Update on the Political Intervention Against the Trust

Sorry for not apprising readers of this blog on the current status of my complaints to my MP and other politicians about the Trust’s decision to end my therapy. I had mentioned it on Twitter, but not all of you are onTwitter, so that wasn’t very fair! Here’s what has, to date, happened.

The first person to respond to me was a civil servant – let’s call him Adam – writing on behalf of Michael McGimpsey, the Northern Ireland Health Minister. Adam oh-so-helpfully advised me that “clinical decisions on these matters are made by the various Trusts”. That is something of which I clearly had no knowledge. None at all! Adam had, therefore, “written to the [My] Trust to ask them to respond to [me] on the matter.” Definitely a highly useful thing for Adam to do, given that I have been writing to the Trust myself since December 2009. Adam kindly advised me that he hoped that “this matter will be resolved favourably.” I am, of course, profoundly touched by this overflow of concern.

In all seriousness, one thing he did do of minor use was provide the details of the Patient Care Council, whom I may contact if things don’t go according to plan (which they won’t, so presumably I will be contacting them). In any event, Mr Director-Person’s boss subsequently wrote to me, on the back of Adam’s epic piece apparently ending up on his desk. This person is called Mr Chief Executive. Mr Chief Executive claimed to be “sorry to hear of the difficulties [I have] been experiencing, and [is] grateful to [me] for bringing the matter to [his] attention.” I’ll bet. I wonder if he recalls that my first letter in this crusade was copied to him (its main recipients being the advocacy charities, who were universally fuckwitted), but passed by him to Mr D-P because he could not be arsed with it at the time?

He claims that an investigation has been launched “into the issues raised” in my correspondence to McGimpsey / Adam, so in fairness to Adam, at least something has come of his intervention that didn’t come of my own. This, in all probability, means one of two things. One – the outcome of the ‘investigation’ is already decided, and is essentially along the lines of “Pandora = WRONG. Trust = BLAMELESS”. Or two – they actually do investigate the issues raised…namely, however, the whole catalogue of errors that the past decade’s ricocheting about the system has brought. That would, of course, be welcomed by me, but what it potentially means is that they can avoid providing extended therapy and seem saintly by merely apologising for all that has gone wrong before.

Maybe I am being unduly cynical. I don’t think I am, but one never knows. As I said above, at least it is something. I really think it’s very far from perfect, but at least it’s not the nothing that was endlessly circular-ised in the correspondence between myself and Mr Director-Person.

The second, and so far only other, person to respond to the letters was the MP himself. His letter was friendly and courteous, and he said that he had written to the Trust on my behalf. He said he’d get back to me as soon as he received their response.

There was a letter from the House of Commons when I arrived at my mother’s – after a NewVCB appointment – this morning. I opened it with my customary dread, but found that it was just an update – my MP had received a letter (copied to me) from Mr Chief Executive, stating that I had written to the Trust directly and that his so-called investigation had been launched. He advised my MP that he would send him a copy of the investigation’s report once completed.

So that’s really it as things stand. Hardly life-changing stuff, but perhaps a small step in the right direction. At least the bastards now know I will not go away without a considerable fight.

NewVCB Appointment

NewVCB kept me waiting for 25 minutes, which is a record for her. During the whole time I was waiting I started blankly at the non-descript carpet, not moving, barely blinking. I heard a couple across the room remark on my probable mentalism. The man’s comment was inaudible, but his female companion, who was incapable of modulating her voice, was heard to comment that I look very depressed and “spaced out – as if her brain’s stopped working, like. Kind of freaky, isn’t it like?”

Interesting. I suppose it really must be a universal surprise that one would find a mental person IN A FUCKING PSYCHIATRISTS’ WAITING ROOM.

Anyway, the meeting was to all intents and purposes pointless. I seem to have an unlikely ally in NewVCB, who agrees that there is a lot of work that remains to be done in therapy. She claims, however, that there is nothing more that she can do on the issue.

Apparently she’s spoken to C and tried to persuade him to at least see me again after a break from the current process. She didn’t advise as to exactly what he said to that, but the inference seemed to be that it was going to be the probable outcome.

Good?

Should be good.

Doesn’t feel good.

Whatever the case, as of her last conversation with him, things are still ending in a fortnight, regardless of whether or not they’re picked up again in the future. I don’t know when their conversation took place, so as of right now it’s hard to say whether or not this was before or after the politicians’ involvement.

I told her that I thought that, finally, my mood had perhaps stabilised a little – I’m certainly still depressed, but not quite as morbidly so as is my norm. I would say it’s at a moderate level on average, which is good compared to the usual state of affairs. I pointed out that adjusting to changes in Venlafaxine totally fucks with my head for quite a number of weeks, so she agreed not to change my doses of either medication at the minute.

However, I told her, paradoxically the whole flashbacks/hypervigilance/rumination shit is as bad as ever. “I wish I’d never met C,” I said. “Or, at the very least, I wish I’d kept my mouth shut about stuff to him. I had many, many issues before I met him but he’s made it all ten times worse, and his choice of point on which to end therefore seems criminal.”

She said that she didn’t think this “turmoil” was paradoxical, and indeed that what I was reporting was quite common. She claims – and I don’t really believe her in the sense of its applicability to me – that sometimes the brain “works through these things on its own” before returning to therapy. Forgive me if I say that that sounds rather convenient.

She then came off with some bollocks about a new service being in development for people who “have complex issues and a history of trauma” and that “that might be an option.” This description irritated me in the extreme. She was clearly describing the personality disorder service that Mr Director-Person has wanked a bit on about to me. I asked for confirmation that this was indeed what she was referring to and she said that it was.

I said, “what, do you mean like DBT?” but before she could finish, I told her that I thought that DBT was a pile of utter bollocks, out-bollocksed only by its older cousin, CBT.

She asked why I held this view and I said that they were both victim-blaming, patronising, invalidating crap. I exemplified.

She agreed that CBT is a treatment unsuitable for me but started blathering on about how it’s used sometimes to ease the “most disturbed” patients into deeper stuff that “they couldn’t otherwise cope with emotionally.” It’s like peeling layers off an onion, apparently. Really, how interesting, NewVCB, thank you. Then she said that DBT was used by the self-harm team in the next Trust.

“Yes,” I sneered, “it’s supposedly empirically proven to treat that and suicidality. That’s very nice, but it doesn’t mean it treats the underlying causes of those behaviours, the psychological distress that they alleviate.”

“That’s my point,” she replied, to my considerable chagrin. “It stops that first, and then we can take the person deeper thereafter.”

OK, fine. Whatever. Just as long as your cunt bosses allow adequate fucking time to “go deeper.” Just as long as your cunt bosses don’t go about pretending that DBT is some sort of universal cure for BPD and related conditions, the way they have gone about pretending that CBT is a complete panacea for some other mental illnesses. Can DBT alleviate certain symptoms? In appropriate individuals, yeah, probably. Can it alleviate everything? I doubt it. Can it work for everyone that fits the BPD demographic? I’m absolutely certain that it can’t.

I asked NewVCB what she thought about C’s high-IQ idea of referring me to a CPN/SW upon discharge. She claimed to disagree with C’s take on this, stating that, “if I was referring someone to such a person, I would need a clear idea of what it is that they’re going to do together, and in your case…well, I don’t have such an idea. I just don’t think it would work for you.”

Excellent. At least she knows that much.

“He also said that you might be able to see me a bit more frequently, in the event that there was no CPN,” I told her.

She said she’d see me once a month “for a while” and that “we’d take it from there,” whatever the bloody, sodding Christ that means.

As she showed me out, she said, “sorry it’s not all good news,” and looked sheepish – even embarrassed – at both the historical and the ongoing colossal failures of her employers. At least someone has the grace to show it.

It was a waste of time, but it wasn’t a bad appointment, not ostensibly. I mean, she agreed with me on at least two points, one of which is quite important (ie. that the therapy should not be ending). Despite this, the whole thing has left me in a foul mood. I even considered ringing Lovely GP and asking him to send the crisis team out, because I feel like I’m a danger to myself. There’s this sort of raging foreboding constricting my internal organs and burning through my skin. I know that sounds daft, but it’s physical as well as psychological. My mind won’t stop; it’s in a whirlwind of negative thinking. I keep seeing my mother’s largest bread knife dangling in front of me and have beautiful images dancing in my head of my going to town with the knife on my arms and possibly even neck. I even told my mother that I was going to kill myself, but her response was a predictable one of withering derision and room-leaving.

I haven’t done anything yet, aside from deciding against getting the scheiße-st cunts involved because they’d only make me more mental, just as they have done in the past. Anyway, don’t worry. At least I have my Twitter group therapy friends and lovely blog readers. I’m sure it’ll pass, though perhaps not until I’ve got tomorrow’s session with C – week 61 out of 63 – out of the way. I have a lot of catching up on his sessions to do, I know. I also have some additional commentary that I need to share with you, but all in good time. I shall endeavour to remain alive so that I can impart these details to you

Oh, and as an aside – the below image shows why I’m being chucked out of therapy despite not being ready for discharge. This is taken directly from the Trust’s website.

As my friend More Voices said to me on Twitter, it’s “amazing how therapy can be set to numbers measuring nothing of value or real importance.” I couldn’t have put it better.

Apologies for the delay in the third post in this series; we had something of a disrupted week last week and last night represented A’s first chance to explore these issues. In this post, we’re talking about the direct impact on him of my illnesses, history of trauma and current treatments.

Life continues to revolve around being mental; this week I saw both my psychiatrist and, of course, not-for-much-longer-my psychologist (blog to follow on him), and next week it’s my (lovely) GP and, again, not-for-much-longer-my psychologist.  Yippee.  Joy deep in my heart.  Being this mental is a full-time job, you know.  Those of you that actually have full-time jobs whilst being simultaneously floridly crazy amaze me.  How do you do it?  You absolutely have my every admiration.

So.  Wednesday morning.  NewVCB.  She kept me waiting for 15 minutes, after I had rushed like blazes and broken the speed limit on a number of occasions to get there in time, believing I was going to be late.  I had dithered and procrastinated and wasted time for far too long before leaving the house ages late; all that was because I didn’t want to go.

Why do I always get worked up over psychiatric appointments?  I mean, they’re generally not that bad (or at least they’re not that long), especially since NewVCB took over the reins.  But of course, despite rationalisation of this description, I was a wreck anyway.  It’s the whole thing, isn’t it, that the thought of whatever it is is actually much worse than the reality of it.  Still, psychiatrists are an occupational hazard when one is as batshit as I am.  They have it within their power to section you, and I’m still bitterly terrified of that.  I assume that’s what always leads to the fear – I consciously or unconsciously convince myself that I’m imminently going to be sent to the bin, and I lose the plot even more.

As it happens, I still believe that the last time I saw NewVCB she made what I considered a thinly veiled reference to hospitalisation.  I don’t think the OldVCB would have done that.  I think, strange as it seems, that because NewVCB is nicer, because she actually appears to give a fuck, she is much more of a worry to me than her predecessor.  OldVCB would never have sectioned me (or recommended a voluntary admission), I’m fairly sure – she just didn’t care that much.  NewVCB wants to act in my rational best interests, and that is dangerous.

Anyway, when she finally came to get me, she led me to her room and I sat down close to her, as I always do.  She began with, “OK, how…no, sorry, I can’t not mention it.  I love your hair!”

It was a better reaction to my new pink hair than the one C had given – she happily acknowledged it, but didn’t make some banal, pointless statement telling me what I already know.

I couldn’t believe that a consultant fucking psychiatrist was complimenting me on my new hair colour.  I asked her if she was serious.

“Yes, absolutely,” she enthused.  ”It’s really nice.”  Her tone appeared to be genuine, so I thanked her.  She wore a sort of surprised but pleased smile, the function of which I couldn’t entirely decipher.  Maybe she read the fact that I’d bothered to do something like this as evidence of psychological improvement (which it’s not particularly, to my mind).  Maybe she’s simply one of those people that takes an interest in others’ hair colours.  Ho hum.

Anyhow, the appointment didn’t go on for that long (despite this being a fairly typical 2,000+ word post!), as there wasn’t a great deal for me to tell her I suppose.  The crux of it was that (a) the hallucinations are markedly reduced (not eliminated, but a hell of a lot better), (b) my mood has been quite low, to the extent where my suicidal ideation is quite considerably heightened again and (c) as detailed the other day, I am freaking out about how to face or avoid Paedo.

We agreed that Quetiapine had been a wonder drug and whilst things are not exactly fabulous, they are very much better than before I was first prescribed it in January (just after I tried to do myself in again).  She again emphasised that psychological therapy was key (someone apparently needs to tell the Trust and Mr Director-Person about that), but that medication did appear to be helping me deal with that sort of work.  She expressed concern about my suicidal thinking and low mood, and asked if I would object to her increasing my dose of Venlafaxine.

