Saturday, 17 September 2011

Twenty: And then some

At the age of 22 it feels like I'm finally coming to terms with what it might be like to be an adult.

Being dependable.  Having people of my very own to look after, albeit only my boyfriend and our cat.  Visiting Ikea to buy wardrobes for his room.  Having to plan meals in advance and cook. Cleaning and doing laundry not because someone tells you to but because actually, if you don't, it starts to get to you.  Keeping in touch with family.  Learning to express your needs in moderation, and to give a fair hearing to those of others.  Leaving difficult situations in time to keep yourself safe when you feel overwhelmed.

Only four months ago things were very different.  Loneliness combined with perverse "coping mechanisms" I've had a lifetime to learn and perfect imposed a Jekyll and Hyde like structure onto my existence.  The days would be spent pushing down tempests of anxiety -  an almost compulsive fear that worsened if any sort of attention was paid to it. I felt, almost always, on the edge of calamity.  Danger lay in every unoccupied moment, and no matter how carefully I planned my day, there would always be more than one. My classes done, at night (or, on bad days, late afternoon), I dived into chaos.  I was exhausted and I just couldn't contain myself anymore.  The GP on campus had told me that if I continued to starve myself I would not be able to remain at university, and for once I had listened.   During the day I would eat enough to satisfy my appetite and give me the energy to work - but I managed this partly (and problematically) only by shutting my eyes to it. 

I knew the nutritional content of what I was eating.  I knew what constituted a healthy, balanced diet, and I aimed towards it.  My body, however, was aiming for more.  It was aiming for curves, periods, and everything else a healthy woman should have - but for me these things also possess unpalatable and still mostly unexplainable psychological implications.  As soon as it got dark I let go.  I would spend £10 to £20 on food and spend the next two hours eating and vomiting  - gorging also on the kind of trashy tv my day-time schedule would never allow for.  When I was done, and I was reassured that my stomach was entirely empty, I would eat a small meal and go to bed.  Ultimately I knew I couldn't afford to lose weight. 

But it was draining.  Sustaining any sense of self in the midst of a raging war between bits of you that you still don't really understand and  that insist on their fulfillment with ceaseless cruelty is difficult.  It's even harder when you're trying to work towards a first-class degree.  Luckily I was able to get through the term.  Two arterial bleeds and two visits to A&E in ambulance, days when I just couldn't muster the energy to get out of bed and clear up the mess (blood, food and vomit) of the night before and recommendations to take leave of absence from university -  regardless,  I got through.  But my God - it feels a world away from now.  I have enjoyed four of the most healthy months I have had since I was sixteen,  and I'm terrified - terrified - to let them go.

Term begins on October the 10th.  I may have more support  in York than previously, since the psychiatrist I saw on Thursday who works for the psychotherapy service thinks I do need psychiatric reviews and a support worker and is writing to the CMHT in support of both.  Briefly, I would say that this was the single positive of  a difficult and frustrating meeting.  More will follow later.

Wednesday, 14 September 2011

Nineteen: Adventures of Poland

Mostly of the emotional kind, I'm afraid.  It was on the whole a successful trip, but being away with someone else's family brought a lot of stuff up for me.

29th July

Just crossed the Polish border.  M and I committed the cardinal sin of going for lunch at McDonald's when we stopped at a petrol station - M's mother and her partner seem to want to drive non-stop from 9am to 7pm for some insane reason - but barring the occurrence of any tragedies of the natural or human kind we should reach Gdansk in good time this evening.  I'm going to attempt to use the rest of the journey productively, and finish Volume I of "Le Morte D'Arthur".

(later)

Is M's mother still cross with me? (for stopping to eat lunch at McDonald's.) Her silence says that she is.  Why do I suddenly feel so small?  Guilty, fearful and tense.  The pull of negative energy is so strong it's as if we were the only two people in the car.  It's exhausting.  Imagined or otherwise, I wonder what the setup here reminds me of.

(later)

It was probably inevitable that this car journey would remind me of going away with my parents as a child.  My mother would drive, and my father would use a map to get us hopelessly lost.  They would fight.  Sometimes it got nasty.  Nevertheless, I remember it fondly.  Sitting in the back with my brother, a bag of sweets between us, being lulled to sleep by the motion of the car and the BBC World Service rumbling low on the radio.  Secure in the care of the adults in front of us, who (mostly) knew where they were going and would always get us there safely.

The later journeys weren't so peaceful.  Either there was more fighting, more tension, more silence, more failed communication and a greater sense of discord between the four of us (well, three - my brother never really featured in my emotional configurations of the family) or I simply became more aware of what was present all along.  My mother became a vicious, relentless harpy, wounding with words chosen for their lethal precision, the threat of real violence never far away.  My father would either become the bleeding martyred target for her poisoned arrows, or beneath a shield of heavy silence emanate a violence of his own.  His aggression erupted rarely, but when it did it was with an amplified and eventually disastrous effect.

Childhood perception is not wholly trustworthy.  After continuing a while in this vein I find myself explaining my father's suicide in the following way:  as she had almost done to me, my mother lashed out one too many times at the most vulnerable part of my father, and unable to cope with what she had discovered, left him alone with it until it consumed him entirely.  Ergo, my mother killed my father as she had wanted to kill me.  (It may be of interest that, after much provocation, my brother did once actually hurl this accusation at her).

But this isn't the whole story.  My mother loved my father.  The silence and the distance he forced between them hurt her deeply, and the final silence was devastating - she lay immobile on the sofa for days, refusing food and literally wasting away.  After he died, I could find no trace of the former spite and malevolence I thought I had detected in her.  Even in the flashes of anger that sometimes came over her when she felt most painfully her abandonment, the "evil" of before was absent.  She was just another fragile hum being, who had loved too much.  However slowly and reluctantly, I have come to accept that who we were and who we are, what happened and why is a puzzle that may never be pieced together - least of all by me.











                                                                       Botanical Gardens.  Wrocław, Poland.

Tuesday, 13 September 2011

Eighteen: Recapitulation

I need to write here again, if for no other reason than that after three months essay writing-free I'm beginning to lose my grip on my grasp of the English language.  I'm perhaps three quarters of the way through the mega-reading list I set myself for next term, and I find when I'm annotating texts that there are words I need which were familiar once and now escape me completely.  Not so great if you happen to be doing an English literature degree.

There is still another month to go before I return to York.  As the weeks wear on I realise more and more that I need to cherish the time I have at university.  It is really very little.  Being that bit older than the other students on my course, with friends who graduated last year and are struggling to find their feet in a job-market that is smaller and more competitive than ever, I know just how lucky I am to have this opportunity. 

I don't feel particularly lucky at the moment though.  My reading distracts me, as does my boyfriend, as does the oblivion-seeking sex, drinking and occasional drug use I turn to when I'm really itching to hurt myself.  Apart from one cigarette burn inflicted in Poland I have been self-harm free for months now.  Tomorrow it will be 90 days since I last made myself sick.  I am a healthy 60kg for my 67 inch height, and I try to remember that I have made peace with my body.  But it was always a very tentative peace, and right now it feels particularly fragile.

