Home 7 weeks later, 5kg heavier

It’s been seven long weeks, and I’ve finally been discharged from hospital. I came in weighing 34.6 kg, and left at 39.4 kg this morning. Which would be 5 kg had it not been for my methods of artificially increasing my weight before weigh ins. Weighed myself without clothes on once I arrived home- my scales told me 38.3 kg.

Had a family meeting before discharge in the morning, with those present being my mum, the consultant psychiatrist, intern doctor, dietitian, nurse, and of course myself. What came out if it is they want me to maintain and not lose weight obviously, and for me to remain in contact with mental health services. I have an outpatient appointment with the psych registrar on the team next week, however, I don’t intend to go. I may be more inclined if the appointment was with someone I liked or at least feel neutral towards, but I don’t and see no value in going to see someone I can’t and won’t talk to. With having an appointment to see a dietitian I also feel it would be pointless, as I could have the most elaborate meal plan in the world, but it won’t do much good if I can’t and won’t follow it.

I’ve never been one to fast though- at least I do eat. I’ve never gone more than a day without eating anything. Just that what I do eat tends to be small amounts of fruit, vegetables, and a few things in between. Found myself falling straight back into old habits as soon as I got home. Chewing and spitting a whole lot of food. Not being able to allow myself to eat certain foods and feeling guilty at what I do eat, telling myself I didn’t need it.

It’s such a push-pull internal tug-of-war. When I think about being able to eat what I want without guilt and ruminating over it afterwards, without always thinking about food and worrying about what the numbers on the same tell me, it sounds so nice. But getting there feels so out of reach, something that belongs in the “too hard” basket. The alternative is to keep on doing what I’ve been doing- restricting what I eat and pushing myself to drive the numbers on the scale lower and lower with each passing day. In some ways it’s easier than recovery, in other ways it’s just as hard.

Banned from blogging (but doing it anyway)

Well thank you to whoever reported me/my blog to the staff at this hospital. Not happy.

On Saturday night the registrar came to see me, and it was brought to my attention that they were concerned about what I post on the internet. I asked them to clarify for me what exactly it is I’m not supposed to be posting, as I have many accounts on social media and couldn’t be sure what they were referring to. I was told I’m not allowed to post about myself because “You’re under the Mental Health Act” and “We have a duty if care to protect your reputation.” I call bullshit. Protect my reputation? More like protect their reputation. It’s not like I even use my full name in association with this blog.

Sunday night nurses and security guards came into my room to search it again and that’s when I got angry and tried to take off. Unfortunately they caught up to me in the car park, I was again restrained, put in the seclusion room and sedated. Fun times. My hands are now all bruised from when I punched and hit the wall, and I was knocked out the whole of yesterday from the two shots of midazolam and 100mg of chlorpromazine I was given that night.

The consultant on my team is back from leave. Apparently I’m not meant to be blogging as my reports of being restrained and secluded can “give people the wrong impression of what happens here” and can perpetuate the stigma of mental health. “I don’t write anything that’s not true,” I shrugged.

A tentative discharge date has been planned for this Thursday, as well as a discharge meeting with my mum. The sooner I’m out of here, the better, I say.

Still not discharged

It’s been over 6 weeks and I’m still in hospital. My 22nd birthday came and went, the second birthday stuck in a psychiatric ward. The Form 6 of the Mental Health Act which allows for a patient to be held involuntarily for up to 28 days expired, and I was put on a Form 9. I thought 28 days was long, but a Form 9 allows someone to be kept for up to 6 months. Not that I’m going to be here that long, but it’s scary how much power psychiatrists hold.

I was told a few weeks ago by the psych registrar that I’d need to get to 38kg before discharge. When I next saw the consultant psychiatrist however, he said he doesn’t know why I was told 38kg, and that I have to be at a BMI of 16 (40kg) or close before going home. I asked both the registrar and the consultant whether I have to maintain that weight for a certain period of time before being discharged- both told me I wouldn’t.

Come Monday I hit 40.1kg. Okay, so it may have taken a bit of water loading, wearing shorts under my pants and having a deodorant and mobile phone in my pocket. However, both doctors have gone on leave and I’m stuck with two completely different doctors until my doctors come back. Apparently it’s not documented by my doctors that I don’t have to maintain, and the only documentation that IS on my notes is by the dietitian, who’s written I DO have to maintain for a week.

