the dawning of a new pharmaceutical age

So, I turn up at the psychiatrists office and I blurt out my prepared blurb. Remember I am mentally ill, have no self esteem an find conflict traumatic. Planning is everything. "I don't want to take the quetiapine anymore". He says, "Ok then." To say it was an anti-climax is an understatement. I was expecting some resistance, a fight, and a sharing of words or opinions. He then says, "well what would you like to take?". I am temporarily stumped as all of this is totally unexpected - I have to hand the power back to him as I have no idea what to take. He's the shrink and I've been politely put back in my place.

The list is slightly boggling and everything seems to do something nasty to you.  Fat, anorexic, fits, jerks, nausea, skin problems, confusion, blackouts, disorientation. Sounds like alcoholism and food addiction to me but hey, I'm not a chemist. The up side (Yes there is one) is that my mood may actually stabilize, the hyper mania will stop and thoughts of hanging myself or dying in a hole with twigs in the woods may disappear. I'll pick one - Its worth a shot eh?

We choose Valporate semi-sodium, or what is commonly know as Depakote. Depakote can be injected into your backside, but they trust me to take it regularly so I get to take it as a tablet, thank goodness. It's actually an anti convulsant, not an anti psychotic. In lay mans terms, the different medications  work on different types of  places in my brain cells, altering the mixture of neuro-hormones to create happiness, wellness and lack of madness hopefully - so maybe it'll do something else more positive to my mood too. I imagine this microcosm of mini brain universes all banging around together in my head, squirting neuro-hormone guns at each other, then changing tactics to try and win the war.  At the present time we haven't found the correct WMD - weapon of  madness destruction!

So I'm off on another chemical journey - Its really hard to keep being hopeful when after 15 months of struggling to be well you're just not getting there. People often don't remember you're ill either, forget to ask you how you are, or assume that everything is ok because to manage to turn up and do things sometimes. Its like putting on your morning mask - if people can see the true face underlying it they'd be afraid to make eye contact. Its not contagious, but people fear mental illness still. Sometimes its easier just to shut up shop for a few hours to get through what ever it is you are doing. Going to bed sometimes is nice as you can pretend its like dying, just to give you a break from the doom and fatigue. But its great as you can actually wake up, and despairingly force yourself through yet another nightmare day. Remember, thinking about dying isn't about killing yourself necessarily. Its about being so damn fed up of fighting 24 hours a day to remain in the game that you want a day off.

So now I'm at the point where I have to risk all again to swap medication over. Its scary as I may come off this old one, start a new one and feel worse; or the same; or better. Or go completely mad.

Stand on the edge of the cliff and jump.....

Chemical chaos - should I ignore my shrink or ask someone else???

Something that is very difficult for me is knowing when NOT to listen to medical professionals and trust my instinct. I'm not a shrink, but I do know my own body and how legal chemicals affect it. However, I often defer to wiser counsel as I'm lacking in self esteem and believe on a deep level that everyone is cleverer and more grown up than me!

So here is the situation. I'm feeling slightly mental - not the whole hog psychotic or suicidal, but definitely on the dark side of dicey. I'm trying to decide if its a dip or a relapse beginning. I call a mental health professional, as my CPN is on a jolly with the older persons team. She told me she felt like a change of scenery. What a choice. Psychotic and delusional adults, or, spongy brained dementia clients. Anyway, the duty cpn isn't sure either as she doesn't know me very well. Neither of us is sure whether I should ride out the storm (hoping it'll pass and I'll Improve) or, not leaving it, come into the mental health team for a chat, and try to sort out what to do.

So I come in to the mental health ranch for a chat and my shrink increases my medication. Obviously I'm not happy. I increase it for 2 weeks; my mood lifts but physically I feel shite. Side effects fill as per normal make me feel like I am filling up with concrete, the appetite of the starved man returns and generally I am knocked about the head with cotton wool and fluff in my mouth. I go off to work leaving the front door of the house with the keys in it, leave the car door open in public spaces, forget what I'm doing whether mid sentence or mid task and just can't get it together. So I reduce it back down and feel mentally in the abyss. So I have to return and yet again he increases the meds (even higher than before) and tells me this is the recommended dose for bi-polar. Take 400mg at night and then 200mg when you get up in the morning. Quite frankly, I feel like giving up. I'm so medicated I can hardly function. I'm experiencing the same symptoms as I do when I'm hideously depressed (Over eating, sleeping, phasing out, lacking in motivation, shuffling around) but I'm not suicidal. I gain half a stone in 3 weeks and am totally demoralised.

I turn up at the gym for my near death experience on a bike session, and a personal trainer asks me if I have got a second opinion about the medication situation and have I challenged my psychiatrist? To be honest it had never occurred to me to challenge him.Later the same evening I sit in the bath and my husband sits on the toilet as we catch up on our day. He asks me exactly the same question, as HIS carer support network mention the benefit of getting a second opinion in their literature. It's definitely something I could consider. It's also glaringly obvious that lack of talking support from my cpn does affect my sense of well being as I feel slightly lost in my so called, "care program approach". Not so much care and absolutely no approach. I suppose the program bit is something I have to make up as I go along - a  program of confusion.

So I take the bull by the horn and make some calls. First to my psychiatrist to tell him I really can't take the quetiapine anymore and the second call to my ex-psychotherapist for some advice. She used to run the Lithium clinic years ago so I trust her opinion about medication. I am regaining control. It feels good.

Is it a dip or is it a relapse

Being a person of obviously fluctuating mood, I'm trying to learn when to panic and when to just ride out a stormy day or two. I've recently been told that if you've had 3 major depressive episodes, you are 90% at risk of having a relapse. Somber reading for those of us who are in that category. I could be one of the 10%. I could also have carrots growing out of my bum.

It's terrifying to even contemplate being so deeply ill again, so people in my position have to work really hard at relapse prevention and using coping strategies for if or when things do go wrong. It can feel like you're walking around with a loaded gun in your pocket most days, and sometimes the smallest thing can trigger a negative thought, which leads to a period of rumination, which in turn leads to your mood crashing. The triggers too, are those things that you are exposed to on a daily basis. Aggression, disappointment, money worries, family problems, illness, fear, stress. I could go on. But I won't. I think you get the picture. Every day can be a battleground of shifting sands.

