Maybe I’m just like my father: of psychiatrists and psychotherapy

Psychotherapy is a general term referring to therapeutic interaction or treatment contracted between a trained professional and a client, patient, family, couple, or group. The problems addressed are psychological in nature and of no specific kind or degree, but rather depend on the specialty of the practitioner.

Psychotherapy aims to increase the individual’s sense of his/her own well-being. Psychotherapists employ a range of techniques based on experiential relationship building, dialogue, communication and behavior change that are designed to improve the mental health of a client” – Wikipedia

woman-in-therapy-session

In my experience, most mental health centres and hospitals look the same. Red-brick buildings with NHS-standard signs directing patients to different departments, a row or two of (usually blue) chairs in a soulless waiting room, and old copies of Lancashire Life stacked on a low table if you’re lucky. Mazes of corridors and doors which are always kept locked. A buzzer or bell to gain entry or allow exit. Sometimes the paint on the walls differs, but it’s usually a palette of beige, pastel green or pastel yellow. “Calming” colours.

They inevitably make me think of the contents of an unwell baby’s nappy.

Our local mental health centre is, handily, in my town. It was recently refurbished and is now very different from the brief glimpses I got when I was being hauled – twice – to a private room on suicide watch in my teens. Back then the entrance led to a huge staircase which dominated the entire hallway of what used to be a beautiful old building but which has now been added to so much that it’s lost most of its character. Now, the staircase has been remodeled and everything’s been painted an off-white. There’s lots of glass and bright posters. It almost feels like a primary school, except you’re always aware that there are people upstairs, being watched 24 hours a day in case they hurt themselves.

waitingroom

I sat with my mother, and waited. As my legal appointee, she has a right to accompany me to any appointments and while I usually try to wriggle out of it… sometimes I need her. My fear of going back into the mental health system after over a decade of let-downs and damage inevitably took over, and I know I wouldn’t have coped on my own. As it was, I had a small panic attack when I realised the psychiatrist was stuck in traffic and would be late; if I ever needed control, it’s when I’m about to open up my fucked-up heart to a complete stranger.

I was mildly surprised that the psychiatrist I saw was a young woman. I’ve become used to stuffy old men in shirt and tie, peering at me over their glasses and shrugging off all my concerns as being “down to my age”.

Another blue chair. Another desk, another patient file. I’ve done this so many times that I may as well just record what’s said and play it at the inevitable next appointment a few years later. You see, I have a problem sticking with things, and I’ve already spoken about how I find it almost impossible to be honest when faced with authority. When everything becomes too much I cave in and accept professional help, but I either pretend nothing’s wrong, or never go back. It’s as though I want to help myself, but the process is too frightening. Therapy means a loss of control and a need to be painfully honest; two things I find almost impossible to deal with.

I explained to the psychiatrist that I felt I was too old to still be dealing with all this, and that the mental health system has let me down a lot in the past. Picked at my jeans and stared at the wall as I detailed everything; the panic attacks, obsessions, paranoia, the total lack of self-esteem, the drugs, the painkiller addiction, the times in my teens when I relied on stolen bottles of gin to get me through the night, the self-harm, the bulimia. As I spoke, I realised that honesty was never going to come easy; although I was forcing the words out with all my strength, I still held back. However, my stumbling confessions were enough to confirm the diagnosis of BPD, and to earn me a referral for psychotherapy.

chickentherapyhut

Specifically, I’m on the 18-week waiting list for CAT Therapy.

Cognitive Analytic Therapy (CAT) is a form of psychological therapy initially developed in the United Kingdom by Anthony Ryle. This time-limited therapy was developed in the context of the UK’s National Health Service with the aim of providing effective and affordable psychological treatment which could be realistically provided in a resource constrained public health system. It is distinctive due to its intensive use of reformulation, its integration of cognitive and analytic practice and its collaborative nature, involving the patient very actively in their treatment.

The CAT practitioner aims to work with the patient to identify procedural sequences; chains of events, thoughts, emotions and motivations that explain how a target problem (for example self-harm) is established and maintained. In addition to the procedural sequence model, a second distinguishing feature of CAT is the use of reciprocal roles (RRs). These identify problems as occurring between people and not within the patient. RRs may be set up in early life and then be replayed in later life; for example someone who as a child felt neglected by parents perceived as abandoning might be vulnerable to feelings of abandonment in later life (or indeed neglect themselves).