It all just went downhill from there. I was fed up that they keep changing the target and angry that they didn’t keep their word about being discharged once I hit that 40kg. It seemed as though even if I comply, I still don’t get to go home, so may as well not comply. I started refusing to have the Ensure Plus.

Tuesday night was an absolute low point. As I’d previously self harmed and had just come back from leave, two nurses came in to my bedroom because they wanted to search it. I was told to get off my bed and stand by the door, which I refused to do. Security was called and I ended up being restrained by three of them on the floor. When they let go of me and left my room, I lost it- I smashed my mug on the floor and started chucking stuff around my room. That’s when the security guards again entered, took me to the seclusion room and I was restrained while given an IM injection of midazolam. I was then left in there and they locked the door behind them.

Yesterday I absconded from the ward. I left at about 10:30am. I ended up being brought back by my parents as the police had contacted them. I wasn’t going to pick up the phone when my mum called, but after 6 missed calls I felt too guilty.

The weigh ins of the past two days I got found out about having stuff in my pocket. Unfortunately it means my weight has dropped- it was 39.2kg this morning.

I’ve repeatedly told everyone that I don’t want their help and I don’t want to recover from anorexia or stop self harming. I don’t see why they insist on keeping me here when I’ve made it clear I intend to lose weight all over again when I get home and I won’t attend outpatient appointments. A nurse has warned me they could put me on a Community Treatment Order. I replied that I don’t care, I still won’t come to appointments, and besides, I don’t think they would anyway.

So it looks like I’m here for yet another weekend. Well, at least I still have stuff to self harm with that the nurses haven’t found for now.

Inpatient ED treatment

So I find myself back in hospital at A St, in the same ward I was in during May. Which makes it my 6th psych admission, though for the first time it’s not after being sent from the emergency department after an overdose but instead for an eating disorder. Or specifically, anorexia nervosa, though it still feels odd when they call it that as I don’t feel as though I’m thin nor sick enough.

On Tuesday I had gone to see my GP. “I can see you’ve lost a lot of weight, I almost didn’t recognise you,” she said, which I thought was a bit of an exaggeration. I weighed in at 35.4kg and according to her records, the last time I’d been weighed in her office I was 43.6kg. She requested for me to get my bloods done, after which I started experiencing nausea, dizziness and my vision started going fuzzy. They put me in a wheelchair so that I could be taken to a bed to lay down. My blood glucose at the point was 3.7 which according to GP was quite low, and my blood pressure dropped to 76/40. “I’m not surprised you fainted,” she told me, after quizzing me on what I had eaten the previous day & the weight I had lost.

On Wednesday morning I had an appointment with the psych registrar at A St. She again kicked me out if the room while she consulted with her consultant then told me they wanted me admitted to hospital. I agreed this time as I did not want to be put under the Mental Health Act and really, I’m just tired of it all. I went home to pack my things and in the afternoon returned to be admitted to the ward. The medical doctor on the team did a physical check up on me, and they also had the results of my blood test back. They were all quite normal, except my white blood cell count was just a little bit low. Which again made me feel like I’m not sick enough to require hospital and don’t need to be here.

After lots of waiting around I was finally taken to the ward. A nurse did the admission paperwork and took my observations, and also did an ECG. She’s a recent graduate and was nice which was good as we both had a bit of a laugh when it came to doing the paperwork and her having to ask me about using weapons, wanting to harm others, and my non-existent drug and alcohol habits. “It’s good to do groups,” she said, in which I just laughed in response.

This morning I was seen by the doctors. My current BMI is about 14 and he reckons an ideal BMI would be around 20. I disagreed and told him that would be too high. “How about we make a goal for you to gain 10kg?” He asked. How about no. I was told I’d have to have daily blood tests to check I don’t develop refeeding syndrome. Given I really dislike needles and blood tests, I was not pleased to hear this. I asked him how long I’d likely be here, he said probably a couple of weeks.

Then met with the dietitian who said that they will do a meal plan for me and also give me nutritional drinks in the form of Ensure.

Unfortunately me being in hospital meant that I missed the last session of emotional regulation group. It also means missing uni and having to cancel with work, and they did not sound happy when I did so :/

Avoiding hospital

Last week I had an appointment with Dr D, the psychiatric registrar I’d been seeing at A St. At this appointment she asked me about my eating, my weight loss and took my weight and height. She also referred me to the CCI, the only public eating disorders service in the state, and to a clinical psychologist through A St, depending on which came through first as both involved a waitlist.

