Livin' La Vida Lamictal

Good afternoon my beauties.

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

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

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

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

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

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

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

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

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

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

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

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

I nodded, seeing what she meant.

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

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

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

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

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

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

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

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

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

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

So. I currently take the following medications:

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

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

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

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

Change of Diagnosis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Srta Gata

To BPD or Not to BPD?

Last night I was reading this post by GoldenPsych, and was reminded of a recent, and potentially significant, development in the saga that is my mental (ill) health – something that I had hitherto forgotten to record here.

I saw Christine, my CPN, last week, who was full of earnest apologies for having had to cancel a previously scheduled appointment with me. A year ago this particular confluence of events might have annoyed me; as it was, I didn’t mind in the slightest – particularly because she’d been ill. People don’t choose to be sick, for God’s sake. I kept telling her that I didn’t mind, but she kept apologising nonetheless. Again, this steadfast sorriness might once have irked me. Instead, I felt rather touched that she gave enough of a shit to say it first of all, and then that she wanted to press home the point that she actually meant it. I can’t say that everyone I’ve dealt with in mental health services has shown such concern.

Anyhow, the long and the short of it is that she’s “delighted” with how I’m doing. I told her about the writing I’ve been doing independently of this blog, and she couldn’t stop smiling. I went on to say that I’ve been reading pretty voraciously for a while now – and that, whilst it’s not at the lofty levels of studying the texts of Dostoyevsky or some other such self-referential literary fuck highly acclaimed author, it’s still vaguely challenging material that requires much more concentration than that to which I’ve been used since I had this breakdown almost three years ago. Christine continued to not stop smiling.

Can it be that she actually gives a rat’s arse about her patients? I mean, this is an employee of my Trust we’re talking about, not one of a properly run nor remotely respectable organisation. But hark! It seems to be true, of both her and NewVCB. Maybe I shouldn’t have allowed my hopeless experience with Psychology and wholly tiresome engagement with the responsibly bankrupt Mr Director-Person to bias me quite so much as it did. At a corporate level, the Trust is a fuckhole – but that doesn’t mean it doesn’t have some good people within its ranks.

I complained about the weight I’ve gained since I started taking 600 daily milligrams of Seroquel (I had no such issues at all at 400mg and below) and we had a conversation around that (“take it up with [NewVCB], but remember the command hallucinations were often still there at 400mg, so you have to be careful…I have a patient who was seriously ill who was prescribed Seroquel; he’s really well, mentally, now but has gone from a fit, athletic man to being over 20 stone,” apparently), the upshot of which is that I’ll raise it – without much hope of a reduction, however – at my next psychiatric consultation.

We also discussed how I live less here, on this blog, in this created online world that was my more vivid life for so long. I’d also had this chat with NewVCB the last time I saw her (which I didn’t write about because nothing happened), and they both agree that it’s a good thing. I assured them both, though, that whilst I’m living as ‘me’ – out here in the ‘real world’ of air and trees and streets and clearly embodied human beings – that I will not abandon this side of my life, at least not for a good while yet. Being ‘real’ is a good thing, but I’m not better yet, and even if I was, the support I gain from all of you would still be invaluable. Christine seemed to feel that I am striking a fair and reasonable balance.

Anyway, I was with her for ages, babbling on in the spoken word in the verbose way I veer towards on this blog with the written word, but other than the above, most of the appointment consisted of her asking y, me answering z, and her smiling in recognition of the supposed progress that z represented. One thing of particular note did occur, though.

I told her at one point that I’m writing an article for <a href="can be recovered from.”

This led to a discussion of the diagnosis. You may recall that I protested to NewVCB several months ago about its applicability or otherwise to me – my view at that stage had been that I had major depressive disorder and some unspecified psychotic condition, with the occasional fugue thrown in for good measure (schizoaffective disorder? Psychotic depression? Psychotic depression plus ((C-))PTSD?). NewVCB whined a bit about how she wasn’t interested in diagnosing me; she just wanted to treat my symptoms.

Of course, this is sensible. I don’t know why I’m fixated on diagnoses, but I always have been, even for physical illnesses. I like terms that help me to understand my conditions, even if they’re not wholly definitive and are in need of some elasticity around the edges (as I believe most mental health, and many physical health, conditions are). I loathe the terminology “label” in this context, probably because I see the validity of a diagnosis; to me, it’s not necessarily a nasty, sticky thing that follows you everywhere.

Except…in the case of BPD, it actually sort of is. Although I fully agree that I had the illness when I first received the diagnosis, I truly feel that I do not now (and indeed that I didn’t when I raised the matter with NewVCB). However, borderline is notoriously difficult to get rid of, officially speaking. Once you get it slapped on your file, whether or not it’s accurate, you can’t get it off your fucking file. So then some idiot that still views the disorder in the outdated, pejorative way that it’s traditionally been considered peruses one’s notes and whines, “oh for fuck’s sake, not a bloody borderline!”

It’s not fair, but it seems to be true. You. Cannot. Get. Rid. Of. It.

Unless, apparently, you’re me.

Christine tells me that when NewVCB first referred me to her, the latter said that she was “seriously questioning” my supposed status as a person with BPD. Christine said, “have you asked her again about it?”

I told her that I hadn’t, alluding to the aforementioned comments of the consultant on treating symptoms. I pointed out that I agree with the approach, to an extent, but that knowing what’s ‘wrong’ is still important to me.

Christine nodded empathetically. “Do ask her about it again,” she urged. “She was genuinely reconsidering the diagnosis.” Then, and I don’t recall exactly how she phrased it, she somehow insinuated that she agrees with me; whether or not I ever had BPD, I don’t now.

I will truly be amazed if there is ever a definitive statement ascribed to my medical notes observing that I am no longer diagnosable with borderline personality disorder, but the fact that the two of them are even considering the issue is hugely significant to me. It’s a measure of their competence and understanding, and (perhaps more importantly) it’s also a measure of how different things are for me these days.

I’d stress at this point (a) that I’m not completely banking on getting BPD ‘removed’ from my file; and (b) that just because things are reasonably OK at the minute, that I’m under some sort of illusion that I’m cured and will never experience fucked-up-ness again. I’m not the wisest person on the planet, but I’m not a complete fool either. Still, I’m cautiously encouraged. All of this represents a good sign.