It all sounds like much of a muchness, and initially I was reluctant to even consider it. Most experiences I read online leaned very much towards the negative, and the idea of writing a “goodbye” letter to my therapist is an odd one; I usually leave therapy sessions by simply walking out and never coming back.

However, I’ve given it a lot of consideration over the past few days. Knowing CAT is a “cheap” therapy is a concern; does that make me a snob? I’ve decided that a minimum of eighteen weeks is a long time to think it through, and I do have the safety net of being able to leave whenever I want; I’m not being forced into psychotherapy. It’s my choice, and I think at least giving it a go is the right decision.

I think.

I hope.

_______________________________________

Sick to my stomach

Sinking to the depths again
the ones you never quite reach
heart in my hands and head on the floor
wishing I was anyone but me.

Falling for my weakness again
and welcoming it like a friend
crushing my heart between my fingers
– that heart you tried to mend.

Sad, tired eyes searching for you
but my hands can’t seem to grip
aching head and swollen fingers
and the shame because I slipped.

sick in my skin and dead to the world
it’s cold on the bathroom floor
smash all the mirrors and hide the pieces
I don’t want them anymore.

(c) 2006

Sick

Bulimia, unlike many of the things I’ve experienced, is strangely easy to write about. The reason for this is most likely because when I think of myself as being “bulimic”, it’s like stepping into somebody else and watching myself from the outside; almost like a movie. It isn’t real. Even after fifteen years of binging and purging, something inside me still refuses to accept that I could possibly have an eating disorder. 

ED’s happen to other people, you see. Not me. I simply… have a little trouble with food. Since I first made myself sick at eleven years old it’s all been a sort of blur to me. I know it happened, but it may as well be somebody else’s story because I can’t ever quite accept it’s not all a big lie I concocted to get attention. 

None of us are free

Listening to: Frou Frou Foxes in Midsummer Fires by Cocteau Twins.

It’s 5.08am. My stomach is empty and the diet Dr Pepper is making four days worth of heartburn worse. It’s become a toss-up between stomach pain or curbing my appetite, and so far the pain seems like the most sensible option.

See, restricting does strange things to your mind, especially when it comes to rational decisions. I may not have much confidence in my abilities or even respect myself much, but I know I’m not a stupid woman. I can dissect situations, and can think logically. Those have always been my greatest strengths, and though I’d never go so far as to say I’m proud – I don’t think I know how it feels to be proud of myself – it does offer me some comfort to know I at least have something I can do well. Right now though… logic simply doesn’t come into it.

I don’t know how long I’ve been avoiding food for now. Two weeks? It feels longer, especially when every breath brings a mouthful of acid up my throat. Strangely, I’m not dreaming of cake and chocolate. If anything, I’m just not hungry anymore. Or rather I am, but it isn’t registering as anything other than a pleasant sensation of emptiness.  This is what worries me – and worrying about my eating habits is a new feeling – because I recognise that pleasure. That feeling of being on a higher plane because your stomach is empty. Pure. Unspoiled. The only uncomplicated thing in your life. The only thing you have complete control over.

I don’t understand why I can’t bring myself to speak to S about all this. I still haven’t said a single word to him, even though I promised to when the anxiety was kicking off. I know it sounds like an excuse, but there honestly hasn’t been a suitable time to bring it up. “Hey by the way, you know how I used to be anorexic? And bulimic? Well, I’m aiming for like, 300 calories a day and pretending it’s the answer to all my problems. Want a brew?” doesn’t exactly go down well when everything between us is perfect and happy. I don’t want to taint the relationship by bringing up my failings.

I’m beginning to think I’ll never escape from ED. Never.

Strength in numbers: the Strong Person award.

Trigger warning: contains talk of suicide and self harm. 

You heard me right! You are not weak, you are strong. You are not a failure, you are a fighter! This goes out to all mentalists. And it’s a gift from me (The Quiet Borderline) to you all – Please spread the love. Mental health is not something to be sneered at and it deserves much more respect. Stop the stigmatising.

I was wondering how to begin writing a post today. The anxiety has passed but otherwise… things have gone a little squiffy. Somewhere along the line, I lost control and grabbed for the closest crutch; food. Or rather, as little food as possible.

After yet another restless night, interrupted by stomach grumbles and dreams of cake, I woke this morning to an award nomination from The Quiet Borderline. It seemed fitting. The above quote is from her blog, explaining the award she’s created; I’ve given my opinion on blog awards many times but I think this one could become something special.

