Hello! Occasionally some posts, like this one, will be illustrated by the lovely Prozacville, so go and visit him and give him praise as you would a deity.
I am sick of having “issues”. But here is a post moaning about them! Delicious irony.
But ooh. I had forgotten the (free and fixed) Macbook had Photobooth. Here I am relaxing in my sitting room. Not pictured are my chandelier, maid, cigar and rent boy.
Except I’m clearly not relaxing in my sitting room, as only maniacs can relax when a lens is on them, and I have in fact turned the Macbook upside down and that’s not a relaxing pose. I also have silly hair. I dyed it red and blue, which apparently means orange and green. I like to think I look like I’m sporting beguiling autumnal plumage, and not that I just look like a twat that’s been left out in the rain too long.
Ah, an illuminating appointment with my social worker today, so, thought I’d write about it. Long, self obsessed and introspective- you could say it’s a Classic Secret Life… post. (And a caveat here: remember this is a blog exclusively about mental health. Some people seem to forget that. I do not go through my day to day life going, “ARGGGGGGGGGGGGGGGGGGH”. I have other, more cheerful topics of conversation).
I’ve never really gone into detail about my now twice-monthly (or, as the kids say, “fortnightly”) appointments with my social worker. They are mostly a bit of a chat, commentary on mood and someone for me to talk to. She’s a lovely woman, quite clearly no-nonsense, which is sometimes appreciated and sometimes not (who doesn’t occasionally want a bit of, “Ah, there, there” and to just moan into your sleeve) and I like her. The appointments are usually conducted in a small room with one window, and today there was the smell of cat piss emanating from…something. I suspect it was me, since I’m not entirely convinced that Girl Cat hasn’t weed on the cords I’m wearing. Then again, I didn’t really care this morning when I got dressed. A cheeky sniff almost clears my name, but I have a bit of a cold so I may well infact stink of her waters. My social worker insisted it was somewhere else in the room as, being a residential area, cats sometimes become cat burglars (a term which used to confuse me greatly) and pee all over the place before they’re shooed away.
She helps me with practical matters, and carried on my old CPN’s work in terms of benefits and housing. But I can mostly do these things alone. Okay, it takes me about three and half millenia to get round to doing it, but I am fairly independent, as far as people within mental health services go. She has been trying to sort out direct payments for me to study something, with both of us agreeing I need more structure in my life. I keep- genuinely- forgetting to ring up, but I will tomorrow. To be quite honest with you, I don’t particularly feel up to a lot right now, but I’d regret not trying, and it may well be good for me, especially with Robert going to university in October. We could compare notes.
Today we discussed therapy, and why the person who makes the assessment had been unwilling to make an appointment with me.
I had therapy was last year, and it was CBT for body image problems (BDD). I spent most of 2008 in a depressive stupor, indeed, I don’t particularly recall much of it. Therapy started off okay, but I was already rather depressed, and as it progressed, I began to feel worse. By the time of the fourth or so appointment, I was so depressed that I didn’t actually give a toss about my appearance, so it was difficult to engage with it. What had seemed greatly important no longer felt important, along with everything else in my life. So, the therapy ended.
It was assumed that the trials of therapy had worsened my depression. The stress of looking inward and so on. To this day, I still don’t think that was the case, but maybe there was something subconscious. Either way, in September (or possibly October), I was prescribed Effexor, went loony, took a huge overdose and there you go.
So. The Therapy Lady didn’t want an appointment for that reason, and also another reason, which is that she didn’t think I saw some of my problems as being part of my personality and that I only saw my problems as part of a chemical imbalance. Ergo, therapy would not be helpful.
It is true that I have tended to be overly clinical about myself. I am increasingly seeing myself as a whole person, with other problems, but for a long time, I was quite clinical about everything. I saw my moods etc etc as being outside myself. Which puts me in a helpless position, no? Not entirely. I have made the appropriate “lifestyle changes” to manage my illness- I didn’t drink for ages and am not doing so again, don’t take drugs, try to sleep, try to eat, avoid stress etc etc etc. But…
Being diagnosed with bipolar disorder was a kick in the bollocks for me. Who in their right mind (FNAR!) wants to be diagnosed with a serious mental illness? It sucks. It’s crap. It makes you feel as though you have, “REJECT” stamped across your forehead. The only way I felt able to cope with it was to see it in a medical sense, as an illness, as something outside myself. Because if I thought that I bought this on myself, that it was my fault, that I was flawed and fucked up (which I do often think), I could not cope. I would simply just not be able to face it. Giving myself distance, writing about it, even sometimes coldly analyzing, was what I needed to do for a few years. And I was rather, “Ah. Well. That explains an awful lot”. And I should have been relieved, but I was devastated.
