Sunday, 26 February 2012

Derealisation, depersonalisation and procrastination

That I am procrastinating constantly about writing here should be a sign to me that I am dissociated. But it's hard to really mind when it feels better to be numb and detached and unreal than to feel despairing and suicidal and alone.

How have we been? Tired. Always tired. Always tired, but now tired and disappointed because I have had the first treatment for my blood disorder and if it was going to make a difference to my energy levels I'm pretty sure it would have by now. I know the doctors all said my tiredness and pains were not likely to be the result of the disorder (even though the disorder is known for having those symptoms) and that it was likely I have chronic fatigue syndrome as well, but I hoped. I knew it was not likely, but I hoped they were wrong. Now I have to face it that they were right: I have a blood disorder and a bloody useless diagnosis of CFS which basically means 'we don't really know what is wrong with you but you're really tired'.

Last week in psychology we talked about the tiredness. It seemed that NP just wanted to gather information: she asked lots of questions about how it affects me. I told her about 'good days' and 'bad days' and she wanted to know what I did on my last good day. She suggested that I perhaps need to pace myself a bit and not do as much as I have been doing when I'm feeling good, because perhaps it makes me feel worse the next day. I said I would try to 'pace myself' but it's really hard to do that when you want to make the most of feeling like a normal person.

We talked about how I've been feeling detached and unreal lately. She asked what it is like. I said "It's like I'm not really real... I'm far away in the background... it's hard to explain. Like either I'm not real: I don't feel attached to my body and sometimes the rest of the world isn't real. It's hard to believe that this is actually happening right now. I feel like I'm stuck in a bubble" I gestured around myself to help her visualise the bubble that I was in.

NP said there is a name for both of these: that feeling separate from myself is depersonalisation and that the feeling that the world isn't real is derealisation. I already knew this as I have read (unsurprisingly) a bit about my condition since I was diagnosed, but I don't mind hearing it again. It's good to know that she knows it too. Most people you meet don't understand these things.

Feeling dissociated in this way, as I said is not the hardest way to be but it can be frustrating because it's harder to function and my thinking is not clear. I also tend to feel like my life is drifting by and I'm not getting the benefit of my days on earth. More and more now I look in the mirror and panic about the age of the person I see looking at me and the dread that soon I will be looking at an old, old woman and I will wonder where my days went and why I couldn't have embraced my time on earth. But it's easier said than done just to 'move on' and 'seize the day'. I feel so affected by the past and so affected by my health in the present.

I am still off work. I have now been on sick leave for five weeks. I have avoided thinking about work, but having the time off and being over the awful crisis that I was initially in, although I'm still feeling pretty 'down', I have been able to reflect a bit more lately and am realising that although I can't change the past, there are some things about my 'present' that I need to deal with. These are things I can change but have been avoiding facing because they are so painful. Last week I wrote a list of the main issues affecting my life. My past and DID were only two of the issues on the list. There were a lot of other things that are dragging me down. The top three things that I need to address are: my relationship with my father, my work and my religious beliefs.

There's not an awful lot I can do about my work, but I have at least acknowledged that I am not coping with the heavier than reasonable workload and that I need to be more assertive in dealing with this. The other two need posts of their own, but to put it in a nutshell: I avoid thinking about God and assessing what I believe now because I feel so confused about it all. I need to address this and find some kind of peace about where I stand. I may never get answers but if I'm honest with myself, I live with the belief, in the back of my mind, that I am evil and going to burn in Hell for eternity. This is what I was told many times. It's no wonder I find it hard to enjoy life when this belief about myself is hanging over my head. I need to review my beliefs and assess if they are reasonable and if so, what I am going to do about it.

The dad thing... well. How do you put that in a nutshell? It's been a long, slow process but I feel I am finally coming to the stage of realising that I can't expect him to be different and I need to cut him from my life/let him go for my own good. It's very hard when I feel like I might hurt him in the process but he constantly reminds me that he spares no thought for how he has hurt me, or how he continues to do so and can I really justify sacrificing my own peace for the sake of someone who has caused me so much pain without regret? I'm coming to the stage of accepting that I don't owe him anything. Part of me still thinks I do, but maybe that will never change. I've reached the point of knowing and am standing on the ledge, ready to take a leap and move on. I'm procrastinating about doing this too. Every day I advise myself that I can do it today: write the letter to end it all. But I find a million and one other things to do each time it comes to mind. I will get there though and when I do, I think it could be huge for me to be free from him.

Tuesday, 21 February 2012

Sibling abuse: time doesn't heal all wounds (and New Psychologist, session 9)

Hi you. I've been a little bit far from my blog recently. I have a tendency to shut down as a coping mechanism. It's not engaged every time things are difficult, but it does happen and I think I have been a little bit shut down recently if my posting trends and enthusiasm for writing posts are anything to go by.

I don't feel like dissecting my last therapy session this time, but in brief: it was an improvement on the recent trends (wouldn't be difficult!). New psychologist didn't mention anything that we'd discussed in previous weeks but I felt that she was listening better and interrupting less this week and just seemed a little bit more respectful, or maybe not that, but just didn't give me any reason to think she wasn't respecting me this week. So that was good. It's not that everything was brilliant, but it wasn't bad the way it had been and that was for me a huge relief.

We talked a little bit about my mum this week and I was trying to explain a bit about how my mum is and why I can't talk to her about any of my mental health problems despite the fact that my mum works in mental health. NP was asking some questions and made some observations which were quite insightful and food for thought for me. Perhaps I'll talk more about that sometime.

We also talked about my relationship with my sister, Katie. You may have read before that Katie, as well as making my life a misery by going out of her way to be nasty and cruel to me, also sexually abused me when I was a child. Yes, my sister did that. We only got onto talking about that because NP asked me about what I'd been doing recently and I told her I saw Katie a few times recently but felt now that I need some distance from her because too much of her and it triggers memories. I ended up having some nightmares after seeing her too much recently. NP asked me why I felt Katie treated me the way she did and I said it seemed clear that she was just treating me that way because that's how she was treated by others and NP seemed to agree that this does happen sometimes.

I expressed that I feel guilty these days because Katie is very different and seems to want to spend a lot of time with me but I tend to keep my distance, as aforementioned. This leads to it being a kind of one sided relationship as far as effort is concerned. It's always her doing the inviting and making the effort to meet up and me just going along with it, or turning her down. NP asked me why I think it is that Katie wants to spend so much time with me. I said I guess that she doesn't think about the past the way I do and maybe she just likes to spend time with me. NP wondered if there was an element of guilt about it; that maybe she knows what she did wasn't on and perhaps she sees the past similarly to me and is trying to compensate for it.

