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”.


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.

What's Annoying Me Today, and Ruminations on Seeing the Psychiatrist

Well, fuck me, but didn’t the VCB actually manage to bother her arse seeing me today.  Will wonders ever cease?!

I took my Mum with me to the horrible, dilapidated, thoroughly depressing place as I wanted VCB to see that I was nervous about seeing her.  And was I nervous, oh yes.

I had had about half an hour’s miserable sleep on the sofa so was completely mentally fucked in any case.  This made the drive to my mother’s somewhat interesting, but anyway, she drove onward from there.

I began to regret requesting my mother’s company within minutes of sitting in the waiting room.  In my attempt to not appear mental and hyperventilating, I was a bit mental and hyperventilating.  I was rocking back and forth in the chair and covering my face with my hands.  The other nutters that were there had the courtesy to pretend they didn’t notice – initially, anyway.  When my bloody mother started going on that I didn’t “look OK” (10 out of 10 for observation, Mum), then they all turned round, as if her opening her mouth gave them a Licence to Gawk.  One of them looked like a bit of a freak.  The other one looked surprisingly normal.  I didn’t.  My hair was a mess, I was wearing the same trousers that I’ve worn on and off since about Wednesday and I was deathly pale, with big black circles under my eyes.  Not to mention the odd psychomotor movements.  Yeah.  A loon.

VCB kept me waiting, as well I suspected she might do.  Every time I heard the door open, I took a deep breath and got ready to face her, yet it wasn’t her.  Needless to say, this didn’t help my levels of anxiety.

Some rough-sounding bitch came in with what was, I presume, her father.  She had evidently already been seen by someone and was waiting for them to come back, but she was bloody raging.  She called the staff “dickheads” and said that her situation was “not fucking funny at all” and that her social worker was a bitch and that she was not taking any more of her crap.

Generally, I hope I don’t behave like this in public places, though I know I do here.  Nevertheless, I couldn’t help but feel the woman’s pain; these people are arseholes, and consistently seem to let patients down.  I also envied the girl’s ballsiness, if only temporarily.  I just knew I’d end up submitting to the VCB and I so desperately didn’t want to.  I wanted to stand my ground, demand answers and get help.

Another thing – the rough bint, as stated, referred to her social worker.  You may have read my rants on Twitter on Friday (here, here and here) that there are actually two Community Mental Health Teams (CMHTs) at the hospital in which the VCB and C are both based.  C and VCB will, in some way, be part of those teams, but as I understand it, CMHTs also include social workers, occupational therapists, CPNs, the stupid crisis teams and ‘duty’ teams who are there when your psychologist or psychiatrist isn’t.  The social workers, CPNs etc are, as far as I understand it, there for use alongside the professionals you normally see.

I’m not going to sit here and tell you that my mental health problems are the most serious in the whole vicinity.  They aren’t.  Mind you, I’m fairly sure that I’m not a million steps from sectionable behaviour, so they aren’t entirely innocuous either, are they?  So I’m wondering why it’s left to C to do all non-medical work with me.  As discussed in the comments of this post, it seems kind of odd that C is practicing psychodynamic therapy along with stupid DBT.  He is always banging on that whilst we need to tackle the underlying issues of madness, I also need practical measures to help me when I actually go mental.  I agree with him.  I just find it confusing to go from one to the other potentially several times during one 50-minute session.  bourach said to me that I should request a CPN to do all of the practical crap with me, leaving the actual ‘deep’ therapy to the psychologist.

In all honesty, I reckon a CPN or an OT or whatever would probably be shite; nevertheless, I think DBT itself is shite, so if it’s going to be insisted upon in my treatment, surely it is best served by someone specifically dealing with practical issues.

So, in short, I was very annoyed that LCP, C and VCB had failed to advise me of these CMHTs.  I did fantasise about ranting to VCB about it, but I reckoned that she’d only say it was nothing to do with her, which to be fair it isn’t especially as she is dealing with the medical side of things and fucking DBT and suchlike isn’t that by any means.  I do think I’ll have it out with C, though.  Was it his place to tell me?  I don’t know, but I do know that at least I can ask questions like this of him, whereas I’m way too scared of VCB to confront her, even if it were her domain.

OK, so that was a digression.  Sorry.  Eventually, VCB stuck her head around the door and summoned me.

Basically, the appointment was alright, but very little has changed.  Despite telling her about Tom, the voice, the delusions and paranoia, the increased mania and the stupid things I do whilst therein, and a full account of what happened on Friday, she is still not prepared to give me mood stabilisers and/or anti-psychotics (though thank Merciful Christ, she is not willing to section me either.  I think she realises that’s just about the worst thing that could happen right now).

In fairness, she has a fair rationale for not prescribing such drugs just right now.  Somewhere in this post, I outlined some of the mad things that have been happening to me since I started taking Venlafaxine – but I also drew attention to the fact that I thought it had made a very subtle improvement to my ‘base’ mood.

Encouraged by this, and at my own suggestion in fact, VCB wanted to double the dose to 150mg daily.  I begged her not to take it off me, as whilst it has a string of hideous side effects, at least it looks moderately encouraging as regards the depression side of things.

So, there are two things to consider in light of this.  The first was that she said that if I thought Venlafaxine had side-effects, then I should wait until I experienced mood stabilisers.  In fairness, she appreciated that I was probably quite aware of this, as she seems quite aware of how well informed I am about many psychiatric issues, including medication (C must have discussed this with her).  Secondly, and more pertinently from my point of view, she said that she would “never” make two medication changes at once (and by increasing the dosage of the anti-depressant, she is already making one).  She would – quite obviously, when you think about it – be unable to see what particular tablet was causing side effects or any changes in my mood if she made more than one change at the same time.

That’s fair enough, but the difficulty of this for me is that – given my original reactions to Venlafaxine – doubling the dose will probably send me utterly batshit again.  Even if it doesn’t cause me to react in such an extreme fashion, increasing the dose of this notorious drug is desperately unlikely to, in itself, stabilise my up-down moods and episodes of psychoses, is it?!  If she sees me again in six weeks, that’s probably bearable…but will she?

I actually specifically asked her this, and she said she would.  It fucking better be the case.

I also asked her, for the avoidance of doubt, if she would consider both anti-psychotics and mood stabilisers if things don’t change (which they won’t).  She said ‘yes’ to both.  I clarified that I actually quite like Tom, but that I recognised that hearing him was not normal (Obviously.  I mean…obviously!).  She agreed, but I think her greater concern (like mine) was regarding the other hallucinations, the delusions and paranoia.  Tom is benign (so far); they are not.  (Quotes to A – “why the fuck are you taking notes on me?  Are you in collusion with GCHQ?” //  “why is that sign trying to tell me something?”  //  “he [my stalker] is there, he’s fucking everywhere [he wasn’t there]”).

She did give me some fairly useful advice on dealing with the stalker. It’s nothing I didn’t really think of myself, but nevertheless it sometimes helps to have it verbalised by someone else.  I don’t think I have the balls to confront the bloke in the way she mentioned, unless I’m once more manic, and she did acknowledge that it’s easy for her to say.  Still, I have to do something about the fuckhead.  VCB said, “I’m not encouraging you to drink per se, but I do think it’s important that you retain the normal routine and do things you enjoy, such as going to your local.”  So I have to face up to him in some way.

Sensing disappointment regarding her unwillingness to prescribe additional medication, she said, “medication is not a cure, you know [no, I had no fucking idea given that I’ve been on it for 12 years.  If it was a cure I’d be cured by now, you old horse!].  The best route to recovery is via psychotherapy.  I know there’s nothing immediate happening in yours, but I spoke to C and he thinks there’s good work being done there.”

I laughed in her face.  I don’t know why; I’ve stated time and time again that I do think there’s hope with C, and my hopeless attachment to him is almost a textbook reaction to a functional therapeutic relationship.  I think I’m angry with C for fucking off for a fornight…again.  Additionally, I remember that when I told him about my planned discussion with VCB that he’d suggested an improved mood was down to him, not medication.  This is funny.  I don’t know why, but it is.

I told VCB about it.  “I’m terribly fond of him,” I admitted, “but really – any positive change like this is strongly attributable to the medication, I think.”

She didn’t seem sure about that, not entirely anyhow, but she didn’t argue either.  Her contention though was that, even though we are pretty agreed I have bipolar disorder as well as BPD, that that illness also requires psychotherapy.

Now she’s a psychiatrist and I’m not, but I always understood that any psychotherapy in bipolar was about trying to recognise triggers, managing mania and mixed states, etc.  I didn’t think there was any exploratory psychodynamnic-esque stuff within it (unless it is co-morbid, as in my case), mainly as it’s largely an organic illness, rather than one supposedly created in large part by traumatic events like BPD.

When I relayed this part of the conversation to A, he said it sounded like she hadn’t a clue what she is doing.  Hmm.  I don’t know.  I suppose research into causation of mental illness, including bipolar disorder, is still ongoing.

So, anyway, it wasn’t the most productive meeting ever, but assuming I actually do get to see her in six weeks as promised, it could have been worse.  If I don’t, well – the shit hits the fan for her crappy department.

Despite the relative non-shitness of it though, I am feeling remarkably low and unmotivated and sad today.  I didn’t get much sleep as already discussed, and even though I appreciate VCB’s reasons for not prescribing me some cocktail, I must confess to some level of disappointment in it.

I was also irrationally angry last night when A told me of a discussion he had with his friend, in which A told him I was diagnosed with clinical depression.  That’s so last decade lol!  A told him that because he (very much a layperson) wouldn’t understand the terms BPD or bipolar, but I’d have thought he’d have understood the old term ‘manic depression’ at least.  This annoyed me as any time any of that lot see me, I’m in pretty good form; thus if he believes I have ‘clinical’ depression, it looks like I’m faking this whole damn thing (plus I’ve developed a crackpot identity beyond just depression since I first realised last year that it was more than that).  This potential belief was exemplified the other day when the bloke in question asked me how work was.  I told him I’d been off and said I was dealing with some “mental health issues.”

He said, “in other words, you don’t like work.”

Jesus fucking Christ, such willful bloody ignorance.  If it were about hating work then I’d have gone and got myself another fucking job.

