, so tired. But I have something to cling to, for now at least.

Anyway, any advice you have on Depakote, Lithium or indeed any other mood stabilisers would be greatly appreciated. Thanks folks.

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The Evolution of Goldfish – Paul: Week 22

 Nexus, Paul, Psychotherapy, Recovery, Sexual Abuse, Traumatic Stuff  9 Responses »
Sep 012011
 

Right. For absolute God’s sake, Pandora, just write this fucking post and stop finding procrastination-borne ways of avoiding it.

It’s not that there’s anything particularly traumatic about what I’m intending to write, but these session reviews are long and tiring in their composition, and moreover, because it’s from a couple of months ago, the feeling is not as ripe in my mind as I’d prefer it to be. That’s entirely my own fault, of course; I have had plenty of opportunity to finish writing about Paul well before now. Instead, I’ve chosen to dick about – oh look, *shiny thing*! Fuck’s sake. Anyhow, the notes do remind me of some of the nuances and subtleties of the sessions – the way he might peer over his glasses, the palpable expression of hurt or rage within the room, my constant hair-playing – but I’m not sure if I’ll ever nail them quite to the standard I would have had I written them up in the afternoons immediately following the appointments. But therapy is a draining pursuit, and so it’s hard to summon the internal mental energy necessary to engage in such writing; to that end, I’m not going to promise to hold to that ideal when I return to Nexus in the next couple of months. I’ll try, but for at least some of the time, I will fail.

Anyway, here we go…

—

Paul was met with my usual opening gambit of complete, hair-fiddling silence, though it was eventually me that broke it by castigating the living shit out of myself for my failure to speak. He responded with some remark about my feeling that I ‘have to’ speak, and about how that made me ‘trapped’. He went on in an entirely predictable fashion: I still frequently behave as if I’m helpless and have to do as I am told. I am reminded of how submissive I really am in ‘real life’. Everything – well, most things – are given deferential consideration before I dare to respond, and generally I will kowtow to the other party’s wishes in the end anyway, even if I loathe them for it. My last-but-one job, of which I’ve never really had reason to speak here, is a glaring example that still (four and a half years later) sends shudders through my body.

After a great deal of fairly repetitive discussion surrounding Hotel California and my aforementioned submissiveness, he eventually went on to say that my current methods of coping with things and defending myself were such that I was ‘trapped’ in this world, and that Aurora was ‘trapped’ in her world, which is full of pain. “To you,” he continued, “she’s just a nagging problem. She buggered up your life, so although you’re intellectually aware of all the facts – that she was abused and badly hurt – you can’t really empathise with her, can you?”

It depends when you ask me, actually, which in and of itself is progress to my mind. I said that I had written an awful lot on this blog (I can’t be bothered to look for the link((s)) right now, sorry) about how my position shifted about, on how I recognised that I didn’t deserve any of it at all, and, crucially, about how I really felt all of that, rather than just knowing it as an abstract sort of concept.

“But,” I said, inevitably, “then I think of my fat five-year-old face and I feel nothing but disgust. If you put my mere outline in place of that image, I can pity and empathise with and wish to protect her, but not if it’s actually the young me. And then, of course, that leads to tremendous guilt because regardless of what I was like, I should still feel that concern for my younger self.”

Paul asked me to put Paedo into this mental vision that I’d conjured up and which was fucking with my head. In that time-honoured fashion of therapists everywhere, he asked me, “how does that feel?” (At least the emphasis here was on something specific, rather than on some amorphous abstract as it so often was with C).

I closed my eyes and let the image consume me for a minute. It wasn’t at all pleasant, but I tried to walk him through it.

“I feel fear, I suppose. Not intense terror in that Lovecraftian horror sort of way [Jesus, how up my own hole am I?], but…well. It’s more like I’d respond to a hallucination. Trepidation, perhaps?” Self-created Paedo leered at me in my mind. Aurora took a step back. I – the envisioned adult me – looked at him with an examining and curious sort of contempt, but none of the three assembled psychic (non-)personnel spoke.