Now, this kind of took me back because I have never really considered that. It also makes me feel very sad. Although I do feel angry with Katie sometimes for what she did, I also don't blame her now. I mean, I feel angry with the Katie of my childhood, not the Katie of today. I see them as two different people. Maybe that's just suited me: to tell myself she's a different person now. Although she is very different. Maybe when you learn to split yourself into different people, it becomes easy to do that with your views of others too. Sometimes Katie still says hurtful things and I think, that's the old Katie popping out. But to her, she's the same person. Her memories are always there. Where I've assumed she doesn't remember or care, perhaps it's actually that she knows she hurt me and feels responsible for that. Is she just trying to make amends? I don't know. I prefer to believe she doesn't remember the past. It makes me sad that she would feel a burden of guilt, even though she did hurt me.

Wednesday, 15 February 2012

Confrontations with my therapist (New Psychologist, 8th session)

I don't know what has been happening with me this week that I haven't been able to do this post until now. Maybe, I've just have been trying to avoid thinking about things in case they affect me for the worse, as I'm pretty fragile at the moment. But, here, at last, is an update on what happened at my session last week with the big confrontation. If you haven't read about what happened yet to necessitate a confrontation with my new psychologist, then I strongly recommend you read the previous few posts or this one might not make much sense at all. This week, I decided to record my session on my phone (shh!). I felt that with everything that has happened and the confrontation that was going to happen, I'd like to be able to listen over it afterwards. So instead of trying to tell you what happened, I'm going to more or less let you read the script yourself! (Grab a cuppa. If you have friends you could even act it out!)

The session didn't get off to a great start as I was half an hour late due to road works and an urgent trip to the loo once I finally arrived with the inevitable IBS squits that come with an impending psychology session. This is the first time I've ever been really late for a psychology appointment as far as I can remember. NP started things off by asking me about sick leave from work again and I said I was still off and didn't think I'd be in work next week. She asked if I think the doctor will sign me off again. I said I did and I explained that my doctor knows me well and knows I wouldn't ask for time off if I didn't need it and had actually been suggesting it to me for a while.

Next she asked if there was anything I'd like to talk about today. Deep breaths... and in I went.
I asked her first of all if she had read the email and letter that I had sent her a few weeks ago. NP said she didn't read it all at the time and that she had asked around in supervision and needed to tell me that she is not going to be able to read everything I send her. She said:
"It's important for you to bring things like that to the session. It's not that I don't want to, it's just my job is nine to five and I just can't read those things all the time.” She then said that because she'd already done the referral to the mental health team on the Friday before she got my email, she didn't read the letter at the time but she did go back and read it all at another time. I said I understood that she may not have had time and it was a long letter but I did feel that the cover email wasn't that long. 

I asked her: “Did you read that?” 

NP: “Emmmm, I didn't read all of the email... and I didn't read the letter at all.” 
Me: “Oh... OK”

NP then expressed that because the referral to the mental health team doesn't really work that way and they have specific questions they want answered, she felt she had given them all the relevant information and had given them a reasonable summary so didn't need to read it.

Me: "So you didn't know that I had said to you that I felt the week was going to be really difficult and I was worried about how I was going to cope and that some contact between the sessions would be helpful?"

NP: "No, honestly, I didn't read that until the week after. But I did say to you before I had so many commitments that week that I wouldn't have time and that to see you twice would have meant cancelling with somebody else. But I didn't read it either way." (I don't remember her saying this)

Me: "I understood that you might not have read the letter but I felt sure you would have read the email."

NP (interrupting the end of my sentence) said something about how she got it on her Blackberry and because she only read a bit of it at the time and because she had already done the referral, she just thought it was a 'done deal' and the email was marked as read (seems to be a bit of a feeble attempt at trying to make an excuse if you ask me).

Me: "I think at the time I thought you must have been annoyed with me because you didn't write back and because I had specifically asked a question..."

NP: "Right... the part I read didn't necessitate a reply."

Me: "I understand that."

NP: "So that is worth communicating: I'm not going to be able to read everything and it is worth keeping those things for here. That's going to be important. In extraordinary circumstances you should ring the receptionist."
She then asked me if I had the number and I said I didn't. She asked me what I normally did and I said I usually emailed T (In your face NP, T didn't have a problem with reading my emails!). NP wrote down the number for me...

NP: "So what was the other thing?"

I explained how I'd seen the psychiatrist last week and that he'd said I'd be seen by unscheduled care team the next day until I would be seen by primary care team.

NP (interrupting me again): "I don't know if you'd meet the criteria for primary care team and it wouldn't be the psychiatrists place to make that decision." 

First of all, what's the criteria for primary care if it's not for someone like me? The trust website says it's for people with mild to moderate mental health problems such as depression and anxiety.

Me: “Right. Well, anyway...”

I continued telling her about the missed call and that I hadn't heard from the unscheduled care team. I said I'd rang the team myself and that the woman was unfriendly and unhelpful etc. then that I was at the doctors on Friday and that I'd heard the conversation between my doctor and a lady from the unscheduled care team. I said she'd said NP told them I was just trying to get more and more people involved in my care and that there wasn't any real risk.

NP (Looking surprised for a moment): “Well firstly, I wasn't aware that there was any risk and I don't think I said that to anyone. I had a phone call from unscheduled care and they told me you are already in primary care because T is part of that team and their job is to refer people in so they don't need to do anything because you're already in the trust.”

Firstly, I'm pretty sure I told her I'd been having thoughts about hanging myself and had done some of the preparations to do so and if she had of read my letter, she would have known these thoughts were ongoing and scaring the shit out of me and secondly, what a load of fucking bollocks about me already being under the primary care team so their job is done... is NP just going to accept that then and not push for me to get more help?

NP mumbled on about various phone calls she had made that week and who she had spoken to. I told her the woman on the phone said she had spoken to her twice and that she was very clear that NP had thought I was just being manipulative.

NP: "But you said they did contact you?"

Me: "Well, I had one missed call on the Wednesday morning but there was no number left and no way I could get back to them... You know, I just think that's unacceptable. I was at the psychiatrist because of the scary thoughts I was having. I don't have thoughts like that all the time and I was really worried about the week and how I'd cope and what I was going to do and for them to say they'd contact me the next day and then to just 'tick that box' and say “Oh well, we tried.” is not really following their duty of care!"

NP: “Well I don't know what their protocols are.”

Excuse me, but protocols aren't always the answer to everything. If someone says they have been having overwhelming urges to go and hang themselves and then when you go to ring them the next day, they don't answer their phone, do you need a protocol to tell you that perhaps you should leave a voicemail or try again or even at least ring the patient's doctor to let them know? That's called DUTY OF CARE.

Me: “And then when I heard what she said about you, I thought, either she has misunderstood something you've said or...”

