Sutures

I’d been experiencing the urge to self harm for a few days, yesterday I ended up giving in. I searched the ward for something I could use, broke a piece of plastic which didn’t really do much. Found a mug, smashed it on the floor and self harmed with that. It’s not what I usually use and did more damage than I’d intended and thought it would. Seeing how much it was gaping panicked me a bit, but once it had stopped bleeding I thought it would be fine. One of the nurses this morning though came up and asked whether I’d cut my leg as someone had seen. I admitted that I had the previous day, and she took the broken fragments of the mug out of my room.

The doctor had a look at the wound and told me they’d stitch it up. “Does it…need stitches?” I asked, not keen on the idea, never having had them before. I was told yes because of how it’s gaping open and reluctantly I agreed. Ended up requiring six stitches, and though the actual suturing didn’t hurt, getting the local anaesthetic injected did.

Despite self harming for about 10 years now I am actually really quite a wuss when it comes to pain and needles and I’m really squeamish. So it’s embarrassing that it was hard for me to tolerate when the doctor was injecting the site with local anaesthetic and halfway through I had to take a break before continuing. The nurses and doctor were really nice about it which makes me feel guilty- I feel like I don’t deserve it and they must be thinking “If you cut yourself on purpose, why are you being a wuss about getting it stitched?!”

It scares me a bit because when people talk about self harm getting worse and/or accidentally going too far, I’ve always thought “I can control how deep it is so that I don’t have to get stitches, I’ve been doing this for years and it hasn’t gotten worse over the years so it’s fine.” And though having to get sutures partly puts me off self harming again because getting the local anaesthetic was a bitch, a part of me doesn’t care and wants to cut even now.

At the goal weight

I’m at the goal weight that was agreed on- 43kg. Originally they wanted me at 46kg, thankfully they’ve lowered it to a weight that is both healthy for me and a number I’m more able to cope with. They want me to maintain the weight for a few days before discharge. Technically I’m now “voluntary” as the Form 6 of the Mental Health Act I was under expired. However when I said I wanted to leave, I was told I wouldn’t be allowed to do so, and that I’d just be formed again if I did. Doesn’t sound very “voluntary” to me. I realised though it’d be better for me to play the game and comply for a week rather than run the risk of being put on a Community Treatment Order when I’m discharged, which could last for up to six months. It’s what I continue to try to tell myself- play the game, not long to go now so don’t screw it up for yourself.

Saw the psych registrar today who told me if I dropped the weight again they may bring me back into hospital which could result in a longer stay and they’ll increase the goal weight even more. Next sentence he’s telling me they want me to continue to see the doctors and the dietitian as an outpatient. I almost laughed and asked him why I’d attend outpatient appointments if it ran the risk of being forced back into hospital? At this stage I’m not sure whether I’ll maintain or lose weight when I go home, but I sure as hell am not coming back here to obtain treatment for anorexia. It makes me so angry to think about the punitive way I was treated here. Taking away my control, insisting on putting in a nasogastric tube without even giving me a chance to eat, taking away my dignity by not even allowing me to walk 3m without a wheelchair, not allowing me any of my clothes and belongings and not even my glasses, being so rigid to the point of ridiculousness in following the “management plan”, confining me to a room on “bed rest”, focusing entirely on weight gain with daily weigh ins, forbidding my friend from being put on the same ward as me even though her doctors were fine with it, taking away the one thing that may lift my mood and take away from being so miserable. I’m not opposed to treatment entirely, just treatment here after this awful experience. On principle I don’t plan on attending any future outpatient appointments here. As for treatment in general, I’m feeling so tired of it all and at the moment it seems futile. I’d seen a clinical psychologist three times during the past couple of weeks, last session however my defences were up, I didn’t talk and told her it was pointless. I’m sick of starting over and over again with countless psychologists and I feel like nothing will work anyway.

I’ve been feeling hopeless about everything and anxious about the future. One of the nurses was saying she’s excited to plan for the future, which I’m envious of, and wish I was too. Instead it just seems bleak with nothing to look forward to and I’m too afraid to think ahead as the future just scares me. When I’m restricting and losing weight it takes away from my emotions and my feelings and now that I don’t have that, the sadness and hopelessness and anxiety is intensified. When I’m eating disordered I can pretend that food and weight are the problems and can delude myself into thinking that if that is solved, everything will be fine. On the surface that’s easy to cure, eat and gain weight and life will be fine and dandy. The reality however is much different- I may be eating and a healthy weight but then I have everything else- the feelings of being alone, hopelessness, feeling I can’t cope with life as well as everyone else, and desperately wanting a way out. That’s much much harder to fix and I can’t even pretend I have a solution to it because for this I really, really don’t.