The word resilience means to be able to bounce back into shape after bending or stretching or being compressed. When your mood is contaminated or pressed down by a negative thought, this is exactly what happens. Your mind can feel like it is suffering physical pressure or you are being dragged against your will to a very dark place. You try to force it back into a happy shape, but you can't do it by just trying to think yourself out of it. That doesn't work. This is why CBT has been so good for my daily mood management. I'm learning to allow the mood to bend my emotions, but not to snap the back of them, so I can return to a more manageable state. But its tiring work. I'm unceasingly working to stay on top of the quicksand, and it can be very demoralising.

Recently my mood dipped in spite of my guerrilla tactics. I could feel myself in free fall and the terror was fueled by the unknown depths to which I might plunge. The panic felt like straw in my throat and snakes in my belly. I tried to do a Mood trigger chain, to see where the slide began and yet again it linked to stress at work and tiredness. My fear was amplified as I'd been trying very hard to do all of the right things to stop a slide. And it didn't work. I called the Duty Community psychiatric nurse (mine is on a secondment to older persons) and gabbled down the phone trying not to cry. She soothed me somewhat, and as if by magic, she got me an appointment to see my psychiatrist. He actually called me at home first to talk things through, then called me in to his office anyway. He increased my medication although he said it was a temporary measure for a few weeks, and then we'd see how we were. I think in his view I was not as well as I could be, but I wasn't banging on the hospital door. He was the one who said, "Stop panicking". How easy for someone to spit out a platitude to soothe my chaotic soul.



And because most of this is going on in my head, noone is aware of crisis.

So where were we . Oh yes! Back at work

So I'm turning up at the office, a partial zombie, self conscious, slightly erratic and detached from the once familiar surroundings. But I'm there and trying very hard to readjust to being back in the workplace. There is nothing like a large dose of reality to help you measure your recovery and level of wellness.  Being well at home on the sofa is a mile away from being well amongst the chaos of office politics. Everything and everyone feels complicated and awkward.

The team I work in is like a jigsaw puzzle. Roles and behaviours are embedded and even when we all pretend to change our behaviour or try something new, we all end up reverting to type. I'm trying to find my place again, and have the fear of relapse or not being able to get back to working the hours I used to. I'm also feeling the perceived  and probably erroneous pressure from a range of personalities, but mostly from myself. So many people say that work is just a means to an end, a place to go to change activity tokens into shoe tokens, but on deeper scrutiny, people get to be the person they aren't at home. They can be flirty or sarcastic, they can moan or feel powerful; it also gives people a sense on belonging and a place in the universe. I often wonder if we were all told that work no longer existed, what we would all do. Die of boredom and feel completely lost most likely.

And I am as inconsistent and the as the wind. My mood swings erratically throughout the day, and I am easily contaminated by negativity. The energy and noise are so immense that I have to keep ducking out of the office just to catch my breathe. There is an endless clamouring that seeps into me and I feel burdened by it. When its time to go home I breathe easy again and rinse out the flotsam and jetsam of the day. I'm hoping I can readjust and that every day that I go in, like exposure therapy, I'll finally not even register the excess mood baggage flying around.

And there is always one person that is your nemesis. A person that pushes your buttons, triggers your shame, infects your positivity, and consciously or not, makes your life a misery. These people are normally thick skinned and with guile, gently stomp all over your cotton soft soul, and muddy your waters. Oh yes, and they tell you its not them, but its you. You are at fault, emotional cripple. I'm just doing it the best way so get in line or disappear. Toughen up jello pants you're a loser. These people can masquerade as friendly, funny and helpful - remember the popular club at school. I try and see them in a more honest light. Is parading with grandiosity a reaction to low self esteem; is the criticism really aimed at me or their own insecurity. Analysing the arse out of it gets you nowhere though, so I have to learn to ignore it or challenge it. But I hate conflict, especially when I'm mentally fragile, so I have to bide my time and stay in hibernation until I can summon the courage to wither the dark beast with the light of truth.

Oh yes and I'm meant to be doing some work too. How the hell am I going to do that in amongst the circus of bedlam?

Living with side effects

When you first envisage taking medication, you tend make an assumption that you'll feel better. Intellectually I know there are medications that obviously make you poorly in the journey to wellness, like cancer drugs, Hepatitis C medication, strong anti-biotics. So I'm unsure as to why I naively believed that mental health drugs wouldn't be as bad. They used to tell me that medication is only a small part of recovery - what they didn't tell me is that as well as fighting the madness, I'd also have to spend an enormous amount of time managing the side effects of the drugs they've given me.

My anti depressant isn't too bad, but it still makes things happen that shouldn't,  like feeling like you want to wee but can't. But my anti-psychotic is a whole different animal. Although its not officially a sedative, I do feel like I've been hit over the head with a badger as I may have mentioned before. A lovely lady in the mental health fat club, told me to take it 12 hours before I wanted to get up, otherwise I'd be gurning and gouching like a smack head for the fist 5 hours of the day. And she was right. Let me talk you through my day of side effects.

I wake up, usually because someone is yelling in my ear (Kids) or pulling the quilt off me to try and arouse me from the cloying and deep darkness in which I am pulled down like quicksand. As I mill about the house trying to kick start my mind, I feel my head bobbing like a nodding dog, and my eyes sinking back into my head and closing of their own accord. Caffeine. I need caffeine.Lots and lots of caffeine.  Strong pot of filter coffee on, HUGE bowl of cereal ready to shove in my face. I am permanently ravenous. The feeling of griping in your tummy when you've not eaten for ages - that is how my tummy is the whole time. It doesn't matter how much I eat, its never enough. I'll come back to this. I also mustn't sit down or I will go back to sleep whilst the children happily destroy the house. Its happend to me on a Sunday morning. I've been watching the news and obviously fallen back to sleep. I've been startled back into the land of the living by a shriek and screaming as my 2 naked sons slip and crash to the floor in the tiled kitchen, because they've poured 2 whole bottles of hand soap across the entire space in an attempt to "Clean it".  So, I open windows, walk about, stand outside and try to force my body and mind into action.

My mind, once electric and accelerated beyond the norm, now plods from one thought to the next in snail mode. Most mornings I forget something that I am supposed to do. Forget to take dinner money to school; forget to take sunhat; forget to fill in form for trip; forget glasses; I've had to learn how to be less reliable than I used to be because now, its impossible to do it all and do it right, and do it on time. Ask anyone close to me about the anal time keeper I am - Not anymore. Being late has started to re-enter my life, and I hate it as I'm OCD, and in not doing it right, and not being on time, anxiety and intrusive thinking are triggered and that takes a whole set of other skills to manage.

