May 092011
 

This pseudo-recovery thing has its downsides. I miss writing this blog with the frequency that I used to, and yet when I sit down to knock out a few (a few! Me?! As if!) paragraphs, the will to do so seems to vanish. I think it’s not so much that I miss the actual writing, although now that I’m actually doing so I can entertain the notion that there’s an element of that, but more ruefulness about the lack of a finished product – the completed posts and the resulting frame of personal reference, and the comments and the resulting support. Some of you have been lovely enough to state that you miss my former regular writing too. I’m sorry about that; it just feels like there’s very little to say at the minute, other than to harp endlessly on meetings with Paul. Of course, confronting the therapy session reviews that the blog is owed in its own self-styled way – now four in total – means remembering said sessions. And remembering risks feeling. That’s a sort of scary prospect when you’re playing with a fragile sense of sanity.

That said though, I have determined that before the end of this week, I will catch up on at least two of them. So if you don’t see at least ‘Paul – Weeks 19 and 20′ by, say, Sunday evening, please feel free to bollock me senseless.

I saw Christine last week. In many ways it was an inconsequential appointment (not that that’ll stop 4,024,203 words spewing out on the subject), in that very little had changed since my previous encounter with her. I said so, then just looked stupidly at her, trying desperately, and failing miserably, to think of something further to say to her.

In the end, I referred to the suggested writing projects to which she had alluded in the previous meeting. I was very good and contacted quite a few of the mental health charities – Northern Irish, Irish and British. Christine was delighted with this turn of events. I suppressed a smug smile and neglected to inform her that I’d only fired off the emails that morning so as I wouldn’t take a bollocking from her. Granted, she doesn’t seem the type to start bollocking people, but in NHS mental health services, one can never be sure. I’ve learnt that the difficult way.

Incidentally, I’ve had two replies to my emails – one from the Mental Health Foundation, and one from the ever-excellent Rethink. The MHF kindly tweeted about my blog, and Rethink have suggested either writing* blog entries for them, or contributing to their magazine, Your Voice. As a Rethink member, I’ve read said periodical for a few years now, and have often thought of submitting a piece to it – the problem was, and still is, identifying a meaningful topic. I just spout dribble here, for the most part, and that seems kind of inappropriate for such a publication. The idea of blogging for them is really cool, especially as there’s an outside chance of becoming a regular guest writer – the same issue applies, though. I’ll have to consider what I may want to write about carefully. So as yet I’ve not replied to Rethink (if you’re reading this, nice Rethink people, I apologise); I want to formulate some ideas that would be worth their audience’s time. When I have done this, I’ll submit them and cross my fingers.

[* I know I said above that as soon as I sit down to write here, my muse fades (it frankly runs and hides in cavernous holes at times). Why would writing for Rethink be any different? I think that maintaining my own account of things is the most important thing I can do but, at the same time, doing something - writing included - for someone else makes it more...urgent? Of utilitarian value? Full of drive, perhaps? Whatever the case, there is something behind it that, if I can identify the right subject(s), will spur me on. But I won't neglect my old friend Confessions, I promise. Not any more than I'm presently doing, anyway :( Nasty Pan :( ]

Anyhow, back to Christine. She was seemingly thrilled that I had “taken the initiative” (an odd expression to behold when it was she, not me, that had suggested the aforementioned course of action) and that it was a “really positive step” symbolising my taking some responsibility in this odd venture towards some sort of mental health. Or some old faff like that (sorry, but I don’t remember sessions with her or NewVCB in the level of detail that I do for therapy, as I never take notes on them in their immediate aftermath). I suppose that I am meant to welcome her enthusiasm, but frankly I don’t. I am terrified that if she and/or NewVCB are under the impression that I’m ‘well’, that they’ll discharge me from Services. I’m well-er (there’s a new word for you) than I was; that much is evident to anyone who’s been in contact with me over the last few months (whether in real life, or here in the e-ther). But I am far from recovered. As NewVCB once put it, I remain a “very disturbed young girl” (given that I’ll be 28 this year, I dispute the use of the word ‘young’ ((and perhaps even the word ‘girl’)), but perhaps that’s not something about which I should complain too much). No, this is a good period – but I don’t know how stable ‘good periods’ are, or are meant to be. I’ve never had one in these kind of circumstances (ie. going through/having been through therapy) before.

Christine claimed that I was looking well. I thanked her for lying, and was rather taken aback when she seemed to be amused by this response. I was wearing a black dress and sandals; for some reason, this was deemed to be significant.

One thing you have probably guessed about me but which I haven’t, to the best of my recollection, stated explicitly before, is that I am about as far from domesticated as my ancestral amoeba were. Probably even more removed from domesticity than that. I occasionally cook (I can rustle up quite a nice, vaguely take-away standard hot curry when I put my mind to it) and throw clothes in the washing machine, but I do absolutely fuck all else about the house (and before someone asks, no: A doesn’t normally do it for me. He does his own stuff and that’s that). This includes giving a flying green shit about my clothes. They’re piled up in a huge box in the kitchen where I throw them to get them out of my way. On this occasion, the black dress was on the top of the pile; it was not chosen as some measure of a welcome of spring or some such other o’er-prosaic wank. ‘Twas a confluence of events assured entirely by the forces of Random Luck.

“Does wearing [the dress] increase your confidence?” Christine asked, grinning from ear to ear like something out of a Lewis Carroll novel.

“No,” I replied, puzzled by the question. “Why would it?”

She made some dull remark about ‘dressing up’ or something. I laughed in her face (sort of, but less cynically than I’ve tended to do with others in the CMHT. After all, she doesn’t know me that well yet) and advised that I could be wearing a bin bag or Kate fucking Middleton’s wedding dress (which, incidentally, was underwhelming, not that I give a toss – you just couldn’t avoid encountering such things with the media in this country being such utter bellends) and I wouldn’t feel any different. It’s not that I think I’m hideously ugly or anything – it’s just that one piece of clothing is much like another to (and on) me.

I’m sure I’ve mentioned that A and I are going on holiday later this month; I imparted this information to Christine, too. The usual pre-holiday question, reasonably enough, ensued; how do I cope with being away, being in a new place, blah blah? I confessed that whilst I am very much looking forward to the trip, I feel a subtle but definite amount of apprehension about going somewhere completely new. Last year, we went back to Turkey as we’d done the year previously, so I bore no such concerns – this year, it’s Fuertaventura, which is an unknown quantity. The reports from friends and from our own investigations are splendid, but I cannot be certain that they are accurate until I have experienced the place myself. As you know, unknowns scare me.

I told her so, and she offered to see me before I went left Norn Iron – which is within a shorter timescale than the gaps my meetings with her have been hitherto – so that was a good thing. Generous and thoughtful of her, I thought. I am to obtain additional Diazepam from the quacks should I need it, she says (not that that’s going to happen, as the chances of me seeing Lovely GP before 21st May is virtually nil. All the patients know that he is good and that the others are cock, so he’s booked up for weeks on end). Take Zopiclone in case my sleep is fucked. The usual really.

I said that one concern is that, whilst the travel insurance company are aware that I’m mental, the actual insurance doesn’t cover psychiatric issues of any description. We could have bought it, but it put the premium up by an absolute fuckload, and whilst it’s a peace of mind issue, on the balance of probability I’m not likely to have an episode that would require acute treatment, so it didn’t seem worthwhile to procure it. Christine, like myself, is of the view that the holiday is more likely to relax me than anything else and that if I’m going to go doolally all over again, then it’s not likely to be then. Well, fingers crossed.

She mentioned that she’d been to Fuertaventura and that it was “lovely”. I asked her what part, but in her reminiscing, she forgot to answer my question properly – not that I minded. She talked of her hotel and how it was a good bit outside a town.

“I like to go to quiet places,” she murmured quietly and reminiscently. “I travel on my own, so I like it to be…well, quiet, you know.”

I nodded expressionlessly, but I suddenly felt overwhelmed by a sense of great sadness. Here is this ordinary but good woman, in my estimation genuinely trying to help people rather than just earn a living, and she seems to be alone in the world. (She could have a husband/wife/partner and travel alone, yes, but is it really likely?). That isn’t fair. I mean, I know life’s not fair, but really. I hate the injustice of that. There are so many epic, epic twats – twats of arrogance, or of bigotry, or of whatever – out there that sport some bint or some dick on their arms and live long, contented, 2.4 nuclear perfected lives together. Then there are lovely, sincere, down-to-Earth people who are kicked in the face with sand by life. Fuck that.

I mean, maybe she’s gratefully alone; it happens, after all. But her body language, her lack of eye contact, the wistful way in which she spoke – I’m not so sure. And what can I say to her? How can I admit to this sense of profound sadness, regret and even on-her-behalf longing? She’s my CPN, not the other way around! So I cowardly lowered my head, and waited for the subject to move forward.