I’m not even sure that Venlafaxine makes any difference – it’s really been Quetiapine that’s helped me, in my estimation – and even if it does, I remember really horribly well adjusting to taking it in the first place – and then to an increased dosage thereof.  It is very, very much not in the least fun.  I must have given my reticence away, because she continued by advising me that for the most severely chronically depressed (like me, apparently) her personal observations were that higher doses of the drug made significant differences.

“I suppose it sounds obvious,” she said, “but the reality is that quite often moderate doses of anti-depressants make major differences.  In this case, however – in the worst cases anyway – I think higher doses are generally more helpful.”

I suppressed a self-satisfied smile, thinking back to Dickhead GP’s contentions that, at 150mg, I was already on a “really high” dosage of Venlafaxine.

I told NewVCB that I was scared about adjusting to a higher dose, given what had happened previously, but she actually felt that that was good: “you know that you are to expect that, that it isn’t your normal behaviour, and that it will pass.  Not everyone has that insight, even if I try to provide it.”

“But,” I said, pessimistically, “what if I want to come off it at some point?”

“Don’t ever do that!” she exclaimed, looking up urgently from writing the prescription.  ”Do.  Not.  Do.  That.  If we decide in the future to take you off it, I’ll be bringing the dose down by 37.5mg each week at most.”

She went on to tell me about another patient that had usually been relatively stable that came to see her one day literally clawing at his face, as if trying to peel it off.

“It turned out he’d not been taking his Effexor for three days,” she revealed.

Well, that’s tremendously encouraging.  I’m going to be taking the cunting, evil stuff for the rest of my life, aren’t I?  Shit.

Anyhow, I slightly reluctantly agreed to let her increase the dosage of Venlafaxine to 225mg, with a view to considering 300mg in future.

This should be interesting.

Leaning forward towards me, she looked conspiratorially me straight in the eye and said, “I have to ask.  [Almost whispering] Just how strong is your suicidal ideation at present?”

I admitted that I frequent pro-suicide newsgroups and that I ergo know what would be most likely to kill me and what wouldn’t.  ”I keep thinking about overdosing, and I am very well aware that unless you have exactly the right ingredients and you plan it very well, ODs are very unlikely to work.  I don’t have the energy to plan something like that, so an overdose would be an impulsive act and therefore probably non-lethal.  Plus I don’t have the figurative balls to jump off a building and I won’t deliberately crash Disraeli, my car, because I love him too much.  In short – I don’t think I’m in any imminent danger of offing myself.”

“OK,” she replied, seemingly relieved, though I’m not sure if relief is the appropriate response to the admission that I can’t guarantee I won’t take an overdose.  ”Because you’ll be aware,  I’m sure, that starting to take Effexor – and, indeed, increasing the dose thereof – can lead to increased suicidality in the short-term.”

I’ve always loved this irony about anti-depressants.  I know that that risk is, generally, only temporary in nature – unless you actually do top yourself, and then it’s kind of permanent – but I find it amusing that the very thing that is meant to alleviate depressive and suicidal thinking can increase it.  Bizarre indeed.

I confirmed that I was thus aware and reiterated that I did not feel in real danger.  I don’t know that I completely agree with that assertion, but I’m not going to give her any more ammunition to throw me in the bin.

She said, “I don’t think you can expect your suicidal thoughts to go away any time soon, given your long history of illness and the intensity of therapy, but hopefully, after the initial few weeks, medication can at least ease the strength of them.”

I laughed.  ”I don’t expect to ever be rid of suicidal thoughts.  There has not been one single day that has gone by in – oh?  At least 20 years? – that I have not thought about killing myself [see this post].  It’s simply a matter of the degree of strength that those thoughts have.”

She accepted that, and agreed that if this line of thinking could be reduced in (a) frequency and (b) intensity, that would be good progress.

For some reason the bloody child abuse topic surfaced, as it usually does.  It never came up with OldVCB, except perhaps briefly in the assessment session that I had with her and her SHO, Dr N.  Again, this disparity seems to be because NewVCB gives a shit.

Anyway, I don’t remember the intricacies of the conversation, but at one point I know that I whined about how I didn’t know how to cope with seeing Paedo.

She interrupted me mid-sentence, shaking her head violently.  ”You can’t see him,” she said simply and definitely, making a ‘no’ gesture with her arms.  ”It would be damaging, given the strength of your reactions to at Christmas and indeed to discussing matters in therapy.  No.  You can’t see him.”

I pointed out how difficult not seeing him would be to execute, given that my mother doesn’t believe me about the sex abuse and loves her family almost to the point of reverence.

NewVCB said, “can you say to her something like, ‘I know you don’t accept what I told you about this man, but nevertheless I cannot see him – not at this point, anyway.’  Would that work?”

I admitted that I had never really considered bringing the topic back up with my Mum, and that I was petrified of doing so.  ”It’s a right can of worms to be opening up,” I sighed.  ”I don’t know if I can do it.”

We pondered on whether or not I could blame my social anxiety issues, given that Maisie and Paedo’s house always seems to be full, always seems to be loud, always seems to be a situation in which I cannot cope, irrespective of Paedo’s presence.  I agreed to give this lie excuse a go.

[As it happens, A has actually come up with a very good short-term excuse to avoid Paedo and friends.  Because the increased dosage of Venlafaxine will, in all probability, fuck with my head for a few weeks, he suggests telling Mummy Dearest that for, say, four weeks or so I need absolute routine without any deviations whatsoever.  I think this could work quite well in my quest to avoid Paedo.  My mother will object, of course, but I can say that I am under medical orders.  Which, if you bend the truth slightly, is not a complete lie, because I am under NewVCB's orders not to see Paedo.]

In any event, NewVCB then announced that she she would be off for four weeks in July, adding, “would you like to see someone else or wait for me to come back?”

I asked would the alternative someone be a consultant – ie. someone who can muck about with the medication if required, rather than an SHO on rota to his/her GP training – and she confirmed my suspicions that it would not be.

I advised that I would therefore wait until her return, remembering the pathetic debable of incompetence that took place when I last saw an SHO.  If something major happens during the period of NewVCB’s absence, I suppose Lovely GP has some knowledge of psychiatry and can try to help.

All in all, I suppose it was a relatively successful encounter, though I am worried about the increased Venlafaxine dosage, particularly when she’ll not be about to monitor it.  Still, as she pointed out, it is considered one of the most effective anti-depressants, and if I need a higher dose to get the full value from it that I need, then so be it.

If nothing else, losing my mind yet again for a few weeks could lead to some interesting blog entries..!

I don’t really see a lot of point in going into great detail about last week’s (15 April) session with C, mainly as we spent almost the entire time together discussing my recent hallucinations which I have already detailed here and here. Furthermore, because I’ve been too lazy, too fuckwitted or too pre-occupied with other inane, probably pointless shite, I have of course forgotten a lot of the session’s nuances and subtitles. ‘Tis my own fault. I should have written about it sooner, but I’ve been existing in a haze of exhaustion and combined Quetiapine/Zopiclone hangovers, so to my eternal disgust the blog hasn’t been as high up my priority list as it should have been. It’s taking all the energy I have left even to write this rambling crap.

C opened the session by noting that it had been a fortnight since I’d last seen him, a meeting during which I had apparently “taken a very brave step” in admitting that I was systematically raped as a child. Brave. He called me brave. He complimented me, or at least I think he did…and my cynical little heart leapt with joy. Pa-the-tic. I hope I managed to hide my internal manic rapture; I know he knows about my attachment to him, but this is ridiculous! (Actually, I think I must have hid it quite well because the next week, when he used the same word, he supposed that I would object to him describing me as such. But more of that in a post or two).

He asked how admitting to the reality of things in session had been for me, and I told him that I was kind of surprised by how calm and measured I had felt as I’d detailed the extent of the molestation. Encouraged by that, he then asked how things had been since that discussion.

I threw my head back and laughed out loud, in what was, on reflection, a hideously maniacal fashion. Sensing his surprised bemusement, I stopped myself and said, quite definitely yet sardonically, “things have been just fine!”

He raised his eyebrow, as well he might have done. He said, “your reaction to the question and your body language would strongly refute that.”

“Well,” I sighed eventually, “let’s put it this way: it’s a good thing I’m seeing the psychiatrist next week”. Then I actually bit the bullet and volunteered the information to him about the ongoing persecution from ‘They’ and fake-Paedo. As I say, there’s not a great deal of point in getting into the minutiae of that conversation, but one point of note was that he decided he would ‘map’ my mind on his whiteboard. He did something similar once before in relation to my behaviour when I feel threatened and on the perennial abandonment anxieties, and the intellect inside me had found it quite fascinating.

C divided the map into two sections. There’s ‘additional’ “presences” in my mind (initially he asked if I wanted to call them ‘presences’ or ‘parts’. I went with the former because ‘parts’ infers that they’re somehow part of me, and whilst I accept that possibility intellectually, that is not how it feels at all), plus there’s the very obvious internal sides of myself, several of whom keep up a running commentary in my head most of the time.

Presences

‘They’ – multifaceted, malevolent, potentially harmful.
Tom – benign and soothing – but does he still exist?
Fake-Paedo – though his ‘existence’ is arguable as he appears outside my mind (as do ‘They’ at times).

Sides of Me

The Bitch – (“I’m only using that term because you insist on it”, apparently). Finds the other sides weak and pathetic. Contemptuous of them.
The Child – scared, hurt, vulnerable – in need of someone to take care of her.
The Intellect – ‘everything can be rationalised’ (though as I said, to C’s amusement, I am a walking quintessence of the ironic falsehood of that statement)
Plus the healthy adult and some others. It harks back to our various discussions on schemas, which he again acknowledged (and on which C has published research specifically on BPD!).

The long and the short of this analysis was that C thinks the psychoses (or, as he perhaps more aptly seems to believe them to be, the dissociative presences) are caused by a splintering of my mind, thanks to having to deal with such graphic and enormous matters in therapy after having repressed them for so many years.

He said, “you are of course extremely intelligent, so I think you know that yourself, don’t you?”

Did he just call me ‘extremely intelligent’? Why, I rather believe he did. EPIC WIN, Pan, epic fucking win! Another compliment!!! Once more my perfidious heart nigh on exploded with delighted glee.

I admitted that rationally it was quite obvious to me that this bout of psychotic symptoms was caused by recent revelations in therapy, especially given the timing of the episodes. “However,” I went on, “that doesn’t keep them from feeling utterly vividly and absolutely real.”

Apparently he had not intended to suggest otherwise, but merely wanted to explore the motivations for their manifestations. The fact that their whinging (“slut, whore, bitch” etc) is in keeping with the whinging of The Bitch seems to provide further evidence for this position – it’s just that ‘They’ have become a more extreme form of a similar thing. In the absence of a compassionate side of myself, Tom had (temporarily, alas) fulfilled that function. ‘They’ are just sort of doing the opposite.

I said to C, “you know that ‘They’ won’t like this analysis.”

“I’m sure they won’t,” he said automatically. “They’ll probably think it’s a load of bollocks.”

For some reason this made me laugh a lot, probably because it was so completely spot-on. I told C that they didn’t like him, and he didn’t seem surprised. He didn’t say it the way A so explicitly does, but something in his body language intimated to me that he doesn’t like ‘They’ either.

He never remembers their name. He keeps calling them ‘Them’ or something, then he ends up berating himself for not getting it right. “It’s not your fault,” I exclaimed defensively at one point, “it’s their’s! They’re the ones that are gramatically challenged, not you!”

I mean, what kind of sad tossers go around calling their collective selves ‘They’? Do they think they sound hard or something? Come on, ‘They’ – it’s not like it’s the fucking Crips or Bloods, now is it? Why can’t you at least assign names to each other?

Anyway, I digress. I don’t know how we got back on to the sex abuse topic specifically, but at one point C said something about getting me to articulate some of the actual minituae of the incidents. I (literally) recoiled in horror at the suggestion.

However, I knew that I, for once, had the upper hand; we had talked so much about the psychoses that I knew there could be very little time left for anything else, let alone something so difficult to address. So I said, “you don’t seriously expect me to do that today, do you?”

I watched as his eyes shifted from me, to the strategically-placed clock behind my head. He looked at it for a few seconds before conceding that no, he didn’t expect me to do it today.

And that was that really. I got a “take care, all the best,” on the way out, which always brightens my Thursdays, pathetic as they and I are.

The ‘S’ and ‘H’ Words

So onward to the psychiatrist, on Wednesday 21 April (also the anniversary of the day I met A!). In a stylistic homage to her predecessor, NewVCB kept me waiting for nearly 20 minutes after my allocated time. I was interested to note that, before summoning me, she came into the waiting room and handed some old git an envelope (which I assume was a prescription, as she did the same for me before I left). I didn’t care in any way that this occurrence took place.

