…And the NHS Cocks It Up Again

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

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

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

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

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

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

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

And that was pretty much that.

Except that it wasn’t.

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

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

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

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

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

She was clearly frustrated by this fuckwank herself.

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

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

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

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

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

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

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

FUCK!

“And if I don’t go with you..?”

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

FUCK!

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

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

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

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

Livin’ La Vida Lamictal

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

Good afternoon my beauties.

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

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

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

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

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

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

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

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

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

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

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

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

I nodded, seeing what she meant.

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

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

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

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

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

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

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

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

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

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

So. I currently take the following medications:

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

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

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

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

Change of Diagnosis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

—

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

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

Srta Gata

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

 Medications, NewVCB, Psychiatry  53 Responses »
Sep 132011
 

Saw NewVCB last Wednesday morning.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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I Lied – The Mentalism is ‘Back’

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

Didn’t I sound so positive on Friday?

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

But that’s the truth of the matter.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So, then. What caused it?

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

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

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

“About five weeks…” I began.

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

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

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

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

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

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

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

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

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

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

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

“What, tonight?” I checked.

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

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

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

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

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

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

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

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

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

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

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

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

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

—

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

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Apropos of Nothing

 Life, Meh  15 Responses »
Aug 192011
 

Writing is a lonely profession (if indeed it can ever be turned into a ‘profession’). But that loneliness is somehow comforting in its own paced-ness, in its ability to protect one from the perils of the outside (some would say ‘real’) world. The pursuit, whilst thoroughly without guarantees and assurances, is still a safe one – published or not, you still have the pleasure of composition, and of knowing, eventually, that you have completed something that at least has potential, if to no one else but to you.

What this amounts to is this. I’m writing a book. I’m not wont to discuss it in detail on a public forum like this blog, but it is going to be mental health related. Many of you have inexplicably but kindly asked me if I would turn this very blog into a book, but that isn’t my plan at this stage, for two key reasons. One is the simple fact that the intended book’s concept is already very clear in my mind, and I don’t want to deviate from that while it’s so vivid. The second is that going through everything written here – post by post, word by almost-endless word – is one hell of a task to take on, especially when my mental health is still relatively fragile. I’d like to maybe do it some day, but not now. Sorry :(

Also, you see, in doing all the factual writing of late that I have – here, and in other arenas – I realised that I hadn’t done any creative writing since…fuck, I don’t know. Since I was at school? Maybe even since my GCSEs? That’s a horrible realisation, to know that I’ve neglected a passion of mine for such a disgustingly long period. I used to love writing fiction, and I’ve only recently realised that I miss it.

So, The Book will be a fictional narrative. Whether it’ll turn out to be a novel, a novella or a short (as if!) story, I don’t yet know, but I don’t really mind whatever the case may be. I also don’t really care if anyone is willing to publish it or not; I mean, it would be lovely if someone did, that much is self-evident – but I’m doing primarily for my own pleasure. I had genuinely forgotten what escapism and what joy comes from such a simple pass time, and I’m revelling in it at the minute.

So I haven’t written much here this week, since the idea for The Book came to me. It isn’t just The Book that is keeping me away, though the other factors are still within the literary realm – I’ve been reading voraciously, planning a few pieces of non-fictional writing, and even the odd non-writing bit of so-called creativity too.

I just thought I should post something, drivelsome and dull as this is, to show you that I’m still alive, and that I’m doing relatively well. Since I cut back on the Seroquel, I haven’t been sleeping well (unsurprisingly) and have had to resort to take Zopiclone on many nights. The new neighbours and their screamer are not assisting in my quest for slumber (they keep the strangest hours, especially for a family, that I’ve ever encountered. They arrive home, child in tow, about 11.30pm, then proceed to talk half the night on the phone, child still in tow. What the fuck?). However, beyond that, I’m OK. Things aren’t amazing, and I might be slightly depressed – but I’m managing, and given everything that’s happened over the last three years, at the moment I really think that that’s good enough.

And it is three years. It’s just over three years now since I left my own little office for the last time. I noted above that writing is lonely, and it is. But having your own office, glamorous as it may sound, is lonely too, yet it doesn’t have any of the advantages that working from a laptop on your own sofa does. Nonetheless, I miss it in some ways: at least the people who worked in the offices bordering mine were, generally, good people, and were I feeling a bit lost, I could normally wander in next door and have a quick chat with them, before returning to my own quiet domain. I can’t do that when I’m sitting here typing all day.