Intro to Group

Today I had my last session of the four week long Introduction to Group Therapy program. I’m glad it’s over because I have actually gained nothing from going. The content consisted of basic CBT, particularly in relation to depression and anxiety. I feel like I’ve done CBT to death, both as a patient and as a university student. I don’t find CBT helpful and it didn’t benefit me to hear all over again stuff I already knew. I probably spent more time tuning out than in. Apparently I wasn’t the only one bored though- another guy actually fell asleep and started snoring today.

The one positive thing though is yay, I’ve completed it. Which means I can now go on to the intermediate group of Emotional Regulation before then progressing to DBT. I was told yet again when I saw the psychiatric registrar this week that DBT is what will help me- I guess we’ll see.

Struggles of the past week

The past week and a half has been hard. Numbness, apathy and anxiety have all been present. There have been a couple of nights where I’ve come very close to overdosing as a way to self harm. Knowing that I had things to do and places to be the next day stopped me on Tuesday night. Went and bought a pack of paracetamol on Wednesday night before going to the park and sitting by the riverside for a while. Tried to remind myself that this isn’t me any more, that I’ve gone over a year without overdosing. In the end I went home and the pack of paracetamol still remains in my shopping bag.

There’s a part of me that almost wants to dare things to slide to rock bottom so at least I know where I stand. Being stuck in limbo feels almost worse. Not feeling well, but also not quite at my worst. Waiting, waiting for either things to get better or to slip into “I can’t do this any more.”

This past week I haven’t had uni and thus have been able to sleep until 10, 11am and returned to bed when the tiredness, feelings of anxiety or the world has felt too much. This coming week uni returns and it could go either way.

I’m trying

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.

Hoping things stay okay

It’s scary how quickly a descent can occur. There was friction with my father yesterday, on Fathers’ Day no less, and from there my thoughts just spiralled. Instead of then just being about the present issue, it became about the past where I didn’t get what I needed, and it became about the future where it felt futile to hope or want for anything more.

I’m glad to report that today was a better day. Because what terrifies me the most is if it’s not just one bad day, but one after the other in succession, which then turns to weeks. It’s funny that it used to be the thought of getting better that scared me, particularly the loss of support it might entail. But now that I’m not seeing any mental health professionals in the first place, there’s nothing to lose and only something to gain. I’ve had months of predominantly wellness and stability and there are no words to describe how much I fear losing that. It wasn’t that long ago I was very unwell that I’ve forgotten what a painful and lonely place it is when in the grips of depression.

It’s been over five months since I last overdosed, and five months since I was last in hospital. In the past almost 2.5 years I’ve never been able to go more than 4-5 months without overdosing and ending up in the ED again. I’ve been crossing my fingers that things don’t go downhill and that I can keep this up. Please let me keep this up. I have no options if things go downhill. Therapy makes things worse because of my fear of rejection and abandonment. I have no doctor to play around with my meds. So I can only hope, and keep hoping, that it doesn’t.

Recovery?

Recovery. It’s the word of the moment with mental health services. They’ll tell you they operate from a ‘recovery framework’. Recovery as the ultimate goal, it’s what we’re all supposed to be aiming for.

I don’t understand the concept.

When I think of the word ‘recovery,’ I think of someone ceasing to have the symptoms of an illness they previously had and are no longer ill. As in someone recovering from an infection, recovering from a bout of gastroenteritis, recovering from the flu. Or if we’re talking mental health issues, recovering from an eating disorder or recovering from depression. As in, they had that illness but do not have it any more, nor do they have any lingering symptoms.

According to the lecture notes from my neuropsych tutorial though, some of the principles of recovery include;

  • Recovery can occur even though symptoms reoccur or remain.
  • Recovery can change the frequency and duration of symptoms.

So then I was just confused.

I Google searched ‘mental health recovery’ and came across a government document entitled Principles of recovery oriented mental health practice. Maybe I’m just slow, but I still don’t understand this elusive concept of ‘recovery’.