Sounds innocuous, right? Of course it does. Why even mention it, Pan, you stupid, pedantic cow? Well, the thing is, if C had come into the waiting room and interacted with one of the assorted mentalists in front of my face, I would have had a complete shit attack, and probably throttled him (and the relevant mentalist too for that matter). I give you Attachment in Action, my friends. C is not allowed to have anything to do with anyone but me, least of all some other bloody mental. I am the focus of his world. He has no other patients. He has no other life. It is only me. C and me. Me and C. He exists only in those 50 minutes each Thursday, because he exists only for me. That is the way it is.

Oh, what a LIFE FAIL as I have.

Anyhow, again I digress. NewVCB showed me to her office and asked how things had been, and I just sort of collapsed in a wobbly mess in front of her. No tears or anything, but lots of agitated, highly disturbed rambling. Somehow, amidst the virtual delirium of my babbling, I managed to convey what had been happening to me.

The first thing of note was that NewVCB used the ‘s’ word in front of me. She had done once before, but on that occasion had absolutely refuted its relevance to me. On Wednesday, however, she said, “in the past – the fairly recent past at that – you’d have been diagnosed with a schizophrenic illness.”

I had, at one point, decided that I had schizoaffective disorder (given my asinine tendencies towards self-diagnosis), but nevertheless – hearing this kind of comment from a consultant psychiatrist unsettled me greatly. ‘Schizophrenia’ is a big word to have thrown at you, even though I can see why I would once have been felt by the discipline of psychiatry to have it. I don’t know why it sounds so daunting; after all, I am effectively medicated for it, or at least a sub-threshold version thereof. Still, her use of the word struck terror in my heart (which by this point most assuredly wasn’t leaping with joy or threatening to explode with delight or whatever other sickly metaphor I used above regarding C’s quasi-compliments).

Anyhow, she continued: “but we now know, thanks to much research in the area, that there’s almost two types of psychosis. There’s your traditional schizophrenic, firmly-believed and long-term psychoses, and then there’s this other branch that is often seen in severely traumatised people like yourself.”

Point of Interest II. Severely traumatised like [me]? Severely traumatised? Rid-ic-ulous! Cue silly internal ruminative roundabout of denial-like idiocy: What the hell is she talking about? I’m not traumatised – I’m a little whore that got justly punished for the disgusting thing of fetid-ness that she was and is. Trauma. Scoff!!! lolz like innit (all this notwithstanding the fact that I diagnosed myself with ((and gained confirmation from NewVCB that I have)) complex post-traumatic stress disorder. Go figure. I’m a walking contradiction).

Of course, the Me that was in control of my voicebox at the time didn’t make use of it, and I therefore found myself simply nodding every so often to acknowledge the fact that NewVCB was speaking. She said at one point that her “instinct [was] to throw medication at [me],” but that she knew logically that this was stuff that, in the main, needed to be worked through psychologically.

Not surprisingly this led on to a discussion about the imminent-ish end of therapy. I don’t remember exactly what she said, but the inference was that useful work can be done in the remaining – what? Eight or nine? – weeks. She said, “you have to stop viewing it as some sort of countdown.”

I laughed in her face. I laughed in her face with barely concealed bitterness, contempt and irritation. “Don’t you think,” I began, through gritted teeth, “that if it was possible to not view it as a countdown that I would be doing so?”

Some non-committal response.

“I have tried, NewVCB,” I told her, very definitely. “I have tried, and I cannot not view it as a countdown. I can still work well with C despite that, but that reality is not going away.”

To be fair, and to my surprise, she backed down and appeared to accept this. Then she started rattling on about breaks from therapy which are only temporary.

Apparently what “quite often” happens is that patients leave therapy, for a matter of months, maybe even in excess of a year. During that time they put their newfound self-understanding and training for ‘real’ relationships and situations into practice. Then, some time later, they’re referred back to therapy to build on the work they had previously done, both in and out of session. How did that sound to me?

“In principle I have no strong objections, though it does seem curious to cut the process short when one is in the middle of something so important as this, especially given how rushed and forced into things I feel,” I told her. “Whatever the case, though, what I could not stomach is being referred back to therapy, only to be forced into some wanky C- or DBT. I promise you, that would be a very bad idea. Any therapy with ‘BT’ in the title will not work for me, and will only serve to make me very angry indeed.”

To my amazement, rather than defend the health service’s little alleged panaceatic wankeries of non-loveliness, she nodded in agreement with me. Score.

I went on. “Besides, it’s not just about the type of therapy; it’s an issue of personalities. I saw Christ knows how many people before I met C, and he’s the first one that has been of any real help to me. I know that literature on this matter agrees that the therapeutic relationship is absolutely fundamental to healing, insofar as healing is possible.”

Again she nodded. “There are no guarantees; things change in the health service just like they do in any place of employment. C could obviously leave his job here for another one. But, assuming there are no such changes, we try to put people back with the folks that have previously treated them.”

Point of Interest Mark III. That was very interesting. C has made no reference to anything of this nature. Additionally, it seems slightly at odds with a comment NewVCB made when I first met her – she said something along the lines of her being sure that C would extend things now if he felt it was necessary. C had, rather obviously, made no reference to that course of action either.

Part of me has wondered since C imposed this ending if he has been doing it to force me into talking. If he would change his mind later in the contract because he was getting somewhere – which he now is, of course. I had always thought that what he wanted me to think was that the cessation of the process was about (a lack of) resources. But if what NewVCB says is true, how can that be? Maybe he wants to end things because of my attachment to him, an issue of which he is fully aware. But surely the antidote to that is to fucking work through it with him, rather than find myself thrown out in the deep end that is the cuntified, horrible, real bloody world?

Anyway. Anyway. Siiiiigh.

Anyway. Eventually discussion with NewVCB centred around medication; she did exactly what I’d expected her to do and told me she would increase my dose of Quetiapine from 300mg to 400mg. She warned, however, that she intended this to be temporary.

Her rationale for this dose and its probable temporary nature is primarily that she wants me to get through this particularly difficult period in therapy, of course – since the drug had had such a good effect in its 300mg dose, it would be hoped that once this current spell is dealt with psychologically, that that dose would once again be effective. Secondly, though, she wants to leave herself “room to play with,” in case the dose needs to be increased further, which she suspects it eventually might. She had already warned me that she’d be reluctant to take me over about 700mg, so she felt that she needed to leave a reasonable gap between that maximum dose and the present one.

And here she scared me.

She said, “I don’t want to over-medicate you [fine], but we do need to make sure you don’t go further downhill and that you can continue to do this work with C [still fine]. If I didn’t increase the medication, then that could slide [OK]. At the end of the day…[dramatic pause]…[looks me straight in the eye, her left eyebrow slightly cocked]…our priority is to keep you safe [clears throat guiltily, shifts gaze].”

Her euphemism, especially when accompanied by such powerful body language, is clearly psychiatristspeak for HOSPITAL. Yet another point of interest, though in this case one I would rather not have had.

No fucking way, no way no way no way. I will kill myself first. I. WILL.. KILL. MY. SELF. Do you fucking hear me, you bitch?

Of course, rather than make any such protest – which may well have been interpreted as a borderline strop anyway – In-Control Me just looked at her meekly, and even fucking nodded.

I was, however, determined to steer her away from continued thoughts around this subject, so I took the opportunity to beg her for sleeping tablets. She agreed, to my considerable satisfaction (and in hilarious defiance of Twathead GP. Interestingly, Twathead had accused me of insubordination vis a vis the consultant’s advice on Venlafaxine, but now the shoe’s on the other foot, Twathead; he refused to give me Zopiclone, and hey presto – look what the consultant is now doing! Hahaha! Mwhahahahaha!!!).

I actually got really lucky with the Zopiclone prescription, owing to an administrative mistake at the GPs’ ‘surgery’. But that, along with the entire comedy of errors that was obtaining my prescriptions, is a story to be told on another day.

In conclusion, I suppose there’s some encouragement to take from this appointment, especially re: the cessation of therapy issue. I think, whether C will admit it or not, that NewVCB probably has some influence on how he proceeds – and if the courses of action that she has mooted are indeed possible, well, that’s better than the alternative of complete abandonment. The question remains though – does C know about any of this?

She was going to talk to him after my most recent appointment with him (blog upcoming) so we’ll see what, if anything, comes of that. In the meantime, I’m a vertiable walking pharmacy and glad of it, and think I am ready to continue the anti-Paedo / anti-’They’ fight with C. All of the non-existent bastards are still hovering about for now, but Quetiapine has served me well in the past, and I have faith that it can do it once more.

Over the weekend and today I’ve been cracking up completely (yeah, I know, <insert standard comment about it ‘being a bit late for that’ here>), and losing pieces of what fragile sanity I have left little by little.  I posted the other day about how ‘They’ were plaguing me with their bile mantras emphasising my sluttery, and how a hallucinated Paedo kept showing up in very close proximity to me.  What I didn’t mention (and neither did I mention them to C on Thursday, simply owing to a lack of time) was the flashbacks.  Oh, the flashbacks.  Dear God, I hate them.  I would almost say they’re worse than the hallucinations.  It reminds me of my writing in this post, where I tried to put the finer points of the abuse into real, tangible words.  One of my overriding conclusions was that the abuse was not then, it is now.  How true and prophetic that statement has proven to be.

On Friday night I collapsed in the middle of the street in a tearful dysphoric panic, as fake-Paedo wouldn’t leave me and at least in part owing to his ‘presence’, I couldn’t stop reliving what he did to me.  A scooped me up and took me home, bless him, and Saturday was mostly fine (about which I was very surprised, but also immeasurably grateful).  In fact, the problems didn’t start again until early on Sunday morning – about 2 or 3am – when I was unable to sleep.

Certain things always seem notably amplified during nights of insomnia.  Things that one can just about deal with during the day are things that one is utterly incapable of fighting during the darkest recesses of night, and to that end the flashbacks and voices threatened to overwhelm me completely.  What’s more, my mood plummeted into the depths of a metaphorical abyss too; throughout all the madness of the last few weeks, I had still managed to remain in a passably alright mood, at least during the flashbacks’ and hallucinations’ temporary remissions – but this episode saw a very distinct and definite end to that.  I’m still in a very deep depression, with no interest in anything nor any concentration.  All I have done, and want to do, is sit here and stuff my face with rubbish.  These 300 words have taken me, on and off, about four hours to write, which is unspeakably pathetic.

I’ve been thinking of doing myself in again.  I won’t actually do it, in all probability, mainly because I don’t want to put A through it – but it’s certainly on my mind a lot.  It’s liberating to know that I can stop it all – the depression, the voices and visions, the panics, the delusions, the anxiety and agitation.  All it takes is a bit of careful planning – then I could be free of it permanently.  But then, on the other hand, I’m a bloody wuss too, because although I don’t believe in an afterlife, it would be just my luck if there was one, and it was populated by ‘They’, Paedo, and any other number of as-yet-unknown nebulous nasties.

‘They’ like it when I contemplate suicide.  They haven’t as yet considered the reality that it would probably be an escape for me, and therefore a Good Thing; no, they believe instead that it would be the ultimate act of self-punishment that I deserve for being a whore, a liar, an insidious, disgusting, hateful being.  They’d like me to do it painfully, of course – no clever cocktails from The Peaceful Pill Handbook or similar for me, oh no.  ‘They’ want me to drown myself, or alternatively to douse myself in petrol and self-immolate – two of my greatest, Room 101-esque fears.

I won’t do it, worry not.  To be fair to ‘They’ (how ridiculous that clause sounds!), they haven’t been babbling on about me killing myself in an unsolicited way – they only address the subject when I have been contemplating it myself.  So for now at least, I can resist them.  The rest of the time, they just shout at me and remind me how much I deserved to be raped and tortured, whether they do it directly in my head or whether it’s in a more vicarious way (Nick Clegg and Noel Edmonds are two of their latest ‘hosts’, though frankly it serves me right for bothering to watch the electoral debate and, worse again, Deal or No Deal).

Someone keeps phoning me over and over.  It’s some old sales bollocks, I know, and to that end I wouldn’t answer the calls anyway – but my irrational mind is simultaneously convinced that it’ll be ‘They’ at the end of the line, seeking another avenue to abuse me.  So I’ve put my mobile to send all calls directly to the answering machine, supposing that anyone legitimate can leave a message – though knowing my luck, someone legitimate will phone and ‘host’ ‘They’ anyway.

*** TRIGGER WARNING ***

But, as I said, the worst of the lot is the flashbacks.  They’re almost like a psychosis, in that they’re entirely sensual experiences; it’s as if it is all completely real, and happening right now.  I can hear his breath in my ear and feel him inside me, harshly thrusting into me, causing me indescribable agony.  I can see his sweat drip from his hideous chest hairs on to my own exposed (flat, as it then was) chest, I can hear his grunts.  I can feel him choking me when he forced me into fellatio and I can feel his vile, disgusting tongue flicking around my own genitals.