It was easier for me to see it that way. I would not have come this far without that perspective. It’s unhelpful for therapists, but I needed to face up to and deal with the other stuff in my own time. I do consider bipolar disorder to be a chemical thing, by the way. The chemical basis, if you will.
I have other diagnosed problems, namely body dysmorphia, bulimia and self harm. My social worker mentioned that those things in tamden with bipolar disorder are not that common, due to the shifts in self perception and weight that comes with bipolar. This is true, but it still stands, although in terms of bulimia, I’d consider myself better.
That’s enough for me- I don’t really want more fecking problems, more diagnosis. I have trouble enough agreeing with the existence of the others. I don’t want to be pathologised. And, although maybe once I did see these things in isolation to bipolar disorder, I don’t think I do anymore. As time has gone on, I’ve moved further and further away from defining by diagnosis, and thinking in terms of diagnosis at all.
Then she said the dreaded words- “personality disorder”. My arse clenched right up. You couldn’t have fit an atom up there. Because I knew what was heading towards me, with the stinging predictability of a slap from a raised hand. Borderline personality disorder.
Diagnose me with shit if it’s accurate. Don’t diagnose me with inaccurate shit just because I’m a woman who self harms and has rapid cycling. Borderline is one of those things nobody really wants to be diagnosed with because it is the equivalent of your doctor saying, “Fuck knows”. I don’t want to be diagnosed with it, either, because I think it’s wrong. I was told I had “borderline traits” after an hour long appointment with a doctor in Haringey a week or so after I left hospital. That isn’t a diagnosis, but I even disagree with traits.
The only criteria I meet for BPD is self harming and mood swings. My mood swings, however, are longer than those of BPD. I am not that reactive in terms of my mood. I can be depressed at happy times, happy at depressed times and so on. Recently, I have been- I got depressed at the end of a relationship, I went a bit mental in May- but I think that’s normal. I’d had an abortion (and my social worker stuck her foot in it by using the word “blase”, my eyes almost glowed red when I corrected her, but I think she just used the wrong word), my relationship ended, things were a bit mad. I think I reacted normally. I actually think I’ve dealt with it well and maturely. BPD is a complicated disorder, but I do not freak out when people leave me (I like being alone), I don’t get self destructive when they do, I don’t threaten suicide or make suicidal gestures (though I think about suicide, but when I’m depressed), I don’t have “inappropriate anger” (I only get angry when pissed beyond recognition, and that is rarely. Otherwise, I almost never lose my temper), I don’t indulge in risky behaviour, I don’t have sex with more than one person, I don’t binge, etc etc, and I self harm incredibly rarely either pissed or under great stress, and then it has always been a private act that I cover up. When I’m pissed, maybe I am more BPD-eque, but I mean pissed to three bottles of wine.
That leads on to what happened next- My social worker said she had seen something about a personality disorder in recent correspondence and went looking for it. She couldn’t find it, but I recalled reading it- in fact, it is here. I quote:
The GP also printed out some correspondence from the psychiatrist which I hadn’t seen, and wish I hadn’t seen. It’s nothing damning, but these letters always seem so. Some things he said interested me, some amused me. What amused me was that he wrote:
on examination, she has a very young appearance for her age
which is bloody true and is why I’m often barked at by schoolteachers as they ferry little crocodiles of primary school children down Upper Street.
obviously of above average intelligence
but not height. Boo. Still, cheers, Consultant Psychiatrist. You’re of above average physical attractiveness. In fact, when my CPN asked me if I’d met you before, I said, no, I don’t think so. She replied, “Oh, you’d remember him”.
He also said:
I was impressed by significant anxious avoidant traits in her underlaying personality
(SNIPPED FOR LENGTH, like a circumsized pe….)
and remarked on my tendency to criticise myself. He said that I was, “warm” but avoided eye contact, found fault with myself too easily and clearly found it difficult to function in social situations.
