Perspectives from the Mentalist's Partner (6): The Blind Leading the Mad

As regular readers may have noted from Pandora’s occasional mentions of me, I have a disability. I’m partially sighted. I usually don’t think about it. Why would I? It’s something that’s always been with me. Well, when I say ‘always‘, I mean the pleasure’s been all mine ‘within living memory’. I hesitate to say that it’s a part of me, because that suggests a welcome I don’t extend to the problem; but the reality is that, yes, it’s made me who I am and so, yes, it’s wedded to me for better or worse, richer or poorer, and all that lark. Inseparable buddies, ’til death do us part. You know the lines.

So, then, how does this constant travelling companion affect me, you might ask? Well, I can get around familiar places for the most part, I can get on with my work. I don’t tend to think about what I can’t do a lot of the time because – well, to be blunt – I can’t do it, never have been able to and likely never will. I can’t play ‘normal’ sport with any degree of aptitude. I can’t drive or even safely ride a bike on a public road. I can’t read signs unless they’re smacking me in the face. I find it too much of a strain to read most newspapers or magazines (so the internet is a gift and the Apple iPad, with its built-in accessibility, is a dream come true). I can’t see well enough to build a PC, despite knowing exactly how to; I get help on the former score from Pandora.

The point I’m trying to make is that there are quite a lot of things I can’t do, and more things besides that I can’t do with much competence. I don’t tend to think about this because, as I’ve already stated, that’s how it’s been for as long as I can remember. Yes, occasionally I get pangs of wishful thinking – possibly more so when I was younger than now – but generally I can ignore my bosom buddy. And since I don’t tend to think about what I can’t do, people who know me tend to stop thinking about it as well. Sometimes I think they forget, or consign my sight problem to the ‘oh yeah, forgot about that’ bin.

Why is this relevant to this blog? Well, it is to the extent that I have what, sometimes, can be perceived as an ‘invisible’ disability. Granted, it’s more readily perceptible than the amorphous ‘what?’ that’s going on in someone’s head, but it’s closer to that than the other extreme of, say, being in a wheelchair.

As we know, if a health issue isn’t readily perceptible, it tends not to be thought about – or, at least, it tends to be thought about less than the more obvious. Lots of buildings are geared up for ‘disabled access’. What this appears to mean, in general, is the installation of a wheelchair ramp or a lift. Worthy additions, certainly, but additions that fail to cater to me and others.

Airports are a good example of this. Many airports are moving away from announcing flights towards a position where the onus is on the passenger to find out for him- or herself when a flight is departing. Fine if you can see the often distant screens with their not so huge fonts. Of course, if you’re hard of hearing, announcements are not much good, but does there have to be only one form of communication?

Or what about going into a fast food joint. You might argue that I shouldn’t be there in the first place. But I am. So let’s look at the board. Oh, hang on, let’s not. I’d better get Pandora to read it to me. Often the same with a menu in a restaurant, the specifications on the back of product’s packaging, the instructions (as a last resort) that I’ll need to understand when trying to get something to work. There’s not a Braille or large print version.

I don’t expect the world to change for me, and it sure as hell doesn’t revolve around me, but I experience the unquestionable feeling of being marginalised at times. Perhaps not deliberately or in a major way – simply a crime of omission. The wheelchair lobby have been very successful in pushing the need for reasonable adjustments, and I applaud those efforts; but others have enjoyed fewer victories.

Now, take my problem and double it; treble it. People at least know what a sight difficulty is and they generally accept that I’m not making it up or hallucinating the bugger. Maybe society hasn’t caught up enough to cater to it in an ideal way, and there are real difficulties still. But things generally tick over. Good Samaritans will often step in to ask a blind person if he or she needs help. A lot of my friends are blind or partially sighted. They lead pretty normal lives. They get disability aids to assist them. They are offered reasonable adjustments. Could things be better for them? Most likely. But their disabilities are seen and recognised, and I for one wouldn’t like to be the person standing between them and the entrance to their local of a Saturday evening! Normal lives, normal people.

If being blind or half blind is Cinderella, then being mental appears to be Cinderella’s unborn sister. From my observations of developments around the Madosphere, it seems to me that there is a very long way to go to achieve recognition of mental illness as a disability (whether temporary or permanent). While stigma – the ‘get over it’ culture – still persists, what hope is there of a genuine cultural shift towards accommodating these problems, of reaching something akin to normalisation of these issues? If the problem is not seen, it often goes unacknowledged. Not through malice, perhaps. Ignorance is the mother of stigma here, I’d wager. The generic term ‘depression’, is a good example of what’s wrong. It doesn’t communicate useful information to Joe Public. In regular usage, it can mean practically anything across a wide spectrum from ‘a bit pissed off’ to ‘suicidal’. It’s symptomatic of, and continued to support, an all too common attitude of ‘Snap out of it! Get over yourself! Cheer up! It’s only in your head!’

