…And the NHS Cocks It Up Again

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

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

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

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

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

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

And that was pretty much that.

Except that it wasn’t.

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

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

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

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

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

She was clearly frustrated by this fuckwank herself.

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

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

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

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

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

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

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

FUCK!

“And if I don’t go with you..?”

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

FUCK!

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

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

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

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

Absolutely Damn All Squared

I’m still in the land of the living. Or the existing, as you prefer. I know I haven’t written anything in what seems (for me) like ages, but there’s not a great deal to report.

I had written an entire post and when I went to upload it, my WP application crashed. So I won’t bother to recreate it; I’ll just make the basic points I was initially going to.

One: voting is still open, until midday next Saturday, in the TWIM awards; just click here. Thank you to those of you that voted for me, thank you: I genuinely appreciate it. However, in the interests of impartiality, I’ve disqualified myself so the votes won’t count – but thank you anyhow. I still don’t understand why you read or like this blog. But that you do genuinely touches me, so thank you.

Two: I probably won’t be writing here much until at least January; I’ll try to do my traditional “what happened this year” round-up, but I won’t promise. For one thing, I’m very stressed (and also disproportionately upset – I so need to get a fucking life) about something I can’t (at least yet) discuss here. More importantly, I have a major piece of professional writing deadlined for 2nd January, and of course that will take priority over my usual garbling bollocks for here. So I have, for once, a genuine reason not to crap on on Confessions, rather than my failure to post being attributable to anhedonia, avolition or laziness (though I must admit to the presence of the former two nevertheless).

Also, please note that I will not be doing anything TWIM-related until at least Tuesday. I’m even temporarily removing the relevant email account from my phone!

I haven’t been on Twitter for days (other than to tweet the odd article via third party apps, or to text a random observation or something), and probably won’t be for…well, some more days. If you’ve @mentioned or DMed me, I’m honestly not ignoring you and will catch up before too long 🙂

Three: after seeing NewVCB on Wednesday, I am now taking 100mg of Lamotrigine. Unfortunately 50mg of this is in the morning, which doesn’t sit especially well with my daily Seroquel hangovers. On the latter, by the way, I am going to be a fat bitch for a good bit longer than anticipated because she NewVCB wants to increase my Lamotrigine dosage again in the new year, and isn’t keen on modifying two medications at the same time (which is fair enough).

Four: A and I are at my mother’s; we’ll spend Shitmas Day here, and then head to A’s father and step-mother’s house for Cocksing Day. It is a good way to spend Christmas, insofar as that’s ever possible, because it’s so delightfully fucking quiet . A pity about the cunt TV, but you can’t have everything I suppose.

Five: the important one. I may hate this time of year, but it doesn’t stop me from hoping that you don’t. For those of you that celebrate Christmas, have a very happy one. For non-Christians celebrating concurrent festivals, I’m sending equally good wishes to you too. In case I’m not here again before January, I’ll also take this opportunity to wish you a very happy, healthy and prosperous 2012.

I don’t say it enough, but I sincerely appreciate every one of you. Thanks for your unending support and friendship. I do love you.

Be safe everyone, and take care.

Love

Pan

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).

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

Saw NewVCB last Wednesday morning.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

marketing

Agoraphobic Persecutory Delusions of Familial Evil and Seroquel. Etc.

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

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

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

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

Appointment With Christine

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

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

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

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

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

Am I Still Proper Mental?

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

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

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

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

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

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

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

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

Rant: Aunt of Evil is on this Landmass!

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

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

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

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

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

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

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

Family is genetics; friendship is earned.

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

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

No, no, no – I’m not bitter or anything 😉

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

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

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

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

Back to the Fucking Point, Pan…

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

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

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

Speaking of her…

Appointment with NewVCB

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Meh and Blah and Yadda and Etc and Such

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

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

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

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

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

marketing

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

Missing a Dose of Venlafaxine, and Inevitable Post-Consultant Blah

When I first started writing this blog nearly two years ago, I was – as the title suggests – plagued by almost continuous insomnia. It is a truly dreadful affliction, but it’s surprising how much the human body and, to a lesser extent, the mind, learn to adapt to it. I remember when I was still at work, about three years ago maybe; I would lie awake all night, often for a number of respective daily cycles, getting a maximum of ten minutes’ sleep if I was lucky – and then I’d get up early, frustrated, and be in the office before 8am. Very often I stayed until after 6pm, sometimes without a lunch hour or even a tea break. It fucked with my head undoubtedly, but I still managed to undertake the duties of my position competently and courteously.

