Last week my A, my community nurse, cancelled on me. “She does that a lot, doesn’t she?” a friend remarked when I told her. Well, now that you mention it… A phoned and rescheduled to see me at my next psychiatrist appointment which is next week. I’ve been really tempted to just cancel both altogether and be done with it. When I get cancelled on it just makes me feel like I’m not important and less of a priority compared to other clients, and I think “Fine, don’t bother then.” As for the psychiatrist appointment, last appointment when I met him for the first time, the appointment lasted literally 5 minutes, so I don’t even see the point in going. The round trip to get to the mental health centre takes about 5x that alone.
Part of me knows that it’s the BPD part of me that’s wanting to react in this way. That mentality of wanting to be the rejector as opposed to the one being rejected. “If you cancel on me, I’ll cancel on you!” and wanting to “test” her to see if she’ll follow up with me if I cancel altogether. Unfortunately or fortunately, my anxiety around making phone calls probably means that I won’t end up cancelling, and I’ve never been able to bring myself to simply not turn up to an appointment- that just seems rude. So more than likely I’ll just go and nod and say that everything’s fine. Guess I’ll see what happens.
Besides that, my mood’s been a bit up and down. One moment I’ll feel okay, and the next moment it’ll plummet. I had been feeling empty, and being stuck behind a computer doing an online unit and assignments has not been great for my mental health. I took a small OD a few days ago and downed 500mg of Seroquel. Which, considering some people are prescribed 500mg daily, shouldn’t be that much. Except that I don’t take Seroquel any more, and even when I did I was only on a very small dose, so 20 tablets was quite a bit for my body. I slept about 20 hours before awaking, and when I did I ended up vomiting and blacking out a couple of times and could feel I had tachycardia. It took another 8 hours before the drowsiness fully wore off. It was just self-harm, I knew I wouldn’t do any permanent damage from it. The last time I had taken an OD was about July/August last year and I guess a part of me is also afraid of getting better. I’m also hoping that now that I’ve got that out of my system, I’ll be able to get through my three fieldwork placements this year without getting unwell or any self-harm episodes. Considering my placements start next week and they’re three blocks of seven week full time pracs all in a row, I better get my shit together. This is my seventh year in an undergrad course in uni, which is long enough.
I was originally meant to be doing the full year of DBT, but due to me passing all my units at uni (yay!) and going on fieldwork next year, I ended up only doing the six months. Which meant I still completed all four modules; mindfulness, interpersonal effectiveness, emotion regulation and distress tolerance, I just won’t be repeating it for the second time round.
I had my last individual DBT therapy session with my psychologist yesterday. When I think about twice when I’ve overdosed/self harmed and ended up in hospital when I had to stop seeing a psychologist, the same when I just thought a psychiatrist was going to stop seeing me, and the rest of the time when I didn’t even properly end with a psychologist, it’s weird not to feel that sense of loss, dread, abandonment and feeling of being ripped apart that I usually feel in ending with a clinician. I guess I just didn’t really feel that sense of connection with her. And it got pretty repetitive and monotonous go go through the same thing every session: diary card, chain analysis, looking at where I could’ve used those DBT skills.
I think I’d feel a much bigger sense of dread and loss when it comes time to be discharged from the mental health clinic and stop seeing my community MH nurse. I was resistant to the idea of seeing a community nurse at the time when I was relapsing with my eating disorder last year, but now that I’ve been seeing her for over a year I’ve come to appreciate being able to just talk to her about whatever’s been going on in my life.
So now that I’ve finished DBT how did I find it? Well perhaps I’m not quite as scathing as I was before starting it. I can see where some of the DBT skills can be helpful when trying to get through a crisis or when trying to deal effectively with other people. At the same time though, I still feel like it doesn’t help me understand myself better on a deeper level and why I feel a certain way then react how I do, and learning the DBT skills doesn’t address if I’m motivated or not to use them in the first place. It’s also quite scary for me that because DBT seems to be regarded as the best damn thing since sliced bread for those who have BPD, now that I’ve completed it, it’s kinda like “Well what now?” So many times when I’ve been in the ED or psych ward, I’ve been told that doing DBT is the solution. Now I’m left wondering “What’s your solution for me now?”
Yesterday afternoon I was seen by the doctors, and my community nurse/case manager also sat in on the meeting. I was asked whether I wanted to be discharged that day or the next, I chose to be discharged that afternoon. Though I still wasn’t great, I at least felt a little better than when I came in and I guess there wasn’t much point in staying any longer. We also discussed my medication, I still remain on 200mg of Pristiq and 50mg of Seroquel XR but have also commenced on 450mg of lithium as a mood stabiliser. It was either lithium or sodium valproate, but according to the doctor the latter has a greater chance of hair loss, weight gain and sedation occurring as side effects.
