Being cancelled on

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.

Last psych appt

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. 

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.

Have you self harmed?

One of the things I dislike in therapy is when a psychologist asks how many times I’ve self harmed that week. Okay, I can kinda see how it’s relevant to gauge whether I’m still self harming or not. From their point of view, it means I’m still engaging in risky, self-destructive behaviours and therefore is an issue that still needs to be worked on. But at the same time, is it really that helpful to put so much focus into it? In my mind, it reinforces the belief that the only way to communicate how I’m feeling on the inside is to physically harm myself on the outside.

A topic that has come up in my appointments with D is rejection; how much  fear it, how much it upsets me, how much I try to avoid it. There is a fear within me that if I report I haven’t self harmed, the professionals will automatically assume everything’s okay. I am afraid of rejection and I am afraid that I will be told at one point or another that I don’t need to continue seeing them any more because I’m ‘cured’.

There’s been a few times D has asked me to record down when I’ve self harmed during the week for homework. I’ve never done what he’s asked. I don’t believe it will do me much good and may even trigger me more by making me think I have to self harm to prove I deserve help.