My annoyance was compounded by the fact that the bloke’s father has suffered from depression but hasn’t responded to treatment.  Yer man therefore opines that it could well be that his “dad is just a dick”.  This, as I saw it, is a refutation that there is anything wrong with me or anyone else that has difficulty responding to treatment.  It is also suggestive that he believes depressed people are ‘dicks’.  Maybe it isn’t, maybe that’s just paranoia, but one thing it definitely is is ignorant.  It’s not entirely his fault; it is, of course, a greater problem in society than just one man.  But this in itself makes me despair.

If this is what someone that knows and seems to like me thinks, what does the world at large believe?

So: (stress of VCB) + (complete exhaustion) + (societal denial that my illness is as real as anything physical) + (other things that I don’t want to write about that really upset me) + (worry about OH on Thursday) = NOT FUCKING HAPPY.

Still, VCB didn’t section me.  I really convinced myself during the night that she would, given some recent events, but she doesn’t think it’s at that point, so I suppose I ought to be grateful.
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Three Days of Professional Madness, Genital Vinegar and C: Week 24

As you know, I’ve been on holiday, and as you also know, I promised I would go into more detail about the three mental health appointments I had in the days that preceded my departure. I had started this post well before going to Turkey, but despite my claim that I’d finish it on the plane, of course I didn’t; even flight-safe phones such as the iPhone were not allowed to be used onboard. Obviously in Turkey I was trying to enjoy myself, though as you will see in a later post that did indeed involve some forays into psychiatry. Anyway, I’ve finally got round to the post in question, so here it is.

Tuesday: The Psychiatrist

I said I’d go into more detail about how I responded to the psychiatric SHO on Tuesday 8th. Basically, I said I couldn’t deal things any more (I’m sick of my up-down moods and am worried about the effect some of my psychoses are having not just on me but the others around me). I said I’d been pushed from pillar to post by Dr C’s department – due to the ridiculous saga to be seen by them in the first place, then their cancelling an important appointment in July – and that I thought it was unacceptable.

The thing was, I was in a complete state and it sounded more than I was pleading with her than that I was angry with her. I was begging, effectively. My first reaction to her refusal to do anything was one of panicked desperation, and I half broke down, but she merely apologised and said she was too inexperienced to deal with a case like mine. She blamed the department’s failure to have me sitting there with Dr C on a “secretarial error”.

She said, “if you need help in the meantime, you can always get the Crisis Team to…”

Regular readers will know what I think of the CRT. See about three-quarters of the way down here, for example. So you can imagine my response.

“No,” I shrieked. “No, I can’t – they’re useless, they’re crap!”

“Well, they’re always there for you,” she started, but she seemed to realise the futility of continuing in this vein, so she changed tactics and continued by saying, “or your GP.”

She said, “Dr C will talk to your psychologist right away and see you as soon as possible – unfortunately she’s just doesn’t have a window today.”

Seems to be her curtains are always fucking pulled, but anyway – I told Dr A I would be on holiday until 21st September inclusive, so she agreed to organise a new appointment for sometime after the 22nd. I got up then, mumbled some sort of goodbye, and almost literally stumbled out of the building. Some other (male) mental sitting near the door tried to grope me on my way out (the “appointment” was in the psychiatric day hospital, rather than the usual outpatients clinic, so obviously he was ((erroneously?)) recently released from the actual bin).

As I was telling C the following Thursday, another thing of note was the physical environment of the “appointment”. As stated it was in the day hospital, which has much smaller one-to-one consultation rooms than outpatients. This was a problem as there was a window in the door, and I could see the other mentals looking in from time to time. Even worse than this was the fact that the room was near the entrance, meaning that all the others waiting for their cunty day therapy and other patronising OT-esque wank were directly outside the room smoking. Not a problem in itself – except that Dr A neglected to close the window, meaning that everyone else could hear the conversation.

I could have (reluctantly) lived with all of this imbecility if they had done something, but obviously they didn’t.

So anyhow, I went and sat in my car. Recognising that I was unfit to drive, I decided to ring A for cathartic discussion. I cried down the phone to him for about 20 minutes. He was absolutely livid with Dr C and her people. He authoritatively told me not to drive until I’d calmed down considerably, but said when I got back to my mother’s house that I should get her to phone them and kick up a fuss and demand answers – not to mention an actual definite date to see Dr C.

After a while I thought I’d calmed down and left, but I remember bawling my eyes out at times on the way home and practically fell through the door to my mother’s. Initially I was incapable of even rudimentary speech, but eventually I managed to convey a basic version of Dr C’s neglect to my mother.

My mother tried to calm me and I suppose she partially succeeded, because she managed to eventually tear herself away from me for long enough to phone Dr C’s admin department (a suggestion unsolicited by me), who emphatically denied a “secretarial error” but did say they would try and find out what had happened. Apparently the girl Mum spoke to was very nice and she said she would phone back with information later.

Then Mum contacted the GP; the one on call was the (only) one I hate in the ‘surgery’ (I’m indifferent to the others, mostly), because on more than one occasion she has blamed my mental health issues on being overweight. Sure, luv; wouldn’t be anything to do with personal pathology, rape, abandonment, bullying, lies or bereavement. Obviously not. As it happens, I think a lot of my excess weight is caused by depression rather than the other way about; partly because of comfort eating, partly as an annoying side effect of antidepressants. But that’s another issue.

Anyway, let’s call this woman Horrible GP, in contrast to her colleague, Lovely GP, with whom I was due to have a review appointment the next day. My ma outlined the issues involved and Horrible GP asked to speak to me. I refused, but she pushed my mother to get me to talk and thus I started to go mental, screaming that there was no way in hell that I was going to pick up the phone.

Mum said to HGP, “she’s panicking now.”

Query: is “going mental” the same as having a panic attack? I’ve certainly had the latter; for me, a panic attack is much more of a physical problem. Not that that doesn’t affect one mentally, of course, but going mental is almost a reverse course of action. It’s the shit in my mind, racing around in a whirlpool splitting my skull, that causes physical distress, rather than the other way about.

Whatever the case, the long and the short of it was that HGP agreed to provide emergency Valium, as I had left my main stash from my last meeting with LGP at A’s house, on the other side of town.

This agreed, Mum sat down with me again and ranted about Dr C and her negligent behaviour and about how she was thinking of going to the media. About this time, A sent me a text message saying that he was “so angry with these abject cunts” and also suggesting contacting a popular local consumer affairs programme.

Handbags at dawn, dearest readers!

Mum eventually went to get the Diazepam from the pharmacy, at which point I inflicted the self-harm that I posted a photo of, perhaps irresponsibly, here. It’s no big deal, self-mutilation is not uncommon for me as many of you know. It helps. I did it as I perceived the situation as Dr C hating me. Therefore, I was a hateful person. Therefore, that had to be acknowledged somewhere. That’s a logical(-ish) train of thought that wasn’t exactly present at the time, but it was at least the sense of my reasoning.

I bled and bled and bled and then worried that I wouldn’t be able to try and hide the injury from Mum, who has been mostly unaware of my cutting. I managed to bandage myself up, though, and the bleeding was adequately hidden just in time for her return.

I took the Diazepam, and the rest of the day was mostly uneventful. A was good enough to go back to our house, feed the cats and get my tablets, then come and stay with me at Mum’s (I wasn’t allowed to drive due to the Valium). He and Mum spent some time scathing about the morning’s occurrence, and the words “criminal negligence” were used. My mother queried what would actually happen if someone were seriously suicidal, little knowing of course that a few weeks ago, I tried to hang myself. Mind you, I hadn’t told Dr A that either. To be perfectly honest, I didn’t tell her because I had forgotten that I’d tried to hang myself. Who forgets trying to hang themselves?! It’s a good thing I did, though, as there’s always the possibility they’d have sectioned me. I am, after all, a danger to myself at times.

Wednesday: The General Practitioner

The next day I had a very long discussion with LGP (his colleague having related the previous day’s fun and games to him). Appointments are meant to be 10 minutes long, so if you’re the poor sod that was waiting at least 15 minutes after your appointment time, then I apologise. At least it shows LGP cares about his patients, unlike others I can fucking think of.

LGP asked to see the self-harm of the previous day, so I showed him, and in fact gave him the guided tour of the words and slashes that litter the flabby rolls of my abdomen. He appeared to be genuinely affected by this; not freaking out like normals do over this sort of thing, nor angry, but sorry that I was in the position where cutting seemed my best course of action (which I maintain it often is, to be honest). He wasn’t judgemental nor overly worried – he’s obviously aware this is quite normal in mental illness, certainly in BPD and very definitely for me on and off over the years – but just fucking caring. Just nice, supportive and caring.

He showed me the letter Dr C had sent him re: my diagnoses and medication change. I was interested to observe that whilst she wanked on and on about BPD, she had then said that “a differential diagnosis” was bipolar II. I thought a “differential diagnosis” was a diagnosis based on the elimination of most other illnesses based on symptoms presented? If correct, that would suggest to me that bipolar is considered my primary diagnosis, but contextually the letter presented it – as Dr C had done to me in June – as if BPD was my primary pathology. Her whinging about NICE’s mood stabilisers and anti-psychotics in BPD to both LGP and me would seem to confirm that. Can anyone, therefore, clarify the meaning of “differential diagnosis”?

One thing it did say that was moderately encouraging was that she was not totally against the use of mood stabilisers in future. She didn’t make further mention of anti-psychotics, but with regret I am beginning to wonder if I really should have them. (Incidentally, Maisie’s husband was put on an anti-psychotic a few years ago to combat his very severe paranoia. It changed his life for the better almost instantly. You can take a guess as to what I think about that).

LGP wasn’t happy with Dr C as well he might not be. He believes that additional medication (though he didn’t say which) seems appropriate, and furthermore that the dose of Venlafaxine is very low, despite its dodgy side effects. However, he said that he was in an awkward position. He certainly has knowledge of psychiatric illnesses, but he’s no expert, whereas Dr C (supposedly) is. He virtually said that in an ideal world after her lax approach he’d refer me to an alternative specialist, but after all the trouble we had had getting me to one in the first place, he didn’t really see that as a viable option.

