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.