Diary entry, 3rd August 2011 (I was still in Poland):

It just keeps getting better.  After a call from Dr S of York Psychotherapy Services, in which I was informed that my therapy at the Tavistock would cease to be funded in October, I found out from A (my therapist) that even this may be in question.  There is something of a row developing between the Finance Department of the Tavistock and York, who are apparently refusing to pay for any of the psychotherapy I have been having at the Tavistock since I moved from London. (I have since been told that the reason they are giving for this is that the Tavistock have prevented me from engaging with their local services - the only problem with this argument being that said local services proved on several occasions to be unwilling to engage with ME).  I don't know quite how this will affect me, but it does mean that money-wise my therapy with A is even more in the shit than before, and it is unlikely that the Tavistock will themselves finance any extension to the October deadline.  I did feel a glimmer of hope when A (I called her from Poland when I received the news, and we had a brief conversation over the phone) hinted at our previous discussion about paying (her?) privately.  But only a glimmer.  I'm sure A will think of a dozen different reasons before I see her again at the end of August as to why this arrangement would be unworkable.


As I understand, A is still fighting to build a case as to why my therapy with her needs to continue.  I have been invited to a meeting in York on Thursday with Dr S (consultant psychiatrist/psychotherapist) and a therapist to discuss whether the group therapy or individual therapy they may be able to offer me would be suitable.  Talking to these people is not at the top of my wish-list at the moment, to say the least.  I envisage throwing things - if not objects, then hard words.  It's childish.  But I am not inclined to give them any more of my time.  There are a number of reasons why I do not think it will be beneficial for me to either enter group therapy (again) or establish a new, short-term psychotherapeutic relationship.  Experience has taught me however that my opinion falls on deaf ears - if anything, it will be seen as further evidence that I am refusing to co-operate, possibly as a result of an unhealthy dependency on my therapist in London.  My boyfriend wants me to go to the meeting, and has said he will accompany me. I still haven't made my mind up.

This brings me to the question of what WILL happen if my therapy at the Tavistock is terminated at the end of October.  A has tried to discuss this with me in our sessions.  She says we need to talk about our options.   I am,in effect, stonewalling her - it's just to painful.  I cannot see any "workable" options being made available to me - rather, in anticipating the conversation I see my last hope, of her agreeing to see me privately (at a cost I would be able, if only just, to afford) being crushed.  Again, M (boyfriend) says I need to have a frank conversation with her.  Not knowing is draining me.  I don't know how much longer I can go on in this state without resorting to the ways of coping I swore (sort of) to forsake once and for all at the beginning of the summer.

I dread Sundays, because they signify two full days until Wednesday, when I have my session.  I dread Mondays and Tuesdays proportionately more.  A keeps apologising to me for what is going on.  It doesn't help.  I have a lot of rage inside of me - rage I do not want to direct at her, but which seems to be blocked whenever I aim for more appropriate channels.  I cannot help but feel that I am just not being heard.  I have come so far, and I refuse to give up something which has helped me so greatly -something that has given me my life back and which I believe needs to continue to fully restore me to health - without a fight.  But there seems to be nothing to take on but smoke and mirrors - the thin veils of bureaucracy.

If there were a God I could believe in, I would ask him to help me through this.  For the lack of one I must try to believe in myself, and my strength - which has surprised me before and may surprise me again.



                                                           Street art, Wrocław Poland.

Tuesday, 26 July 2011

Seventeen: In brief

Very, very annoyed.  I managed to delete the post I've spent the past hour writing just as it was autosaved.

Take two will be greatly limited, seeing as it's already two o'clock in the morning and I have an early start ahead of me - we leave for Poland on Thursday (I'll be away three weeks) and there's lots still  to sort out. 

Before my finger slipped, I had basically written out what took place at my meeting with the psychotherapy service in York last Thursday.  The psychiatrist I saw is only involved in CBT work, so he said he would discuss with his team what we had talked about and meet me again possibly with a colleague who knows more about psychodynamic work.  Though he gave me no clear indication as to what at this point he thought he was likely to advise the commissioners regarding my treatment, we discussed the various options and he agreed with my boyfriend's mother that it is extremely unlikely that funding for open-ended therapy as provided by the previous Trust would be granted.  There is a possibility that I could be assessed for psychotherapy in York, though this would last a maximum of two years and I did say that I was ambivalent about whether it would be beneficial for me to pick up the work with someone else.

He said that resources for mental health are very stretched at the moment - for instance in York no patients are being sent to private treatment centres any more.  I asked him about the CMHT consultant's claim that the view of the psychotherapy service is that the only effective type of therapy is short term and goal oriented, and he said that although he cannot speak for individual practitioners this is largely true.  His own personal view is that therapy needs to be conducted in short, repeated bursts and he told me that there is no research whatsoever to evidence that psychotherapy "works" (this infuriated M's mother, when I repeated it to her later).  He also said that he was incredibly surprised, given my history and his own experience, that I had managed the transition from twice weekly to once weekly therapy, commuting from York to London.   He commended me on what I have achieved in managing to maintain my weight and keep myself well enough to be at university, considering everything that has happened.  In his view my psychiatric history is extensive - he said that he had had to take notes from my notes before meeting me.  He asked me about the intention I had expressed a few months ago of wanting to open an artery, and when I said that I had in fact managed it seemed slightly amused.  He told me that if I was to do it again our discussion would be futile, as there would be no point in discussing therapy I wouldn't be alive to undergo.

All I can do now is wait.  And not think.  I'm sick of thinking and agonising over something that I really cannot change.  While I'm away I want to focus on building on and consolidating the things that I have been able to change recently, particularly regarding my eating.

On my way back to the station after the meeting I saw a painting on the side of the house that would have offended me not too long ago, but makes me smile a little (if wryly) now:



It's a strange World.



Monday, 25 July 2011

Sixteen: Sweet reminder

"You're lagging Grace, you're lagging", as my boyfriend would say.  I promised myself I'd write up the second opinion meeting I had last week, but something in me is resisting.  Not that anything spectacular happened.  I just seem to be in a sort of mental torpor where the whole issue is concerned, and I don't want to disturb it just yet. 

I keep re-reading and editing my last few sentences.  I am not at all sure that what I am writing is making any sense.  It is my speech but I do not quite understand it anymore.  In the days following Amy Winehouse's death it would be crass to suggest my own drug use creates anything like the problems attached to serious addiction, but I do have a growing sense that I need to slow things down.  Tonight is the third night we've smoked pot (the Americans staying with us roll Californian joints, composed wholly of weed, no tobacco), and the first night for a while without a (in)decent amount of  alcohol.  Within the past two weeks I have also tried LSD and ketamine, two substances I never touched before.

M isn't right.  Within half an hour of lighting up I noticed an abrupt change in his manner and speech.  It's persisting and I hope to God it will lift when he sobers up, but what if it doesn't?   My own cognition is somewhat impaired too, but it's as if he's in a whole different realm to me, a place where time creeps and thoughts shift like sand, burying all my distressed attempts at connection.   He's silent unless I ask him a question, which he may or may not begin to answer after a prolonged pause and will certainly not finish.  He stares at me, or his eyes don't move.  He hears me within his own frame of reference, divorced from and contemptuous of mine. 

It scares me.  The M I know is just no longer there, reminding me and warning me of  the possibility of a complete, future absence.  The absence of psychotic mania, or the absence of any other unwanted parting.  When I think about losing him, my best friend, my lover, I can't stop from crying. In losing the (nearly) complete understanding that I thought we had achieved, I lose myself.  All the castles in my head come crashing down, shuddering and splitting to their foundations which vanish like scotch mist.  The wilderness overwhelms me.  I doubt whether my perception is accurate.  Maybe it is me who cannot understand him, and maybe it is me that needs to understand him, because I am the one that has strayed from the path of reality - I have conjured this storm myself.  Again, I know this may not make much sense.  My words are running away from me.

I will stop now and read over, once.  Then try to engage with the man in his dressing gown, pacing the kitchen and trying to see over my shoulder.

Perhaps lagging is needed after all.

