As much as I feel my new soon to be old therapist ‘gets’ me more than other’s I’ve had perviously I still faced a worrying moment when I explained how I felt and was met by a very confused look.

This was in the midst of a the worst depressive mood I’d had since I started seeing him. It seems to be similar, people seem OK with the not so bad bad moods but when I slide into the abyss they can’t seem to conceptualise it.

I was trying to explain I felt blank, I felt dead inside, I felt unable to feel. This has been a big problem for me and I am convinced it is to do with my meds but no one listens to me on that issue. I’d use the term ‘anhedonia’ but the poor guy didn’t know what I meant by ‘ambivalent’ (to be fair to the guy English isn’t his first language and perhaps that’s where some of the understanding problems stem from) . Though it goes beyond anhedonia, it’s not just an inability to feel pleasure it’s an inability to feel anything but a dull, gnawing numbness.

This is why this blog goes silent for so long; if I can’t feel anything I have no impetus to write , to do anything but lull about in a half catatonic state. I can’t THINK, I don’t have to words to describe how I feel because my brain won’t fucking work. There’s a line from a Bob Dylan song ‘Tomorrow is such a long time’ that goes

I can’t see my reflection in the waters
I can’t speak the sounds that show no pain
I can’t hear the echo of my footsteps
Or can’t remember the sound of my own name

whilst the song refers to being in love that inability to function at even a basic level is what I feel, but with more angst. I swear I do struggle to remember my name sometimes. It is so unbelievably frustrating, especially as someone who has constructed part of their identity around intelligence, when you’re shit at sport, not very popular but like reading it just sort of happens, “I might be a geek and a bit fat but at least I’m not stupid!”.

I’ve also been reading up (on my blackberry, in the dark, in bed when I can’t sleep and I wonder why my eyesight is so bad) about depression and I came across this article ‘Hard depression, Soft Bipolar” which seems to explain how I have been since I was about 11. It would certainly explain the tendency for me to ‘poop out’ on various drugs (I must be on no 3 or 4 by now and I’m still not really any better) and a million other things (I am never depressed ‘all the time’ but it comes and goes, often frighteningly quickly and intensely)  but alas the whole ‘not really recognised by most doctors’ bit gives me little hope.

 

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I really should update more, writing is good therapy supposedly.

Anyway I have a new counsellor I’m more than halfway through my allotted 6 sessions of NHS time, which is apparently sufficient to sort out a whole life time of fucked uped ness. Budgetary concerns trump humanity.

My new counsellor is, quite frankly, a bit crazy. In a good way, I like him. He says I am intelligent and feel out of place because I do not buy into the ‘robotic’ nature of society, I resisit. Which is all very well but how do you deal with that when you do feel so out of place? When it feels like the world operates on a set of rules that are morally abhorrent to you? Add on always being picked on for being ‘the wierd kid’ (even by supposed friend’s in thier 20s who saw fit to chastise me for my choice of eco friendly washing powder and ethical bank, no wonder that friendship ended, badly.) feeling alienated and wondering if you’ve been put here by mistake. And a whole adolescence full of shit hitting various types of cooling devices.

I’m  not sure I’ll ever feel I fit in anywhere so the key is acceptance I suppose. I’m working on it, I’m trying to meditate again; very interesting when the voices in your head are ranting on at you, I’m beginning to worry if these are more than just an inner monologue and maybe I should be worried about it, especially when your inner monologue is telling you it’s god and you should ‘look at the bread’ (am I going even crazier or do I just have an overactive imagination and hypochondria, is it ok to have longer conversations with your inner monologue? can it even be a monologue if you converse with it?). Though on the plus side ‘god’ is nice to me not like the other inner monologue folks who seem hell bent on my self destruction. Maybe I should check my meds side effects again. Or maybe I’m just a hypochondriac with an overactive imagination. I’m trying to be more connected, more holistic.

