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.

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.

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.