In the absence of Paul (more session reviews to come), I’m seeing Christine at two-week intervals for the time being, meaning that our next appointment is next week. I’m due to see NewVCB the week after that as well. I shall explore this further with them both on these occasions.

(Aside one: Christine mentioned a patient whom she’d referred to Nexus. The woman had been very mental prior to going to them, but after completing her course of therapy, was “a different person”. That’s a great thing in itself, but Christine continued by saying, “I was so happy for her, I just gave her the biggest hug!” I thought this was rather lovely. She does genuinely seem to care 🙂

Aside two: Remember C? C of NHS-Psychology-I’m-Dumping-You fame? When I used to see him, he worked at the hospital in which I see Christine and NewVCB on Mondays, Thursdays and Fridays. My consultations with Christine have previously been on a Tuesday or Wednesday, but the appointment to which I’m referring in this post took place on a Thursday. Do you see where we’re going with this?

I didn’t go into his building, of course; it’s too small, and he could easily have spotted me. I did drive round to it though, to see if his car was there. It was. I stared blankly at for a minute or two, then turned round and left.

I don’t know what I was hoping to achieve, but the silly endeavour only succeeded in evoking a stale taste in my mouth, a vague mental conjecture as to what he might have been doing right then, at that very moment – and, ultimately, an involuntary utterance of “meh”.

A was somewhat less ambivalent. “Did you throw a fucking fire bomb at it?” he seethed when I told him, bouncing around in a fit of pique. It seems odd, really, but I think A has even more contempt for C than I do.

((For the record, in case the police/GCHQ/MI5/any similar organisations are reading this, I didn’t firebomb that or any other car and, furthermore, A was employing verbal hyperbole to emphasise his frustration and his comments are therefore not to be taken literally in the least. Sorry lovers, but one apparently now has to add these sorry disclaimers to such comments – after the Twitter joke trial farce, you can’t be too careful, can you?)).

So yeah. I don’t know if I still compartmentalise everything about C ((quite possible)) or whether I really don’t care at all anymore ((not inconceivable either)). Either way, it wasn’t him that helped me get to the stage I’m at, was it?).

Alas. I’ve had enough of composing this dull post; I just thought the above merited reporting. See you next time, darlings.

marketing

Bye, Bye Borderline!

These are the criteria, at least five of which are required to be met, in order to be diagnosed with borderline personality disorder. Apologies if this is too much of an echo of my year-old post called ‘BPD vs C-PTSD‘ – but there’s method in the madness, I promise 🙂

But what is that method?

I realised something last night, when I commented on Frankie’s blog, The Sunshine Diaries. I was saying to Frankie (who has both schizophrenia and BPD, the former being an illness that she is managing well, the latter being something she still struggles with at times) that I had felt so much better lately, showing that (contrary to a lot of uninformed but sadly popular opinion) there is hope for people with the disorder. As I typed, the following words seemed to roll of my fingers

I’m not sure I meet the required five criteria any more and if so, only just.

I hit the ‘reply’ button largely without thinking…then I realised what I had said, and the possibly enormity of it. Could that possibly be true? Honestly, literally true? That I might no longer meet the criteria for BPD? Really?! Surely not!

Well – this is not official in any way, but stilll…as it turns out; yes, it could be true. I no longer meet the diagnostic criteria for BPD!

😀 *does a happy dance* 😀

Let’s examine it one by one.

[BPD is a]… pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

  1. Frantic efforts to avoid real or imagined abandonment. (Note: Do not include suicidal or self-injuring behaviour covered in Criterion Five)Me? NO. I’m not even that anxious in terms of abandonment issues any more, never mind going to extreme measures to avoid it. I don’t suppose I ever really went out of my way to prevent rejection, other than to make the complaint against the Trust about the end of matters with C – but really, that was more about morality and rights within the system than it was about me and him per se (not that that wasn’t part of it, admittedly. It just wasn’t the whole story).
  2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealisation and devaluation. Me? NO, and this has never been true. I have had issues with splitting in fairness (although this is increasingly less true as time goes on), but it’s very rarely been the case in the context of my close relationships. A and I will have been together for eight years this month. My two best friends from school are still my two best friends. Aside from the normal ups and downs any lengthy connections go through, all of these relationships have been pretty stable.
  3. Identity disturbance: markedly and persistently unstable self-image or sense of self. Me? NO. Not significantly more than anyone else anyway, I think. In the last few months my self-perceptions have been stable, or at least consistent with an ongoing mood. When severely depressed, I don’t like myself – who does?! When I’m feeling euthymic – as I think I am at present – I am reasonably content with myself. So yeah, it changes occasionally – but it’s not some sort of yo-yo disparity at all.
  4. Impulsivity in at least two areas that are potentially self-damaging (eg. promiscuous sex, eating disorders, binge eating, substance abuse, reckless driving). (Note: Do not include suicidal or self-injuring behavior covered in Criterion Five)Me? MAYBE. The binge eating thing still applies, though in fairness that’s only really gone out of control since I started taking such a high dosage of Seroquel. Even if we can assume that it is a BPD symptom, is there (at least) a second such trait? It’s hard to say. I used to do a lot of stupid shit when I was driving, like seriously exceeding the speed limit. In the past few months, I’ve actually noticed myself being exceedingly boring whilst ensconced behind the wheel. I haven’t even gone beyond 60mph on the motorway in the last few months. *zzzzzzzz* Oh, and – assuming we’re talking in terms of consent (*coughs*), then I’m about as far from promiscuous as you can get without being one of those no-sex-before-marriage people. Yeah. I should vote Conservative.
  5. Recurrent suicidal behaviour, gestures, threats or self-injuring behavior such as cutting, interfering with the healing of scars (excoriation) or picking at oneself. Me? YES. Not threats and gestures; I’ve actually never been guilty of that. And I haven’t attempted suicide in well over a year, though I have seriously toyed with the idea since. Suicidal ideation is still a very big part of my life, and I can’t see it ever going away. However, it’s about degrees; right now, it’s fairly low by the standards to which I am used. As for self-harm, I’m perennially guilty of the whole ‘interfering with scabs and picking at self’ thing, and I do self-injure with my old friend the scalpel from time to time. 18 months ago, though, I was doing that at least once a week. I find it hard to average out its frequency in terms of today, but it would be less than once a month anyway – perhaps not as often even as that.
  6. Affective instability due to a marked reactivity of mood (eg. intense episodic dysphoria, irritability or anxiety usually lasting a few hours and only rarely more than a few days). Me? YES, but also NO – not in terms of the specific criteria detailed here. The DSM says that people with BPD have reactive moods, and that said moods last a few hours or days, and only ‘rarely’ longer. This is not me at all. My mood ‘episodes’ last for weeks, quite often months actually, and – in an opposite to the DSM criteria – only rarely last for shorter periods than these. In this way, any affective ‘instability’ is much more consistent with major depressive disorder and/or an anxiety-related difficulty.
  7. Chronic feelings of emptiness. Me? NO. No! I don’t feel empty at all. One can feel hugely depressed, anxious, traumatised or whatever without feeling empty. I have all those issues and more, but no – no emptiness. Not any more.
  8. Inappropriate anger or difficulty controlling anger (eg. frequent displays of temper, constant anger, recurrent physical fights)Me? NO. I rant and rave on this blog all the time, but as I discussed somewhere else (I can’t be arsed looking for the link, sorry), that’s often because I’m really pretty submissive in ‘real life’. I have occasional tiffs with my mother and with A, but – shock! horror! – that happens in such relationships. Big wow! All that said, my types of ire can alternate – but even when it’s internally explosive, my old skills at acting allow me to behave, mostly, in a measured fashion. I am not constantly angry, and the one, solitary physical fight I’ve ever been in was when I was being bullied at school and had no choice but to defend myself.
  9. Transient, stress-related paranoid ideation, delusions or severe dissociative symptomsMe? YES. This is still the main criterion that applies to me, though things are a lot less severe in this regard than they used to be. They could also be explained by other illnesses with which I am diagnosed, but I accept that they could certainly still be BPD ‘traits’ too. NewVCB has told me on a couple of occasions that, in her observations, there are two main strands of people with BPD: you have one bracket of folks who are (to use her phrase) “classically emotionally unstable”, then another who tend more towards dissociation and psychosis (which is much more in keeping with Stern’s original observation of the phenomenon, ie. that it was on the ‘borderline’ between psychosis and neurosis).