That’s fair enough I suppose, although it didn’t help me much. Regardless, LGP has been the only one out of the three main health professionals with which I deal that has been a constant source of support, rather than frustration, so I’ll forgive his reluctance to interfere with the psychiatrist’s domain. We discussed sleeping pills and he suggested I return to Zopiclone over the holiday at least, as it worked for me before and I wouldn’t have to drive on the holiday (prolonged use of it has affected my vision in the past, though not on every occasion on which I’ve taken it). I remembered that he’d given me an inhaler when I was about 14 to help with panic attacks and asked if, in conjunction with the Valium, this would help me when I start to go mental. LGP agreed to provide this inhaler and as I left, after wishing me an enjoyable holiday, he said that if I hadn’t heard from Dr Cunt within the next few weeks, to phone him and he’d get slabbering.

Thursday: The Clinical Psychologist

So the next day’s measure of insanity was with twatting C. We had agreed to spend most of that day’s session discussing coping methods of mentalism on the holiday, and he reiterated that point at the start of the session.

However, he firstly wanted to discuss a few housekeeping issues. The selfish prick chose to take leave the week I came back from Turkey (ie. what would have been today’s session), rather than taking it the same bloody week that I was away.

Is this annoyance on my part unreasonable? Probably, but sometimes I really wonder if mental health professionals, including C, realise the positions of responsibility, authority and trust in which they are placed by their patients. Anyway, at least he’d given me notice of this unfortunate absence before; I sat seething in silent rage as he then explained that the week after that, he’d be on a training course. This means three missed sessions, as opposed to the original expected one.

Fuck. Fuck. FUUUUUCCCKKK!!! Fuck you, C!!! [As it happens, so far I have hardly missed him at all, but (a) there’s still two weeks until the next session so Christ knows what’ll happen between now and then, (b) I’m trying to replicate my frustrations from then rather than my feelings now and (c) whether or not I miss him is not the point. The fact that I am essentially entirely devoid of mental health support for nearly an entire month is the fucking point].

So anyway, C asked was there anything I wanted to bring to the table before we discussed preventing and coping with madness whilst on holiday. I decided to refrain from coming right out and asking him directly if he had spoken to Dr C, and instead enigmatically replied, “has anyone spoken to you about me?”

He furrowed his brow a little and said, “not since I spoke to your psychiatrist, Dr…Dr..,” he searched for her name.

I reminded him, and asked when the conversation to which he was referring took place. It was clear he couldn’t remember exactly, and he eventually replied with something vague like, “a few months ago.”

Great work, Dr C. You and your SHO claim you want to speak to C and see me as soon as possible thereafter. Clearly it was right the fuck up there in your list of priorities.

I nodded at C, feigning casual indifference, eventually cracking under the pressure of his piercing stare of curiosity a few minutes later.

“You won’t be aware of the events of Tuesday, then?”

“It was Tuesday you saw her, wasn’t it?” he asked in all sincerity.

I laughed bitterly and made some vicious snipe about how useful “seeing” her was.

I went on to detail the circumstances in full. Those have all already been reported here so I can omit that part of the discussion from this summary of the meeting. Basically, two issues arose.

Firstly and of foremost interest was that C seemed utterly perplexed by the fact that I had cut myself in the wake of his colleague’s fuck up. Well, aside from the fact that’s a fucking hallmark trait of my illness, you twat, I was going totally up the walls and self-harm – as I have told about 496,960 times – is a quick, simple and effective tool to suppress such spiralling insanity.

OK, SI. Why the need for something so elaborate, then. Perception at time: Dr C hates me. I am hateful. That needs to be acknowledged.

Entirely predictably, C droned on for about 40 years on methods of “distraction” and “grounding myself in the moment”, all this bollocks we visit in a circular motion time and time again. I don’t remember my response to him. I just remember my metaphorical eye-rolling and desire that he’d move the fuck on from this DBT nonsense, because in its simplest form anyway, it doesn’t fucking work.

Anyhow, the second issue arising from the Dr C conversation was what he thought of the treatment meted out to me by Psychiatry. He seemed surprised by the strength of the reactions of A, Mum and (obviously) me, and his expressions and body language suggested, to me, something akin to nonchalance about the situation. Well – maybe ‘nonchalance’ is an unfair word. But I certainly did not get a vibe of overt concern like I had from LGP.

So, I set him a challenge. “If I ask you a straight question,” I began, “will you please give me a straight answer?”

This, of course, garnered a slight non-verbal reaction, because it was a strong inference that he often doesn’t answer straight questions. Well, he doesn’t. If he doesn’t like my directness about that on this occasion, that’s just too bloody bad.

“If I can,” he responded.

Ha! What you mean, C, is if you’re willing. Do you think I’m stupid? Can’t you even plan the answer in a straight fashion?!

I asked him if he thought I was being unreasonable in expecting better from the Health Service. I reminded him that I had been fucked about by Psychiatry from January to May, then fucked about again in July after a serious medication change to a seemingly effective but nonetheless insidious, potentially mind-altering, drug, then fucked about again in September. Was that fair? Was it fair, also, that such carelessness was exhibited vis a vis my privacy in my meeting with Dr A? Whilst acknowledging that to some extent the NHS is ‘free’ to use, was it fair that I had worked since I was 16 (insofar as my illnesses permitted) and will hopefully return to and continue to work until my 60s, thus facilitating the salaries of Dr C and her team via national insurance – only to be treated in this fashion? Was any of that actually fair? Was I being unreasonable?

When he didn’t immediately respond, I pointed out that my enquiry was serious. I genuinely wanted to know if something about my fury, and that of Mum and A, was somehow unjustified.

He eventually started wittering on about it being fair to expect certain standards from a service, regardless of what that service is, and certain frustrations were bound to be evident were those standards – or, more accurately, the expectations of standards (my distinction, based however on what I inferred from what he said) – were not met.

Exasperated, I said, “yes or no – do you think my anger is unreasonable?”

He sort of sighed, then said, “you talked about your main GP as being a good doctor, but the on-call one on Tuesday as being someone you strongly dislike. Dr C is, presently, in your mind, a second ‘bad’ doctor. If I answer ‘no’, I am just another ‘good’ doctor, affirming your present mindset. If I say ‘yes’, then I become a ‘bad’ doctor.”

He was obviously accusing me of black and white thinking, which is generally not a particularly unreasonable view for him to take, but nonetheless I resented every syllable of this fuck. Is what he said not profoundly black and white? Can’t he understand that if he can coherently and reasonably defend his position on the matter that I might have some insight, that if he disagrees with me that I might be able to derive some perspective from that? Oh no. Even in someone with an IQ of 148, it’s apparently as simple as a childlike concept of good v bad, with no room for relativism at all. I might have BPD, but I’m not completely colour-blind to shades of grey.

Rather than lose it with him, I tried to rationally explain my reasoning for my views on the GPs, the subject of his comments that had especially irritated me. My views on both have been developed over years. I first met LGP over 12 years ago. I first met HGP maybe six or seven years ago. I just didn’t meet either of them once or twice and form a view of them. My views on them, and on all other GPs and health professionals I’ve met, are based over time. They can change dramatically or quickly, I’ll admit, but not without very good reason.

In general, that is.

He conceded that perhaps there was more to it than good-doctor-bad-doctor, but pressed, “why self-harm though?”

This was irritating, as I’d already outlined my reasons. I sighed and said something like I wasn’t sure we’d ever see eye to eye on this.

He said, “I wouldn’t be sitting here with you if I didn’t believe you had other coping methods.”

Seeing my eyebrows raise, he added, “…or at least if I didn’t believe that you could develop them. What would be the point in that?”

I don’t recall my thinking now, but I looked him straight in the eye with what I think was some sort of oddly demanding expression and asked in a dark monotone, “are you going to leave me then? You’re going to abandon me?”

Poor C. The man was genuinely stunned. Reflecting on it now, so am I. Talk about adding two and two and getting half a million. There was absolutely no tangible link between expressing that he had hope for me and a suggestion he was going to desist from seeing me. None.

“Where did that come from?!” he exclaimed, mystified.

I honestly don’t remember my answer; I am writing this a fortnight later. I must have said one of two things; either I tried to justify my ridiculous belief that C had suggested he was going to ‘dump’ me, or I immediately apologised and submitted to him. Either way, we ended up in the submissive position, with me predictably following my Attack-Defend-Submit pattern. I said that my comments were clearly bullshit, that I was being daft and he should forget it.

“But it’s obviously something you’re bringing to this room,” C pointed out. “Why is that?”

As can be my won’t at times, I began playing psychologist. Interesting that I refuted any suggestion above that I was childlike, because I remember telling C that that’s exactly what I was. When he asked me why I thought this, I sardonically replied that I wasn’t allowed to intellectualise matters so I couldn’t answer his question.

He laughed and said, with a kind of amused defeatism, “go on then.”

Of course, I couldn’t. This was a PhD qualified clinical psychologist I was talking to. I’m a Wikipedia qualified psychologist. (Actually, I’m underselling myself, as I do have some knowledge of the subject, but it is from some time ago and was not even half as in-depth as a full undergraduate degree, nevermind a doctoral one). For the record, I was thinking of attachment and object relations theories and their roles in transference.

Anyway, my paranoid whining led to a monologue from C about ending therapy. Obviously I’m aware it’s not indefinite, it’s not a permanent fixture in neither his nor my life, aren’t I? But he’d like to assure me – again – that it will never just abruptly end. He envisions a minimum of four sessions of preparation before discharge, probably more, blah de blah.

I just sat there and looked at the floor, struggling to not burst into tears like a bloody newborn, struggling not to get down on my knees and beg him not to leave me to try and make some sense of insanity, my past, my future – my entire damn life – alone. I know I sit here and spout bile about the man and slag him off and call him names – but I do like him despite it all, and I need him and see hope with him and I can’t do it without him – not yet anyhow.

I was utterly overwhelmed by how much I don’t want him to abandon me and how inadequate and feeble I felt because of that. How sad and ridiculous that an intelligent woman of 26 wants a man she doesn’t even know to take the place of her missing father, grandfather and, frankly, friends, given that she only has a few close ones. How pathetic that she is vulnerable like a girl 20+ years her junior, and that she wants this unknown figure to scoop her up and take care of her. It’s so wretched that it’s almost kind of darkly amusing.

He interrupted this self-indulgent and piteous stream of consciousness by asking, “how are you feeling now, in this moment?”