NP (interrupting again): “So what did she say again?”

I repeated what the conversation between my GP and the woman was again and that she'd said NP felt I was just trying to get more and more people involved in my care. I said that it was very clear that it was not in a 'good way' trying to get more people involved. 

I said “That's not what I'm doing, I'm trying to get more help because things are so difficult. I'm not always like this. I don't know if it's difficult for you to see that because you've only met me, but normally I cope well. I get on with life, go to work and try to keep a normal life. I wouldn't ask for help if I didn't need it.

NP: “I didn't say that. I didn't say that. I didn't say that... I'm trying to remember what it was I
did say to her”.

Me: “Well, my doctor actually apologised to me for what the woman had said.”

NP: “Mmmm... well, what I'm baffled by is your doctor ringing up and saying you're at risk, why they didn't try to set up something with emergency care...” 

NP went on a bit about why my GP was insisting on unscheduled care etc. I think she was trying to veer the focus away from my point. I explained AGAIN that my GP was ringing unscheduled care because that's who the psychiatrist had said I'd be contacted by and my GP admitted he didn't know the procedures. NP said that unscheduled care wasn't the right team for someone in crisis. I explained again what the psychiatrist had suggested and we went round in circles a little bit talking about why who thought what team should be best for me (is it really my job to know how all the teams work and who is most appropriate?).

Me: "Now I just feel like in being assertive and asking for help when I knew I'd need it has just been taken as me being manipulative and asking for attention."

NP: "Did anyone actually say that?"

Me: "I don't know exactly if she said those words but it was very clear what she meant and from the way they spoke to me on the phone when I rang them myself, it was very disrespectful and..."

NP (interrupting again): "Do you think that's personal to you?"

Me: "I don't think I'm being paranoid."

NP: "Do you think it was only you they spoke to that way?"

Me: "Well I have phoned them in the past as a health professional and they haven't spoken to me that way."

NP: "But that's different, that's professional."

Me: "Yes. So why should they speak to patients in a completely different manner?"

NP: "I just wonder if it is different. They are gatekeepers of a service and have a remit and sometimes are... I don't know..."

Me (interrupting her now): "Well I wouldn't speak to a patient that way... and I don't expect to be spoken to that way either."

NP: "OK"

Me: "But at the end of the day, I can deal with people being rude or unfriendly but I don't expect that..."

NP (interrupting): "Or 'firm' and 'boundaried'. They've got their job to do and they're funnelling people into care..."

Me: "Well that's different... if they're doing their job... but at the end of the day, it wasn't done last week. It was a really hard week and I asked in advance for help and during it... and I wasn't given it."

NP: "Did you seek help elsewhere apart from professional care?"

Me: "I rang Lifeline."

NP then asked me if I'd heard from the befrienders yet and I said I had just met them and she asked how it went. We talked about this a little bit (I will update you on that later) and she asked if I'd heard from the alternative therapy treatment yet and I said I had an appointment for the following Saturday (all great things and I am grateful for these but they weren't in place at the time I was having this crisis and so were no help in that situation.) I felt NP had tried to steer the conversation away from the issue again by asking me about the befrienders and I was still feeling upset about this. I humoured her with the conversation and answered her questions but I was determined not to leave the session without having said my piece and feeling like I had been understood so I brought it up again...

Me: "I just feel like, what happened last Friday was such a huge thing for me and I don't know if that's how you feel about me or not, but if it is, then it's a serious problem."

NP: “If I feel what you're saying the unscheduled care person said? What is it she said again?”

(How many times do I need to repeat it? I felt she was testing me now to see how solid my story was or something)...

Me: “That I was just trying to get more and more people involved in my care”

NP: “I didn't say that. It's not even the type of thing I would say. One thing I have wondered about myself is why only professional input? Because there were other things you weren't interested in exploring...”

Me: “Like what things?”

NP: “Like talking to your husband, or your friends, or doing some distraction techniques yourself...”

She obviously hasn't listened to me because she has jumped to a conclusion that I wasn't interested in these things. I explained that to her:

Me: “Well, where you talked with me about things I could do myself: I am happy to try these things and have been and I didn't have a problem taking them on board at all. I think I just felt defensive and I know this is my problem but I felt like I had been coping for a long time and that you were just telling me basic things which I felt at the time weren't the answer. And we talked about that already, but even though I felt annoyed, I thought I would do them because if they help then that's a good thing.”

NP: “I appreciate what you're saying. I think people often only come to services after they've been throwing all their efforts at things for a reasonable time, but I also think in times of crisis, people might know all of the things they should do, but might not do them and it is a bit of a reminder... If I was looking back, I might say I probably should have done
that and also explored how you were missing T. Because you did say that you were finding that difficult, so perhaps I should have left more time to explore that.” 

(I couldn't have made that more clear actually at the time)

Me (trying not to cry): “Yes. And I think I was feeling frustrated because I felt like I wouldn't be having so much of a hard time if I could just talk to someone about how difficult things are and I felt like I just needed to have somebody understand and I felt like it was all practical stuff, which I'm not saying isn't useful, but it wasn't what I needed at that time. 
NP: “That stuff is going to be vital. But yes, I might say, I felt I should have put that in a bit more. But some of it is finding out what works for you. People are very different in what helps. It is a difficult thing and this is an enormous event... your therapist changing; that is unsettling... no?”

I felt a bit patronised now, It seemed she was just saying this because I'd basically slapped her around the head with my previous about how I needed someone to understand. It didn't seem genuine. Not that I didn't appreciate that she was trying. I nodded and returned to her accusation about me not being interested in other avenues of help...

Me: “And what you were saying about friends and family... I don't really have friends so that side of it... there are not people I can talk to... and my family... it's very complicated. It's just not an option to talk to family about the way things are. From years of experience of the attitude of people in my family towards others' problems: it's just not an option to talk to them about it."

NP: “I think it's important though that you can use these people as distraction and companionship, not so much to talk to about your problems.”

I explained that I do that and that in the difficult week I had seen Katie twice and visited my brother in law and his family. NP asked if there are any people that I have shared interests with and I talked about how I get on with my sister in law quite well and that she has a little girl who I spend time with. 

Me: “Like, I'm not sitting at home wallowing in things. I'm trying and I'm happy to do any little things that I think will help. I asked for help from the service because I feel like I'm trying everything that I can.”

NP: “In a way I think you and I could easily start having a conversation about services and how they're organised... and that's not therapy. That's not what you want. In a way it's the voluntary and community sector who do this other part of it. Services are quite rationed.” 

