Thank Christ(ine) for Christine

A lot happened this week, but I have neither the time nor inclination to discuss it in detail. Perhaps next week. In summary: I saw Paul on Tuesday for our first ‘proper’ therapy session of the new stint. A bit of a weird dynamic was present – I babbled relentlessly, flitting from one random tangent to another rather than discussing anything remotely meaningful. Not that he agreed, of course; he opined, as he always does, that anything that runs through my mind (aside, perhaps, from “oh, look, the sun’s out” – though could that be read as an example of avoidance?) is worthy of raising in the therapeutic setting, and can give insights into my psyche. That said, he did admit at the end of the appointment that things had been a bit up in the air (I forget his specific terminology), and said we’d get down to some proper work next week. I await it with interest – but not at all without trepidation.

Last weekend I decided I was going to turn a corner of the kitchen into an office. I don’t think I can do much about it right now, but I think if I have a future, then I ought to have something to aim for – and I’ve decided that this will be professional writing. My dream: to register as a sole trader business, and make at least a part-time income from writing – and no longer have to claim at least some of my welfare benefits (I would like to think I could keep my Disability Living Allowance, on the grounds that the disability remains, but that in having my own workplace I don’t have to engage with general office tradition, which would exacerbate my illnesses). I know I’m capable of professional writing now – or, at least, I know other people think I’m capable, and that matters much more in this arena than my own self-assessments – and I’m building a few contacts. For now, that is all it is – a dream. A few commissions here or there doesn’t really mean much, but I’ve narcissistically (why is that not a word, spellcheck? Incidentally, why is spellcheck not a word when it’s the precise term WordPress uses to refer to this utility?) got it into my head now that I can achieve this if I don’t do myself in any time soon. When I mentioned the proposed office to A, he suggested that instead of setting it up in the kitchen, I actually reconvert our former study – lately, since the advent of The Everythinger, nothing more than a place for dumping stuff we can’t be bothered to sort out.

It seemed more palatable than the kitchen, admittedly: for one, it’s fucking cold in the kitchen no matter how long the heat stays on. Secondly, as I am not wont to be in the former study much, with a bit of re-configuration, it will feel more like an office than part of this house. Currently I do all my work sitting on the sofa with the laptop on my knee – but I do all my fucking about in this fashion too, and ergo it is difficult to associate the environment with work specifically. The study in many ways resembles – or will resemble, when I have it sorted – my office in my last job: small, but with everything necessary to get on with the task at hand. As such, I feel that I can ‘trick’ my brain into thinking that the proposed office will actually be a workspace, rather than a mere spare room.

We ordered a new desk, which arrived on Wednesday. I sat down to it last night and, aside from a few side panels that A had fitted, built the entire thing from scratch. It is (optionally) an ‘L’ shape, and has ample surface area, meaning that aside from the PC and laptop, I’ll have plenty of room to write by hand, consult the Writers’ and Artists’ Yearbook, or study the professional writing course materials I bought several years ago.

All of that, particularly my suggestion about setting my writing projects up as a business, is a long way off – because right now I’m not a professional writer, but a professional mental. I even get paid for it! Though for how much longer?

As you may have gathered from the last couple of posts, things are dreadful. It’s at the point now where people are noticing: when I can no longer maintain a fa√ßade, then I know things are bad. My mother has even realised that the excrement has been liberally sprayed in the general direction of the thermantidote, and that is a tremendously dangerous sign, since I have always attempted to muster every last atom of energy my mind and body possess into convincing her that everything is fine (the reason being that she shouldn’t have to worry about me all the time).

As if things were not bad enough, therefore, when I got up yesterday morning and found an ESA50* form waiting for me, I thought I was literally going to have a heart attack – I hyperventilated so fucking much that I could see no way that my heart could continue to pump blood around my not-insubstantial body.

My ma immediately said, “we’ll take it to the Citizens’ Advice Bureau.” Reasonable advice, to be sure, but she’d missed the point; the point was that, re-fucking-gardless of how competent the CAB may have been in the completion of the bloody thing, I would almost certainly still have to attend a medical examination with the fuckwitted social security agency. I know I’ve written in passing about one of my previous exposures to this immense trauma…where?…ah yes, here it is. (*This post also explains a bit about ESA ((which stands for Employment and Support Allowance)) to those of you outside the UK. Basically, it’s a disability/illness benefit – but it has two components that complicate it, which the aforelinked posts discusses). After that experience – and even regardless of it – I genuinely don’t think that I can go through another assessment of this ilk (or of any, come to that). Not any time soon; pipedreams or not, I’m still really ill. I told my mother that if I had to go through such an encounter, that I would end my life.