Meetings at work are hard too. Concentration is particularly difficult as I tend to "Zone out" and then return from the misty annals of the plastic mind, slightly befuddled and hoping people haven't noticed. I'm unsure as to whether or not I actually look vacant or just feel vacant. Sitting still brings it's own issues as now I have a distinct twitch. Its usually my hands, and I may be gesticulating to push home and important point in a discussion, and my leopard print Biro flies across the room, now a missile in my hands. More recently, bright orange nail polish has flown across the carpet, Jackson Pollack-esque style and won't come out! I feel it in my legs at bed time too when I am drifting off, and as well as the little flick of the foot, I seem to let out a weird, "ooh" noise as it happens. I'm terrified I'm only one spasm away from the tongue flicking, shuffling, loonalike person of the late Victorian asylums!!

Managing the daily, never ending hunger is an all consuming nightmare (Excuse the pun). I try to battle the muffin top with exercise, portion control and healthy eating and when I say battle, I spend half the time thinking about food, a quarter of the time looking at food and trying not to eat it, and the final quarter eating it and feeling bad as I know I'm more than likely eating too much. Its completely demoralising. I could play a mantra in my head that reads something along the lines of, "Beauty comes from within, I am a woman of intelligence and substance - I accept myself  exactly as I am." Yeah right - vanity is an insidious creature that constantly tells you are aren't working hard enough, looking thin enough, and if you carry on the way you are you will look like "The Rolly Pollys". And once the food goes in, it won't come out without assistance. I have a dry mouth the whole time too and I worry that I'll get that weird white deposit around the corners of my mouth the people get when they've been talking for too long without a drink. I still have weird dreams too, usually along the line of being abandoned or being in a relationship with Noel Gallagher. Quite frankly I don't know which is worst.

But is it all worth it. Do I actually feel better or not?  Can I live with the symptoms that need micro management on a daily basis? To be honest, I'm really not sure. I've accidentally missed taking my tablets before, and I had withdrawal like a Junkie - I was like the bloke from trainspotting grabbing his twisting gut, sweating and groaning. Apparently it'd be a week like that if I just stopped taking it. But do I feel "Happy" and less manic? The answer to that is most of the time. The problem I've had over the last 6 months is my illness keeps pushing through the medication. The Milligram amounts keep creeping up to reign in the cycling mood and we're getting to a point where the levels are probably too high, and I'd end up being a zombie.  I'm having a review with my psychiatrist soon to, "Talk about my options." Don't think about "One flew over the cuckoos nest".

What I keep having to weigh up it the balance of wellness with side effects. I have to try and maintain some kind of normality, but I'm doing so many things I feel like I haven't got the time or the energy to do more, or take different medication, or come off this one and try that one. In amongst all of this I'm also trying to be a parent, a wife, a sister, a work colleague, a decent human being. Its really hard work and although I'm hugely better than I was, I wonder if this is as good as its going to get, because if it is, I'm still not sure if it's good enough.And if its not, what is there left. I expect  I'll have to try and figure that one out.  And it not going away. Not ever.

The secret life of the Muffin top

As my owner trudged along the path of slight madness, I worked hard at storing up her comfort food. I gave her sugar cravings and made her pop sweeties in her mouth when she was sad or bad. After some time, I became a soft, pastry dough type ring around her tummy. I was able to bounce and fold, I could pop above her trousers and give the world a peek of my magnificence. I became, "The Muffin Top."

I could bounce and sway, depending on her activity. The bike was fun as I could use her thighs like a ping pong bat, and jiggle to my hearts content. I tried to stop her reaching her toe nails to make them pretty. I made her enjoy adult fun in the dark. I masqueraded as a pregnancy, and I laughed when people asked if she was in the family way. I was soft and creamy, and she could balance her cup or plate on me whilst sitting on the sofa. I felt important, and hoped to keep growing. I could cast a shadow of my own, I was immense and dominating. All clothing had to give me priority as I grew and grew. I loved the new me.

She tried to keep me under control. She hid me under black, loose clothing to disguise me, and sometimes forced me into tight, Lycra pants to try and stop my hideous bulging. I kept telling her that a size 16 was average. I kept showing her other, larger muffin tops to try and encourage her to keep feeding me. I was in control.

But then, a healthy witch cast a spell. She introduced a new mantra for her life and repeated:

I will eat and I will claim,
that healthy eating is my aim,
The muffin top shall be no more,
I shall banish it out of my door,
No more wobbles, no more fat,
No cup or plate where I am sat,
My shadow will be long and thin,
Unhealthy foods go in the bin,
Goodbye to muffin the chocolate slut,
The door of fatness will now be shut.

I began to shrink, and felt myself losing my grip. She dissolved me with her activity and fruit. Instead of bouncing, I mildly jiggled and was pulled inward by abdominal muscles, my greatest enemy. Trousers began to laugh at me as they had room to play, and I was disappearing. My once unfit, overeating friend had turned on me, and I was soon to be no more. I was withering, fading , melting out of existence.

RIP muffin top

Exercise - the evil of the cross trainer

When you are so depressed that even breathing is an effort, the thought of actually going to the gym is abhorrent and ridiculous all at the same time. Why would a fat and verging on suicidal woman, want to go and run on a machine like a hamster? In front of people? In a silly outfit of Lycra from the 1980's? I know - it sounds like a bad idea, BUT, endorphins make you happy. Happy people don't want to kill themselves. That's the theory.

Part of my return to mental health is the whole "Healthy living" thing, so after a chat with my cpn I finally go to the gym to sign up for "GP referral" - exercise on the cheap, with anonymity thrown in if you want. No one needs to know why you are there. It doesn't involve going up to the front desk and saying, "Is there a special scheme for the fat mad people", but does involve being weighed (OMG), having my blood pressure taken and being shown around by a very muscular, thin, super fit women in her 50's. I bet I could bounce ping pong balls off her abbs.

Sadly she actually introduces me to some other gp referrals who are absolutely ancient, heart patients and stroke survivors. I immediately do not fit in and promise that I will not be going for coffee with them affter my session of torture. They are lovely but I'm afraid if I break the news to them that I am mentally ill in quite a serious way, they might keel over with the shock or something.

