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Therapy Assessment

Or, “One hour of me feeling defensive and being asked questions like, “Why do you use labels like manic depression”?

Because I have this treatable illness called “manic depression” and you were asking about it? I’m fairly well read when it comes to psychiatric diagnosis, mostly because I write this blog and like to be informed. Using the “label”of manic depression comes naturally to me, because I write about it so often. I also find the whole thing easier to understand and explain if I can use the bloody words that describe the illness. I hate this about psychiatry- I do my best living with this, but it does affect my life significantly. I don’t “let it”, I’m not weak, it just does because that’s what it does to me. Just because it affects me and I acknowledge that, it doesn’t mean that I define myself by it. I use the phrase, “I have manic depression” rather than, “I am manic depressive”. If I had another illness that significantly affected my life, nobody would call it a fucking label. People are always very suspicious if you know anything about psychiatry. I have the internet, a library and a curious mind- if I’d been diagnosed with any illness I’d have found out everything about it by now. It is how I make sense of it and deal with it. If it was still this faceless thing, like it was, it would be harder.

They also asked if I was showing them my scars. I wasn’t, I was fiddling with my bracelets because I was nervous.

I did talk about eating issues and body issues (which I find nigh on impossible talking about in the flesh- manic depression, fine, it’s almost my job to talk about that) but fucking hell, that was so traumatic and I feel completely shaken and tearful. I really didn’t expect for it to be so hard, and sitting there in front of two impassive faces was just fucking horrible.

They asked me what I wanted out of therapy. I told them Rob was worried about me, and I wanted to make an effort to try and sort out my eating and body issues as much for him as for myself. And because dysphoric mania is too easily triggered by antidepressants, I’d like some help in coping with depression since I can’t take medication for it. In short, just some help coping with things.

I just hated that whole hour and feel shaken by it. They were nice, it’s just so fucking hard to talk about that kind of stuff in front of strangers when you’re not absolutely pissed. Here’s why I prefer to write than to talk.

I’m repeating the experience next week.  Ah fuck.

At least I went, though! I was so nervous beforehand that I chainsmoked for two hours.

The Sane Guide to Living with Mental Illness: Medications

I was watching cigarette advertising from the 1950s onwards on Youtube today. It’s all very aspirational, grand cars billowing Camels smoke from the driver’s window, doctor extolling the virtues of Chesterfields and such like. So I made my own non-aspirational cigarette advert.

Anyway…

Here is another one of my more sensible guides to mental illness, this time, medication, from someone who’s been on most of them and suddenly packed in nearly all of them. (Although I am on 50mg Lamictal with Seroquel now to see if it dents my mixed episode). I guess a lot of you who are already on medications won’t find this helpful, but some other people might.

So!

The Psychiatrist has decided that you’re mental. Well done! By now you’ve probably been told what flavour of mental you have. The flavour favoured by most is bipolar disorder but you may have been told you have schizophrenia, depression, anxiety, a personality disorder, obsessive compulsive disorder or an eating disorder. Or even more than one of those things! That’s good, it means you’re extra special.

What will happen now is that they’ll hold a little conference behind your back to determine whether you’re going to be prescribed medication, going to be referred for therapy or whether you’re going to be kicked out of their office.

Chances are, you’ll be prescribed medication. It’s likely that they’ll be an antidepressant, antipsychotic, anti anxiety drug or mood stabiliser. Or pick and mix from all of the above.

So, here is the guide to medication.

1. You’re taking them because…?

Psychiatrists sometimes have a habit of thinking that their patients won’t understand clinical terms like “psychosis” or, “you’re flipping the fuck out”. So they might use helpful little phrases to explain to you why you’re being prescribed a certain medication, and they try to avoid frightening you by implying that your behaviour is a little…let’s say, off?

“This will calm you down”- “You are vibrating like a badly drawn cartoon”.

“This will help….even you out”- “You have burst into tears six times and then burst out laughing another ten for the thirty minutes you’ve been said here”.

“These should help lift your mood”- “You tried to kill yourself with my stapler”.

“These will help alleviate your compulsive behaviour”- “I’ve noticed that you’ve been counting the vowels I use in my sentences” (That was twenty three).

“These will help with your strange beliefs”- “You’ve referred to yourself as The Queen for the duration of this discussion”.

