This’ll be badly written as I have about three minutes!
Reading around the madosphere, there is a lot of poor treatment out there. The Crisis Team in particular seem to get various boots hoofed into them, which I understand. On the occasions I’ve dealt with them, they’ve been rather useless, but it’s difficult to know what their use actually is. My understanding of them has been that they come round to talk to you and check you’re not dead. Which has a function in itself- if you don’t want to be admitted to hospital, the hour in which they say they’ll appear, genie-like, is the hour to aim for looking like you’ve had a wash and haven’t been neglecting to wipe your arse and drink fluids, even if you have. They’re good for the facade, and the facade can be handy, it’s good to practice it, especially when you are depressed, so everybody doesn’t worry. When you feel bad enough for the crisis team, though, you kind of want them to show up, take you very seriously (therefore not suggesting you have a bath or make tea) and then all is well. But the zenith of, “taking seriously” seems to be hospital admittance, which is equally boring and often pointless anyway. Apart from the first time I ever dealt with them when I was treated at home with them for six weeks (having them come to administer medication, and watch me take it, which was amusing), my dealings with them have been brief because I learned quickly what to say in order to get discharged. There was one appointment that they couldn’t get to because someone had been stabbed outside my front door- they weren’t allowed in by the police. I pointed out that it wasn’t me who did the stabbing so not to worry.
Psychiatrists get it, too. I’ve never really had a psychiatrist I particularly liked, but it’s only because I’ve never gotten to know any of them well enough to like them, and the highly charged situations I’ve seen them in have been too fraught, and made me feel defensive. Since psychiatrists largely exist to tell us things we don’t want to hear, it’s difficult to like them. They’re like that friend that presents barbed criticism as helpful advice. The first one I had was when I was sixteen, who slapped me with a mood disorder then bammed me on Carbamazepine then I never saw him again. After that I saw someone else, but that period of time is so blurry (all I can really remember from it is that I thought I was in a computer game) that I don’t remember him. I do remember the Olanzapine and the 3 stone I gained on it, though. There was one, the geography-teacher elbow patched, tweed trouseredness of Dr. Issacs, who I liked, despite sometimes disagreeing with him. My first impression of him still makes me laugh- he floated into the a side room at the hospital, stuck his hand out and said in the most cavalier fashion imaginable, “I’m Jack, Dr. Jack Issacs”. I half-expected his teeth to ping pearly white. There was another who was so handsome that I would burrow into my chair to smother the shame of the faint, tangible smell of urine that clung to my legs, the sweetish smell of old sweat and clothes that hadn’t been washed in weeks, unkempt hair, and an increasingly bloated, antipsychotic face. There’s Dr Lashes who I’d seen a few times and saw recently with the Crisis Team, who has such a low, calm voice that I nod off whenever he speaks to me. Then there’s the consultant, the one who slammed me with BPD, who is quite chipper but doesn’t listen. He is a consultant, though, so I think it’s in the job description. My issue with him is the very dismissive way he told me, and not making another appointment to explain- this was partly my fault, though, as I was very late to that one. Apart from in hospital and the crisis team afterwards (and possibly some periods before, the ones that I don’t remember much, the ones were doctors gave me things to, “calm me down” and they were heavy antipsychotics), I’ve almost never seen a psychiatrist in any state other than depressed, due to successfully dodging doctors and services otherwise, because, y’know, why wouldn’t you.
I haven’t had much dealings with therapy. I had therapy when I was a teenager after my friend committed suicide, which involved me lying through my teeth for six weeks so that I didn’t have to endure the depressing journey in a social worker’s car to a hospital ward where people came to die, and teenagers lined up on plastic seats outside, self consciously fiddling with their sleeves. I was transfixed by a growing mole on her chest. The journey there was always horrible- the social worker clearly believed that because I was a self harming teenager, I was an attention seeker, and explicitly told my parents so, which made my life wonderful for a little while.
I was referred to group therapy just after I left hospital, but it never transpired. I had a short burst of CBT with a student therapist, who I liked, and who, despite cutting the sessions short because I had slipped into depression and couldn’t engage, did help me. The therapy was for body dysmorphic disorder, and I did learn some little things that I still use now, and still find helpful. The going out without make up thing, even just to appointments now and then, helped, and I started increasingly the times I did that, and nothing awful happened, and now I do it fairly regularly. I’ll always wear heavy clothing and a hat (for people who have met me and been puzzled by how much I overdress, that is why), but it’s still something, and I don’t stay indoors so much now because of it all. The problems weren’t so much the way I felt about my looks- I’ll never think I am beautiful- but the way I dealt with it, the anxiety. And CBT did help.