What has gotten into me? This whole craic of pity doesn’t sit well with my ‘Hard Bitch’ attitude (an attitude which, I was told today by Paul, I have never had. Paul met me when I was 26. I met me when I was 0, which strikes me as being a considerable head-start on what he has. So why does he profess, apparently in earnest, to think contrary to my own assessment?!). It must be a whole pre-30, slightly-more-than-third-life crisis thing. Or maybe I’m still just completely batshit mad, and managing to do a good job of disguising it, even to myself.

Anyway, for some reason we ended up having a discussion regarding Zopiclone. I admitted to her that I receive repeat prescriptions of it, but (perhaps not entirely surprisingly) I omitted the detail that this was simply down to an administrative error. This led Christine to believe that it was a doctor-sanctioned thing. Which, when you think about it, it is – technically. I mean, someone has to sign the monthly scripts, right? And anyway, I didn’t lie to her. And lies of omission don’t count. Because I said so, in case you’re wondering why.

The long and the short of the conversation was that I have an absolute shitload of Zopiclone lying about the place. As I told her, this is because one of these days the GPs’ practice will realise I’ve been receiving a repeat prescription of the stuff since the dawn of time (or at least since NewVCB prescribed it on a one-basis last year, anyway) and desist my allowance of it forthwith. She frowned slightly and, a trepidatious concern lacing her words, said, “you’re not planning to take an overdose with them, are you?”

I wanted to laugh at the suggestion, but I managed to control myself and instead shot her a wry smile.

“Most certainly not,” I assured her.

She raised her right eyebrow questioningly.

“I suppose I could OD if I wanted to self-harm, but it’s not at all my MO,” I told her, probably a little too matter-of-factly. “If I want to do myself in, however, believe me – there are more efficient, more reliably lethal, more peaceful methods than a few too many Zopiclone.

“But,” I added, realising I was making myself sound like I was her intellectual, psychiatrically-aware superior, “I’m sure you know that anyway.”

She ignored my secondary dictum and asked, “are you still having suicidal thoughts?”.

“Of course,” I replied, incredulous at the idea that I might not be thus afflicted. “How could I not be?”

She asked me about the severity and nature of them, I answered her honestly, blah de blah. “Basically it’s just everyday fantasy,” I concluded.

“‘Everyday fantasy’,” she repeated. “I know we had this conversation before, but it seems worth exploring again – you do know that suicidal ‘fantasy’ [the word was spoken with heavy...I don't know. Irony?] is not…it’s not…normal for most people?”

She was right; we have had this discussion before. But I just can’t believe it. How can anyone not at least have some daily suicidal thinking, even if it doesn’t translate into exact, in-depth plans? How is that even remotely possible? It just does not compute on any level in my mind.

Christine, however, assured me that it is indeed the case. “Most” people, apparently, do not live with daily (or even less frequent) suicidal ideation to any extent.

In return, I assured her that I had no active plans to catch the bus, and that is indeed a truthful account of circumstances as they stand. But I don’t think I will ever not have at least peripheral suicidality permeating my mind. I truly don’t know anything different, and – AGAIN – I don’t believe in cures for mentalness. As long as such ideation is mere fantasy, though, I presume that I should interpret it as a mental health win.

A few further questions ensued, mainly about getting out of the house. I try to avoid it, meh. But you do do it? If I really have to, yes. Do you see friends much? No. Why? One lives in London, one works two jobs, something always happens to prevent my meeting a third (the ‘somethings’ have become increasingly ridiculous over time. It’s now a bit of a running joke between us). But! Hark. I am meeting said third friend (Aaron, if you care) on Monday after therapy. That’s great! Is it? Yes. But it’s…well, it’s ordinary. People meet their mates all the time. It can be ordinary, but when you’ve been as isolated as you have, it’s actually a really good step forward. Um…OK.

I did meet Aaron today and it went well, as it always does when we manage to circumnavigate fate and actually get to fucking see each other. There is little to report here, though, because as I said – meeting a friend is ordinary. Normals do this all the time. I rarely do. I like Christine, but I’d rather she’d just have call a spade a spade. Fuck the terms ‘isolation’ and suchlike – just say that it’s not ordinary for a mental, but that it is for normals. That’s what she meant, after all. I know that I’m not a normal, and I don’t mind that. It’s OK.

A final matter that was addressed was, unsurprisingly, Paul. I reiterated to her that despite the views of “some” (namely her and NewVCB, but I couldn’t bring myself to be so direct; it would have felt accusatory), the impending end of my Nexus therapy was not about feeling “abandoned” or some old wank like that.

Instead:

“There has been a lot of productive work done with him. I therefore know that the therapy works. However, there’s an awful lot still to do. By Paul’s [and, indeed, the general literature's] own admission, this kind of trauma therapy should be conducted over two or three years. To use his terms, my…issues…were severe, systematic and long-term. That can’t be adequately dealt with in 26 weeks. So I’m regretful of the fact that things are drawing to a close, because I know it helps, and I know that it could continue to help.”

I went on to tell her that Paul had suggested that once week 26 has been and gone that I wait a few months, then simply go back to Nexus. “Which is good,” I conceded, “but I’ve convinced myself that despite Paul’s best intentions, it won’t happen and I’ll be therapeutically fucked. Again.” (Actually, I’m sure I didn’t use the word ‘fuck’ in the meeting; I’ve yet to make my assessment on how acceptable such parlance is to her. But you know what I mean).

“I’m sure he wouldn’t say that if he didn’t honestly feel that it was going to happen,” she offered.

“I know, I know, but…bah, I just can’t convince myself of it.”

She nodded sympathetically. “Have you any plans for those months in between the two stints?”

“Well…I was hoping to ask you about this, actually,” I began. For some reason, it felt like I was asking her to sacrifice her (possible) children to Satan, and I started stammering and bumbling like the idiot that I am.

“I…well, I…er…I kind of wondered…um…yes, wondered…well, if maybe…perhaps it would be p-p-possible, just maybe and if not it’s fiiiiine [hideously over-emphasised, thus proving that it is/was not 'fiiiiine']…if maybe, y’know…you could…well…see me, meet me…[massive clearance of throat]…I was wondering if I could maybe see you more often during that period than I currently do.”

After all my moronic mumbling, she didn’t take a second to even consider the request. Instead, she immediately nodded – and nodded emphatically. “Of course,” she said. “That would be absolutely no problem at all.” She smiled reassuringly.

Thank God!

And (finally) that was really that. One further thing she did do was try to negotiate an appointment with NewVCB before our holiday – I’ve been asked to attend during the holiday, which is obviously impossible if one is 3,000 miles south of the proposed meeting place. Unfortunately, though, the next appointment isn’t until 8th June – but that’s only a week after we return, so it could’ve been worse. Hopefully NewVCB will have the results of my recent ECG, enabling us to discuss whether or not I should brace myself for a daily hit of 375mg of Venlafaxine.

3,000 odd words to say something really rather simple. Christine is a likeable and gentle person, and despite it being fairly early on in our alliance, I already believe that she wants – and will seek to get, insofar as she can – the best for me. I left her office feeling reassured and pretty positive about my current care team. I hope I’ve judged the current situation well – I’ve been known to fuck things like this up in the past. But I think she is a good thing. I’m pretty confident about it, actually.

And I still feel sorry for her. Which is wrong on so many levels – it shouldn’t be like me, and moreover it isn’t my place to take pity on the woman. She is, after all, her own person with her own agency. But I can’t shake off this sense that she maybe doesn’t have the lot in life that she actually deserves, and that continues to sadden me greatly.

I’m seeing her again on 19th May.

marketing

Sep 262010
 

Today is the mensiversary of my last psychotherapeutic encounter with C.

What has struck me most acutely about the past month is how remarkably well I have coped with therapy ending despite my hugely significant attachment to C, and despite my righteous fury at how I was treated (and am being treated) by the Trust (and to some extent by C himself). The first few days after that final session were rough as fuck, and the first week in general was certainly not great, but overall I haven’t found myself the psychological heap of batshit insanity that I thought I would be.

I’m being told by various sources that my new position that I wasn’t abused in any way and my belief that I’m being watched are delusionals catalysed by therapy’s end. Thanks to the new Quetiapine dosage, I am starting to see things in what is in sane circles probably known as a ‘more rational’ fashion, and I accept that people probably aren’t watching me (unless they are shooting occasional, surreptitious glances at my blue hair). The sex abuse thing I remain conflicted about; I don’t believe it, but the ‘memories’/creations are pretty vivid, and my twisted sickness notwithstanding, I can’t really see why I would make it up. I told A yesterday that it was probably because I was bored, but apparently that is ludicrous. Looking at it from an entirely removed and objective viewpoint, I can agree with him – even if I don’t feel it.

Anyway, let’s assume for the sake of argument if nothing else that this denial/’paranoia’ is some sort of delusional psychosis. A and NewVCB (and some lovely readers) feel that it’s been brought about by the cessation of therapy, and is little more than a ridiculous form of defence mechanism. If so then, in the short-term at least, this reaction is better than the complete psychological breakdown that I had anticipated.