Fortuitously, I had an appointment with Christine in the early afternoon. Since the hospital in which I see her is close to the CAB, I took the form with me. I went in, sat down, when asked reported that since our last encounter everything was still appalling, uncopably (new word) terrible, and that “the icing on the fucking cake” had just arrived, at which point I pulled the ESA50 out of my handbag.

She shook her head in frustration – “everyone’s getting those bloody things!” – and I repeated my promise that if I was called to a medical I would commit suicide.

Christine said, “I’ll complete it for you. At least that will be a weight off your mind.”

“That would be brilliant, thank you,” I replied, “but won’t they still send for me anyway?”

She told me that she is getting the impression that the Social Securitcunts have been sending out the forms to weed out the few “scroungers” that exist in the system, and also to catch out those with a mild to moderate illness, who they (quite possibly erroneously) perceive as being able to work. She exemplified by telling me about a patient of her’s that has mild, borderline moderate, depression. “She’s been found fit for work,” Christine explained, “but honestly, Pandora, there are things she could do. Not everyone’s in that boat, and in fact most of my patients haven’t even been called to a medical, and these forms have been arriving through their letterboxes since the start of January.”

“Are you saying that you think I won’t have to go to an examination?” I checked.

“I’d make an educated guess that when I’ve finished with this” – she nodded with contempt at the form – “it’s highly unlikely.”

She smiled conspiratorially at me, but I pressed on with my concerns. She wasn’t saying definitively that I’d not have to go to the fucking thing, after all.

Eventually she said, when I had finished yet another monologue of social security-driven angsty misery, that if they did call me to an examination, that she and NewVCB would write to the bastards advising them that I would be unable to attend, as to do so would be “severely and dangerously detrimental to my mental health.”

I stared at my CPN in something akin to wonder. “Really?” I murmured in a small voice laden with disbelief.

“Yes,” she said definitely. “So don’t worry. I’ll deal with this, send it off to them, give you a photocopy at our next appointment – and if an ‘invitation’ letter turns up at your door, contact me, and we’ll make it go away.”

“Thank you,” I almost-sobbed. “Thank you. I really appreciate it.”

Christine dismissed my gratitude – not in an unappreciative way, just in the sense that she was happy to provide the service and information that she had – as part of her job. Then she said, “you’ll be horrified when you read what I’ve written. Try not to be. They need to hear the very worst aspects of your illness; yeah, some people could accuse me of extending the truth, but I don’t think that’s the case. The case is that all of what I am going to write has happened and even though you’re taking measures to control these things, the unfortunate truth is that they also have the potential to happen again…possibly at any point.”

“Why would I be ‘horrified’ that you accurately explained the most severe symptoms of my illnesses?”

She sighed. “The voices tried to get you to kill yourself. They tried to get you to kill your baby cousin. Cameras follow you wherever you go and GCHQ are obsessed by you. You’re endlessly suspicious of people, and are cripplingly anxious when you’re forced to be in any proximity to them. Some days you can’t get out of bed due to overwhelming depression. You have, at times, to be watched to make sure you don’t harm yourself. There will be occasions on which people have to remind you to take your tablets – or even make you do so.”

She paused, flicking through the form, then added that one of the key parts of the mental health section of the ESA50 was about interaction with other human beings. “Given the aforementioned symptoms, that’s not…er…well, it wouldn’t really work for you, would it?” Ah, the sweet scent of diplomacy.

We talked about other stuff. Paul. Writing. Mum’s cancer scare. Rhona’s operation (with which there were no complications but lots of pain followed by a hook-up to morphine, which was removed five days after the procedure and even then caused quite significant withdrawal symptoms). An increase in Lamictal to help me with this current vault of depression (she’s going to discuss this with NewVCB on Monday). The exact nature of how low I felt, not that I could quantify it in words. I was acutely aware that I was acting very differently around her from my norm; regardless of how I’m feeling, I usually witter on and on and on, engaging with her non-verbally too – often it belies the reality of my mental (ill) health, but it seems to come naturally around her anyway. This was completely different. I steadfastly avoided eye contact, one of their favourite observations, and apart from issues surrounding the ESA50, I didn’t speak much at all. In fact, to my abject horror and disgust, at one point I believed I looked like I was close to tears. I didn’t cry, thank fuck – I can’t imagine the shame that would have been wedded to that – but I suspect that Christine thought I was on the verge of it.