So I am led around the machines - its a masochists version of Alton Towers, and masquerades as "fun" and "good for you." I try my first effort on the cross trainer. Its the weirdest sensation and completely throws off my sense of balance - and yes I do look ridiculous. After 3 minutes I'm heaving for breath and my legs are burning and wobbly. I am the epitome of the unfit. Lord only knows how I'm going to try anything else. We do bike, treadmill, rower, arm presses and some weird leg weights thing. At the end I'm so exhausted I might not make it to the car. My legs are so unstable I might not be able to depress the pedals or focus. My face is as red as a radish and I hurt in places I never knew existed.

But hold the phone. I also have a mild feeling of exhilaration. And its not of the psychotic tendency either. ooh. Maybe this is what people get addicted to, the mild euphoria and lightness of step. I like it. Sadly it doesn't last long and the following day I think I have rigor mortise. I have to roll out of bed as i can't lift my legs up properly and shuffling is the best I can do. It takes about 3 days to pass, but, with leggings and water bottle in hand, I trudge back to the air conditioned yet sweaty room, and commit to a program of wellness. I decide that I should try it at least 3 times, not because I want to, but because CBT tells you too. And I want to be well, and I do as I'm told.

Bring on the butt cheeks of Iron. Mad woman's in the house.

Stepping back into normal living

Reintegration is a finely tuned event that requires planning, bravery and a desire to be as normal as possible. I find people hostile, dishonest or scary at best of times, so having a massive chunk of time off work and then going back into "The lions den" creates apprehension in copious amounts. Just before my return I yet again have to visit occupational health (more like occupational hazard) and discuss my recovery.

The doctor reminds me of a small, hunched over mouse. I cannot recall if I've told you about this man yet or not, but he covers his computer mouse with a tissue, and places his briefcase between us on the desk so he has to peer over it. I think he has a phobia about germs and people, to the extent that he has to have a physical barrier to protect him from the great unwashed. He's odd to say the least and always looks like he's ended up in this crappy job by accident. I'm sure he had high hopes for a career in Harley Street, but he's ended up being a second rate note taker at a local council. He sighs a lot and oozes disappointment throughout our discussion.

Half way through our chat I have to remind him that I'm not actually back at work as he hasn't realised.He flails a bit and gets all tetchy and then finds his thread again. The service really is ridiculous.

Anyway, in February I try my second phased return to work, following my bi-polar mental health sabbatical. My desk is dusty, my orchid is dead and there are stray papers, food crumbs and a large amounts of other peoples stuff scattered all over my workstation. I have no stationery and I feel utterly despondent. I think my work station has become the communal bin. When I try to turn my computer on its so slow I might have to come back the following day to give it time to boot up. I feel a bit giddy too and its very bright, very noisy and disconcertingly normal.

Everyone seems to be an over sized caricature of themselves and I can sense the energy floating about. Its a bit surreal after being cosseted in the safety of my living room for so long. I jump at everything, drop things and feel disorientated. I do what comes naturally, which is clean my desk and drink lots of coffee. Smiling makes my face hurt and by lunchtime I'm am more than exhausted and go home. Its going to take a while to get back in the swing of it. My colleagues are actually lovely and want me to be well. No one wants a psycho team mate, so they treat me gently at first whilst they judge whether or not I might have a total breakdown at any moment. I think everyone's a bit nervous.   Bless them all. The genuinely don't quite know what to say, so I tend to make it more comfortable for them by making quips about being bonkers and laughing about my OCD. It gives people permission to relax a bit and takes the fear away from putting your foot in it. I should make up light bulb jokes. How many Bi-polar depressed people does it take to change a light bulb? 1, but they have to keep going and down...Ha ha!Or Violets are blue, and roses are red, mania's a nightmare so I'll kill myself instead! Its not the best topic for humour and poetry now eh! But seriously I really have to make it less uncomfortable for everyone. Its not an easy topic to broach, and some people are intensely private about it. I'd rather be honest and open about it. Mental illness isn't something to be afraid of. Its not contagious and most of us are actually ok.

So I'll try to get back to work, and build up to the hours I did before. I'll try to be ok and do what is asked of me. I'll try not to freak out if things start to go wrong. Yeah right!

Fall out

From any situation that involves a degree of chaos, there is going to be some fall out. This can be practical, emotional or financial, and the problem is, it can cause stress and anxiety, which in turn, can trigger episodes of depression or mania or both. Its like weathering a very bad storm. You're overwhelmed with gladness that the storm has finished and you have survived, but you now need to do a massive tidying up operation, and learn to live in the place you have had to rebuild. Its fraught with broken glass and the odd sticking up nail, and although it looks like your house, it'll never be the same as it was. You can rebuild or move.

Its a difficult time. Trite phrases tend to be flung about in a casual manner. Life is what you make it. You're not the person you used to be. You're how much in debt? These issues are not the sole ownership of mentally ill people, but those commonal garden problems that "Normal" folk have can seem magnified and slightly more severe. There is also the risk that the now fragile recovering slightly less mad person, could tip over the edge at any point, so people tend to be overly polite, anxious and suspicious of any behaviour even slightly away from the norm. The accentuated, "How are you?" question happens a lot, and heaven forbid if there is a "Pregnant pause" after the initial questioning - fear and paranoia jump into the quiet place, and wild projections of a new phase of madness dance around the imagination.

Its funny as I don't want to be pitied or treated with kid gloves - I need to be understood, listened too and supported. Fear mongering makes me resentful and irritable. Its bad enough that I worry about a relapse, let along carrying everyone else's concern. It takes time for the community you live in to relax and return to the patterns of every day living.

Its easy to be self centred about what has happened, and behave as though noone else was involved or effected. Even if I have managed my condition with drugs, CBT, psychiatric and psychotherapy input, there will always be other people experiencing me and my behaviours.They will worry, they will challenge you, they do care. Sadly being completely unaffected is unavoidable. I wish sometimes that I could have done the whole thing by myself on a long mentally ill sabbatical of some sort, then return to the fold, well and equipped for the future.

So we are on the road to recovery, and things are almost slotting in to place. I wonder what else might happen, now that the chemical balance is better. Will I be able to settle for normal? I suppose I'm about to find out.