When my attention is somehow drawn directly to C, I confess that I do feel sparks of regret and sadness…perhaps even longing. There have been a few instances where this happened, the minutiae of which for various reasons I can’t really discuss here (not without a password, anyway). It’s why I haven’t attempted to write up the final six sessions with C yet; I haven’t forgotten, and I still intend to write them for at least the sake of narrative completion, but I need to be certain that I can cope with it, and not end up being driven into the messy situation that I predicted, but which has remained curiously (yet welcomingly) elusive to date. The onset of the madness could simply be delayed, and I wish not to invite it unnecessarily. Yet at a deep, visceral level, I think that when the time comes to record the last few weeks, I will be strong enough to do so.

Despite the potential trigger, I have had a necessarily brief but illuminating glance through some of the archives here about my sessions with C, and can reluctantly recognise that whilst he ultimately did more harm than good (his culpability in that being debatable), he did at least do something positive. I know more about myself now, and I know more about why I am and why I became mental – and I feel like I can start to face things in some sort of tangible fashion as a result. I should have been facing those things with him, but I’ve already sang from that song sheet 50 million times on this blog, so let’s not go there.

Last Thursday night, I ended up in a lay-by off a roundabout about 60 miles down the motorway from where I live. It’s the second time I ended up in that lay-by specifically. The difference between the two otherwise identical trips is simple: previously, I ‘woke up’ in such places, alarmed and confused, having suffered regular stress-induced fugues in the immediate wake of therapy sessions. Last week, I ended up there because I fucking wanted to end up there. I drove speedily and with symphonic metal blasting out of Disraeli, my car, because I wanted to. And I fucking loved every second. At one point on the trip I was struck by how much better I felt overall and, tellingly, had felt for a while. I still believe I’m seriously ill, but I have been given a reprieve for a wee bit of time anyway.

A believes that before therapy concluded, I was in a more positive frame of mind than I had been, say, a few months before that. That obviously wasn’t because therapy was ending, because of course I was petrified of that eventuality – and I still absolutely and completely refute any contention on the part of the shitty Trust that it was properly brought to a halt.

Anyway, I agree that things have been at their most stable in months, despite this catastrophic event haven befallen me. And that, dear readers, is because my medication fucking works.

It’s no miracle cure, and it’s not a substitute for proper, long-term therapy (that of the nature that I am apparently not allowed); having not resolved all my issues means that I am susceptible to regression and relapse at any point, and I do not consider myself well in the least. But I am surviving, I’m coping, and I’m not the vapid, catatonic non-entity nor the hallucinating, fearful, crouching-in-a-corner madwoman that I have in turns been. For as long as my mental health problems are unresolved, I will be those things again; I know that. But for now, I am managing in my own quiet, uninteresting way.

I can’t make up my mind on Venlafaxine, though I think that the current higher dose has possibly made a bit of a difference to my mood. Putting it specifically aside, though, I honestly believe that Quetiapine has saved my life more than once this year – much, much more so than over 60 sessions of psychotherapy ever did.

Sep 032010
 

I swear to living fuck that the Trust will not win this fight if I have breath in my body and blood in veins. I will battle them to the very death – literally, if needs be.

This is, of course, in response to yesterday’s received correspondence from Mr Director-Person. Your thoughts and comments on the letter are, of course, most welcome as always.

Dear Messers McGimpsey and [MP]

Re: Access to Mental Health Services

Thank you both very much for your recent kind assistance in communicating with the [my] Trust on my behalf. By now, you will have received the response from Mr Director-Person, the Director of Mental Health Services, dated 24 August 2010. I apologise if this letter crosses in the post with any communication from yourselves to me.

I remain very dissatisfied with the Trust’s response to my concerns for a number of reasons, and would hope that you could therefore kindly continue to assist me in this matter. I have not responded to Mr D-P directly, as such dialogue has, to date, proven to be an utterly fruitless pursuit. As you can appreciate, the Trust’s negligent and frankly dismissive stance on this matter has greatly added to my psychological distress.

I would make the following points in response to Mr D-P’s recent correspondence:

  • It is contended that Mr D-P has been informed that I was advised “early on” about a “therapy end point”. This is factually incorrect. [C] and I first met in late February 2009, at which point we worked on rolling contracts of six to 12 weeks, although there was always an expectation that unless significant progress had been made, these would be extended (which they were). I was not advised of a “therapy end point” until December 2009. Eight months subsequent to the commencement of the process cannot accurately be described as “early on” therein.
  • Mr D-P also alleges that my treatment programme with [C] was of a duration of 18 months. Technically, in a wide sense at least, this is correct – however, the impression given is misleading. I met [C] for exactly 63 weeks, which is obviously one year and 11 weeks – ie. just under 15 months. I point this out because I would not like the Trust to be allowed to overplay the sufficiency of their frankly inadequate service.
  • The cessation of therapy was against the specific clinical opinion of my consultant psychiatrist, NewVCB (of [Relevant Hospital]), as acknowledged by both her and [C] on at least two separate occasions. I am astonished that consultative medical advice counts for so little within the [my] Trust. Furthermore, [C] admitted in our final session on 26 August that I had been significantly “let down” by the Trust.
  • The aforementioned consultant psychiatrist, whilst acknowledging that I have a form of complex post-traumatic stress disorder due to significant childhood abuse, has stated to me on several occasions that she does not want to engage in diagnostic “labelling” of me, and instead wishes to treat my specific symptoms and circumstances in an individually appropriate way. The Trust’s attitude to my case would again appear to be in in opposition to her quite reasonable position; although I have never tried to hide or deny my earlier (ie. prior to NewVCB) diagnosis of borderline personality disorder, it seems clear to me from his letters that Mr D-P and his colleagues have chosen to fixate on this “label” specifically. Borderline personality disorder is probably the most stigmatised of all the psychiatric diagnoses and I must confess that I am coming to believe that I am being discriminated against considerably because this diagnosis has been applied to me.
  • Chief Executive Mr Chief Executive’s acknowledgement letter in response to my original complaint to yourselves suggested that, as well as investigating my complaints with regard to my current situation, an investigation into the Trust’s failings in my mental health care for over a decade prior to same would take place. It is evident that this has not been the case; Mr D-P’s letter of 24 August focuses solely on my present circumstances. Only the most cursory of apologies was offered for the present inadequacies, and none whatsoever proffered for the many errors and misjudgements of the past.
  • Perhaps most tellingly, Mr D-P claims in his letter of 24 August that “further support” would be “in place when [my] sessions with [C] come to a close” and that “…through close working between the psychological therapies service and the [Community Mental Health Team] it is planned that the work done with [C] will be incorporated into the ongoing support from the team.” This is categorically untrue. My sessions with [C] ceased on Thursday 26 August, and apart from my pre-existing relationship with my psychiatric consultant, I have absolutely no “further support” whatsoever, and in my latter sessions with [C] no such references were ever made. The matter of a referral to a community psychiatric nurse or a mental health social worker had previously been discussed; however, my psychiatrist and I were agreed that such a referral would probably be inappropriate in my case, at least as a sole support system. No such referral came to pass and I have not heard anything to suggest that any “further support” will come to fruition. It was certainlynot in place at the end of my psychotherapeutic treatment.

In light of the factually inaccurate statements made by the Trust, I feel that it is appropriate that you be made aware of the above to correct any misapprehensions that may have been created. I understandably feel let down by the Trust and am seeking your assistance to secure appropriate treatment.

I am aware that it is relatively common for the Trust to outsource psychotherapy to private sector third parties; indeed, I know of several individuals who have been treated in this way, and [C] advised me in our final session that it was certainly a possibility for me (we had discussed the possibility of my entering psychoanalysis in the private sector in particular). I am reliably informed by both professionals and other service users alike (within both this Trust and others) that, through your continued advocacy and support, this is something that would be obtainable for me. That being the case, I would ask that, as my political representatives, and in light of the Trust’s continued failings, you help secure assurance of this or an equivalent form of treatment for me.

I feel that I ought to note that I am the author of one of the most popular mental health blogs in the UK (currently written under an anonymous pseudonym and widely supported and read by both service users and mental health professionals) [let's not piss about with false modesty here, people - no arrogance intended, but, y'know - it kind of is], and that as a result of the deficiencies of my experiences within the [my] Trust my case has become something of a cause celebre across the aforesaid blog and various social networking internet sites. More formally, I write occasional freelance articles for a popular online magazine, and am giving very serious thought to specifically addressing this matter therein. I would certainly prefer to keep this issue private and anonymous, but if speaking out publicly about it will help me secure the care and treatment that I clearly need, I will not hesitate to draw wider attention to the matter.

I would like once again to thank you for the interest in my case that you have shown to date and would also wish to thank you in advance for your continued support. Please do not hesitate to contact me should you require any further information.

Kindest regards.