I feel it all physically, mentally and e-fucking-motionally (and in any other possible way, for that matter).  And I feel nauseous to my physical core, not to mention despairing and lost with every neuron that fires through and every chemical that imbalances in my traitorous brain.

I will be OK, I’m sure.  I don’t know how to get through this in the next 36ish hours until I see NewVCB, my psychiatrist, but I’ve managed it for a week without any self-harm or a suicide attempt – and even though it’s getting progressively (regressively?) worse, I’m sure I’ll manage (whatever ‘manage’ means).

It’s just so hatefully exhausting, so overwhelmingly depressing and painful in every way conceivable.  I don’t know how to get out of this vicious little mess, and I therefore I wish I could turn myself off,  even if only for a little while.  There is no ‘off’ switch visible to me, though, which fills me with dread and foreboding.

So apparently Seaneen, my fellow Norn Iron mental health blogger who writes at mentallyinteresting.org.uk, has been told she does not have bipolar disorder, but borderline.

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

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

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

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

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

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

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

I saw my consultant psychiatrist, NewVCB, for the second time this morning, an appointment that I’d been dreading for days.  Even though my first encounter with her back in January had gone without any significant hitch, and even though I had established on that occasion that she was not as formidably intimidating as OldVCB, I still found myself feeling scared of her in the run-up to today.  She’d been ostensibly much nicer than her predecessor, but there had been moments where I’d found her a little condescending, and anyway I think I’ve just developed a fear of psychiatrists anyway.  Don’t ask me why.

I was fully expecting that NewVCB would keep me waiting for 23 light years before she emerged to escort me to my for-today fate, but to my astonishment she actually came to get me shortly before the appointed time.  That was quite impressive; OldVCB was never on time, never mind early.  I was also pleased to note that my file seemed to have been fully updated to reflect my name change.

She showed me into her office as usual and gestured for me to sit opposite her, before quite amicably asking me how things had been.  I was honest and told her that Quetiapine has, in general, made my life better.  I said that I had come from a point of being severely depressed when I first met her to being, now, perhaps only moderately so.  I said that whilst not perfect, this was clearly a significant improvement.  I also said that there probably wasn’t the same mad variation in my moods that there had been around Christmas and the months surrounding it.

She agreed that this was encouraging, but said she was also wondering about the status of the voices.  I said that Quetiapine had not completely eliminated them, which it hasn’t, but that they were (a) less frequently in evidence and (b) much less overwhelming.  I pointed out, with some regret, that the benevolent one (Tom) has disappeared entirely (though admittedly Olanzapine, my previous anti-psychotic, seemed to have been his murderer).

NewVCB asked me to describe the status of ‘They‘ relative to the unfortunate incident on Christmas Day, the details of which she was aware from our previous meeting.  I said that a comparison was impossible because the horror and overwhelming nature of that particular incident was almost unique.  “They have tried to get me to kill myself before,” I told her, “but since on most of those occasions suicide has been in the forefront of my mind anyway, those occasions did not seem so serious.  Christmas did, but they don’t have that hold over me at the minute.”

She nodded, apparently encouraged, and we discussed a bit more about the frequency of the hallucinations (no set pattern, but perhaps once a week on average) and how I can now…not ignore them, but tolerate the levels of their malevolence.

“Regarding Christmas,” I started, uncertainly.  “The baby involved, doing you remember me telling you about him?”

She responded in the affirmative.

“His baby brother was born yesterday.  They’re naming him after my child abuser.”

NewVCB was visibly horrified by this information.  She gasped, threw her hand over her mouth and winced.

“Oh, Pandora,” she sort of sighed, through gritted teeth, shaking her head rather despairingly.  “That must be dreadful…”

I nodded.  “It’s not the parents’ fault; they don’t know about the abuse.  And of course it’s not the baby’s fault.  But I feel irrationally angry all the same, as well as…not hurt, it’s deeper than that.  I’m horrified to the pit of my stomach.”

We discussed the fact that I have been covering really difficult material with C recently, though at this stage I didn’t specifically tell her that it was in relation to Paedo.  I said that although it was hard stuff, I nevertheless thought it was productive work, and the fact that I hadn’t completely lost my marbles as a result of it was a testament to the wonder of Quetiapine.

We moved back to talking about ithe drug, in particular with reference to the dosage.  For now, NewVCB wants to keep me on 300mg, as – according to her – that’s presently thought to be the most effective dose for those presenting with mainly depressive symptoms.

She said, “doses above 700mg or thereabouts tend, according to the recent research, to be most effective for schizophrenia or full-blown mania – and you don’t have either of those.  So for now I want you to remain at the present dose.  How do you feel about that?”

“That’s grand.  I suppose my thinking had been to maybe increase it in the long-run, but I’m happy enough to maintain the status quo for now.”

“In all probability we will have to increase it as time goes on,” she admitted.  “600mg is a future possibility, though as I said I’d be dubious about raising it much higher than that.  For now, though, I want to monitor just how much this dose helps you over a sustained period, rather than just a few months.  Thereafter, if you still feel that your depression is within the ‘moderate’ zone or the voices are still there, then yes, we can think about an increase.

“At the end of the day,” she continued, “the most important aspect of your treatment is psychological.  All medication will ever do is take the edge of your distress until you’ve worked through things psychologically.  Traumas, depression, whatever – certainly, they do change the physiology of the brain, and we can deal with that from within the medical model.  But it’s only one part of treatment in a case like yours.”

Of course, I was very well aware of that, but I didn’t press it.  Her point was valid: leave the Quetiapine as it is until it has had several months to work its magic, just as she had planned from my introduction to the drug in January.  (Interestingly, and gratifyingly from my point of view, she didn’t mention Venlafaxine at all.  In the previous meeting she’d expressed the desire to wean me off it, which I don’t want her to do.  I admit that my reluctance is partly to do with the horrendous potential discontinuation syndrome, but it’s mainly because the current cocktail is making a difference, and I don’t want to interfere with that).

We discussed concentration and focus, and I said that it was still abominable.  “I pick up a book and find myself reading the same sentence 20 different times,” I told her, “which is incredibly frustrating, as I’ve always loved reading and have a thirst for knowledge.”

New VCB asked me to describe a typical day.

“I get up late, go to the sofa, watch TV.  I don’t make food beyond Pot Noodles.  I just sit there.  And I hate that, because I’m actually quite an intelligent person who is capable of so much more.”

She nodded in agreement (yay) and said that she did honestly understand my frustrations, but that concentration was one of the last things to return in the ‘recovery process’, so I therefore shouldn’t feel too discouraged.

She suggested that I make a pact with A to once a day do something other than sit in the living room – a walk, a coffee, whatever.  “It’s easier to be motivated when someone else is doing it with you,” she said.  “And if you start doing something like that in the evenings with your partner, after a while you can start setting yourself small goals to do such things yourself during the day.”

Eventually she asked if there was anything else I wanted to discuss with her, and I said I had read up on and discussed PTSD with a number of others, with many thinking the diagnosis was more apt for me than BPD.

She asked why I felt that my symptomatology was consistent with that diagnosis so I told her about what happened with C last week, then gave her a brief run-down of the other symptoms, a la the other day’s BPD v C-PTSD post. However, I purposely refrained from mentioning complex-PTSD in order to see if she would bring it up unsolicited.

She did not disappoint.  She said, “well, PTSD tends to be most applicable after a single traumatic event – an earthquake, a bombing, those sorts of things.  When there is repeated trauma, things become more complicated, and we call that complex-PTSD.  I think it actually goes without saying that you have C-PTSD – how could you not after the traumas you’ve gone through?”

I felt smugly pleased at the success of my latest self-diagnosis (the original, in which I correctly diagnosed myself with BPD and bipolar disorder, is here).

“Having said that,” NewVCB went on, “your case is not a simple one.  You’re not really classically borderline.  You’re not classically bipolar.  You aren’t entirely a classical example of C-PTSD, and your psychotic features don’t classically fit any specific psychotic disorder.  I could diagnose you with this, with that, with the other – but you’re a mix of all of these things.  They all apply, but in a convoluted mishmash.”

I said that I understood and agreed with that, but I had – in part at least – been seeking recognition of C-PTSD as unlike borderline, it emphasised trauma, thus contesting my default “it was all my fault” position.

“It is helps you to deal with things, then yes absolutely, that’s great.  You can’t not have it anyway, at least to some extent,” she said.

She remarked that I’d mentioned experiencing flashbacks in session with C and asked me how things had been with him, noting that last time she’d seen me I was very concerned about the cessation of psychotherapy.

“Well, I still am,” I confessed, “but we’ve agreed to sort of put discussion of that on hold for now and tackle this sex abuse stuff, which I think is important.  I think the key thing to report is that, although this material is difficult and triggering, C and I are working very well together at the minute.”

“Good,” she said, again pointing out that limited as it may be, psychotherapy is still the crux of my treatment.  “And I think that hits on an important point.  I feel that your prognosis is quite encouraging, because (a) you’re bright, and your ability towards insight and your hunger to learn about your conditions make a huge difference and (b) you can work psychologically.  Not everyone has even one of those, never mind both.  Having said all that, you’re not ‘uncommon’ either, in the sense that you cross diagnostic criteria, so please be reassured by that.”

I’m not particularly, as I quite like being unique.  Nevertheless, I suppose I should be glad that my prognosis is apparently quite positive.  Since I don’t believe in cures I’m dubious, but I suppose a prognosis suggestive of an ability to manage my mentalness is quite a good thing.

As I left, she said that she did actually notice a change in me from the last time she’d seen me, echoing A’s sentiments on my recent mood.  I don’t for half a second expect it to continue indefinitely, but it’s nice not to have to fight the urge to throw myself under a bus at every single opportunity.  Let’s just see how much upcoming therapy sessions will conspire against me in that regard.

(PS.  No ‘Article of the Week’ this week, for which my apologies.  I simply haven’t come across much that I found worth sharing.  Normal service will hopefully be resumed next week).

The first article I’d like to look at this week is from the excellent After Silence blog, which is about regaining one’s confidence, hope, life – one’s voice – after rape or sexual assault.  This particular entry discusses the physiological effects of post-traumatic stress disorder, which in the author’s case was of course caused by her own rape, but which is applicable to PTSD brought on by any type of trauma.

The author, Kimberley, discusses an article on the phenomenon from Pandora’s Project, which is a support site for those effected by sexual abuse (interestingly, ‘Pandora’ is the name currently leading my poll on what I should be ‘called’).  Firstly, Kimberley discusses the symptoms that are commonly seen in this illness, such as hypervigilance, flashbacks, severe anxiety and dissociation, though she then moves on to outline the biological research undertaken into PTSD.

The bottom line is this: PTSD is not just a psychological illness, but a physical one too.  Trauma does not just damage our psyche, it can actually change the physiology of our brains.  In particular, traumatic events seem to affect the hippocampus (a part of the brain that has responsibility for a lot of memory functions) and the medial prefrontal cortex (responsible for cognitive functions such as personality expression and decision-making).

I have come across information like this before, but Kimberley’s analysis of the Pandora article is worthy of particular note for her eloquence and understanding of this subject.

PTSD and Your Brain

Now, this I like.  Anyone who has followed this blog in the long-term knows about my complete disdain about all forms of cognitive behavioural therapy.  I think it’s the biggest pile of toss in the history of psychology, at least for people like me.  To say that I have faith in the psychodynamic and analytical schools of therapy would be false, because I am not sure that I really believe any form of psychotherapy works entirely.  Nevertheless, I hold the latter in much higher regard than the ‘newer’, in-vogue, supposedly cost-efficient therapies.

The problem in this position in the last few years has been that the psychodynamic schools have lacked empirically-based evidence for their effectiveness, whereas (surprisingly for me) CBT and its kindreds are backed by a myriad of studies supposedly supporting their effectiveness in treating various forms of mental illness and distress.

Well, finally it seems the psychoanalyst types have sought to prove the efficiency of their practice.  This article from Scientific American (reported prolifically elsewhere too) discusses a recently published journal article apparently demonstrating that psychoanalysis and psychodynamic therapy not only work, but keep working after cessation of treatment.

The piece claims that psychodynamic therapy has been shown in controlled trials to effectively treat anxiety, depression, eating disorders and, crucially for yours truly who is in psychodynamic therapy, personality disorders.  According to the author of the original journal article, this type of therapy enables patients to develop tools to better function in the “real world”, increases self-confidence and decreases the symptoms of their illness(es).  A key ingredient in achieving this is, of course, the therapeutic relationship.

Like the preceding article above on PTSD, there’s a wee bit of neuroscience thrown in here; current research seemingly suggests that psychodynamic therapy can produce changes in the prefrontal cortex of the brain, as patients begin regulate emotional health.

Naturally this isn’t a faultless paper; for one thing, the studies therein simply aren’t numerous enough in number.  But, not unsurprisingly in my view, most of the main detractors of the article’s findings are CBT devotees, who complain that this study is across various mental disorders, rather than focusing on just one.  Fair enough, but the analytic schools had to start somewhere (and admittedly should have done so sooner), and ‘somewhere’ is proving to be a promising start.