So! There you go. I have two of the main symptoms, and a couple of others remain arguably applicable. That’s probably still enough to see me considered to have ‘borderline traits’, but by the definition of the full-blown disorder, I can no longer have its ‘complete’ version.

It’s weird to write this, you know: in a way, it even feels uncomfortable. Waaaaaay back just after I started writing Confessions, I debated the issue of whether or not if, if given the option, I would flick the fabled switch to bring me to sanity. I said that I wouldn’t, and I still hold to that largely. Yet here I am, effectively devoid of an entire set of insane-ish personality characteristics that seemed such a normal part of my apparently abnormal life for so long. Someone once accused me of being obsessed with the diagnosis, which I don’t think I ever was; I did, however, embrace it in many ways – in terms of learning how to be able to manage it, of interacting with others in similar boats, of advocating and trying to fight that ridiculous stigma that permeates it.

I am not ashamed to have been diagnosed with borderline personality disorder; the stigma is unfair, and the histrionic, manipulative stereotypes are blown out of all proportion and are in no way representative of the majority of people that have the illness. You can’t base everything on what you see in an A and E department on a Saturday night, and if you’re stupid enough to think that you can, then you’re not worthy of further words on the subject from me – aside from screw you.

So no, I’m not ashamed, but at the same time, I’m relieved that it’s seemingly no longer with me too. The diagnosis will never leave my medical notes so it’s not about that aspect of things; no, it’s about progress. If I can no longer be diagnosed with BPD, then I have moved forward considerably – and, maybe, returning to work is not a million miles down the road. That is still my ultimate benchmark of ‘wellness’ and ‘recovery’.

All that said, perhaps oddly I still meet the criteria for the similar psychiatric problem of complex post-traumatic stress disorder. I won’t bother to go through the whole thing with it like I did with BPD, but perhaps the reason that it could still be applied is that it puts more emphasis on dissociation than the BPD definition does, or that some of the more specific sub-criteria are applicable to me in a way that the BPD symptomatology is not. Since NewVCB first told me that I “couldn’t not have” complex PTSD, I’ve tried to embrace that diagnosis much more than borderline – not because I was ashamed of the latter, as I’ve noted, but because it seemed politic, wise and even affirming to acknowledge the trauma partly associated with my illnesses.

Furthermore, it’s evident that I still have major depressive disorder, (social?) anxiety, psychotic and dissociative episodes (potentially part of C-PTSD or a BPD trait, but possibly independent thereof too), plus arguable issues with agoraphobia, panic disorder, yadda yadda. But still. It’s progress. I’ll never be rid of everything. I don’t believe that for a second, as well you know, good readers. But if I can manage some of it, eliminate other bits – then maybe I can go back to work and stop wasting my life like this.

How did we get here, this point of non-borderline-ness? Intense, in-depth therapy, with a competent, vaguely integrative (but non-behavioural!), caring and demanding therapist. Someone with whom you’re comfortable – but not obsessed. Someone who cares about you and not targets or looking good to his or her colleagues. Someone who asks a lot of you but is willing to give a lot back in return.

However, therapy is only one part of the equation. I have to say that Quetiapine and, in its higher dose, Venlafaxine, have both worked wonders. It pisses me off that NICE strongly recommend against the use on medication in BPD – the right combination, under the supervision of a good psychiatrist, has made my life better. Simple as, end of. I don’t think therapy would have improved things so much on its own – not in less than six months, anyway. And would I have been able to even have undertaken such intensive work without the relative stability the medication gave me in the first place? Probably not.

In fact, although I think therapy with Paul has been incredibly useful (and will continue to be), the timing of my positivity* is consistent with starting to take the higher dose of Venlafaxine. Placebo? Given that I formally thought it was a useless pile of wank before and had no expectations of it, higher dose or otherwise, whatsoever? Placebo my fucking arse.