Yours sincerely

Pandora

Sep 022010
 

In response to both my last letter to Mr Director-Person and my MP‘s intervention.

Dear Pandora

Further to my letter of 3 August 2010 [wherein he acknowledged his failure to reply to the letter first linked above, not replicated here], I am now in a position to respond to your detailed letter [ie. the one to my MP and friends] outlining the background to your situation and the treatment received from our Trust.  I am sorry that it has fallen short of your expectations and that you feel that the progress initially made with [C] has not been sustained.

As indicated in my letter of 12 May 2010* the provision of specialist services for people with personality disorder is at an early stage of development in Trusts across Northern Ireland.  The [my] Trust did receive some additional funding last year towards such services and we have appointed a dedicated practitioner**.  The major focus of our approach in using this practitioner is to provide training and support to generic services both in-patient and in the community to improve their capacity to support people with a personality disorder***.

Within the generic mental health services we make every attempt to match individual client need to an appropriate level of intervention within the resources that are available to us.  With regard to your situation, [C] made a clinical judgement that was endorsed by his clinical supervisor to offer a treatment package consisting of weekly appointments and I am advised**** that early on you were given information about session numbers and therapy end point.  This was to establish clear boundaries to treatment facilitate the working through of any concerns that ending therapy might arise, and prepare for any potential transfer to CMHT colleagues.  This has resulted in the delivery of a package of assessment and treatment over an 18 month period******.  During that time it was recognised that you could benefit from further support and this will be in place when your sessions with [C] come to a close*******.

Given these inputs from our services the Trust believes that it is appropriate that this phase of your treatment is brought to a conclusion.  However through close working between the psychological therapies service and the CMHT it is planned that the work done with [C] will be incorporated into, the ongoing support from the team******.

The Trust is continuing to work on developing services for people with personality disorders as resources become available.  Thank you for your offer to provide service user input to this service development, which we will be in contact with you about in the future, and we appreciate your support with this.

Yours sincerely

Mr Director-Person
For Mr Chief Executive

Copy to:  Michael McGimpsey [NI Health Minister] and my MP

I have tried to retain in the above replication the multifarious punctuation and grammatical errors, though I’m sure some have slipped past me.

* Yes, I know: I did receive your letter of 12 May, after all.  Why are you repeating your self?  I am mentally ill, not fucking braindead.

** Wow, a whole practitioner?!!!1!!11!!!!eleven!!!one!!!!three!!!26!!!!  He or she will indubitably serve thousands of people quite eminently fabulously by themselves!

*** Jargon designed to confuse, Mr D-P.  But what you are, in essence, saying is that your appointment of this individual is already failing, because generic mental health services are apparently fucking scared of people with ‘personality disorder’ and thus do not seem to want to bother to treat them.  C admitted to me in one of the sessions about which I have not written that I was at least in part being discharged because of my wanky diagnosis of borderline – “the service cant continue to fund personality disorders,” apparently.  This is clearly a fail.  What a surprise.

**** You were advised incorrectly in that case.  C and I always worked on rolling contracts – until Christmas anyway – so there was no way that I could have been advised “early on” even in a vague sort of way about treatment ending.

***** This is incorrect.  I had a total of, I think, 63 sessions with C.  That equates to just under 15 months.  One year and 11 weeks.

****** Who?  My sessions with C have already ‘come to a close’ and I am not in receipt of ‘further support’.  None at all.  Admittedly, NewVCB and I agreed that a CPN or mental health social worker was essentially pointless in a case like mine, but the point is that Mr D-P either doesn’t know or doesn’t care (or, in all likelihood, both) about the accuracy of his claims.  So he may say that ‘further support [would] be in place’ when things with C ended, and that ‘through close working between…psychological therapies…and the CMHT it is planned that work done…will be incorporated into ongoing support from the team’, but this would be (and is, obviously) absolutely untrue.  His blatant fallacies (or at least ignorance) are, of course, to my considerable advantage: he has been caught in the throes of an outright lie on paper :)

Other observations:

  • I note with interest his failure to acknowledge that NewVCB, my consultant fucking psychiatrist, railed against the end of therapy at what she (and I) perceived to be such an early state.  C and his ‘clinical supervisor’ apparently therefore actively ignored direct, consultative medical advice, but of course Mr D-P wouldn’t like to admit to this.  Well, that’s OK with me.  His lie-by-omission will be openly highlighted in my response to my MP and Michael McGimpsey.  Mr D-P had better not say this is a borderline manipulation of the truth or something, because let’s just say that I have evidence that NewVCB’s disapproval of C’s actions is absolutely factual.
  • As usual Mr D-P completely ignores my references to complex post-traumatic stress disorder and my retraumatisation at the hands of C.  ’Progress initially made…[having] not been sustained’ merely suggests I’m mildly annoyed – perhaps not much better, but not much worse either – and does not in any way, shape or form grasp the levels of trauma that psychotherapy at the shocking mercy of his Trust has put me through.
  • What is really galling, what is really really fucking galling, is that he has completely ignored everything that I had written about my frankly appalling experiences within the health service prior to my meeting C.  About how I was pushed from pillar to post.  Regarded with open disdain.  Left in the lurch with no support by resigning members of staff.  Referrals not being made.  Referrals that were made then being ignored by those to whom they were made.  Over the course of 12 fucking years.  12 years!  So many of them formative ones at that!  No wonder I’m a complete fuck-up at the age of fucking 27!  He doesn’t care about any of it despite the possibility that (as pointed out to him), if I had received adequate treatment back then, I might have been reasonably well recovered by now, and functioning as a normal member of fucking society – ergo topping up his own bastard of a salary with 11% of my own earnings.  He doesn’t have to be altruistic about it; it would have been in his own best fucking interests.  Regardless, does he actually think that is acceptable?  Remotely acceptable?  Does he think that is an adequate response from the NHS to serious, life-threatening health concerns?
  • There was something else about which I wanted to rant but in the course of the rage of the last point I’ve forgotten what it was.  I will add it in the comments later if I remember.

Now.  Is it time to craft my reply?  Or just relax and work on it with A tonight?  And is it too early for red wine?  Red wine and a Pot Noodle, methinks.  With extra burning hot chillis.  Oh yes.

Cunts.  One and all!

Aug 252010
 

Plus Bye Mum! and The Obligatory ‘I Had an Appointment’ Post.

Let’s start with the first one.

Bye Mum!

One of two things has happened as regards my last post, in which I speculated that my mother was reading this infernal bollocks that I call Confessions of a Serial Insomniac.  Either I have been suffering from a paranoid psychosis (or, in less hyperbolic terms, just paranoia) regarding all the reasons that I thought she was reading it, or she has become shockingly technically savvy over the last few months.

I went to her house this morning after an appointment with Lovely GP and, when her attention was distracted, I searched her history, cookies and Temporary Internet Files on both Firefox and Internet Explorer.  There was no evidence of any visitations to this site at all, save for one single cookie which is probably from a time I wrote a post from her PC (as it had some references to an upload, to which, of course, she would not have had access.  For the record, I thought I had deleted all reference to that session, but meh).  When I say ‘searched’, I actually mean that; I used the built-in search boxes to search for terms such as ‘serial insomniac’ or ‘confessions’, rather than really rip the piss out of her privacy by wading through each single thing.

So seemingly I stand corrected on my earlier accusations.  Mother, I apologise.  Even though you aren’t reading this and don’t know about it.  Hmm.  Sorry anyway.

The Obligatory ‘I Had an Appointment’ (Part of the) Post

I saw LGP at the unGodly hour of 8.50am.  OK, so for a normal person, that’s not that bad, but I’m still registered at my mother’s old surgery, and since I live at A’s in the main, it involved a drive to the other side of town and then a hike up the motorway for a while.

I realised with horror last night that I had failed to fill in a form for the admin staff at the surgery.  Rather than do any work themselves when they receive DLA claims in from Social Security, they write out to the applicant asking them how their disability or illness affects them.  To be honest this suits me fine as they don’t really know how being mental affects me, and of course I do, but nonetheless I’d received the form the other week and had kept putting it completion of it off, despite their request to return it promptly.  I therefore sat in LGP’s car park immediately before my appointment and scribbled all the bollocks I could think of down – psychosis, dissociation, failure to engage in everyday tasks, severe anxiety, major depression, self-harm etc.  I hope I’ve covered everything.

Anyway, the main reason I went to see LGP was to scrounge Diazepam due to the now absolutely-imminent abandonment of me by C(unt).  LGP was sympathetic towards me given C/The Trust’s unprofessionalism, and seemed to understand that I have been completely retraumatised by the experience; however, the poor sod seemed unable to do anything about it.  He asked about NewVCB, and I said that she too was horrified about what C/The Trust are doing, but that she also seems uterly powerless to do anything about it (though she did try to dissuade C from cutting the process short, but the miserable git chose to refuse to listen to her).