Paul went at me again for trying to over-analyse the scenario, though he did admit to my description being a realistic one (in the sense that, the first time or two, rapes that are the start of systematic abuse are met with overwhelming terror – but that gives way a resigned stoicism as the abuse continues). “What else?” he pressed. “What is she feeling?”

I ‘looked’ at her. She didn’t look petrified at all, but I felt a sense of dread emanating from her. I suddenly knew what she was feeling, even if there’s not a specific name for it.

“It’s a sense of ‘oh no, not again’,” I told him.

“Not the reaction of a blameful child,” he mused. “More like a helpless wee girl.”

(Completely off-topic, but does anyone else find it odd – not bad, just a bit weird-sounding – when someone who isn’t Scottish or Irish says the word ‘wee’? I remember reflecting on this that day: how interesting it was to hear a Brummie say ‘wee’ ((utterly disregarding the fact that Paul has lived here for years, of course)), yet I say it a hundred times a day. Funny the little things you pointlessly ruminate upon whilst in therapy).

“I agree with you,” I admitted, “it’s just…” …I started my usual carry-on of being unable to articulate the words I wanted to convey… “it’s just that I can’t…can’t throw off this…this persistent self-disgust. That picture of me when I was five that I mentioned…Jesus, it makes me cringe.” Pause. “But…being cringe-worthy does not equate to being at fault for being used as a sex toy.”

“Indeed,” he nodded, his head cocked, his eyes unblinkingly fixated upon me. I wondered what it was that he was so intently looking for. A manifestation of how I was feeling? A tell, as we call it in poker circles?

“Indeed,” he repeated. “You could have been the worst child on Earth and you still woundn’t have deserved a second of it.”

“Do you remember I told you about the picture of the baby?” I asked.

“Yes. That was hugely significant, I thought. You looked at that little baby and thought, ‘You’re just an innocent baby – yet you’ll have that taken away from you before long. I know your future’.”

“I still think there’s something terribly sad about that,” I confessed, fixating my own gaze upon Random Point A on the off-green, non-descript carpet. I could feel his eyes upon me, but I refused to look at him. A lot of stuff was circling in my whirlwind of a mind, and it was frankly quite horrible to think about the issues this conversation raised. I don’t know why. I don’t like babies any more or less than I like five year olds, so my reaction to this one seemed wholly out of character.

“There is something sad about it,” Paul replied, “tremendously so. I recall the sadness in the room when we talked about that before. In fact, when I was writing up my notes on that session, ‘sad’ is the word I used. I think…I think you have some sort of separation from the baby. You can’t remember yourself then, you can’t see any of the physical characteristics you now have [wanna bet, Paul? The baby is certainly fat, so we have that in common], so perhaps you don’t think of it being really yourself.”

He’s right. I don’t.

But the picture of the baby was only once facet of therapeutic discussion that I thought particularly relevant: the other was the session in which we pretty much ignored the sexual abuse and focused on my parents and their tumultuous relationship. In the aftermath of that, and in particular in my writing it up here, I was a complete heap of psychological spaghetti, and at one point, seeing me in a flood of proper tears, A opined that “the therapy [was] finally starting to work.”

“I am given to believe that crying is a more appropriate way of expressing distress than other ways I have I might have chosen,” I self-decried.

Paul cocked his head. “You still view crying with contempt, then.”

Um…yeah. Of course I do. As I said to him, people look strange when they’re crying, and I don’t want to look any stranger than I already do.

I laughed then. “That coming from the girl who dyes her hair pink, blue, green, purple, etc.”

“What’s that about?” he queried. “The hair dying.”

Fucking psychology. Why does something always have to reflect something apparently deeper?! I drolly and cynically responded that presumably I was ‘seeking an identity’, and waited for him to lap the comment up in scrutiny.

Instead, for once he surprised me in dismissing the potential psychoanalytic ramifications of this most ordinary thing. He said, “maybe you just like dying your hair. My former mentor once told me that you don’t have to analyse everything: he said, ‘sometimes a fart is just a fart, Paul’.”

Whilst I laughed at the remark, I was ever so slightly pissed off that I looked like the one that was over-analysing. I mean, of course I do over-analyse, but oftentimes I am wont to dismiss psychobabble, and this was one such occasion. I’m not convinced he picked up on the derisive tone which nuanced my original comment.