I’ve written about being a big old socially anxious bird before, and it’s true that if I meet most of the criteria for any personality disorder, it’s Avoidant Personality Disorder (common, by the way, in people with Body Dysmorphic Disorder. Even my appearance screams, “Look at my clothes, look at my hair, but not my body, not my face”, or I cover up entirely in an enormous coat that makes me look mental enough for people to look through me, not at me).
I’d rather not, given that I feel I carry enough diagnosis’ around, and I don’t think it’s entirely accurate, but it is perhaps rather surprising to some given my “engaging” nature, my slight arrogance and self confidence just how socially anxious I am. If you want a cause for being allegedly avoidant as a person, then I guess being bullied to fuck for years probably covers it.
I think that’s possibly what she was referring to, because she couldn’t remember the name of the disorder. Again, “traits” doesn’t mean a diagnosis, but in this sense, I agree. And because of the mentioning, I think it’s more strongly suggested, rather than just a passing thing.
I don’t see my problems in isolation to bipolar disorder, nor do I want to see them as avoidant, etc etc etc. I want to dispel with the names and just get some help with other stuff, which is why I requested therapy in the first place. I have increasingly, as I have become better at dealing with my illness and so on, began to see things as a whole, intertwining, one big, fuck-off Venn Diagram. But it gets tiresome looking inwards so much- for feck’s sake, bipolar is enough.
The way I see it is that bipolar stuff is the unsteady basis for everything. There are moods that do feel out of my control and aren’t often “triggered” by stuff. I manage it better these days because I know when a fall is coming, and my medication caps the worst excesses of mania. I am very very self aware in these terms- perhaps too much. The shifts in moods do cause shifts in my self perception, and massive shifts in my energy, which makes some things harder for me than other people. It isn’t through lack of trying, just often a total lack of energy. That’s what I mean by an unsteady basis.
But I have zero self esteem, which is the thing I’d like to change. There are a lot of things about myself I’d like to change which is why I wanted therapy. I want help. Bipolar pisses me off, but my self image stuff is just sad and annoying. My social worker mentioned childhood trauma in relation to this. I certainly had a traumatic childhood, but not in the sense that I was being told at home I was shit, because I wasn’t. It was hard, for all of us, dealing with an unstable, violent, mentally ill mother and an alcoholic dad. But honestly, without pretense, I don’t hold it against them, and I don’t think it fucked me up much. Because as a mentalist myself, I understand. I wish things had been different, for their sakes. I want my dad to still be alive, and I want my mum to be happy.
She also mentioned that people with bipolar disorder have often been criticised in childhood and therefore build up a false sense of self esteem when manic then it comes crashing down when depressed. In my case, the self esteem thing is kind of accurate in mania, but more often than not, my self esteem is in the gutter somewhere.
WHAT FOLLOWS IS AN EXERCISE WITH ROGER RUSKIN’S SPEAR’S “WAH-WAH” RABBITS.
I was bullied very badly, which I already said is probably the cause of my body image problems, which get worse, or better, depending on my mood. (My social worker, bless her, said that she couldn’t understand how anyone could call me ugly. Oh I chuckled, because that’s all people ever called me). In that sense, I was told I was shit every day for a good few years. But BOO-HOO bullying. Who wasn’t bullied? But it made me think of the “false sense of self esteem” she mentioned, which you could say is how I conducted myself in grammar school. As a preening, mouthy, class clown of a peacock.
Anyway- yes, I have bugger all self esteem and am shite socially, hence why, when utterly nervous, I drink (have gone into this before on Anti-Social Anxiety). It’s quite strange because I am very friendly. I should, by rights, have quite high self esteem, if you based it upon what other people said to you. I have been very lucky in the people I’ve been with. They have been loving, encouraging, sweet, telling me I am great etc- but it doesn’t affect me. It barely dents, which is frustrating for all involved. No-one shouts at me and tells me I’m shit except myself. Likewise, in my “professional” life, people saying, “Hey, you’re a great writer” just doesn’t work, and it means I tend to shy away from things that could be great for me, because I think, “I’m shite, this will prove it”. So I waste opportunities. And I’m quite ambitious so that’s a pain in the whole.