To that end, as well as writing The Book, I’m applying for a voluntary job. I think I might have mentioned this before, but I’m finally going to do it, and whilst I’m extremely nervous, I’m also quite excited about its potential as well. I haven’t put in the application yet, but I plan to this week…and then we’ll see. At present, I’m only going to offer the organisation a few hours a week, but for the type of position I’m hoping to get, I suspect that for the moment that’s more than adequate. If not, and if it works out, and if I even get it for that matter, I might be willing to increase the hours a little bit further down the line.

I don’t know why any of you like this blog, but since some apparently do (thank you!), please be assured that none of this means I’m winding it down or anything. I’m trying to plan the final posts on Paul, and a few other bits and pieces, so you can’t get rid of me that easily :) I just won’t promise that I’ll post once a week or more, as I usually try to do. We’ll see how it goes. But Confessions will remain, so worry not :) This is very far from ‘goodbye’; it’s simply a boring “here’s where I’m at right now” update.

What else? The Everythinger is gone (YAY!), I’m seeing Christine on Monday, NewVCB at the start of September, and I’m probably going to re-contact Nexus some time next month to re-embark on therapy. Part of me dreads that for what I assume are obvious reasons, but mostly I feel reassured and hopeful about the potential of it, given how useful my last course with Paul was. I’m back into something of a routine now that both Aunt of Evil and The Everythinger are gone, A seems a little less stressed at work than he had been, and I’m relieved that both Daniel and CVM are both alive and well and that the stupid riots in England appear to be over.

And that’s about it really. That’s what’s been happening in Pan’s world of late. I hope your existence has been more interesting but at least equally stable, and that you’re all well and happy :)

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Writing for the Rockstar CPN

 Christine, CPN, Moods, Recovery  5 Responses »
Aug 022011
 

Sorry for yesterday’s pathetic rant. I’d initially made it a private post, but then decided to go ahead and publish it; what’s the point of a blog but for people to read it? That said, despite its moderate success (and as I am always harping on), Confessions is still written primarily for my own benefit, so I do still occasionally write private material, if I want to keep track of particularly personal issues. But by and large I like to have things available for others to read and comment on, as it’s a huge source of support and insight. Anyway, thank you for having the kind diplomacy not to tell me what a silly bitch I was being :)

I’m feeling a good bit better today. The Everythinger is still here and the house is still a tip of epic proportions, but I’m a bit more rested than I was. I’m not sure if I’ve mentioned it here before, but I suffer from relatively frequent migraines, and when I got up this morning I felt one coming on. I’m relatively fortunate compared to some thus maligned in that if I act quickly, I can sometimes prevent it developing into a full-blown, lie-in-a-darkened-room-for-three-days attack, so I threw 2,000mg of paracetamol down my throat (yeah, I know, I know) and told the Everythinger that I was going back to bed for a few hours. This I did, and though I still felt rough when I did get up, another dose of paracetamol (yeah, I know, I know x2) and a few minutes to myself seemed to curb the problem. Now the sun is shining, the cats are not being their usual indifferent, offhand selves and the Everythinger is working outside, so I’m feeling relatively OK.

Anyway, this was going to be about Christine, was it not? I saw her a few weeks ago, the day after I went completely doolally thinking that there were secret, governmental cameras all over the house etc etc. Frankly I was petrified of seeing Christine because I know she remains surprised that I’ve never been hospitalised for my psychotic difficulties. To be honest, to be sectioned in Northern Ireland it seems to me that you have to run at a psychiatrist with an axe and 13 AK47s (which is odd because so many of you in the rest of the UK and, indeed, other jurisdictions have written about how a mere idle mention of, say, suicidal ideation can see the quacks telling you to accept an informal admission or be forced into the bin), and since I am hopefully unlikely to ever do such a thing (I have no idea where to get an axe or even one AK47 anyway), I’m hopefully safe. Yet it was still a passing concern because Christine has mentioned it a few times in the past.

Anyway, as you can see from my continued bilging here, on Twitter, etc, I was not put away. In fact, I was very surprised by her reaction to my episode; yes, it was disturbing, she felt, and yes, it must have been very unpleasant for me (no shit), but given all that had been happening (the burglary, Aunt of Evil, not seeing my mother because of the presence of Aunt of Evil, etc), she felt that I was still doing remarkably well. She was of the opinion that because I had managed to retain some insight, however small that had actually been, and because the whole thing had been fairly short-lived, that it was probably a response to the stress I had been under, rather than a mentalist episode per se.