As if to confirm this, he suddenly said, “sometimes it’s like you live your life in a goldfish bowl. Everything is there to be watched and examined, and there’s nowhere to hide.”

I snidely returned that if a goldfish was removed from its bowl then it would cease to have oxygen, wouldn’t be able to breathe, and would eventually die – thus, the goldfish bowl is a necessary place to be. Internally, I smiled at what I perceived as my clever comeback, and I looked at him with a smug and challenging expression adorning my facial features.

Right enough, he hadn’t planned for such a point, and was forced to concede it. It was desperately hard for me to hide my cocky satisfaction.

BUT! The man is too fucking quick for his own bloody good. After a few seconds, he ably destroyed my egotism by asking, “what about evolution, then? What if you don’t want to be a goldfish anymore?”

I resisted the urge to point out that merely wanting to evolve does not necessarily mean actually evolving, thinking I had already pushed my luck with my awkwardness. Instead, I went back to a more therapeutically pertinent form of dialogue. “This is the thing. If I didn’t want all this crap to stop, I wouldn’t be here – I would never have been here – in the first place. And I think things have changed a bit, or at least are doing so. Maybe I’m less of a goldfish than I once was.”

“It’s like there are two goldfish in two bowls,” he offered. “One gets its water regularly changed, and it’s well-fed. The other only receives the very minimum possible to keep it alive.”

“That’s self-inflicted,” I commented.

“Perhaps, but maybe when that fish was first hurt, it couldn’t deal with any more than that – it could only concentrate on its most basic needs of survival.”

“Yes, but it wants to deal with everything else now, and it’s brain won’t co-operate. That is so frustrating.”

“Interesting,” he said thoughtfully. “The fish still blames itself for everything. It forgets that it was hurt by abusers and is faultless in this regard.”

“I think its point is that other hurt goldfish progress to a level of not being hurt any more…Well, OK, not entirely – this kind of thing can never just go away. But said other fish somehow capably manage their lives, whereas this one does not.”

“Perhaps the best it can hope for is to move into a bigger, better tank with its healthier friend from the other tank, where that friend can take care of it. It won’t make previous events go away, but perhaps it could make them easier to deal with.”

This was striding into difficult territory for me, which I proceeded to explain to him. “This is a stupid thing to say, I know, but it’s so unfair. Surely people (or fish) who’ve been hurt the most deserve the most relief – and yet they’re usually the very ones that continue to experience the greatest pain.”

“It’s not stupid,” Paul replied reassuringly. “Of course the world doesn’t work like that, but it’s still unfair.

“One of the hardest things in this kind of arena is having to get clients to deal with the bereavement of it all. The pre-abuse person that they were – he or she is never coming back, and that results in a tremendous amount of grief.”

Something about the statement resonated deeply and painfully with me – probably particularly because I don’t really remember much from before it all started. I have no frame of reference of who I was, and who I ‘should’ have become. “Obviously I was always aware of that,” I told him, “but there’s something about hearing it here, in those terms, that’s really big.”

“Huge,” he nodded. “For some people, though, it gives them a reason not to bother with therapy. If I can’t give you your childhood back, what’s the point?”

An understandable but obviously fatalistic view. I said, “but recovery – insofar as that’s possible – is surely better than perpetual misery. Sure, tinges of regret that you can’t make it unhappen are inevitable, but…don’t you have to make the most of what you have?”

After a brief pause, I had to laugh at my own hypocritical optimism. I am the last person on Earth who believes in the ‘count your blessings’ response to depression and related difficulties. How crude of me to patronisingly bring it up in this context!

Paul didn’t respond directly, though. Instead he said that he felt that whilst we were still occupying the bowl of the healthy goldfish, we were at least looking over at the other one. I wasn’t, for once, trying to ignore it, and I could see through the stagnant water that permeated its enforced domicile.