However, since I was prescribed Seroquel* last January, sleep has been much less elusive, to the point where I partly regret naming the blog what I did – though it’s established under this moniker, so I have no intention of changing it. Seroquel does tend to lose its soporific effects over time, but as my dose has increased on several occasions, I’ve been more immune to that than many that take it. I’m presently taking 600mg daily, and have been since October-ish. It’s a pretty hefty dose by UK standards, and so far although I often have difficulty in falling asleep, I usually get there eventually. The trade-off for both the management of psychosis and getting some rest is that one has a horrible, drowsy drug-induced hangover the next day, but it’s a balance I’m prepared to accept.

[* Please note that I use the terms Seroquel and Effexor interchangeably with Quetiapine and Venlafaxine in this post. For some reason, I’ve got into the habit of calling the former by its brand name, despite more typically using the generic medication terms, as I do with the latter in this case.]

So when, on Tuesday night/Wednesday morning, I was still wide awake at 3am, I was puzzled. I was at my mother’s house, and mused briefly on whether it was being out of my normal bed, but I dismissed this fairly quickly as I usually stay with her one night a week, and am therefore not exactly unfamiliar with the sleeping quarters to which I am allocated.

Then it dawned on me: I had forgotten to take my medication.

I was beyond furious with myself. After this bizarre incident last year, I know what missing both Venlafaxine and Quetiapine means, and it is not fucking good. I mean, on that particular day I ended up quite hypomanic, but it wasn’t all so pleasant; I have this gruesome memory of lying in a toilet cubicle in Newcastle, shaking my tits off, struggling to breathe, alternating between hot and cold flushes, desperately trying to throw up and being so consumed by ‘head-zaps’ and dizziness that I thought I might die. Even though I thought I was already dead. So yeah. I’ve had better times.

At about 6am I got up, still not having slept, and took the Venlafaxine. I decided to omit the Quetiapine in case its sedative properties caused me to end up passing out, especially as I knew I had to see NewVCB at 9.30am.

I sat with a coffee and watched the sun rise. As I did, it began to start. I could have blamed it ‘merely’ on insomnia at first, but as time wore on, it became clear that it was to do with missing the tablets. Not for the first nor last time that day, I cursed my idiocy in forgetting to take the damn things.

At 8.30am, I went to my mother’s room, where fortunately she lay awake. I explained that I was mental and did not feel in enough control of myself to be able to drive to the hospital, and asked if she would take me. She agreed and duly arose.

All the time it was getting progressively worse. I nearly fell over with the unquantifiable dizziness at one point and several times I was surprised that I didn’t faint. I was shivering. I was hypervigilant, jumping out of my own skin at even the most subtle noises. I was restless and agitated. Suspicious and ‘zappy’. Nauseated and sore.

By the time we got to the hospital I could hardly stand. In fact, when NewVCB came to get me from the waiting room, I had to drag myself along the wall all the way as I followed her to her office (getting a few looks as I went – but what do they expect? It’s a psychiatric service for God’s sake!). As I sat down, I just went completelybluegh at her. “I’m fine, really I’m fine – just not today. I forgot the tablets last night, and I’m going out of my mind.”

She swung into action, telling me how to manage having missed the stuff. Apparently I was to go home and take 150mg straight away (I neglected to mention that I had already taken the full 300mg. For some reason, I am still scared of doing something even remotely opposed to her advice, even though I know that she’s nice). Then I was to take a Diazpeam or two, as required, before taking the second 150mg as usual. I was not to take any of the Seroquel until the normal time.

As the minutes passed, I was feeling worse and worse. I hadn’t noticed I was clawing constantly and fervently at my skin until NewVCB pointed it out to me. She said she was reminded of a man she’d see a few years ago who’d been stable when she’d last seen him, but was literally clawing off his face the next time she met him. He had missed three doses of Venlafaxine.

She asked about the symptoms I was experiencing, and I told her it was beyond description. She asked me to try anyway, so I did. I said I felt like I was being attacked from the inside. My muscles felt as if they were on fire; I needed to pace or hop about to mitigate this, but as soon as I tried to my head was overwrought with dizziness and I felt faint. I said that I was incredibly cold one second, but sweating my arse off the next. I tried to describe the head-zaps but couldn’t – the best I could do was to say that it felt like a million minuscule guns were shooting something toxic into my brain, from inside my brain. I tingled. I shook. I was agitated. I felt sick. In terms of mentalism, I was paranoid and filled with a feeling of unspecific dread. Reading that back, and remembering what yesterday was actually  like, it actually reminds me a good bit of akathasia. How odd that one can feel that as a side-effect of not taking a drug…as well as a side effect of taking said drug! (It’s normally seen as a side-effect to anti-psychotics, but has apparently been observed in some that take Venlafaxine).