Only in your head? What a quintessentially galling statement. Everything’s in your head. Everything is filtered through the lens of our senses; everything goes through our heads, all those neurons firing away merrily to create what we call our world view. Can things that are ‘just’ in your head be so readily trivialised or dismissed? Really?

My conclusion isn’t revolutionary. It’s stating what the Madosphere and mental health advocates generally are already stating: there is a need to begin to see mental issues in the same way that we see other health issues. We must collectively stop laughing them off and begin to provide the interventions, empathy and adjustments that are being extended, albeit sometimes slowly and imperfectly, in so many other areas.

Here endeth the sermon.

Pan

I think this post is particularly timely, given the shocking ignorance, offensiveness and self-righteous cuntery of the utter bollocks shown on the otherwise respectable Channel 4 this week (words to the wise: follow the link at your peril. It could genuinely upset or trigger you, and it will almost certainly anger you). For those unfamiliar, some God botherer, Malcolm Bowden, has been wanking on that depression – and as A notes in this post, that’s certainly an overused term – is a character failing, caused not by biopsychosocial factors, but by the dirty heathen sin of ‘pride’ (incidentally – as my next post will discuss, at least a little – there’s fuck all wrong with pride anyway. Conceit and arrogance are ‘sins’, if one must employ Biblical nomenclature – but they are
quite different from simply taking pleasure in the fact that you’ve done something good).

Yeah. The words “fuck away off” came to my mind too. Apparently leading mental health charity Rethink agree.

Can I just say that this is not how all – or even many – Christians view depression and other mental health concerns. This is clearly exemplified by some lovely people who actually practice the doctrines preached by Christ, rather than sitting in self-referential, holier-than-thou judgement.

Unfortunately, though, Mr Bowden has done neither people with mental illnesses nor his warped view of Christianity any good. He’s poured gallons of fuel onto the stigmatic fire, and has in all probability provided cocks like Richard Dawkins with a new pile of wank fodder.

Depression is real. Depression is a real mental illness. Godliness, or the lack thereof, has fuck all to do with it. Yet society, or at least parts of it, will nod along to Bowden’s demonising rhetoric, because it suits them to believe that teh m3nt@lz are all evil/scrounging/lying etc etc etc.

So hard as it is, on we must fight. All of us with disabilities – seen or unseen, mild to severe – in solidarity. That we must do, despite members of the community being some of the most marginalised and vulnerable in society, is disgusting, but cockjockeys like Mr Bowden, and indeed challenges such as A has discussed above, prove that it’s sadly a necessary evil even now, in a supposedly enlightened 21st century.

Perspectives from the Mentalist's Partner (5): Thwarting the Downward Spiral

I should preface the following by noting that this post has not been written by Pandora. Rather it is a guest post by her partner, known to regular readers of this blog as A. The views expressed, needless to say, are not necessarily those that are held by the Serial Insomniac herself. Now, with that disclaimer out of the way, I’ll proceed.

Over recent months, I have sometimes found myself wondering to what extent worklessness, quite independently of Pandora’s mental health issues, breeds the kind of motivational collapse that this blog so often and so effectively chronicles. The question seems particularly apt with the Coalition government taking forward very significant changes to disability support and out of work benefits.

Let’s get something straight from the outset; in raising this question, I’m not for one moment suggesting that Pan is in any position to work at the moment or that she isn’t deserving of the support that she currently receives. What I am asking is this: is being away from work for such a long time a contributor to the difficulties that now stand in the way of Pan resuming a ‘normal’ life? (Cue all the usual reservations about the word ‘normal’.)

In speculating on the life-deadening impact of worklessness I speak to an extent from personal experience, albeit not a long stint of same. When I completed my university education some years ago, I naturally went job hunting. I didn’t think I’d get anything quickly, and in the interim determined to enjoy myself, drink in (sometimes literally) the freedom that being away from full time study could bring. Without a care in the world, I could begin on any number of projects I’d always thought I’d like to do – writing some short stories, composing music, improving my guitar technique, learning to program a computer in a much less amateurish manner, honing my understanding of the world and its most important issues through wider reading. Sounded good. And yet I’d been warned that prolonged exposure to the dole could be psychologically debilitating. A friend of mine, a long term doleite, told of the fact that he had come to the stage where he couldn’t even be bothered getting up or having a shower on many occasions. I dismissed such thoughts; that was him, I was me. Nothing like that would happen to me.

Well, for my first four or so weeks of freedom, I was right. I had a whale of a time. No commitments. No pressures. I could go out when I wanted. I could stay up as late as I wanted for some deeply interesting all night philosophical conversations. I could catch up on series upon series of the good TV shows I’d missed, read good books, experiment with writing, compose bits and pieces on the computer, and so on. I could pursue what I wanted to pursue, all the while job hunting, attending a few interviews – not having much success – but oh well, time would sort that out, wouldn’t it?