Talk Therapy: Off the Couch and Into the Lab

A few other articles of interest came up this week, but I think I’ve drivelled on enough.  Enjoy.  *coughs*

C is off tomorrow   So I shall report on last week’s session then, hopefully.

Yet another day with two posts.  Sorry.

In short, she is better than her predecessor, though as W said to me this morning, she could hardly be much worse.  In fairness to OldVCB, I had come round to her a little before our relationship was severed, but nevertheless, I am not exactly sorry to see the back of her.

NewVCB is a shorter, younger, longer-haired, less officious, more Northern Irish version of her predecessor (who was ((and presumably still is)) tall, short-haired and Scottish).  It surprises me that NewVCB is old enough to be a consultant, but apparently it is indeed so.  She said that she works closely with OldVCB – in fact, they job-share – so she claims that she has been fully informed about my case.

She opened the mentalist discussion by saying that she had had the opportunity to speak to C on Monday.  “And,” she added, “BS [the unfortunate initials of the psychiatric liasion woman [[henceforth known as PLW]] from Saturday].”

I rolled my eyes.  Having not heard from PLW (despite PLW telling me she would give me follow-up phone calls), I had hoped that maybe she had not phoned NewVCB et al after all – but clearly it was a futile desire.

NewVCB continued, in that time-honoured fashion of mental health professionals, by asking me how things had been.  I said that they were (are) fucking terrible.  I told her how I have been on a downward spiral since before Christmas, and that neither Venlafaxine nor Olanzapine seem to have made a blind bit of difference.

She is the only professional that I confessed to about what happened at Christmas; I didn’t want to, obviously, but what choice did I have?  Risk it happening again, end up hospitalised or just tell her, and let her offer me some proper outpatient treatment?  Needless to say, the latter is the least worst option…so tell her I did.

It was apparent that she and C have already had the Christmas discussion, which – thinking about it now – is actually really annoying.  C never asked for my permission to reveal the finer points of my life history with NewVCB.  If he had asked me could he do so, I would have happily given my permission, but he didn’t.  He was too fucking busy last week psychologically battering me.

NewVCB continued by asking what had happened to precipitate the sheer forcefulness of ‘They’ at Christmas in particular, so I told her about the McFs being a freakshow of abject cuntery, and about Paedo being a paedo.

“Ah yes,” she said, knowingly.  “This is something that came up in conversation the other day [evidently with C, because it is highly unlikely to have been PLW].  These kind of transient, stress-related psychoses are quite common in people who have been through that kind of trauma, so don’t be thinking…”

Don’t be thinking what, love?  If you have something to say, just say it.  Am I supposed to think I’m not a freak, or that because it isn’t that unusual that it’s therefore not serious?  Whatever.

I don’t remember how the topic of C came up, but it inevitably did, and I told her he was discontinuing my treatment.

She sort of laughed and pointed out I still had over 20 weeks left of psychotherapy.

“Yes,” I retorted, “but all published research on borderline personality disorder recommends therapy of a much longer time frame than that.”

To be fair, she agreed that BPD therapy should be at least two years but then babbled on for a bit about there being no personality disorder service in our Trust area (so?  How the fuck is that my fault?) and that therefore C was being “very kind” in treating me (um…no actually, he’s doing his job, for which he’s paid a very decent salary).

She continued that she has “a lot of respect for C” (that makes the sum total of one person I know, then) and when I protested vehemently about C’s decision to flog a dead horse every bloody week, she said that C knew what he was doing and that the issue of abandonment was part of my problem.

I am so sick of all of them assuming this is just about transference.  IT IS NOT. Not entirely.  I freely admit that whenever therapy ends I will be upset, as I will be sorry to lose my connection with C, because I am pathetically attached to him, however much he can be an arse.  I mean, how can you not mourn the loss of a long-term relationship of any kind, never mind one in which the other party has been privy to your deepest secrets, fears and fantasies?  No, I’ve never, ever denied that potential sense of loss.

However, this is also about getting that to which I am entitled and that I need.  It is about the health service screwing me over for years, and then slapping me in the face by doing it again.  It is about somebody finally taking responsibility for all the failures to which I have been subjected.  It is, above all, about improving psychologically to a point where I am able to adequately cope without the support that is therapy.

She said that C sees something in me that he feels he can work with and that that “isn’t the case with all people”.  I’m keen to work with C, apparently, C’s keen to work with me, apparently, and therefore there’s a lot that can be done in 20 weeks (and apparently I need to “get some perspective” on the timeframe.  Cheers for that.).  I’m sure that’s in part true – if C will allow me to discuss the fucking issues for which I am in therapy in the first place, rather than endless bollocks about him rejecting me.  But what do I know.  He and NewVCB have it all worked out amongst themselves and Heaven forbid the stupid mental might have a differing view.

I said that I was feeling no better whatsoever after months of C’s involvement, and in fact that I was feeling distinctly worse.  I admitted that I had always expected to feel worse before feeling better, but that I hadn’t expected to be actively suicidal all the time.

NewVCB said, “but you’re feeling these things now – you’ve repressed and dissociated so much in the past and are now learning to feel.”

I’m sorry, but if this is what experiencing emotion is like then I’d rather stay a repressed, dissociated mental freak forever.  And anyway, that’s bollocks.  I’ve felt like this before many, many times; it’s just the worst it has been during this current breakdown.  I saw this quote today – “[I've reached a] new level of worst.”  That sounds about right.  A new level of worst for the past breakdown.  I haven’t felt this low since I was about 16, but back then it was basically perpetual.

Anyhow, NewVCB eventually moved on and asked me about manias, making the connection that OldVCB never did that some of the mixed and manic episodes were considerably exacerbated by Venlafaxine.  I was unable to describe a (hypo)mania to her, as frankly I’ve been on the downside of the cycle for quite a while now, though admittedly I’ve had quite a few delightful mixed states thrown in too.  Things are, however, looking very cyclical to me – I rarely have hypomanias lasting any amount of time, but I do experience long-ish-term mixed episodes and depressions.  I told her so.

She said that she is still uncertain about a bipolar diagnosis, but that it’s a distinct possibility, and in any case with or without it, my moods are very changeable.  To that end, given that the Olanzapine hasn’t really worked as either a mood stabiliser nor as an anti-psychotic, she has decided to change it to Quetiapine.  Apparently, there is a lot of research coming in that, at 300mg (the dose that she has prescribed – very high for a starting dose), this drug stabilises moods considerably.  I see that it is indicated for both mania and depression in bipolar I, and depression in bipolar II, as well as schizophrenia.

NewVCB therefore wants to wean me off the hateful Venlafaxine, about which I am both encouraged and horrified.  On the one hand, I think it is an evil, insidious medication and would prefer to have it out of my system.  On the other, I’m petrified of not being on anti-depressants specifically, given as I have been on them in one form or another for 12 years.  On the third hand which I’ve just grown, I know that Venlafaxine is particularly difficult to withdraw from, and I am not sure that my head will be in a space to cope with that in the next 12 or 14 weeks, which seems to be her rough timetable for doing this.

On that note, that’s one thing I liked about her.  She probably sounds like a condescending bitch from most of this post and, regarding C at least, at times she was.  However, she did tell me how she foresees things developing and what her plan of action is; basically, as things stand now, she would plan to keep me on the Quetiapine for quite some time, as it can take a while to fully get into one’s system.  However, if it doesn’t work after about two months, she’ll just take me off it and try again.  She did speak to me as if I had half a brain for the most part, and assumed that I had prior knowledge of that of which she spoke.  I appreciated that a lot, though I am sure it would be a reason for some other people to dislike her.

She says she will see me again in “four to six weeks”.  In the Psychiatrists’ Dictionary, that means 18 months or something.  Meh.  To be fair to her, I actually think she might see me again in the timeframe specified, because I really don’t think she’s as bad as OldVCB.  I had made a polite dig to her about OldVCB failing to see me as promised in December, so I hope she has taken the hint.

One final point she made on C, although she said it almost in passing – apparently if work still needs to be done after the 20-whatever weeks, she is sure that he will “carry on.”  I wonder if someone has told him that?

I always seem to leave Psychiatry in a bad mood, and today was no exception.  However, he appointment really wasn’t that bad; I have got a decent dose of what I hope will be both a mood stabilising and voice-reducing medicine, and someone overseeing it all who seems like she may take more interest than her colleague did.  Time will tell.

The Main Course

My favourite psychiatric article this week was on schizophrenia.  Specifically, the piece from X-Ray Technican Schools (I agree that this seems a curious place to have an article on schizophrenia) provided a concise, accessible but intelligent refutation of the many myths that surround this illness.

One of my pet hates is the mistaken belief that so many seem to hold that schizophrenia is, or at least shares key symptoms with, dissociative identity disorder.  I suspect I’m preaching to the converted on a blog about mental illness, but lest there be any doubt schizophrenia does not involve multiple personalities!!!

Another mistaken and highly stigmatic belief that I despise is that mentally ill individuals (especially schizophrenics) are more dangerous and/or violent than normals.  This simply is not true, as statistics frequently demonstrate.

This article analyses these two myths, plus eight others, discussing how they’ve arisen and why they are false.  Many thanks to Wounded Genius for posting this for us to find.

10 Myths About Schizophrenia

For Afters

There were so many excellent articles upon which I stumbled this week that it’s hard to narrow them down.  Here’s the runners-up that I’ve come up with.

A close second to the above schizophrenia article is a piece in the New York Times that discusses the “Americanisation” of mental illness.  By “Americanisation”, as far as I can tell they really mean “Westernisnation” (not that that’s a word).  This is quite a long article, but its well worth sticking with.  It goes into considerable and fascinating detail as to how some mental illnesses are (or were) culturally dependant, and how they now seem to be becoming increasingly homogenised – in line with Western interpretations.

The Americaisation of Mental Illness

Jonah Lehrer at Science Blogs have a post on daydreaming, and why it isn’t necessarily such a waste of time:

Intelligence and the Idle Mind

Science Daily reports that migraines may have links to child abuse.  This could explain a lot…

Abuse in Childhood Linked to Migraine and Other Pain Disorders

Finally, I want to have a look at two articles from Psych Central that discuss transference and the therapeutic relationship, both written by Sonia Neale.  The first discusses how the therapist can never really return your transference – not in a manner in which you would know it anyway.  It discussing how what it terms ‘transference love’ is very real, given as all any of us ultimately want (allegedly) is to be loved, but will always (sadly) be one-sided.

Transference is Not Transferable

The second article explores a similar, but distinct, aspect of therapeutic relationships – that fantasy that we can or will, eventually, be friends with our psychotherapists.  Ms Neale discusses why this is a bad idea, but argues that it’s not necessarily transference but a genuine connection that drives this.

Why You Can’t Be Friends With Your Therapist – Ever!

*SI walks away, whistling innocently*

Anything Else?

Any suggestions for Article of the Week are very welcome, as are comments on those posted here.  Get in touch or leave a comment.

I’ve decided to undertake a new venture for a new year.  Whilst I feel very lucky that so many people enjoy this blog (why?!), I also thought it would be good if I could make it of some use too by sharing some of the most interesting psychiatry and psychology articles I come across through my travels on teh interwebs.  To that end, every Wednesday where possible, I shall put up my Article of the Week.

Article of the Week

The first is from Current Psychiatry, who have an excellent article on the differences between borderline personality disorder and bipolar disorder.

There’s an analysis of the overlapping symptoms, a look at what is different between the two illnesses, and possible reasons as to why one illness is often misdiagnosed as the other.  The article also points out that there is, genuinely, a high correlation of co-morbid BPD and bipolar disorder (especially type II), nodding at the possible biology underpinning both conditions.

A slight warning: some of this stuff is technical (well, it is for psychiatrists!), but if that doesn’t faze you, this is a very insightful article.

Borderline, Bipolar or Both?  Frame Your Diagnosis on the Patient History.

Honourable Mentions

A mention too to Kathy Broady at Discussing Dissociation, who writes a moving post on the hopelessness and despair felt by those who have been affected by psychological trauma.  She also advises on how to combat these feelings.

Hopelessness and Despair

The Canadian Globe and Mail asks whether or not psychiatrists and therapists have their own significant mental health difficulties.  The author says at one point that she has wondered if her therapist has, and I can certainly confirm that I too have made the same mental queries.

The Secret Life of Psychiatrists

Finally, Psychiatric Times posted a decent entry on how therapists and psychiatrists can end the therapeutic relationship with minimum disruption to the patient’s well-being (maybe C should read this).

Psychiatric Abandonment: Pitfalls and Prevention

Any Suggestions?

I find most of these articles via interesting links from Twitter, as well as my own explorations.  If you want to suggest an article for inclusion here, I’d be delighted.  I can be contacted in a variety of ways, or you can simply leave a comment here.