Anyway, she was brilliant. My current episode continues, and no doubt will not abate for quite a while – either more Lamictal will help, or the vileness of the low will end itself in some sort of cyclical fashion, or I’ll off myself before any improvement manifests. But for now, what would have been one of the most serious stressors this year – as if there have not been enough already – has been removed from my responsibility. I didn’t thank her enough, because I can’t thank her enough.

The only downside to her brilliance is that it makes me even more sad and distressed that thanks to non-sensical bureaucratic bullshit I may well lose her. Good mental health professionals like her, ones that actually seem to care about you, are sadly uncommon ūüė¶

I’m in a rush so haven’t proof-read this, for which my apologies are due to you. Please forgive the probable multitude of errors of grammar, punctuation and spelling in the foregoing. Thanks x

CPN Appointment

***Possible Self-Harm Triggers, Blah Blah Blah***

Saw Christine on Thursday afternoon for the first time late December. Explained all that had happened in the first few months of 2012 and how things are very, very shit. She seemed to be of the view that this is a depressive episode more generally, because of the self-harm in which I engaged before Maisie’s death (she views it as serious because I was trying to dig out the veins in my hands, and seeing if I could sever the tendons in my wrists. When I shrugged it off, she said, “you do realise that this isn’t…normal, don’t you?” I said that I didn’t know). All that has happened, of course, has not exactly helped me claw my way back up the slippery slope I’m currently navigating.

She was horrified to hear that, as I spoke, Paedo was sitting in my mother’s living room. I explained that the reason for his presence was my mother and the McFauls’ over-compensatory just because the matriarch is dead doesn’t mean we’re not still family!¬†routine. Christine opined that this must have been very difficult for me. I said that I didn’t care, but I don’t think she believed me.

Complained about either losing her or losing NewVCB; went on a rant (well, insofar as I was able to speak) about how much the health service has failed me in the past, and just as it had started to get things right, it was cunting them up again. I must have looked particularly distressed at some juncture because she appeared to think I was about to burst into tears – “that’s really¬†hit you hard, Pan,” she said, adding that the entire CMHT is furious about the changes – at which point I said that I do not do¬†tears and that even when I’m sitting alone in the house and feel the ‘need’ to cry, I do not permit myself to engage in said activity because someone will be watching me through the¬†clandestine¬†cameras that follow me about.

Naturally, this remark piqued her interest, and she asked if I really believed it, or if it’s just a feeling. I said that I knew it was ridiculous – “maybe they were right when they diagnosed me with a personality disorder, it’s just that they got the specifics wrong; it’s not borderline, it’s narcissistic” – but that I believed it nevertheless. Cue the usual questions about voices and visions, of which I was able to truthfully say there are none.

Either way, she was extremely concerned about my levels of depression. I laughed (if one can call such a hollow, cynical sound ‘laughter’) and said that this was nothing. I know how bad it gets, and this isn’t it – even though it’s heading distinctly in that direction, and has been for weeks. Christine said that in a sense this was good – might I be able to ‘get it in time’, she wondered, if I wasn’t yet at rock bottom? ¬†I shook my head. “By the time it’s got to this stage, it’s still gone too far to prevent it from getting to its worst. It creeps up on you so slowly and insidiously that when you get to ‘now’ – the realisation you’re spirally into the abyss – it’s virtually written in stone that the very worst of depressions will be upon you anon. Like a fixed variable in space-time.”

She kept asking me over and over again if I could “guarantee [my] safety”. I kept trying to make non-committal responses, but she wouldn’t let it drop. Eventually I said something along the lines of expecting to be alive at the time of our next appointment. She accepted that, but added that she wasn’t just¬†concerned about my trying to top myself; she was also worried that I’d engage in more self-harm, and this time actually succeed in doing myself some proper damage. I stated that I couldn’t guarantee¬†I wouldn’t do anything of that nature, but that I thought it was highly unlikely. As I told her, you need at least some mental vigour to engage in self-injury, and with each passing day I have less and less of such commodities available. Depression sucks out your very soul.

Christine nodded, but kept prattling on that my safety was the most important thing. Meh. Fuck my safety. Don’t fuck my safety. I don’t care either way. I was just glad that she let me leave without a shiteist¬†crisis team assessment.

She wants me back in two weeks rather than the usual month. In the meantime, I am to contact her urgently if things get notably worse or if I’m running helium cannisters through price-comparison websites again. I said, “I know you always say I can contact you, but can I actually¬†do so? Do you mean it?”

She seemed surprised by the question, and emphatically told me without breaking eye contact (which was odd, because I’d spent the entire appointment trying to avoiding looking at her – mental health professionals love it when you don’t engage in eye contact; it’s always splattered over your notes) that of course¬†she meant it, that she wouldn’t have offered it had she not, and indeed that she wanted¬†me to contact her if things get worse. ‘Get worse’ is a stupid phrase in context – of course¬†things will ‘get worse’. But I think she means ‘really¬†bad’.