More waffling about various teams and how they work, then she said very nervously and hurriedly: “So it is a bit about... as I say and I did think after when I found the email and I saw that you had asked for some help at the bottom of it and honestly, I didn't see it at the time... I did think 'Oh Gosh, [Candy's] not going to now trust me, because I did say that you could contact me... but I honestly didn't see it... but I did say that I would get back to you, if you ever did contact me and I would do that within twenty four hours... but I wouldn't always be able to cancel something...”

Was that an APOLOGY in disguise?!

Me: I wouldn't expect you to cancel something.


Me: I just thought at least...

NP (talking over me): But I didn't see it. I didn't see it... I didn't see it.

Me (talking over NP): and I understand now that you hadn't read it, but at the time I thought “she could have at least written back and said 'sorry but that's not an option'...”

NP (interrupting me): “Honestly, I just thought that what you were sending was the information for the thing and then because I'd already been with the psychiatrist to make the referral, I thought 'that's done'. But I would only be able to see you for extra sessions on a one off exceptional basis."

Me: “I understand that. And I wouldn't have asked if I didn't feel like it was..." (NP tried to interrupt me here with a 'but' but I raised my voice and kept talking) "but then I was thinking because you had..."

NP (INTERRUPTING AGAIN!): “But still I might need to say 'No'”

Me: "Yes but..."

NP: “...even though you're asking and you're asking in genuine need”

I let out a loud sigh and sounding frustrated and close to tears with my voice shaking I said: “I just want you to understand that I was just worried that because you had seen me twice the previous two weeks that you had thought that this is just the kind of person I am and that I'm always going to ask for more...” 

NP: “No. Honestly, I attribute it to the transition and I empathise. I think it's a difficult time. If anything it was because as I'd said I was out two days doing something and everything else was squeezed in. And I hear what you're saying that you wouldn't be expecting it. I wouldn't always be able to offer another appointment, I could ring for a brief conversation.”

Me (really croaky voice now, trying so hard not to cry): “I think just that and everything that happened last week... it was just because... like... I told myself... I should never ask people for help and I should never expect that from people... and I'm just angry with myself that I... that I hoped it would be different.”

This was so hard for me to say. I really had to hold it together at this moment and admitting I felt this way to NP was huge. 

Unfortunately, she responded with:
Do you see the voluntary and community thing that I set up for you? Do you see that as help?” (she's referring to the befriending and alternative therapies, which I've said previously that I'm grateful for but these weren't set up at that time)

Me: “I don't mean just you. I mean, everything last week.”

NP: “That almost took me two days to organise those things... honestly.”

Me: Sigh

NP: “Just if you're saying about 'do people hear you?'. It did take a lot of work to sort those things out for you. 
Me (almost in a whisper because I feel like I'm holding back a dam of pain and now with an added guilt trip on top of it): "I appreciate it."

NP: “That's not all to do with you; partly it's because I don't know my way around all of that and some of them are a bit hard to access. But you know, I did think about it”

Me: “That's why I felt confused because I thought, if you really think those things about me then why did you try to set those things up?”

NP: “No, no, I spoke to the trauma team before I did the referral for the body therapy and that's what they recommended and I spoke to the therapist to ask if it could be just reflexology that they do with you but they wanted the autonomy about that. I had read in the book which you yourself said you like and it talks about it sometimes not being great so I wanted to be cautious about it. So there was a reasonable amount of liaison needed and I'm not saying that to... I'm just saying, there was thought put into that... Who else did you ask for help?”

Me (choked up and voice all crumbly): “I think it was because of seeing the psychiatrist and being told that I'd be helped that week and I felt so much relief that I wouldn't... be on my own... and then just whenever I asked them on Friday, I was just treated like... I was made to feel bad for even asking... and that I'd thought that was what you thought about me.”

NP: “No honestly, I didn't say that.”

Me: “Does it not concern you that somebody would say that about you?”

NP: “About what I said?...Erm... it does, it does... it does. I wonder what would happen if I asked her?”

Me: “Well, I think that she made it very clear, what she thought you had said so obviously she must have misunderstood something.”

NP: "Mmm"

Me (now with a strong voice): "I know I'm sensitive but I always try and think 'what did the person actually say; am I looking at this the wrong way?' but there was no doubt that I didn't misinterpret that. And the doctor was annoyed with her on the phone and apologised to me for how unhelpful they were. I don't just hear what I want to hear, I know sometimes my feelings will go: 'Oh they mean this', I will try and say to myself: 'Maybe that's not what they meant; they said these words', but there was no way around what she said on the phone. It was clear.”

NP: “Honestly, I, I, I didn't say that. I didn't say that... I mean, the time I spoke to them was only about my confusion that when they found out this person is already in the trust that they weren't going to do anything...”

Me: “About that: does that mean I'm not going to see a psychiatrist?”

NP: “Well, do you want to be put on meds?”

Me: “Yes”

NP: “Well why don't you just ask your GP?”

Me: “She has prescribed me something but I just wanted to know if there was something other than an antidepressant because my GP doesn't understand my condition and I feel like a lot of the time it's not depression that's my main problem. I feel like there are
parts that are depressed...”

NP (interrupting me again so I missed the first part of what she said) “...medication recommended for lots of other things. If you look at borderline personality disorder; I know that's not your diagnosis, but we don't really recommend any medication for it. Even though there are lots and lots of symptoms."

Me: "Well, I don't know anything about medication and my doctor doesn't understand what's wrong with me and that's just why I wanted to speak to someone who does know and maybe they'll tell me there's nothing... but if you can tell me that then that's fine."

NP: “So you'd be going to see a psychiatrist for medication?”

Me: “I just wanted to know if there were any other options than an antidepressant. I didn't know that I could ask you that.”

NP: “Well, no, no, no, I'm not an expert on medication and a psychiatrist is one. But why not give what your GP suggests a try first and if that doesn't work we could consider it”

I explained that I was on an antidepressant before and felt numb and that it held me back from progressing in therapy because I couldn't relate to anything and that's why I came off it. The session came to the end and NP talked about the time of our next appointment and although it's probably clear to you from reading this that I had put my point across, I think I still felt I hadn't really been heard because of her defensive responses and interrupting so before I left I said:

I just don't want to spend another week feeling like that's how you feel about me”

NP: “Honestly, I didn't say that. I didn't say that. I didn't say that... I think the only thing I can think of that might have communicated that was that I said at one point that I had offered you three things and you had said you would like them all. But in tone, I didn't say... (etc etc)... I think I was factual. It depends how they interpreted that. Are you sure I was the only person she'd spoken to?”

Me: “Well she said your name”

NP waffled on about how she couldn't think how it could have been her etc.