The last time I saw LGP he had suggested going to see the Nexus Institute in the wake of the whole disaster that my therapy with C has become.  As I noted in the post in question, by psychological association I’ve developed an aversion to the Institute due to a really antiquated encounter with some NHS assessment bitch, but nonetheless I have been thinking about the suggestion and have perhaps warmed a little to it.  My concern now is that they offer, according to C anyway, a maximum of 24 sessions, which seems hideously inadequate to me.  When LGP raised the issue again this morning, I said so to him.  I pointed out that I felt that about 15 – 20 sessions was the minimum required to open up to a new person – and that was when the relationship was a good one.

He said that his experience of patients using the Institute’s services was that they had managed to actually achieve a lot in that timeframe, therefore opining that it was at least worth a shot.  He told me that they have a waiting list as they genuinely seem to be good at what they do.

Fair enough, but I bet they have never met a cynical, snide fuck like me before.

Anyway, it was left with me telling him I would, indeed, do as I was told for once and contact them for an appointment.  I am shitting myself at the mere thought of this, so how the fuck will I feel when I actually get round to the fucking meeting?!  And my concern is also this – my relationship (or, rather, the premature cessation thereof) with C has traumatised me so severely that that’s yet another thing for a new therapist to have to deal with.  It’s not all about the sexual abuse in the first place – it never was.  Now there’s just another layer of trauma-shite to add to:

  • the sex abuse
  • the bullying
  • the whole dreadful saga with my ex that I’ve still never written about here
  • the fact that I still weep for my grandfather nearly 12 years after his death
  • V’s abject cuntery towards me
  • V’s abject cuntery towards my mother
  • V’s relatives’ abject cuntery towards me and, to a lesser extent, my mother
  • an issue I’ve never discussed here pertaining to how my mother treated me when I first manifested severe depressive symptoms as a teenager
  • general life disillusionment that, unresolved, simply leads to further crippling depressions.

Can a therapist trained in helping people overcome sexual abuse deal with all that bollocks as well?  And do they have any expertise in treating people fucked up the arse by the NHS and being more of a mess as a result?  (Actually, they probably do; I’m sure my situation isn’t terribly uncommon).

Of course, the long-term plan is for me to enter analysis, but at least Nexus are free (donations notwithstanding), so I shall try them first.  I just hope that the limited timeframe afforded is not going to end up with a repeat of my current therapeutic disaster…more psychotherapy-induced trauma?  Oh yes please, world – give it to me, yeah!!!

Anyway, I risk never getting to the point if I don’t stop blathering about points made a zillion times before.  I led LGP to believe* that I was having a breakdown within a breakdown over the end of things with C and begged him for Diazepam.  ”The last time I had any was May!” I pleaded.  ”Please!”

It was truly pathetic.

He checked my notes and confirmed that May was the last time I was issued with a script for the beautiful, wonderful, amazing, fabulous tablets, and noted that I am “clearly not abusing them.”  No shit, mate.  He agreed to give me some more, though I was disgusted when I left the surgery and read the prescription that he had only issued 14!  I have seven left from the previous script, so there’s 21 – that’s only a fucking week’s worth!

To be fair, he said that if I was having a really hard time, that I was to ring him and he’d let me have some more.  You can be sure that I will be “having a really hard time”.  I feel that I need to hoard them, to have a proper size of a stash – just in case.  You never know when they’ll be needed, do you?  On that note, I observed with amusement that the back of the script paper now instructs you not to heard medication, as apparently that’s stealing money from the NHS or something.  This caused me much merriment – I hoard like fuck.  Too bad.  They failed to give me what I needed, so if I’m ‘stealing’ from the fuckers (such melodrama!) then I feel like a Robin Hood character, and am glad to be involved in screwing them.  Fuck them.

LGP asked the old rote question of whether or not I would overdose on the Diazepam.  I said that I wouldn’t, and then proceeded to tell him that I’d had my stomach pumped before and had no wish to relive the heinous experience.

“But are you having suicidal thoughts?” he asked.

I laughed in his face.  ”Of course I’m having suicidal thoughts,” I chuckled.  ”My entire life revolves around suicidal ideation.  But I won’t overdose, don’t worry.  I know how to do myself in and, unless you plan really carefully, that is not an outcome facilitated by overdoses.”

He raised his eyebrows, intrigued.  ”You’ve become something of an encyclopaedia about mental health issues,” he said, smiling.

“Well, I read a suicide newsgroup, so I know a bit about suicide methods,” I admitted.

He nodded.  ”But it’s not just that,” he went on, “you’re very self-aware, aware of what’s going on with you, and you’re extremely articulate about it all.”

I couldn’t help but blush.  That was nice.  I think.

He asked if my interpersonal relationships were of a satisfactory standard, and I responded that I had the support of A, a mass group of wondrous online friends, and a number of non-online friends that were supporting me unwaveringly.  I also told him that relations with my mother are at a reasonable point, though at the time I was still paranoid about what she was or wasn’t reading.

“It’s not that I think you should be grateful for the situation you’re in,” LGP said, “of course you shouldn’t.  But at least you do have a support network, it’s better than absolutely nothing.”

I suppose it is.  I asked if I could see him in a month as support additional to NewVCB and he said that of course I could.  He then mused for a second, and when asked what he had been considering, he told me that they also have counsellors that operate in the surgery.

“However,” he said, “I don’t think it would be appropriate for you.  Firstly, your issues are clearly very complex.  And secondly, you are clearly…” he searched for the words “…at a level above that sort of therapy.”

I regarded my lovely (but, alas, ginger) doctor with interest.  Was he implying that I am more intelligent than his almost-certainly-CBT-practising staff?

Mwhahaha!

He took my blood pressure, which he felt was pretty high.  He reckons that this is generally the usual PANIC PANIC that people get themselves into when in medical appointments, as well as stress over C.  ”I suppose I should also recommend losing some weight though,” he added, clearly uncomfortably.

I advised him that in the last year I have lost over four stone (yes, those of you that met me on Saturday – that does mean that I was even more the size of a mansion a year ago) and am continuing to lose pounds.  He was beside himself with joy (!) and kept congratulating me over and over, which was in hilarious stark contrast to the battering I took from his cunt of a colleague in December.

I left with the Diazepam script, a promise to him to contact Nexus and an agreement that we would meet again in about a month.  Ah.  Sighs.  I do like LGP.

I went to the chemist next door to get my medication, and whilst waiting looked around for other bollocks to spend money on.  I chose some Rescue Remedy, to aid the workings of the Diazepam, plus some anti-IBS stuff and Pro Plus.  Then I saw Seri-Strips, bandages etc – and I jumped on them.  I don’t feel like self-harming at the minute, but who knows what tomorrow will bring?  Better to be prepared, because it could go totally tits up after my final session with C(unt).

Which leads me to…

The Final Countdown: The Eve of the End of Therapy

So.  Here we finally are.  All my efforts to fix this dire situation have been a waste.  After 10.20am tomorrow, I will never see C again.

I look through my archives on this subject and actually find myself laughing at some of the histrionics displayed therein.  Wa wa, I can’t cope without him.  Wa wa, my life is over.  Wa wa, I’m so miserable, I can’t cope, please kill me someone please!  Tonight I feel…

…ambivalent.  Fine.  Asi es la vida.  I don’t care.

Now don’t get me wrong.  I am still positively full of righteous anger and indignation at the appalling way I have been treated by the Trust, and I don’t intend to just lie back down under it and let the fuckers abuse me more.  However, as regards C as an individual specifically, I really don’t feel anything much about our soon-to-be-permanent-separation.  * In this sense, my “I’m having a breakdown within a breakdown” performance to LGP was perhaps slightly exaggerated in pursuit of drugs.  Maybe I should contact Narcotics Anonymous whilst I’m in the process of contacting new therapists?!

There are two probable reasons for this.

One: I have already done most of my grieving.  About a fortnight ago – after a session itself after an unpleasant meeting with NewVCB – I was in a particularly bad state, so much so that I caused a fuss on Twitter, apparently having implied I was going to do myself in.  That was a bad day, but it was one amongst many.  I have shed millions of tears over this and whined and bitched and moaned about it here so much that it will no doubt seem like another blog once I desist from such shittery.  My pain was so real, so deep, so astoundingly visceral – and now, it’s just not.  It has apparently played itself out.

Two:  a limited number of people know this, simply as I haven’t written about any of my sessions with C in five or six weeks, but in that time my view of him has shifted almost 180 degrees.  I know that the fault in this whole sorry mess is only partially his, but he has become the fall-person for my disdain and derision.  I used to respect him greatly and I was very fond of him, and that was on top of my issues of transference and attachment.  Now, I kind of feel like he’s…I don’t know…a fly or something.  He’s there and he’s actually rather irritating and frustrating, and you feel like swiping him – but, ultimately, he’s something of an irrelevance, his existence little more than a passing inconvenience.  And that existence, in terms of my life anyhow, will cease to be in 13 or so hours.