But perhaps it doesn’t matter, seeing as whatever this word means, it doesn’t feel attainable, achievable or realistic anyway. I may achieve periods of ‘doing better’ but I don’t expect to be completely free of depression and anxiety any time soon, or possibly even ever.

High functioning

I know that for a number of people, a decline in functioning is a symptom of their mental health issue. Declining invitations to go out with friends, remaining in bed instead of turning up to work, or failing to hand in school or uni assignments on time. Yet, I find it quite difficult to muster up sympathy and take it into consideration when someone finds themselves unable to do certain things due to their mental health. I feel like I should be more understanding, but I tend to feel rather impatient, irate and at times even resentful of such people even if I’d never outwardly portray it.

I can try reason it out and rationalise it; everybody experiences different symptoms of their mental health issues, there are varying levels of severity, people deal with things in different ways, some people are just able to attain a greater level of functioning than others no matter how severe it gets…but it still doesn’t overrule how I truly feel. I guess a lot of it is probably due to my past experiences as a child and the role it plays in my life now.

As a child I had huge anxiety issues and I would cry in complete terror and dread at the impending situation or task. Despite this, I was never allowed a reprieve. There was no gentle guiding me and holding my hand so I could tackle it in little steps. I was forced by my parents to confront whatever it was, and thrown in head first no matter how terrified I was and how much I didn’t want to do it. I suppose the lessons learnt as a child has done me some good in a way. It’s taught me that I must fulfil my responsibilities and commitments no matter how awful I feel. And for the most part, I do, asides from when I’m in hospital. I’ve never backed out on a friend when we’ve planned to meet up just because I’m feeling anxious or down. When you don’t have that many friends to start off with, you can’t exactly afford to blow off the ones you do have…! I remember overdosing on paracetamol one day and going out with a friend the next, as if nothing happened. In my three years total that I’ve been a uni student, I’ve never ever missed a compulsory class at uni nor a day of work because I felt too miserable to show up. I may have backed out of my volunteer work before, but for the most part I keep my commitments. Last year I even went from the ED after being treated for paracetamol overdose straight to a volunteering event I said I’d attend, despite looking and feeling like shit. I never had the luxury of backing out as a kid, and I don’t afford myself the luxury of doing that now. That is the reason why the feelings I have towards people who do this are somewhat harsh. My thoughts go something along the lines of “Dammit, I suck it up and get on with it…”

Unless I’m practically dying, there aren’t many acceptable excuses. One drawback of this is that it means when I really can’t keep it up and handle it all any more, I go to extremes to avoid having to do my duties. Simply ‘not feeling up to it’ is not a good enough excuse, and so, I make it that I do have a good enough excuse. I make myself fit my definition of ‘practically dying’ by taking an overdose and ending up in hospital. It’s only then I give myself a reprieve and allow myself time to breathe.

Another reason why this issue particularly irked me is because it came up in the consultation I attended today regarding a new youth mental health service being set up for early intervention for BPD or risk of psychosis. One of the criteria that must be met for a young person to access the service is that they must have experienced a marked decline in functioning. I’m already feeling quite disillusioned with mental health services at the moment and that just reminded me of how frustrating it is for people to assume I’m fine and don’t need help because I appear to be doing all the things I’m meant to be doing. “You’re very high functioning,” the doctor said as I was discharged from my last hospital admission, as if that was meant to make me feel better. I can see why having high functioning would be an advantage and an asset, but it does not mean everything’s perfectly fine and dandy. Even up until the very day I end up in hospital, I will still most likely be attending all my commitments. It would be nice if people didn’t assume certain things.