2. Know your enemy

Occasionally, a doctor will withhold a diagnosis from you or whoever bought you to the psychiatrist in the first place. Generally, you can guess what’s up with you via your medication. Antipsychotics, like Risperidone, Quetiapine, Amisulpride, Haloperidol and Olanzapine are generally used for psychotic disorders like schizophrenia, schizoaffective disorder, delusional disorder, manic depression, some types of personality disorders, some sleep, anxiety and compulsive disorders and occasionally, depression. Antidepressants like Prozac, Citalopram and Effexor are used for depression, some personality disorders, panic and anxiety. Anti anxiety drugs (the ones that are benzos, not antidepressants like Paxil) like Valium are for anxiety and panic and mood stabilisers, usually anticonvulsants, like Lithium (which is an antimanic), Depakote, Carbamazepine and Lamictal are used for some types of depression, personality disorders and manic depression.

If you have the interweb, and you do, since you’re reading this, research your medication. But be prepared to find out some things you didn’t want to know about…

3. Side Effects

Psychiatric medications are notoriously awful to take for some people and chances are you’ll have side effects. In short:

Get used to drooling. Antipsychotics and anti anxiety drugs can be really sedating and make your body go a little bit floppy, though it probably feels as though your limbs are made of lead. They can also cause you to slur your words, so, a little bit of spit might make a dash for freedom.

You will feel weird for a few weeks. Lots of medications take a while to work on the illness they’ve been prescribed for. In the wilderness of waiting, you might feel weird. You might feel blunted, spaced out, anxious, irritable or you might be having some odd thoughts. Tell your doctor.

You will sleep forever. If you’re taking antipsychotics, anyway.

Avoid the scales. It’s a shitter but psychiatric medication can make you gain weight. Antipsychotics are worst, anticonvulsants like Lithium and Depakote are pretty much wank too, antidepressants can be tricky and anti anxiety drugs, well, the benzo type, aren’t meant to be used for more than a week or two, so you shouldn’t gain weight from them.

Shake, shake, shake. The anticonvulsants will give you the shakes, listed on the PI sheet as “tremors”. It can be a bit embarrassing as people might assume, like they did me, that you’re an alcoholic. Try not to take sugar in your tea as it just causes confetti.

You might not think as clearly as you used to. Most drugs affect how your mind works. Even caffeine does, so psychiatric medications will. Well, they’re designed to. For the first while taking them, your head might be a bit foggy and…

I had a point here, but I don’t remember what it was… because I’m taking antipsychotics.

4. Don’t expect miracles.

Some drugs work on some aspects of illness very quickly. Antipsychotics are good for getting people out of psychotic and manic episodes pretty fast. Antidepressants can lift your mood within a fortnight.

You have to take drugs in order for them to work. If you’re not taking the medication as prescribed, the medication isn’t “not working”. You’re just not taking them.

There is more to mental illness than direct symptoms and medication isn’t a cure for them. The chances of you being suddenly completely better are slim, and because of this, medications will be changed, doses will be adjusted and other treatments will be drafted in alongside them.

You don’t actually have to take medication if you don’t want to. There will be times when you will have to- i.e if you’re under section, but aside from that, you can choose. Of course, if you’re under the care of a psychiatrist or mental health team, you will be strongly advised to take what they’ve prescribed you.

But, you can weigh up the pros and cons of medications. If the side effects are too much, say so, because another medication can be tried. If you hate the way they make you feel, say so, same applies. The decision is ultimately yours, though.

In reality, it’s best if the decision is ultimately yours and someone elses’ because getting ill again- relapsing into mania or psychosis, for example- means that you won’t be in the place to decide if you should be taking them because you might feel that nothing is wrong. It’s always good to have someone else tell you that you’re mental when you don’t believe it yourself.

5. The medication Hissy Fit.

Yeah, chances are you hate your medication, even if it is helping. You’ll want to flush them down the toilet, chuck them into the Thames, strap them to a rocket, etc etc etc. Have your hissy publically with the doctor before you decide to do the above, as they will be only too happy to tell you what a pain in the arse you were when you weren’t taking medication.

6. If you’re going to continue medication, DON’T:

Drink. Alcohol and psychiatric medications are a ridiculous mix. They make you a lightweight and you’ll be drunk a lot quicker, but be less inhibited so you’ll drink more. That way lies making a total dick of yourself in front of your friends, passing out in the street and pissing yourself or ending up in hospital.