Week five brought a niggling feeling that things were starting to veer off course. I’m obviously an impatient person, because by the time I’d reached this stage, the boredom had subtly, insidiously started to set in – and with it, the transformation of my motivation into molasses. That morning shower? Bah! Showers were for losers! [Pan – yes, they are. I’m actually scared of them, and since I am soooo awesome, anyone who thinks that showers are cool is wrong. Matter closed]. It could wait. Going to the shop to get milk? Black coffee would do just fine. Tomorrow, maybe. Getting up? Well, surely past midday was perfectly respectable. Maybe I could even practise some lucid dreaming! In short, postponement and procrastination gradually became the order of service, and with this development, the ebbing of creativity marched dolefully in step. Days blended into other days. Weekends were the same as weekdays. Friday afternoons weren’t the great escape they once had been. Time to do stuff was, well, just more time. And I had plenty of that, so why rush?

By weeks six and seven, my brain was beginning to atrophy. By week eight, I was finding it an achievement to force myself to take a daily walk into town – I’d even set this as a bloody goal, so pathetic was my motivation by this stage. That was the height of my ‘achievement’.

Luckily for me, I’ve always been driven by some sort of guilt trip which prevents me from giving up entirely – so far, at least. I continued the job hunting, somehow, and eventually secured a position.

But enough about me. The point I am trying to make is that worklessness – or so it seems to me – creates its own challenges which are generated separately from, or at least contribute in a separate way to, the challenges brought about by what I will call, for want of a less generic description, clinical depression.

I’ve now had this conversation with Pandora on a number of occasions. What part of her is unable to get out and about, to find motivation, to look for work, etc, as a result of her condition? And what part of all that is the result of being in the situation she has been in – without work, without what one might call external responsibilities – for around three years?

This thought process of mine should not be interpreted as a suggestion, as some would have it, that people struggling on benefits are necessarily work-shy and simply need a good kick up the backside. Do such people exist? Certainly. Are they typical? I doubt it. The long term unemployed who have lost hope need help back to work – a carrot and a stick, probably – but at the same time there are plenty of mentalists who, for various reasons, are unable to work, who want to work but are simply not currently in a place where they can do so at this moment. Let me put it like this: would you want your colleague having paranoid delusions, or bursting into tears/storming out of the office or off the building site because they can’t cope with what might seem an ordinary task? I have an acquaintance who sees conspiracies everywhere and who is working. Or was. Until he was fired. For threatening colleagues. On more than one occasion. Even after formal warnings. Because he erroneously thought that people were engaged in a conspiracy against him. He needed help. He ultimately couldn’t stay in work. He needs help now to get him back to a place where he can resume work. (That he fails to acknowledge this [I’d say ‘doesn’t realise he needs it’] does not negate the fact that he needs it.) I’m sure about this: a person like him should be nowhere near a workplace until he has had an opportunity to deal with – and be helped to deal with – whatever conditions afflict him.

I’m somewhat worried that the proposed changes to the system will fail to recognise cases like this; the medical assessors, as I understand it, won’t be specialists in the field they are assessing. Does that make sense? Not to me.

To return to Pandora’s case, and I can’t and won’t generalise about others, I still wonder how much her chances to get back to a ‘normal’ existence are constrained not alone by mentalism but also by having become stuck in a rut – through no fault of her own – for so long. Adjusting again to the concept of work, after the passage of a long time sitting in the house, will almost certainly be very difficult. It would be difficult for most people, I’d venture. For me, definitely.

So what’s the point of this post?

I’m not sure, really. I suppose I want to reassure myself, and Pandora, that a return to work will be possible, but I need to acknowledge that, independently of mentalism, it will be a gradual process, perhaps starting with some very light voluntary commitments and working its way up to some part-time, low pressure role. Eventually, of course, the objective will be a return to a full-time and, ideally, fulfilling career. You may have observed that Pandora is a smart cookie, and I think she’ll do very well for herself as a professional, provided she is able to reach a sound level of stability and find something that she really doesn’t mind (or, dare I say, enjoys) doing [which is all I’ve ever really wanted out of life].

I don’t have the answers, but would certainly be interested in the views of others on the ‘worklessness breeds worklessness’ theory.

You can follow A on Twitter at @TheNyarlathotep.

Perspectives from the Mentalist's Partner (4): The Hidden Reaches of Therapy

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.

Perspectives from the Mentalist's Partner (3): Impact on the Partner

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

Q:

On a day to day basis, what’s it like living with me? Like, really. Be honest. Be brutal.

A:

A difficult question, I fear. One might well ask, “what’s it like living with anyone?” and my prior experiences of living with people have been experiences of living with friends who are male and do not suffer from any mental illnesses. On the comparative front, then, it is difficult to locate a suitable yardstick. Comparison, I think, will not work in this situation.

Perhaps a different approach, then. To be frank, it’s, well, normal. Normal for me, because it is what I am used to. On most days, even if you are not in the best of moods, you do a fairly good job of not allowing that to interfere with our interactions. You may be quiet and non-interactive at times, but then that is a trait that we share to some extent. Talk is cheap, and often I do not wish to engage in it any more than you might. At other times, we can have some great conversations and, when we’re both in the mood, that is exactly what happens. I don’t imagine that is any different from what most people in a relationship experience, though I can’t proclaim myself any expert.