She did ask if I felt it was the start of something more, but I found myself rather inclined to agree with the sentiments she’d already expressed. Nevertheless, when she said that I was to contact her urgently should it develop into anything – even the following week, when she was on leave! – I was most reassured. I laughed lightly and said, “it’s nice to know there’s someone professional I can talk to if this all goes tits up.”

Christine cocked her head, and asked me if that had not always been the case. I wryly recounted a redacted version of a conversation I once had with C, my ex-psychologist (I’ve made reference to it here, though I can’t find the specific post on the session in question):

Pandora: Who am I supposed to contact in a crisis? I mean, no one has given me the number of the crisis team, no one has referred me to a CPN or social worker, my psychiatrist [OldVCB at the time; her successor is completely different] doesn’t want to know. So what am I meant to do when I can’t cope? Who do I contact?

C: The Samaritans.

Someone commenting in the afore-linked post aptly stated that “…The Samaritans comment was particularly wank.”

Christine laughed when I told her about this, as I did in memory of it. I don’t recall what she actually said (I don’t keep the in depth notes on appointments with her and NewVCB the way I do with therapy sessions), but there was a derisive (of C) quality to it which made me feel both dryly amused and smugly vindicated. Since I’ve been discharged from Psychology and have a proper, decent psychiatric team looking out for me, I’ve been surprised and pleased by how many times they’ve either directly criticised NHS mental health services, or delivered loaded, highly implicative statements about same with coy but suggestively raised eyebrows. It delights me no end.

Anyhow, that was the last appointment, and I didn’t go completely batshit in its wake, so didn’t need to contact her urgently. Perhaps this is a case of the stick in the drawer is the biggest stick of all, in the same way that having a stash of Zopiclone and Diazepam is. In other words, having the option there is reassurance in itself; with that very reassurance, one does not need to access the option. So instead of having to arrange an emergency appointment, I instead saw her as normal yesterday.

Those of you that read the nonsense I wrote yesterday will know that I was absolutely fed up, so I just went into the appointment and told her so.

Stress and Routine

“It’s ordinary fed up, having said that,” I added. “About normal life, and the challenges it brings.” Yet again I find myself reminded of Sigmund Freud’s dictum that recovery from “hysterical misery” means an advancement into mere “common unhappiness”. I am finding the vicissitudes of “common unhappiness” more and more starkly present in my life as I find myself to be relatively symptom-free. There’s a small part of me that rejoices in that – she’d rejoice even more if I could be symptom-free (thanks, overpowering anxiety) enough to go back to work, mind you – it’s ordinary, it’s real, it’s a part of a proper life. The larger part of me sneers at this saccharine idealist, and laughs a bitter “fuck away off” in her general direction.

In any event, I moaned and moaned about my stress pertaining to the Everythinger and the state of the house in much the same way as I did here yesterday and in the post before that, citing the unmitigated exhaustion I was feeling pursuant to my defiance of the instructions of my demanding custodian, Seroquel. I left a very important detail out until the end of the appointment, however, which I will leave out until of the end of the review of this appointment, however. However, however, however. It’s a nice word.

We also discussed how I have hardly seen my mother at all over the last few weeks, initially due to the presence of Aunt of Evil and secondarily thanks to my having to be about A’s house so frequently to accommodate the Everythinger. She asked me how I felt about that, and I felt guilty saying that it was a probably a good thing – but, all things considered, it is.

Christine asked if my levels of irritability had gone up, and I admitted that they were at an all-time high. The thing is, little things my Mum does – perhaps unfairly – wind me up to the point where my entire body seizes up in a red-blooded, silent scream. By the same token, she loses it with me quite a bit (and doesn’t try to hide it) for reasons that are rarely clear to me – a tone of voice she has (in my view) misinterpreted, or something inane like that. And at present, I’m not the only one that is stressed and irritable as a result of circumstance; my mother pretty much hated every second of Aunt of Evil’s visit, and is only beginning to recover from the stress of it.