I know some of you follow the insightful and informative Mental Nurse blog, written by…er…mental nurses. As regular readers of it will know, each Saturday (usually) they publish a review of that week’s musings in the mental health blogosphere, terming their summation ‘This Week in Mentalists’. I was featured once, with the child sex abuse post, catapulting it to the most read spot on my blog.

Anyway, at the end of the year Mental Nurse let their readership vote on the best blogs in given categories, and this year’s winners and runners-up have just been announced. No, yours truly has not won anything, as in I have not come first or owt like that…but this blog did come joint third in the Personality Disorder category.

First place in the category went to the very worthy winner of Genius Gone Wrong, whose blog I follow and whose comments I have had the honour of having here. Second place was Becoming Hannah, and my fellow third-placed contender was Writing in the Margins of My Mind. I shall look forward to reading these blogs, plus other mental health blogs that were featured as winners.

Thank you to all who voted for this blog. It was an honour to even be mentioned as a possible contender, never mind to be actually placed. I really do feel very honoured.

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

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

THE BAD

Being Mental

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

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

Specific Issues on Mentalism

–> Psychoses

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

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

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

–> Dissociation

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

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

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

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

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

–>  Self-Harm

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

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

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

Losing My Job

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

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

Trouble with the NHS

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

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

Christmas

It was fucking God-awful dreadful.  Enough said.

C

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

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

THE GOOD

C

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

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

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

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

Diagnoses

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

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

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

Turkey

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

This Blog

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

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

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

Twitter

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

–>  Thank Yous – Twitter

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

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

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

–> Thank Yous – Blogging Buddies

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

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

Again this is not an exhaustive list.

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

Friends

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

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

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

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

And of course a re-acknowledgement of CVM and K

A

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

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

AND FINALLY…

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

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

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

Yours ever

SI x

Those that follow the Twitter stream that I have allied with this blog will know that I did not intend to write a blog today (LATER: yesterday). I was feeling a bit low after CVM called me this morning to report that her father had sadly died early this morning (LATER: well – technically now yesterday morning). However, sitting here brooding won’t do either her nor me any good, so I decided to go ahead and write it anyway.

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

—

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“I’m curious.”

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

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

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

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

I nodded non-committally and waited for the backlash.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“But…” he went on.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The iPod has been acting as a mindreader again.

I’m not in the habit of doing this as this blog is mine; my life, in my words. However, sometimes others just say it (whatever ‘it’ is) better than me, and this is very much one such occasion.

So, ladies and gents, I give you the nature of my present sorry existence – as presented by Metallica.

Until It Sleeps

Where do I take this pain of mine
I run but it stays right by my side

I’ll tear me open make you gone
No longer will you hurt anyone
And the hate still shames me
So hold me
Until it sleeps

(c) James Hetfield and Lars Ulrich, Metallica (from the Load album, 1996).

I will write properly tomorrow, but in the meantime you can listen to and watch the video for the above here.

The phenomenon of Stockholm Syndrome has been bandied about a lot in the media recently, in the wake of the Jaycee Lee Dugard abduction and, to a lesser extent, in discussion of the Fritzl case (though I am not sure to what extent Elisabeth Fritzl was affected by it).  There is a particularly good article, by trauma therapist Kathy Broady, on the condition here.

For those of you not familiar with the issue but who don’t have time to follow the links, Ms Broady puts Stockholm Syndrome thus:

It is when victims form positive, caring attachments with their violent perpetrators.  The more victims have to depend on their perpetrators for their very survival, the more likely the victim will form an attachment to their perpetrator…

[Victims] knew that their life and basic survival needs were completely dependent upon keeping the perpetrator happy.  They learned to base their own survival on effectively meeting the needs of the perpetrator, and the perpetrator had the power to decide if they would live or die.  To survive, they became loyal to the perpetrator.

Perpetrators purposefully create this kind of dependence in their victims.

As far as I am aware, and it fairly logically follows given the above set of circumstances, Stockholm Syndrome is most frequently seen in cases of long-term abuse (and is thus not particularly applicable to me).

During a recent documentary on the Dugard case, my mother sat aghast as the narrator described how Kaycee and her two daughters wept as their abuser (and father of the two younger girls) was arrested.  She admitted that, had they randomly told their story without proof, that she would have thought them to be either unforgivable liars or seriously afflicted by folie a trois.  How, she argued, could you care so deeply about a person who had so horribly and systematically abused you?

I spoke to her at length about Stockholm Syndrome, but to little avail.  She understood the concept in theory, I think, but was nevertheless unable to grasp how it could actually be.  The whole idea is so alien to her that she cannot conceive of it being a very real condition, borne – initially at least – out of necessity.

A similar, though distinct, query arose with her when the Fritzl story broke last year.  “But how is it possible for her father to have done this to his daughter?” she despaired.  As with the Dugard case, had the story not been there in black and white, I don’t think she would have believed it.

“He must be mad,” she concluded.

Quite possibly.  Indeed, quite probably.  But at what juncture do we allow abdication from Fritzl’s personal responsibility (not to mention his duty of care to his daughter, morally if not legally at her age), due to the fact he clearly had a twisted and sick brain?  When does bad become mad, and/or vice versa?

Anyway, the point of this post is not to write a psychocriminological masterpiece on Stockholm Syndrome.  I’m only here to say that, although I do not believe for one second that I have it or anything approaching it, I do understand it.

I suspect some of my readers – those few in my real life, in particular – will dislike the latter part of the title of this entry.  “Defending HIM” – ‘Him’ being Maisie’s husband, perhaps unsurprisingly.  I am going to defend him…but, and it is a very BIG ‘but’, that does not mean that I am defending his erstwhile actions towards me.

I mentioned in the last post that I’d explain why I had become less concerned for Marcus’s welfare so let me clarify that point.  I have been exposed to Paedo in large doses twice recently and have found myself to feel nothing other than overwhelming pity for the man.

In some ways, I have done for many years, but he was so much a shadow of his former self of late that the sense of sorriness felt all the more palpable.  I think I have alluded to the fact before that he is mental too, suffering from some unspecified psychotic disorder.  He, like me, takes Olanzapine to counteract it, and it has been effective in its indicated usage.  But he is now incredibly depressed regardless.

So what, SI?  (a) Doesn’t he deserve to be and (b) depression is treatable, so why are you decreasingly concerned for Marcus?

(a) Well, yes, maybe he deserves to be.  But the man has had no life.  His life, for as far back as I can remember, has been nothing more than a pathetic existence.  He was forced to marry MMcF when they were both very young, as she was up the stick (a reviled state of affairs in the ’50s), and he has been under her tenacious grip ever since.

As I have stated on the page about the people in my life, at face value MMcF is a lovely woman.  The reality, however, is that she is domineering, manipulative, cruel and overwhelmingly demanding.  I consider it no coincidence that the two of her children that still live with her – S and K – both have no lives.  In their 40s now, they will never leave that house.  I also consider it no coincidence that S had very severe social phobia and still has depression (she claims she has bipolar disorder, but none of us have ever witnessed anything approaching even hypomania, and she only takes Venlafaxine, no mood stabilisers.  But what do I know) and indeed that Paedo is severely delusional.  The two other sons eventually escaped, but are nevertheless intrinsically linked to every brick of the house’s build, as are their children.  S’s daughter seemingly escaped but her, her husband and little Marcus might as well move in because they are always there.

The hold is enforced by MMcF.  Frankly I am scared of her.

Now, re: Paedo.  Well, given his entrapment, I actually can understand a willingness on his part to stray.  Could he separate from her, divorce her?  He could – or could have, more accurately – but even if he had, she would have manipulated him back.  I guarantee it.

So, yes, I feel sorry for him, and long since have.  MMcF does nothing but criticise him, and yet he serves her and complies with her selfish desires without complaint, and endlessly worries about her health and welfare (neither of which are great).

It does not, however, condone child molestation, because quite clearly nothing does.  No matter how shite his life may be, may long since have been, I did not deserve to be raped by him (nor, of course, by anyone else).

All I am saying is that the person is distinct from the act, no matter how heinous or twisted that act is, so I have the ability to feel pity for this man, who did this most horrid of things to me.  I don’t like him, and I most certainly do not love him, but I feel regret that he’s had such a waste of a life, and if I can feel that, then I can completely understand how in more serious cases of abuse that that could progress to compliance, submission, friendship and even love.

(b) Yes, depression is treatable, and Paedo may well be able to be treated for same.  Still, it is very chronic, and with the aforementioned shitty life, will be all the more difficult to shift.  We have a saying in Ireland: if a person is perceived to be on their last legs or just otherwise haggard and decrepit, it is often said that they are “done”.  Well, Paedo is thoroughly and utterly done.  Quite honestly, death would be a mercy to the man.

So on the balance of probability now, I am fairly sure that he simply isn’t either physically or mentally capable of posing a threat to Marcus, Marcus’s impending sibling, or any other member of that (or any other) generation.  He is beyond it.

Of course, I am not, and cannot be, 100% certain of this – who is ever 100% of anything?  As such, I will remain vigilant and will tune my awareness to any changes in Marcus’s behaviour as finely as possible.  If I think for a second that the child is under threat, I will act.  I will break Paedo’s neck myself if needs be.  However, I do genuinely not perceive this as likely at the present time.

To address my mother’s points vis a vis the sad Dugard and Fritzl cases.

If you, mother, find it so hard to accept Kaycee and her children’s attachment to their abuser, consider proportionally the defence your daughter has just given of hers.  Does it seem so alien now?

Furthermore, as stated Stockholm Syndrome develops of necessity – in the case of most long-term trauma victims, because they cannot escape the situation, so it is better to ‘embrace’ (for want of a better word) what the abuser wants, in order to make life somewhat more tolerable.  In my case, evidently a less serious one, I would also say that some of my reaction to Paedo has developed of necessity.

I have basically accepted him, and I have kept the story to myself, to save an entire extended family.  Others could have been abused, I know, and I will never stop wondering if I could have prevented that – but I would have had to go to the police, alone, as a traumatised child, and with a total lack of evidence, what would have happened anyway?  So, with the best will in the world, I could hardly have prevented harm to that generation, and so I did all I could in the circumstances – I tried to keep the family my mother loves together.  And now I am looking out for the next generation’s welfare, which is the best I can do now.  I cannot ruin a family over an incident 16 years ago for which I have no evidence.

So no, abused individuals do not automatically hate and reject their abusers, for a multitude of reasons.

Finally, why is it really so impossible to believe that close relatives can and do abuse those close to them?  Many readers will be aware that most acts of sexual violence are perpetrated by someone known to the victim.*  Well, I can’t say the rape and the overt sexual behaviour were particularly systematic in my case but still – he was my uncle, I was his niece, so there you go.

* Child Sexual Abuse Fact Sheet, National Child Traumatic Stress Network – http://www.nctsnet.org/nctsn_assets/pdfs/caring/ChildSexualAbuseFactSheet.pdf

Owing to the pain of this -

- I’ve been somewhat in absentia from the blogosphere recently.  Was this gash – which is actually worse than the above suggests, being as it was nearly a removed-tip-of-finger – deliberate?  Was it fuck!  I even commented on the annoying irony of this on Twitter.  On Saturday the lid to a toothpaste tube had become lodged in the sink plughole, and the only way to get it out, aside from amateur plumbing, was to edge it out at the side with a knife.  A certain angle, a lot of force, and it wasn’t just the offending lid that ended up deeply cut to pieces.

I was urged to go to A&E to get this stitched, and I should have; it’s deep, and it’s very, very open.  But I didn’t.  Inertia?  Yes.  Social phobia?  Yes.  But the fact that an XBox 360 Elite has arrived in the house didn’t help either, not that I could use this finger to use the controls.  Neither could I drive initially, nor type, so forgive my lack of posting.

I admit to some malaise re: blogging though – I can’t blame everything on my half-axed physical extremity, given as the blog has gone unwritten for just under a fortnight.  A post that I’d originally started on Wednesday afternoon was to be called ‘The Rollercoaster’, such was my mental state between the last post and then.  Most of it is faff and I could never be arsed finishing it, so I thought I’d condense (ha!) the salient points of it into this new post.

Of course, I am aware that I haven’t written about my last session with C; I shall try and rectify this tomorrow.  In short summary, we are, for now, friends again.  We discussed the previous week’s annoyances, and although I didn’t give him the letter as intended, I did tell him about it.  He actually wanted me to read it to him, but I’ll detail that later.  I was honest with him for a change, but because I’d been too lazy to wash my face from the previous day, when I had worn mascara, I refused as ever to cry in front of him.  I think I might have done, though, had I not been horrified by the thought of having black streaks down my face, so I suppose that’s progress.  A silly reason?  Well, if I was a therapist, I’d laugh at an individual in such a position, so I can’t expect C not to.  On the other hand, I’m probably just a sick fuck.

Anyway.