I then got a phone call today from Dr D asking me if I could come in to see her today. I agreed and so went in this afternoon. She took my sitting and standing blood pressure and my pulse which was all good. However, she then said that she had discussed with her consultant and they wanted me to come into hospital at A St, the public psych ward. Umm, what? Last week she didn’t even seem that concerned. From what I gather it’s all only because she got a letter back from the CCI stating that my current weight is concerning as from what I know they don’t accept outpatients under a BMI of 14 and on my referral I’m only 0.5 off that.

Medically I’m fine though. Even Dr D said so. However her reasoning is that if I continue to restrict and lose weight as I have been, I will not be medically sound. I don’t think that’ll happen, and I told her I didn’t think hospital was necessary. I especially didn’t want to go to A St, as it would be utterly pointless given I’ve been at A St before and know what their programs are like, and it’s not like they have an ED program. I asked about the possibility of going to a private hospital with an actual ED program instead but according to her you have to have been seeing a private psychiatrist with admitting rights to be able to go to that hospital. “Both you’ll be seeing a dietitian anyway,” she said, indicating it’d be the same thing. Umm no, I don’t quite think so.

“What if I say no [to hospital]?” I asked Dr D. I don’t have time for hospital, I have uni to go to, assignments to do, fieldwork to attend. She then tells me she’d have to ask her consultant whether doing a Mental Health Act assessment was necessary. Woah, overkill. The consultant then came in and asked a few questions. According to him, for someone with a height of 159cm, 59kg is the ideal weight. I disagreed with this and let him know. In the end they decided a Mental Health Act assessment wasn’t necessary. What saved me is that my body seems to be behaving rather well, my heart rate and blood pressure were fine (105/80), I still get my period, albeit very light, I feel mostly physically well and my blood test results from 6 weeks ago were still quite normal.

The conditions however are that I have to see my GP regularly, get regular blood tests and see a community mental health nurse. They also wanted me to see a dietitian but I was not keen and said that I didn’t see the point as I likely wouldn’t follow a meal plan anyway and don’t want to gain weight or eat more.

Honestly, all this feels unnecessary and I’m fine.

Pdoc appt at A St

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 😦

Locked ward to open ward

Well. It’s been a turbulent past few days to say the least.

Sunday afternoon I took an overdose of paracetamol. Felt really nauseous afterwards and called the ambulance myself. Was transported to the ED. The doctor suspected I had taken something else as my ECG was apparently “very abnormal.” I however, definitely had not. Was told something completely different the next day by another doctor who said my ECG was normal. And so I was put on a NAC infusion and a psych liaison nurse came to have a chat. The plan then was to discharge me after the NAC had all gone through.

The next day however, another group of psych doctors assessed me. Somehow on the second day I always feel worse, as I think about how it feels as though I always turn back to this and that nothing will ever help. My wishy washy answers to what my plans were after leaving the ED didn’t really help my case, and they talked of admitting me.

Upon the NAC infusion finishing at about 5pm, I was told that I had to wait around to be seen by a psych liaison nurse yet again, who didn’t start until 7:30pm. Waited around for a bit. Pulled my cannula out. Eventually I just walked out, as I didn’t feel like mental health services will do anything to help anyway and I felt frustrated.

Walked around town for a bit, sat crying and feeling hopeless for another bit. Got 2 missed calls and messages from the ED and ignored it. Eventually wound up at the train station and sat watching the trains, wondering what it’d be like to walk in front of one. Half wishing I had the guts to do so. A friend called and I talked to her for a bit, after which I intended to just take the bus home. However, I then got a call from the police, who said they had to spot me before they could write the job off as done. Was met by the police, and when I expressed by reluctance to return to hospital, I was told I had to come with them and “You’re under the Mental Health Act.” Wasn’t sure how serious they were, but I wasn’t willing to test it out. And so back in the ED I go.

Cue more waiting around, and me crying and feeling miserable. Was assessed by another psych doctor, after which I was transferred to a locked ward. Was patted down by a nurse in a bare room with a mattress with about 4 other nurse watching, then had my phone, jacket, necklace and bra taken off me.

The next day the doctors came to talk to me. It was then I was told I have Bullshit Psychiatric Diagnosis Borderline Personality Disorder. “Has anyone ever discussed this diagnosis with you before?” the doctor asked. Umm no, because I’ve never been diagnosed with BPD before- I’ve only been ever been told I don’t have BPD. Sigh. They thought it a good idea for me to do DBT, I was rather ambivalent.