Sunday, 24 July 2011

Fifteen: Brand power

What is it that entices me to buy expensive clothes on no income to speak of?  I'm not in any kind of debt, but I do feel ever so slightly guilty spending money the government gives me to support my *disability* on apparel that I really, really don't need.

The particular purchase I have in mind is a pair of jeans, reduced from £170 to £85 by Acne, "The Fashion House and Creative Collective from Sweden".

(Same jeans, unfortunately different legs)




I found many ways to justify my (expensive) lust for denim, none of which are wholly convincing but may as well be stated nonetheless:
1.  They were reduced.  By a lot.
2.  They were very soft, and (possibly) good quality
3.  I haven't bought new clothes for AGES.  It used to be easy when I was skinny (read, emaciated) - everything looked the same on me since I had no curves to speak of.  Now I have a more "womanly" shape it is rare that I dare to buy something that shows my body off in new and alarming ways.
4.  I haven't made myself sick, or bought food in order to do so, for a decent period of time.  This accords with the vast amount of money I have saved from abstaining.  It was not unusual for me to spend £15 + per DAY on food that ended up straight down the toilet.
5.  Spending  money on clothes implies a new-found respect for my body and the person inside it, and even if this respect or compassion is shaky at best, dressing as if it existed may help to re-affirm my sense of self-worth.
6.  There are many people who spend even more on clothes.  I refuse to take my boyfriend shopping, now that I've seen the amount he can charge to his Amex in a single afternoon.

Not convinced?  Me neither.

Glancing through the Evening Standard last week brought home the real reason I bought the jeans. I don't particularly admire Peaches Geldof, but there is certainly something about a moneyed "fashion icon" yapping on her smartphone, shopping bags from said brand in hand, that makes Acne clothing seem desirable.  Never mind the unfortunate name.  The company could be called "Rich Bratz" and it would still probably sell, in an ironic post-modern sort of way. When I initially saw the jeans my eyes were drawn to two things:   the name and the price.  I had been shopping unsuccessfully for three hours, and I wanted to buy something - anything.  I had of course seen Acne clothes featured in magazines, product placement in which is hugely influential in creating the prestige attached to the brand.  I knew I was buying "cool".  I am ashamed to say that had they not been reduced (and £85 is still pretty hefty), I may still have considered buying them.  The price promises exclusivity - even though for all I know the item may have been produced in the same factory that manufactures Primark.

I like my jeans.  A lot.  But the spell is bound to wear off before too long, and drive me to another unnecessary purchase.

Wednesday, 20 July 2011

Fourteen: Awaiting a second opinion

Tomorrow (actually today in eight hours) I have to catch a train to York.  At 12 I have an assessment with the psychotherapy service as requested by the Consultant I saw at the CMHT, who wanted a second opinion as to whether to the mental health commissioner should be advised to grant funding for continued psychotherapy.

I have reached a dead end in Anxiety Street.  I feel I should be going over in my head what I need to say, rehearsing and perfecting my argument, but I cannot suppress a conviction that it hardly matters what comes out of my mouth tomorrow.  My inner pessimist warns me that the matter has already been decided, and that a favourable outcome is extremely unlikely.  Warring against this faction is the part of me that is still desperately hopeful, a part that I indulged this evening in requesting a meeting with M's mother.  Although she works privately, and I knew it was clutching at straws, I did feel an informal chat with another psychotherapist might be helpful - at least in taking the edge off the worst of my nerves.

It wasn't a waste of time.  She understood that all of this is mainly bureaucracy and politics, machinations against which I have little agency, and agreed with what I had felt -  that the letter sent to the psychotherapy service by the consultant I saw, stating that he was "torn" about whether or not he felt continued funding was necessary, had given me a false sense of the potential influence I have on the panel's decision.  This said, however, she did give me some advice about how to best present my case.  One thing in particular that she mentioned, that it was important for me to state that I do want to work towards an ending with A, but as there is still work to be done this needs to be prolonged, seemed especially relevant.  If the PCT has some sort of time-scale around which funding could be arranged, with a definite end date in sight, they may be less likely to dismiss it out of hand.  She also thought I should play up the destabilising effect a too abrupt ending would have on my mental health, but I have already decided to steer away from tried and tested threats.  I think it is a far better idea to concentrate on the important changes that my therapy has helped me to make, despite ongoing difficulties, without forgetting that my therapist and I both feel there is work still to do within a perhaps more specific time frame.

Tomorrow is not the be all and end all.  My mother's advice was simply "que sera sera", and in a way she is right.  I will survive a premature ending to therapy, as distressing and difficult as it might be, and as horribly unfair as it might seem.  After tomorrow I will try to put the whole thing out of my mind.  I've fought a good fight and I'll see it through to the end, but at some point I do have to let go.  Not everything is within my control.

Tuesday, 19 July 2011

Thirteen: Bridesmaids

Possibly the WORST film I've seen this year.  I know we're only in July, but still.  My mother and I, her partner and my boyfriend (a double date I wouldn't have foreseen in a million years) were suckered in by the rave reviews.  Maybe I need to get with the times, but I completely failed to see the funny side of  a distressed woman in a wedding dress shitting in the middle of the street.  If the volume of hysterical guffawing was anything to go by, this for most of the cinema was the pinnacle of Bridesmaids' side-splitting comedy.    Kristen Wiig, the main character, failed to raise a laugh in our aisle - I thought her timing was poor and unconvincing and killed any possible humour in the badly-scripted plot.  Matt Lucas and the lady who played his (slightly special needs) sister did manage to amuse me slightly, but the brief screen time they were granted was hardly enough to carry the film.

In short, a disappointment. 

Sunday, 17 July 2011

Twelve: Acid

Saturday night was my first experience of LSD, aka those little paper tabs a quarter of the size of a postage stamp that taste like shit but promise awesome things.  Or so I'd heard.  My boyfriend recounted fun times communing with ducks on a previous trip, and my brother, on hearing about what I had in the freezer informed me that the guy who came up with quantum mechanics was apparently on acid. 

I suppose I wasn't so lucky.  M decided not to join me since he's on a shit load of risperidone and lithium and didn't want to risk another psychotic break, so I took it all on my lonesome.  Probably a good thing, since I needed someone to interrupt me when I became fascinated with skulls on the pavement and decided to experience a cat's eye view of the world by slinking around ninja-stylee with my nose to the floor.  It was nowhere near as intense as I'd expected, however.  After an hour of little more exciting than shifting colours and floating 3D bubbles as I lay flat on my back staring into the ceiling lights, I decided to take another tab.  Still nothing much.  Except I felt stoned, and my stomach started to hurt.  A lot.  I also had a go at my boyfriend for the "misogynistic" music that was blasting (okay, playing quietly) out of his speakers, and informed him that I knew the real reason he wanted to take me to Poland this summer was to fatten me up and feed me to his family there. 

At ten o'clock I decided I wanted to go out.  At least, I thought I did, but changing my clothes and applying makeup proved to be an ordeal and a half.  All my imperfections were magnified, though I felt at once outside of and hopelessly trapped inside my body.  It was like dressing an ugly misshapen mannequin.  Our plan was to go to a sushi restaurant and then onto a club in Covent Garden, and as we walked out of the house my legs (which I'm usually relatively okay with) became tree trunks and my skin looked decrepit and old.  M informed me that I was hungry and that my stomach would stop hurting once it had some food in it - I had explained to him that he had to tell me what I was feeling, since he knew and I had no idea. 