I can return to ranting now. I swear to fucking God that I am sick to death of that phrase. He must surely use it as his meditation mantra. Is there some cadence in it that I’ve missed that makes it an attractive thing to say all the time?

I cleared my throat and said I was fine. He looked at my cynically, but decided against pressing the issue, presumably as there was very little time remaining in the session.

“When Dr C contacts me,” he began, “I can tell her nothing if you want. What we discuss here is confidential. Some people might not be at all comfortable with the idea of a discussion about them behind their back. Others may find it helpful. What’s your take on that? What do you want me to tell her?”

“It is weird to think of the two of you discussing me whilst I’m in absentia,” I admitted. “However, I don’t think that makes it unhelpful.”

I shrugged. “Use your discretion, I suppose. Answer her questions, give her any information you feel is relevant.”

He nodded, and I saw him look at the clock, which to my annoyance he’s moved to behind ‘my’ chair so (I presume) that it’s less obvious to the patient when he checks the time. Which it’s not as you can see his eyes shift above your head. And in any case it was pointless to hide it on this occasion, as he said, “we’ve left very little time to talk about your holiday.”

Oh really, I had no idea, I thought we had six hours. To be honest, I was glad. The preceding minutes had been pretty intense for me and I was tired.

We did conduct a quick and fairly basic discussion on coping if I were to go mental in Turkey, but beyond talking about getting A involved in the techniques, there was nothing new in what was discussed. I did talk about the inhaler from LGP and the Valium, but C kept whinging that these were external sources (oh really? I thought I had them sewn into my oesophagus) and that I needed to develop internal responses. To be honest, I just sat there and nodded, not really agreeing, not really even thinking about what he said, because I just wanted to leave. Not a good thing probably, but there you have it.

As I left, he said, “I hope the holiday goes OK.”

I ranted to A about this later. OK? You hope it is OK?! No “have a nice break” or “I hope you have a great time”?

To my surprise, A defended C. A contends that C had to be careful; had he said he hoped it was “great” or whatever, I would have been too cynical to really believe that he meant it, or that I expected it was possible that the trip could be great. I actually don’t agree that that would have been my view, but in fairness I can see why C might have thought that. So I can forgive his lack of enthusiasm to some extent. I suppose.

Friday: The Flight

OK, the title says ‘three’ days and this is a fourth day, but it doesn’t involve professionals attending to my madness, and in any case I’m not going into too much detail. You can probably tell from the style of writing here and here that I was (hypo)manic on Thursday night. This carried on right into Friday.

I suppose there is an argument that I could simply have been excited about going on holiday, but I don’t think that is the case. Forms of mania are, to me (and as far as I know to diagnostic manuals), different from contentment or excitement, in subtle ways at least. I understand that bipolar II in particular often goes undiagnosed because the hypomania therein often presents simply as an especially good mood. Maybe I seemed in an especially good mood on the Friday of that week, and I probably was, but I was also behaving oddly and saying really stupid shit.

I don’t have the best recollection of it, I’ll admit. I do remember sitting at the departure gate at the airport, delayed, babbling incoherently and in a racing fashion to A. I remember dropping my bag and having some sort of hysterical fit of laughter and more racing speech about this ludicrously uninteresting event. People around me were looking at me as if I was mad (which clearly I was). A found it amusing, and I can understand why it might have been to some – but it is also not ‘normal’; certainly, it was not appropriate behaviour for a public place.

And it very certainly, profoundly and completely wasn’t appropriate for a plane, and luckily I had enough cognisance to realise this. So, for the first and to my credit (?) only time from then to now, I took Valium to space me out and slow me down. It worked, to A’s self-proclaimed disappointment, but obviously it is not a long-term solution to episodes of mania.

Thus began our holiday. I will write in more detail about that shortly; it’s a separate issue from most of this post’s material. However, don’t worry; I’m not going to bore you to death by telling you what we did, what we ate etc etc etc – even if you actually know who I am, such things become dull very quickly. Of course, I keep this diary primarily for my own reasons – but more in relation to my mental health, not ‘normal’ stuff, if there even is any of that presently in my life. No, I want to think about how I felt on the holiday, how I behaved – whether there was an overt exhibition of madness thereon, or whether I actually managed to acquit myself well. I hope to write this tomorrow, but if not hopefully early next week.


When A and I were waiting for the plane, I received a message from my mother stating that a letter had arrived from Psychiatry offering an appointment on Tuesday 15th. LOLOLOLOL. Can’t they get anything right? I clearly told Dr A I would be away until the 21st. Mum rang them for me and whinged some more, pointing out they had not explained the situation as promised to her on the phone on Tuesday. They promptly and without question rearranged the meeting for Tuesday 29th. I am now terrified of it. It’s not great timing either as I have another bloody OH appointment on Thursday 1st October as well, but there’s not much I can do.

So, finally, you’re probably wondering what the reference to ‘genital vinegar’ in the title of this post relates to. It relates to Dr C. In ranting on Twitter, someone responded to me that Dr C was a “vinegar cunted bitch” – or so I thought. It turned out he was actually referring to some bint spreading more “Obama is a Nazi” bollocks in the US, but never mind – the title as one for my psychiatrist stuck.

Obviously there are a lot of ‘C’s in my life anyway. The actual C, CVM, Dr C…I’m sure there are more. Therefore, to avoid confusion and to reflect my current position on Dr C, I shall henceforth refer to her as the Vinegar Cunted Bitch, or VCB. I know I have a terrible penchant for acronyms, and when combined with usage of terms such as ‘BPD’ etc it is bound to get confusing – but I’m not going to start calling C ‘John’ or VCB ‘Dr Alfonso-Smythe-Hetherington VI’ just to anonymise them, so you’ll just have to bear with me. I have to bear with myself, after all.

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Today's Psychiatric Appointment

Saw a new Senior House Officer, Dr A, who listened to how things had been and asked me to explain various specifics. After 20 minutes, she summarised things – missing a lot of points in my view, but I couldn’t be arsed arguing – then went to see Dr C. Dr A said either she or Dr C would come back. Whilst in the waiting room, I saw Dr C calling someone else. As I am scared of her, I was in part pleased she wasn’t going to see me – but I was also outraged that she was abdicating responsibility again.

However, the people she’d be seeing left before anyone came to get me again, so it looked like she might get involved. Alas, Dr A turned up again. After I’d been waiting another half hour.

She said that there had been a “secretarial error” and that Dr C would need to see me, but couldn’t today, how unfortunate, she’d send me out an appointment as soon as possible, things must remain as they are for now, Dr A isn’t experienced enough to deal with a case like mine, Dr C needs to speak to C (um, didn’t you have three months to do that, luv?), must away now SI, we’ll be in touch soon. Byeeeee!

I could go into detail about my response to Dr A, and I will, but for now I think how I feel about the whole thing and how I think they feel about me and indeed how I feel about me is best expressed by a graphic rather than words. It ‘speaks’ louder.

My mother had to phone the GP’s office to get me Valium, as my main ‘stash’ is at A’s. Hey ho, ho fucking hum.

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A (Half-)Life in Therapy: The Fabled Post of Therapists

As any of you who have read this blog since I began it in May will know, it has long since been my intention to write about each of the different therapists of one description or another that I’ve seen over the years. The idea was inspired by the same type of post by Introspective at Conversations with my Head, so hat-tip and thanks to you my dear.

It’s now September, so you can see how successful I’ve been to date in getting around to this. But here I am, finally, with all the fascinating (!) details.

Be warned; this is very, very long. I’d suggest you don’t even bother reading it if you wish to remain awake (possibly alive). If you really want to, try it in two parts or be prepared to be sitting at your screen for a while.

I was about 12 or 13 when I began to think that I had mental health problems. With the benefit of that wonderful thing called hindsight, I can see that I might have been a bit batty even as a child – I was a complete narcissist even then, and once tried to amputate my foot. I was an insomniac and experienced nightly hallucinations. I thought it was normal at the time.

But with the onset of adolescence (though not puberty, for I experienced that mostly in its entirety a bit earlier than most), I began to feel increasingly depressed. I felt hopeless, like my life was worthless, that the future was bleak and dark, that everything was utterly futile. Even I had the sense to recognise this as a bit unusual.

The realisation that I was depressed came one day when we were visiting my grandfather in hospital. In the corridor, there was a sign detailing the diagnostic criteria for a depressive episode. I hadn’t had five of the criteria for a few weeks; I’d had them all for several months.

I remember going back and looking at the poster over and over again, in the hope that my mother would notice that there was something on it that was piquing my interest. I never succeeded in that endeavour, but sooner or later she did, somehow, realise that my marked change in behaviour was quite long term, and off she marched me to the GP. Thus commenced about 12 years, to date, of on-off psychotherapy.

The GPs

Not therapists obviously, but it was of course one of my GPs that initially made the diagnosis of clinical depression; I was aged 14 at the time. To be honest, I think they just gave me a diagnosis and medication just to get rid of me. I am still of the view that I was initially seen as an angsty adolescent that they wanted off their hands. Best to give me Prozac, then say toodle-oo. Except it wasn’t so simple. Mum had me up at the practice more times than enough and eventually they sought the involvement of…

The Counselling Bloke

In all honesty, I remember very little of this guy. I don’t remember his name, and I don’t remember the precise point at which I saw him. I remember that he was a counsellor, of course, but I can’t recall whether he felt I needed more specialist help than he could give me, or whether we just closed the meeting and mutually agreed there was no point in continuing the brief alliance. Whatever the case, I’m fairly sure that I only saw him once, and I found the meeting utterly fruitless.

I do remember what he looked like; he was a short, thin, dark haired bloke, and actually reminds me a bit of C. It’s not beyond the realms of possibility that he in fact was C; although I’m not sure of C’s age, I’m guessing he’s in his mid-thirties. That would make this meeting just on the side of possible; he could have been an undergraduate or new graduate gaining some work experience. Perhaps I am creating a phantom memory, but it doesn’t really matter either way. The meeting was still useless.

The Trainee Child Psychiatrist – Anna

I’m not sure how I ended up with Anna, but it could have been one of two ways. Either the Counselling Bloke referred me, realising I needed more help than he could give, or Mum and I went back whining to the GPs and they eventually referred me. I don’t remember, but it doesn’t matter.