It’s hard to articulate the kind of feelings that were bouncing around the room. As I told him, I was indubitably affected by the analogy and, presumably, aspects of transference and whatnot, but when he asked me to describe said effects, I found it exceedingly hard. I could hardly speak – not a first in therapy with Paul (so much not a first, in fact, that it could almost be described as entirely normal in that circumstance). After a lot of stuttering and idiotic gasping, I eventually concluded that I was sad. Perhaps grieving.

“I had DBT forced upon me once,” I complained. “One of the aspects of it is some old wank about knowing what you feel and accepting that. Accepting, I get – but knowing? There genuinely aren’t always adequate words to describe some of this stuff.”

He shrugged. “I don’t think we do always need to explain. ‘Sad’ is enough.”

After a few silent moments of apparent reflection, he added, “you know, ‘sad’ is big for you. It represents a transition from anger, which is incredibly noteworthy.”

I nodded, but felt no need to reply. We avoided each other’s gazes for another quiet few minutes, before Paul continued by stating that he felt that there was a “softness” to me in those moments.

Needless to say, whatever spell had been temporarily cast was suddenly broken. I was repulsed by the idea of appearing “soft”, and in horror begged him not to “say that”.

“No,” he protested. “It’s OK to be that here.” Pause. “Or is that a step too far for now?”

“No,” I robotically replied. “I’m being stupid.” Then: “I have this life narrative, I suppose. I’m a bit of a bitch, harder than a fucking coffin nail [anyone like Papa Roach? I think they're utter shit, but I do love that lyric]. You know. Misanthropic, a miserable sod. That’s me. A bitch.”

“I don’t see any bitch,” he responded. “Would it be easier if I did?”

There was a long pause before I randomly asserted that I was a child in a woman’s body. I told him that I took very little responsibility for myself, that standard practice in adult domestic living scared the living fuck out of me (example). I admitted to him about the dozens of cuddly toys I’ve ammassed over the last three or four years, despite having almost no interest in them as a child (save for Mr Friendly, of course). I confessed to the childish little ways I will sometimes privately talk to A (though mercifully I’m apparently not entirely alone in my experience of this phenomenon – Maybe Borderline reflects on her similar mannerisms with her husband here. Though I am nine years old than her…).

“Well,” Paul said, with a tone of exculpation. “You had to live as an adult when you were a child…”

“So am I trying to somehow vicariously relive my childhood?”

“Well, you’re trying to reclaim what was stolen from you.”

He brought up the concept of regression, which he says is sometimes used in trauma work. He said, “I wouldn’t ever do that here. You have to accept the loss, whereas reliving it in a therapeutic context only succeeds in avoiding the reality of the here and now. You are an adult – but you have an unheard child inside you, and the ongoing challenge is to allow her to speak.”

“I do think we’ve made some in-roads there,” I replied.

“Yes,” he agreed. “And the thing is, you’ve consistently turned up here each week. On time. That alone speaks volumes.”

“I must be getting something out of it, yes. I’m way too cynical to have kept at it if I wasn’t doing so, and I’m hardly engaging in the process because it’s fun.”

“Indeed. You do appear to be able to see the value in what we do, despite its inevitable difficulties. And that in itself is therapeutic.”

And, I think, so it is. I know I’ve had something of a relapse recently, but revisiting this session reminds me that progress has been made. I am intending to return to Nexus in the next few months to attempt to advance that further, and despite the current bleakness of my world, I am reminded, sometimes, that hope can and does exist.

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I Lied – The Mentalism is ‘Back’

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

Didn’t I sound so positive on Friday?

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

But that’s the truth of the matter.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So, then. What caused it?

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

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

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

“About five weeks…” I began.

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

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

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

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

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

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

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

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

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

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

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

“What, tonight?” I checked.

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

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

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

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

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

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

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

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

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

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

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

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

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

—

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

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Anders Breivik: Mad or Bad?

 Off-Topic Non-Mentalist Ramblings, Psychiatry, Random Mental Health Related Philosophising  7 Responses »
Aug 082011
 

First rant of the week.