We ordered sushi and sake, which I ate though I had no appetite.  My stomach still hurt and a muted nausea ambushed me in waves.  Then we headed out.  I did a lot of thinking on the tube.  Since dropping the acid my thoughts had hardly stopped, and it wasn't altogether enjoyable.  It wasn't at all that I was immersed in them, I was very aware that they were products of my own mind which I accused myself of conjuring to torment myself with, over-intellectualising being a curse of mine at the best of times. Silhouettes of kissing faces morphing into different shapes and ages swam out of the seat in front of me, much like the body suits in A Scanner Darkly which we'd seen the night before.  Looking down at my scaly, aging skin I had a sudden realisation that I was living myself to death - the smoking, the worrying, the anxiety, the anorexia, the vomiting, the carving my arms to shit. The last three don't perhaps apply at present (I am a healthy weight now, haven't made myself sick for 30 days and counting and have cut once in the past three months) but this did not prevent me from berating myself for past sins.

Then I had an alternative vision, one of complete health.  My mother appeared in this image, gleefully caressing my plump white, slippery body, owning me as she might have in the womb.  This of course was no less horrifying.  It came to me that all I have done to myself, all the stripping down and the scarifying was a futile attempt to escape this other, consuming kind of death.  Death lay at the end of both possibilities, both of the courses I had available to me.  This was a rather depressing thought.  We got to our destination and I made it onto the platform before my legs gave way on me.  Whether this was a result of the acid in my stomach, dehydration or the strenuous yoga class I had put myself through the night before I'm not sure.  But M convinced me that I wasn't dying, and we got to the bar which was actually pretty cool.  It was a place called Foundation, which has incredible interior design and seemed to me to give off friendly vibes.  I felt the love, so to speak.  We had a long island ice tea cocktail, which was served in a teapot alongside a token chocolate digestive and custard cream.  There were other drinks served in jam jars which also looked interesting, but we moved onto to another club before I got to try them.

It was a good night, eventually.  We got home at 5 in the morning.  But it might have been better without the drugs.


Monday, 4 July 2011

Eleven: Verbal battering

I.e the London Review of Book's "Conference on the Literary Essay", held at Queen Mary's.  I had tickets for both days this weekend, but sheer exhaustion prevented me from returning on the Sunday - Friday I was up at 6 to collect our ten week old kitten, and I had to be up again at 6 on Saturday to get to East London for the conference.  Two friends from Ireland came to stay on Saturday night, so I couldn't catch up on sleep in the evening.   My boyfriend also suffered a massive sleep deficit, due to work deadlines left till the last minute.  He stayed up all night Friday working and keeping the kitten company, and was functioning better than I was the next day, despite my fears.  He has manic depression, and though he has been stable now for a good eighteen months I am on constant alert for signs that he's getting ill again.   One of these is sleeplessness.  Sleep deprivation is one of several factors that have precipitated episodes in the past.

Had I been more awake, I would have got more out of the conference on Saturday I think.  I was alert enough to pay attention to the three speakers I had most wanted to hear: Hermione Lee ("Dreams and Clouds: Lamb, Woolf and the Essay"), Adam Phillips ("The psychoanalyst and the essay") and Andrew O'Hagan ("The Essays of Robert Louis Stevenson").  Of the three, Adam Phillips' speech was the worst delivered but the most entertaining.  His discussion was based around why psychoanalysts seem to avoid the essay form, and why, when it is used it seems somewhat rebellious.  He posited that psychoanalysts write very much for other psychoanalysts and are anxious about communicating beyond their own circles, partly because they are insecure about approaching domains usually reserved for other fields and partly because their is something about the  essay that is inimical to the "science" of psychoanalysis.  Although an essay drives towards definitiveness, it is by definition an attempt, something uncertain that does not reach completion. For writers of fiction or critical literature,  this impossibility of completion creates the freedom of exploratory space.  But for psychoanalysts, this can feel threatening.  As Phillips said, Freud insists that we are ambivalent creatures - and yet no psychoanalyst will admit to being ambivalent about psychoanalysis!

Phillips went on to discuss Freud's own use of the essay form,  which he suggests Freud used to investigate our desire for an ending, as well as to indulge his own literary tendencies .  The abundance of footnotes, particularly in his three essays "On Sexuality" reveal the author's search for the "something missing" in the theory he felt compelled to revise time and again.  The essay form may seem appropriate for such a search:  Phillips notes that like psychoanalysis, the essay encourages digression whilst there is still a point to be made.  Indeed, Freud never seems to lose faith that there is a point worth making, but significantly, at the end of "On Sexuality" he admits the impossibility of finding an all-encompassing, satisfactory explanation for the mystery he set out to uncover .

I am unsure what conclusion to draw from this, or if there is a conclusion to draw at all.  It may be relevant that at the time of writing, though Freud was of course jealous of his reputation, psychoanalysis as a profession was in its infancy and there was far less competition between different "talking cures" to prove the most effective than there is today.  In our time, psychoanalysis though not perhaps universally threatened, does in the UK at least seem to have to work a lot harder to fight its corner against quicker, more "cost-effective" treatments.  In this climate, perhaps it is no wonder that most psychoanalysts prefer to steer clear of what can seem a potentially subversive form, and one that undermines the scientific credentials of the profession.

I have my own meeting with a consultant psychiatrist and psychotherapist in York coming up in July.  This is the meeting requested by the CMHT psychiatrist after I persuaded him to at least consider supporting my case for the Tavistock therapy to continue.  If I can be equally persuasive on the 21st, the doctor may advise the mental health commissioner that the therapy should continue, and that instigating another sort of treatment for me in York would be inappropriate to my needs.  It is a lot to hope for, I know.  But at the very least I may have won myself some more time. 

Saturday, 25 June 2011

Ten: Marsha Linehan

Dr Marsha Linehan, renowned for her creation of a pioneering treatment for bpd, has spoken out about her own mental health difficulties. 

I was surprised, more at the revelation itself than her announcement of it.  Since I was first made aware of it maybe five years ago, I have held a rather disparaging attitude towards the therapy programme which became known as "DBT", or Dialectical Behaviour Therapy.  Primarily, my experience of this therapy took place during my admission to the Crisis Recovery Unit of the Royal Bethlem (Maudsley) Hospital.  The philosophy of DBT underpinned much of the work staff at the CRU tried to engage patients in, some more successfully than others.

It didn't work for me.  I resented what I saw as the "holier than thou" top-down way in which groups were conducted and the ward was run, and failed to see how I could be educated to better regulate my emotions when I felt I had perfect insight into my thought patterns and did not agree that splitting them off and beginning to change them could have any real impact on the way I felt.  Moreover, I was wary of the intentions and motives of the staff and was at times extremely defensive -  I was prone to "intellectualising" and could not resist getting into endless arguments over the logical fallacies I noticed in the cognitive exercises we were asked to perform.  I was (and still am) skeptical of the principle that changing behaviour can make profound and long-lasting changes to attitude and mood, particularly for people who have great difficulties with trust and find a six month admission period insufficient to form the relationships necessary to really engage in the work.  It is for this reason that I think the consistency and prolonged duration of psychotherapy has been most helpful in getting me to discover and examine parts of myself that lead me to self-destruct.

But back to Marsha.  Her admission that she had, as a young woman, struggled with the very difficulties she subsequently attempted to treat, made me wonder if I should reconsider my view of DBT.  At the very least, I am no longer able to understand it as the arrogant, proselytising model of good "health" I had so despised before.  I find it impossible to overstate the importance that feeling really heard and understood has for me in trusting someone enough to let them help me.  I am able to recognise this in psychotherapy, where A's integrity (or otherwise) is a constant feature in my assessment of our work.  That she has more or less consistently managed to sustain a genuine connection with me accounts in my opinion for much of the change she has helped me to achieve.   Since it is emotional work, I suppose it is unsurprising that "emotional" reactions not only to individuals but to treatment models themselves could play a large part in determining the responsiveness of patients, particularly those as wary as myself. 