So what is it like living with you when things are bad? Well, I think I have covered this ground before to some degree, but it’s…well, “challenging” might be the word. That said, I realise now that on most occasions there is probably little I can do to “fix” things for you. Maybe I am wrong, but when you are experiencing bleaker periods my reaction at present is often to ask you whether there is anything I can do for you, and if (as expected) you reply in the negative, then I leave you to your thoughts. I hope that does not sound cruel or harsh. I think it is just a straightforward approach. When there is nothing I can do, it is fruitless to try, and could In fact prove counter-productive. That doesn’t mean I will seek to ignore you at times like that, but I try not to interfere.

Q:

So, there are certainly some times when I appear vaguely normal?

A:

You appear vaguely normal, or indeed more than vaguely normal, most of the time. As I say, the occasions on which you clearly display symptoms are probably fewer than you think. You do a very good job of hiding how you truly feel, perhaps. Whether that is for the purposes of defending me or protecting yourself – or indeed both – I am not sure [it is, for the record, both.  Mainly the former, but certainly both]. Perhaps I should be interviewing you!  [Be my guest!] I often learn more about how you are feeling from this blog than from speaking with you. That is no criticism. You probably just find it easier to spill things out here. I am another individual who feels more comfortable expressing difficult things in writing, and so you won’t get any misunderstanding from me on that score.

Q:

OK, but I think it’s inevitable that my sicknesses has impacted on you, probably in ways I can’t even understand. Could you outline the effect they have had on you, and how have you dealt with that?

A:

I suppose there are a number of effects. The one that comes first to mind is the stigma that is associated with talking about mental illness. This doesn’t so much apply now, but at the beginning, when people did not know much about your condition, I felt in some way bound to say as little as possible about it to those I knew. The time that comes most to mind is when you were out of work for over a year, a time during which I continued to sell the story that you were working. It was the story you were telling most individuals as well, but I suppose concealment of that sort is not easy for anyone to manage on a consistent basis. Being out of work due to illness should not be an issue of embarrassment, but in fact there is certainly a [huge, in my view] stigma attached to it. There appears to be a widespread perception, or at least a perception that the media wishes to perpetuate, that the long-term out-of-work are ‘work-shy’. The concealment for over a year was a cover-up that I would have wished to avoid, but then what would I say, and would people understand? It was a necessity, really, until I got a better grasp of your conditions. As it happens, I know much more about mental illness now and can hold my own against anyone stupid enough to suggest that you might be work-shy. However, I suppose I – like you – face difficulty in communicating what this all means to people who are ignorant (wilfully or otherwise) of these issues.

How else does your illness affect me? I know of one other case where a carer for a mentally ill individual has himself begun suffering from symptoms of mental illness. Luckily for me, I do not believe that I am in that position. Some might say I am not normal, and I certainly have my quirks of character and a fiercely cynical perspective, but I’ve not changed substantially from the person I was ‘before’. Well, actually, I’m not the best judge of that. You’d probably have to ask a neutral observer. I feel like me, anyway, and I’ve not been battered into the ground by having to deal with difficulties you have faced. From time to time it has been stressful, of course; how could it not have been? But stress is stress and, while it can be a precursor to more serious conditions, in my case this has not yet been so.

Is it frustrating at times? I’d say so. However, we’re dealt imperfect hands by life (and I should know that as you beat me at poker all too often! [almost always these days, my dear… 😉]) and we just have to get on with it. No point in my crying over what can’t be changed. Let’s look instead at solutions, such as seeking alternative sources of therapy when your time with C comes to an end. A horrific prospect for you, I know, but we’ve tried to knock some sense into the NHS to little avail. That isn’t to say we’ll stop trying, but the best and the worst planners alike need contingencies. So I temper some of my frustration by attempting to think of answers. Not cures, because they don’t exist in respect of some of your conditions. Answers that will assist, in whatever small way.

Q:

I suppose there’s an issue here too about the extent of my history of sexual abuse. You knew bits – just like C, a few close friends and my blog readers knew bits – until really quite recently, when I admitted to C, and by virtue of that everyone that reads here, of much, much more. Do you feel hurt that I didn’t fully disclose things to you?  How does the reality make you feel overall?

A:

How did I feel? Angry. Not at you. At the perpetrator. What you first told me of course sickened me, but I did not have a strong reaction to it because you did not suggest that the abuse was prolonged or quite so serious as it later emerged. I understood and sympathised with those first few things you told me, but it did not shock or disturb me unduly. You seemed to be over what had been a comparatively small if hateful incident or set of incidents, and it seemed best left that way. I have known one other who had experiences that were in some ways comparable, and that person seems to have managed to consign the hateful activity to the past and move on. So I assumed you were a similar case.

