Asking for help

This is the letter I sent to both my GP (doctor) and my new psychologist with the email I pasted before. I said that she share it if she was hoping to refer me on to psychiatry etc. New psychologist never responded to the email or mentioned the letter. I don't think I could have made myself much more clear in it, do you? (I have changed or taken out the bits which would compromise my anonymity.) 

I am writing this letter to ask for help with managing difficulties I am experiencing currently with my mental and physical health. These are having a large impact on my quality of life. 

I suffer from symptoms which I have been informed are likely to be the result of chronic fatigue syndrome. I have also recently been diagnosed with XXXX (attending XXXXXX) and PCOS. I also suffer from a dissociative disorder called dissociative identity disorder (DID) which has symptoms similar in many ways to complex PTSD. 

I am attending clinical psychology weekly, which I feel is helpful for me in that it provides support but also can be very energy consuming as I am trying to deal with the effects of childhood abuse and an isolated upbringing in a strict and controlling new religious movement. These effects include DID (as mentioned) which affects me by causing dissociation, depression, anxiety, sleep disturbances, nightmares, flashbacks/disturbing visual images, memory problems, self harm, thoughts of suicide, identity problems, somatic problems and I have a history of eating disorder (which I have not sought help for in the past for various reasons). 

I strive to keep going with a normal life and to keep a normal routine of going to work and earning a living. I don't want to have to rely on benefits or sick leave so I do my best to keep working. I struggle with this, mainly because I normally work full time and because for the most part my job is sedentary, I can manage this without worsening the fatigue and muscle pain I tend to get from physical exertion. My job is also very stressful and I am under a lot of pressure with a heavy workload. I have raised this issue with management with little success. I do find working full time takes up a lot of my energy and I am usually exhausted by the time I get home. 

At home, I am able to do very little housework: generally I can do about ten minutes, slow moving e.g. hanging up laundry etc before I need to lie down again for half an hour. I try to do small amounts but struggle to keep up and as a result my house not well kept and I rely heavily on my husband to help me, which is OK at the moment (although not ideal) because he is out of work, but I worry about how I will cope when he goes back to work. On a bad day I would be unable to do even small amounts and would find even standing up to walk to the bathroom a huge exertion. Understandably, I have very little energy for anything else in my life and although I do try to go out and interact socially or include activities outside of the home, I find them more hard work than enjoyable. 

I am extremely socially isolated as I have very few friends or acquaintances and none whom I see regularly or am close to. I struggle to form friendships because of my history and the problems with trust and feeling extremely 'different' from other people, although I do try. In terms of family support, although I do have three sisters and my parents are both alive, none of my family live near me. I don't see them often and they are not a potential source of support. My father lives in England and we have very little contact. My family don't know anything about my mental health problems. I feel I can't share these things with my family, for various reasons. For the most part, I find spending time with my family difficult, not helpful. As I mentioned, my husband helps me on a practical level to a certain extent and is aware of a lot of my history and mental health problems. He is supportive of me, however it puts a lot of pressure on him and he struggles with seeing me suffering, therefore I often tend to keep things from him when I feel things are really bad. 

I feel that given my physical and mental health problems and my lack of social support, I have been doing very well to continue working, despite feeling for some time that something will have to give eventually. I am not the kind of person who wants to rely on other people if I don't need to. I have always striven to be independent and not 'owe anyone anything' but I feel that I have gone on as far as I can without support and now is the time where I need more help. 

Recently I have been feeling much more severe symptoms of depression, anxiety and dissociation. I have also been struggling with a return of my eating problem which includes frequent purging and other behaviours. I have also been relying on self harm as a coping mechanism. Although both of these problems have been issues for me on and off since childhood, I have felt the eating disorder had been quite settled for over a year until recently and the self harm, although still sporadic, I try to minimise. I feel both have been much more dominant in recent weeks and are a sign that I am not coping.  