I prefer being alone most of the time, then get really sad and lonely because of it. I am BALLIX at being around people for more than short amounts of time. I am BALLIX at living with anyone other than myself. I am BALLIX at criticism. I am BALLIX at instigating social things or even saying, “I love you” in case I get laughed at. I have problems trusting people. I don’t like myself at all (I’d use a stronger word but it would veer into total self pity). I am paranoid beyond paranoia- I replay all my conversations, I apologise constantly, I make a dick out of myself, I second guess everything. I blame myself for everything. I feel like nobody likes me, and nor should they. I don’t trust people’s opinions. I am nervous to the point of physically throwing up before big social things, especially if I organise them. I am emotionally distant, I can be almost stone cold when I fear being hurt. I can callous in that regard for that reason. I want to be liked, loved, even, but my behaviour means that I am not sometimes. And even if I’m not by some people, then what’s the problem? Rationally, I know there isn’t one but it burns. Why should it when I have one or two people who don’t just like me, but love me intensely? But, of course, being a mentalist for one makes everything feel uber-conditional, that all love and like and everything in between can be snatched away at any moment because people get sick of your mentalism.
In short, I am mess. And all my bullshit actively hampers my personal and social life. IT PISSES ME OFF!
What I don’t do is feel dependent on other people, and I don’t mind being left alone. Aye, I’ll be a bit sadfaced when someone I love goes away because I like them, but that’s about it. I used to be worse at this, but I value my own company, and my own initiative. I also don’t particularly feel that people are more “capable” than me- everyone’s a bit buggered, aren’t they.
But I am loathe to pathologise it as another disorder. In the same way I want to headbutt people who say things like, “Ooh, that’s so bipolar of me!” or, “Ooh, I’m so borderline!”, I don’t want to have to perform an epic self-headbutt by thinking things like, “Ooh, that’s so avoidant!” I just want to think, “Aye, that’s me”. It is something I would very much like help with as my lack of self esteem does fuck up my life. It IS part of my personality which is why I don’t want to say, “Oh look, ANOTHER mental diagnonsense!” It’s just, I guess, a catch all term for certain personality traits. And there MUST be an element of narcissism to me despite all this or else I wouldn’t publicly blog. That said, I have explained before that I find it easier this way because it’s more impersonal. I feel like a twat, and a liability, talking face to face with people.
Anyway, the problem with therapy was that she thought I only saw myself as a mood disordered person without any issues that I was willing to change and tackle. I have never seen myself in that sense, I just wasn’t ready to tackle them- it was difficult enough dealing with the whole manic depression shebang, galling enough to be mentally ill in a seemingly-classic-chemical-sense, as well as apparently being mentally shit in other non-chemically ways that relate but are still shit. I had to deal with that particular kick in the bollocks first. And I guess repeated episodes of mania and depression also impact on your self esteem. I’ve written before about how amazingly alienating it can feel sometimes to have a mental illness, like you’re floating out in space. Ashamed, isolated, feeling unliked, unloved and unwanted, and most of all, unable to even talk about it, or anything relating to it. And it does burn me that people have seen me bad, psychotic and so on- it’s incredibly embarrassing and makes me want to run away and hide.
I could just be more, “I don’t give a fuck”. Robert impresses me by his, “I don’t give a fuck” attitude towards people. He has no desire to be liked. He’s happy with his family loving him, my love, and the love of his best friend. That aside, he doesn’t care, he doesn’t seek validation. He’s quite shy himself, but doesn’t agonise. He is, in a sense, liberated, and I admire him for it. I’d like to be more like him.
On the upside, I guess at least I attempt to deal with problems and be a better person instead of avoiding them. And I’m quite young, so maybe in ten years time I might be something approaching sane. So, er, that’s good?
So, my social worker said she’d talk to Therapy Lady again and tell her I was okay with tackling issues and that I didn’t see myself as living in a test tube. Which would be good, as I’d love to feel a bit better about myself, so I was like one of those twats in an advert that rides a mountain bike and went, “YEAH!” before grinning stupidly at a camera and shagging twenty men and twenty women then being promoted to Lord of the Universe where the annual pay is the world’s economy and blowjobs. Rather that than throwing up in my toilet because I’m scared of being around people this weekend, rather that than not replying to emails from interested parties because I think they’ll think I’m toss anyway, rather than not answering my phone so often people stopped phoning, and I blamed them instead of myself for it. Because that, let’s face it, is kind of pathetic.
Filed under: Bipolar Disorder