Busy volunteering, studying & being a mental

Life has been rather busy up until this point. Doing things I want to be doing, as well as things I not so much want to be doing. Among that which I want to be doing, I attended a youth mental health roundtable a week ago. The first half of the day was spent providing feedback on the National Report Card on Mental Health. The group of young people in the room were great, all had such a wealth of experience and ideas to share and it was so inspiring to be part of this discussion on mental health. A range of issues were brought up including mental health services, mental health in Aboriginal and rural communities, mental health in schools, CALD issues, and others. The second half of the day was dedicated to providing feedback on the new youth mental health service that is currently in the process of being built. This new services is aimed at young people who are at ultra high risk of psychosis or emerging Borderline Personality Disorder. There were a couple of questions I brought up, BPD being something I feel rather strongly about given the prejudice that is often held against those with BPD, even when they’re in a vast amount of emotional pain and in need of support. One of my questions was regarding the six month limitation on this service. I wanted to know how six months is adequate for an illness such as BPD which often has a lot of underlying issues, and how they were going to deal with the issues of rejection and abandonment when the relationship is terminated at the conclusion of those six months. The answer I got is that their service is a starting point before going onto another service is required, which is fair enough, and that often if you’re clear with the young person from the beginning that at the end of six months they’ll have to move on, it will help so that the person doesn’t feel rejected. Is this usually the case? I don’t know. But I know for me, it’s part of the reason why I’m reluctant to see psychologists again. Because it just hurts too much when I’ve started to trust someone, they too leave.

Yesterday I was there while a conversation took place between the people who are setting up this new service. They were trying to work out how exactly ’emerging’ BPD is going to be defined for eligibility for their service. Another eligibility criteria is that someone has to have had a decline in their functioning. I asked whether someone who say self harms and are showing signs of BPD but are functioning fine in work/school/uni, whether they’d access this service. And the answer was no, they’d probably be accessing another service. It was interesting to me because there are definitions of mental illness that say it must impact on a person’s functioning. When I look at myself however, my daily functioning is very rarely impacted. I have never missed a lab class of uni due to feeling too depressed or anxious. When I’ve made a commitment to my volunteer work or going out with friends, I don’t think I’ve ever bailed because I was feeling too emotionally awful or anxious. The only time I have failed to attend these things is when I’ve been in hospital. Despite ending up in hospital at least once every semester that I’ve studied OT, I have not failed any classes and passed them all the first time round. So based on functioning, you could say I don’t have any serious mental health issues at all. But it’s my coping mechanisms and emotional reactions that get the better of me. Because things that most people are able to cope with in everyday life, I react by having a meltdown and overdosing. So it’s like functioning, functioning, functioning….then have a meltdown and crisis.

I finished my one and last exam on Wednesday. Though marks haven’t been released yet, I’m almost entirely confident I passed all four units. I’m thrilled because in three semesters of OT I’ve managed to pass three semester’s worth of units, whereas when I was studying pharmacy, in three semesters I hadn’t even managed to pass a full semester’s worth of units. Not to mention I’ve been inpatient in psych wards once per semester for all three semesters too during my OT course. I also went out with a group of my OT friends for lunch after we finished our exam, the first time ever I’ve gone out with friends from OT. Yes, after 1.5 years of studying in this course I finally have an actual group of friends that I belong to.

I’ve still been collecting my meds weekly from the pharmacy. An annoyance when I have to stop by on my way home from Uni on Fridays, an even bigger annoyance when I don’t have uni and have to go especially just to pick up meds. Using public transport. To make things worse, a girl I went to school with who was in my year and so we know each other, works at the pharmacy. I see her every Friday when I go get my weekly meds supply. Awkward. And so today being Friday, I went and was informed my box of Seroquel has run out and they’ll have to dispense a new script for me. Fine. Then the pharmacist asks me, rather loudly, “WFH, has the doctor lowered your dose of SEROQUEL?” Just announce to the whole pharmacy that I’m a mental, that’s fine… Turns our my GP faxed a script for two 25mg Seroquel tablets per night which I used to be on, instead of the correct one 50mg Seroquel XR tablet a night which I’ve been on since they changed it when I was in hospital. So it’s back to the GP I have to go, and there goes my plan to avoid her out the window. Not too keen to answer her probable questions about my not wanting to see the psychologist at A St. My answer if she asks what I plan to do in terms of getting help? Nothing. It’s my life and I choose and plan to do nothing.

I’m on break until Uni starts up again on July 9th and I have mixed feelings about this break. On one hand, it’s great to not have to do any study or uni work. On the other hand, it gives me quite a bit of spare time, too much spare time to dwell on how lonely I feel. It’s hard when I see people going out with their friends and I’m alone at home, reminded that I don’t really have people to hang out with. It feels pretty awful when it seems like everyone else has these wonderful close friendships and all these people to spend time with, and I don’t. I am headed to Melbourne and Sydney in a week though. Melbourne just for a couple of days to holiday as I’ve never been before, and Sydney both for a bit of a holiday and the Young Minds Conference, which I obtained a free ticket to.