I have found myself often questioning where my life is going and I have concluded that I don't want to continue living any more if this is the way my life is always going to be. I would like to think that things will improve, but looking at things practically, improvement is not likely without implementations to make it happen. I feel I have been doing everything I can to make my life better and to help things move forward but this is not enough. I am also having trouble with intrusive thoughts of suicide and urges to hang myself. I have obviously not done this yet so feel hopeful that I won't (as I have not come to the conclusion yet there is no hope for me) however, I have found the thoughts extremely disturbing and have also found myself dissociating and taking unhealthy actions like tying a rope around my neck and pulling it or taking the first steps in preparing to hang myself then stopping. At these times I have felt like I have not been in control of my actions momentarily and this is why it is so frightening. 

There are a few things that I think could really help me at the moment. I feel that this crisis I am in could be short term and that with some support, I could get back to work before too long. However, I also need more help once I do go back to work so as to prevent this falling apart from happening again and to help me feel like there is some kind of hope and that life is more than just a mission to survive the day. 

Firstly, I feel it is important that I take some time off work. Although my GP had suggested this to me a few times recently, I declined because I like to try to keep going with work and also because I am not in a permanent job, my husband is out of work and we have a mortgage and loans to pay, so I worry about my job prospects and financial implications of stopping work. However, I have felt unable to attend work this week and I feel that on reflection, it's probably not a bad thing if I do take a few weeks off to try to recover some energy and deal with the current crisis. 

I think it is important that I get some more social support so that I will feel I am not struggling on my own. As I mentioned, I attend clinical psychology once a week, but I feel that this is not enough at the moment. I have recently transferred to a new clinical psychologist [new psychologist] temporarily while my usual clinical psychologist (T) is on extended leave from work for approximately six months. I feel this change has been very difficult as I had built up a good working relationship with [T] over the past three years and is possibly adding to the pressure I have felt. Where my resources were already being used to the maximum to keep going with everyday life, this change has taken more from me than I have resources left. [New psychologist] has seen me twice a week for the past few weeks as I have been really struggling which has helped however this is just a one off offer of support and not likely to be something she can offer continually. It would be helpful to me to have some input from someone who can help me with some further support at the moment. I am not sure of what is available but I feel it is important. 

There had been some mention of the XXXX team getting involved and although at the time I felt this could have been helpful as I was very scared about the thoughts about killing myself and the risk that I would do something spontaneously, I am not keen to have input from this team as [family member X] is a XXXXX in the team and I know a few of XXX colleagues. I would not wish [family member X] to know anything about my situation and the team couldn't guarantee my confidentiality. I also feel that although still bad, things have been a little bit more settled over the past two days in terms of my thoughts and so I don't think this input would be appropriate. I do think though that there is the potential for things to get much worse again and I want to prevent this from happening. I also want things to get much better! I would like to know what is available to help me such as a mental health nurse, psychiatrist e.g primary care team etc to provide some back up between my weekly psychology sessions to help me get some stability and avoid any serious risks. 

I am quite worried about the next week also as my husband is going away on a trip and I feel I may not cope on my own. I would like some support urgently to help when he is away. 

I have been discussing the need for medication with my GP on and off for a while. Although I took an antidepressant in the past, I stopped taking it because I felt that although it helped reduce the anxiety a bit, it also reduced any other feelings I had, meaning I felt numb and detached and unable to relate to my history and the problems I was attending psychology to deal with. I have problems with sex and very low libido and I felt the antidepressant affected that even more so. I also worried that it was causing weight gain. Given that I am unable to do much exercise, my weight is already higher than ideal. I feel I would consider taking medication again now as a short term measure however I would like to have guidance from a psychiatrist who is experienced with dealing with trauma and dissociative identity disorder, as I am concerned that due to the nature of my condition I am very variable and I don't feel that an antidepressant is always what's needed. I would like to know if there are any options around this. I am obviously completely naïve about medication and understand that an overall numbing may be my only option but I would like to know for sure and as DID is not one of the more common conditions, I feel guidance would be helpful. 

I am writing this in the hopes that it will be understood that I am clearly in need of and asking for more support at this stage as a way of preventing things from becoming critical and to help me be able to achieve the potential I feel is realistic in life. I would like someone to discuss with me all of the options for support and how I can get referred asap for something that will help. I hope you will understand that I would not be asking for any help if I felt I had any more capacity to manage things on my own at the moment and that asking in this way is preferable to leaving things any longer. 

Thank you

[Candycan]