Spent this morning in tears as I emailed a uni lecturer about something totally unrelated, and in her reply she again brought up an incident last year which resulted in a general miscounduct and me getting into a whole load of trouble. It feels awful that I continue to have that held against me by a lecturer I will again have this semester despite me completing the disciplinary action that was dealt to me and having damn well learnt my lesson. I then attended the last session with my psychologist at the eating disorders program in which I cried some more both talking about this situation with my uni lecturer, and then saying I felt “A bit sad,” when she asked me how I was feeling about it being the last session. It’s the first time I’ve ever admitted to feeling anything other than indifference towards any psychologist I’ve seen as I’ve always been ashamed of feeling attached to or having any emotional connection to others, especially when it’s not reciprocated. Though it wasn’t easy attending knowing it’s my last appointment, I’m glad I did and handled it much better than I did the last time I had to change psychologists. It’s quite embarrassing when I remember how I spent the second last session crying, refused to come back for another session or to see the psychologist I was being transferred to, overdosed and ended up in hospital thus never having a proper concluding session, then wrote him an angry email about how useless therapy is.
I’m starting DBT next week with the group component running on Tuesdays and my first individual therapy session is on Thursday. I’m really nervous about DBT and how full on and strict it seems. At the end of my assessment sessions for DBT I was given a contract and asked to sign it, with rules such as not being allowed to miss a certain number of group or individual sessions, having to complete the homework, rules around interactions with other clients and your therapist not having contact with you for 24 hours if you’ve self harmed. I also have a lot of ambivalence about whether I really do want to change and to stop self harming or not, and so much fear when I think about doing so. Plus I’m hesitant about starting all over again with yet another psychologist knowing that if I do develop a connection it will feel like another loss when we have to cease therapy, especially after weekly appointments for a year.
I’m always relieved and a bit surprised when I eat adequate amounts of food and I don’t gain a load of weight. In hospital when I began refeeding, I gained 4 kg in a week. Even the nurse was surprised at how much weight I gained in such a short time- “How is that even possible? You must really want to get out of here,” she said. And because it’s happened before, there’s a part of me that’s afraid that’s going to happen every time I start eating more. But it hasn’t.
These past three days I’ve been eating well and my weight has remained at what I think is possibly my body’s set point. On Friday when I saw my psychologist we talked about weight and the fact that while I’ve managed to maintain the weight I was discharged from hospital with, I’ve also been controlling it so that it hasn’t gone above that number. Technically my current BMI is just under the “healthy weight range,” but I am naturally petite anyway. I said that I may be okay with it if I gained a couple of kilos from eating what a person is supposed to eat in a day- regular meals and snacks that are balanced and nutritious. What I can’t justify is gaining weight for the sake of gaining weight or if I gain weight from overeating, eating lots of unhealthy foods and/or bingeing and purging. My psychologist is fine with that, which makes me so glad I’m getting outpatient treatment for my eating disorder instead of inpatient treatment. Instead of inflexible and ridiculous rules being imposed on me, I get to have a say in my own treatment and recovery. Which means for me eating regular and balanced meals and snacks throughout the day, and if I gain weight that’s okay, but if I don’t gain weight that’s okay too. What recovery and good treatment doesn’t mean to me is being forced to eat to the point of almost vomiting, and being forced to gain a certain amount of weight and punished if I don’t.
Though being in hospital was such an awful experience, it’s almost a good thing it was so bad, because it serves as an additional motivator to be well and stay out.
I received a call today from the CCI, which is the only public service in the state that offers an outpatient eating disorders program. I was offered an assessment appointment which I accepted, and it’s been scheduled for next Friday. There’s a part of me though that has doubts about whether obtaining treatment is the right decision or not. As I’m now weight restored after being in hospital, I feel as though I don’t need or deserve treatment for anorexia. After all, I’m not underweight any more so not only do I not look like I have anorexia, I don’t even fit the criteria for a diagnosis any more. Although I know it wouldn’t be a good decision, I’m tempted to lose weight before next Friday because I fear I’m going to go and be told that I don’t really have an eating disorder and don’t need help, after all, I’m not underweight.
I also had a visit from A, the Community Mental Health Nurse this morning. She asked about me appearing on the media about my experiences of ED treatment in hospital, which made for an interesting conversation. She mentioned she didn’t actually see the segment when it aired on TV, but was told by other staff about it. “Which staff?” I asked her, curious to know. “Oh I couldn’t remember names,” she replied. I told her a friend was advocating for better ED treatment in the eastern states, she asked me whether I was interested in talking about my experiences so I did. A asked me what I wanted to see so I told her- a dedicated inpatient ED program like they have in the children’s hospital, for hospital to also address long term recovery and psychological aspects instead of simply force feeding, and for there to be a step down, like a day program, so that people aren’t just going straight from hospital to home with no support.