Me: “I just want you to know that that's not the case. I asked for help because I really need it at the moment and I don't have a set plan of what I think I need. I don't know what there is and I am happy that you have referred me for the befriending and alternative therapies and hopefully anyway... hopefully things are going to settle down now and it'll be fine but I just feel really disappointed in how I clearly asked for help and I wasn't given any at the time... last week... I think I just wasn't taken seriously... and I feel really unhappy with the way the unscheduled care team have acted.”

NP was quiet for a moment and I hope that's because she had actually heard what I'd said at last. She then said that it sounds like some people have taken me seriously. I agreed and said that my GP surgery were brilliant and she agreed that this was a positive and so the session ended.

I felt upset afterwards. I cried a bit and listened over it with Adam and cried a bit more and he said he felt I couldn't have made myself more clear and that I did well to keep to the topic despite her attempts to divert the conversation. I felt happier after this and content that although she may have been defensive, I've said my piece and perhaps it has given her something to think about now. I think she will be careful in future how she treats me if nothing else. I don't know how I feel now about our relationship. In a way, I feel that if she is not cold towards me tomorrow and seems friendly, I will be able to move on and cope with having her as my therapist until T comes back. I wonder though if she can be OK with me. She never did say that she doesn't believe me to be manipulative or wot not and I may still feel I can't trust what she thinks of me. I guess we'll just have to see how it goes. I do know that I need to ask her about why she keeps mentioning borderline personality disorder to me all the time and has not mentioned DID or parts in weeks. I feel worried that she thinks I've made it up or doesn't believe in it and we as a whole feel that we need to hide the parts and try to talk as a singular person, which is difficult sometimes because not everything is easily explained in the singular when you have parts.

I've given up hope of any help from the NHS other than psychology. I feel kind of resigned now. At least Adam is home and things have settled down a bit anyway, but it doesn't give me much hope for if things go back into crisis in the future. I wouldn't want to be in that situation again.

Wednesday, 8 February 2012

Wish me luck

I would like to thank everyone who left me comments on my posts about the ongoing saga with New Psychologist. Your comments are so helpful to me; I'm always interested to read what other people's views are and it's really reassuring when I read that other people would feel similarly to me.

I have been going over and over the dilemma in my head all week. It's really keeping me up at night. As soon as my head hits the pillow I start thinking over the whole messed up situation again, trying to figure out what NP's thinking is; asking myself if I'm being unreasonable; thinking over what I'm going to say to her; wondering how things are going to turn out... and so on. I'm going back to the doctor on Friday and I'll need to get more sleeping tablets. I seem to have completely lost the ability to get to sleep before 3am without them. I tried really hard not to take them often but I'm realising now that having so little sleep probably isn't helping my mood either.

Speaking of my mood, things have been a bit more settled over the last few days. They're definitely not good, but at least I have stopped having intrusive thoughts about hanging myself (now it's more of a general reflection about how life seems hopeless and I don't have any options). I also haven't self harmed since the incident last Friday and haven't made myself sick in over a week, which is great. So in terms of behaviours, things have improved. Unfortunately I am just really not in a great place still. I slept until 1pm today. Granted, I didn't get to sleep until 2.30am but I could have gotten up much earlier if I'd felt like I had wanted to. I kind of woke a few times and couldn't even face the thought of the day so just forced myself to go back to sleep and by 1pm I felt like I could stay in bed all day and not wake. Besides feeling down and hopeless, I've also been feeling irritable and angry a lot. It's not surprising really given what's happened with NP and my dad (which I haven't told you about yet but is as anger provoking as the NP fiasco) that I'm feeling pissed off and my patience for everything is short but it is hard going being angry with everything and as Adam tends to be the trigger (poor boy), I also end up feeling guilty too. My tolerance for anything is low. I think I'm also hormonal which really doesn't help! It's hard for me to know because I don't menstruate but if I feel permanently angry for a while, it's often a sign of hormones too.

I was at the hospital on Monday and had about 700ml of blood removed. This is the treatment for the genetic blood disorder and the nurse warned me I wouldn't feel great for a few days (although I actually haven't felt any worse than usual) but I'm hopeful that soon it will affect me for the better and I'll start feeling more well. I've put off starting my antidepressant for the same reason; I want to know if any improvement is due to the blood removal and if I've started an antidepressant this could interfere. My doctor isn't going to be happy about that though but I think my reasons are fair enough.

Today I went to the hairdressers as I had a voucher that needed using and I was SO nervous (don't like the hairdressers). Adam seemed to find my anxiety quite funny and said anyone would think I was about to go in for an exam because I was doing deep breathing exercises in the car and having a conversation with myself about if I could just run away and not go in. I survived it anyway and it's not the worst hair cut I've ever had although I think I look more 'cute' than 'cool', which isn't the look I was going for really. At least I don't look like a Lego man, which is what happened last time. Afterwards I talked Adam into going out on a date with me, so we stopped at Tescos and bought some cinema style popcorn, a bottle of Diet Pepsi, some Maltesers and Cadbury's Creme Eggs and then I smuggled them into the cinema and we saw a movie using an Orange Wednesday voucher. Movie and snacks for no more than a fiver each! I felt like a student again. I think it was really good to get out of the house and 'do' something (wouldn't the mental health people be pleased). I came home and painted my nails too so all in all I've done a few nice things for myself today. I feel a bit guilty about doing things like that for myself; I feel like I don't deserve them. I can't help thinking that NP will look at my hair and nails tomorrow and think: "Not too ill to pamper herself obviously." Well, you can't win with some people.

Anyway, I came on here to ask you to wish me luck for the session tomorrow. I'm going to confront NP directly about the things that have happened. The main things I want to ask her (maybe not in these exact words, but who knows) are:

1) Did you read the letter and email I sent you two weeks ago and why didn't you reply to it? Do you think it was reasonable that you didn't contact me at all after I specifically said in the email that I was worried about how the week would go with Adam being away? I also want to point out how difficult last week was for me and how her not replying to that email was very hard. I should also remind her that she gave me permission to email things to her.

2) I will explain what happened with the psychiatric assessment and what I heard the woman tell my GP about what she said to them (that I'm just trying to get more and more people involved in caring for me) and ask her if she did say that and why she has come to that conclusion. I want to know if that's what she truly believes or if it was a misunderstanding. If it was a misunderstanding, I want to know what she actually said and what she is going to do to put it right and if it wasn't then I am going to tell her that I don't think it is going to work out between us because how can I work with someone who believes I am a time waster and just looking for attention. I'm also going to tell her that I am thinking about putting in a complaint about the Unscheduled Care Team.