Character rebuilding

My level of serenity is directly proportional to the amount of acceptance I have in my life, apparently. It is so terribly easy to say, "I accept  it", but the process involved in this is a really long one. It takes mental, emotional, physical and spiritual practice to lever yourself in to the place where everything feels ok. Its a fine balancing act, and I have this internal seesaw that I have to add to, or take away things from, depending on how my mood is.

For example, work. Should I do a little bit, do loads of it, or do nothing at all. The implications of any of these decisions has fall out. Skint and mentally balanced but bored, or full of anxiety and stress, but having money and a career, or trying to find somewhere in the middle. I also have to balance up the practicalities and cost of childcare and try and fit in a relationship with my husband, parenting, healthy living and rest and relaxation. It's quite a big ask. Its when I see it in black and white like this, that I realise why my CPN asked me to consider giving up work until I was stable and well for a long period of time, before going back to the ring, leading with the chin!

Somebody once used the term, "Internal landscape" and I may have referred to it before, but this is what I am coming to terms with. I am no longer the sprightly, gamboling youth I once was. I'm a slightly older, slightly more mental woman of substance and I really need to adjust. But lets talk about  my character, and how that plays a part in all of this. Character traits either undermine my progress, or aid me in my new persona.

Pride and ego are my major downfall. I have an idea in my head of what I want to be, as a career woman, a, lover, parent. And when you move away from this projected image, it digs at my pride and sense of self. People want to believe they are infallible, or able to do whatever they choose, and I am one of them. Women in the 21st century feel that they can have it all. The media push this image of the alpha female doing everything, having everything and having no consequences. Its a life of heaven on earth. But in reality, for me, that is all very far from the truth. I cannot have it all, and there are always consequences to everything that I do.

In my mental health recovery I am in the process of ego deflation and a crash course in humility. I need to be more modest about myself, than an inflated image of "Have it all." And then I have to deal with envy, when I desire what other people have, and I wistfully reminisce about the way that I was and what I have lost. I have to constantly remind myself that life is not always greener on the other side. And I mustn't bow down to jealousy as I will become bitter and resentful of all of those other people who supposedly have a better life than me.

I also have a stubborn streak a mile wide, and without that, I would have never as got as far as I have in my rebirth into the mentally well person I am today (Well, slightly more mentally well anyway). Stubbornness is a double edged sword for me though,  in that I can dig my heels in and be truly bloody minded just for the sake of it or to be obstructive when I am angry.

I'm never quite sure how many people do this character inventory on a regular basis, but I am learning that others do not do the same things as me, whether mentally ill or not.  I practice being honest about myself in all situations in my life, and a lot of people view you as some kind of idiot for making yourself so vulnerable in a hostile world. Others see it as a gift, so they can use your "weakness" for their personal gain. And still others see it as a virtue, but in no way, shape or form would they ever consider following that path themselves. Its a lonely old path at times, and I can feel very isolated in company.

I wonder some times if it is all worth the hassle.

TRying to maintain balance is a full time job

Most people (I assume) roll out of bed in the morning, wash, dress, eat and go to work. Plod through the day, chat and do whatever is necessary, come home, eat, sleep and its all over. Not wishing to totally simplify the life of others, but I can be hugely resentful with the ease in which non-mentally ill people function. This may be a fallacy or folly, but I do actually know people for whom very little happens in the way of stress or trauma. This is what I aspire to be - the benchmark of serene mundanity. Stress for these people doesn't mean they might end up in the mental health unit. They are not boring, but just regular.

And for me this is so terribly difficult. I have to put so many things in place to maintain normality, that it feels as if  I'm doing a full time job just to reach the level most people function at with no effort at all. Sometimes I just want a rest. Or give up. Or scream at the top of my voice in the street in rage. These are the days when my cross to bear feels unfair.

What really bugs me is when people choose to disregard the severity of your illness, or dismiss how difficult it is to do the very simple things, when you try to have a transparent and honest conversation with them. I know the mass of the general populous cannot be empathetic or educated, but I hope that some of the people I work closely with, or know me quite well, would maybe give me that courtesy. I had a conversation with someone today, and without trying to be a victim or wanting special case status, I tried to explain why I was struggling. The response was one of exasperation and annoyance more than anything. All I wanted was  understanding about my humaness, but it seems that was a little too much to expect. It must get on people nerves when you can't deliver things to their expectations, or, you have a different way of doing things. I realised today that some people speak with the golden tongue of disability equality, but when push comes to shove, these people can't be arsed.

Today I felt like giving up.

I really sat and thought about the psychotherapy concept of "Mood contamination" and this does happen to me when people refuse to accept my limitations. I just become demoralised and angry. I either have to have a hide made of steel and be an ignorant git, grin and bear it, or, remove myself from the jousting arena and retire to the florist shop. Maybe I'm just really difficult to get on with and expect too much from others. But maybe the person I spoke to was a ........

Madness, self esteem and chocolate

Within a few weeks of taking my anti-psychotic medication, I begin to eat like an Olympic body builder. The ravenous never ending hunger I talked about - well it is a monster! I find myself quite regularly, buying family packs of Wispa bars, and pretending to myself that I'll eat one now and save the rest for later. Yeah right. Alcoholics try this behaviour with booze. I'll have a little bit now, then tomorrow I'll finish off the bottle. An hour later, they're back down the "offie" pretending they dropped the bottle on the concrete and need a new one.

Its not just chocolate either. I keep having 2 breakfasts - one when I get up, and then another one about 9am. Then I'm eating a huge lunch, snacking in between and feeling guilty as I know its going to land on my midriff and expose me. My body doesn't lie. But whilst I'm still depressed eating is the only thing I seem to enjoy. The trouble is, becoming Mrs Tiggiewinkle doesn't do much for my self esteem. Its a rotten cycle to be in - eating because you are depressed and hungry because of the medication -  then getting fat and feeling rubbish so you eat for comfort. And on it goes.

So when I was told about the healthy living group, I assumed it would be a bit like the CBT group, a large group of people and someone helping us with new techniques. When I arrive there are only 5 of us around a very small table, 2 mental health workers and a set of scales. Thankfully I am the slim Jim of the group - I know that sounds awful, but its a ray of hope for me as I feel that I am actually enormous. We all have to take our shoes off and stand on the scales. I want to cry as I experience yet another rock bottom. No-one really speaks and no-one discloses their illness. There is shame even amongst fellow sufferers. One person has been on the course before and is back for more inspiration. Lord knows how big he was before poor love.