Aunt of Evil Visitations

One of the few times I have seen her in the last few weeks was when Aunt of Evil was still in the country. I met my mother one Friday afternoon and spent about three hours listening to her ranting about what a cunt AoE is (which was a bit of a failed conversion really; she was already preaching to the choir on that one). To cut a very long story short, AoE lashed out at everyone except her offspring, his bitch, and their young offspring. Everything was someone else’s fault; she demanded service and opportunities that should only be available to someone staying in a five star hotel with spa facilities; she complained when something wasn’t up to her perfect USian standards; she patronised anyone that she perceived as being less intelligent or interesting than her and her twats; etc blah yadda. Even her husband, of whom I’m not the biggest fan but whom I also don’t utterly loathe, was apparently not exempt from her fuckery – I was interested to learn that he was even heard to complain about his wife to my mother.

They all fucked off again back to America last Tuesday, to my mother’s, the McFauls’ and even Aunt and Uncle of Boredoms’ evident and expressed relief.

(Aside: in one of her less ranting moments, Mum advised me that despite all the Amazonian-scale water under the biggest bridge in the multiverse between AoE and me, AoE considers me “the daughter she never had.” I responded cruelly: “her attachment to me makes my hatred of her all the more amusing,” or some such. I mentioned this conversation briefly on Twitter, to which @bourach expertly replied, “next time she says that say, ‘well, she’s the aunt I never wanted’.” PLUS ONE, Ms bourach :D ).

So in short what I’m saying is that, thanks to my aunt’s pavonine exploits, my mother is stressed too. Putting her and I together in such a potentially double-charged situation could lead to a few sparks flying in the heat of an ill-thought-out moment. I don’t like arguing with anyone, and least of all her, so it’s for the best.

Even so, Christine argued, I have an established routine of seeing her regularly, and that’s being broken. I do feel regretful of this, but more from my mother’s point of view than my own; she is getting on in years now, and lives alone. Yes, she has the golf club and the family to visit, but of course it’s not the same as living with someone and having the comfort of coming home to them. So I feel guilty about not seeing more of her, but there’s not a hell of a lot I can reasonably do about it when I have to keep to the schedule of the Everythinger.

Depression?

I must have seemed down to Christine, because she seemed concerned that my mood had dropped (overall, in her estimation, since the burglary). I think it has, in her defence – not like the body of the condemned dropping suddenly and sharply from the gallows (sounds like fun!), but slowly and insidiously trickling and meandering its way down a mountain. I’d say I’m only a little bit down that particular hill as of yet, but the fact that this is a concern to Christine in turn concerns me. I thought I was Almost Proper Well, Like.

So I responded to her apparent worry by insisting that even if things were slipping, that that was all they were doing. No avalanche, no impending disaster. “Indeed,” I continued, “I think today’s particular frustrations relate to being so overwhelmingly exhausted. I think it’s normal – or at least normal on 600mgs of Seroquel – to feel this bad as a result of this exhaustion and stress.”

“OK,” she said cautiously. “But I want you to call me if this gets any worse, OK?”

I casually nodded my apparent assent whilst averting my eyes from her cross-examining gaze. Despite my witterings earlier about knowing she’s there for me being a reassurance, realistically I have no intention of calling anybody. I don’t do phones. Why the fuck can’t they give out email addresses?! I would, happily, contact her then.

She later commented that she didn’t notice any other deteriorations, and I assume she was referring to hallucinations and delusions. Barring what I’d told her at the previous meeting, there have been none for a long time. This is undoubtedly positive, but it was never psychosis that put me in danger. Well, it was, but not in the chronic, soul-crushing fashion that the true black treacle of depression was, can do and – let’s fucking face it – probably will (though hopefully not any time soon..?). So, if my ‘mood is slipping’, I see that as a greater problem right now than the odd voice or delusion-induced panic, cruel and heavy as those of course are.

Non-Confessions Writing Projects

Bah. This is turning into an introspective examination of my mental health problems, rather than a report of yesterday’s meeting with Christine. What followed the above was a discussion about writing, and I told her that I had completed and submitted my piece on recovery from BPD to Rethink. For those interested, by the way, I’m not sure when it will be appearing in the members’ magazine, Your Voice, but it won’t be the Autumn edition because the editorial committee had something already lined up for that. The Editor – a lovely, helpful and supportive lady called Natasha (Tash) – will advise me of its publication date, and so I’ll keep you apprised. Tash was even nice enough to tell me to keep in touch with her and send her other interesting (as if anything I write could be termed ‘interesting’!) articles, which I thought was a really delightful parting gift :)

Christine was all smiles about this. In a moment of madness – that, thank God(s)/Nagi/Vishnu/Allah/Morrigun/Xuan Wu/some pantheon combination of the lot of them/common sense, I managed to keep silent – I wondered should I take her in a copy of the magazine so that she can see her little writing protégée in action. This would be what is known in the trade as A Very Bad Idea. The article links to this blog…do I want the professionals reading it? Nope; no matter how much they help me, no matter how much I feel I owe them (and I do have a strong sense of recompense towards her and NewVCB ((and, of course, Paul)), despite the many previous vacillations of the Health Service when it came to my care), I don’t think it a particularly wise idea for them to come across this nonsense.