* Well. There we go, readers. I’m bored with the newfound positivity of this blog. This is not me, is it? I mean – don’t get me wrong – life is still shite and everything…but it’s a little less shite. Tolerable. Acceptable and passable. This is new and different, and is less bollocks than it is normally. That’s good, but I feel like I’m becoming some sort of saccharine fucking cherub here, and that makes me want to vomit all over this screen.

So…

As I said to my CPN yesterday (blog on her tomorrow, I hope), it’s all going to go tits up again before long. This is probably a calm before a gargantuan cunt of a storm.

Random rant to prove I still can: the human race is an out-of-control fucking virus of much disgusting-ness and David Cameron and friends are cunts who need to have their smug, wanky faces beaten in by ASBO yobs. And, whilst I wish both concerned parties well, who in the name of all that is HOrwell (geddit?! Holy Orwell! HOrwell?!!!1!!!1!!11! No? Sigh :() gives a damn about the Royal Wedding? And this fucking post has taken me about three hours, not because the content is so amazingly refined – it certainly isn’t – but because WordPress is shit. gah. I feel sorry for WordPress now; I didn’t mean that, I’m sorry. I do actually love Wordperss, but honestly – they really, truly, honestly need to revise the user’s ability to create bullet points and so on. This has been eminently frustrating to format.

Bla. Blafuck. Fuckblah. Fuck. FUCK! FUCK!

There’s more to say and more to rant about, but I have a more general update planned for tomorrow so it’ll go there.

I’ll sign off with this. tai has been creating some collages based on her perceptions of her blog readers and commentators. I was pretty chuffed when she did this one of me:

Pan by tai

Isn’t that class, and isn’t it a brilliant idea? I love tai’s creativity, both in her art and in her prose, and feel very privileged to have been part of this project – so thank you, tai, very much indeed! 😀

‘Night everybody. x

My Medical Notes: Initial Thoughts

Geezer, our new friend as discussed in this post, finally sent out (some of) my medical records this week. To be fair to him, he was very apologetic about the delay in supplying me with same, so I have elected not to hate him. Given that he works in the Trust, this is somewhat surprising. Fair play to him, I suppose – that’s no mean feat.

This will be a series of posts, given the magnitude of digestion and analysis required. I’m not sure why I’m even writing this one at all; I suppose I’m in a bit of a spin about the whole thing, and am hoping for some sense of catharsis, which is indubitably a tall order. Still, I’m awake at 5.35am, and I’ve flicked through the bastarding things. To this end, a brain dump seems completely worthwhile, even if it’s 0nly to shut my head up for the few minutes it takes to type this dirge.

Let’s start with…

The Very Vaguely Non-Shit Stuff

Well. Well..? Well, nothing much really. One less than hateful remark came when C, in referring me for psychiatric assessment at the CMHT, described me as “an intelligent and articulate lady.” He had made occasional similar remarks to me in session, but of course the verbal word is so much more informal in this kind of arena than the written one. For some reason, it made me smile, perhaps a little nostalgically. A sense of external validation, perhaps? Some residual transferential shite about him actually holding me in even vaguely positive regard? Who knows why it pleases me. But it does, slightly.

NewVCB seems to have been broadly supportive of me since she took over my psychiatric care in January 2010, and reading her predecessor’s comments made me realise just how lucky I was to have my “case” transferred to her. In the letter she wrote to Lovely GP in the wake of the cessation of my therapy with C, she made it quite abundantly clear that she was annoyed that the Trust had failed to even consult her about either my long-running complaint or on what she felt the best method of proceeding was. This letter alone provides me with a fair amount of fuel, which can only be aided by the admissions of my being “significantly let down” that C made in our final sessions. I have the last six meetings recorded, though I haven’t listened to them. I don’t really give a fuck how illicit or full of subterfuge such actions may have been; when you’re dealing with such a mess of bureaucratic self-servingness, compiling evidence seems wholly necessary and appropriate. So fuck them if they don’t like it.

NewVCB also described me as “a very disturbed young girl [young girl!!!], who does struggle day to day.” She also wrote that she felt that continuing therapy would be (have been?) of benefit to me.

I was also interested to note that C had written to Mr Director-Person (utter cunt) in the wake of my original complaint, and whilst he’d (C, though Mr D-P was perennially guilty of same too) engaged in his usual self-justifying bilgewank, he did observe that my letter had highlighted a number of deficiencies in the service, and that these should be considered in future service provision. (Which is nice and all, but if I end up dead then it all seems personally rather pointless. I’m not aiming to be a fucking martyr to this cause; I just want help).

Anyhow, onto the flip side of…

Bias, Lies, Embellishment, Stereotyping, Assumption, Blah Blah Blah

My favourite piece of nonsense in the notes is possibly the following quote from the Psychiatric Liaison Nurse from last January as quoted in her follow-up phone call to C:

She was almost boastful about cutting herself with a scalpel and about how she managed to obtain it on eBay. I have no concerns about her mental health but she will probably use self-harm to up the ante as your time together grows closer to its termination…blah blah blah…[some patronising arse about my ‘using’ my diagnosis of BPD or some such]

“Up the ante”! “No concerns about [my] mental health”! I’ve been the first to admit that the incident in question was the shittest suicide attempt in the whole of creation, but according to what I hear from normals and professionals alike, people aren’t generally supposed to self-harm or ruminate on suicide in the fucking first place. So how my mental ‘health’ can be considered something unworthy of concern to a serious so-called professional is beyond me.

What galls me about this one especially is that I had no idea until tonight (last night, whatever) that the woman in question was such a two-faced cunt. She played all nicey-nicey, wearing a convincing veneer of maternal warmth, to my face. In the next breath, she was advising C to be wary of my twisted modus operandi of manipulative evil. Fuck you, love. Fuck you very much indeed.

The second most entertaining comment came from a letter from OldVCB to Lovely GP after my initial assessments with her (here and here). It is her clinical opinion that I have borderline personality disorder, with a possible differential diagnosis of bipolar II disorder (the latter, interestingly, was something NewVCB also brought up, “particularly in light of [my] family history”). Fine. I knew well before I met any psychiatrist that I had BPD. What I accused myself of, though did not honestly think was seriously considered, was the possibility that I had narcissistic personality disorder. Apparently, I wasn’t so far from the truth: I have “strong narcissistic traits”! MWHAHAHAHAHAHA!