It can be dangerous to drink alcohol while on certain medications like Lithium and Depakote.

And alcohol is a CNS depressant and it will generally make any mood unstable. There’s no point in taking an antidepressant to make you feel better, only to get wasted and feel like shit.

Take drugs. Because you’re already pumping powerful chemicals into your body and you don’t need more.

Drive. Don’t even attempt to drive if you’ve just taken an antipsychotic as it will result in a DUI and probably the end of your car. Don’t cycle either, because, like me, you might find that you’ve forgotten how to steer and career into the pavement of the Seven Sisters Road.

and DO:

Get a pill organiser. One of those cheap plasticky things you can get from chemists for the princely sum of £4.99. They sort your pills out by day so you can’t forget or take too many.

Keep tabs on them. By recording how you feel every day. Or ask someone else to do it for you if you don’t trust your own insight.

Drink lots of water. Because they can piss about in your blood stream, liver and kidneys.

7. And if you’re not going to continue taking medication:

Do it slowly. Don’t come off medications suddenly. They are drugs, and like any drug, they might have withdrawal. Do it slowly.

Look into other treatments. Like therapy, for example. For some people therapy works as well as or better than medication.

Tell someone. If you’re in the right frame of mind to. Quitting medication can cause a relapse that you might not notice but other people will. Subtle things, like stripping to your knickers and running into traffic.

Anyway, that’s my Sane Guide to Medication. Anything you want to add?

Operation You Make Me Sick

I spent a good hour on the phone this afternoon to an eating disorder charity, Beat. I initially rang them to ask one simple question- “If I begin eating again, will I gain weight?” The answer was, “Maybe to begin with you’ll gain a few pounds as your body adjusts”. Looking down at my bruised and scarred knuckles, I felt my stomach plummet into my shoes. It wasn’t the answer that I wanted.

My knuckles roughly look like this, on a scanner at least:

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There’s a bruise there, under my forefinger, and those scratches and scars are due to abrasions from my teeth. My hands feel very rough as I scrub them often.

Time ticks on, and the elephant in the room is about to “Ta da!”

There is one thing I do every day that I never discuss.

I have a serious eating disorder. And I have to say something about it to a professional. So far, I have backed out of mentioning it. For a year and a half of being cared for by the community mental health team, I have mentioned it maybe twice, then immediately dismissed it. On Thursday, I have my first meeting with the team psychotherapists.

Oh, I know I have an eating disorder. Every body has an eating disorder. I don’t know very many people who don’t agonise over every scrap of food that goes into their mouth. Who don’t say, “I feel bad eating this” as they nibble a biscuit, who are afraid of putting sugar in their tea, who eat their lunches self consciously in suicidal offices, buying a salad, but they wanted a sandwich.

It’s all very cloak and dagger. I’ve come up with some ridiculous lies as to why I can’t eat that and why I need to throw up right now, so that when I return from the toilet (in public places, disabled toilets are a godsend) I can just smile apologetically and eat a mint rather than rub soap all up my arms and inside my fingers and chin, panicked about the smell. I’ve had so many mysterious tummy bugs, I can’t count them on one calloused hand. Rob found out recently that I had been lying to him.

He is worried about me. He is very worried about me. We have lots of pleading conversations in which I promise to try. I did not realise until recently that this had stopped being something I had a handle on. I have totally lost control. It is an automatic reflex. I don’t binge eat. In fact, when I do eat (and it is rarely), I eat very healthily. But even that is not good enough. I throw it up anyway. My trying lasted three horrible days. During those three days, I took laxatives. I have to get them from two different chemists after my usual place began asking questions. Why would I need two packs in three days?

It is panic. Pure panic when I eat. I feel it clogging up in my blood stream. I feel it attaching itself to my flesh, making me fatter. For about two months, I was on a meal replacement diet. I thought it would make me better. I thought it would be so controlled that my old habits would disappear. They didn’t. It has become so much worse.

I have lost weight- I am 8st 12lbs now, as opposed to the 12 stone I was at the beginning of the year. I know this because I have two sets of scales that I weight myself on at least seven times a day. I haven’t really been on that diet since April. On, then off, then on. Alternating between drinking shakes and then eating and throwing up. One is safe, the other is safer.