“It’s the Effexor, not the Seroquel,” NewVCB said, certainty lacing her tone. I have just checked it out, and indeed I must have seemed like a textbook case to her yesterday. I had almost every symptom of it in remarkable abundance. She reiterated the need to go home and “straight away” take half of the missed dose. Since I’d already taken the full dose, albeit 10 hours too fucking late, I hoped that this would indeed lead to a reduction fairly quickly in the horror story that I was living through. It took its time as it turned out, but I’ll come to that.

NewVCB said she realised that given the circumstances it would be difficult to discuss the general state of things, but I’m generally OK at seeing what some arsehole manager somewhere would call ‘the bigger picture’, so despite my physical discomfort, I instigated a conversation with her on how matters had been since our previous meeting.

Firstly, given her intention to ultimately increase my dosage of Venlafaxine to 375mg daily (God forbid I ever miss a dose of that), I have been ‘invited’ (yeah, it’s going to be such a laugh, isn’t it? RSVPiss off) for an ECG on Wednesday 13th April. Other than that, I didn’t really have much on which to update her – other than that matters with Paul are due to come to (a hopefully temporary) end in less than six weeks.

I told her that luckily Paul had advised me that I could simply return to Nexus a few months after last seeing him, and that he would intend to simply pick up my file when my second application had gone through the system. “However,” I said, “that means – I don’t know – eight, ten weeks with no therapist, so I was wondering if I could continue to see Christine during that time? I know we’d both intended for her intervention to be pretty short-term, but I really think it would be helpful to have some support during those months.”

NewVCB was nodding her head vigorously. “Yes, absolutely,” she assured me. “I’ll talk to her about that this week.”

She paused, then continued by telling me that she wanted Christine to discuss practical matters with me. The term ‘practical matters’ reignited a subtle fear somewhere in my mind – it always reminds me of those types of therapy that I utterly despise, such as C- and DBT. However, NewVCB surely knows me better than that; she would know that I cannot abide anything that I even vaguely perceive as patronising, and to that end, I (hope that) I can trust her not to make the ‘practical matters’ with Christine to be some wank of this ilk.

She asked me how things had been with Paul in general, and I advised that I thought the work had been very productive overall. I tried to explain what we’d been doing but it’s hard to put it into succinct terms, so I ended up saying that he was basically trying to convince me that everything that’s happened wasn’t my fault.

“Despite working for who he does, though, he doesn’t just focus on sex abuse, which is good,” I said. “Certainly, that is a big issue, but it isn’t the only one.”

“And that’s part of the reason why 26 weeks is often enough for Nexus clients,” she opined. “You get a lot of people there that have maybe one or two incidents of abuse, or have much fewer defensive mechanisms or complex issues than you, and so in a relatively short period you’ll often find that they can resolve many of their difficulties. Unfortunately that’s not the case with you – but then, as they’re essentially a self-referral organisation, it means that as Paul says, you can return.

“How have the last few weeks been with him?” she continued.

“Introspective,” I replied. “I don’t think it’s been useless, but I’ve found myself sitting there in silence a lot, thinking about things rather than verbalising them.”

“Do you think you shut down when you know there’s an ending coming?”

It did sound that way, certainly. However, unless it’s very unconscious, it hasn’t been the reason for my recent long silences – all that has happened is that a lot of strong shit has been brought into the room, and I’ve been sitting there experiencing it, rather than talking about it. I’ll try and write about these sessions shortly.

“At an unconscious level, maybe a bit,” I ventured, finally. “However, I don’t think that’s really the case. I still expect the next six weeks with Paul to be productive, unlike the last six months with C were.”

To my amazement, she said, “therapy on the NHS can be pretty questionable.”

Obviously I know this, but I did not expect a consultant psychiatrist to say it to a patient’s face. I cocked my head in query at her.

“Well, you know…” she shrugged. “Finances, bureaucracy, targets. Sometimes voluntary and private sector organisations provide a much better service.” She laughed lightly. “You of all people know what we’re like..!”