This is well and good in hindsight. Unfortunately, at the time of my CRU admission, I was unable to recognise, or voice, the part of my frustration with the treatment that  emerged from distrust.  I only hope Marsha's courageous decision to speak out about her own experiences will help others to accept help, and feel less alone.

Wednesday, 22 June 2011

Nine: Four years

It's the fourth anniversary of his death today.  I don't feel much. Numb.  Anxious that I'll stop feeling numb.  My session at the Tavistock was not terribly gruelling.  I spoke minimally about my Dad, more about my relationship with my boyfriend which feels a more immediate issue.

In short I made it through the 55 minutes without crying, and I felt relatively okay until on the way out, I crossed paths with the inpatient psychiatrist who saw me through the whole ordeal four years ago.  I have seen her maybe once since, also at the Tavistock, and although I think she did nod at me on that occasion I had no expectation that she would engage in conversation with me if we encountered eachother again.  Perhaps it was the date that made her response today seem particularly heartless.  I know she noticed me, as I saw her scanning my face.  When I reached the bottom of the stair case (she was ahead of me on the floor below) she turned round to look at me again, and I said "hi".  That was all.  But she didn't nod at me, or smile, or do anything else to acknowledge the greeting.  She just walked away. 

It hurts.

I've been staying with my boyfriend for the past 6 days, during which time I have not cut myself or vomitted once.  I do however have to go back to my Mum's tomorrow, at least until Monday, and I'm not sure at all how I'll manage.  I'm trying to live very much in the present, and not let a moment's anger or sadness spoil the next.  Tonight we're going out for a Thai meal, and I know I'll feel safe at least until tomorrow night.  If not, the poster campaign I keep noticing around York may (with a certain irony) serve to remind me of why I should not hurt myself:


A visit to A&E costs on average £117 per patient, so Dr Lethem tells us.

Wednesday, 15 June 2011

Eight: A Cigarette is Like a Kiss

A return to the personal.

A cigarette is like a kiss.
Each toxic puff wastes dizzyingly
Into the stratosphere,
The light getting shorter, you fight for breath
Alone in the fag-end of morning.

One kiss is never enough.
Cling to my lips in familiar grip,
Cling and never let me go.
Who hears  our kisses,
Who holds us to account?
An-ever changing sky watches, receives,
Arranges its clouds in storm-spun silence.

Taste, and taste again the death of morning.
Let you into my heart, my mouth, my lungs
You burnt out too fast for a possible last time -  
But It  did happen.
I  have the smell of you.

The Personality Police would be happy with this one, I think.  It ticks all the borderline boxes.  Which is fine, since it’s a nonsense diagnosis anyway.  Is it not the case that I feel only what every other bloody human being on this planet feels?  I love my transience and despise it at the same time, I want to hold on to all that keeps me fixed and safe,  but I have to let it go or risk a living death.  Somewhere in the holding on or the letting go lies the problem.  It is a problem for me.  But I won’t accept that it could ever be solved – no one has the solution, just the offer of a thicker skin.  And that will come to me in time.
Last week (when I wrote the above) was an angry one.  From (another) letter that I didn't send, the following:
I am horrifically angry at the moment.  I feel let down by everyone and everything.  It disturbs me how angry I am.  I’ve been having some really nasty, graphic thoughts.  Violent images that seem to leap into my mind from nowhere like dreams (I wish they were).   One of these flashes involved me turning up to the Tavistock in a wheelchair, having amputated both my legs.  In another I saw myself  slash one of [ my consultant psychiatrist in the adolescent unit's] arms.  Possibly exhaustion is the cause.  My conscious mind doesn’t usually make such savage leaps to the unacceptable – of if it does, it contains the violence firmly within the boundaries of my own body.  I enact my fury bodily without ever really having to confront it.  Sometimes I think self-harm is the safest outlet for me after all.  The safest for the people who I co-habit this planet with too.  Something must insulate the live wire, or impede the flow of current it conveys.
I come to this conclusion, and then I remember Dylan Thomas: 
Do not go gentle into that good night.
Rage, rage against the dying of the light.

Rage for raging’s sake, even if all I will ever have to make a fuss about is a storm in the smallest of tea cups?

Instead of sending the above to my therapist, as intended, I ended up writing a letter to the psychiatrist aforementioned.  When I left the adolescent unit, she told me that I could write to her and that she would always write back.  Over the years, I have written less.  I had sent her one letter previously this year.  But we are now well and truly in anniversary month (My Dad would have turned 52 today, and next wednesday is the 4th anniversary of his death), and I wanted to send her a card.  Enclosed in the card was a letter, mostly focusing on my achievements and other positive aspects of my life, though I couldn't resist whinging a bit about the psychotherapy funding situation.
I'm still reaching out, however cautiously.

Seven: "Ghosts in the Machine" - Locating the Soul in the Bionic Age

Parts of a group presentation I'm giving tomorrow, for my "Bodies and Minds" module.  Since I ended up writing nearly the whole thing myself (which I'm bloody annoyed about, but hey, these things happen...), there shouldn't be a problem with me putting it up here.





Metropolis - Fritz Lang, 1927








The phrase "ghost in the machine" was coined by the philosopher Gilbert Rye in his book, “The Concept of the Mind”.   Rye criticised Descartes' mind-body dualism, arguing that the terms "mind" and "body" should not be considered as belonging to the same category, and that mental and physical states are inseparable.   In the film “I, Robot”, the phrase is used to refer to inexplicable actions by robots that possibly hint at the existence of a soul or mind that works beyond their mechanical bodies.

As a group, we examined our own beliefs about the soul, or more generally, what it is that for us separates man from machine.  Of those that we examined, we selected the ability to love and make ethical decisions as the most “human” of human aspects, or those that a machine would find hardest to imitate.  As our presentation will demonstrate, however, the increasing sophistication of Artificial Intelligence problematizes this assumption.  

We have placed the examination of these issues within the context of the "Bionic Age", which we define as an age in which machines and mechanical parts are used by humans to carry out tasks that are difficult, intricate, or dangerous.  The question of where and how we locate the soul as man and machine become ever more closely linked continues to be explored in science fiction film and literature, and across the fields of science, philosophy and psychology.

R.U.R


Karel Capek coined the term 'robot' in his 1920 play "R.U.R." in defining his artificially created creatures, the word 'robota' in Czech literally meaning "work", or "labour". Traditionally, "robota" was the term used for the work period of a serf, an unpaid member of the lower classes required to work for their superiors. Serfdom was banned in Bohemia in 1848, but this obsolete term would have carried its meaning across to Capek's early 20 century audience. This immediately colours the way in which the artificial beings of R.U.R. are viewed, reduced by the concept of slavery. They are introduced as "goods"(p3), and are a highly demanded product: willing slaves in attaining the ultimate human ideal of an elevation to a god-like status where "Man will do only what he loves doing, free and sovereign, with no other task than to better himself"(p23), unfettered with the need to labour. From Domin's point of view, this is ethically sound. The robots' intended purpose is to work; they are "without will, passion, history or soul"(p20).
However, young Helen arrives, adamant to dispute this. She is determined to see their usage as exploitation, her "League of Humanity"(p17) extending to the "liberation of the Robots" (p20). Immediately the audience is posed with a contradiction. The robots seen are apparently soul-less, unable to comprehend human emotion, yet their complete assimilation of outwardly human manifestations staggers her. "Can't tell the difference, eh? Feel this hair we gave her! Soft and blonde! M-mm, lovely!" (p11). JD Humphries, in his introduction to "The Robots are Coming", draws attention to the problematic nature of " 'other minds' ". Humans "cannot be directly aware of any other consciousness in other human beings […] One has, therefore, to assume, in terms of similarity of appearance and overt behaviour, that other people are in fact much the same as oneself." (p18)
 Helen is unable to come to terms with the fact that "they're not bothered what you feed 'em […] And no-one's seen them laugh yet!"(p20), when they appear so absolutely human. By her understanding it must be unethical to treat those who appear so similar to ourselves with such flippant disregard for their welfare. Yet apes are similar to humans, and we treat them also as soul-less. Humphries continues his introduction by stating that "Theologians argue that though man's thinking processes may be similar to those of an ape, the man possesses something extra - his 'soul'. In “R.U.R” it seems unethical to treat the robots as if they have no consciousness, or personality, or however our sentient conscious "soul" is defined, yet unless the existence of such a soul can be empirically proved, their status as slaves cannot be contested.