My eyes widened in horror when I first read that, but as I sit here now at 6am, I find it bizarrely amusing. It’s inversely self-validating, I suppose; I always wanked on and on and on to anyone that would listen about what a narcissistic heap of fuckery I am, and for once someone agreed. There’s a certain twisted but likeable logic in there somewhere.

There were a few minor but deeply frustrating inaccuracies in OldVCB’s report to Lovely GP; she got the names of both my schools wrong. She also got my ‘A’ Level results wrong. In and of itself it’s no big deal, but if the boney fucking bitch couldn’t even be arsed to listen to fundamentals like that, why would I suppose she would listen to anything else I had to say? She also prattled endlessly on about my “interpersonal difficulties” as evidenced in my relationships with “friends, teachers and parents.” Oh really?

I feel like directing her to this post about one of my teachers, and seeing what she thinks then. Clearly the dynamics of a profoundly turbulent relationship, oh yes. In reality, I only had a difficult relationship with one teacher, and whilst I do accept culpability for being an awkward pupil for him, to be fair it was as much about him being a knob as it was about my assholery. Oh and yes, I had ups and downs with my friends…like TEENAGERS FUCKING DO. OldVCB contended that she was “unable to get a sense of [my current] relationships with [A, Daniel and Brian]” but her tone was one of doubt and cynicism. She seemed genuinely confused by the fact that I’d been with A for (as it then was) six years. Nevermind, though. Just slap a “bah, patient was unresponsive about this so we can therefore be certain that she actually knocks the living fuck out of her partner and friends” on my face so as it fits neatly with your nice little bit of stigma-in-a-manual.

C’s discharge letter fucked me off, not because he was offensive per se, but because either he’s the one that’s in cloud-fucking-cuckoo land or he’s just trying pathetically to cover his own arse. A position arguing that both apply is certainly arguable too. I can’t remember all of it now, but the comment that most stood out was that he felt that I had “learned methods of affect regulation and non-destructive ways to deal with overwhelming feelings.” I’m glad to hear that’s the case, because hitherto I really had no idea. It’s reassuring to know that my reality is actually false and all that, oh yes indeedy. So, I ask myself…how had God C managed to achieve this miraculous wonder, so subtle and clever in its delivery that even I had not noticed it? Aha, good readers! How else but by teaching me “techniques of mindful-breathing [sic], which seem to have had some positive results”.

MWHAHAHAHAHAHAHAHAHAHAHAHAHAHAHA!!!!!

Really, C? Really?! Could that be the same mindful breathing that I so positively reacted to and analysed here? Good to see that we were singing from the same hymn sheet throughout our time together, my friend!

I haven’t perused his hand written post-session notes in great detail yet, mainly because – as is par for the course in the field of healthcare – they’re nearly fucking impossible to translate into something that begins to approximate English. A couple of asides I did note, however, were wanky references to “anger”, “acting out”, “defensiveness”, yadda yadda. He appears to be under the delusion that because of these ‘traits’ I epitomise borderline personality disorder (despite his one time comment that “…it is not borderline personality disorder that c0mes into this room; it’s Pandora.”) Unfortunately for historical accuracy, the reason I was “angry” and “defensive” was because he was refusing to fucking treat me at least until my condition became moderately self-manageable. Go and read through the archives of my posts on him. I was, by and large, unerringly nice (despicable word) to the man until Christmas 2009 when he told me that I had to fuck off.  Duh-de-DUH! Coincidence much?!

There was one particularly irritating and condescending piece of arse that he’d obviously written in the wake of a difficult session late in our time together. I must have seen him and/or therapy as a cunt/cuntish or something, and he noted that I was engaging in his favourite little game of psychological splitting (helpfully for him and the psychiatrists, a typical “borderline trait”). Waa, waa, waa. Apparently, though, he felt it “unhelpful to break Pandora’s projections towards me at this time by pointing this out to her…for now it is best to allow her to feel [whatever it was he alleged that I felt].”

There are two things in this world that I cannot abide. Being lied to (and that includes lies of omission, as observable here), and being FUCKING PATRONISED. What a supercilious fucking cock! He knew, he fucking absolutely knew, that I understood the dynamics of splitting, projection and transference. We spent about 98.3746563% of our time navel-gazing on such issues, for Jesus’ sake! But nah, let’s just let the little borderline freak act out on me rather than try to fucking work out why she’s doing so. Let her think that she’s really furious with me, when it’s actually her uncle or her fucking father or God or the fact that she hasn’t personally discovered a curse for cancer (given, after all, that she has such strong narcissistic traits!) that’s actually fucking frustrating her. Tosser.

Let me be rational momentarily (sorry to disappoint the rant lovers, but normal service will resume anon, worry not). I can see why C may think that if he reduced everything to splitting and transference and whatnot that (a) that would be intellectualising, something he fervently sought to avoid with me and (b) maybe he did genuinely think it would be useful for me to be angry with him in a transferential sort of way, if only temporarily. The problem is that he sat down, thought about it, then went ahead and consciously decided to try to deceive me (a comment which, if he were ever to read this, would no doubt be interpreted as “a paranoid persecution complex,” which came up once or twice in the notes), rather than exploring the psychodynamics of my frustrations. I thought that was the whole fucking point of that style of therapy?

Anyway, I’m analysing, rather than reporting, here. I should leave the detail for specific posts, but you know me – I can’t help myself. In closing, I’ll note one other thing that really annoyed me, not by its belittling stereotyping, nor even its inaccuracy, but by its very omission. Only at one solitary, passing juncture was PTSD ever mentioned, and that was by C, who does not have the requisite qualifications to make any form of diagnosis, at least beyond speculation. NewVCB sat with me last March and said to my face that I “…couldn’t not have PTSD…and in case of chronic trauma like your’s, we call that complex PTSD…”

Some of the foregoing made me angry, some made me laugh owing to its inherent ridiculousness and textbook anti-borderline bias, but this – this actually hurt me. I remember Seaneen once writing a really good piece about people with post-abuse mental health problems.

She said:

There’s the “good” abuse victim (hello, PTSD) and the “bad” abuse victim (hello, BPD).