1. Make sure to add in the above text and image (below) to spread the love and add how little or how much you want! 2. Name your diagnoses – Stand loud and proud! You can tell us a little about them also if you’d like. How you’re affected by these diagnoses and how you are fighting your way out of them. 3. Add a photo of yourself, or some abstract picture that represents you, anything you like! 4. Send this on to as many, yes, as many, people that you like. It can be five, ten, fifty.

2. Depression. Probably my most important diagnosis is clinical depression; a permanent feeling of doom with regular visits to a hideous abyss I can only describe as being as close to hell as it’s possible to be. I know that sounds like an exaggeration, but I know there are others reading this who understand all too well how it feels to be trapped under the dark duvet of depression. Since puberty I’ve struggled with suicidal thoughts and occasionally actions; my first overdose (antidepressants I’d been stashing away for weeks) landed me in hospital for two or three days, and the second involved cups of hideous charcoal water and having my blood cleaned after I woke up, still alive but with bright purple blotches all over my body where the combination of paracetamol and strong coffee had taken its toll on my liver. After trying a couple more times and failing – ending up either in hospital or missing the vein on my wrist entirely and bleeding all over the bathroom for half an hour, feeling like an absolute twat – I realised that suicide was never going to be the answer. I still struggle with the thoughts sometimes… they creep up and try to drag me under. I just don’t act on them anymore. Medication keeps me just about safe.

Depression: why it was never about sadness

Borderline Personality Disorder (BPD).  Eighteen months ago I had no answers for the way I often reacted to events; multiple psychiatrists and doctors had seen me in their offices over the years and tried to stick a label on my total inability to cope with, well, anything. To describe it all sounds ridiculous; hiding indoors in case somebody spots me (agoraphobia from a fear of being judged and laughed at) and panicking every time somebody says they’ll call me and are late. Banging my head against the wall because nothing makes sense. Because I’m so fragmented and messed up. Self-harming to cope with the anger inside me I could never let free; a quiet borderline, if you will.

What is borderline personality disorder?

Anxiety. Crippling, soul-destroying anxiety. Is that part of BPD? I don’t know. Everything melds together into one fucked-up disorder with no name. A combination of Cipralex and beta-blockers keeps me on a somewhat even keel. It feels like the fight or flight response in me is broken; I run away from the most ridiculous situations, freak out over next to nothing, and react to stress by hyperventilating and becoming convinced the whole world is against me. Watching me. Waiting for me to fall.

There are others. Bulimia. Anorexia in the past; I’m no longer anorexic but still restrict calories when I lose control over life. Major paranoia, but does that come under anxiety? The occasional psychotic episode.

3.

4. Passing this award on is difficult, because I’m sure there have been many nominations by now. If I repeat anybody, apologies; you greatly deserve the nomination regardless and don’t have to accept.

lalaemzo / Living with BPD / NZ Cate / atwistedfantasy / alwaysallegoric / buckwheatrisk / onxuncovered / Don’t Let Me Get Me / You Know You’re Borderline When… / makeupandmirazapine / Bats / Resilient Heart / notthinginmynoggin /  Diabetic Redemption / aasouthernbelle / Hello Sailor / mm172001 / mysterytopursue / Quit The Cure / roosiegoosie / Temper_Tantrum / Gypsy

Really, I could nominate a hundred more people and still not give everyone the respect their very honest blogs deserve. As time goes on, I may add more to the list; yes it’s a lot of links, but there are a lot of wonderful bloggers out there sharing their experiences and being brave enough to speak out.

You’re all awesome.

If we get through this alive, I’ll meet you next week, same place, same time.

I stayed away from sharp things. Suffered from the codeine; entirely self-inflicted, and I’ll never be proud of shoveling bright red pills down my throat until the anxiety stops. Binged on Kits Kats and plain crisps at 3am. Lay awake in bed on Wednesday night, swimming in a sea of chemical highs and sweating out every last bit of water in my body, determined to sleep but flying too high from the codeine and dope.

I don’t know how it works elsewhere, but in the UK codeine can only be bought mixed with paracetamol; 500mg per pill. More than two tablets is therefore an overdose, and I usually need eight or so to give me enough chemical serenity… and I know my liver is paying for it. My addiction… once, I thought I’d be okay, that I wasn’t like other people who had to rely on drugs to get by in life. I convinced myself that I wasn’t addicted. I could stop any time.

 

Now, the lower back pain and constant diarrhoea is telling me otherwise. The headaches and nausea and bloating… it baffles me how I can be terrified for the health of my liver, but still continue to assault it with large doses of paracetamol.