I might take her up on it, assuming I can get out of bed.

End of terrible post, and of pathetic pity-party. Can’t be bothered to proof-read, for which you have my apologies. Love to all. xxx

…And the NHS Cocks It Up Again

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

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

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

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

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

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

And that was pretty much that.

Except that it wasn’t.

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

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

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

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

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

She was clearly frustrated by this fuckwank herself.

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

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

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

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

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

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

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

FUCK!

“And if I don’t go with you..?”

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

FUCK!

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

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

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

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

The Good, the Bad and the Facades – 2011 in Review Plus Other Garbage

I am not OK. I’m not. Well I suppose I’m not going to run out and top myself or something, but things aren’t exactly sweetness and sodding light (as if they ever are). There are reasons; it’s not just that some mentalist episode has jumped up on me and started to suffocate me (although I may be taking on more stress than a normal thanks to all that’s ongoing), but on the other hand, in part at least, it’s not just ‘normal’ life either. I really don’t want to get into the ins-and-outs of some of the issues, because some of them could have the potential to intrude on the privacy of a friend, and I am most indubitably not willing to do that. All I am willing to say is that what’s happened, by any measurable standard, it is horrible. Really, truly, in-fucking-utterably horrible.

It’s perverse though; the issue to which I’m referring doesn’t impact upon me directly; only via my friend. I actually feel guilty for giving so much of a shit, because it feels like I have no right to intrude upon my friend’s suffering. How dare I let it upset me so much, when it is not me that has to stare the horror of the situation right in its ghastly, twisted face? I’m a bystander to this, and whilst obviously it is natural to wish to support your friends in their hardest times, it also feels crude to feel so gutted for my own reasons.

Some of you will know what I’m talking about, but unless you are the specific friend to whom I’m referring above, please don’t give away any details if you wish to comment. I’m sure you can understand the privacy issues potentially involved, which has become especially important in light of the frankly appalling intrusion of some unscrupulous individuals who have already been harassing my friend.

There have been other issues surrounding the above that could seem trivial in isolation, but which have had the cumulative effect of helping to screw my mind to a 90¬į angle. It isn’t a secret that one of these stressors has been the recent disarray on This Week in Mentalists, but it’s not confined to that. For example, this blog was hacked! Cheeky fuckers! A pox on you you, you lifeless cunts. Shove your discounted Viagra up your (probably flaccid) urethral tubes and eat it out the other side!

But yeah, there’s been more even than that to Piss Pan Off, but it’s late; I’m tired and fed up, and if it’s worth writing about at all, it can wait until another day.

In any case, I don’t think I’ve by any means recovered from the slump I took earlier in December. Lamotrogine has made no fucking difference to my mood, though to be fair I’m still titrating up to a therapeutic dose, and NewVCB has advised that she doesn’t expect it to turn my life around even when that has been achieved.

So. I’m not OK. I saw Christine today, and got a laugh when she described me as “very stable at the moment”. She’s probably reading this (she knows about the Mind Award, so it wouldn’t take a rocket scientist to realise the New Media winner was me) – if so, hello! I’m not having a go at her, but at myself.

It’s this fucking facade that many of us who experiencing mental health issues will be familiar with. You can, perhaps, say that x happened or that your mood is fucked or that you’re being persecuted by something or other, but two things always occur, do they not: one is that, whilst you do not lie, you find adequate language to enable you to play down the potential seriousness of your situation. Secondly, unless you’re in the very worst depression or the most obvious psychosis – in which case, you’re highly unlikely to have bothered going to see your mental health workers anyway – you manage, whether consciously or otherwise, to simply seem less fucked up than you actually are.

Oh well. On another note, Daniel was home over Shitmas. We went out one evening with Mum and A, and, to Dan’s particular delight, had a lovely Indian (Dan’s partner Craig apparently refuses to eat most ethnic foods because their propensity to use certain spices and suchlike scares him. Get your finger out, man!). The next time we met, the two of us had the opportunity to spend some time alone, a circumstance which had not been realised for over a year beforehand. This might seem odd, but this was the first time he and I had conversed directly about the dark revelations contained within this bloggocks about Paedo.

We recalled that I did tell him some things when we were a teenager, but that the full story did not in any significant form emerge. Part of that was due to my dissociation surrounding much of it; part of it was just something I found inevitably difficult to spit out in any detail.