I love the fact that people tell me how nice I look. I hate the fact that I can see absolutely no difference in myself. Rob thinks that I never will. Another conquered thing, I thought, was body dysmorphic disorder. Because I wear less make up these days. Because I go out in daylight.

It is not.

I think about my appearance and my weight constantly. I am in a state of paranoia and panic twenty four hours a day. I can’t watch most films because the actresses are so much more beautiful than me. I can’t look some of my friends in the eye. I am back to self harming. I tremble as I pass people in the street, silently praying that they won’t remark on my appearance. I am The Monster. I will always be the monster. I am still torn up inside by self hatred that refuses to diminish. I could be the most successful writer in the universe and I don’t think one shred of it would shimmy way. It is as though it is threaded into my veins.

Of all the things I am ashamed of, I am most ashamed of this.

I’ve never considered my eating disorder to be serious. I’m not thin. I’m not even underweight. To me, that marked “serious”. Me, I’m fat. You’d never guess I had an eating disorder by looking at me. You’d probably assume that I ate to much. You’d probably assume that I was going back to my lair armed with donuts. I could go to a forum and talk there, but I’d feel like they could sense through the screen that I was fat, that I didn’t belong there.

The woman on the phone said, “It is serious. You are seriously ill”.

“No, I’m not. I’m not ill, it’s not serious. I’m not thin”.

“You are doing so much damage to your body. Damage you can’t see. You’re going to end up in hospital”.

I see the logic. I say I don’t know why I’m exhausted and can barely walk half a mile. But I know why. I know what I’m doing to myself.

I throw up about three times a day. I throw up normal amounts of food. I don’t binge.

The lining of my throat bleeds. It hurts to swallow.

My teeth are rotting out of my head.

I have so little energy. The lack of physical energy is at odds with my overt mental, slightly manic energy at the moment. It is killing me.

I can’t have sex. I don’t have the energy. I get exhausted after walking half a mile. I don’t have the energy.

I am having heart palpitations. I am getting breathless.

During the times I have tried to eat solids and not throw up, my body’s reflex was to gag, and I would throw up over myself.

I feel dizzy all the time.

I strongly suspect, and so does Rob, that I have developed anemia.

My rationale goes like this:

I don’t care. I’m fat.

But you’re going to end up sick.

I don’t care. I’m fat. If I stop doing this, I will become fatter.

And I hate myself for the fear that puts into me.

As if I need any more problems. I am already contending with manic depression.

The woman on the phone said I had an illness. I never considered that I did. Not bulimia.

She gave me the number of some places that could help me. I do not know if I’m ready.

I hate smelling of sick and I hate, more than anything, what it is doing to Rob. How we can’t enjoy anything because I am so paranoid about my looks. No lovely meals out because it’s a waste of money. I just throw it up. I like food. I want to enjoy food. I want to enjoy something in my life because manic depression has stripped me of that. It should not be minutes or hours, it should be days, weeks, months, years. I hate the sad look on Rob’s face when he realises that I have only been lifted for a moment, and there is hideousness swirling in my head.

My first therapy meeting is on Thursday, after a year and half of saying nothing.

I have to say something. And I am terrified.

What if she looks at me and thinks I’m lying? I’m fat.

What is she thinks I’m vain? I’m ugly.

What if she thinks I’m an attention seeker? I am covered in self harm scars.

It is trivial, it is vain.

Hannah brings it up, I dismiss it. I am scared. It means admitting to it in front of another human being. And it means I will not be allowed to continue anymore. It means that someone else is in control. And that is already the case, with the medications, the psychiatrists, not being able to drink, having to sleep. My whole life is ticked and measured week by week. The pressure to be well, to get better, to be insightful and helpful when sometimes all I want to do is retire to self abandonment, it is incredible and it is constant.

This is all so frightening to me.

But I’m looking at my knuckles again. I have no choice. There are so many mental mechanisms that are trying to kill me. And I know, deep down, this is one of them. I just can’t have another conversation with Rob where he pleads with me, and where I do nothing, where I confess that he can do nothing.

I have to do something about this.

Friends of the Madosphere

A question I get asked a lot in relation to this blog is- “Have you made any new friends because of it?”

The rather blunt answer is, “Not really”. There is one actual friend that I have made from this blog, and a few acquaintances who I might be friends with if I was not so notoriously bad at keeping in touch with people. I love my readers and commentees, who are, by turns, hilarious, caustic, sympathetic, helpful and massively intelligent. And are pretty much the reason I continue to write here. I would have stopped a long time ago if not for them.