Play – intro. 
One possible way that we could attempt to measure and quantify the soul in articulate beings is via the “Turing Test”, an idea introduced by Alan Turing in 1950.  Designed to  discern intelligence, a human judge engages in conversation with one human and one machine, programmed to appear human.  If the judge cannot correctly guess which is the machine, it is assumed to be an “intelligent” entity.   The concept of the test has inspired the short play that follows, in which we attempt to distinguish human from robot by posing a series of ethical questions.

                                                                *****DRAMA*****

Class questioned.

                                                                              Play – conclusion
As our scenarios illustrate, finding a universal definition of what it means to be human is exceedingly difficult.  It is not possible to say that being able to adapt to new situations, communicate and interact with others, feel love and empathy, and respond appropriately to ethical questions are characteristics shared by all humans. If it were possible to create an organic, intelligent robotic being, would we be able to differentiate it confidently from one of ourselves?
 LOVE.

As we have tried to do with ethics, could we design a Turing Test for love?  If a machine behaves in a way that suggests loving emotion, should we assume that it is capable of loving, whether it is itself, other robots or even human beings?

In understanding how our attitudes towards robots who love are shaped, it may be helpful to examine the ways that love is conceptualised in Western philosophical tradition. 

Rousseau’s second Discourse, in which he discusses the views of Thomas Hobbes, proposes three different kinds of love:  amour- propre (base self-love), amour de soi (gentle or at least benign self-love), and charite (love of God and things public).

In stating that charité is a "natural repugnance at seeing any sentient being, and particularly those similar to us, suffer pain or death",  Rousseau placed the capacity to suffer above the ability to reason in describing what makes creatures worthy of compassion. 

This view is one that is widely held today, but love in the philosophical tradition has not always been held to emanate from compassion.  In the thirteen century, Thomas Aquinas picked up on the Aristotelian theories of friendship and love to proclaim God as the most rational being and hence the most deserving of one’s love, respect, and considerations.  Accordingly, in the Summa Theologica, he states: “Each human being has a share of the eternal reason, whereby it has a natural inclination to its proper act and end: and this participation of the eternal law in the rational creature is called natural law” ( Summa Theologica, 1a2ae, 90.2)

 Could YOU Share a bed with your Robot?


Perhaps the real question is not whether robots, possibly the most rational creatures of all, are able to love, but whether we, as humans, have an appetite for robots to have this capability.

Extolling the virtues of sexbot cyborgs trained to help humans improve their sex lives, David Levy hypothesises that marriage with robots will be legalised in some countries by 1950.
Even if this rather outlandish prediction is fulfilled, however, our creation of beings that are allowed access to our deepest needs and desires has profound implications for how we understand ourselves as human beings.
As Sherry Turkle says, in her book “The Second Self”,
"We ask [of the computer] not just about where we stand in the world of nature, but about where we stand in the world of artefact.  We search for a link between who we are and what we have made, between who we are and what we might create, between who we are and what, through our intimacy with our own creations, we might become".

The darker side of robotic, soma enhanced and psyche reduced love is explored in Aldous Huxley’s 1931 novel, “Brave New World”, where soulless, impersonal love is a form of social control.  Unlike R.U.R, the protagonists of Huxley’s novel are all ostensibly human, and yet in Brave New World it is only in the past that “there was a thing called the soul and a thing called immortality”.  The tragic irony at the heart of the novel is that the marginalised “savages” appear more human than those that inhabit the civilised, sanitised world where physical pleasure is maximised and love forbidden.   The novel warns of the danger of a creator becoming engulfed by his creations – where love is deemed redundant and unnecessary, there is no place for a soul – it is literally destroyed by the machine of society.

In recent years, attempts have been made to tackle our anxiety and distrust about machines that too closely approximate humans.  In Pixar’s Wall-E, the love between two robots (Wall-E and Eva) is redemptive, and leads to the recolonisation of Earth.  The film does not attempt to deny the robots’ mechanical nature, incorporating it instead into the way they communicate their love for each other.  Despite this, it must be acknowledged that the degree of anthropomorphic animation of the robot characters that the film-makers indulge in does not really challenge popular, human-centric notions of what it is to love.

Conclusion
Whilst our terror of hypothetical “ghosts in the machine” must be balanced against the growing needs and demands we have for artificial intelligence and the ways it can serve humanity, it is important to remember that the problem does not end here.  It is not simply a question of whether ethical and loving robots could live alongside their human counterparts.  As we make the transition from the post-modern to the bionic age, we must use the privilege that human status grants us wisely to negotiate the ethical and moral dilemmas we will face in the coming century. We must accept that as we adapt and change the world around us, our conception of ourselves will inevitably change too.     Some of us, none of us or all of us may have souls in the bionic age –but if we are to retain them, they must be guarded fiercely.