Right here, right now, that statement resonates with me like never before. To me, in much the same way as Seaneen suggested, BPD blames the sufferer; PTSD blames the perpetrator/event/whatever.

So when all is said and done, for all her apparent support, I’m still just some attention-seeking, histrionic pain in the arse to NewVCB – not someone who was or is a victim/survivor/sufferer (depending on your preferred parlance), a belief that she has on occasion led me to believe she holds. I can shake my fist at OldVCB’s brusque manner and dogmatic stereotyping; I can laugh incredulously at C’s misinterpretations of matters or questionable decisions at any given time; I can astonish myself with the shocking hypocrisy of the Psychiatric Liaison bint.

But in the end, that’s somehow little more than rant material, at least for now. They don’t hurt, not really – not deeply, not rawly. Being just another case, another fucking number, rather than a person? That hurts. Being the one apparently to blame for all of this? That cuts me to the fucking core. It really, really does.

And that, for now at least, is that.

Lies, Damn Lies and Statistics

Statty-Wats

The latest post on Karita’s blog, where she talked about having filled in the Goldberg Depression Scale, inspired me to find out exactly where I am vis a vis my depressive symptoms. My guess would have been that I was in a moderate depression, because although I’m not exactly running through fields of corn with fluffy puppies and a smug, fat grin exercising my facial muscles (though I like my face to be fit, which is why I normally wear a frown instead), I feel like I have a certain amount of cope left in me. Serious depression doesn’t have that feature, in my experience. This current state, relative at least to the rest of those over the past three-ish years, is about as close to ‘normal’ or ‘OK’ as it gets.

The first test I took was the same one that Karita had consulted. This is how it’s scored:

54 & up – Severe depression

36 – 53 – Moderate/severe depression

22 – 35 – Mild to moderate depression

18 – 21 – Borderline depression

10 – 17 – Possible mild depression

0 – 9 – No depression likely

I scored 82. 8fucking2!

Alright, then, I thought. That’s just one test. Try some of the other ones, and see if you still get that kind of result.

So, once again I made contact with everybody’s favourite detective, the omnipotent DI Google, this time searching for the Beck Depression Inventory (BDI). The scoring for it is as follows:

0 – 10 – not depressed

12 – 18 – depressed

20+ – very depressed, take action

I scored 33.

This was not turning out well.

The next test was the Hamilton Depression Scale (HDS). A score of 28 or over indicates severe depression. I scored 43.

Finally, for a laugh I completed the Modified Scale for Suicide Ideation inventory (MSSI). I think it’s important to bear in mind that I am probably at my least suicidal than I have been in years, so the results of this one were especially interesting.

The MSSI is scaled as follows:

0 – 8 – Low Suicidal Ideation

9 – 20 – Mild – Moderate Suicidal Ideation

21+ – Severe Suicidal Ideation

My result was 32.

EDIT 13 February 2011: Purple Sapho has written her own version of this post, in which she includes another scale – The Burns Depression Checklist (BDC) – across which I’d not yet come.  So I took it today.  It is scored thus:

0 – 5 – not depressed

6 – 10 – normal but unhappy

11 – 25 – mild depression

26 – 50 – moderate depression

51 – 75 – severe depression

76 – 100 – extreme depression

My score?  90.

I know that these scales aren’t always to be considered as 100% accurate, and to that end I am regarding these results with a pinch of salt. However, that the results were so consistent on all of them is possibly telling. Have I lost my conceptions of what suicidal ideation and depression actually are? Am I so normalised to them, so absolutely inured, that I underestimate just how ill I am?

In the spirit of empirical results, I went back and did each test a second time, picking the absolute lowest value possible in each question rather than the statement that is most frequently true. For example, at one point the MSSI asks…:

Over the past day or two, when you have thought about suicide, have they been intense (powerful)? How intense have they been? Weak? Somewhat strong? Moderately strong? Very strong?

…the possible answers to which are as follows:

0. Very weak.

1. Weak.

2. Moderate.

3. Strong.

Over the past few days, I would say that my modal answer to this question would be ‘2. Moderate’. However, there have been a few occasions when the strength of the ideation could have been described by the lesser value of ‘1. Weak’, so instead of the picking the most frequent description in my second round at the test, I chose the latter.

The reason for this is that apparently I’m a histrionic, exaggerating freak when it comes to psychological scaling. I therefore felt like I had to prove to myself that my responses were as honest and non-dramatic as possible, but if anything, the answers I gave the second time round felt dishonest, as they aren’t a fair reflection of the frequency or intensity of those very things that they’re supposed to assess. Even so, it seemed the only feasible way of making sure I wasn’t being melodramatic.

My new results were as follows:

Goldberg – 67

BDI – 29

HDS – 29

MSSI – 29

EDIT 13 February 2011: BDC – 81

29 must be my unlucky number. So even when I am downplaying my symptoms, I am still considered severely depressed and/or suicidal.

What is depression, anyway?

If this is severe depression, what the fuck have my darkest days been? A literal manifestation of hell? A delusion? I’m not under some impression that I’m doing well at the minute, but I really would never have supposed that clinically speaking, things are as serious as they are. This makes me question the very nature of major depression: what even is it? I know what it feels like – or, according to all these testwankthings, I don’t, but you know what I mean – but I can’t quantify it well in words. My first reaction is the word ‘black’, which is certainly accurate, but a small word compared to the magnitude of the actual condition. I described it on my other blog as a “crippling treacle of blackness”, a quote that someone apparently viewed as “poetic”, which was a welcome compliment. I’m not sure I’d use that term myself, but it does serve as very brief description of such levels of depression.

In my experience the worst forms of depression are when suicide is about as unlikely as it’s ever going to be. Although you wish that you were not, you just don’t care enough about anyone or anything to have the motivation to hit your own ‘off’ switch. Perhaps that’s one over-riding characteristic of this state; complete and utter apathy. It’s inherently narcissistic too, but I don’t mean that in an offensive way; you are utterly consumed by yourself, but only because depression forces you to be. It’s full of hatred, mainly for the self. It’s irrational, it’s bleak, and it’s so, so lonely. In the unlikely event that a severely depressed person were in a room full of people, he or she would still be utterly alone.