Later on at night while I was in the TV room, a patient came it and told me “You better leave, as I’m going to start throwing things soon.” Told her I was staying as I was watching TV here first. She responded by saying she was going to start throwing things in the direction I was sitting. “Well throw it in the opposite direction then,” I said. True to her word, she started throwing things, nurses came and told me to leave, the duress alarm was pressed and she was restrained and escorted to a seclusion room.

The next day when the doctors came to see me again, I expressed that I didn’t find it helpful to be in hospital and that I didn’t see the point. Doctor responded by saying they still thought DBT would be helpful and maybe I’ll change my mind about it. Hmm yes. He also said that with a personality disorder, it’s very possible to get better, less difficult than a chemical disorder like major depression or bipolar. “But I thought a personality disorder is a lifelong thing,” I disputed. BPD more treatable and a better prognosis than depression?! First time I’ve heard that ever. The good news though is that I was them moved to an open ward, where I am at the moment. He warned me that I’d still be under the Mental Health Act, and if I abscond I will be brought back to hospital by the police. Currently I’m on 1:1 specials.

Was given a copy of the form I’m on at the moment, Form 4 under the Mental Health Act which means I can be detained for up to 72 hrs from admission to be assessed. It expires tomorrow night.

So far I’ve managed to keep this from my family. Not sure how long I’ll manage to keep this up, what I’m hoping is they’ll meet have to find out. My boyfriend has been visiting. It’s the first time he’s been exposed to when I’ve actually been unwell. He’s been good, but sometimes it’s hard when he’s never been exposed to mental illness prior to this. He obviously knows I’m under the Mental Health Act and I’ve told him about the BPD and the recommended DBT. I can’t help wondering though, “Wouldn’t you rather be with someone a lot less complicated?”

Therapy is too hard

I attended the appointment yesterday with the psychiatrist and the clinical psychologist who is meant to be taking me on. Afterwards I spent some time sitting on the garden ledge with my sunglasses donned, crying.

Did I like the psychiatrist? Well it doesn’t really matter seeing as my medications remain unchanged and he’s told me to simply continue seeing my GP. Alrighty then, back to Dr L I go. Did I like the psychologist? I’m not entirely sure and that’s part of what upset me. The advantages of the public system are of course that it’s free, but it means you don’t get a choice as to who treats you. I’m afraid of being stuck with someone I dislike and whom I don’t feel I can work with.

I also felt as though I was being pushed into doing DBT and that is the only option I have if I want to receive treatment through A St. As you may recall I don’t have the fondest impressions of DBT. I also dislike that so many mental health professionals seem to think DBT will be the magic answer that cures all. Because I was intimidated though, I wasn’t able to voice the issues I have with it. So I reluctantly shrugged and okayed doing DBT even though I despise feeling like I’ve been pushed into doing something I really do not want to do.

Unsurprisingly, as is always the case with people I don’t know, I found it difficult to talk. They were lucky if they got more than a “Don’t know”, “I guess” or “Okay…” out of me. I don’t want to do this any more. I’m completely fed up with continually having to start all over again with someone new. It’s hard to start to open up and trust a person. By the time I start to do so, I’ll find that therapy with them ceases. Yet again. Plus, the clinical psychologist I am meant to be starting with is going away for a few weeks, so it has been suggested I see his replacement before starting with him. Considering how hard it is for me to open up, I see little point in doing so.

I had an appointment with D this afternoon. The majority of the session was spent in tears, noticing that he wears brown shoes with red socks and that the carpet in the room is chequered, alternating between a lighter and darker shade of blue. After lots of prompting on his part and shrugging on mine, he eventually established I was upset by the appointment yesterday. I told him it’s “too hard” and “I don’t want to do [therapy] any more.” Upon him saying he would see me again next Wednesday, I replied that I have fieldwork. Every Wednesday. “What about Monday?” he asked. “I have uni,” I told him. “What about a later time on Monday?” I again replied that I have uni. He asked until when? “June,” I replied. “Did you have fieldwork today?” I confirmed I indeed did. “Did you have to leave early to come here?” A little sheepishly I admitted I did not. He said he’d see me next Wednesday. I’ve never not turned up to an appointment because a) I don’t have the guts, b) it is rather rude and c) other people could have used that appointment slot. If I don’t turn up next week though, well, he did have prior warning…

D also suggested I may be upset due to the change of having to cease seeing him. I cannot emphasize enough how much I resented that statement coming from him. Even more so that a few more tears escaped when he said it. I am absolutely repulsed at needing and relying on someone, especially when the feeling is not reciprocal. I refuse to need anyone emotionally more than they need me. It puts me in a vulnerable position and gives the other person immense power. Can’t let that happen.