I’ve just watched a speculative documentary on the repugnant Anders Breivik, the man responsible for the horrific attacks on Oslo and Utøya Island last month. Before continuing, for the little it’s worth, I’d like to extend my sympathy and solidarity to anyone from Norway reading this. Living in Northern Ireland, I have not been a stranger to terrorism. It is a truly despicable thing, that someone could think politics (or more specifically, in the Norwegian case, reactionary extremist racism) could be worthy of ending even one – never mind multiple – human lives. One of the survivors of the shooting attack on the island, who was attending a summer camp on what the documentary described as “left-wing” politics, stated at the end of the programme that he was sure his ideals rather than Breivik’s would, in the end, be the political victors. It is my fervent hope and belief that this will indeed be the case.

I commend the survivors in the programme for their bravery and determination in the face of such horrible, senseless adversity; I hope that in time all of the survivors can heal from both their physical and psychological injuries; and I send sincere sympathies to the loved ones of those that died.

In the sense of the survivor and eye-witness accounts, the documentary was interesting, informative and very powerful and tragic. I am not the nicest person on this Earth, let’s face it, but even I will never, ever understand how someone can be filled with so much loathing for other cultures and different demographic groups that doing something like this would ever cross their minds.

And herein comes the rant. Inexplicably renowned criminologist David Wilson, a supercilious little man that I’ve come across dozens of times both in an academic context and in my more amateur investigations into criminality, was employed by the film-makers as an ‘expert’ witness on Breivik’s psychology. Can you guess where we’re going with this, readers?

According to Wilson (who, to the best of my knowledge, has no more insider knowledge of Breivik than you or I do), Breivik has a “classic cluster B personality disorder”; Wilson exemplifies this point by highlighting the sensationalism of the attacks, and of Breivik’s apparent at-easeness, even his thrills, with the media frenzy after his arrest. Wilson also contends that Breivik is a psychological splitter (ie. a black and white thinker), presuambly in reference to his “MUSLIMS BAD! LEFT WING BAD! KNIGHTS TEMPLAR GOOD!” kind of thinking. Also, he’s a classic narcissist – look at the “manifesto” and the ridiculous pictures the man posted of himself online the day before he embarked on his awful plan.

I can’t argue with any of that, but neither can I see how it took Wilson years of training and work experience to come to these frankly blindingly obvious conclusions. (Also, he contradicts himself on the histrionic thesis at a couple of points by then pointing out how much of a loner and how reclusive Breivik generally was before this all took place, though to be fair that doesn’t exactly mitigate the gruesome exhibitionism the man demonstrated when he enacted his plans). Given that Wilson fails to explain his hypothesis further (or at least that any further explanation was not shown in the programme), I also don’t get how exhibiting a few (admittedly extreme) traits of cluster B pathology makes the man a “classic” example of same. Yeah, he’s probably a narcissist – but being narcissistic does not necessarily mean having narcissistic personality disorder.

Breivik is certainly a classic example of a cunt, but that is far from always the same thing as being someone with a personality disorder. Look. Maybe he has a one, and maybe he doesn’t. Maybe he has some other form of mental illness (the whole Knights Templar thing sounds vaguely fantastical to me), and maybe he doesn’t. What I object to is the programme’s, and Wilson’s in particular, testimony to these possibilities without any qualification.

OK, so they shouldn’t have to point out that just because one exceptionally extreme (possible) example behaves in this heinous way that the overwhelming majority of people with allegedly similar disorders do not – but let’s be honest here; the public love the morbid sensationalism of reporting on supposed madness, and that – and personality disorders in particular, stigmatised as they often are – is (are) often the perfect scapegoat(s) for outrageous behaviour that decent people have difficulty understanding.

I think, as an unfortunate consequence of things like this, that each examination in the media of a criminal that may or does have a mental health problem should carry a clear disclaimer with it: that people with mental illness are generally no more violent than the general population, and are in fact much more likely to be victims of crime than perpetrators of it (if memory serves me, schizophrenics in the community are about seven times more likely to be affected by violent offending than other members of the populace, but I could have the specifics of that wrong). It shouldn’t have to be that way, that we need to qualify every generality, but I’m a pragmatic person. I’d rather that than have everyone outside the mental health community demonising those within it, because the consequences of the latter are potentially devastating.