Incidentally, I still haven't heard ANYTHING from the Primary Care Team, even though it was now a week and a half ago that I was assessed by a psychiatrist who agreed with me that I should have some immediate short term support from the Unscheduled Care Team until I got up and running with the Primary Care Team.
Frankly, at this stage I'm thinking I'm probably better off on my own. The chances are, if I do see the PCT, they are going to treat me like a time waster because they obviously already have that view and even if they don't, they're probably just going to tell me things like 'get a better sleeping routine, eat healthily, do exercise and get out of the house'.

Monday, 6 February 2012

Being judged and running out of hope

I went home on Thursday morning after my session with New Psychologist and sat on the sofa feeling exhausted and tearful and thinking about self harming and hanging myself for a few hours. I decided I should get out of the house for my own safety, so I went to visit my sister Katie. If I see too much of her it can be triggering so I try to limit time with her but I thought better to risk it than risk sitting at home. She wasn't in great form and I regretted going up and it has since triggered some bad dreams but that's another story. Thursday night when I got home was bad again: crying, feeling alone and despairing; Ebony out. I took a sleeping tablet at about 3am and it knocked me out before long. This time I didn't set my alarm clock. I didn't wake until midday on Friday, which I think was a good thing, but the thoughts and feeling of despair started almost as soon as I woke up and were just as intense as they had been. 

I decided to take matters into my own hands at this point to see if I could get some help sorted out and I rang the Unscheduled Care Team directly to see what had happened that I didn't hear from them. I spoke to a mental health nurse who crossly told me that it had been recorded in my notes that I had been called on Wednesday and hadn't answered my phone so that was it! They didn't leave a number, voice mail or any way I could get back in touch and they only rang me once! I would like to know: is that acceptable? Do you think that when someone has said that they are having thoughts of hanging themselves and are scared because they are on their own and need support, that it's OK to ring once then give up if they don't answer the phone? Is that a policy in the health service for people who are having a mental health crisis? I find this disgusting, disrespectful and unacceptable. I am horrified actually. I asked the lady what could be done and she again crossly informed me that I had been referred to the Primary Care Team and would hear from them. I asked how long that would be and she said she didn't know (in the health service, it could be months for some things and I have no idea of knowing what this one will be). Needless to say, after that conversation I wasn't feeling any better, in fact I was feeling pretty dramatically alone and hopeless and despairing and Ebony was affecting me a lot (near the front of the bus). 
I thought about all the advice my psychologist had given me and so I swallowed my pride (and better judgement) and tried ringing Lifeline again. Granted, this time the lady seemed to be a bit more understanding and less preachy at the start of the conversation although this probably could have been because I was bawling my eyes out and there wasn't much room for advice between the sobs. Once I'd calmed down she asked me if I'd had anything to eat that day and when I said I hadn't she asked me if I'd go and get something to eat and then ring her back. Really not the right thing to say to us at that point. I know it's not bad advice, but I was despairing and already feeling like I had been given so much 'advice' recently that I don't need. I just wanted to be understood. 

Ebony took over at this point and, well what happened was she cut herself. She didn't just cut herself the way I normally do (i.e., try to keep it light so that it won't scar in the long run); she wanted to slash her wrists and she cut my wrist more deeply than I ever have on my arms (I know, she's part of me, so I did it to myself too but it's not just as simple as that). The blood started running out and it was such a shock. I started hyperventilating; I was so scared. I didn't know what to do. I've never had a cut like that before on my wrist. I tried to Google what to do (good old Google: one of the other answers to all of life's problems). I felt scared and alone. I didn't know if I should ring an ambulance or not because I didn't have any idea how serious it was or if it was going to stop bleeding. 
After panicking for a few minutes I tried ringing New Psychologist. I think I thought she would be able to give me practical advice. She was in a meeting and I declined to leave a message. In hindsight, it's probably a good thing I didn't get through to her because from what I now know about her, she probably would have thought I was just being manipulative and attention seeking (more on that in a minute). After this I tried to ring my doctor. The lady at reception told me she was out that afternoon but that she'd ask her to ring me back asap so I lay down on my bed and cried while mopping up the blood from my wrist and feeling like I wanted help at the same time as wishing I was dead and feeling like there's no hope and hating myself for hoping. 

Doctor rang me back after about half an hour, by which time my wrist had more or less stopped bleeding and I was feeling like a right idiot for 'crying wolf'. I tried to explain that the panic was over and I had just been worried because it bled so much. She tried to convince me to come down to the doctors and see one of the male doctors who would be there (a guy who laughed in my face once a long time ago when I said I thought there was something wrong with me despite not 'feeling' depressed and who I haven't been back to see since) but I declined as I was now feeling like I wasn't going to bleed to death after all. I was still slightly worried about the cut given that it had a depth to it that was visible and eventually I agreed to go and see the practise nurse to get her to shut up, despite not really intending to go. 

After some reflection and peering at the cut, I decided to go and see the nurse and I'm glad I did because despite feeling guilty and embarrassed that I had made a big deal about nothing, she was so caring and sat with me for about half an hour. She didn't judge me or lecture me. She just cleaned it up and put steri-strips on it and bandaged my wrist and patted me on the hand while I muttered a few things about what had been going on and she listened and offered a few words of understanding. She also talked me round to going to see the man doctor. I didn't say why I didn't want to see him but she said. “I know people think he's a bit cross, but he means well.” (It's not just me then). I didn't really know what the point was in seeing him but she said it might be helpful just to talk so in I went, concluding that it couldn't be worse than some of the other attitudes I have encountered in the health service lately (remind me to tell you about my shocking trip to the hospital about my blood disorder: it's on my long finger of things to tell you).

So I went in to see Dr Cross and he asked me why I'd cut my wrist and what had been going on and what was going to stop me from doing any more harm to myself and what had happened that I got referred to psychology in the first place and questions, questions, questions. The main thing he wanted to know was how he could know if I left there today I'd be safe and wouldn't do something else. He also asked me if I had done it as a cry for help. Although I was annoyed that his view of self harm was so typically ignorant, I was not surprised. I told him that I have self harmed for a long time and I don't talk to people about it and the only reason I contacted the doctor was because I had done it deeper than usual and was worried about what to do with it and that self harming helps me to manage my feelings and that it's easier to feel a physical pain than an emotional one. 
He asked me if I'd rang Lifeline (good old Lifeline: the answer to all of life's problems) and I said I had rang them before I did it. Anyway, to spare you all the detail, I told him a summary of everything that's been going on and how I had seen a psychiatrist and had been supposed to see the unscheduled care team the next day and they hadn't seen me. At this point he picked up the phone and rang the team himself to ask what had happened. I could hear the woman gibbering on in the background and saying that I had been contacted and hadn't responded to them and etc. He exclaimed that I had seen the psychiatrist because I'd had thoughts of hanging myself and had now cut my wrist and he gave off a bit about this and then I heard the woman, in defence of the team explaining to him... (now read closely because you are not going to fucking believe this)... that NEW PSYCHOLOGIST had been talking with them and explained that I am JUST trying to get as many people as I can involved in looking after me and hook more people into caring for me. I must admit, I cannot remember the exact wording, but I guarantee you that it was said in a way that made it explicit that my psychologist was saying I was being manipulative and that there is no real risk or need for more input! She may have even used those words but I can't honestly guarantee that. The doctor didn't seem any more impressed with the lady's attitude than I was and I butted in that new psychologist doesn't know me at all and has made a judgement based on nothing. He gave off a bit to the lady and talked about risks and asked what he should do with me then? I heard the woman say “Tell her to ring her psychologist on Monday morning”. He again exclaimed that I had just cut my wrist and was having thoughts of hanging myself and what was I to do in the meantime and she said: “Tell her to ring Lifeline”.