Thursday, 26 May 2011

Six: Funding Battles

90% of the review meeting I had with the CMHT psychiatrist turned out to be about the Tavistock funding issue.  He began by saying that given the current economic climate, and the dire shortage of money available for out-of-area treatment, it was not a question of IF I stop seeing A, but when and how it is managed.  Since he is also of the opinion that the *only* truly effective therapy is short-term, goal oriented work, he would not be supporting my case.  Apparently this is also the opinion of the entire psychotherapy service in York.  I brought up the fact that the consultant psychotherapist I have been seeing for 4 years has a very different opinion, and thinks it is important that our work continues.  He said that if either she or the Tavistock were funding the therapy that would be fine, but since they’re not her view is inconsequential. 
I asked him whether he had arrived at this from a clinical or a financial perspective, and he said that for him the two were inseparable.  I pointed out that if the Tavistock treatment is withdrawn and no adequate replacement found quickly enough, there is a risk that I would be turning up A&E more frequently or requiring an inpatient admission if I am unable to manage, costing the NHS more money than the price of the therapy itself.  Since this year, with the support continuing, I have already had to receive medical treatment for injuries and be assessed by the on-call psychiatrist at A&E on seven separate occasions, two of which involved ambulance transportation, that this would be the case is not wildly improbable.  The doctor agreed that I had a valid financial argument, but explained that the problem is that the funding of the NHS is not quite as cohesive as it would need to be to recognise this.  It’s a question of different pots of money for different services. 
The economic problem is very real, and it’s not his fault.  I understood what he was saying, and I also know that the treatment I receive impacts on that which is available for everybody else in the region.  I have been very lucky to have had the therapy on-going for so long – it isn’t available to most people who could profit from it.  What I did take issue with, however, was his idea that A plays a completely “supportive” role in my care, suggesting that since I am not symptom-free, the work has not helped me to make any real lasting changes.   I vehemently disagree with this – and I asked him to leave alone his general views about therapy for a moment and just LISTEN to me.  It really isn’t a matter of being attached to a particular therapist, and not wanting to let her go simply because it will be painful.  A too is of this opinion.  In the past four years, things have changed quite radically.  I am no longer in and out of hospital every few months (my last admission was over a year ago), I have maintained my weight for almost a year and I am  stable enough now to be able to complete a degree course – something which I have wanted to do ever since life interrupted me at 17.
He did listen, finally.  And something positive came of it.  Although it is still extremely unlikely the funding will be granted, he thinks it might help my case if I talk to the psychotherapy service here in York and get them to recognise the value of my treatment at the Tavistock and agree that the short-term therapy they could offer me would not be appropriate.  He said he would refer me to a colleague at the service so the conversation could take place.  I also told him about the psychopath dream, which seem to amuse him.  He said he didn’t even need to turn up to my appointments – a cardboard cut-out would stand in for him just as well!  On a more serious note, he wanted me to know that all of this had nothing to do with the way he or others in the service perceive me.  It is not a case of personal dislike getting in the way of providing me with help.  As I told him, I do know this, rationally.  Emotionally it is another matter.
Therapy yesterday was tough.  I spent most of the session crying.  A has begun to use the past tense when she talks of our work together.  We discussed what would happen when the therapy ends – she suggested the option of paying privately for psychotherapy, though since I have no income I would have to talk to my mother about this (who, I might add, is not likely to help).  I asked if she meant paying to see her, and she said “yes” – “or someone else”.  Ideally of course I would love to keep seeing her, even if I have to pay for the privilege.  But realistically it’s not likely to be affordable, since I would also have to pay travel costs.  Introducing the money aspect more overtly into our relationship is also likely to change it drastically.  I’m sure she is aware of this, and although she conceded it as a possibility that I could pay to see her I am not sure she really thinks it would be the best option for me.
We are coming up to a month of anniversaries – my father’s birthday and the day of his death.  Not the best time to be dealing with this.  But is it ever?

Tuesday, 24 May 2011

Five - A taste of my own Medicine

Last night, my phone alerted me to a text message at 1.30 in the morning.  It was from a girl on my course who I have got to know slightly over the past few weeks – let’s call her Ellen.
The message read: 
I’m in hospital, taken an overdose”.
Ellen and I originally got talking when she sat next to me in our first workshop of the current term.  She was in one of my classes last term too, and she told me she had been really worried about me when she saw a bandage on my arm.  Apparently she had tried to catch me up after class to ask if I was okay, but I was walking too fast (I do, particularly when I’m on edge.  Ellen has bad knees so she didn’t really stand a chance).   I was surprised that she had noticed, and rather gratified that she cared enough to worry.  Despite the very obvious signs of self-injury I display, including one memorable day last term when I was really out of it and walked around campus with clothes soaked in the arterial blood I had spilled the night before, no one here has asked any questions.  I do appreciate the respect of my privacy, but for me there is a fine balance between an intrusive and an uncaring reaction. The fact that not a word was said by anyone about the scars on my arms had an unexpected isolating effect.   In some ways, I think I have grown reliant on remarks from others about the scarring to affirm my more hidden suffering.  I have felt for a long time the existence of a “split” in myself, the emotionally unstable hurting core armoured by a shell of social enthusiasm, rational capability and intellectual interests that seeks to distract and divert attention from the “real” me.  But while this attention is terrifying, I also crave it.  It proves that I exist, or at least, that the part of me that is often overlooked exists.  When this recognition or “attention” does not take place, it has a greatly destabilising effect, barely discernable at first but increasingly apparent over time – last term, it got to the point where I felt SO divided, SO unacknowledged that I began to doubt my sanity.
This is a rather long-winded way of explaining that Ellen’s interest was valuable to me, and that I felt disposed to encourage a friendship between the two of us. There was (and is) however, a complicating factor.  Ellen of course has her own problems, problems which I have come to realise she presupposes I can intimately identify with. I have come to expect the appeals “You know how it is, you know what it’s like” to pepper a sizable proportion of our conversation – which, more often than not, is about her.  Ellen is diagnosed with Asperger’s Syndrome, as well as depression, and I do wonder if the nature of our exchanges has something to do with this.  It may be a case of pot and kettle to suggest that she is particularly self- absorbed, but while I too tend to feel my existence as particularly isolated, I (perhaps overly) compensate for this by showing a pronounced interest in other people when I spend time with them.  Ellen feels that she “does not exist” when she is alone, that she needs other people to make her exist.  When I am on my own, I am all too real – it’s the rest of the world that disappears.  If it is possible to form such a comparative hypothesis, perhaps then this  explains why Ellen is “larger than life” (she has informed me that people have told her she comes across as “intense” and “frightening”) around others,  the only time she is able to realise the concreteness of her existence, whilst I am overwhelmed by other people’s needs when I engage with them, to the extent that in order to recuperate, I have to cut off from a recollection of these completely when I am alone.
The more I think about it, the more it sounds like two sides of the same coin – though I do not think I fit the diagnostic criteria for Asperger’s, I think Ellen could quite easily be diagnosed with BPD.  The irritation, as well as concern I felt when I received her text message was an important reminder of how my poorly integrated outside and inside worlds have worked to cause a lot of damage to my relationships, hurting those who I fail to realise (until too late) love me.  Ellen is fine.  The overdose she took does not sound substantial enough to have caused any damage, if her reports of the lack of medical treatment she was given in hospital are anything to go by.  Ellen, I think, wants me to help her, if only through the understanding she thinks I possess of how she feels.  She offers, unasked, details of her self-harming behaviour and watches closely for my reaction.  I cannot help but be responsive, but I am very wary of getting too involved.  For various reasons, which I won’t go into now, I think some of her recent behaviour has been modelled on what she knows of my history.  A few days ago, before her recent overdose, she told me she had once again taken a few too many of her citalopram pills.  I was bemused, and asked her what she had wanted to achieve – assuming she knew, as I do, that (whilst not a great thing to do) a small SSRI overdose is not particularly dangerous.    I can’t help but wonder if my reaction played some part in the fact that last night she appears to have taken paracetamol as well as citalopram.
I am annoyed partly because I hardly know her, and in some ways I do feel the text was an imposition. I was also angry because it took no account whatsoever of my possible feelings, and gave me only enough information to make me feel worried (disproportionately, considering the situation wasn’t in the end dangerous) and powerless.  It did make me think, though, of how my own self harm and suicide attempts must have affected those close to me – if I felt the way I did about Ellen, who after all is only really an acquaintance, how much worse it must be if you have a greater personal investment in someone who seems to behave towards themselves, and towards you, in such a cruel, careless way.  Those are emotionally loaded words, and my anger towards Ellen was almost entirely an emotional response.  While it may not be the most useful reaction, it is human – it is human to hurt when someone, particularly someone you love, hurts.  My experience of re- gaining consciousness in intensive care, hooked up to a million tubes, my mum, her face ashen, standing over me; or of my mother telling me how my Dad (he was still alive then) had cried when I was being treated for my first serious overdose and they were still waiting to find out if I would pull through, has a flip-side.  A flip-side which is at heart no less caring, but requires more insight, and in my case personal experience of being on the other side, to understand.
It is the frustration with a friend who has once again put herself in hospital, the friend you were relying on that weekend to come to see you on your Erasmus placement abroad.  It is the bewildered, frightened fury you feel when she goes out to celebrate a birthday with you only to spend an hour vomiting in the toilets of a bar and then sits down in the middle of the road, and you have to call an ambulance.  It is my mother’s terror, as she finds me hurting myself once again – the terror that provokes a hysterical “you don’t have to kill yourself; I’ll do it for you”.  It is my therapist's questioning of why I am “tormenting” her by making her watch me lose a dangerous amount of weight, yet again.   It is all this, and so much more. 
Thank you, Ellen, for helping me to see.