Anyhow, what Christine didn’t know about – because it had all happened very quickly, and took place after I’d last seen her – was about how it wasn’t just Rethink that contacted me. The evening after I’d previously seen her, I was checking Twitter and found a direct message from @MindCharity, which is the account of that other big UK mental health charity, Mind (incidentally, they and Rethink co-run the Time to Change programme – if you haven’t already done so, you should follow the link and sign their pledge to end discrimination against mental illnesses). The tweet asked me if I’d be interested in reviewing one of the books Mind have short-listed for their 2011 Book of the Year Award. Um…yeah?!!

I wrote back and expressed enthusiasm, which was rewarded with an offer to send out an advance review copy of my choice of one of four (out of a full eight) titles. After a bit of dithering, I elected my tome, and it arrived the following Tuesday. I finished it on Wednesday last week, and sent the review off back to Mind, who will later publish it on their blog. I’m not giving any details away until then, however ;)

This impressed Christine greatly – she seemed genuinely thrilled that I had been contacted in a completely unsolicited fashion by a major organisation about a fairly major event in their calendar. I have to say that I was similarly pleased – not to mention rather stunned. Why do you like this blog? What have I done to garner (potentially influential) people’s respect with my blatherings here? I don’t get it, but it’s flattering, humbling and exhilarating in equal measure. Thank you. ‘Thank you’ doesn’t seem enough, but it’s all I have.

On a roll of positivity, I then told her something that I’ve not really mentioned to anyone but A yet. I’ve actually decided to pull my finger out and look into a voluntary placement somewhere. I have a position in mind, but I haven’t applied for it yet, so won’t give out any details, suffice to say that it’s in this same general arena – writing about and awareness raising of mental health issues. I’ve no idea at all if I’ll get it, but the two projects detailed above must surely stand me in good stead, as must my current editorship of TWIM (yeah, I don’t know how that happened either!).

Clouds

However, all those silver linings belong to clouds. They don’t just shiver and shimmer around a perfect blue sky by themselves, much as that would be desirable. The following issue pertains to a friend of mine, so I don’t want to discuss the details here, but I will state that her difficulty is directly affecting me too – and could, in a peripheral but still intrusive sort of way, be contributing to any whisperings of depression on the wind that is my life. However, Christine was extremely supportive and reassuring in relation to this matter, so I mostly feel assured that I can cope with my friend’s problem.

So, all in all, it was (as usual) a good appointment. “But!” I hear the eagle-eyed amongst you mutter. “You said there was a very important detail to share, Pan! Do tell, or we’ll spam your inbox from here to eternity.” I’m very wary of any so-called meat put into cans – a feeling surely shared by anyone else who played GTA III – so I shall, indeed, oblige.

As things were drawing to a close, she said, “so, is there anything else we need to discuss?”

I shrugged ambivalently, and looked away.

#lyingfail

Unfortunately for me, I must have looked away in the wrong manner, because she picked up on some sort of vibe of dissent. Examine the following scene from L A Noire:

LIAR!!!

LIAR!!!

Observe how our suspects angularly holds his jaw and avoids the gaze of the interrogator. Moreover, observe how he directs his eyes upwards. (This is actually a bad example, because he’s looking up and to the left, whereas I understand that looking up and to the right is more indicative of falsifying statements). Do you press Truth, Doubt or Lie?

I do have a vague recollection of looking up, to the right, whilst sort of biting my upper lip, at which point Christine had licence to hit the figurative ‘Doubt‘ option. (She can’t press ‘Lie‘ unless she has clear and present evidence to back it up, mwhahahaha! Oh, how I wish life were as simple as gaming).