Then there was psychotherapy assessments with Marigold, who, unbeknownst to me, had been assessing me for therapy for borderline personality disorder, at least, I think she did, given some of the things she asked. In retrospect, I now understand why she said things like, “So, you write to cover up your emptiness”, which gave birth to the world’s longest silence as I had absolutely no idea what she meant, because I’d never mentioned feeling empty, and don’t. I answered, “Er, no”, and left it there. She said I must react extremely to normal events, and when I pressed her for what she meant (for I was confused, as it is not true, and I thought she must be referring to life events, like my dad dying and the abortion), I didn’t know what to say. I was upset by the implication that my reaction to the abortion (grief, sadness) was, “abnormal”, but I think I had misunderstood. I had wanted the therapy to deal with social anxiety because I’d started throwing up and shaking when I was faced with social interaction. The PD I thought I had been hit with was avoidant personality disorder, which is one I would wholeheartedly agree with, and it’s on my rap sheet, somewhere. It’s why BPD confused me, the whole, “problems with relationships” thing, as it has been purely social and a lot of my self esteem is tied up with how crap I feel I am in these situations and at talking to people. But by the time the assessments were coming to a close, I’d started just biting the bullet and was feeling more in control of my anxiety on my own, and wanted to see if I could keep that up. We both agreed we didn’t really need to continue, and it was the best decision. We didn’t get on- she is an icicle with a flower’s name (and someone who I referred to as having all the warmth of a mass grave)- but she was gracious and helpful in our last session. Unless something happens, or I’m forced to (which is unlikely), I think that will be my last involvement with therapy.
Then there’s the social workers and CPNs. The first one was a waste of time. One of the crisis team social workers (who I liked a lot, she smoked frantically out the car window when she drove me to St. Ann’s) after hospital fought for me to get a CPN as the plan then had leave me on Lithium and other random drugs while I vomited, shook and still jumped around like a mad person. I did, and she took notes for fifteen minutes a month, and that was that. In a fairly bad state (as I was for the year and bit after hospital) I rang her up and angrily asked her what we were supposed to be doing, as the two buses I took to our appointments were expensive, and there was no point going there. I regret some of my behaviour with her, not least me booting the door of one of the offices during the short period on Paroxetine which kicked me into a very angry mood episode where I was raging constantly and agitated to fuck. She encouraged me to work, despite the fact I was clearly too unwell to, and had gotten a letter from my GP who had written to her on the sly telling her to help me get benefits because I shouldn’t be working. So, that was Haringey, which is vaguely legendary for its bad social care. A lot of Haringey was a bit of a mess.
When I moved borough, the quality of the care I got changed. I got a great CPN, who was incredibly helpful from the off, especially with the practical things, which is largely what I needed help with at the time. When she left, I got a social worker who I initially didn’t get on with due to her giving me a leaflet on, “good sunshine” on our first meeting. But as time went on I warmed to her more and more, and now I like her immensely. She’s supportive, she’s funny and she doesn’t mollycoddle me when I’m being a dick. I appreciate that from people in general. I think they assign me the Slightly Alternative Ones due to my clompy shoe feet and my youth when I entered mental health services. And I’m grateful for that because it was comforting and calming to talk about PJ Harvey with my old CPN as an anchor, and sometimes I see my social worker bombing about on her bike in her boots and it makes me smile.
I have been luckier than most with my care, I think. I’ve had some bad experiences, but the good ones, in the past few years, have compensated. I’ve always had a fair amount of support when I’ve asked for it, and especially support when it comes to the practical things, which are the first to fall by the wayside with me. I would most likely be homeless now if it weren’t for them, as they’ve advocated for me, and fought for me. One of the most stabilising influences I’ve had in my life is having a home- just somewhere to be, that I can’t bugger up and lose (I make sure I pay rent as soon as I get it in case I do get a funny upswing and think it’s a good idea to buy a thousand cups). They sorted out my freedom pass, which is probably the single thing that I couldn’t live without, as I wouldn’t be able to afford to leave the house otherwise. I’ve never really minded when phone calls or emails go unanswered because I know they’re fairly busy, and if it were urgent enough I’d just go down there anyway. I am not the type of person who asks for help anyway, but when I have, they have tried. I like the receptionist as well, who I remember humouring me during the summer when I was apparently a bit high and trying to demonstrate to everybody there that the disabled handrail (which I had never noticed) was very fun to tumble on. My first CPN in Islington even wrote to my family to explain my diagnosis because I was having a hard time accepting it and didn’t know how to explain it to them. I appreciated that a lot. I also appreciated them checking that the people I was with (Rob and Robert, respectively) were okay and coping, too. They also gave me the guided tour of the crisis centre (and we were supposed to go to the hospital, but I missed the appointment), so I would know what to expect if I was admitted, and I appreciated that, too. The run of two excellent professionals is partly why I have wanted to get into this profession; I’ve seen first hand the impact that someone being good at their job can have on a person’s life.
I’ve asked to be discharged twice within the past six months and been miffed when they won’t- the rule was, “six months off medication, if nothing happens, cheerio!” and stuff happened. If we’re talking good treatment, I didn’t get any psychiatric appointments during that time when I probably should have, but hey ho/ But they did honour my requests not to go to the building anymore (now we meet near my house for tea), and I have fewer appointments now, except for during the summer when I was being rang a lot, as was Robert, to be checked on, and in September with the crisis team.
Most of my bad experiences have been with shite GPs. I still hate going to see one and put it off as long as possible, or just visit a walk-in centre.
So, in conclusion- I think since the age of about 22 I’ve had quite good care with helpful staff. There are obviously good and bad working in the system- so tell tales of horror and heroics!
Filed under: Bipolar Disorder