Still clawing away at myself, I managed to laugh a little myself. Oh yes, NewVCB. I know what you’re like alright. Except that I don’t like including ‘you’ in my general derisive view, because you’re alright. It’s the sprawling mass of red tape and management-speak bollocks that you’re part of that I hate.

She went on to question me on things more generally. Mood? Awful at the time, thanks to the Venlafaxine withdrawal, but overall actually fairly reasonable. Anxious and stressed at times, but not completely pre-occupied with bringing about my own demise nor unable to get out of bed. Trying to live a little, rather than just hanging on to mere survival by a thin thread of second-by-second-ness.

Voices? Nothing much. Whispers occasionally, but no real commands and comparably little hassle. Delusions? It’s not a delusion but GCHQ and related organisations are still reading my blog, Twitter and Facebook messages. Why is it not a delusional? Because I know people who are involved in such agencies and am aware that they do this. But do they actively do it to you? Yes. Well, does it stop you from writing what you want to write? No, I stick to fingers up at their unseen faces and think, ‘if you don’t like it, you can sod off’.

She laughed. “OK. I think that you’re maybe reading a little too much into their motives, if they have any, but it doesn’t seem to be bothering you unduly.”

“Not really.” Pause. “Seroquel really is a wonderful drug, you know.”

“It certainly seems to have worked for you.”

“Paul’s not a believer in the medical model. He thinks mental illnesses are social issues. I don’t agree; medication has been instrumental in making me feel a bit better.”

She shrugged. “Whatever works is what’s important. Medication, therapy, no medication, no therapy, whatever. A combination of both seems to have made a real difference in your case.”

At this point, she turned and looked me straight in the eye. “Compared to the girl I met here last January,” she said, “you’re almost a different person. I know progress is slow, but take it from me – it’s evident. There will be times when things are bad again – it’s the nature of the beast – but overall, I really think you’re moving forward.”

I found myself smiling slightly, and I agreed. “I don’t know whether it’s a combination of the therapy and the drugs, or just the latter,” I told her, “but one way or another, I think things have improved, yes.”

There was little remaining to be said. Yet again, she advised me to go off and dose up on my missed dose. I apologised for “being stupid enough to forget it,” but she said that it happens to everyone from time to time, and that at least it might encourage me not to do it again! As I was walking out the door, she said – surprising me again – “bye, Pandora, it was nice to see you.”

NewVCB has generally been a pleasant and helpful woman to work with, but she’s never before actually given me any compliments, however vague that one may have been. It was a weird but nonetheless appreciated gesture.

Not that my body cared. I stumbled back to where I’d come from to collect my waiting mother, then went into a spin of dizziness and fell out the front door. Fortunately, the rail for wheelchair users prevented me falling flat on the concrete and splitting my face into 22 pieces.

The journey from the hospital to my mother’s house is a short one, but the motion of the car sent my withdrawal symptoms out of control. When we got back to the house I retched several times (being unsuccessful in my attempts to vomit, given that I had a completely empty stomach), then stood at the back door smoking and jumping about in an attempt to curb the physical agitation. Apparently I was also babbling endlessly on about some stupid nonsense with barely a pause for breath; I remember a little of that, but not a lot. My mother, who was going to the doctor’s surgery to have her monthly blood checks, decided that she had better take me with her. Originally she had instructed me to return to bed after seeing NewVCB, but upon seeing me so mental, she decided that it wasn’t a good idea to leave me alone.

I went with her without complaint, but it just got worse and worse. I didn’t go into the surgery, as I feared that if one of the GPs came out and saw me, they’d see how mad I was and try to bin me (realistically, I know now that that was highly unlikely, but it’s still a good thing I didn’t go in as I’m fairly sure I could have upset other patients with my evident insanity. I was even fucking drooling by this stage.). I sat in the car, audibly moaning from time to time, dissociating in some places, being miserable in all.

When my mother returned, she offered to take me home again, but I demurred. I didn’t want to stay out, but I didn’t want to go home either. I didn’t want anything. I didn’t even want the paradisical escape of unconsciousness – just nothing. I know that makes absolutely no sense at all, but there aren’t words to describe what I’m discussing (or if there are, they – like so many wonderful concepts – are foreign terms that are not at all easily translatable to English). I only existed in the moment, and anything beyond it was out of reach.