After the weigh in we talk about food groups and portion sizes. I know its all common sense, but to own in within a group stops the denial and engages you with a desire to look after yourself a bit better. Staving off depression comes in many forms and diet is a great place to start. Resentfully I take a food diary sheet to fill in during the week. What this does is stops me eating crap and brings me up short. I really need to get to grips with it and nurture my body as well as my mind. We're going to be doing this for 6 weeks and then we'll see how we've all got on. The facilitator states very clearly that "This is not a diet group." We don't stop eating and starve, but we eat more intelligently, and learn what foods will give us energy, vitamins and won't damage our bodies. Apparently, it turns out, I've been eating about twice the sensible amount of calories every day. No wonder I'm chubby mummy.

I've met other depression sufferers and they can't eat at all when they are ill. They cannot swallow and everything tastes like cardboard. This is just as damaging for the body and mind. I wonder if there is a group for these people too?

On top of the healthy living group, I've been signed up to do exercise on GP referral. It means I pay a lot less but still run around like a mouse on a wheel, amongst svelte and tanned lovelies. In this environment I am the walrus. A lovely lady inducts me in to the hall of pain, and I hate the fact that after 3 minutes on a cross trainer, I think I'm going to throw up and my legs have gone wobbly. I'm glad that I didn't have to go to the gym on my own steam and sign up. I don't want to have the whole discussion of do you cater for mentally ill fat people? I get my own little program to do, and its suggested I go 2 or 3 times per week. This is really going to take huge effort. I detest the gym. I feel awkward, self conscious, old and fat. If my self esteem was low before, its now under the floor by ten feet. I'm surrounded by huffing weight lifters, and stick thin women sweating profusely. I am so far out of my comfort zone its not funny. This is where I realise that I am willing to go to any lengths to get well. I am doing so many things that go against the grain, I must want to recover.

I tell you this, if I do all of this and still feel rubbish, I may have to reassess my life in a totally different way. And Lord only knows what that might involve.

The compulsive eating zombie

Anti-psychotic medication is "Heavy duty" medication, my psychotherapist tells me. Lately I feel like she looks at me with a degree of pity, and treats me very gently. In therapy terms, she tries not to treat the illness specifically, but treat the person and their symptoms, and avoid labels. She bangs on about drinking water all the time so "I can flush it all out of my system". I must admit, I feel like a sloth has inhabited my body and I zone out on a regular basis. I'm used to being all high speed, sharp thought and energy, but now I am struggling to get motivated and I cannot hold on to many thoughts at the same time. I find myself standing around quite a bit, not knowing what exactly I was doing, or where I am going.

Something else is happening too. I wake up and feel like I haven't eaten for a week. I am absolutely ravenous and instead of slowly warming up with a coffee and the news, I am head stuck in cupboard, pouring myself a sink full of crunchy nut cornflakes and ramming them in at a speed of knots. Then I'm still hungry and so it goes throughout the day. I was warned about this, so I make a promise to myself that when the mania, depression and side effects ease, I will then look at my diet and health regime. Being borderline suicidal and not eating anything that tastes nice is like punishment. I don't have the joy of alcohol, drugs, inappropriate sexual relationships and other mood changing bad habits. Food is all I have left and I am now nurturing a very unhealthy relationship with it, and be damned....

I slowly turn in to a very large shadow of my former self. Everything gets a bit tighter, I feel a slight sway as I begin to waddle (this may well be my imagination I hasten to add), and when I see myself in the mirror I look like my great grandmother. Lovely though she was, chubby is more accurate a description. Its not pretty. Intellectually I know I'm not up for a morbidly obese award, or a gastric band - I see other women who are most definitely larger than me, but in my head I am the most enormous person alive. If I keep going I am going to be wearing leggings and large sweatshirts and have cankles!

My cpn tells me that although the medication is slowing down my metabolism and increasing my appetite, its me who is putting the food in my body. I agree with her in a very resentful manner. She may as well have said its all your own fault you fat bitch. My husband also puts a very loving boot in when he reminds me of how nice and confident I am when I am smaller. He was practising the whole, "Lets be honest and open" thing, but I'd rather he was less honest about my appearance quite frankly. It was a day when he knew as soon as it had come out of his mouth, it was the wrong thing to say. Poor old men. They are always caught between a rock and a hard place.  So CPN and I discuss my weight and my options. She tells me that the side effects will ease, and I will "Level out" at some point. Its at this point I can join the "Healthy living group."

Introducing mental health fat club. A club for the insanely fat!

Lets talk about anti-psychotic medication

I prefer to call them mood stabalisers as people are less afraid of you then. They are not sedatives, but reduce the level of Dopamine in your brain, which apparently, slows you down. It was a horrid rock versus hard place choice when I was told that this type of medication was now to be my best friend. The up side, they tell me, is that I will no longer be off with the fairies, the rushy thinking and confusion will cease and I will, once again, be sane. The down side is that I'll have side effects. As I've said before, these include weight gain, dry mouth, involuntary twitches, sluggishness. I'm going to be a fat, shuddering, half asleep , slightly less mental, shadow of my former self. I am deeply resentful of my new illness and have a bit of a strop.

A wise person once told me accepting it doesn't mean you have to like it. And I don't like it. I remember a few years ago, being so anti medication that I used to use self will and defiance to get through depressive episodes. When it started to get worse, I actually accepted anti-depressants but had to take them with a friend sitting with me, as I was so terrified of what it might do to me. And now here I am  approximately 7 years later, loading up with all kinds of voodoo magic, dizzy pills and the like, and I don't really have a choice. Well, that isn't the absolute truth, but if I refused medication, I may well have ended up somewhere far, far away in body and mind.

So I take my prescription to the local pharmacist, and as I hand it to him, he looks a little uncomfortable and states that, "We don't keep this medication, but I can order it in for you for delivery tomorrow?" Now I feel really mentally ill and in need of special medication. A lovely lady arrives at the house the next morning,  and hands me over the little white bag , and I read the horrible leaflet inside and dread having to take it. This is a rock bottom. I wish I were someone else, not mentally ill, and not about to take scary tablets.