My Grandmother, my last grandparents, died on Sunday. I was there. I have never seen anyone die before, it was oddly subdued. It was peacful which I am glad of but it just seems such an anti climax really, the way death is always seen as this big scary looming thing, not something which just happens so quietly and with little fuss. So needless to say my emotions are more confused than normal. Loss is a strange thing, especially of someone who was so close yet at the same time so far. For the last few years she suffered dementia and didn’t really know who I was or where she was or what year it was  so in some ways it felt like she was already gone. Yet inheritance is an odd thing; I look so much like she did when she was younger, I have inheritied the crazy hair; which reminds me of Heathcliff, Yorkshire side of the family you see; plus it’s dark, crazy, coarse and unwilling to be tamed. Again a sign I read too much. My Granny once pulled out a lock of her hair from god knows how many years ago that she had kept in a drawer (I am  also loathe throwing things away incase they are ‘useful’ one day)  and held it next to mine to compare. It also feels like another part of my childhood dying; the house I grew up in has been bulldozed and is now a block of flats which makes me sad when I think of it. I suppose childhood was the last time I was actually properly ‘happy’, and even then I’m not sure, it fees like I’ve been dysfunctional my whole life. As Elizabeth Wurtzel puts it in Prozac Nation, it’s as if I was broken on the assembly line.

The whole thing is just so confusing, trying to ‘re programme’ myself to love and respect myself , not to self destruct and hate myself, whilst questioning the whole god/afterlife/death/cosmos/vague ‘spirituality’ thing. Also questioning the whole ‘can I really re programme myself?’ if depression is a chemical imbalance can I really just wish it away?

 

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A.K.A “Not more bloody forms”.

So after an initially hopeful session of therapy where I started (please note the word ‘started’ here) getting into the issues around my depression and how far back they go in my life, how I felt as a child and all that, I’m back to ‘working on behaviours’ and filling in (or not as the case may be, it’s technically ‘homework’ so it can be done at the last minute as is proper for such things) little forms about mostly inconsequential areas of my life.

I am going to give this a try again. I have to , I have no other choice. I just wish that I could have some form of therapy that allowed me to talk about things, that tried to get to the roots of all this, as opposed to more sticking plasters that will eventually peel off and leave a sticky mess. This happened before, I had a session or two though ‘ohh this is good, I’m being brave opening up, talking about stuff’ and as soon as that teeny little gap opened up it got closed again as it all went filling in daft forms tastic. If anything it’s far more frustrating to see that brief glimpse and then have it cut off again than it is to never see it. I’ll probably get discharged again at the end of it as unless I try to sever my my own arm off in-front of someone I’m obviously ‘O.K’ and don’t need more money spent on me. I read a statistic about how a high percentage of CBT patients end up getting discharged at the end of their teeny tiny allotted time scale of treatment only to wander back in again a year or so later feeling much the same. I can see that happening to me. All in the pursuit of ‘outcomes’ or whatever, being able to fill in a form saying someone completed this course of and as they haven’t yet killed themselves or been caught trying to gnaw off their own leg they’re ‘fine’.

From what I can gather I’m pencilled in for about 6 more sessions of less than an hour. That is what I am being offered for a problem that leaves me currently unable to work and if I’m brutally honest, may leave my life at risk. A problem I have been ‘treated’ for for the last 5 (or is it 6?) years with little or no lasting improvement. In short something that’s a major, chronic health concern but may have less treatment time spent on it than a stubborn verruca.

Maybe I should write the forms in blood? Just for a laugh.

I’m considering going private, which as a someone who doesn’t really agree with private healthcare and is also utterly skint, is a scary prospect.

As an aside, my spell check did not know the word ‘verruca’ yet the computer’s dictionary did. Perhaps I am not mad but the world is?

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They’ve been in the news, mostly focusing on in patient care. Whilst this does need highlighting I’d like to have a rant about out patient services, or the complete and utter lack of them.

I’ve never been in in patient care, I was threatened with it once as a teenager but I can barely remember those years and ironically I wasn’t really crazy then (they saw my M.E/CFS as psychological, so I was sent to the psychiatrist from hell), they just thought I was and now I am actually going crazy everyone seems much less keen to actually treat my craziness.