According to Anna herself, so my mother says anyhow, people under the age of 18 aren’t allowed to see psychiatrists. This seems ridiculous and unlikely to me, especially given that Anna – by her own admission – was a “medical doctor” (Mum asked her one day if she had a PhD in psychology), so surely the only mental health specialism of medicine is psychiatry?

Anyway. Whatever the case, she was based at a Child and Adolescent Mental Health Unit and I saw her for quite a few months. I liked her, and despite the bizarre situation and the fact that we never really made any headway, she liked me too (more on that in a minute).

I remember few of the specifics of the psychotherapy. I do remember her giving me stupid, patronising little sheets to fill in. You had to complete the end of the sentence, eg. “I secretly…” or “I really hate…” or whatever. Though in thinking about it, this maybe only happened a couple of times.

I think she was trying some sort of cognitive behavioural approach with me, because I remember thinking at the time that whilst she was well intentioned, her methods were unintentionally condescending (even though she herself wasn’t) and I just knew they were never going to work. I did apply myself to the therapy, though, and tried to work with her, but I never let my guard down and was always very careful in what I said to her. She knew I was bright and I think she actually found me quite entertaining; I remember one incident where I had the woman doubled-over laughing (thanks to some scathing remark I’d made about someone that was intended to be amusing, but I hadn’t predicted just how funny she’d find it).

I don’t remember the exact reason that my sessions with Anna came to a close. We must have agreed to have a break, though I don’t remember that happening exactly. All I do remember is that, whilst I hadn’t seen her for a week or two, I was expecting to see her again, when a little card arrived in the post from her, explaining that she’d been offered a new job on the other side of Northern Ireland and would not be able to see me again. The letter was kind, stating that she’d enjoyed working with me and wished me all the best for the future.

I wished her well and fully understood her reasons for moving on. Our therapy hadn’t much worked anyway, but nevertheless here I was left high and dry again.

The Education and Welfare Officer – Elaine

Actually, I’m not sure whether it was Elaine or Lorraine, but I’m going to go with Elaine as it’s quicker to type.

Elaine wasn’t a traditional psychotherapist; she was actually a social worker attached to the local education board, and was involved in my situation as – owing to my mental health problems – I missed a lot of school. Nevertheless, our relationship became one that more closely resembled a therapeutic one; she was more like a counsellor than someone involved to keep tabs on me. I would meet her each week on a Thursday – it was during GCSE Maths which of course was especially gratifying 🙂

As is the wont of social workers, especially (though not limited to) those not directly trained in managing mental health issues (or so I’d imagine), Elaine’s discussions with me would centre around practical measures I could take to help myself, rather than an psychoanalytical exploration.

Although she wasn’t much like Anna in her actual therapeutic approach, she was to some extent in her reaction to me: I distinctly got the impression she recognised that I was not being deliberately awkward as some of my teachers believed, and that she believed that I was a bright, not unpleasant kid, with some genuine difficulties. She liked me. I would take her in photographs of events I’d been at the odd time and she’d always compliment me on how well I looked in them. She took me out to lunch a couple of times as well. She was the only one (other than my best friend D) to whom I would show my prolific self-inflicted injuries (which were more than just silly little cuts, but long, occasionally complex words all over my body). I don’t remember whether Anna ever asked to see them or whether I just avoided it with her, but I’m pretty sure she never saw any of it.

I don’t remember, again, the exact reason why this relationship came to a close. I don’t think Elaine left her position; I think it must’ve been something to do with me taking my GCSEs and therefore potentially leaving school, and ergo, her remit. As it happens, despite my previous intentions, in the end I elected to return to school for sixth form, but by the time I got to that stage, things were more (not entirely, but more) settled anyway.

It was during my time with Elaine that I seriously tried to kill myself (the first attempt, a gesture in retrospect, had been about a year beforehand, catalysed by a break-up with a boyfriend). On this occasion, although I decided upon doing it on a whim, it was something I had been thinking about for a long time and I really intended to die. I took a massive overdose of everything I could find in the house – paracetamol, ibroprufen, various prescription medicines of my mother’s, my Prozac etc etc – thinking it would be enough to off me (I know better now, but I genuinely believed it would kill me then).

I am reminded that my time with Anna and Elaine must’ve overlapped, because I now recall Anna coming to see me the next day in hospital, after I’d had my stomach pumped. When I went back to school the next week, Elaine took me out for lunch. I remember asking her why she was rewarding my behaviour; she responded that she didn’t feel that she was ‘rewarding’ it, but she was upset that I had felt so desperate that I’d seriously tried to kill myself, and she wanted to do something to cheer me up. Well, as anyone who’s been there knows, it takes more than skiving off school for lunch – but I appreciated the gesture, as well as the rest of her tenure as my EWO.

It actually pains me to write about Elaine, because it reminds me very acutely of what was probably the bleakest period to date in my life. It was only through thinking about what I was going to write about on this post that so much came flooding back to me; clearly I had compartmentalised much of it (I was whinging about this to bourach here recently). In a way, one could argue that this past year of my life (ie. 2008 – 2009) has been even worse in the sense that I have experienced a lot more than ‘just’ depression, and that would most assuredly be true. But now, at least, I have a support network, and a network that understands this whole mess is not something of my choosing. I very distinctly didn’t have such support when I was 15/16. I had a few friends, yes, but with the best will in the world it was hard for them, not having been there, to understand a disease so often (and often unfairly) solely associated with adults (I’m not even sure they’d understand it then, but anyway). Although she recognised that I was mentally ill, my mother couldn’t fully grasp the enormity of my despair either, and reacted aggressively to my illness at times, although in fairness she did champion me a lot with the GPs/counsellors etc. I was picked on by a couple of teachers too, though in fairness there were a few good ones. All in all, it was a horribly dark period in my life, and rather than discuss the specifics thereof, I think I’ll just leave it be. Maybe another day.

After doing my GCSEs I existed in a relatively sane frame of mind for a while. My dosage of Prozac had been upped, and a lot of the wankers that had made my life so miserable at school had either left or had grown up a bit. Additionally, I was only having to do subjects I liked and was good at for A Level, so things were a lot more settled for a while. Things were far from perfect; I continued to miss a lot of school, and didn’t do as well in my A Levels as I could have done – but things were certainly better in those two years than they had been in the previous five. In fact, it is only through writing the above about Elaine that I am shown how much I wear rose-tinted glasses regarding school. I tend to be quite defensive of the place should anyone slag it off, and when I think back upon my time there in an abstract sense, I am sometimes overcome with fond nostalgia – this is based almost entirely on not absolutely hating those two years of sixth form. Clearly at least part of me blocks out the unbearable misery that were the preceding five years.

But anyway, that obviously didn’t spell the end to the madness…

The First Assessment Woman

I’m not sure when this was. After sitting my GCSEs, the next time I really remember losing it big style was when I was doing my postgraduate course, but I’m fairly sure the First Assessment Woman was earlier than that. Perhaps I had been feeling low for a while in sixth form (or whilst I was an undergraduate) and had yet again been at the GPs’ ‘surgery’; given my history, they might have referred me to the Psychological Therapies people. Who knows. Whatever the case, I went to see this woman at the same hospital in which I now see C and Dr C.

I believe the meeting was intended to assess what the most appropriate psychological treatment would be for me given my history. It was, short of the Crisis Response Team (see below), the most useless and frustrating mental health-related meeting I have ever had. The woman quite openly sneered at me as I tried to relate some very difficult information to her. I think it was because I expressed everything with a distinct absence of emotion and she therefore didn’t think there was actually much wrong with me (or such was my impression, anyway).

When I related a very abstruse outline of the sexual abuse, she decided that that alone must be the entire cause of my problems and gave me the number of the local Nexus Institute. I remember protesting that I didn’t want to phone someone (so clearly the phone phobia has been ongoing for a good while then) but she dismissively said it could be in confidence “if I wished” (thus totally missing the point) or that I could see them in person, if I preferred, and that that was all, I was to run along now. I didn’t have the energy to argue with her and that was that.

I had a major breakdown whilst undertaking my postgraduate degree. I had, at this point, only the dissertation left to write and had finished the taught part of the Masters programme, so took a full-time job which looked to be like a very good opportunity, and which was, unlike my previous and subsequent jobs, directly related to my academic background.

Unfortunately, I had been in a slow, but with hindsight obvious, downward spiral, largely thanks to my own doing. I had been feeling pretty good during my postgraduate year, so cut back on my Prozac without medical approval. DO NOT EVER DO THIS!!! By the time I realised I needed to remain on the dose I’d been at, the spiral had already taken its grip and the return to the full dose didn’t make a difference.

In fairness to myself, it would probably have happened sooner or later anyway, because at no point had I seriously tackled the underlying causes of my mental health difficulties – surely a recipe for disaster. It’s one thing to be aware of what they are, but it’s different to fully face them and be aware of all the subtleties therein. To mitigate their effects, or at least begin to reverse them, in my view I need to do this. Of course it had been my choice to never get into this detail, as I’d already seen a number of different ‘therapists’ by this point and had failed to utilise the opportunities presented. On the other hand, until you’ve been there, it’s impossible to understand how difficult this is, and how skilled a therapist needs to be to get it out of someone with so many defensive walls built around them, like me.

Anyhow, as ever, I digress. The breakdown meant I lasted a sum total of one week in my new job, and eventually had to leave my course with a postgraduate diploma rather than a Masters degree.

I returned to my GP. LGP had joined the practice by this point, but I didn’t see him consistently until more recently; it’s dog eat dog in our practice, and you take who you get unless you’ve planned the appointment for weeks. So I went to another one, who simply told me to “fight against it”. Unsatisfied with this, I went to the practice’s Nurse Practitioner, who prescribed me a new anti-depressant – Mirtazapine (in part because it’s good for insomnia) – and referred me for wanky CBT. I saw ‘wanky’ now, but I was hopeful at the time.

The Second Assessment Woman

She was a CBT Nurse at one of the main bins in Northern Ireland. She was certainly better than the first bint of her ilk (see above), although I disagreed with her ultimate conclusion. I remember that she asked me the one question that every single one of them has consistently asked me: “don’t you have any female friends?”