I’m not a stupid woman. For all my failings, I know I’m pretty intelligent. However, I have the ability to create my own strange logic; to remove myself from situations and become convinced I’m okay and won’t damage myself so long as I take the occasional break. And on the whole, I’ve been doing well – since deciding to give up codeine, I’ve managed months at a time without even touching the stuff. Recently though, it’s been harder to resist. The world has been heaped on my shoulders without my permission – with the tendonitis and the fraud allegation – and I’ve retreated to the old habits in order to cope.

This is what relapse feels like.

I intend to make it as short as possible, because cutting myself and overdosing instead of coping with situations isn’t emotionally or physically healthy. Thinking about purging is a dangerous road to travel down; I made myself sick a few months ago, and don’t want to get back into that habit so soon – or at all – because I’ve been doing so well. It’s one of the few things I feel I can be proud of, and I’ve let myself down far too many times in the past. Over a decade of bulimia, and I’ve almost cracked it… I don’t want to go back there; don’t want the puffy face and swollen fingers and constant taste of bile in my throat.

 

Sixteen years, in fact. Sixteen long years since I first stuck my fingers down my throat in a tiny blue cubicle, skipping a lesson so I could throw up everything I’d eaten. Sixteen years since I first realised that fat = unhappy,  and I had to do everything in my power to prevent it.

Seventeen years since I first cut myself. Since my first overdose.

The codeine? That began when my relationship with O started falling apart, six years ago. I would stay awake at night, smoking out of my bedroom window and waiting for the chemicals to kick in and squash the rising panic dead. If O didn’t call, I’d take a handful, knowing it would take away all the anxiety and paranoia that he was cheating on me. When I found out he was cheating on me, I stepped it up; packets of amitriptyline, diazepam and co-codamol, taken as and when I needed to calm down. Days and nights spent tripping on Tramadol overdoses.

I’ve had a lot of abnormal liver function tests. Still, I punish my body so my mind can feel okay.

When you’re young, you think nothing truly awful can ever happen to you. When those bad things do happen, you still think you’re invincible and no amount of abuse could ever harm you. Even years later, when the dentist points out the eroded tooth enamel… it’s not real. Bulimia, self harm, pills… they’re all an addiction, and the brain plays cruel tricks so you don’t give the bad habits up.

 

This weekend, I plan to sit down with S and tell him what’s been going on. About all the stress and bad thoughts. I’ve told him a little about the rising anxiety, but brushed it off somewhat. I don’t like talking about these things in person, and I’m always afraid he’ll find it too much to deal with.

Most people do.

 

Walking in circles

I don’t usually warn if there are going to be triggers in my posts, because I can’t censor everything I write and the nature of this blog is probably triggering anyway. However, there’s detail of self-harm which, if you’re feeling at all vulnerable, probably should be avoided. Eating disorders too. Be safe <3

A lot of the posts I write never get published. Some are still sitting there in my drafts folder, others have been permanently deleted because I never want to read them again. Some I abandon halfway through because typing those words is just too painful. Others I start, but then I pass out in a dope/codeine/alcohol haze before finishing them.

This post, I want to publish. I don’t want to write it – God knows I don’t want to write it – but if I’m going to be honest and keep track of the ups and downs, I have to stop hiding behind the magic “publish” button. True honesty – the entire point of this blog – can’t be had if I’m going to delete posts and never let anybody know they existed.

Today, I thought of both cutting myself, and making myself throw up. Not only did the thought enter my mind, but I planned exactly how I was going to do it; taking my new razor apart (with much sweating and swearing with a pair of scissors, trying to cut the plastic off) and repeatedly cutting all the part which made me feel inferior. My pale, wobbly belly. My flabby underarms. My hips. Inner thighs. My chin. All those hideous freaks of anatomy which make me avoid full-length mirrors and looking at myself naked. I walked around Asda – supposedly shopping but avoiding buying any real food – with my paranoia switched to full and the urge to harm myself almost reducing me to panicked, hysterical tears at the checkout.

I take two steps forward, and ten back. Some days I can almost believe I’m on the road to recovery from all this shit, and on others I realise that I’m always one tiny step from total meltdown and the slightest thing could send me all the way to crazy again.

I didn’t harm myself, or make myself sick. By the time I finally got home – what felt like milennia later – the urge had dulled a little, and a couple of joints calmed me enough to feel safe-ish. Not safe, just ish.

However, something came home with me. 28 Solpadine Max tablets.