Anyhow, as far as I can see Breivik was mostly sane anyhow. Null made a very good point on TWIM the other day – no one with a serious and active mental health problem could honestly have spent so much time* meticulously researching and planning a major ‘event’ in the fashion that he apparently did (except, arguably, a sociopath, the more organised version of the psychopath ((depending on which textbook you read))). We just don’t have the concentration, the calculated calmness and, more practically, in all probability we don’t have the economic and physical resources to engage in anything so necessarily complex. That sounds like a cold statement, maybe, but the point is that mentally ill people who kill because of (as opposed to in spite of) their illness tend to do it on impulse (because of a false sense of feeling persecuted or threatened, perhaps) or because they genuinely have no rational conception of what they’re doing (eg. because hallucinations compel them towards the crime).

* Null’s comment suggests that Breivik was planning the operation for nine years, though the documentary claimed it was three. I’ve heard different reports from other sources too, so don’t know what to believe. Either way, it’s a long time and was, by all accounts, a complicated process.

Further, in September 2001, did we start hearing speculation on whether Marwan al-Shehhi, Mohamed Atta, Nawaf al-Hazmi, Ahmed al-Haznawi et al, and – presumably – Osama bin Laden himself, had cluster B personality disorders? Did we spend any significant amount of time discussing whether they had folie à x? No? Didn’t we just accept that they were representing a particularly extreme and reactionary version of Islam (which, I would add, in no way represents the vast majority of people that belong to that faith)?

It’s not an entirely fair comparison, granted, because as far as we know Breivik worked alone – whether or not the two supportive ‘cells’ to which he referred were somehow involved in the attacks is at present unknown, but either way the bomb and the shootings specifically were carried out by him alone. The 11th September attacks were organised by a huge, world-wide cult of extremists.

But therein lies the point. Breivik, by his own delighted admission, is a racist that loathes Islam and wants to wage a war to drive Muslims from (Western) Europe. He claims to be a “cultural Christian”, which I think in effect means that the man is not particularly religious, but supports whatever continuing influence Christianity has on an increasingly secular and culturally inclusive continent. But although Breivik is probably not a religious extremist, he is certainly a political one.

To further exemplify, when the Troubles here were ongoing, we didn’t try to examine whether or not Johnny Adair or Thomas Murphy were personality disordered. Do we debate the state of Nick Griffin’s mental health? Was that the first thing on people’s mind when London was attacked in July 2005? Indeed, is it the lead speculative headline as regards the current ongoing rioting in London?

No. Because we used to be able to, and still can on occasion, accept that some people are just twisted fucking dickheads. People have always committed unspeakable acts in the name of religion, politics or other fucked-up ideologies. Anders Breivik is one such example. He may be mad after a fashion, but he knew what he was doing. So, ultimately, he was just fucking bad. Very, very bad.

RIP to all those that were killed as a result of the attacks on Norway on 22 July 2011.

Disclaimer: author of the above is not a psychologist, not a psychiatrist, not a criminologist, not a political scientist, not a sociologist, doesn’t know Anders Breivik, doesn’t know David Wilson, doesn’t know anyone from the Discovery Channel, could be wrong on all counts, could be wrong on everything she’s ever written, it’s all merely alleged, she’s only speculating just like the programme was, is not a member of any organisation, believes in free speech. Author of the above is a provincial nobody who apparently can’t stop her vociferous gob (fingers) when presented with a topical story and a laptop. Author means no harm in voicing opinions, welcomes sensible and reasoned debate, wishes most people well, though doesn’t wish Anders Breivik well.

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Agoraphobic Persecutory Delusions of Familial Evil and Seroquel. Etc.

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

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

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

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

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

Appointment With Christine

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

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

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

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

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

Am I Still Proper Mental?

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

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

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

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

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

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

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

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

Rant: Aunt of Evil is on this Landmass!

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

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

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

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

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

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

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

Family is genetics; friendship is earned.

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

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

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

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

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

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

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

Back to the Fucking Point, Pan…

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

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

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

Speaking of her…

Appointment with NewVCB

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Meh and Blah and Yadda and Etc and Such

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

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

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

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

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

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