I said that I didn’t like other women, adding, remembering her gender, that I meant “no offence” to her. (To qualify this a bit, I generally don’t get on well with other women in real life, though I felt more harsh about this at the time than I now do. Online, this isn’t the case at all – most of my online friends are women. I do have one real life female friend at the minute, so maybe I’m making progress! It all goes back to a terrible case of black and white thinking; because many women express emotion, want children and dream of white weddings, stuff I hate, I behave like I think they all do. Rationally of course I don’t think that at all, but then rationality and I are not always the best of friends, regardless of my desires to the contrary).

Anyway, Assessment Woman Two listened to me and, in fairness, seemed non-judgemental and accepting of the fact that there was something wrong. She did seem puzzled by my customary lack of emotion and even apparent amusement at some stuff, but she let it pass. Her conclusion was to refer me for group CBT. I protested vehemently against this – I was terrified of the group thing. The woman said, though, that she felt it would be beneficial in two ways: (1) the waiting list was shorter for group therapy than individual therapy and (2) it would help me confront my fear of group situations face-on. I reluctantly agreed.

The Psychoanalyst – Ian

As the waiting list for even the group CBT was six months, I went back to my GP’s ‘surgery’ and asked for a recommendation for a private therapist in the meantime. The physician I saw that day suggested Ian.

Ian was a very well regarded psychologist who’d even practiced as a forensic psychologist. Without detailing my academic background too much, this appealed to me strongly at an intellectual level and although he charged £70 per hour, I was happy to ‘try’ him.

I liked Ian. In a way, he reminds of me of C, the psychologist I now see; he was qualified to PhD level in his discipline, was clearly intelligent and astute, and seemed to be able to read my mind.

It was he who first suggested to me that my narcissism was an elaborate defence mechanism, built up over the years to disguise inherent and strong self-dislike. I remember arguing, “but I genuinely do think I’m better than some people,” and him responding by saying, “you genuinely think that you think you do, yes.”

We did discuss some of the stuff that effected me as a youngster, but although this was closer to psychoanalysis than any other therapeutic situation in which I’ve been, he was still primarily interested in here-and-now of my psychology. I believe that this was not because he wasn’t intending to explore everything else in more depth, but because if he had an understanding of what was now the case, it would allow him to work backwards. C did something similar, but has a more structured approach.

Again, though, my whole ‘lack of emotion’ thing was pronounced and perhaps he therefore didn’t realise how serious the situation was, or at least was becoming. Furthermore, if I am entirely honest the whole thing was kind of like an extended intellectual discussion between two parties interested in the way people’s minds work. To this end, I don’t feel that it was necessarily a particularly helpful relationship, even if it was an interesting one.

I think Ian could perhaps have helped me had I allowed him to break down more barriers, but then again, just because we liked each other at an intellectual level doesn’t mean that we ‘clicked’ especially; I don’t think we did, and there is increasing evidence suggesting that the dynamic of the therapeutic relationship is what allows the most useful and effective type of work to be done (see here or here, for example).

I went maybe five or six times, approximately every fortnight, though it became progressively less frequent as time went on. Aware that I wasn’t working, Ian suggested that I do some reading and practical things, and suggested I came back in a couple of months to save myself some money. In fairness, he did genuinely seem to want to provide me with a value for money service.

I didn’t go back, but not because I just gave up.

The Hypnotherapist – Edith

Having heard that I was paying out £70 per hour, the McF dynasty decided to get involved, recommending a hypnotherapist that S and her daughter Suzanne had both gone to, finding her effective and more reasonably priced than Ian at £70 for two hours. I must confess that I was cynical, but my mother offered to pay for the treatment so I thought, “what the hell?” My intention was to have it compliment the work with Ian, rather than replace it, and for a short while nearing the end of my contact with Ian, the two did overlap.

Edith was the sweetest, most gentle woman you’re ever likely to meet. She oozed empathy and sympathy and absolutely tried her level best.

For my part, I did open up to her, but still in a pretty detached sort of way. For instance, I remember one discussion in which I was supposedly hypnotised where she was “regressing” me to my childhood. She asked if I could see the little SI in my mind’s eye, and I said that I could. There was a conversation about the kid’s actions, behaviours – I don’t remember it fully, but in any case, despite outward appearances, it became apparent that Child Me was probably not very happy. Big SI was very bad and said that she didn’t care that her mini-me was somehow unhappy. Edith said, “doesn’t she need to play? Shouldn’t she be enjoying these years of her life?”

I can’t remember my exact response, but it was certainly a definitive no. She kept pressing the issue – “but can’t you empathise with that little girl, that innocent child” blah blah blah – but no matter what way she tweaked it, or however she phrased it, I didn’t like Child Me and did not empathise with her. Edith kept trying and trying to instill empathy in my unconscious, but it never worked.

I’ve always wondered if I was completely hypnotised anyway. Whilst I obviously recognise that hypnosis is generally not like you see on the Paul McKenna show or whatever, but that it is rather just a heightened state of relaxation, my experience in Edith’s was distinctly different to both that of S and Suzanne. S in particular had found that her body took on the characteristics of her abusive ex-husband – she spoke in his voice, she lashed out a couple of times and emulated his stature. Suzanne hadn’t quite such an intense experience, but more so than I had, and neither remember much of it, whereas I remember a lot of it quite clearly (and anything I don’t recall is more to do with the passing of time rather than the hypnosis bit, I think).

I’m not faulting Edith; if I wasn’t hypnotised, then it is probably because I resisted it. I don’t know about the accuracy of the claim that some people can’t be hypnotised – maybe that’s part of it? But still, once more, I wasn’t fully willing to confront everything in detail. Again, yes, this is arguably stupid, but I still utterly despised the notion of expressing emotions (I still do) and was incredibly defensive.

One issue of difficulty was that I had to point blank lie about McMF-paedo-fuck to Edith. This is because she lives close to the McFs, and of course she treated Maisie’s husband’s daughter and granddaughter. Although I have more than one uncle that is still alive (and did then too), it would just have been too awkward to admit that it was an uncle. She did directly ask me who was responsible, so had I said, “my uncle,” there was nothing to stop her from asking which one. I therefore had to lie and say it was the husband of a friend of my Mum’s. This meant having to remain on guard about this issue a lot, which no doubt didn’t help the hypnotherapuetic process.

Having said all that, Edith must have done me some good. One thing she did do was set anchors, though as far as I know this is as much about neurolinguistic programming (NLP) as hypnosis. Occasionally I’ll still grab my wrist in a certain way to try and calm myself – that was one of the anchors.

Whether it was partly this, or partly expunging myself each week to her in general, even if still in a detached way, something must have helped in some way, because it was after seeing Edith for a few months that I started looking for work again.

(For the record – when I got a job, thinking I was back on track, I didn’t return to Ian. I did eventually receive a notification to attend a CBT session back at Holywell, but it was in the mornings, and that clashed with work, though as I was part-time back then, afternoons were ‘do-able’. I let Holywell know this, but was told that the group sessions only took place in the mornings and that therefore I’d have to wait another while for individual therapy. I never heard from them again).

A initially advised me against going to the four interviews I got at this point, as I would totally lose it each morning before the interview of that day. But I somehow forced myself to go to them all, and in the end was offered two of the four positions (I had temped briefly at the full-time one, and had other experience in the area, so no doubt that helped). Ultimately, I took the part-time one, because (a) I felt really encouraged by the staff I’d met at my interview, (b) it was in part working with animals and (c) I felt that a part-time position would be a better way to ease myself back into work.

Unfortunately, it didn’t entirely work out well, as despite appearances some of the staff weren’t quite so nice – but that’s another story. I did keep in touch with two of my colleagues from there (AC and DL), and thus am still grateful for the experience. Anyhow, I applied for another part-time job, got it, then a few months later got promoted to a more senior and full-time job. This is my ‘current’ job.

Things were fine for about a year, though the year had many stresses – V’s death and the will fiasco, a change of manager, a lot of stresses in the job itself that really shouldn’t have happened. Eventually, I was becoming increasingly agitated and depressed, and even dreading going to meetings as I knew I would only have a pile of extra work laid at my door, when it wasn’t possible to do any more. I was becoming increasingly neurotic and disillusioned with life in general, and one day I cracked and rang my mother in tears, begging her to put an appointment on with the bloody GPs the next day.

This she did, and that was the last day I was in work.

The Crisis Response Team (CRT)

I initially saw the Nurse Practitioner that day but when she heard I wanted to die and I couldn’t see a future for myself (amongst other things), she said, “you know, you’re really ill,” and decided to involve one of the partners in the practice.

He, in turn, decided that I needed to urgently see specialist mental health professionals and arranged for someone to come out to my house that day.

I am not sure that I have enough pejorative terms for the two women that turned up. Whilst the first one was friendly enough, when the other (apparently the more senior) one took over, she was incredibly passive and didn’t stand up for me, so I hold her as well as her colleague culpable for my annoyance.

Despite outlining how unbearably bad I felt, despite trying to tell them why, despite all the efforts I made to convey the longevity and seriousness of my condition to them, the more senior woman said I should “perhaps try meditation”. I actually laughed, thinking this was some sort of twisted piss-take, but her facial expression conveyed the information adequately that she was not joking. For the record, I have no problem with meditation, but don’t believe it’s a substitute for proven medical intervention.

She continued by asking me to analyse a scenario. Bloke A is in the park with his six brats running around screaming and doing my head in. What’s my reaction? “That Bloke A should die.”

“Alright,” she said, “now assume you approach Bloke A and tell him to shut his children up, and he apologises to you and says it’s just that his wife died that morning. What’s your reaction now?”

“My reaction is that while I am sorry for his loss, Bloke A should die.”

She looked puzzled and said, “but don’t you see that there are different ways of looking at things?”

“Yes,” I said, “I’m not stupid. What is your point?”

Apparently I was not recognising that there was an alternative viewpoint to the behaviour of Bloke A’s children and his inability (or unwillingness) to discipline them.

“That is incorrect,” I protested. “I do accept that there’s an alternative viewpoint. I still think he should die as his grief isn’t my problem. In fact, I’m offended on behalf of his wife. Shouldn’t he be taking his kids to see her parents or something? Or, in an alternative viewpoint, let’s assume the wife’s parents are dead – surely she has some family? Shouldn’t he be engaging with them and sharing grief? Or if he needed to be alone, why isn’t he alone? I appreciate that it’s possible that neither he nor his wife have any friends, family nor colleagues, but I think even you’d agree that that’s unlikely.”