The main thing of interest since my last post is the development of ‘They’.

‘They’

Poor A has been doing a lot of home-based overtime recently, and the morning of Saturday 31st October saw no exception to this.  That morning, he was in the study working, whilst I was lying in bed trying to fight off the usual Saturday migraine (this used to happen when I was at work each week, but when I became a dolescum, it mostly disappeared.  In the six to eight weeks prior to this date, however, the weekly migraine has returned.  Reassuringly, A asked me to ask Lovely GP if this combined with recent hallucinatory behaviour could be symptomatic of a brain tumour.  Yippee).

For contextual reference, overnight on 26/27th October, I had been plagued by horribly frightening auditory hallucinations all night (see this tweet), indicating to me that the hallucinations had moved beyond ‘just’ Tom and the shapes.  The music was the most terrifying, for reasons I cannot really articulate.  It was only about four or five notes on what sounded like a xylophone, but it carried the same unspoken message of hostility that the shapes do.  Not that the knocking and the whimpering didn’t.

So, anyway, here I was trying to soothe this migraine by lying in the darkened bedroom, when someone who wasn’t A nor Tom told me to get up and brush my teeth.  For some reason, I acquiesced and did as I was told.

Upon completion of this, the ‘someone’ became a ‘they’ – instantaneously, yet simultaneously gradually.  I know that makes no sense.  The best way to put it, I suppose, is that it was like an operatic or orchestral crescendo.  The nebulous ‘they’ then instructed me to go to the top of the stairs.  Tom turned up and told them to leave me alone, but they laughed at them.  I (internally) enquired as to what I should do.  Tom said to go back to bed.  ‘They’ repeated their aforementioned direction.

‘They’ and Tom kept bickering about what I should do but, much as I don’t mind Tom, the collective voice of ‘They’ was so much stronger, and carried a weight I can’t explain.  It was a compulsion.  I went to the stairs.

I have fallen, and thrown myself, down the stairs at my mother’s house many a time, but the stairs there are relatively ‘safe’; they aren’t especially steep, are thickly carpeted and, until recently, had a…shall we say…deceleration zone.  This is not the case at A’s; the carpet is thin, the stairs are incredibly steep and there is maybe a foot of hallway at the bottom before you go crashing into the front door.  That’s if you don’t hit the radiator on the right.  In short, falling down A’s stairs could seriously injure me.  I doubt it would actually kill me, but it could definitely injure me.

Here I was at the top of these steep stairs.  It was almost as if they had morphed into a sheer cliff face – I mean, I didn’t see such a thing, but…I don’t know, it’s hard to describe; it just felt like that.  At this point ‘They’ started telling me that I was to throw myself down the stairs.  Tom tried to intervene, as did the voice of Me.  But ‘They’ were too strong.

When I didn’t immediately throw myself down, they became enraged and started chanting/screaming: “YOU MUST DIE!  YOU MUST DIE!  YOU MUST DIE!” followed shortly by, “THROW YOURSELF, THROW YOURSELF HARD!”.  Simultaneously, parts of ‘They’ were laughing in the manner that the dark monster’s under a child’s bed are supposed to.  Sinister.

I remember little of what was going on outside this mental cacophony, but I do recall that it was a physical effort to not throw myself down the stairs.  I have a very vivid memory of watching my bare toes teetering precariously on the edge of the step, trying – amidst this madness – to will them not to go over.

It’s funny really.  Given the almost perpetual suicidal ideation in which I engage, why not just go with the flow of ‘They’?  But I wanted to fight them.

Still ‘They’ went on, “die die die, throw yourself, throw yourself hard,” in their ritualistic chant.  Still Tom and Me tried, with considerable futility, to dissuade them that this was a desirable course of action.  But ‘They’ either just spat bile at or ignored us.  They called me (both me-me and the Voice of Me) a range of names such as “slut,” “cunt,” “bitch,” etc, but they just audibly sneered, if that’s possible, at Tom.

Somehow I sat down.  By this point, I presume in order to distract me, the amorphous ‘They’, were knocking at the side of my head, exacerbating the headache (as if their bloody noise hadn’t done enough of that).  I put my hands over my ears and started rocking back and forth, but of course that didn’t stop them.  That was a pointless gesture – they’re in my head so, how can covering my fucking ears shut them up?  But it was instinctive, I suppose.

Despite Tom’s best efforts to diffuse the situation, it wasn’t getting any better.  ‘Me’ wondered if taking my gaze away from the stairs would do anything to help things, so I lay my head down on the next step and hid under my arms.  They didn’t stop, but part of me ceased to be entirely sure of where I was, so the sheer compulsion to obey ‘They’ abated – but only slightly.

It was shortly after this that A emerged from the study and asked if I was OK.  He had been talking to himself whilst in the study and his voice had kind of morphed with that of ‘They’, so I didn’t even know if he was real.  Nevertheless, aside from Me and Tom, he was the only voice there with which I was familiar, so I told him what was happening.

A helped me down each individual step.  ‘They’ mocked him, sneered at him and wanted me to hurt him, but somehow, I managed to resist them.  When A finally managed to get me into the relative safety of the living room, he called ‘They’ “pathetic non-existent cunts” and told ‘They’ that he was going to “destroy” them.  Tom laughed agreeably and told ‘They’ to fuck themselves; ‘They’ were both insulted and incredulous.  ‘They’ called A a number of names that I no longer remember, continued to tell me to die, and although they didn’t ‘verbally’ say it, there was an intense sense in my head that ‘They’ found the notion that A could defeat ‘beings’ of such epic power an irritation and a source of amusement.

To cut what is already a very long story a wee bit shorter, eventually ‘They’ and Tom left.  A was disturbed; I was exhausted.  We were both worried about how this would turn out.

In fact, the possibility of voluntary admission was discussed.  My fear was not so much for myself – I don’t really matter to me, after all.  But ‘They’ hate A.  It turned out later that ‘They’ hate C too..  They’re more tolerant of Mum, but they still don’t like her.  ‘They’ haven’t met my friends yet, but I’m sure they’ll hate them too.  So, whilst if I want to do myself in I want it to be my decision and not theirs, and that side of things presents as an issue, my greater concern is that the complete control of ‘They’ over me would lead to harm of someone about whom I care.

I had an appointment with VCB today (more on that in a moment), and A and I both hoped that I could hold out to then before the drastic step of admission, but I did discuss that possibility with several individuals and, with a few qualifications, it was agreed amongst all that if ‘They’ returned with such hostility, that it was probably a good idea.

‘They’ did return a few days later.  ‘They’ were not demanding my death this time, nor the injury of anyone else, but they were chattering insults and laughing scornfully at a low level at the back of my head.  “Whore,” “cunt,” “slut,” “bitch” etc.  They were whispering spitefully and when A started into them again, the insults were then divided between him and me both.  But although distressing and unpleasant, there was no danger from this episode, so luckily I didn’t embark on a course to the bin.

‘They’ were there on Thursday morning when I went to see C.  This was the first time when I verbally spoke to them.  ‘They’ told me they thought he was a cunt, and I said to him, “they don’t like you.”

‘They’ got really mad at this; apparently, I was meant to tell C that he had been called a ‘cunt’ specifically.

“Tell him, tell him, tell him,” they ordered.

“Alright, for fuck’s sake, I know!” I yelled at them.  I’m not sure how C kept a straight face.

But they’ve not been there in a dangerous capacity since 31st October, thankfully, so I haven’t incarcerated myself.  As stated, I had an appointment with VCB today, which I had been anxiously waiting for thanks to ‘They’, but of which I was also simultaneously terrified, given as I am scared of VCB.

I was actually slightly surprised that she herself had the decency to see me today and not palm me off onto some minion.  Perhaps C told her about my threats of advocacy, media and contacting her boss from last time.  Anyhow, as usual I had developed my written list of symptoms from which she – unlike her stupid SHO – allowed me to work, recognising that it’s not always easy to remember everything.  She did quiz me on specifics – “what did ‘They’ say specifically?  Pretend you’re them talking,” or “what does Tom talk to you about?” – but mostly, she allowed me to speak freely about the last few weeks.

Essentially, the result of the meeting was that she wants me to decrease the Venlafaxine back to 75mg – not because of the hallucinations per se, as she actually does not seem to believe they are a side effect of it, but because being on 150mg hasn’t made any difference to the feelings of depression.  I’m not sure I like this.  I basically think Venlafaxine is crap (not to mention evil and insidious), but I’m scared of being on a low dose thereof again, and in particular I am petrified of a pseudo-discontinuation syndrome caused by a dosage reduction, despite VCB’s claims that there should not be any noticeable difference.  I am seeing LGP in the morning so will discuss this with him.

Secondly, and more helpfully, VCB says that the more recent hallucinations and delusions do represent outright psychoses.  Well, not that that in itself is nice – obviously it’s not, but it had a hopefully positive outcome.  She had been expecting to prescribe me a mood stabiliser today, but in light of the information I gave him, obviously decided that “a trial” of an anti-psychotic would be more appropriate.  I know how hideous side effects of such medications are, but frankly I’m glad because things as described above can’t go on.

She has decided upon 2.5mg of Olanzapine; she chose this drug because she thinks it’s better in terms of its secondary indication of mood stabilising than many of the other atypical anti-psychotics, despite most of the manufacturers’ claims that they all mood stabilise fabulously.  2.5mg is the lowest dose of this drug, but that’s fair enough I suppose.  VCB says it can be increased as necessary, but it is of course best to start on as low a dose as possible.  Unusually, she wants to see me in a month rather than six weeks.  Although she (obviously) didn’t bin me, this did suggest some concern on her part in my view.

I asked VCB if the revelations had any impact on my diagnoses, as I was aware that psychoses weren’t generally a feature of bipolar II, and whilst they are seen in BPD, it is usually (as far as I understand it) during episodes of considerable stress, which I hadn’t been experiencing especially during the development of ‘They’.  She said that she still felt the diagnosis was correct, as the episodes of psychosis have been transient, as is seen in borderline, rather than prolonged and sustained.  However, she did imply that she would be willing to reevaluate things in future, should the need arise.

She warned that the main side effect of Olanzapine is weight gain, which is not apparently caused just because the drug itself makes you fat, but because it increases your appetite.  She said that I have to try and develop methods of ignoring any new or unexpected bouts of hunger, which I suppose I can discuss with C.  She also recommended exercise (obviously I suppose), so when I get my windfall from work, I may rejoin the gym.  As a dolescum, I do get to use the local leisure centre for cheap, but it’s usually full of pricks all day long, whereas I know for a fact that the gym and its pool are both almost empty during the day.  In any case, I’ve lost a lot of weight recently, so whilst I don’t exactly want to regain any of it, I suppose I can deal with a little bit more whilst I try to address countering any new-found appetite.

A final side effect is strong sedation, but perhaps it won’t surprise you to learn that this would be a positive thing for me.  Unfortunately, apparently that tends to wear off as one gets used to the drugs, but hopefully I’ll have the lovely Zopiclone in waiting then.

I haven’t got the pills yet; I have to take VCB’s script to the GP’s for them to load it onto the system and then prescribe and sent to the pharmacy.  Had I done so today, I would not have got them until tomorrow anyway, and since I’m seeing LGP in the morning anyway, I can just get him to prescribe them directly.

So all in all the VCB was quite useful today – I just wish she’d make that state of affairs consistent.  Perhaps the best thing about this – and I know this is really sad and childish – is that she’s defied the NICE guidelines on BPD.  I suppose she had little choice given the circumstances, but she always wanted to adhere to them insofar as was possible.  But I think NICE are useless knobs, a waste of public money who sit about saying a lot about very little, so this pleases me.

Other Events

New Friend

On Wednesday 4th, I had the pleasure of meeting K (can we call her K?  There’s no other Ks on this blog, are there?), another BPD ‘diagnosee’ that I met via Twitter.  K is also from Northern Ireland, though now lives in England (she was here on a quick visit).

We spent a couple of great hours chatting over tea – the conversation was lively and wide-ranging, but in terms of mentalism specifically, it was a relief to discuss things with someone who has direct experience of many of the same problems I have.  I’ve relied on the internet for this to date, still do and probably always will – K and I agreed the temptation to catch the bus without the support of online friends would be considerably higher than it already is – but nevertheless it’s great to actually speak to someone in person that understands.

I would normally be very nervous about meeting someone new, as you can probably imagine from earlier ramblings.  However, I actually wasn’t with K, and even had I been, her easy-going charm would have relaxed me very quickly.  So thank you, K

Georgie

Fucking cunt of evil bastardry aunt Georgie was in situ for the second time within a few months last week.  Why come across the Atlantic twice in such a short timeframe?  Last week was for my cousin’s wedding, that was only organised recently.  Needless to say, I didn’t go.  I can’t presently think of circumstances that would in any way make me tolerate seeing that woman and her shit descendants.