Everyone is in bed, and I sit with the magic tablets in my hand. Its very "Alice in wonderland" and I do feel that I'm about to travel down the rabbit hole. So I pop them in and wait. 30 minutes in and I feel woozy and most disconcerting of all is that my right arm suddenly starts jumping up and down on its own. I'm a partial marionette. Its springing about uncontrollably and I look like a deranged break dancer.  I'm also feeling sluggish and droopy eyed, but I cannot sleep as the alien arm is dancing to its own tune. I actually end up laying on it to stop it moving whilst trying to keep my eyes open and watch a DVD. It's all a bit zombie town.

Finally I'm so zonked I pass out.

When I wake up in the morning, I feel like I've been hit over the head with a badger, and someone has poured sand down my throat. It takes several extremely strong coffees to bring me back to normality and I cannot think straight for love nor money. I have a good chat with my CPN the following week, and apparently, I am now thinking at the speed of normal people. I have one thought at a time, or no thoughts at all. Also, I have the dawning realisation that I am sleeping all night long with no hideous nightmares. After 4 years of disturbed sleep, I can finally sleep like a baby.

Over the 6 week suicidal period and slow introduction to scarily heavy duty medication, I do actually start to feel better. What I have also started to come to terms with is the fact that I am no longer the girl I was, and my internal landscape has had a mental horticultural overhaul. What was once overgrown, slightly chaotic and and rather magical, is now a lawn, some daffodils and a patio. Without wanting to sound dramatic or masochistic, I miss the old garden. When you spend a large amount of time in a maelstrom, you understand it and the devastation that can come with it. Its a roller coaster ride - frightening but exhilarating at the same time.

Welcome to life in the slowly spinning tea cups.

Feeling suicidal and being suicidal are 2 very different things

"A great many people think about suicide, but the majority do not go on to kill themselves. Like them, you can help yourself and you can get help from other people. There is no feeling so terrible that it cannot be changed. There is no difficulty that is insurmountable." (WWW.Mind.org.UK)

It's easy enough reading that statement, but when you are right in the middle of it, it really isn't as clear cut. For me, I have a readily available mind list of reasons not to die tonight. I also have a suitcase of CBT techniques, a raft of friends and family, and a stubborn streak a mile long. Mostly my focus  is my children and my loved ones. I follow the rule of, "If I can endure this for the next 12 hours, I can get through it until tomorrow, and tomorrow may be a different day." Even with all of these safety skills, it hard work.

The desire to terminate your life isn't a fluffy and whimsical dreamy thought that passes through your mind. It's a leaden and violent intrusion, that crashes in to your entire being and suffocates you. You cannot get away from it and it taunts you. I remember when I was first in psychiatric services, my husband requested that I don't kill myself as he couldn't bear the thought of finding me dead on the sofa, and then having to explain it to the children. I can see why he felt that way. I wouldn't want to explain a dead wife to 2 children under 5 either. But a suicidal thought sits piggy back on your head, and it natters incessantly about doom and that dying is really the best thing to. It'll put you and everyone else out of their misery. 

I am terribly aware that suicide is a very dark and rather taboo subject. So instead of random fear, lets do some statistics to ease you in.

"Although the overall rate of death by suicide is falling, more than 4,300 people still die by suicide in England and Wales each year.[...] In the case of depression, studies have shown that, on average, the risk of suicide is about 15 times higher than the average for the general population. [25] However, this is likely to be an underestimate, as many who die by suicide may have been experiencing undiagnosed depressive illness. The Mental Health Foundation estimates that 70 per cent of recorded suicides are by people experiencing depression, [26] often undiagnosed. [...] Depression is often accompanied by thoughts of suicide; indeed suicidal ideation is an important element in the diagnosis of depression. The deeper the depression, the more likely a person is to experience suicidal ideation. However, suicidal acts become more likely when a person is coming out of a depressive episode and energy levels and motivation become stronger" (WWW.mind.org.UK)

This all sounds a little contradictory - I'm too depressed to kill myself, but when I feel better I'll do it. To be honest, you can never truly know the mind of the person who is feeling suicidal, and a very small thing could push a person over the edge. The other thing I have learnt is that if someone really and totally wants to end their life, there is very little you can do. This is a tough one, particularity if it's someone you love and treasure. But what I do want you to focus on here, is that suicidal thinking is not necessarily suicidal doing. You don't have to panic.  It takes strength, courage and absolute conviction to end your life. And it takes a while to go that far down that particular route. Thankfully, for those of us with a CPN and family support, you can talk through your thoughts and know that if you cannot handle it alone, they can get you help.And if necessary, very quickly. I my experience, to spend 6 weeks, trying your best to not buy into the thoughts in your head  about dying, takes incredible effort. It takes patience, trust in the process of recovery, and a belief that eventually, your life will be worth living again and the thoughts will go away. For those people who have no support, either family or health, their chances are probably less than average.

What really annoys me is when you're on the tube in London, and the announcement comes over the tannoy about "A fatality" or "An obstruction on the line." You hear a lot of sighing, and phrases such as, "Oh how selfish", or "Why couldn't they do it somewhere less inconvenient." Nobody wants to see behind the inconvenience; the son or daughter, the mother....what tragedy and despair pushed them to deciding that death is the only option. I pray that you be a little less unloving and rash next time you here the ping-pong tannoy spring into life.

So here is my 6 weeks of hell in a few short bullet points - its easier to bear that way:

1) First 2 weeks, loud speaker volume on channel death, 16 hours a day whilst awake, but thankfully, off whilst asleep. Do the very basic stuff that I have to do and sit still and wait for it to pass. Rule for living - Do NOT act on thoughts.
2) Mid-phase week 3 and 4: Mid level noise pollution from channel death, with a few special intrusive thoughts from "hang yourself weekly" magazine. Functioning better, but still waiting for the madness to pass.Rule for living - sleep a lot, eat, rest and keep it simple. Do NOT act on thoughts.
3) Entering the calm phase - week 5 and 6: Someone has found the remote control and the noise is barely audible. Every now and then a few noises pop in but they are drowned out by reality and the mundanity of the normal, and slightly more sane, life. Rule for living - Remember There is no feeling so terrible that it cannot be changed.That there is no difficulty that is insurmountable. The insanity will pass. Get on with the business of living.

...and relax. 

Finally - a diagnosis of bi-polar

On reflection, my mood has never been truly stable, and in periods of hyper mania, I've either got on peoples nerves, exhausted them with my energy,  or left them feeling baffled and confused. I can clearly remember being told to slow down, and actually not being able to. So where were we? Oh yes, going to the psychiatrist.