But apparently I still missed the point.

After a long and protracted argument, about the above scenario, meditation and other issues, I admitted defeat and told the two of them that I was disgusted that my national insurance went towards their salaries.

This comment was ignored and they agreed to refer me to a…take a guess…wow-ee, a CBT therapist! Deja vu, anyone?

As they left, they told me it was “lovely” to have met me (so they’re liars as well as morons). Perhaps needless to say, I didn’t return the ‘compliment’.

The Cognitive Behavioural Therapist – Margaret

Given my previous experience of CBT therapists twatting about, I knew if the dumb bints from the CRT even did refer me (which it turned out they hadn’t), that I’d be waiting a while for it, so back I went to one of the GPs, and again asked for advice on a private therapist, though this time I specified that I wanted to try CBT rather than psychoanalysis.

Enter Margaret, at £90 an hour.

Although I liked her as a person, it was Margaret that gave me my intensely negative view of CBT. Initially, I was cautiously optimistic, but it didn’t last. As is apparently typical in CBT, now that I’ve read about the process more in-depth, she would have me analyse the likelihood of a perceived negative event. As a very rudimentary example, someone I know walks past me in the street without speaking to me. I can (a) assume (s)he hates me or (b) rationalise it – maybe (s)he didn’t have her glasses on, maybe (s)he was on his/her mobile, maybe they’re depressed.

Um…so? I know there are a million other explanations and I know that it is almost certainly not about me unless there has been a very clear reason for that, such as an argument. I already fucking know all that, I don’t need anyone to patronise me about it. The question is how does one really believe it? When I asked Margaret that, she said you just have to have an evidential base for the belief, which tallies with the literature on the subject, but that’s bullshit in my view as it’s already been recognised as utterly irrational by me; I already see and recognise that evidential base, but it’s doesn’t stop me from believing that the worst case scenario is the case, even if I don’t rationally believe it. If that makes any sense.

Another technique would be to directly face that which is most feared. As an example of this, I told her that I was freaking out about an interview for a job for which I’d applied, and she said I must go, as exposure to the event would be helpful.

I ended up in LGP’s office having gone totally batshit, and he gave me Diazepam for the first time.

In fact, I actually did go to this interview, and of course it didn’t go badly (in the sense that the panel weren’t Satan Incarnate; it did go badly in the sense that they were looking for someone much more qualified than me). But I already knew it would never be as bad as my panic was making it out to be. This happened another few times – I would utterly and completely lose it, even though I knew it could almost certainly not be as bad as my losing it would suggest. It doesn’t matter than I’m rationally aware of probable realities. It doesn’t matter that I know the worst that can happen is that the interview panel don’t like me or that I don’t get the job, and it doesn’t matter that neither of these things are likely to matter in the grand scheme of things.

I still fucking go mental when I’m under stress, or sometimes (mostly, actually) ‘just because’. Furthermore, in the case of the latter, I am not losing it because of any specific reason – as such, how can I rationalise what I fear? I mean, I don’t (consciously) know what the fear is in those moments. Even if I did, I already know anything a CBT-like approach could teach me.

Although I liked Margaret, I became increasingly disillusioned with the CBT approach, not to mention the fact that I was beginning to get into horrific debt – meaning that her employer’s ludicrously high charges were too much for me to pay. So that was the end of that.

My mother happened to be seeing the Nurse Practitioner at the GPs’ ‘surgery’ on an unrelated matter. The Nurse asked how I was getting on, and my mother said that things were not good. Upon a brief glance at my records, the Nurse saw that no referral had been made for me by the CRT for psychotherapy (I knew they were incompetent).

The Nurse therefore took it upon herself to make a referral. Fortunately for me, though, she cocked it up and didn’t make it specifically for CBT, like it was meant to have been when the bitches from CRT decided upon it.

I was really struggling during this period, and at my behest, had my medication changed to 40mg of Citalopram daily, which is the highest dose they were prepared to give me. It was at this juncture that the GP I saw decided to refer me to a psychiatrist, on top of the Nurse Practitioner’s referal to a psychologist. I finally saw her about five months later, despite the fact the waiting list was less than three months at the time. Contextual links follow later.

It was somewhere after my CBT with Margaret than I began to believe I probably had more than ‘just’ clinical depression and anxiety. I didn’t really investigate anything further at the time, but I recognised that for a while I’d been experiencing a wider set of symptoms. I assumed, rightly as it turned out, that seeing a psychiatrist would shed some light on this.

A relatively short period after my mother’s appointment with the Nurse Practitioner, I received a questionnaire through the post asking me to outline my psychological difficulties to help cut waiting times for a psychologist. I was prompt and, I hope, thorough in my completion of this document.

Some weeks later, I received a letter from the same hospital in which I’d seen the first assessment woman, asking me to attend an assessment with Dr C J, a clinical psychologist. Mum and I were both raging, as we wondered how many more fucking assessments it would take before they actually offered treatment? In both of my previous assessments, I then was simply moved to a waiting list for whatever the treatment deemed appropriate was. Still, I went along, because one has to do things the way the NHS wants.

The Multi-Disciplinary Psychologist – C

I’m not giving his first name. I’ve already told him I’ll keep all references to him here anonymous, and even though his first name wouldn’t give away his identity exactly, there’s always the chance that someone who doesn’t already know may find out who I am and work it out from there.

The ‘assessment’ session with C ended up turning into three assessment sessions, because he actually took the fucking time to discuss each of the points raised in the aforementioned questionnaire in detail with me. Surely he must have been breaking NHS protocol by actually taking his time over it?

I didn’t know what to make of him at first. His intellect was obvious, and I respected that, but there was something indefinable about him that I found quite irritating. Nonetheless, when I told him I thought CBT was a load of crap, even though I wasn’t a psychological expert, he accepted that and said that I was certainly the expert in myself, and that if that didn’t work for me, then it didn’t.

By the end of the three sessions, whatever it was that irritated me about the man was beginning to abate, and when he said that he would continue to treat me, rather than someone else, I was glad. We initially agreed to six weeks (his optimistic suggestion), shockingly commencing the following week! Progress at last. He did warn that although it might be mutually attractive, we couldn’t let our sessions become some sort of intellectual endeavour (as had been the case with Ian, though C is not entirely familiar with all that). I did stress that I couldn’t abide being talked down to, nor could I bear to not communicate comfortably because I had to ‘dumb down’ what I was saying. C accepted that and stated that he would be glad to have an intelligent dialogue with me, but it wasn’t to become a discussion of my issues as a psychological abstract; it still had to be directly about me. Given my narcissism, I was happy enough to acquiesce to this.

During those first six weeks, I began to grow from being pretty indifferent to him, to becoming really rather fond of him. He seemed to have got the mix right between employing intelligence and empathy in his approach – this is a position I still maintain about him. At the end of those first six weeks, I burst into tears in his office and begged him not to abandon me, as he was the first therapist to really ‘get’ me out of the many I’ve seen. We agreed to another 10 weeks at that stage, and when those came to an end, another 12 (of which we have presently had two sessions, with the third tomorrow). I see him once a week, first thing on Thursday mornings.

Perhaps because of his balance between intellect and empathy, rather than just one of them being in evidence, I have opened up considerably to him and have even shown the dreaded emotion, though I still curb it to some extent a lot of the time. I’ve told him stuff I’ve told no other living being.

In essence the therapy is mainly psychodynamic, though he has tried – usually to my annoyance – to bring stuff like DBT into the mix. His rationale is fair; psychodynamnic exploration is important, but when I lose it I need practical help too. I’m still dubious about DBT, but at least it has an ancient philosophical background which CBT doesn’t.

The main thing I’d say about my relationship with C is that there is a bond between us now. I am horribly attached to him, and whilst I won’t delude myself into pretending that he returns that attachment, I do think he likes and gives a damn about me. He is the first of all of these people that I have actually experienced transference towards, which is demonstrative of the fact that my psychotherapy with him just might be the vehicle I need to a recovery of sorts, as of course the phenomenon is generally expected to manifest if the therapy is to have any hope. Transference does cause me to get annoyed with him over very little at times. He causes me to get annoyed with him at times; the way he’ll avoid a question infuriates me, but this is him trying to avoid getting into a intellectual discourse with me, for the most part.

But all this transference, bonding etc is not to say that the process is fun; quite the opposite. It’s intense, overwhelmingly so at times. It often (ironically) depresses or angers me, saddens me, has made me lose it a couple of times. Even though I’ve opened up to him on many issues, I am still incredibly defensive and tend to (figuratively) run away if he hits a nerve. Yet somehow he manages to get most of it out of me eventually, showing his subtle but evident skill. I always crack up though. But then I always expected that things would get worse before they got better, because I have not faced any of my ‘baggage’ in any real depth before.

Overall, it’s possibly the most difficult sustained experience I have ever been through, but nonetheless, I think the relationship is a very good one, and despite the regression in my condition since I met him, in conjunction with his colleagues in Psychiatry, I have a glimmer of hope that, over time, C may be able to help me get some control back over my life.

The Psychiatrist – Dr C

Again, no names. In this case I don’t even know their first names anyway.

Obviously she’s not a psychotherapist and exists mainly to monitor my illnesses from a medical point of view. But I want to hat-tip her anyway, for providing my diagnoses back in June. Dr C also changed my medication to Venlafaxine on that occasion, but was open to the possibility of adding further medication to the cocktail should it prove necessary.

Unfortunately it took a hell of a lot of trouble to finally get to see her (it was only in discussing self-harm and suicide ideation with C that I was ever seen by them) and now that I have met her, it apparently takes a lot to continue to be seen on a regular basis. Basically, I feel fucked over by her, just like I have been by the NHS on several occasions, but meh. I ought to be used to it.

At least, though, when she does bother to show up, she seems to be willing to tackle my case in a straight-up fashion and to do something that might actually have something like a positive effect, so in conjunction with C, I have my fingers cautiously crossed.

So there you have it. The life of the Serial Insomniac through therapy. I realise that I have whinged an awful lot in the early part of this post that people kept attributing my madness to teenage angst. For what it’s worth, I do understand why this was thought to be the case, for the laypeople anyway, and I am working towards letting go of my anger in that regard, though it’s not easy.