I am absolutely disgusted with myself. I used to be a fucking excellent liar – what the shit has happened to me?! OK, so that’s an admission not to be proud of, but let’s be (ironically?) honest for a minute here: lying does come in useful when dealing with certain individuals and certain circumstances. How many times have you lied to a mental health professional? How many times have you told a so-called white lie to avoid hurting someone? How many times have you lied by default? Yes, just like that time your boss came in and said, “here’s 50,000 pages of turgid fuckwittery to proof-read and edit. Can you do that by yesterday, please?” and you merely smiled in response, leading him or her to believe that that was absolutely hunky-dory.

Seroquel Manipulation

Right, right, OK, I’ll get to the point. Christine realised that my shrug meant that there was something else I had to bring to the fore, even though I didn’t want to. I screwed up my face in an expression of embarrassed expectation and said, “I’ve decided I’m a consultant. I’ve cut back on the Seroquel.”

I waited for her to wince, or to bollock me, but instead she said, “by how much?”

I bowed my head and looked up at her meekly. “By half,” I admitted.

Then she winced.

In the end, she had mixed feelings about it. She said that it’s not always the worst thing to decrease a dose of something, particularly something that so potently affects one’s ability to do anything, but by the same token she did (reasonably enough) opine that to cut a dose of an anti-psychotic in half is potentially conducting playgroup in an incinerator.

She instructed me to call her “the second anything happens”. In this case, assuming I’m not …told… not to, then I actually will. I asked her should I just start taking the higher dose again if anything happens. Curiously, she said no – again, I was to call her first. I reluctantly agreed to this (reluctantly because it’s the cunting, fucking, shitting, bastarding phone), and also agreed to discuss it in full with NewVCB next month. I’ll see Christine before that though, on 22nd August.

And that was really that. I have to admit that, generally speaking, things have so far been fine since I cut my dose of Seroquel. No voices, paranoia, no significant mood drops other than that which has been already discussed and accounted for. What I’ve noticed, though, is that whilst I’m still stuffing my fat face, I’m slightly less out-of-control on that front than I was, and I’m slightly less lethargic than I was, say, last week. It’s not a huge difference, but (a) it’s a start and (b) it’s very early days.

Bye

Anyway, well done to anyone who got this far. It’s after 11.30pm now and I’ve been writing this on and off since about 4pm – in between bouts of reading, examining the crimes of H H Holmes and random mysterious disappearances, plus other silly, mostly self-inflicted intrusions. But I’m still in relatively good form, all things considered, so I’ll depart on that hopefully-non-shit-for-you note. Goodnight x

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Pointless Rant of Utter Pointlessness

 Life, Meh, Moods, Triggers  8 Responses »
Aug 012011
 

Will to live = - 465,927 Life Points.

Abilities of written communication as of this moment in time = - 2,852,937,563,828,445,643 Writing Points.

Decision to go ahead and write a post anyway = + 28,426,384,722,044 Stupid Points.

Wrote the below in the midst of an exhaustive fit of pique:

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WAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAHHHHHHHH.

The Everythinger is a really decent man, and it’s not his fault that I am completely and utterly fed up, but this whole house decoration business is doing my head in. If I have to see B&fuckingQ one more time, I will scream. No, literally: I will actually scream. My formerly held ambivalence towards the place has transmogrified into a demon of bitter resentment.

I know of people who have their houses decorated every year or so. How is this possible? There are no circumstances under which the alleged feasibility of that could compute in my brain. How could you do this on an even occasional basis without putting a bullet in your head? The disruption of routine (such as it is, in my case), the constant presence of someone in your house, the constant trips to the aforementioned shop of doom and woe, the movement of furniture and its intrusion into places of comfort, the fucking smell (admittedly faint in these days of modern technology), the constant “would you like another coffee?”s…gah. Even writing about it makes me shudder. For someone who is mentally healthy, surely this a stress that hardly seems worth it (and yes, for what it’s worth, the apparently sane A is cracking up too). For someone with as much batshittery in her belfry as me, it’s remarkably demanding.

I dissociated a bit on the way back from B&Q this evening. That’s the first time in a very long time, and isn’t a particularly good sign. It didn’t develop into a full-on how the fuck did I get here mode, like it has so many times in the past, but I did notice myself losing a few seconds here and there (or rather I didn’t, but you know what I mean). I know we all do from time to time when driving, but this was different from normal ‘highway hypnosis’ – my experiences of both that phenomenon and more atypical dissociation have taught me the difference between the two, though it’s hard to quantify the distinction in words. Perhaps mentalists develop a sixth sense for mentalist issues over time? Perhaps I am just doing my usual thing of making something out of nothing, or over-pathologising, or any of the other lovely things I could easily be accused of.