Codeine. My old friend. My worst enemy.

I’ll always be walking in circes.

Very Inspiring Blogger Award

I’m not immune to writer’s block. Usually when I don’t write as often, it’s because something’s going wrong; I’m in a depressive episode or incredibly stressed. I’m too tired or sore to sit with the laptop on my legs. Rarely do I avoid it because I can’t think what to write, because since puberty I’ve wanted to tell stories and finally having a way to express all those trapped words is wonderful.

Still. I just haven’t had the inspiration lately. So for Shermeekaflies from The Possible World to nominate me for the Very Inspiring Blogger Award amused me; I haven’t felt at all inspiring or inspired for a week or so. It also touched me, because despite my reservations on awards being little more than chain-mail, I always appreciate being nominated. I never thought this blog would be read, let alone have almost 100,000 views and more than 2,000 subscribers. Seriously, if I think about it too long, my mind retreats into a nice, safe place where I never put myself out for the public to judge. So huge thankyous, Shermeekaflies!

As usual, the rules are pretty simple;

  1. Thank the blogger who nominated you.
  2. Share seven things about yourself
  3. Nominate other bloggers you think deserve the award, and post on their blog to let them know they’ve been nominated. Actually, I changed the rules a little; originally it asks for 12-15 nominations, but I always think that’s unfair on those who don’t have many blogs they follow or who are just starting out. So nominate anybody. If you can’t think of a blog, nominate a site you believe is inspiring.

1.  I met my first boyfriend in high school, and initially didn’t find him at all attractive or interesting. We had a shared love of The X-Files and my best friend’s older brother was his best friend, but because he was a couple of years above me, we only really saw each other in the library and at parties and I certainly never saw him as relationship material. I still wonder why I agreed to go out with him; I did really like him but can’t help thinking that I was just reaching out for some sort of affection. Anorexia was still lurking, and I was at the height of bulimia and self-harm when he first kissed me on a bed at a house party when I was fourteen. The kiss was memorable, but only because it was far from the romantic experience I imagined; his tongue seemed to fill my whole mouth and neither of us really knew what we were doing. I couldn’t stop shaking; each time he touched me I’d break out into noticeable spasms, my arms and legs shuddering like crazy until he let go.

After three months of talking on the bridge in the park, sitting on swings and eating chicken and sweetcorn pizza together, he left me. He came to my house, and I freaked out; I can’t even remember what caused it. I was paranoid and edgy, backing him into a corner and screaming uncontrollably in his face. I’d been jealous of his friend Carol. I invented scenarios where he was sleeping with her. Each time he went to her house to study for his GCSE’s, I’d break out into a cold sweat and convince myself he was leaving me.

I threw a chair at his head and left a hole in my bedroom wall. We didn’t speak again for over a decade. He’s married now. His wife shares my first name.

2. Songs almost guaranteed to make me cry include Vincent by Don McLean, Out To Get You by James, Why Not Smile by R.E.M, Exit Music (For A Film) by Radiohead, The Pills Won’t Help You Now by The Chemical Brothers, Johnny Cash’s cover of Hurt, Bulimic Beats by Catatonia, and Asleep by The Smiths.

3. Since taking antidepressants, I’ve rarely cried; not even at the songs above. I’ve always been a very outwardly emotional person and in the past it’s been hard to control the waterworks. I cried at everything. Now it’s difficult to squeeze the tears out even if I want to. It’s not a listed side-effect but I can only pin the change down to the chemicals in the pills filtering the urge out of my brain. Take it from me; the ability to cry whenever you need to is a blessing, not a curse. I miss the outlet.

4. The idea of reaching the age of twenty seven never used to occur to me. By puberty I’d decided I wasn’t going to live to eighteen. I didn’t really have a reason for it other than morbid hormonal obsession with my own death and mortality, and once the eating disorders and suicidal behaviour kicked in, I accepted that I’d never become an adult.

Now, I’ve been an adult for nine years, despite all the hospitalizations and suicide attempts, and I’m still unwilling to let my childhood go. I was never supposed to make it this far. I wasn’t prepared for it.

5. My favourite poem is I Am, by John Clare:

6. I don’t know how many people I’ve slept with. It’s in double figures, but I can’t begin to guess.

7. One of my favourite artists is Paul Kidby. I’m a huge Discworld fan:

Nominations:

I’ve chosen the above bloggers simply because, as the title suggests, I find them inspiring. Either through their honesty or ability to tell their stories in a beautiful, powerful way.