It is only now, about 14 years after first really feeling that there was something psychologically wrong with me and about 13 after seeing someone about it, that I feel I might actually be finally moving in the right direction.

I expect it to be a slow process, but I’d rather have that than have no hope of regaining control at all.

Apparently BPD has a decent prognosis in the right circumstances, though I certainly won’t hold my breath. Bipolar disorder has no known cure. Either way, I’m not asking for ‘cures’. I accepted years ago that I will probably be on medication for the rest of my life; I am fine with that, and I am not against some sort of semi-regular ‘top-up’ psychotherapy after completing my main course, if that is what is required. Cures are not what I seek, as discussed in more detail here and here.

But I do want to be able to at least be functional, and I do hope that with C’s help, maybe – just maybe – I might be able to regain enough control to achieve that. I don’t know. The journey will continue to play out on this blog.

Lucky you, dear reader. If you’re still reading this post, then I’m amazed and don’t understand how you’ve not passed out or even died of boredom. Even by my verbose standards, this is fucking long. So, until ‘C: Week 23’, so long.

I Hate Psychiatrists

So, after my grovelling apology and new-found respect for Dr C back in June, the current behaviour of her and her team has reinforced to me why I thought they were shit in the first place.

I was supposed to be seeing Dr C next Tuesday, so as she could review how the change to Venlafaxine was affecting me.  Regular readers will know that I’ve gone completely fucking mental since I changed to them, as demonstrated in just about all my posts in the last few weeks, but especially here and here.  Dr C, or perhaps more accurately her bint secretary, had already changed my appointment time several times.  This was irritating, but meh; as long as they were to see me, I could live with it.

Well, a letter arrived on Friday from their office stating that whilst they “apologised for the inconvenience”, the outpatient clinic had been cancelled and that an appointment had been rearranged for 8 September.  September.  What the fucking fuck?

I went to ring them but instead of being able to type their number into my phone I just ended up panicking and ultimately throwing it across the room.  Eventually I got my mother to phone the bint secretary for me.

The bint told her that the clinic wouldn’t have even been with Dr C in the first place.  My mother didn’t get the name, but it sounded like it was Dr N, the SHO I met the first time I went to psychiatric outpatients.  That wouldn’t have been ideal, but I could have lived with it.  But anyway, Dr N has cancelled her clinic.  Just like that, apparently, and no more reason was given.

Alright, my ma went on.  But SI is climbing the walls and would really need to speak to Dr C.

But that isn’t possible, apparently, since Dr C is on holiday.  For “quite a while”.

And in the meantime?

September is literally the first appointment available, so that’s too bad really, oh how regrettable, but that’s the way it is.  If there are any cancellations, they’ll apparently phone me.  Yeah, right.


Go fuck yourselves, one and all in psychiatry on the NHS.  Fucking bastarding cuntflapped bollockheads.

No wonder I don’t want to be hospitalised, if this is the standard of care one can expect.  Mental health professionals don’t care about mentals, clearly.

I got off the phone with my ma and threw my head at the wall with such force that I literally fell backwards, and very nearly knocked myself out.  I sat down again, got back up, sat down, got up, paced, sat down, paced some more and eventually ended up in the kitchen looking for the knife.  I then went and re-carved the word ‘HATE’ across my tummy, about which I wrote here.

That action having been completed, I sat on the sofa with the knife for a while wailing and sobbing in utter desolation.  (For what it’s worth, after a fairly short while I felt a lot better, proving that self-harm does indeed work).

It’s like the conversation I had with C on Thursday.  I don’t think I’m being taken seriously by the NHS.  I really don’t.  I would love to have the nerve to make a suicidal gesture and that would fucking show them.  Even better, I’d love to actually be successful in catching the bus and then the cunts would face a potential lawsuit and be forced to apologise to my family and friends and shit.  But as of right now, obviously, I don’t have the nerve.

Everyone is commenting that these tablets don’t seem to be good for me.  As I detailed here, if they are creating mixed episodes (which they are), then the apparent way of treating this is to add mood stabilisers to the medication cocktail.

How the fuck am I meant to get these if the psychiatrist refuses to fucking see me for months?  My GP can, theoretically, prescribe them, but of course he’s not the expert that Dr C supposedly is.  She would know if the mixed episodes are caused directly by the Venlafaxine, or whether it’s something else.  She would know whether she should change me to another anti-depressant, or whether adding mood stabilisers on top of Venlafaxine would be the best answer.  I am not sure that Lovely GP has this in-depth knowledge.  As CVM (a registered nurse) said to me, he went to university for five years and then trained as a GP thereafter, so he damn well should be able to know – but, simply, he doesn’t have the same knowledge and specialist experience than Dr C and her ilk are reputed to have.  Still, I may go and see him anyway.

I am convinced that C could get them to take notice (it turned out that it was him rather than Lovely GP that did in the first place), but of course there is no C this week 😦  I will have to rant about it to him next week before he then goes away for two weeks 😦 😦

Additional worries:

  • Georgie is on this landmass.  In fact, she is – until her departure next week – never more than about 40 miles away.  I feel violated.  I wonder, despite my request for her not to, how much back-chat she has engaged in about me?
  • Fucking occupational health tomorrow 😦  Panic panic panic panic panic panic
  • Because of the shrinks wanking about, it is almost certain that I will lose my job now.  If they’d see me as planned next week then I might have been able to get a solution to my present situation fairly quickly.  Given that I am now likely to continue feeling this fucked up until at least September, about the time work are expecting me back, I really cannot see how the situation can be resolved.  I didn’t realistically think it could have been anyway, but it was possible, and now the chances of not getting dismissed are low to infinitesimal.
  • The effects of my mentalism on poor A (I went mental again on Saturday, though it was remarkably less severe than the previous couple of weeks).
  • The fact that some people are still unwilling to try and understand that this is not something that I can help, that I could end being mental by “changing my thoughts” (ha!), and decide to tell me what I should and shouldn’t do about it and how I should count my blessings.  Never thought of that or anything, thanks.

I’m not totally losing it today, but things do seem pointless and bleak.  Nevertheless, that’s a fairly default position for me, so I suppose it’s progress from going totally off my head.

Well, I will report back on the occupational health tomorrow.  Can’t wait…!

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I Love Psychiatry!

A bit of a turn up for the books, this is.  After the misery of C yesterday, and my intense dislike for Dr C the last time I saw her, I am very happy with how this morning’s meeting with the latter went.

There is not a great deal of point in detailing the entire conversation I had with her, as a lot of it was her clarifying points I’d made previously and on matters she had discussed with C.  I would be repeating a lot of this if I went into details.  Suffice to say, I discussed the points she raised with me in detail, brought some of my own to her attention, and let her proceed.

I was interested by a number of things.  Firstly, it was just Dr C I saw today, thankfully.  Not that I have anything against Dr N, but having to speak to both of them felt like I was being interrogated by a panel of interviewers.  Secondly, Dr C did not seem to be nastily questioning me in the way she had been before; I did not get the impression this morning that she felt I was a bullshitter, yet I previously had done so.  I suppose she needs to take that stance to weed out those that are bullshitters.  Thirdly, and perhaps most importantly, she spoke to me in absolutely non-patronising terms.  She assumed I had previous knowledge of most matters, she spoke in academic and erudite terms and she didn’t come off with off with any airy-fairy arse biscuits whatsoever.  It would be fair to say that I was impressed.  I was surprised that I was impressed, as – as you know, dearest readers – I had not liked her at all when I first met her.  But really, this was a positive change.

The crux of the meeting was that Dr C says my diagnosis is tricky.  She says that I do not clearly fit the diagnostic criteria for any one mental problem, but I do have strong elements of some.  Apparently it is not at all uncommon for crackpots like myself to not neatly fit into one diagnostic category.

The disorder that she feels is most strong in me is Borderline Personality Disorder.  Perhaps unsurprisingly given this, I feel completely vindicated by this assessment. In fact, she actually asked me how I felt about this diagnosis; I told her it was one of the conclusions I had come to myself in my endless foray into self-analysis.

She was glad that I was not distressed by this but nevertheless went on to say that it is not just BPD.  She said there are also clear signs of Bipolar II, a type of bipolar disorder in which the depressive elements are the prevailing symptom, but in which mania and hypomania are certainly present at times.

Of course, I still have clinical depression on top of all this.  As a friend on Twitter said, I should win a prize for multiple diagnoses.

Dr C said that she believes the BPD to be stronger than the the bipolar disorder.  She said the mainstay of treatment for BPD is psychotherapy combined with anti-depressants.  Obviously it’s clear that Citalopram are not working in the least and as such she has now prescribed me Venlafaxine.  According to her, NICE have recently issued guidelines advising strongly against the use of mood stabilisers and anti-psychotics in the treatment of BPD, apparently due to the fact that there is no evidence that such drugs help the illness.

Dr C had the decency to ask me what I thought of this.  I said that I was no expert, evidently, but that based on the little I do know of mood stabilisers, I thought that they could potentially be helpful in my case.  She considered this, and said that although she certainly thought they could have benefit in treating the bipolar elements of my mentalism,  that she thought the BPD was the stronger illness and as such she was reluctant to try the mood stabilisers for now.  To be fair, she says she is not at all ruling out prescribing them; if the Venlafaxine doesn’t work, or only works in some ways, she is willing to try other stuff.

She explained that as Venlafaxine is an SNRI rather than an SSRI, which is all I have taken hitherto, I may find it more useful than my previous medications.  I’m still relatively cynical about its potential for success I suppose, but it’s reassuring to know that she is not ruling out other options in future if they are needed.  As she said, we are both new to each other and it may or may not take some experimentation to get it all right.

All in all, I’m very pleased.  Someone finally has the decency to tell me what is going on.  I am grateful for all C does, of course, but it was important for me to get a name (or rather, names) for this fucking thing (or these fucking things), and now I have that (those).

I don’t think this is a solution – in fact, I know with absolute certainty that it isn’t.  Nothing ever will be, and psychotherapy is going to continue to be incredibly difficult, I fear.  Nonetheless, I am encouraged, and feel I it’s a step in the right direction.

Even though she almost certainly doesn’t know about, never mind read, this blog, I think I owe Dr C an apology for my previous rant against her.  So sorry, Dr C – and thank you.

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