My sympathy for you remains, but now I also carry immense hatred for the perpetrator. Yes, I know only too well that hatred is not a constructive emotion, but I fail to perceive any alternative, so much does my blood boil now thinking about the true extent and severity of what he did to you as a defenceless child. The worst is attempting to stomach the bastard’s presence when we visit the McFaul household. I am not a violent person, but I only wish him ill. Hateful, despicable, monstrous, deceitful, subhuman cunt. Let him burn in hell forever – if I believed there was a hell.

Do I feel hurt that you didn’t reveal all before recently? Possibly a little, but I have to understand that you did not yourself realise the full horror of this until the therapy started to recover it from your memory. Or until it allowed you to start exploring those dark places. I wonder whether there is not yet more to what happened sometimes [as do I]; things you maybe haven’t been able to tell yourself yet, or things you have only been able to tell C. I hope not, but if there are, I have no right to know and it is entirely your choice as to whether to reveal it to me. So, hurt? Not really. The hurt is yours, and you can share or keep it to yourself as you choose. It must be extremely difficult to share any of this with anybody, and I commend your for your blatant honesty to date, particularly in this blog.

Q:

I’m going to explore this more in a future post, but briefly – your thoughts on my experiences in psychiatry and, especially, psychotherapy? Have these processes impacted on you in any way?

A:

Perhaps this is indeed worthy of a more detailed exploration in a future post, but in summary I would have to say that I remain somewhat dubious about the benefits of the therapeutic process – at least as it has applied in your case. Sometimes it appears to have helped you, yet one can almost guarantee that a week or two after a positive session, a follow-up session will have placed you in a black mood once more. I’m not saying the therapy is to blame for the black mood per se, but it is at times clearly a trigger. This is probably reasonable enough if one has a long time to discuss issues with the therapist – but 50 minutes a week is barely enough to dip a toe in the deep and dangerous waters of self-exploration. 50 minutes a week is a joke, quite frankly, and a rather sick one at that.

I also have issues with transference in the therapeutic process, again specifically relating to your case (because my experience is limited to it). I understand the purpose of transference to some extent, but to invest such trust in someone who is ultimately only a professional, whose service will ultimately be withdrawn, to me seems fraught with danger. Perhaps the process is designed to operate in a situation where there is no artificial time limit, as there is in your case, but even then I am somewhat uncertain – would the benefits outweigh the drawbacks?

Psychiatric treatment appears also to have been a mixed blessing for you, although I would be more positive about it since the advent of Seroquel, which really does appear to have assisted you since the December/January lows, both in terms of keeping away the voices and in terms of mood.

We shall return to this subject, I would imagine, in more detail. However, I have pontificated enough for most people’s sanity by now, so I shall beat a hasty retreat.

Perspectives from the Mentalist's Partner (2): From Depressed to Doolally

In this post, A details how he has rather curiously found my more recent and ongoing breakdown less personally frustrating than previous ones, outlining in detail his reasons for this.

(Aside: I considered calling this ‘From Bleak to Batshit’, which I found pathetically amusing, but ‘Depressed to Doolally’ seemed slightly less obscure ;))

Q:

My symptoms, I think you’d agree, have gotten worse over – say – the last two years or so. There’s been overt psychosis, clear dissociation, significant self-harm, etc etc blah blah blah. As a result, you’ve seen stuff in that time that most ‘other halfs’ don’t see in a lifetime. Surely dealing with this stuff has been more difficult than dealing with someone who, three or four years ago, seemed ‘just’ depressed? But as noted previously, you were less tolerant and/or sympathetic then than now. Is it actually easier to deal with someone in the throes of a psychotic break than with a depressed person? If so, how is that? What has enabled you to tolerate all this stuff, when depression often drove us apart?

A:

Good question. To help you and indeed your readers understand this one, I need to refer you back to some of the ground I covered last week. My own journey towards a greater understanding of mental illness was quite long and, in its initial stages, I perceived that you had an amorphous condition known as ‘depression’ which, with time, would dissipate. At times my attitude was indeed unsympathetic, and this comes down to an view that I once had, and which I believe many of the uninformed share – that those experiencing depression ultimately still have some form of control, an ability to resist and to say “no” to the bleakness if only they could summon the willpower to do so. I label myself a hard worker, at least in the career context, and I expect others to struggle through adversity in the same way that I do. What I feel I didn’t realise was that this amorphous term “depression” referred to something very specific, requiring much more than willpower and self-control. It would not be possible to ‘pull yourself together’.

The stance I once took sounds very negative, and I’m not suggesting that I felt like this all the time, but I suppose a complete lack of understanding of your condition at times led me to think that you had more say in the direction your life took than you actually did.