Monday, 23 May 2011

Four: When Doctors Grow Up

An odd dream last night has set my mind off along familiar tracks.
The scenario was a review meeting with a CMHT consultant and CPN, a meeting which in actuality is due to take place at 9.15 this morning.    If I don’t manage to drag myself away from the laptop and into the shower soon I’ll miss it, which would not be a good thing considering that the appointment has already been twice rescheduled, and after today the psychiatrist is on leave for a month.
It will be only the second time I have met this particular doctor, hence the reason why, for me, it is quite interesting that I should dream about him.  Even people I see regularly take a while to appear in my nocturnal fantasies – my therapist took a good few years – and I very rarely dream of acquaintances.  A bit of background:  the first appointment with this doctor took place after I moved here from London, and was referred on from one CMHT to another.  I think I wrote about it in the previous entry – anyway, it wasn’t fruitful.  I took away the feeling that there wasn’t ANYTHING they were prepared to do to help me, which was a bit of a shock to the system considering I have been under psychiatric care in one form or another for the past five years.  Then, the next appointment, twice rescheduled.  Although the new team had previously discharged me this was supposed to be a CPA meeting, made necessary by the fact that I had cut dangerously twice in one week (at this juncture, I’ll refrain from going into what happened in any more detail) and been placed under the Intensive Home Treatment Team – whose supervision I “escaped” by going back to London for the Easter break.  Before I left I promised them I would come back for the CPA a few weeks later, but when it actually came round to it I did not feel safe enough to travel up alone (being at my Mother’s saw a drastic decline in the cutting behaviour, since she won’t tolerate it in the house), and I gave them notice that I would not be attending only a few hours beforehand.  I spoke to the CPN who would be in the meeting on the phone.  She did not sound at all pleased, but said that they would go ahead and hold it without me, and schedule a review meeting for when I came back to university.
This meeting was supposed to take place last Friday.  I was in the right city at the right time for it, but I went to the wrong place.  I assumed it would be held where the initial assessment had taken place, since the letter regarding the review had been sent from this address.  Wrong.  Ergo, a pissed off CPN and psychiatrist whose time I had once again wasted.  Third time lucky?  In the dream last night, I told the doctor I am due to see today how contrite I was about the missed appointments, but he refused to believe me.  He said that psychopaths were incapable of remorse, and when I insisted that I was truly sorry, suggested that since such people are very good at saying what they think others want to hear this was just further evidence of my pathology.  I’m pretty certain the language in which the dream content manifested had something to do with this article, which I read yesterday.
The underlying conflict between patient and doctor, however, the tussle over truth which is the patient’s own but which must be relinquished to clinical authority, is an old anxiety of mine.  It was there right from the beginning of my “psychiatric career”, if I may so term it, but it seemed to grow more urgent with my transfer from child and adolescent mental health services (CAMHS) to adult psychiatry.  My experience of doctors at this time saw a dramatic turnaround within a matter of weeks – the time between leaving a secure child and adolescent unit and being referred on to a CMHT consultant, since I had turned 18 during the hospital admission.  During the 9 months I was in hospital my father had died, and the consultant I was under worked closely with me and was very involved in my care.  Admittedly, these were unusual circumstances, but even as an outpatient my community psychiatrist had been far more “on a level” with me than I could ever expect to find with those who worked in the adult service.  (Adult service, adult sector… my terminology has unfortunate connotations but you know what I mean).  Take, for instance, the issue of address.  Although I knew my psychiatrists’ surnames and professional titles, I was introduced to them by their first names, something which made them approachable and more inclined to win my trust.  On my first admission to an adult ward, which again took place no more than a month after I left the child and adolescent unit, I asked my consultant what his patients called him.  He was a nice man, friendly and more personable than many of the doctors I have seen since, but he reacted with astonishment to the question.
  Dr [last name] of course”, he said.  What else would they call me?”
A new boundary was established, one which I have never since transgressed.  The naming problem is but a small matter, however, symptomatic as it may be of the dynamics a patient may expect in such professional relationships.  Of far graver consequence to me was the treatment of my “illness”, which was now termed as such and given a formal diagnosis.  Indeed, this psychiatrist told me that it was a condition not only of my discharge but of everybody’s that a diagnosis was received – the computer system was set up in a way that demanded it.  I was incredulous of this at the time, and I’m still not sure it was entirely true.  During this and subsequent hospital admissions I encountered people who struggled with difficult social circumstances and sometimes had troubled histories, but who had never before come under the remit of mental health services. Once their “problem” was confirmed to be of a social rather than medical nature they left hospital as quickly as they arrived.
I had a different experience.  Although I was treated with a wide range of medications during my adolescent admission, including anti-depressants, anti-psychotics, so-called mood stabilisers (also used to treat epilepsy) and benzodiazepines, my psychiatrist refused to formally diagnose me with anything other than depression.  I had done some reading and noticed that one diagnosis, “borderline personality disorder”, seemed to describe me pretty well.  My doctor disagreed.  She told me that she was dubious about personality disorders in general, particularly “borderline” which nearly everyone could be said to display traits of, traits which were anyway particularly pronounced in young people.  Our personalities were still in the process of developing.  She said that there was a real danger that I would be diagnosed with the disorder by a CMHT psychiatrist, but this worried her and she would not pre-empt it.  At the time I did not understand why – I was in fact annoyed that she withheld from me a simple explanation of what was “wrong”, an explanation she could easily have provided.
It turns out I didn’t have long to wait.  I was indeed discharged from that first admission to the adult psychiatric ward with a diagnosis of borderline personality disorder, a label which in my view has led to many assumptions and treatment decisions which have been ineffectual, if not detrimental to my so-called mental health.  That, however, is a story for another time.  The title of this blog entry was “When Doctors Grow Up”, which is supposed to suggest  the strange phenomenon whereby as a mental health patient your transfer from child to adult services pre-supposes not only a radical progression in your own development, but an abrupt change in the people around you and the way you must relate to them.  Strangely, given that the treatment I received as an adolescent was more intensive and thorough that that which I received from both inpatient and outpatient adult services, there seemed to be more room in CAMHS for development and growth.  More “wait- and -see”, more “maybe you’re like this now, but your current difficulties do not have to define you or the life you will go on to lead”.  I can only speak from personal experience of course, and the treatment of children with, for instance, psychosis-based illnesses may well be different. 

But back to my dream.  There was certainly no wriggle-room in the fantasy doctor’s condemnation of me to psychopathology.  Furthermore, this diagnosis implied not only that my current behaviour was pathological, but that there was a right and “well” way to behave, and that a responsible practitioner’s job involved hypothesising an illness to show the patient how he or she had deviated from the prescribed path.  Psychiatry as a form of social control is by no means a new idea – Foucault amongst others wrote far more sharply on the matter than I am ever likely to be able.  But if it is true that doctors in adult psychiatry take on a more controlling, educative role, based on behaviour based medical theories than those in child psychiatry, there seems to be an issue still to address.  My treatment as a “child” seemed far more modern and progressive than that which I have received as an adult.  Whether it was more successful in terms of outcome, I don’t wish to speculate.   I only know that I sensed the people I worked with had belief in me and hope that I would come out the other side – that I wouldn’t be stuck inside their box forever.