What pisses me off when Georgie is here (and even when she isn’t) is that my mother wanks on about what a poisonous twat Georgie is – Georgie knows everything, Georgie always thinks it’s worse for her than for others, Georgie must interrupt people and be the focus of the conversation, etc – yet as soon as I open my mouth to make any vaguely critical remark about the old battleaxe, Mum rages at me for being so cruel about her.

Fuck that, and fuck Georgie.

Meh

There was another ‘other event’ that I wanted to add but alas its exact nature has evaded me.  Another time – in any case, I think I have drivelled on for long enough as usual.

Did I say something near the start of this post about ‘condensing’ my words?!

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

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

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

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

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

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

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

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

I am sure that one does not require the IQ of Einstein or his counterparts to work out, from the last post, that bleakness, futility and utter self-disgust presently permeate my existence. There were precipitating factors, but I am not prepared to discuss them in any detail here.  I do keep this blog primarily for my own reference, but I do not need to document this incident as I will never forget the evil of which I am capable. Never.  Even as I bounce my (very metaphorical) grandchildren about on my knee (if my ‘life’ ever gets that far), my psychotic break on Friday night will never be far from the forefront of my mind.

Rationally, I can tell myself that it wasn’t me behaving in the fashion that I did.  Rationally, I can sit here and say, “well, you’re mentally ill”.  Rationally, I can (and do) accept that I was not in control.

It doesn’t matter.  It isn’t an excuse.  I wouldn’t care if it were just about me, for fuck’s sake I’d gladly do myself in if it were just about me.  But I am ruining other lives as I continue on the destructive path on which my mind seems intent on following.

I rail against the idea of being committed, and to that end have been known to be careful in what I have said to C, LGP and VCB, so as to avoid them instigating a process that would end in that result for me.  Being sectioned, or even voluntary hospitalisation, would be about the most horrendous thing I can imagine – group therapy, disillusioned and overworked (and probably incompetent) staff, being in a ward with other fucking people.  I cannot bear the idea.  It makes me feel physically ill when I even contemplate it.

But I have enough insight, shockingly, to know that this isn’t just about me.  For the sake of my friends and family, it really may be the best option if throwing me in the asylum is exactly what the three of them (or whomsoever) choose to do.

I don’t think I’m being irrational in writing this.  Granted, you (the reader) don’t know the context under which this miserable spiel of crap has been created (with one or two exceptions), but I believe my self-condemnation is wholly appropriate.

I don’t want to have this out with C tomorrow, but I’m going to have to find some way to overcome my cowardice and discuss it all with him, because I have gone too far this time and I can’t guarantee that I’ll have the level of self-control required not to go too far again. Some proponent of the newer types of therapy such as behavioural techniques might wank on about my own responsibility, and yeah, I might be abdicating from my sense of it – I don’t know.  I just know I didn’t at any point choose the behaviour that has disturbed me so profoundly.  It was almost like what I imagine stage hypnosis is; you have some level of awareness, but you are not controlling your mind or body.

This week has been fucking awful.  I would use the phrase ‘downward spiral’, but that would be bollocks, as I’m thoroughly at the bottom of the spiral.

The little social contact I’ve had – on Twitter, in the main – might represent my status this week as relatively mentally intact, but nothing could be further from the truth.  I am still a consummate actress. Thinking about it, I’m narcissistic enough (though not thin enough, admittedly) to have a very successful Hollywood career.  Though that would send me even more insane, if that’s possible.

I’m sorry for turning the comments off in the last post. I figured some well-meaning people might say, “no, you’re not fetid/disgusting/depraved/whatever,” and whilst, indubitably, I appreciate the sentiment behind such words, they are in my present-thinking false words.  I need to reflect on what I have done, even though it causes horrible pain.

I really, really am a vile human being. Well, perhaps I’m not – that’s up for debate – but this mental persona, and whatever nefarious afflictions control it, most assuredly are.

I’ve mentioned the voice quite a bit lately, but I haven’t really gone into any detail about it. Largely, that’s because there’s not really a great deal about him to discuss. Still, I thought I’d make my best effort, as quite clearly hearing voices represents psychosis (or at least something odd), which clearly does not resemble anything approaching sane.

Let me start by introducing the voice. He is called Tom. He didn’t tell that he is called Tom – he just is. As discussed in the last couple of comments here, I don’t know why. I just thought of him as ‘Tom’ from the beginning, without consciously doing so. I thought about other names thereafter but dismissed them; ‘Tom’ still seemed the most appropriate. It just fitted.

You see, he sounds like he’s in his 30s – roughly speaking, anyway. One of the alternative names that I considered was ‘Ernie’, but that makes him sound like a sweet old man, and he’s not.

So he’s not old, but is he ‘sweet’? I’m not sure that that’s an appropriate description – not entirely. Nevertheless, many normals seem to believe that voices heard by mental freaks are all persecutory, or compelling the voice-hearer to commit heinous acts, or trying to convince the hearer that things of considerable distaste are imminently going to happen to them. Clearly, this happens quite a bit in this particular type of hallucination.

But not in all cases. Tom, so far, is none of those things. He’s friendly, comforting and reassuring and no doubt if I raise this with C – and I don’t think that I will – he’ll say my compassionate, vulnerable self is looking for an outlet, and it has provided it in Tom.

Hmmph. I’m more inclined to believe that Tom is a side effect of Venlafaxine, but it doesn’t really matter. Well, OK, it does, as hearing Tom speaking to me has implications for my diagnosis/es and, potentially, medication (and, again, C would no doubt say psychotherapy). But it doesn’t matter in the sense that I don’t mind Tom being there, and in that sense the reasons for his ‘existence’ don’t matter much to me.

Obviously, the voice is male, and as stated sounds circa early to mid 30s in age. I have more difficulty describing his accent. I keep wanting to say ‘normal’ or ‘non-accented’, but of course everyone has an accent so that fails at the first hurdle. I suppose he must be Northern Irish, but he doesn’t have some of the strong accents often heard here. Neither does he sound like a toff. An average, middle-class bloke, I’d say.

As to the content of his speech, it is totally innocuous stuff. The first time he spoke, he just said my name. That was a bizarre, surreal experience. I was alone in the house and the neighbours were out, so I knew there was no one there. Still, I walked in and out of each room to check, just to be sure. One thing it wasn’t, though, was frightening. Just one of those “what the fuck?” moments.

Since then, Tom will talk about stuff like the weather, what I’m watching on TV, what I have planned for the next few days. Utterly mundane and unfathomably dull smalltalk. However, he sometimes (not always) gets involved when I’m going mental. For instance, when I was losing my mind over the stalker the other week, he started talking to me. He was trying to be helpful, but unfortunately he wasn’t particularly. There is an inherent irony and curiously black humour in the fact that a voice that isn’t fucking there is trying to tell me that a visual hallucination is also not a part of what is understood to be reality.

The SHO I saw a few weeks ago – in the majorly fucked-up psychiatric appointment – asked me something that surprised me, though it really shouldn’t have done. She said, “is the voice inside your head?”

The obvious answer, from an outsider’s perspective, is “of course it fucking is”. But, in actuality, that would be false. Tom doesn’t sound like he’s ‘inside’ my mind – Christ knows there’s enough battling sides of myself chattering away in there, arguing interminably with one another. No, Tom sounds like he’s sitting or standing maybe two or three feet from me. Usually he’s on my right-hand side (my right-hand man?!), but sometimes he’s behind me. It’s odd; obviously I know he’s a product of my mind, but it really doesn’t feel (sound) like he’s in it.

I often reply to Tom, but not necessarily audibly. I might direct a thought at him – which apparently he can hear – or whisper ever so softly. Because I know he’s not real, I feel terribly silly about speaking out loud to him, even if alone. Even if there’s no one else there, I can’t bear the idea that someone might witness me talking to the shitting air (in fact, this has just reminded me of a long-held delusion – so long-held I’ve had it since I was a child; that someone – Mum, the paramilitaries, the government – had rigged secret cameras everywhereI was, and that they were always watching me. How come it’s only now, as I become more deranged by the day, that I’ve realised that that’s just a teensy-weensy bit abnormal?!).

So, overall Tom is not a bad thing. Having said that, I have heard of cases wherein the voice starts off to be completely benevolent, gaining your trust – only for it later to use that trust to manipulate you. I don’t necessarily think that’s as common as the media would have you believe – but it can happen. I hope I can retain enough rationality to recognise it if Tom ‘turns’; I do think I mostly have that quality, at present at least.

Which brings me to another point; since I recognise that Tom isn’t real, is he even a hallucination at all? Psychoses, as I understand them anyhow, require a clouding of the lines between reality and non-reality in the perception of the psychotic individual. In my case, that is definitely true of my delusional and paranoid beliefs – well, when I’m actually experiencing them anyhow. Yet I always know Tom isn’t there, not really. As for the main other hallucination that I experience – the shapes – well, I’m not actually sure about them. I think I know they’re not real, but perhaps because unlike Tom they are hostile, I feel greater distress over them. Bizarre stuff.

I briefly alluded above to the implications all this has in diagnostic terms. Psychoses are, as far as I understand it, not part of either BPD nor bipolar II. They can be part of bipolar I, whilst in mixed or manic states, but I haven’t been given that ‘upgrade’.

In fact, VCB made no reference to my diagnoses on Tuesday (not in relation to this material, anyhow). It’s possible that she considers Tom, and some of the more extreme delusions, to simply be a Venlafaxine side-effect (it’s uncommon to experience psychoses owing to it, but it’s certainly not unknown either). That is a viable explanation, especially given the timeframe of these symptoms’ arrival – but it can only explain some of the psychoses that I experience. Clearly, a lot of the paranoia was there well before I took this medication, as were the shapes. Both were, in fact, there years before I took any medication on a regular basis.

I’ve just remembered yet another childhood delusion (though not one I experience any longer): every night, when I went to bed, I was utterly convinced that an IRA gunman was on the landing, and that I was imminently going to be shot. Every creek or noise was evidence of him (or her, I suppose) being there. I used to creep out of bed and tiptoe, terrified, to the door of my room. I’d stand there, paralysed with fear, for a minute or two, then take a deep breath, fling open the door and look round the corner. Of course, the landing was always empty. Of course, that did not reassure me the next night.

This one is more understandable in some ways, as I was a child when The Troubles were still (to some extent) ongoing. The fact that I ‘grew out of it’ would support the idea that it was entirely circumstantial and not remotely organic nor chemical. Having said that, no one to whom I’ve relayed this story – including people that grew up or lived through the very worst of The Troubles – experienced anything similar.

I’ve recalled that one at various points over the years, but I seem to compartmentalise a lot about my childhood, so I hadn’t thought about it in some time. Ha – this post is turning into quite an education for me.

So anyway, my point had been that the psychoses kind of (or at least potentially) screw with my diagnoses. I’m not saying that I don’t have what VCB diagnosed me with in June, merely that there is maybe additional stuff which runs co-morbidly with it. Possibilities would be bipolar I (which as stated previous can produce psychoses – if this was correct, obviously I wouldn’t have bipolar II), schizoaffective disorder, bipolar subtype (this is my current self-diagnosis, even though I hate the idea) or even psychotic depression (if you can get that with mixed/manic states?). Yay! Of course, an alternative point of view is that I don’t have anything other than that with which I have already been diagnosed. As VCB told me in June, it’s not always just as simple as fitting people into one diagnostic box; some people present with symptoms that don’t fit with any specific disorder. She claimed it was not uncommon.

In conclusion – is Tom a good thing? I think that remains to be seen, to be honest; I don’t encounter him frequently enough at the minute, nor has he been ‘there’ for long enough as of this moment, for me to have formulated a definitive view on that. Having said that though, as of now he is certainly not a bad thing. I like him. He’s nice to me. It’s a start. InterVoice International argue that many people that hear voices should actually embrace them (assuming they’re not harmful, obviously) and not view them as psychotic or part of some disorder. I don’t agree entirely, of course – it sounds like PC Mad-Pride-esque nonsense to me. On the other hand, I can see the rationale for such beliefs; if your voice is benign, why not accept it – befriend it, even? (Incidentally, InterVoice’s website is well worth a look if you or someone you know hears voices – it has oodles of resources, information and real-life experiences there for your delectation).

I most assuredly do not like the delusions nor the shapes, though. Therefore, if it gets to the stage where VCB thinks I should take an anti-psychotic, I will gladly do so. I recognise they’re not necessarily miracle cures for psychotic symptoms, and in fact I’ve read that they don’t always eliminate the psychoses entirely anyway – they just lessen your reaction to them. But I would expect and hope some positive outcome in dealing with the delusional beliefs.

If they have the effect they’re meant to have (if I ever even get any, of course), then they’ll probably kill Tom. I’m not entirely thrilled with that idea, I have to be honest, and I will feel guilty for doing it. But in order to live a functional life, some bad things are necessary evils, and while I really don’t want Tom to go, ultimately, with regret, he may have to.