I must confess to being a believer, to some extent at least, in the view that we create our own realities. I don’t want to get too philosophical here, but nothing is definitive; everything is perforce seen through the filters of our own perceptions. To take a very simple example, individuals can perceive the same photons entering their eyes, but their perception of what they are seeing is constructed through the lens of their life experiences. Everyday technology to me might be magic to someone else. If I show you a car and ask you what colour it is, we might agree that it is red; but do both of us use the abstraction “red” to mean exactly the same thing? I hope I’m making sense. Nobody really sees anything independently of their own perception. Following on from that, I take the view that it is possible, with effort, to change the way in which we perceive things, react to things, and so on. These are our perceptions and we can control them. You might call this a very CBT-ish approach, and perhaps it is. I understand your cynicism about this: if somebody said “You can change the way you feel if you just think about things differently,” I would be forced to laugh in their face (if feeling unkind) or hide my derision (if not). I do, however, believe that such change is possible with will and persistence. All this is a round-about way of saying that I thought it was possible for you, or anyone suffering from “depression”, to change things over time. I’m not saying I believed there was a magic bullet you could fire and fix everything overnight, but I did believe that time and persistence could be great healers. I still think that is not an unreasonable view.

There are several problems with this analysis in the context of your illness, though, not the least of which was my complete failure to understand what the umbrella term “depression” covered. A second problem is that I myself, while believing the above, have been completely unable to exercise such control over my own thought processes. Being mentally ‘healthy’, or fairly so, if I cannot do this myself, how can I expect others to do so, especially those suffering from conditions that I have never experienced? Self-change is possible, I don’t doubt, but I have concluded that it is very difficult without some form of external help (therapy, medication) or internal motivation (spiritual revelation, high motivation, etc).

I think another thing which perhaps drove us apart at times was my inability to understand what was wrong. My logical brain seeks an explanation for everything. If you are depressed, it figures, there must be a reason, and it is natural that I should wish to ascertain what that reason is, and to try to help in whatever way I can. Often, however, depression left you uncommunicative, leaving me with a sense of frustration, not knowing why you felt the way you did and being unable to do anything about it. At other times, you might cite some event many years ago, or some issue over which you had no control, as the reason for your low. In this case, my frustration would derive from that fact that I felt there was no point brooding excessively over something you were unable to change. Of course, that is easier said than done, but we’ve all had problems in our lives, and I wondered whether yours had been so much worse than those experienced by others. Of course, at this time, I was unaware of the full extent of some of the terrible things that actually did happen to you. You had spoken in general terms of the abuse, for example, but its long-term and systematic nature was something of which I was unaware. I think possibly you weren’t fully aware either.

So, I’ve not painted a particularly complimentary portrait of myself. So be it. We did have good times, and not every day focused on depression or related issues, so we generally got on with things, having the odd downward spiral in our relationship, but a range of good times as well. I don’t mean to suggest that I had no sympathy or made no attempts to understand, and I hope that isn’t how I came across. However, it is clear that the efforts I did make were not especially successful.

So why can I cope with much worse things now than the ‘mere’ depression of old?

I explained in my last post that my attitude changed as the concept of “depression” was happily (for me) dispelled in favour of a much clearer explanation of what you were suffering from and why you were suffering from it. Although you are much further ‘down’ than you ever were when you were ‘simply’ depressed, the fact that I now have some level of understanding is the crucial difference. Having an explanation makes it so much easier to empathise, and I’ve ceased telling myself “Well, if it was me, I would do x or y“, since I couldn’t possibly know what I would do – I’ve never been in your position. A clear diagnosis fulfils my need for a logical explanation of your state of mind. My understanding of where you are and why you are there mentally has been vastly enhanced since you entered therapy and started writing this blog. Now that I understand something of the conditions with which you are afflicted, I realise that the hole in which you find yourself is too steep-sided to climb out of on your own, or even with the assistance of those close to you. You need expert help. A sympathetic and well-meaning hand of personal friendship is not enough. A heavy duty problem requires a heavy duty solution – enter therapy and the dreaded (but seemingly essential) medication.

A second aspect of the current situation has made it easier for me. Now that you have diagnoses, I am able to see that there is scope for medically valid action plans providing a genuine ray of hope that you will eventually emerge from this in better shape. I am no longer naive enough to think that you will be ‘cured’. I may as well wish for my own permanent physical disability* to vanish. However, there are coping mechanisms, means of managing the condition and sharing your life with the demons stuck in your head.

In the end, it is the combination of increased understanding and hope with a logical basis that has enabled me to get closer to you despite the sometimes horrible situations in which you have found yourself (my least favourite of which was one night in Accident and Emergency after you had befriended a scalpel).

Easier to deal with someone in the throes of a psychotic breakdown than someone sitting on the sofa silently and broodingly?  Yes, it does seem a very strange thing to say.  I certainly do not find it at all a pleasant experience dealing with situations where you are dissociated, hallucinating, self-harming, and so on, but these are so far from being in any way associable with the common understanding of “depression” that I find it very difficult to compare the two.  I suspect the latter may be more readily faced by me because this is so clearly the outworking of a very serious medical condition.  Why that should give me some form of strength I am not sure.  Perhaps it is because I know I am not responsible for it, you are not responsible for it, neither of us have much control over it when it strikes, and we have to work together to overcome it in the long term, with the assistance of medical professionals.