This conversation took place in a rather busy coffee shop, and we therefore spoke in euphemism and metaphor and other devices of linguistic avoidance. That isn’t a bad thing necessarily; it makes it easier for me to talk about it, to have the truth finally ‘out there’ with Dan. This is one of my ever-defining contradictory positions: I don’t believe in the power of language, only the power of linguistic intention. Yet despite this, using the terms “rape” or “sexual abuse” or whatever are nigh on impossible to verbally enunciate; I found that even when I was talking directly about this whole fetid little saga to Paul, my erstwhile therapist, as regular readers may recall.

Whatever the case, as observed, it was good to have the conversation and get it “out there”, face-to-face, between us. I know Dan doesn’t think this, nor do any of the real life personnel that read this vomit-on-a-screen (or even my online friends, for that matter!), but the cloak of the internet could mean that a lot of what I write about here could be tempted to only exist here. Being able to talk about it in person, then, however difficult it can be, has a sliver of catharsis to it.

Anyhow, Dan’s simple but enduring quote that day was, “I hope he [Paedo] dies.” This is a view often posited by A, yet I remain strangely ambivalent about the man’s future. He’s nothing to me.

Next…

Review!

I suppose I should do a review of the year. I usually do, after all. Find the links yourselves via the archives thing on the right if you care; if you have any sense, you don’t, but whatever floats your boat ūüėČ

The Good

  • The therapy with Paul in the first half of the year.
  • The referral to, and the emergence of, Christine (pity I was trying to off myself with helium at the time, but shit happens).
  • An ever improving relationship with my psychiatrist.
  • Venlafaxine at 300mg and the period in the middle of the year, in the wake of that prescription, where I actually felt vaguely like a normal member of the human race.
  • Meeting bourach and Carrie for the first time.
  • Nice shiny award, which I still don’t believe I deserved.
  • The incredible generosity I was afforded at both my birthday and Christmas (yes, even Shitmas!).
  • Professional writing contracts.
  • Editing TWIM (though the glossy shine has been sadly anti-polished off that by some of the decisions that have had to be made recently, and the inevitable upset that has caused).
  • The lovely trips on which A and I went together – Fuerteventura, the cottage, a couple of local-ish hotels.
  • The amazing people that continue to support and care about me via this blog and the related Twitter account.
  • A, my Mum and my wonderful friends – all of those friends, but especially Daniel.

The Bad

  • The unspecifics of everything else.

Meh

The thing is, there have been some genuinely wonderful things that have happened to me in 2011, and in terms of my mental health, I even had a(n all too) brief taste of that elusive, nebulous thing we call recovery. But sitting here, right now – and granted, I am not in a good headspace this evening, which probably makes this an inappropriate time to write, but I don’t really care – I can’t remember the year overall as a good one. Well, OK – I probably don’t know the meaning of the term “good year” anyway, but you know what I mean; everything’s relative.

If the truth be told, I don’t remember an awful lot of the past 12 months; most of it has passed in that dichotomous haze in which time moves simultaneously quickly, in retrospect, and slowly, in the moment. What I will say is that I am grateful for the good, and I’m grateful for the people. The rest of it I’ll be glad to see the bloody back of.

I hope you all had as wonderful a Christmas/Hanukkah/Pagan festival/general time to sit around and eat and drink/whatever as possible, and I wish each and every one of you a peaceful, happy and prosperous 2012. I know that’s an optimistic wish, but the sentiment at least is sincere.

Anyway, I have an article to edit the living fuck out of and I’m fucking wrecked, so I apologise for not proof-reading this and for the likely myriad of punctuation, grammar and other errors. The minimisation of these is not helped by the keyboard on which I am typing, given that my laptop decided to die a week ago ūüė¶ So sorry. Anyway, take care and, again, all the best for the new year.

Love to all. x

EDIT: I almost forgot! I had an article in One in Four‘s winter edition, rounding up my favourite blogs. An addendum to the piece states that the links will be available on the magazine’s site; I can’t see it yet, but you might want to check this page at some point in the future if you’re interested. Or, you know, show your support for the publication and just buy the thing. Either way, if I regularly read your blog, you’re probably featured ūüôā x

Hypomanic Hogwash (and Seeing the CPN)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Good night, lovers. ‚̧ xxx

Change of Diagnosis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Srta Gata

I Lied – The Mentalism is 'Back'

Didn’t I sound so positive on Friday?

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

But that’s the truth of the matter.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So, then. What caused it?

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

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

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

“About five weeks…” I began.

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

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

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

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

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

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

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

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

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

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

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

“What, tonight?” I checked.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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