Is it possible to just ‘get used’ to being severely clinically depressed? I know that it can certainly be done for certain types of physical pain, but I also know that I’d rather experience a lot of physical pain before I experience the bleakest days of depression. So how can you just not react to it being there? Being miserable every day is my norm, but it seems ridiculous to think that one can take a stoic attitude towards it. It just seems completely inconsistent with the reality of the illness.

What does depression mean to you? How do you demarcate between levels of it?

Lies…

To topically diverge completely, I have good news. The Social Security Agency have finally paid me the oodles of lovely cash that they owed me! I mean, they were completely full of shit when they told me, when I lodged my original complaint, that I’d be paid within a week; it was nearly three weeks later. But at least it’s there now, and fuck am I relieved. Not as jump-up-and-down-and-open-the-Champagne excited as you might expect when I’ve just found almost £2,000 in my bank account (probably as a lot of it will go on bloody bills), but I’m glad to finally have the matter sorted.

I took a deep breath and phoned the fuckers yet again on Friday. After 700 parsecs of Vivaldi and a string of utter fallacies about how my call was important to the Agency, I finally spoke to a helpful geezer named Alan. He said that the money had been paid on Wednesday, the day after Pamela had phoned them, and that the reason that I then still didn’t have it was because it tokes three days for the bank to process. There was no money on Friday, but on Saturday – hark! ‘Twas there, in all its glory. I was stunned at this because, even though all transactions are surely computationally automated, banks use any excuse to get out of doing their jobs, and the weekend would surely be the perfect opportunity for them to do fuck all.

On the point of Pamela, I told Alan that she had called me and was seeking my dubious company at what would no doubt be a wonderfully helpful and interesting “interview.” I asked him to confirm that I was, indeed, in the ‘support’ group of Employment and Support Allowance (ESA).

He looked at the records, and then reported that yes, I had been in the ‘support’ group since week 14 of my original claim for ESA (about July 2009, although that was retrospective in that I first had to appeal against their original decision, which I won in June 2010).

To that end, I asked Alan why I had been “invited” to a “work focused interview”. He asked me to hold the line whilst he consulted his manager. Though he was, overall, helpful, I couldn’t help but think that I knew more about the fucking benefit than he did.

Anyhow, back he came after a few minutes, sounding rather perplexed. He said that he and his boss had no idea why Pamela wanted to see me, stating that I was correct in my understanding that her “interviews” are not a requirement whilst in the support group. He asked was I certain that she knew my group allocation.

I relaid a redacted version of my conversation with her. “I did tell her that I’d won the appeal about my original placement in the work group,” I told him. “So she cannot fail to know the present circumstances.”

I could almost hear the cogs of his brain whirring on the other end of the phone, as he searched for possible reasons for her behaviour. Eventually, he simply said, “all I can suggest is that you ring her back and make sure she knows that you’re in the support group, and that attendance is not required.”

My mother rang me about an hour later, and I reported Alan’s advice to her. She said that she would ring Pamela and get back to me. She rang back about five minutes later; Pamela only works to 2.30pm so had gone for the weekend, but Mum did manage to briefly converse briefly with another member of staff, who confirmed that support group claimants are not required to attend this shite. The woman said she’d pass a message to Pamela and get her to ring my ma back on Monday.

I am cautiously hopeful that maybe this bollocks can be avoided after all.

…and Damn Lies

***Beware of sex abuse triggers***

Last night after a few pints and half a bottle of wine, I admitted something big and dark to A. Well, in the grand scheme of things it’s not that big and dark – but in my life, it is. I was once (I think it was merely once) penetrated (or ‘raped’, if you prefer) with some sort of pole thing – my adult self supposes that it was the end of a brush or mop or something, but the child couldn’t figure out its use in this world. I don’t suppose it matters, at the end of the day. And it was just an inanimate thing, so I suppose I shouldn’t really care. But I do care, unfortunately; perhaps it’s because the inanimate, non-living thing seemed to me to be a reflection of how Paedo viewed me. A useless piece of crap that serves only one purpose in this sorry world. The whole sordid business seems even more degrading than actually being fucked by him – I mean, he had to put some effort into fucking me, an indication of giving a shit on some level. Or something. A pole doesn’t possess any such considerations.

Anyway, I don’t know why I wrote that paragraph, because it isn’t true. None of my allegations of sexual abuse are true, and I am nothing but an evil Münchhausen-esque, attention-seeking liar of epic proportions. I know that Paul and, when I see her later in the month, NewVCB, will respectively say that “denial is easier than facing the ‘truth’,” and that I am in another “delusional psychosis”, but what do they know? They didn’t bear witness to my childhood.

It disgusts me that I have sucked people into this little web. What kind of vile human being creates such a saga, especially when it inevitably has an impact on other lives? Why have I done this? What an evil, twisted bitch I am. There are no words strong enough to articulate what a repugnant human being I am.

I’m sorry.

(I’ve just read over this and find it interesting that I’ve ended on such a hideously depressing note, when I was earlier stating that I was surprised to find that I am “severely” depressed. Ah well. Its just more of those defining, idiosyncratic contradictions).

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Can I Have Some Schizophrenia With My "PTSD" Please?

A few months ago I wrote the following in a post about C(unt) blathering on about my not-insignificant levels of dissociation:

…I think the only two diagnoses that would really faze me would be DID and schizophrenia…

Apparently my view is no longer represented by this sentence.  Having BPD now fazes me.  I was grateful for the diagnosis in the beginning and for a long time after it, and part of me still is: having one’s symptomology even conceptualised based upon observed behaviours in others is a relief, because you know that whilst you’re societally ‘abnormal’ or ‘sick’, you’re certainly not alone.  You are not a completely random, anomalous freak of nature.  At a less abstract/more personal level, I have been able to connect directly with so many amazing people with whom I share diagnoses, and this would not have been possible to anywhere near the same extent but for my own getting them in the first place.

Nevertheless, given the discrimination levied at me by the management of the Trust, and given the asinine ramblings of certain alleged psychologists out there in the blogosphere (NB. not because of said asinine ramblings themselves, but because of the wider prejudice that they reflect), I have come to dislike being diagnosed with BPD.  Not because I personally am ashamed of it, but because I am ashamed of the way certain people – mostly so-called professionals, as far as I can see – have chosen to see it.