I said it was difficult to compare the “depression” scenario with the psychosis one, but I will try.  In the former case, I think I have gone into some detail on that both earlier in this post and in my last one – in a word, my reaction was frustration.  In relation to psychotic episodes and the like, my reaction is one of fear, alarm, helplessness, adrenaline, confusion, worry, and other similar ‘flight’ type instincts.  Yet these conditions also force me to take some form of action.  I remember on that A&E visit, during your very long wait to be seen, you decided that you’d had enough and were going to walk out of the hospital and home.  You have told me you don’t remember this because you were in a dissociated state.  I have a very clear recollection, however.  I had to physically restrain you – block your exit from the building – for a minute or two before being able to persuade you that you must return to the waiting room.  There is a frightening adrenaline surge to events like this.  I don’t wish for it, but at least I am able to do something.  A similar occasion arose at Suzanne’s (Marcus’ mother’s) house over the Christmas period when, as your readers may recall, you went (to use your own terminology) ‘batshit mad’.  Again, a combination of my verbal and physical restraining, combined with the very last vestiges of your rational personality, prevented your condition from becoming evident to the whole gathered clan.  Once more, the need for action on my part was there.  I’m fundamentally not saying I like this – I abhor it – but perhaps there is more of a sense of satisfaction in being able to do something, however minor, than in being able to do the square root of nothing (in the case of depression).  I don’t want these situations to develop – ever – but they have been a fact of life and I’ve had to deal with them, as you have.  They are tangible in a way that ‘mere’ sofa blackness is not, and they are very clear manifestations of medical conditions, demonstrably so in a way that our old friend depression is not.

Does that explain things a little?

The above account doesn’t paint me in a particularly sympathetic light, and I don’t want to suggest that I speak for anyone else living with a ‘mental’, but it is my tuppence worth, and I hope it is at least of some interest.

* A is completely blind in one eye, and has only partial sight in the other.

I think one more thing to note is that generally my psychoses and dissociation are stress-induced and transient.  Not always, but normally.  Depressions can linger for months, with no clear end ever in sight.  I don’t know if this has any impact on A’s view of things, but I can see how it might.

For all his self-confessed cynicism, A does have a wee bit of idealism and hope inside him still 😉  (I don’t, like, but I suppose it’s useful that one half does..!)

Next interview with A next week, all being well.

Perspectives from the Mentalist’s Partner (1): Understanding that Mental Illness is Real

I deal with a set of symptoms representing the diagnoses of BPD, C-PTSD, clinical depression and social anxiety on a daily basis. I fall victim to the nefarious antagonists of psychotic and dissociative episodes with more frequency than I would care for (although I must hat-tip the efficacy of Seroquel in decreasing the former, having said that). I’m occasionally and essentially without warning flung into states of exuberance that are largely uncharacteristic and rather OTT, leading to a question mark of manic depression. I’m also fairly sure I could be diagnosed with agoraphobia these days.

Me me me. I have this, I experience that. Me. I. Yours truly. Myself.

But it’s not just about me…is it?

For some time I’ve been thinking about ‘interviewing’ A on his experiences of living with a woman with mental illness. It’s of interest to me both intellectually and as a girlfriend, and I hope that it might be of interest to you, my dear readers, too – particularly if you are in, or are hoping to be in, a relationship. So I give you the first in a series I am going to call Perspectives from the Mentalist’s Partner (PMP): how through his relationship with me, A has developed a greater understanding of what mental ill health really is.

Q:

Let’s start at the very beginning. You knew I had a mental illness before we even met [I was diagnosed with severe clinical depression at the age of 14, and corresponded with A for nearly a year before we met when I was 19], but that didn’t completely manifest at first. When it did, you will recall that you viewed that mentalism fairly unsympathetically, though your mind has clearly been changed, as over the course of this present breakdown, you have been extremely supportive.

So I suppose I’m wondering – do you remember when you first saw evidence of my mental health problems, and how did/do you feel about that incident or period? Can you explain your reasoning for your evident lack of sympathy at the time – and what was it that modified your opinion into what it is today?

A:

It took me a very long time to realise what mental illness actually is. Sure, I was peripherally aware of depression as an issue, and you made it clear that you had suffered from it*. However, I probably wouldn’t have perceived it as a ‘mental illness’. I associated the term ‘mental illness’ with, well, very extreme conditions involving padded cells and the like. A very stereotypical view, for which I apologise to readers of this blog; however, I simply didn’t think much about it as it had not really affected me or others I knew. Granted, I’d experienced what I considered ‘depression’ at the age of 15-16, and I therefore assumed that what you suffered was some variant of that. Not at all a pleasant phenomenon, but something that would nevertheless gradually recede, with time. (In my teenage years, I think my own experience of ‘depression’ was one of those ‘growing up’ type problems, though I never have been and never will be a cheerful or optimistic type). Anyway, I am digressing.

When we first met, you seemed far from depressed. In a recent post [this], you talked of the dichotomy between Pandora and the ‘other’ you, the everyday person whose name I shall not utter here. The person I met was essentially Pandora; sociable; intellectually agile; opinionated (in a good way); lively; challenging; interesting – a person with aspirations and apparent self-confidence. Of course, we all package ourselves in similar ways, or try to, in order to impress those we wish to impress, especially in the first flower of a relationship. Sure, there may have been a bit of that, but it was certainly more than that, and indeed that part of you continues to exist now. When others meet that part of you in person, they are extremely taken aback to learn that you suffer from ‘depression’ (to use the generic term that most of us who are not informed might use).