She then went on in jibber jabber for a bit and I heard her stop after a minute and say in a short tone: “What is it that she actually wants?... ... ... I don't think I need to type any expletives here for you to understand how shocked and horrific I was about what I heard. What do I want? WHAT DO I WANT?????? What I want does not picture anywhere in this whole stupid, fucked up process. What I want is that my life could have been very much different than it has been so that I wouldn't be having these problems now. What I want would be that T wouldn't have left. Now that she has, what I want is to be respected and supported and taken seriously and given the help I need in order that my thoughts can settle down, I can start to feel more stable and perhaps might be able to get back to some normality and work. What I want is to feel like there is a little bit of hope that maybe one day things will be OK. Haven't I made it clear what I feel I NEED? When I went to the doctors, what I wanted was to get some steri-strips to hold the cut together. I didn't go there with a plan in my mind of what I wanted to happen. For fuck's sake. I am so angry at the way I have been judged by people who have never met me. I'm more angry at the way New Psychologist has judged me. She has met me and things have been really bad in the short time I've been seeing her (four weeks); I've asked clearly for more help but she can't see that things aren't always like this for me and that I wouldn't normally be asking for this help. She has obviously just decided that I am an attention seeking time waster. 
I don't know what I can do. I don't know if it's possible to change how someone sees you when they have already made up their mind what they want to see. I feel like the person who is supposed to be on my side is actually the one blocking me from getting help. I think it's also likely that after what she said to the Unscheduled Care Team about me, they decided not to bother trying to get in touch with me this week after a brief attempt Wednesday. They were just ticking a box really. I am not blaming anyone in this situation except myself for what I did to my wrist on Friday, but I think it is fair to say that I did everything I could to try to prevent needing to hurt myself and asking clearly and maturely has only served to turn people against me and make them (NP) view me as manipulative. AARRRRRGGGGGGGHHHHHHH!!!!!!!!!!! It seems like a hopeless situation.

Sunday, 5 February 2012

Psychiatric assessment and New Psychologist (session No. 7)

So much I have to tell you about! I said about a week ago that I hoped it would be an uneventful week so I could catch up with telling you about some stuff. It's actually been so eventful that I'm going to have to put last week's stuff on the back burner in order to attempt to explain all of this week's stuff. I need to tell you about the last psychology session and how it went after the fiasco with New Psychologist not replying to my letter and email where I asked for help and her general attitude about Adam being the answer to all my problems etc. First of all, I will tell you what else happened between the previous session and this week's, besides her ignoring my email etc.

If you remember, I sent her the email on the Thursday which was now ten days ago and I had also sent it to my doctor who I was due to see the next day. So on the Friday (nine days ago now), I went to see my lovely doctor and she had read the letter. She was obviously quite concerned about the fact that I'd been having thoughts of hanging myself and wanted to know all about this. I don't know if I've actually talked much about this with you, but the thoughts started about two weeks ago when I was driving home from my mum's house. It's like something in my head clicked and all of a sudden, with everything I looked at I was thinking: “Could I hang myself on that?” The thoughts just seem to arrive and when they do, I can't get it out of my head. I think through in my head how I would do it; what I would use and wonder how it would feel in the moment when I take the action and can't go back. Would I regret it and want to change my mind and die wishing I hadn't done it, or would it feel right? How long would it last before I passed out? How painful would it be? And so on. It's not just a fleeting thought. The thoughts bring a strong urge to act on them. 

I have had this in the past and found myself taking steps towards making it happen, but feeling detached from what I was doing all the while. I have tied dressing gown chords or a rope around my neck and pulled it tight as a way of testing how it would feel. This doesn't happen often. You may remember a period last year where I did that but it settled down again after I told T and she helped me with some discussion of what parts it might be and we started doing some work towards EMDR with the parts most in distress. I think them even knowing they were being acknowledged and that there was hope helped to take the 'crisis' away a bit.

So it's started up again a few weeks ago and has been really scary and disturbing when it happens. At the start the thoughts would mainly come when I got into bed at night and tried to sleep. I haven't been able to get to sleep most nights before three or four a.m. More than a couple of times the thoughts have lead to actions towards getting ready to hang myself. I'm scared about it. Over the last week the thoughts have become a bit more spread out across the day. They seem to be arriving at various times and are more persistent. So I talked with the doctor about the thoughts and that I was really worried about Adam going away and that I was going to be on my own and she felt that it was important that I get referred to a psychiatrist urgently. She said she would do this and that I'd probably hear from them soon. She also prescribed me some sleeping tablets and antidepressants. 

I didn't hear anything that weekend but my doctor rang me again on Monday and said that I would need to go down to see her again because psychiatry don't accept urgent referrals unless the patient has been seen that day (she obviously didn't get round to doing it on the Friday). So I went to see her again on Tuesday and told her that things were the same and that I had gotten up in the night and put a rope around my neck and then after a while went back to bed. She asked me if I would sit out in the waiting room while she rang the referral people to see what they thought should happen so off I went. Once I got to sitting and waiting, I started to feel a bit scared and wondered if I was going to get locked away. Part of me started to panic a bit and I was wondering if I should do a runner and get out of there while I could! I could hear her on the phone through the walls (so much for patient confidentiality) explaining everything I'd told her. Eventually she called me back in and said I'd hear from them by phone and would be given a time to go and see someone today. She asked if I'd be OK until then and sent me on my way.

I got a call telling me to go to the out of hours at 6pm that evening, which I did and was met by a nice young man who introduced himself as Dr Something. I wasn't sure what kind of a doctor he was until the end of the assessment when he said “have you any questions?” and I asked if he was a psychiatrist. He looked a bit embarrassed and said he probably should have told me that. Well, I guess I kind of assumed since it was quite clearly a psychiatric assessment he was doing. I basically had to tell him my entire life story and was in there for probably an hour answering his questions. When I was telling him about my family and family member X who works in one of the mental health teams he said kind of coyly “Is that [so and so]?” Sigh. He said he knows them (and I've since noticed he really knows them cos they're Facebook friends) but assured me of my confidentiality. Still. It's a bummer. It's always a risk that my confidentiality won't be upheld. I don't believe it would ever be intentional, but people do talk about patients in front of other colleagues and might not be aware of the link. Arrgh! My life seems to be full of annoying coincidences!