People will no doubt read this and say, “get a grip – this is a normal and ordinary life event! God, you are so frightfully immature!” I suppose it is and I suppose I am, and it’s quite probable that I am suffering from a normal, if (I would wager) severe, form of everyday stress. I think, and hope, that’s all it is. But, as noted, everyday stress in those with pre-existing insanity is at best a dubious state.

Ah well. That’s all terribly boring, but then you must be used to that from this blog by now, surely? I don’t think I’m about to be binned or anything. I’m fed up, unspeakably tired and really rather irritable, but I think that’s all reactive to circumstance, rather thank some sort of mental health crisis.

—

Actually, now (half an hour or so after the above) I’m feeling a little less bollocks, which is particularly curious given that we have just had to move a nightmare amount of stuff out of and around the over-cluttered kitchen. I have an apparent phobia of reorganising things, let’s not forget – and yet I feel more energised and slightly less irritable than I did.

One of the tidier bits of my kitchen right now.

One of the tidier bits of my kitchen right now. It is upside down.

That could be very, very temporary, however. A new family have moved in next door and they have a child, who is – I would guess – about 18 months old. Now, as well you know good readers, I’m not a huge fan of those to whom I will diplomatically refer as little people – however, were they to adequately modulate the noise that they emit, then even I can be tolerant. That, alas, is not the nature of young children (and yeah, I know it’s not their fault, I know I was that age once, yadda yadda yadda. I’ve heard it all before and I have all the childfree responses, so…). Anyway, as I type the wee boy is screeching the entire street of houses down. It’s one of those high-pitched, guttural, throat-agonising screams that children seem capable of producing with gay abandon, yet which would leave someone over five with a 10 week long case of laryngitis. These walls are paper thin. There is no way I can cope with this in the short-term, never mind for anything longer than that.

Will we have to stop swearing for fear of offending the parents’ sensibilities? Are we still allowed to have sex in case we wake the child? Will the Everythinger pottering about cause him upset? What if he gets a scratch and the cats are blamed and have to be put to sleep?

Paul thought that I didn’t like kids because I was forced to grow up too quickly, or whatever it was that was related to my experiences of child sex abuse. I think I don’t like kids because I don’t like kids.

And yeah, the irony of my having thrown all my fucking toys out of the pram in the preceding paragraphs whilst then moaning about children crying is not lost on me. I’m a hypocrite. I’ve never denied it, have I? So meh. My blog, my rants.

(Of course, there is a deeper issue here. I’ve often considered posting my views on whether it would be wise for me to procreate, even if I did like children, even if I loved everything about them, even if they brought me unparalleled joy. Does anyone care or would I be wasting my time?)

Anyway, A has just said, “thank Christ we’re leaving.” Though earlier he said, “if we’re this stressed over getting the house, how can we even contemplate moving?” And, as I continue to type, we are having a conversation about it in which he’s just reminded me that moving is the second most stressful thing a person can do in their life (after divorce, I believe), and that maybe it’s the wrong time to seriously consider it. Plus he’s not in the best frame of mind himself at the minute; he’s under a lot of stress at work, and is suffering from that general life disillusionment which befalls us all at some point in our existences, to greater or lesser extents. Maybe the burglary affected us both more than we realised. Maybe it’s just life, which is often a sucky thing in general. Who knows. Who cares. It is.

The original point of this post was to update the blog with reference to the my most recent meetings with Christine, but it’s nearly 800 words long and I’ve decided to make a conscious effort not to write 4,000 words every time I put fingers to keys, so even though this is nothing but a meandering, idiotic, probably offensive and irritating pile of pointless, ranting, steaming manure, it is getting published now. I’ll write about Christine tomorrow whilst the Everythinger does everything.

The child has shut up. And I think I feel better for ranting.

Maybe it will all be OK.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Anyway, enough.

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

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Agoraphobic Persecutory Delusions of Familial Evil and Seroquel. Etc.

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

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

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

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

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

Appointment With Christine

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

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

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

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

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

Am I Still Proper Mental?

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

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

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

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

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

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

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

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

Rant: Aunt of Evil is on this Landmass!

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

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

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

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

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

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

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

Family is genetics; friendship is earned.

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

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

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

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

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

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

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

Back to the Fucking Point, Pan…

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

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

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

Speaking of her…

Appointment with NewVCB

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Meh and Blah and Yadda and Etc and Such

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

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

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

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

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

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