I do talk to a few people off the site but I am now cautious about such things as, on one hand, a few people have plagiarised me and pissed me off (I’m not linking, but discussions have been had) and on the other, when I publicised my MSN address, I was inundated with people telling me they were going to kill themselves, and I had no way of helping them. Considering I recently lost one of my best friends to suicide, I just can’t cope and I don’t use instant messaging anymore. So I don’t have much opportunity to speak to people off the site, aside from lurking on their Facebook profiles (which I do). So, sometimes, for sake of self preservation I necessarily keep a distance.

The two friends are:

Mental Patient: Or the artist formally known as Tony Nunn. Tony’s forty two, literate, a total lifesaver to me and he has schizoaffective disorder. I haven’t seen Tony in a while but we do keep in touch and very occasionally meet up in various cafés where we eat food, he disapproves of my smoking and we both argue the toss about the joys of being mental. I enjoy being around Tony a lot. He’s similarly mental to me- we’re both frequenters of intense paranoia and have suffered through some similar delusions, therefore we’re both unshockable in regards to each other’s stories. We both have very rapid cycling so there’s no need for hurried explanations on the pitfalls of being a moving target. He has a big laugh and he likes wine. There is something very classy about him, it’s probably his manners. Tony is partly responsible for my continuing existence in London, so blame him.

Zarathustra of Mental Nurse: I’ve known Zarathustra for five years, long before he was a nurse and before I knew I was manic depressive. Faltering communication and very different geographical locations mean that we don’t see or speak to each other often. We met on a Manic Street Preachers forum, back in the days when I was a precocious mentalist. He has had the pleasure of meeting me while I was submerged, or should I say, stratospheric, in a manic episode. We once ran a piss-poor satirical website together which lasted for about five minutes.

And notable acquaintances:

Lou: Lou is one of my readers. She lives in Northern Ireland, not far from my stomping ground. She has been unbelievably supportive and I sometimes read her e-mails when my finger is hovering over the “delete” button of this blog.

Scott: Scott writes Exact Science. We only seem to talk very late at night when we’re both feeling hysterically bad.

Wife of a Schizophrenic: She doesn’t publicise her name so I won’t, either. Not only does she run one of the best mental health blogs there is, she is also an amazingly lovely woman.

There are loads of other people I speak to occasionally, (like Nessa) and a few whom I used to, but have lost touch. There are some blogs I still want to add to my blogroll and there are some people out there I am too shy to speak to. And various people have donated to this blog and helped me continue to live somewhere that isn’t a cardboard box and I’m indebted to them.

I have entertained fantasies about having a Mentalist Meet Up, somewhere posh. (Namely, I was dying to get loads of my readers and fellow bloggers together at the impossibly posh Berkeley for afternoon tea. I just love the idea of a ton of bottom-barrel (by that I mean “perceived as by certain factions”) mentalists like me in fancy clothes mingling with the rich and never had to budget for teabags).

I would love to meet a lot of you in person. And, in my own narcissistic way, I also wonder what you’d think of me in person. I vary wildly depending on what mood I’m in, as most people do. Sometimes I am utterly withdrawn, almost belligerent, tingling with agitation, and sometimes I am forthcoming and funny. However, I am always shy, I just deal with it in different ways.

If I’ve missed you off my list, don’t be offended. It feels rather cruel of me to make the list in the first place. I am getting better at keeping in touch and responding to e-mails so if you ever do want to talk to me, e-mail me and I shall happily respond.

In Happier News

Edited the link- I’d put the wrong one in there.

But in good news, I received my copy of One in Four today, which I wrote for!

In hindsight, the article I wrote is far from my best work but I’m still proud to be a part of it. The magazine itself is fantastic and is available free in various places (mental health trusts and the like) so keep a look out. Mental Nurse also feature in their web review.

Snake and Crocodile

Just popping by to gratuitously plug Rob’s new web comic, Snake and Crocodile!

It features Snake…

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…and Crocodile…

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…with occasional special guest stars sauntering in to be cocky.

Anyway, go visit. It’s brand spanking new so expect it to be updated regularly.

Hurrah!

(You may have seen two entries here today but those were mistakes, I was just talking to myself. Whoops!)
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