As we got to know one another better, and the first flush of spring faded (it always does, as I know you agree), I started to see your occasional black moods. However, as I’ve said, I have not been a stranger to such in the past. ‘Depression’ was something that I felt, with time, one could ‘get over’. That will undoubtedly seem insulting to some, but it was how I felt.

I was also very much opposed to attempts to control depression through medication, believing that the solution lay in rethinking one’s approach to life (somewhat DBT-ish, you might say). I’ve never taken many pills myself, although I’ve been fortunate in my health for the most part. You’ll recall that I was no fan of you taking medication, and eventually made the drastic error of persuading you to come off Prozac**. Bad mistake. I suppose it was at that stage, several years into our relationship, as you really began to spiral downward, that it began to dawn on me that this was not something that would go away easily, without some form of concrete assistance.

My realisation grew as time passed and a pattern started to emerge. You were unable to hold down a job. You’d start one, seem to enjoy it at first, but gradually find it more and more difficult to cope, lying awake at night worrying about what might go wrong the next day or week. Of course, you were not helped in that by some of the horrendous managers you have had the misfortune to work for; still, even somebody as insensitive as I began to notice A Problem. Nonetheless, on my more cynical days I wondered whether it was just that you needed to find ‘the right’ job, and that you needed to foster a greater sense of ambition and commitment to achieving this. I have always been somewhat driven in the work sphere, if not elsewhere in life, and I suppose I expect the same in others. So, yes, at times I still thought less about illness and more about ‘what I would do’. Obviously, I couldn’t possibly know what I would do, given that I don’t suffer from mental illness. However, I didn’t always think like that at the time.

Really, then, although my realisation was dawning, I believe that it’s only in the past two years that I have really started to grasp what mental illness is, and the extent to which you are afflicted by it. Gone now is my illusion that you simply had ‘depression’ that you would ‘get over’, or that you could will yourself to cultivate a greater personal drive.

Just as an aside, thinking about my prior attitudes, I have come to believe that ‘depression’ is a horribly overused term, as in popular usage at least it can signify anything from a bad few weeks to serious clinical illness. I am not saying that those who actually understand mental health issues talk of depression in this way, but the word has become seriously devalued by its more general societal usage, whereby it can connote practically any bad feeling a person may have for a sustained period***.

Anyway, I suppose my first lesson in the seriousness of your illness, which came long before the realisations mentioned above, came from your occasional black moods. I remember in particular one Sunday evening where you did not really wish to speak or interact. You exuded a aura of bleakness, and no matter what I tried to do or say, there appeared to be nothing I could do about it. It left me wondering things like, “What have I done? Is this my fault? How can I fix this? Why is Pan behaving like this?” I didn’t know how to handle it. Your illness seems to have changed, and your black moods are subtly different now. I’m not sure I have figured out how to deal with them, from my own point of view, but I certainly know more about what to do and what not to do than I once did.

I might add that much of the understanding I have gained of your illness has come from you. As you have educated yourself about the issues, you have educated me. In that respect, Confessions of a Serial Insomniac has been a tremendous help. You write cogent, coherent, insightful and moving accounts here that you are often unable, due to the difficulty of talking about these issues, to express to me or anyone in person. I started writing ‘real life’ there for ‘in person’, falling into the dangerous delusion that the written form is somehow less real. Far from it. In fact, it allows one to be more revealing in some ways. I suspect that the closest you come to being able to communicate as you do on here, in verbal form, is when you meet C.

Anyway, next question please…

* Through our 10 months’ email correspondence prior to meeting face to face, I had shared a lot with A, including the fact that I had depression and that I took Fluoxetine (Prozac) to treat it it.
** This was during my postgraduate course – I would have been 21 or 22. I was taking, I think, 60mg daily, and initially cut it down, before I stopped taking it altogether. It was partly because I’d been feeling fairly good and fell into the trap of thinking I was ‘better’, and it was partly due to A’s encouragement. It – in part, at least – led to my second biggest psychological collapse (after the present one) to date.
*** One thing that A hasn’t mentioned here is that he has in the past said that he felt that my receiving a proper, psychiatric diagnosis was of great benefit. As I recall (and I welcome his correction(s) if I am misreporting him), he felt that saying, “I have borderline personality disorder” as opposed to “I’m depressed,” allowed one brought up with the views he had formerly held to note the presence of a real, tangible medical condition, rather than expressing their ‘having a few bad days’ erroneously. I would point out that I feel, have always felt, and that A now feels, that depression is a ‘real, tangible medical condition’. However, we are dealing with stigmatic stereotypical societal views here (how alliterative), and I would agree that most people probably do misuse and, indeed, misunderstand the term.

Next interview with A to follow soon…