Anyway, he was a lovely doctor and really respectful. He was respectful of my explanations of DID, even though I said I knew that many psychiatrists don't believe in it's existence and he acknowledged this. He said, it's not that they doubt the cause of the condition, the patient's integrity or the symptoms but that it is debated that the collection of symptoms is not due to a condition that should be named as such but is due to other conditions. I asked if he meant like complex PTSD and he agreed that that would be part of it. He said they question whether DID was a useful label to give the condition. I explained that it has been useful for me because I've always felt I was just a freak and now that I know a name for it I have been able to research it and discover that there are a whole bunch of freaks just like me (no offence to my DID friends; you know what I'm trying to say!) and it's helped me to understand myself. It was all very amicable and I felt that although he didn't personally express a view, he was respectful of my experience and believed me to be genuine, whatever interpretation he would have put on what is wrong with me. 

I explained that I feel I need more support both in the immediate with Adam being away and me being in a crisis, but also in everyday so that this wouldn't happen again and that I could see more progress rather than just surviving. He agreed and said that he felt for me there is much more hope that for the one other person he had met with 'a diagnosis of DID' (lol) because he felt I had been managing for so long on so little support as just one clinical psychology session a week (even though he did emphasise that it is great that I have the privilege of that service) and that I should definitely be seeing a psychiatrist regularly and have other support in place (finally! Someone who gets it!). He said he would be referring me to the 'Primary Care Team'. 

He asked how I was going to cope in the meantime and we agreed that he would arrange for the 'Unscheduled Care Team' to contact me the next day and arrange to see me that week for support while Adam was away. I agreed that I felt I would cope better knowing there would be some support in place this week and that I felt that would help reduce my risk (just knowing I wasn't all alone). So I went home, feeling alone but with a little glimmer of hope that someone would ring me the next day and arrange for a little bit of support. I set my alarm early even though I still didn't get to sleep until after three, partly because I didn't want to miss a call but partly because I don't want to get into the habit of lying in, which is never going to help me get to sleep at night. My phone rang at 9am-ish and by the time I managed to set my tea down and answer it the call had ended. It was a withheld number and no voice mail was left. I spent the next few days permanently attached to my phone, hoping that any minute I was going to get a call from the unscheduled care team. No call. 

Things were really, really, really hard for me this week after Tuesday. I tried hard to keep busy on Wednesday and Thursday. Wednesday I met my friend for lunch and went to babysit in the evening. When I got home that night, the thoughts started up again and I spent hours thinking about killing myself and feeling so scared and alone. I eventually fell asleep at about 3am and then had to get up for my psychology session at 7.30a.m. I won't go into a lot of detail about the session this week but remember how I'd been expecting a lecture about not emailing her? Well she didn't even mention it. In fact, she didn't ask me one single question about the letter, or how I'd been coping this week or anything. She just looked at me and did that really annoying psychologist thing where they refuse to be the one to start the session. I was already angry and didn't want to speak to her (like I'd told you before) and I didn't want to play her stupid game so I threw a curve ball in and reminded her that she never finished filling in her assessment form and did she want to do that. In my head I was thinking, 'I don't want to talk to her about my feelings but I know I can't sit here in silence so I'll answer the stupid form questions. That's something straightforward and I don't need to trust someone to do that'. The conversation went something like this:

Me: “I was wondering if you wanted to finish filling in your assessment form?”

NP: “We could do that. Is that would you would like to do today” 
Me: “OK” 
NP: “OK... erm.... anything else?” 
Me: “I didn't really come here with a plan of what I wanted to talk about”

NP (blabbered a bit about how sometimes people come with things that are in their mind that they might think they need to talk about, also about 'unconscious' and projections etc...)

Me: silence

NP: “I know from a note I got on my desk this morning that you have been referred to day treatment. Is that right?”

Me: “I haven't been told if I have.”

NP: “So have you been assessed recently?” (Now she knew I had, otherwise I wouldn't have been referred to them and she probably already had been told about it, so why couldn't she have just asked me when I sat down rather than playing the stupid mind games?)

I told her about seeing the psychiatrist on Tuesday and she mumbled a bit about what might happen (nothing very informative), then she told me that she thinks people will tell me I need to go to the 'self harm team'. She's mentioned this before and told me that if I saw them I wouldn't be able to attend clinical psychology anymore. Now, at this stage I'd be more than happy to get rid of her but I am not happy to give up my future with T. She understands me and obviously knows what approach works well for me (I naively assumed all therapist's know this, but I am now realising how lucky I was with T). 

I feel that NP is just trying to fob me off on a different team. She's also mentioned that the self harm team is mainly for people with borderline personality disorder and a history of self harm and that they could provide the input I need. Firstly, I don't have a diagnosis of BPD (whether I have it or not is not something she could possibly judge having only just met me) and the fact that she has now mentioned BPD at least five times in the last four sessions and hasn't mentioned DID once is making me feel very paranoid that she either doesn't believe in DID or doesn't believe me (even though she did tell me at the start that she did believe me... something has changed in her thinking and I just wonder if that could be what it is. Maybe I didn't 'fit' with her expert experience she thinks she has from working with the ONE other person she has ever met with DID/from watching 'Sybil'). Secondly, and I told her this: I don't see self harm as a big deal for me. It's one symptom of a number of things wrong with me and I need help to deal with the issue, not the symptom. I also said that I wasn't willing to move because I want to see T when she comes back. She said: “But that is the care pathway for people who self harm.” She mumbled something about how self harm tends to make health professionals anxious though but that no one could make me move there if I don't want to. Really? I find that hard to believe. Probably what they might say is that I don't have to go there but I can't continue to go to psychology either. 
So after that we moved onto talking about the assessment form that I had mentioned at the start. She didn't mention the letter or email issue and neither did I. I wanted to ask her if she thought it was reasonable that she completely ignored my email but I chickened out. I didn't even think until afterwards that it was strange that she didn't even ask me how I was coping with Adam being away. I felt angry with myself and still angry with her when I left the session. Nothing was dealt with. No issues were raised. I know it would probably have been pointless trying to discuss them with her anyway but I still felt a little bit disappointed in my lack of backbone.

I will save what happened after this for the next post, but you actually won't believe it when you read it. I'm sure you're going to think I made it up!

Saturday, 4 February 2012

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