My experience of outpatient care can be mostly described in one word :


min·i·mal

–adjective

1.

constituting a minimum: a minimal mode of transportation.
2.

barely adequate or the least possible: minimal care.
No 2 specifically.

I was formally diagnosed with depression (as opposed to the false it’s not M.E it’s depression mess from my teens) about 5 or 6 years ago. In those 5 or 6 years I’ve been on about 3 different anti-depressants, none of which have really worked and some of which have sent me crazier, or just not worked at all. My doubts and queries about my medication have rarely been given an answer beyond the monosyllabic, I have felt for the last year or so that my latest medication, venlafaxine (which has had the dosage raised again and again, like all the others) is leaving me emotionally dulled and deadened to the extent that it is starting to add to my depression symptoms. All I’ve been told is I am not well enough to consider lowering the dose as I am still ‘very depressed’. I need to be ‘more stable’. It’s like talking to a brick wall.

I have been referred to psychotherapy twice. The first time was useless. I had 16 sessions of CBT which I didn’t find very helpful and when I came to the end of my allotted 16 sessions I was told that was it regardless of the fact I was still as depressed as ever. It took me about 2 years to get referred for a second time; with one memorable false start of referred for counselling at my GP’s surgery only to be told a few weeks later I wasn’t eligible as I was seeing a psychiatrist and was thus too ill. That counselling wasn’t for ‘people as depressed as me’. After asking the psychiatrist and GP about 20000000 times again the psychiatrist (not my regular guy, interesting)  referred me to some ‘improving access to talking therapies’ thing. About 6 months or more after I got that referral I had my first appointment. It seems like it’s CBT again, which I have told everyone I didn’t find helpful. Though on the plus side the guy seems nicer than the other one and said there were other options available should I need them.

My appointments with the psychiatrist last about 5 minutes on average, I say I’m still depressed, go over my feelings, say when I was hurt myself or felt suicidal it all gets noted down and nothing happens. I raise the odd question it gets ignored or I just get told to go away.  I had one good one hour or so session about 5 years ago where I went over things in depth, but no more since as it was an introductory type thingy-ma-bob.

I am just given pills and sent away. I am not getting better, if anything I am getting worse. No one seems to care.

Beyond mostly ineffectual pills or short courses of CBT it seems there is nothing anyone can offer me.

The treatment I found most helpful, when I thought I might be getting somewhere was when I saw a clinical psychologist, I had more than one long session where I could talk in depth (one hour is woefully inadequate for a long history of ‘shitty stuff that fucked you up’) but that was arranged through university and I graduated last year.

I feel pretty much left to get on with it on my own.

It’d be nice to have someone who listens to me and my concerns, to not be fobbed off with more pills that don’t seem to bloody work; it’s the same pattern over and over. I get a bit better, it fades, the dose gets raised with little or no improvement till I plateau or even get worse, I can’t go any higher on the dosage so my medication gets changed and it starts all over again, or I just get stuck asking questions and being ignored. Not to mention the good few months of the horror that is withdrawal and changing over of anti-depressants , which I why I won’t just stop taking them as I am often tempted too, it’s too fucking hard to come off them without doing it properly, If I miss even a day or two I go ‘cold turkey’ (or more accurately hot, sweaty, dizzy, nauseous, headachy and roller coaster emotion turkey).

I spend more time starting at the fish in the waiting room than getting anything that can be described as ‘care’.

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During my long history of being ill (can you be a professional ill person?) I have undergone many ‘treatments’ and being the lucky girl I am I have managed to develop not one but two illnesses with no definitive cure and piss poor access to treatment on the NHS.

I am also lucky enough to have the wonder cure all CBT do fuck-all for me twice, for both my M.E and depression.

Though what really, REALLY annoys me is how I have been made to feel like the world’s most awkward patient and that the failure of certain treatments and therapies has been my fault for not ‘engaging’ with the therapy enough or ‘not trying hard enough’ or another assortment of excuses. What did I do that was so awkward? Well I asked questions,  I had doubts and I expressed them; something which I assumed was supposed to be a good thing during something billed as ‘therapy’.