Anyway.  Did I just write ‘…I have come to dislike being diagnosed with BPD…’?  Why, I rather believe that I did.  What a silly thing to say, Pandora!  You should dislike being diagnosed with anything!  Right?

Wrong, apparently.  Oh my God, what an attention-seeking, pathetic use of a not-insubstantial amount of freak-holding space I am.

Last week, when NewVCB was adamant that my supposed psychoses are not of a schizophrenic nature, I was actually a bit disappointed.

How utterly and unforgivably outrageous does that sound?  I even astound myself sometimes with my disgustingly warped twisted-ness.  I’m sure many people with schizophrenia could read this and want to punch me square in the face because they have to face every fucking nasty day with the horrible thing, and would do anything to get rid of it – and I’ve just stated that I’m disappointed that I don’t have it!!!

Furthermore, I’ve been one of the most ardent critics of those (very few) people (who are much less in number than the mainstream media would have us believe) that go around thinking that certain forms of mental illness are chic, or even desirable, ostentations – or, at least, the domain only of the successful and the witty.  I reveal myself a hypocrite almost every time I write on this blog, and here we have yet another example of my wretched doublethink.

I’m writing this post now (as opposed to last week) because I was trying to determine exactly why I had reacted in this fashion.  This is what I have concluded:

  • I know there’s an anti-psychiatry movement who oppose medication and the ‘chemical imbalance’ theory of mental illness.  I, however, do not agree with these positions (although I do respect them), as most who have read this blog will probably have concluded.  The specific whys and wherefores of that are matters for another day but I believe that there’s ample evidence that certain forms of mental illness such as schizophrenia, bipolar disorder and depression can – at least in some cases and circumstances – be caused by ‘abnormal’ (relative to the ‘mentally well’ population) brain chemistry and/or neural pathways.

     
    Of course, NewVCB would jump in here and point out that in my case, and in those of cases similar to me, neural pathways are damaged and that brain chemistry is abnormal.  This, she would argue, is caused firstly by an underlying biological pre-disposition to mental health problems.  That in itself may be fair enough, but she would then continue that trauma has damaged existing brain chemistry and thus catalysed the difficulties associated with the underlying issues.

    But therein lies the point I’m trying to make; I (allegedly) have complex post-tramatic stress disorder, and of course the evil borderline personality disorder, as well as major depression and anxiety.  I could, in theory, have developed all but the C-PTSD quite independently of trauma…but apparently I didn’t. So that means having to admit to the fact I am someone who’s experienced trauma.  As per my last two posts (yadda, yadda), I refute the existence of one of those traumas (even though the original allegations of same came from my own embittered mouth, which is something of a fail, but anyway).  But there are others, ones that I do believe happened as I recall.  I would rather be ‘ill’ because I am ill than be ‘traumatised’.  People have sicknesses, whether they are mental, physical or whatever – it sucks, but it’s life.  Trauma, beyond normal life events such as break-ups or death, is apparently not life – not in the way that most people experience it.  It feels easier to accept the normalcy of illness than to accept the repugnance of some examples of humanity.

  • Psychosis is certainly not unknown in BPD nor PTSD.  However, it is nevertheless a deviation from the normal psychopathological symptoms thereof.  I can’t even have standard forms of mentalism.  I have to have even-more-fucked-up-and-abnormal-pathology-than-most-people with my diagnoses, oh yes! Nothing is ever straightforward in this murky world of mine.  My point: at least if I had schizophrenia, many of the symptoms I present would be ‘normal’ for it.
  • Most importantly, if we can agree that schizophrenia often (usually?) has its primary causal basis in chemical/biological/neurological issues as opposed to psychosocial ones, then it reasonably follows that it is primarily treated by chemical/biological/neurological means.  Medication helps me, and I would undoubtedly be dead without it.  I particularly respect Quetiapine, despite many mentalists out there actively despising the stuff (I can see why they do, for the record).  However, by the admission of both consultants I’ve seen (as well as C(unt)), medication for issues like those that I present can only ‘take the edge’ off the mentalism.  Long-term, and I’m supposing intense, psychotherapy is the only thing that can properly reorganise all those fucked-up pathways, patterns of thought, recollections, etc etc.

     
    Aside from the fact that therapy isn’t exactly a great deal of fun, apparently people with mental health problems that can only be properly managed or alleviated by therapy are not actually allowed therapy under this twatty system.  That catch-22 is really kind of unhelpful and confusingly paradoxical. All I can cling to at the minute, from an NHS point of view anyway, is more medication.  Wouldn’t it be ‘better’ then, at least in a sense, if I had a condition that was primarily managed via this means of treatment?  (By the way, I know that therapy has been shown to be useful in the management of schizophrenia.  However, as I understand it, it is mainly to enable the sufferer to begin to understand when positive symptoms are flaring up, or to help them manage occupational and social functions in their day to day life, rather than about examining the underlying issues of the disorder.  So it’s quite a different type of therapy, I think, and to the best of my knowledge isn’t necessarily long-term.  But I’m happy to be corrected).

Of course, the thing is that BPD etc etc etc can remit, and of course schizophrenia – whilst it can be managed – is incurable, at least in current understandings of psychiatric investigation.  But I’m not some sort of optimist, as well you all know, and the best I feel that I can hope for is mere ‘management’ also.  That being the case, what’s the difference?  I’m stuck with this bastardry for life, just like I would be if I had schizophrenia.

It doesn’t, of course, matter which illness it is at the end of the day.  Being mental has fucking ruined my life, and that’s that, full stop, the end.

That being said, I know this is an utterly ridiculous, and probably grossly offensive, piece of ordurous so-called writing, and I apologise for it.  Clearly my psychotic symptoms – when I experience them, which is not now, whatever NewVCB may say to the contrary – are fuck all like schizophrenia, and to apparently ‘want’ to have it without any knowledge of how truly terrible it must be to live with on a daily basis yet again highlights the fact that I am truly invidious, contemptible, navel-gazing and utterly narcissistic cunt.  But I’ve written this bollocks now, so live it goes.

Maybe I’m trying to distance myself from the [whispers] trauma [/whispers] and/or the evil insanity of BPD.  I don’t know.