It should have been different.  Of course it should have been different.  There is a small part of me that feels sad that I have come to view him thus, and as stated I know that it’s mostly not his fault.  But this is the reality of things as they stand; he is the figurehead for every failure I’ve ever experienced thanks to his employers.  Poor C.  But not poor C too.  Who cares?

Is this a defence mechanism?  Probably.  And it could unravel completely in the morning and I might be a suicidal, dissociated, agitated mess.  For now, though, for this one important evening, I am OK.  Surprisingly but genuinely OK.

Now.  Who likes my new logo?!

Pan x

Aug 122010
 

Q:

I’m obsessed with a man that isn’t you. Discuss.

A:

Short, sweet and to the point, I see, and a most frank admission. Not that you’d choose to disguise it, of course, given this blog’s ample testimony to your obsession.

It’s a strange one, I must admit, and I might have cause to be jealous but for the fact that you have made it clear that there is nothing of a romantic or sexual nature in the obsession. I understand that some therapeutic relationships tend in this direction, but luckily for me, yours does not, and I am satisfied that that is a true account of how you feel. I must admit that this does not prevent the odd stab of perplexity (read: minor jealousy) from time to time. Here you are, sharing your deepest, darkest secrets, or a good number of them anyway, with someone who is in many ways a stranger. I learn of these secrets on occasion not from you beforehand, but afterwards through the medium of your blog or during one of our regular Thursday night trips to our local coffee shop. I’ll have a cappuccino please, a scone – oh, and some dark revelation about sexual abuse. Do I want jam with that? Of course I do. Silly question.

Why my mystification/baby green-eyed monster? C, in essence, remains a stranger to you. The therapeutic relationship seems to me, from my knowledge of your case at least, to be fundamentally asymmetric. You talk. C listens. C utters the occasional ‘wise’ or ‘understanding’ comment. You play with your hair or your phone or look out the window. C sits in silence. You spout something angry. C says “so how do you feel about that?” You laugh, bitterly, because you knew that was what he was going to ask. You talk. He listens. “Have you thought about it like this?” You probably have. On rare occasions, you haven’t, and he thereby brings something new to the table. On most occasions, though, your therapy seems to have become a circular dance of frustration. There were occasional good weeks throughout the process, but most that I have observed have either been about as effective as a chocolate fireplace, or else actively damaging to your mood for the following days/weeks.

Why then, I ask myself, are you obsessed with a man who gives so little and asks so much of you? Clearly, the relationship is designed to allow you to talk about certain issues, to get them out of your system, to engage with an expert who may be able to help you deal with the issues. That’s the theory, and doubtless sometimes it works. You undoubtedly ‘click’ with C on a personal level, and yet the number of times you’ve come away from therapy angry, hurt or bemused makes me at times incredulous at your apparent liking of him, your relentless desire to know what CDs he listens to, what he does on his ‘off’ days, what his e-mail address might be, and so on [...um...for those not in the know, you might need the password to this. It's the usual password if you already have it.  If you are C, then you can't have it: please fuck off].

What you have is by no stretch of the imagination a friendship, though of course you admit as much. Perhaps had you met under different circumstances, it might have been so, but the imbalanced power relationships and the need for C to maintain his professional role mean that it is impossible for this to be anything more, in my view, than a doctor-patient engagement which, regrettably, is failing because an arbitrary time limit has been placed upon it. That being so, I fear that your obsession sets you up for crushing disappointment when the whole thing, in a few mere weeks from now [two from today], comes to its premature end.

In that sense, I resent C because he will very shortly reward your clear attachment to him with what you will perceive as abandonment. But then this all comes back to attachment. They say attachment to your therapist is necessary to get you to open up, but clearly this is a two-edged sword. If issues are not properly addressed during your therapy and the relationship is severed in an unsatisfactory manner, then the amputated pseudo-’friendship’ leaves a gangrenous wound that will fester. Thanks, NHS.

This process, in fact, seems to have actually required you to obsess, and I resent that tremendously, because the result is clearly going to be highly negative. Is that C’s fault? Probably not, but he could have handled things better, made it clear that the end of therapy was not ultimately his call. Do I blame him? Somewhat. However, the system is what is at fault in the end. I ceaselessly harp on the idea that the NHS would never do this to someone suffering from a physical illness. Yet that is precisely what the NHS is choosing to do to you. Because it can. And it has more important things to spend money on. Like managers. Grr.

Jealousy, then, isn’t my main reason for disliking the obsession. I’m not jealous, mostly. What I dislike is the damage that is being done to you. For transference to work (and I’m still not clear on the theory of how), attachment is necessary. In attaching yourself to C, you have grown to care about him, but unfortunately that care is misplaced in a relationship that can be ended at any time because someone wants a nice shiny annual report showing how efficient their psychotherapy service happens to be. It makes me angry, but that’s not a whole helluva lot that can be done.

Jul 282010
 

Well…I don’t really hate this blog.  As I’ve said several times, it is in fact my pride and joy – or, at least, what has gone before has made up what I call my pride and joy.  I don’t feel very proud or very joyful at the minute, though it’s not the blog’s fault, obviously; it’s mine.  I keep saying to myself, “you’ve got to write about this,” or “you should say a few words about that,” and then I look at the screen of the laptop, poise my fingers across the keyboard’s home keys – and everything goes blank.

I have two therapy sessions to catch up on and, since I probably won’t write about them before tomorrow morning, a third will probably join them.  I remember the interactions pretty clearly, as I usually do – one pièce de résistance was asking C if therapy was really meant to make you feel worse, which hit a nerve ;) – but I just can’t find any motivation to record them in writing here (or anywhere else for that matter).  I think, letters to MPs notwithstanding, that as things draw to a close I’m increasingly finding our meetings to be utterly futile and to that end, perhaps, I can’t face writing about them.  To do so would maybe be to acknowledge that, this time next month, psychotherapy – my only hope of a recovery of sorts from my perpetual anguish – will in all likelihood be over.  That’s a thought that is both sobering and chilling.  CPN/SW or not, good family and friends or not, I’m not at all convinced that I can keep myself safe from the end of next month onwards.

To go from making what was really rather good progress in therapy to regressing into this barren Purgatory-like wasteland is frustrating to put it mildly.  I don’t know how to articulate my current feelings on the matter beyond that.  Grieving, hurt, depressed, anxious, angry, I suppose – but all of these with a certain degree of measured stoicism; perhaps I am simply resigned to his abandonment of me now.  Overall I feel straightforward but profound sadness and regret.  Sadness for the fact that I will miss him greatly, I suppose, and regret for what could have and should have been – a relationship that had the power, if given the requisite resources, to greatly improve my quality of life.

Even if I had the will to write up the last two sessions – even if I had it right now – I wonder to some extent what the actual point would be, because as I say our sessions are feeling increasingly pointless.  I don’t really blame him, and I don’t really blame me.  It feels inevitable that things would just sort of ‘trail off’ mid-sentence, mid-air, as D-Day approaches.  Just the nature of the beast, methinks.  Pointless, futile, dancing around things and dodging others.  Still, I suppose the reason I started writing such detailed posts on therapy in the first place was for a record…for reasons of mere posterity.  Empty discussion or not, surely it is equally important to discuss the final sessions of this process if that has been my aim.  So I should – and therefore, I have now decided, will – review them, but I can’t say when.

Because the problem is that my current apathy is not just about examining psychotherapeutic matters.  I am finding it excessively difficult to write about anything (perhaps not unlike how I felt two weeks ago and indeed a week before that).  In part (probably in large part) that’s because I have absolutely no life whatsoever.  Yeah, I sometimes go out for a drink with A or to a shop with my mother – but so what?  What’s that got to do with anything?  Who’d be interested in that?  Certainly not me, and since this blog (despite having quite a few lovely followers these days) is primarily my record of these dark times, I’m not going to blather on about stuff that bores me to death (death is more peacefully achieved by other means, thanks very much).

This failure of expression and engagement with life extends to contact with the outside world at large.  I’ve been ignoring Twitter, emails, text messages – everything.  I refuse to return my mother’s unanswered calls, and the only person I speak to is A.    I do go through phases of doing this every so often, but this feels deeper, like it’s likely to go on longer.  I’m in a rut, both in terms of social communication and in terms of the one form of communication I’ve always held so dear – writing.

I thought about taking a brief break from blogging – say a month or something – but as I stated here, my concern, justified or otherwise, is that even the most short-lived of interludes would lead to a situation where I never felt able to once more lift my metaphorical pen.  And ergo you get stupid little filler posts like this one, designed to at least be something, but which are pointless and vacuous in their story-telling and exasperating in what catalysed them.

But that’s not this blog’s fault.  I don’t hate this blog.  I do, however, despise its author.

Jul 262010
 

Hahaha!  Didn’t see this coming, did you Mr Director-Person?

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

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

Dear Mr MP

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Kind regards.

