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".


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.


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.