I had an outpatient appointment scheduled yesterday with the psychiatrist registrar who was my doctor whilst I was inpatient. Unlike a year ago where I cancelled my follow up appointment after being discharged from M St, I actually did attend this time. It was a little disheartening to be back in the A St outpatients department, when I was prepared a year ago to never have to step back in there again. It was a short appointment. He asked whether I’d ended up getting 25mg quetiapine to use as PRN, to which I replied he didn’t, as I’d said before that it makes me too drowsy. He then asked what other medications I’ve had before as PRN. I told him I’ve had lorazepam before which at least doesn’t make me drowsy, but it seems as though he doesn’t want to give me benzos. He suggested propranolol instead which he explained is a beta blocker but can be used for anxiety. I’m a bit skeptical about using a beta blocker for anxiety, but I guess I’ll see…
He’s told me that even though I could probably just be managed by a GP, apparently E St (group program) require that clients are also be seen as an outpatient by someone at A St. It is for that reason that he said I will be referred to a community registrar, who will probably see me every 2-3 months. Well why even bother then, if as he said, I can just be seen by a GP? I don’t want to be given a psychiatrist appointment if they don’t feel like I need it, more that they are obligated to if I am to attend groups at E St. I’m beginning to feel that familiar temptation to sever all contact with mental health services again to save everyone the bother… Even though I know I’m being hypersensitive to this, being told I don’t really need to see a psychiatrist there feels a bit like rejection and my instinctive reaction to this is to reject their services first. Dammit brain, stop being so BPD 😦
It’s been over a week now that I’ve moved out, and I’m beginning to settle in and even enjoy my new found freedom and independence. At first there were bumps, as I was pushed out of my comfort zone. I missed my home, where I had spent the majority of my life. There were tears as I wondered whether I could really cope and even contemplated picking up and going back. But now I’m glad I took the initiative to escape a situation I did not want to be in.
Moving to a new area, I went to see a new GP close by. He issued me the scripts I asked for; Pristiq and Seroquel, with enough repeats to last six months. Prior to this I had still been having only a week’s worth of medication dispensed to me at a time. Though it may be a little deceitful of me not to disclose this to the GP, I was tired of having to go to the pharmacy every week. Besides, I haven’t overdosed in 9 months and if I really wanted to, I could anyway. And for the moment, I don’t. Things are going well. I’ve finally moved out. I passed all my units at uni and will be going into my third year of occupational therapy in 2013. I have friends, and I even have a boyfriend now. The guy I’d been dating has become my boyfriend, in fact my first at the age of 21. And I too am his first, at the age of 25. For now, I am rather content.
It’s difficult trying to find the balance between trying to stay on top of everything, trying to take action in my life and not overloading myself with too much stress and end up completely giving up on life. Have been feeling rather anxious lately, which is probably understandable given all that I’ve taken on and am trying to do.
Had a try of a new job this week. It’s an easy job, just spending time going on an outing with a woman who has a mild intellectual disability. It pays well too. Whether this will be ongoing though I’m not sure, as they are trialling another person too. I also potentially have an interview for another job next week. It’s for the position of being a live-in support for a woman with Downs Syndrome, free rent in exchange for part time support. I’ve also been looking for a room to rent so I can move out. Though I want to be free of living in the same house as my father, I still have a lot of doubts and anxieties about whether I can do so. Can I afford it financially? Can I manage independently? In some ways I still feel like a child pretending to be an adult in an adult world.
On top of it all I still have uni work and assignments. Was totally panicking and crying about it all this week. Failed my neuroscience test yesterday. I feel bad for using my mental health issues as an excuse, but I went to my GP to get a medical certificate so I can get an extension on the assignments. Ended up crying when GP started talking about stuff. How for me, it’s been a cycle for a few years now that I end up in a crisis then back at hospital. That I can take medication but it doesn’t get to the bottom of it if I’m not seeing anyone. She doesn’t want to see me when I’m still 40 and doing this And that there are people who have been through so much, but they don’t act like victims. Which I thought was a bit unfair, as I AM trying, dammit. I’m trying to keep on top of uni, and asking for a bit more time on assignments, instead of just overdosing when the pressure gets too much, as I have done in the past. Because my father is one of the big triggers for unhappiness at home, I am trying to see if I can move out. I am trying to find employment so this plan is financially viable. Last uni break we had, I was the one who organised for us my group of friends to go out for lunch which in the past could be quite a challenge for me. Even though it can be hard, I am trying not to let friends who are unwell trigger me. I. Am. Trying. Dammit. GP seems to think that not seeing a psychologist equates to not taking action to try to beat depression and again suggested I consider seeing a psychologist. Seriously? That’s like putting me on the fast track to becoming unwell again. She did acknowledge though that it’s been about six months now that I haven’t overdosed and said “You should be proud of yourself.” Yes it has been six months, which is the longest I’ve gone without overdosing for about 2.5 years.