During my latest bout of CBT for depression (which seeing as I’m still depressed as ever has been an amazing success) I made the mistake of uttering the word ‘existential’. I got threatened with having my treatment stopped as I wasn’t ‘engaging’ as I kept trying to get across that for the most part my depressive moods don’t tend to have any obvious external triggers, that they come on suddenly and for no reason. This was apparently not good enough. I couldn’t just come in and say I was depressed and I didn’t know why (I’d also like to point out I was given no help in trying to figure out any ‘hidden’ deeper reasons for my moods). I was patronisingly told ‘well obviously you’re intelligent’ (I think I mused about Descarte’s ‘cogit ergo sum’ on one of the forms, I may depressed but I can still be a pretentious arsehole), which seemed to be code for “stop questioning things now ! don’t reveal the holes in the treatment we didn’t ahve the time/money to think about! Shut up an fill in a sheet!  and no you can’t have ‘musing on my existence’ as an acitvity!”.  My depression didn’t fit into the narrow categories that the CBT seemed designed to cope with and I felt like I was made the scapegoat for this. I tried I really did, I racked my brains trying to think of things to put in the stupid little forms and make sure my mood-swings fitted into the little ‘thought pattern’ sheets. I went through the thought excercises and tried to make them work, sometimes they did but when they didn’t I was yet again made to feel bad that my ‘mood score’ hadn’t improved after doing the excercises, so by the end I was inflating my scores so I didn’t get ‘dismissed’. I tried and admittedly it did help with some  minor, more peripheral problems like being anxious about uni work etc. But the big looming problem which was my main problem? The mood-swings that come on so suddenly and without any obvious logic behind them, the problems that have been haunting me for as long as I can remember? Those were left untouched. Unless my moods had a ‘trigger’ or a ‘negative thought’ I could counteract I was left helpless. I tried to explain that the whole illogical, unknown  and unpredictable nature of my depression is what scares me the most; how those moods that seemingly come out of nowhere are the worst and most terrifying. Yet those were the problems that were ignored, I was told (not in so many words) that by drawing the focus on this I was being ‘unhelpful’. I started out being as honest as possible about my moods and by the end I was effectively lying. I was lying so I wouldn’t be chastised for not having a ‘trigger’ or some identifiable thought pattern.  In short I was trying to change my illness to fit in with their definition of what my illness should be as opposed to reflecting honestly on what actually was.

I’ll admit I wasn’t perfect, but as I was doing this treatment due to chronic mental health problems I think that can give me a bit of leeway in the whole ‘may not actually be thinking like a logical human being’ department. Why should someone with serious depression who obviously isn’t ‘thinking straight’, be under so much pressure to make a treatment ‘work’ even if it means their concerns are ignored? Is it really that much of a shock to a mental health professional that severly depressed people are sometimes really rather apathetic about things, that it’s not deliberate ‘awkwardness’ but a symptom of our illness? When you’re on the edge of despair and you just wish it would all go away, even if that means suicide, it’s safe to say that logically appraising things is not really something you’re finding easy and that filling in a form and rating things on a scale from 1-10 can often slip your mind.

Why should people be made to feel they cannot speak up about what is truly worrying them as they will be chastised for being ‘awkward’?

I am not saying my therapist was a bad guy: I feel the problems with this lie primarily in a lack of NHS funding. Even with the best therapist in the world 16 hours is nowhere near enough to treat someone with serious depression, but that was all I got.  I worry that if I apply for more benefits (atm I can’t work I’m far too unstable, unless anyone wants to employ a moody, unreliable, tired person with fuck all experience who will take a lot of sick days; in which case I can send a C.V) I will be penalised again for not ‘doing my best to access treatment’. If the treatment isn’t there and what is there has failed me, what the hell can I do? I’m even considering going private but as I have about 2p to my name this isn’t an option I can seriosuly consider beyond a short daydream about recalling my childhood on a Le Corbusier lounger.

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