Upcoming Pdoc appt and Mentalism & Driving

It was surprising how many of the other patients when I was an inpatient didn’t actually have a regular psychiatrist. Many of them had their mental illness managed by their GP. Which has led me to believe psychiatrists, particularly those in the public system, are really for those with more severe mental illness like schizophrenia or bipolar disorder. If the statistics are correct, 1 in 5 of us have depression. In other words, it’s rather common. Too common to be seeing a specialist in the public mental health system for?

One of my fears when meeting with a new mental health professional is that they won’t take me seriously. Or they think I don’t really need to be seeing them as there are plenty of people sicker than me. I tend not to talk very much when confronted with mental health professionals. When it’s someone new who knows nothing about me, what if they take my reluctance to talk about my issues and struggles to mean that nothing’s wrong? Or assume that I’m deliberately being ‘shy and secretive’ as the first psychiatrist I saw accused me of being? Another barrier to talking is I can’t help thinking if I do describe in detail what I’m struggling with it will be assumed I’m exaggerating. That I’m deliberately talking up my symptoms to ‘prove’ I have depression and therefore deserve help.

Hopefully what may make tomorrow’s psychiatrist appointment a little easier is that D has been in contact with I, one of the clinical psychologists at A St, and told him a bit about me. While I’m not exactly keen on being discussed without knowing what’s been said about me, if it helps them understand a bit more about where I’m coming from I won’t object.

I’m meant to make an appointment to see my GP as well, but on top of a psychiatrist appointment on Tuesday and a psychologist appointment on Wednesday, a third appointment in a week seems rather excessive. I went to renew my Learner’s Permit in relation to driving and because I’m mental, the Department of Transport seems to be questioning whether I’m fit to drive. Being the honest person I am, I ticked Depression where it asked us to tick whether we have any of the medical conditions listed, and dutifully wrote down Pristiq and Seroquel where it asks for medications. I was then told because of that I have to have a medical, get my GP to fill in a form stating whether I’m fit to drive, and come back next time. Ugh, seriously? My ability to drive isn’t affected at all. And I’m smart enough to know not to drive after taking Seroquel because of the drowsiness it causes. Ever since I’ve been thinking I should have left those sections blank to save the hassle it’s causing.

Counterattacking schemas

I received a letter on Thursday from A St informing me I have an appointment with one of their psychiatrists on March 13. An appointment less than a month away? In the public system too? A-mayyyy-zing. Is this really the same service that left me on the DBT waitlist for over a year before removing my name without my knowledge? I’m not quite certain how it works though. Do I only get one appointment for a psych review and that’s it? Or do I get ongoing sessions with this psychiatrist?

You’d think it gets easier to say what you want and need to tell them after starting over so many times, but in fact I’ve become more reluctant to do so. It’s become tiresome having to retell the same story over and over again that I don’t know what to say any more.

In the meantime I’m still seeing D. Same problem. Not that I had much to say to start with. We, or rather he, has been talking about some of the schema stuff I had done when I was still seeing R in therapy. One of the schemas R and I had identified for me was subjugation. According to this sheet;

This schema refers to the belief that one must submit to the control of others in order to avoid negative consequences. Often these clients fear that, unless they submit, others will get angry or reject them. Clients who subjugate ignore their own desires and feelings. In childhood there was generally a very controlling parent.

According to the Reinventing Your Life book there are three ways you can cope with your lifetrap: surrender, escape or counterattack. These three terms are fancy names for what roughly equates to a freeze, flight or fight response respectively.

I guess at times I can be a bit resistant in therapy. I will sit there in silence or fail to do what the psychologist has asked me to do during the week. D has accused suggested I am in fact counterattacking the subjugation schema by not doing what he’s asked, whether it be practice relaxation or grounding exercises, record when I’ve self harmed or read certain handouts he’s provided me. How I’ve seen it though, my silence is indifference, not wanting to be there in therapy in the first place. I don’t do relaxation and breathing exercises because I find them lame. Not doing them is my passive aggressive way of saying so. Could D be right though? Is this my way of fighting the subjugation schema? I’m not quite sure. I’ve never looked at it like that before.