I did give it a go. I mean, this was my third time meeting with this psychologist, though the first in terms of seeing him on his own. But I think it’s enough to determine whether I feel I can work with him or not. Unfortunately I just don’t feel I can.
I already had my reservations from that first time when I felt misunderstood and pushed into treatment I wasn’t keen on. And today I think he pushed too hard too soon for me to talk, given it’s our first actual session together. If you’re going to ask me to talk to you straight off about the reasons around my OD which I feel quite embarrassed and ashamed about, no I’m not going to do so. It takes time for me to open up and whomever I’m seeing, I need them to understand that.
He was also rather blunt. Yes, I know sugar coating everything and treading too lightly isn’t going to be the most helpful. But a bit of sensitivity wouldn’t go astray either.
About halfway through the session I could feel myself reacting by putting a barrier up and becoming oppositional. My responses were more abrupt. My attitude became one of indifference. I again grew resistant to the idea of therapy and change. Within this mode I stubbornly told him that I don’t want help and that I’m fine with how things are. That it’d be a waste of time coming back and he’d be better off seeing someone who actually wants the help and is ready to change. When asked whether I would come back for another session I said ‘no’. He told me he’d send a letter to my GP and I’ll discharged back to her.
How do I feel about that? Rather sick with anxiety really. I’m aware I’m choosing to throw away this opportunity for free psychological therapy that’s not limited by a certain number of allowable sessions. I know I’m lucky in that many people don’t get this kind of help. Just last week in the courtyard at A St I was reminded of this, listening to a woman sobbing to a nurse that she needed to see a psychologist but was still on a waitlist. But at the same time, I don’t see much good in seeing someone I don’t feel at ease with and cannot open up to. In a medical setting it wouldn’t matter so much, but within the context of mental health being comfortable with the person you’re seeing is important. Within the public system you don’t have to pay and the number of sessions is based on need, but you’re stuck with who they give you. In the private system, the advantage is that you get to choose who you see, but it’s costly and limited to ten sessions per year.
Don’t really know where to from here. I guess I’ll just have t see how things pan out.
I met with K, the replacement psychologist for I, this afternoon. She acknowledged that yes, she is temporary while the psychologist I am meant to be seeing is away, so I may not want to go into the deep stuff when I won’t have the opportunity to get to trust her and see her for a longer period of time. And so we talked about general and some rather light hearted stuff. Stuff which included my cultural background, what I do when I’m not studying, where I did my prac placements, countries I’ve visited and would like to visit, and my cute little Maltese-shihtzu puppy. She also explained that when people are discharged from hospital they usually offer a psychiatrist appointment as follow up. “Psychiatrists can have some helpful things,” she said, which I struggled not to laugh at, but was told that ultimately it’s my choice whether I go or not. I see her again in a fortnight.
Later on in the afternoon I called to cancel the psychiatrist appointment meant for next Wednesday. “What’s the reason for cancelling?” I was asked by the receptionist. “Ummm….” I stalled, not expecting to have been asked. “Just so I can put it in the computer,” I was told. “Umm…I just don’t need to see him,” I answered. It’s not the principle of seeing a psychiatrist I object to, it’s that I’ve met him once and felt uncomfortable and he’s not someone I’m able to talk to. There have been a couple of psychiatrists I’ve found okay and would more willingly attend an appointment with. Unfortunately he isn’t one of them. While I was at A St to see K today, I saw that my psychiatrist whilst I was in hospital in October/November last year is now one of the outpatient psychiatrists at A St. See he was okay, why couldn’t I have been allocated to him? Instead I get allocated to the one I don’t feel comfortable with. Sigh.
Dr L provided me with new scripts today and typed up a letter, instructing me to hand it to the pharmacist. The contents of the letter basically asked the pharmacist to only dispense my medications weekly. That’s a big assumption to make, that I’d willingly hand over the letter to the pharmacist myself. Was very tempted to just not do so- how would Dr L know? In the end I did. I’d like to say it was my integrity and honesty, but really, it’s just me being afraid of the consequences I may have to face if I don’t and I’m found out. “It’s a good excuse to go shopping!” remarked Dr L of the weekly trips I will now have to make to this shopping centre. Except hey, I don’t have spare money to spend on frivolous things after spending $123 on Pristiq and Seroquel today. Yay!
Tomorrow I’m meeting up with M for lunch whom I first met when we were both inpatient in Oct/Nov. A social meet up with a friend? Well that’s something new. According to my diary records, it’s only been since February that I haven’t met up with friends. It feels a lot longer than that though 😦