My mother had to go to the bloody golf club, so I accompanied her. I was scared of running into some of the pretentious fuckwits that permeate the place, thus mortifying my mother, but fortunately she has a tendency to hide in deserted offices when there anyway. I sat. I tilted my head to the left, I tilted it to the right. I stood and paced a bit. I sat again. I stretched. I moaned. I spaced out. I shook. I flushed. I sweated. I froze. I stood. Sat. Moved. Wiggled my fingers and toes, stretched my leg muscles. I banged my head off the wall once in an attempt to stop the ‘zaps’. My mother asked me to desist. I did. I sat. I felt my eyes dart from left to right. Up and down. I scrunched up my face and shook my head speedily. I clawed at myself. I punched my muscles. I bit my lip.

And so on and so on and so on.

However, towards the end of my mother’s tenure behind the golf club computer, it subsided a little. Encouraged, I dared to look at my iPhone; I’ve got quite into geocaching recently (assuming someone’s with me, obviously, as I can still hardly go outside alone) and wondered were there any caches in the near vicinity. As it turned out, there was one right across the road. I said so to my mother, prompting her to ask if I wanted to look for it. Had it not been across the road, given my fucked-up state there was no way I’d have bothered, but I figured since I was already there…

The fresh air seemed to have some positive impact upon my condition – or maybe the medicine was simply starting to makes its mark by that point, who knows. In the end, I was able to have lunch with my mother in the town, although I picked through a lot of it.

The hot/cold flushes remained with me all day. I wrapped myself in a blanket on the sofa, but the next minute I’d throw it off again. Only to pull it back 10 seconds later. The zapping significantly reduced as time went on, but didn’t go away entirely – the same was true of the agitation and akathasia-like restlessness. I didn’t have to get up/sit down every five minutes, but I would have to alternate between lying down and sitting up. Overall, although I felt better than I had, the afternoon and evening were still quite wretched; however, I determined that I would stick things out and go to bed at 11pm, a fairly normal time, rather than oversleep.

I did so, and passed out within minutes – with one of the most peaceful night’s slumber I’ve had in ages (though not before I found a fucking packet of fucking Zopiclone sitting on the fucking bedside table that I had failed to fucking spot the previous fucking evening. In a furious rage at the sod’s law involved I threw them at the wall, but upon getting into bed I was able to roll my eyes a little and see the humourous side of this frustrating turn of events). I suppose I had been awake without a single second’s interruption for about 40 hours, so a good sleep was deserved.

When I woke up today, I was still exhausted – but I felt half-human again. Thank Christ. Of course, being half-human leads to half-human thoughts, or at least the thoughts of a half-human who’s a mental anyway. I mulled over NewVCB’s positive words about my mental health progress, and started panicking that this meant that she was imminently planning to discharge me. Here we go again: rationally, I doubt that this is likely, but since it’s actually physically possible, I am now convinced it’s going to happen.

Rather than sit and obsess about this all day, though, I let my tiredness consume me, and went back to sleep. Having been unable to drive yesterday due to being mad, I finally came back to A’s this evening, where I was distracted firstly by taking him out for a coffee and, secondly, by writing this post.

Both last night and tonight, as soon as my phone alarm went off, I dutifully whipped the pillbox out of my bag and knocked the fucking tablets back right away. I have no intention of letting yesterday’s awfulness happen ever again.

I’m tired again now, and have written over 3,700 words for a post that could have been done in 10% of that. So I shall bid you good evening, lovely people. For those of you that do – keep taking your tablets! x

var AdBrite_Title_Color = ‘BA1F1F’;
var AdBrite_Text_Color = ‘9E9E9E’;
var AdBrite_Background_Color = ‘000000’;
var AdBrite_Border_Color = ‘000000’;
var AdBrite_URL_Color = ‘BA1F1F’;
try{var AdBrite_Iframe=window.top!=window.self?2:1;var AdBrite_Referrer=document.referrer==”?document.location:document.referrer;AdBrite_Referrer=encodeURIComponent(AdBrite_Referrer);}catch(e){var AdBrite_Iframe=”;var AdBrite_Referrer=”;}

document.write(String.fromCharCode(60,83,67,82,73,80,84));document.write(‘ src=”http://ads.adbrite.com/mb/text_group.php?sid=2061399&zs=3732385f3930&ifr=’+AdBrite_Iframe+’&ref=’+AdBrite_Referrer+'&#8221; type=”text/javascript”>’);document.write(String.fromCharCode(60,47,83,67,82,73,80,84,62));
Your Ad Here