Yours sincerely

Me

Encs

Jul 232010
 

I’ve discussed in the past C’s accusations that I’m ‘aggressive’ or ‘angry’ or whatever.  I have also discussed the fact that I think that if I am these things, that I am perfectly justified in my being so, at least as regards the end of therapy and my ongoing battle with the misTrust.

I’ve been reading some of your comments, here, on Twitter and on Facebook about this matter and almost without exception you agree with me both in my right to be angry, and in that there is no way I should be discharged from therapy.  I was wondering if you would mind if I presented him with a collection of these comments.  I wouldn’t, of course, use any names, websites or any other identifying information unless you specifically requested that I do so.

I’m not stupid enough to suspect that he will take an tangible notice of any such comments, but I think it’s outrageous that he’s going around thinking I’m being unreasonable (especially when he tried to encourage me to fight the Trust back in December / January), and I want him to know that I have yet to meet anybody that would even remotely agree with his apparent position.

If anyone objects to their comment being used, please just comment here.  On the other hand, if you would like something to be included, I’m game!  Let me know.  x

Jul 192010
 

AND NOW

BY POPULAR DEMAND, AND FOR ONE POST ONLY

CONFESSIONS OF A SERIAL INSOMNIAC BRINGS YOU...

THE
NEXT

THRILLING

INSTALMENT
OF

C

WEEK 57

CUE LA MUSICA DRAMATICA:

[audio:http://siarchive.files.wordpress.com/2010/07/guesswhat.mp3|titles=La Musica Dramatica]

(Anyone that gets the aural reference gets a gold star.  I think I’m looking at you, Karita… ;) )

This post follows on from the extraordinarily thrilling events detailed here.  The following may make no sense if you have not read them.  It may also may no sense if you have.  Then again, they were so tremendously exciting that if you read or have read them, you might die of a hedonism-induced heart attack, so proceed with caution.  Alternatively you might die of a boredom-induced heart attack so, again, proceed with caution.  If you really must read this pointless wank, be prepared to be blown away in amazement by my inspirational transcriptional crafting and the thrilling nature of the fabulous material contained herein.  Either that or expect to find a cure for chronic insomnia.

[The Scene:  C has just admitted to Pandora that it is inevitable that, as he has worked with her for some time, he cares for her in some way].

This should have set a fire of joy off in my heart; he was effectively telling me that he cared, in whatever way his profession allows, about me.  But I was too depressed, suicidal and fixated with his abandonment of me that I didn’t care.

Eyes firmly ensconced towards the floor, I made some noise of response suggesting that any response on his part was purely professional.

“Have these things been on your mind recently?” C queried.  I suppressed a laugh.  What a stupid fucking question to ask.  As if there’s ever anything else (other than suicide, I suppose) on my mind!

I shifted uncomfortably in the seat, and sat silently.  Eventually, whilst still avoiding his gaze completely, I nodded subtly.

“You’re frightened about how I’ll respond to what you want to say,” he said, proving once again his innate and remarkable aptitude for Stating the Fucking Obvious.

You know, at the time I didn’t make the connection.  Now, as I write this, the question seems slightly out of place with my refusal to admit to my suicidal ideation, and much more connected with my perceptions of what he felt about me.  Therefore, it seems he thought that the thing I wanted to say was that I am obsessed with him and want him to like and take care of me.  He’s bound to know that, is he not?  Why do I have to go through the affront of being forced to admit that verbally?  In this particular instance he was wrong.  I was considering telling him that I’m stockpiling medication.  Of course, whilst this is true, was my game-playing of telling/not telling him an avoidance technique to avoid telling him the rest?  Or was it, as I later denied, a “cry for help”?  Who knows.

Anyway, I told him that I didn’t want to discuss the matter with him, but he tried to point out that there were bound to have been things in the past that I had not wanted to address, but when I had, they were not as bad as I might have supposed.  Even though I couldn’t think of an example, I admitted that this had probably been the case at some point or another.

I listened intently to the progressively annoying rhythmic ticking of the clock throughout the ensuing silence.  At least the arseholes from the corridor had apparently been diffused (hopefully literally).

“It must be tricky to be in this position,” said C eventually, but I chose not to respond.  After a few minutes he went on a bit again about how I felt about him and what he thought about me, so he clearly thought – or, as he later proved, merely appeared to think – that everything I was hiding was related to this issue.

“So what if it’s tricky?” I asked mournfully, resenting the fact that he was making me more and more miserable – and, what’s more, visibly and verbally so – than I had been.

“I’m just putting that out there,” he replied.  I hate this fucking phrase of his.  Just say what the sodding hell it is that you want to say, C, please!  You’re the one that gets paid to have these fucking conversations, you need to do some of the fucking work here!

I ignored him, but was stunned – utterly stunned - when he said, “this goes back to what you said earlier about being homicidal or suicidal, doesn’t it?  Maybe you feel that you’re the cunt and that you may as well kill yourself.”

I looked up in a flash and gawked at him.  ”My God, you’re good,” I said, laughing in surprise.  I’ve said it before and I’ll say it again: he doesn’t just look (a little bit) like Derren Brown.  He’s a fucking mindreader too.  Just when I thought he was felt that my thoughts were related to something completely different, he jumps in and works the dirty little enigma right out.

He appeared to be surprised that he had read my mind, and asked in what way.  I admitted, finally – and before I could change my mind – that I was stockpiling pills.  He asked which ones, and I said anything on which I could get my hands that I knew could be lethal in overdose.

Then I said, “have you ever seen a film called The Bridge?”  [I have become obsessed with watching this disturbing but very human masterpiece in the last fortnight or so, and would heartily recommend it to everyone].

“No, but it’s on my to-see list.  That’s the one where people jump off the Golden Gate Bridge, right?”

“Yes.  Watch it.  It’s good.”

“You saw it recently?”

“Yes.  I was actually on the Golden Gate Bridge a few years ago,” I went on, sighing.  ”Unfortunately I was moderately sane at the time and didn’t consider jumping from it.  That was a mistake.”

He asked how long I’d been stockpiling for.  I wasn’t sure exactly but reckoned it was months.  I told him I’d become fixated with the film as I was fixated with suicide and that when I finally watched it, it was ‘beautiful’ (even if a jumper’s death itself is not the most pleasant).

Only 2% of jumpers have survived the leap from the Bridge.  C asked if any of them had been interviewed in the film, and as fortune would have it, one man with a severe form of bipolar disorder actually had been.  C was obviously hoping that this bloke would say he was glad that he was not killed.  As it happens, that’s exactly what he said, though I was cursory in my admissions of this to C.

In a later but related rant, I pointed out that stability in my life has been found on some occasions.  However, it’s only ever for a few months…maybe a few years if I’m exceptionally lucky.   The guy who lived to tell the tale of plunging into San Francisco Bay regretted jumping as soon as his hands left the railings, apparently, and was subsequently glad to have lived.  But…will he always be thus glad?  What happens if and when he’s back in the throes of the deepest, darkest, cruellest recesses of the human mind?  What happens if, for instance, his voices return, and order him to kill himself?  What happens, in general, if and when his stability is once again lost?

I wish him well, and hope that he doesn’t experience any suicidal ideation ever again, and I also hope he never has any reason to.  But in my own case, I don’t believe I can ever be cured, and indeed the whole ‘retraumatise-abandon’ issues of therapy’s closing weeks have led me to believe that I am going to be so badly traumatised all over again that a state where I can adequately manage my mentalism can never be attained.  Why bother, I philosophised to C, when it always comes back to this?  It’s a pointless, fruitless little dance of abject, round-the-fucking-mulberry-bush misery.  Why bother?

I went on to tell him about an interview in the film with the parents of a ‘successful’ jumper, the content of which mesmerised me.  The father said, his wife nodding quietly in agreement, that although they obviously missed their son very much and regretted that his life had been so marred by misery, they had a “who are we to challenge this?” attitude to his suicide.  They honestly felt that if his life was so unbearable, that it would have been selfish for them to have tried to keep him alive.  The father said, “some people talk of their body as a temple.  [Their son's] was a prison.”  Their mature selflessness, their humanity, brought me to silent tears.

“That’s an attitude that I think could be wisely fostered by many people,” I said.

“So, regarding you stockpiling these pills, you think I should just say, ‘OK, fair enough, kill yourself if you want to’, is that it?” he asked me.

“Maybe, but it wasn’t really you that came to mind when I regaled you with that story.  I’m more thinking about my mother.”  I exemplified by telling him about the third conversation detailed herein.

“Have you thoughts of actually taking these pills?” he questioned.

“Yes.  I am planning to do so, but not imminently.”

“You’ll be here next week?”

“Yes, unless something dramatic happens.”

“Where has this come from, Pandora?”

I considered the question briefly.  ”That fucking poison Venlafaxine doesn’t work,  this [therapy, a relevant gesture denoting his room] hasn’t work, isn’t being allowed time to work – I’m at least in the same mental position I was two years ago, and indeed it’s probably worse.”  At this juncture I went into the aforereferenced “what’s the point?  It always comes back to this” rant.

“This isn’t a life, this is an existence,” I declared (one of my favourite phrases, it seems).  ”That’s always been the case, but I had some tiny semblance of hope, quantum as it may often have been.  I don’t even feel that anymore.  Only a handful of people would miss me anyway, and what they don’t even realise is that they’d be better off without me.”

He asked how long my suicidal ideation had been building for, and I concluded it was since about April, which is when I started collecting prescriptions.

“If you take a massive overdose, you do realise you’ll be given your medication weekly,” he said.

“Of course, but that assumes that I awake from said overdose, which I have no intention of doing,” I responded in the blink of an eye.

“Are there times when you haven’t felt this way?  These thoughts seem especially strong of late.”

“I can honestly say that, in – oh? – the last 20 years, I think, there hasn’t been a single day that I haven’t thought about suicide to one extent or another.  I remember telling that to A once, and he said he couldn’t conceive of it.  I said that I couldn’t conceive of it not being the case.”

C annoyed me again by telling me that I am, he thinks, an expert in Not Killing Myself.

Right on, C.  What you don’t seem to realise, mate, despite my having already intimated the relevant information to you, is that I’m also an expert on not not killing myself.  There’s at least one newsgroup out there in the ether that details exact ways to do it (peacefully), and I am now intimately acquainted with the methods described therein.  In fact, there’s also at least three published books on the same issue – two get away with it by pretending they’re about euthanasia in the cases of terminal physical illness, but one is really open about having a pro-choice attitude towards topping yourself.  I have a copy of the latter.

(Actually, it’s a very interesting book to read even if you’re not intent on doing yourself in ((assuming you have some sort of interest in psychology, sociology, anthropology or any other -ology that takes an interest in the comings and goings of human beings)).  The first part of it, before the ‘methods’ section, includes quite a comprehensive consideration of suicide and suicidality as a societal phenomenon.  Much better than Emile Durkheim’s unbearable dirge on the same subject, though to be fair the whole approach is rather different and about 100 years more relevant).

Anyway, my feelings on suicide are meant to be for another post – one that is in the making, I promise.

I said, “it’s not through want of trying,” but the smug git instantaneously batted back with, “well, you don’t try to kill yourself every day.”

He cocked his head at me and said, “look, I take what you’re saying, I get that you feel this way.  I just think you must be fairly resilient as well.”

I laughed bitterly at him and proclaimed ‘resilient’ to be “not a word I would use to describe myself.”

And then….

Nothing.

Except…

Tick, tock…tick, tock….tick, tock.

I wanted to turn round, pull the offensive object off the wall and throw it out the window with a brute force seen only during absolute, unquantifiable rage.  Or maybe I could have considered throwing it at C’s face; that could have been an attractive option at points.  With the clock’s infuriating bloody tick tock mantra, I could hear my time with C ending, those few precious weeks disappearing down some cruel wormhole of time.  C rubs that finity in my face, NewVCB rubs it in my face, Mr fucking Director-Person rubs it in my face, and now even the bastarding clock thinks it is funny to rub it in my face (or, more specifically, eardrums).  Thanks, world.  Thanks so much, you fucking cunts!

After 17 super-eons (OK, there’s a considerable surfeit of casual cosmological terms in this post, what the fuck is that about?) he eventually said that perhaps I felt I was being left alone to deal with all this stuff.  I smiled cynically in response.

Wow, look at Einstein over there.  How insightful, C, that’s brilliant.  Well done.  Get out the champagne, my friend, because you have just come out with the psychological equivalent of the general theory of rela-fucking-tivity.  Or perhaps it’s something akin to the very first tentative bold but wise suggestions that the Earth was not, in fact, flat.  WELL. DONE. C.

“I’m used to that,” I whined.

I paused, then whinged for a few minutes more about how contemplating suicide was very comforting and liberating.  ”You know,” I said.  ”To know that you don’t have to put up with it any longer, to know that at any point you can just go, ‘fuck it, cheerio existence’.”

“Hmm, hmm,” he responded.

For some reason the ‘hmms’ enraged me, and I said, challengingly, “you don’t think I’m going to do it, do you?”

“That sounds like a dangerous mindset to get into,” he replied, furrowing his brow.  ”It’s like you think that for me to take how you feel seriously, you have to do something, such as taking an overdose, to make me believe…”

(Well, actually, asking for your help hasn’t fucking worked, so yeah, I could see how I might think this, as it happens.  STFU).

“I’m not trying to make a point to you,” I interrupted, shaking my head vigourously.  ”I just don’t think you think that I’m going to do it, and I am.”

He went off into a monologue in which he opined that he doesn’t think I have sat down and said, “right, let me make a point to C here…ha ha, I told you so,” but that I have, barely consciously, concluded that this is “the only way [I] can communicate how [I] feel”, and that the only way in which he will “actually understand” me is by my “showing it”.

“You see,” I sighed, again shaking my head at him, “you’re fixated on the idea that I want to communicate something.  I don’t want to communicate something.  I don’t want to exist.  That’s what I want.”  (Or rather don’t, I suppose).

Thinking that he was probably wondering why, then, I had bothered to communicate this information to him, I said that I was only telling him about it because he had already worked it out with his Derren Brown/Mysterion-like powers of mental deduction.  Which, although the matter had been floating around in my mind throughout the session, was sort of true.  Intellectually, I always knew I should tell him, but as already discussed, I really didn’t want to.

“What’s that like for you?  That you feel I’m not taking you seriously?” he asked.

“It doesn’t particularly surprise me,” I responded, in what might have been a slightly pompous, dismissive tone.  Just maybe and just slightly…hmm.  Then, “everybody thinks it’s a ‘cry wolf’ issue.”

He said, “so what did you think I was going to say?  Sort of brush it off and say, ‘oh never mind, she won’t do it’, or what..?”

I smiled cruelly and said,  ”I expected you to say, ‘maybe you should phone the Samaritans’.”  I laughed slightly at the idea, of which he had previously been a proponent.

This remark, to my considerable surprise, seemed to cut him to the bone, to the extent that, despite my palpable wryness at this juncture, I actually felt guilty.

C sighed and said, apparently very earnestly, “I hope I take you seriously – well, I do take you seriously…I hope you feel I take you seriously.”

“Is that a question?” I checked, and he nodded uncertainly.

Overcome with my own guilt, I said, “I do, yeah.”  Which is mostly the truth; I just get so frustrated at the difficult circumstances under which we presently find ourselves, and end up remembering every little thing he has done to piss me off.  In general, it is not my held position in the least that he patronises or dismisses me, and it was indeed cruel, by dent of my underhand Samaritans comment, to suggest otherwise.

“Look, I just wonder if the fact that I’ve actually bothered to tell you this means that you think it’s indicative of it being some silly cry for help, which it isn’t,” I told him, trying to be as nice as I could about it.

“That suggests that wanting help is silly, which I don’t think,” he told me.

“Let me rephrase, then.  What do they call people like me in general…manipulative?  Attention seeking?  Some other pejorative nasty referencing how annoying I am?”

He ignored the latter part of my statement and replied, with enraging reasonableness, that “I see it as that someone who is in distress quite justly wants or needs to be attended to”.

I looked away, unable to think of a clever comeback, and listened to the sodding, cunting, fucking, bastarding clock ticking away the last few seconds of my time with him that morning.

“We’re going to have to finish for today,” he predictably told me in due course.  ”But this is something for us to be looking at [oh, really?] and for me to be taking seriously with you.  I’ll be bringing this back up next week [oh really? x II].”

“OK,” I nodded, and I went to leave.

He stopped me from going however, which – as noted on the only other occasion that I remember him doing it, not that I can be arsed looking for the link right now – suggests that he is actually worried about my state of mind.  I suppose having had me just confess that I have a lethal amount of pills that I fully intend to ingest might just create such worry, to be fair.  Though it is only professional concern, I remain convinced.

“The most important thing for now,” he started, “is that that you’re saying that you don’t have any plans to enact this lethal act today, or in the immediate future.  You’re not going to do this now.  You will be here next week?”

“I have a date in mind which is not in the next week,” I confirmed.

He looked visibly relieved, though I suspect that is only in relative terms.  I tried to smile reassuringly, but I’m not sure I succeeded.

I was still alive for the next session, about which I hope to write soon, and during which I apologised for the laughable histrionics about which you have just read.  It sounds so pathetically childish and self-absorbed as I read it back, but then in thinking that I am betraying my own position on suicide, which is that it is not a per se selfish act.

For those of you convinced that I’ll be dead shortly, please don’t worry.  I told A on Friday night that I’ll try my best to remain alive until such times as a natural or accidental death is forthcoming, and that’s about as big a reassurance as I can give.

There’s very little of amusement on which I can end this.  So I’ll just take the finality of this post out of my hands :)  [Warning: do not view the embedded video if you are overly PC, offended easily, have a sense of humour that is not sick or twisted, yadda, blah, meh, gah, la, da, de, wah, etc]

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