So, I book a taxi to take me to my psychiatric appointment as I'm not allowed to drive after my operation, and request that he wait for me to take me home after. On arrival I sit in the waiting area, and scanning around the room, realise I've been booked in on what looks like geriatric mental health afternoon. I must be the youngest by about 40 years, and wonder if this is where I will be in the future. Everyone one looks disorientated and vague - maybe this is actually a good frame of mind to be in?

I'm finding it hard to sit still and am literally jumping in my seat and cannot concentrate. All I attempt to focus on is the request I have in my mind which is, "Can you help me?" I feel erratic, agitated and so deeply depressed, I feel as though a force in pushing me down into my seat and I can hardly see. I just want it to end. I feel breathless and frightened. I finally get called in, and get a whiff of TCP and old cigarette smell as I pass the old duffers into the waiting room. I sit on my designated chair, hunched over and fractious. I must look like a rabbit caught in headlights. My lovely psychiatrist has a slow, smooth voice and he asks me what is going on and requests that I communicate to him my thoughts and feelings. This is actually quite difficult and I've got so much going on in my head I can't seem to hold on to a train of thought for very long. He keeps asking me if anything has happened, other than the accumulation of stress incidents. I keep telling him no, and continue to try and describe the pictures in my head. I have an internal visual world that is like an I-MAX cinema screen and I attempt to translate these pictures into words of explanation. I am speaking so fast I can hardly keep up with myself, and at the same time, break down in sobs as I feel so depressed I am actually ready to give up.

Sitting there, I feel that I had lost touch with my insight and turned into a raving, rambling thing, with no consistency, boundaries or understanding. I am out of control. What brought me back into the moment was my psychiatrist picking up the phone. I immediately panic, thinking he is ringing the mental health ward, and my legs literally begin running on the spot, ready to run for it. But then he speaks to reception, and asks if my old CPN is around, and could she come down. For a second I feel some relief, but then think she is being summoned to give me a lift to the psychiatric unit. The tension and fear is unbearable. I'm still rambling when she comes in the room, and immediately she says how awful I look. It must be odd for them as most of the time I'm functioning at a reasonable level. To see me on my knees, babbling and gesticulating wildly in some ways is a reassurance. They kept me in services for the 3-5 year window for exactly this reason. They needed to see me this way, instead of me just telling them how I can be.

What happened next was both a relief and a moment of despair. My psychiatrist says I am having a manic episode, mixed with a severe depression which is known as a mixed phase episode. He politely explains that I have Bi-polar disorder, and that I am going to have to take a mood stabalising medication today and for the foreseeable future. The cpn and the psychiatrist both start talking to each other about different types of medication, trying to agree what would be best to level me out. At this point I feel left out. They both turn to me smiling like weird parents, and tell me I have to take a medication called quetiapine. It will bring down my mania and will work well with my anti-depressant. Apparently, although mentally I will be better off, I may gain weight, twitch, have a dry mouth and constipation, feel sluggish and generally a bit naff. For a while. My response is, "Great! I'm going to be mental and fat." Well its either that, or get even worse and go on a mental health holiday for 6 months. Maybe not.

Although throughout my mental health journey up until this point, there was a possibility of being diagnosed as Bi-polar, to actually have it confirmed is devastating. Life as I know it has changed beyond recognition and the fall out will be significant. I know my illness is treatable, but to take anti-psychotic medication feels like the worst thing that could happen. Its a confirmation of being seriously mentally ill that bothers me. I know it makes sense, the diagnosis, the medication, but I don't actually want to be like this. It feels so very final.It won't go away. I wonder if people will now categorise me with the stereo typical serious mental health image - the one where I shuffle, poke my tongue out uncontrollably and scare small children by my general demeanour. I take my prescription resentfully and scurry off with my head in my boots.

The taxi driver is still in the car park and the charge is huge. I've actually been in the centre an hour and I now have to go home via the chemist. When I hand over my magic slip, the pharmacists face changes slightly and says, "Oh we don't have this in normally so I'll order it for you and get it delivered to your house tomorrow." I feel like shouting, "Yes I'm fucking mental, so fuck off!" I think I have some residual anger regards my new diagnosis.

All I want to do is go home and go to bed. For a long time. This is where my mania will stop and the period of suicidal depression will begin. I'm entering 6 weeks of living hell.

and the nightmare continues

The whole family go to my mother-in-laws for the weekend as I am unable to function. I lay about on the sofa feeling slightly spaced, but I'm grateful for the peace and quiet, and I don't have to do any lifting or carrying of children. I have both boys at home with me on a Monday, so I ask my friend and her son if they would like to help me out whilst my husband is at work. She agrees and the day starts well. The sun is out, I feel a little better and all of the boys are playing in the garden together.

As we drink coffee and chat in my dining area, we can watch the boys running about through my big patio doors. It feels warm, cosy and almost idyllic. Then a scream rips through the clear air and my son comes flying down the garden holding his arm. Even from a reasonable distance away I can see it is horribly bent. He has just become a re-break statistic. He is absolutely beside himself and wailing, and regardless of my stitches I lift him up to my chest and hold him. I am appalled and distressed, but manage to get my friend to get the phone as I ring an ambulance. They're going to want me to set up an account at the rate we're going. When they arrive, they look annoyed as I think they thought we should have driven ourselves to A+E. I explain that I've just had an operation, cannot drive and will need someone to look after my other son as I go to the hospital. They are all apologetic and confirm that yes, its really broken and we'll have to go back to hospital and go through the whole procedure again.

I begin to get paranoid in the ambulance and wonder if they think I'm abusing my child or am emotionally absent and don't look after him. The whole "Its my fault" self esteem trigger is through the roof. Its horrible to know he's going to have to have yet another operation, a full arm cast, and to top it off, he'll be in plaster for at least the first 2 weeks of school.  When I call my husband he is furious, and is even more furious that he's got to do the whole hospital thing again. I feel like giving up. There have been too many stressful events going on and to be honest, my grey matter is imploding. And I slowly have the dawning realisation that I am in mental health free fall. I'm hanging on by my finger nails. When I said to my cpn that I could make it for a few weeks before seeing my psychiatrist, I really thought I could. I'm now beginning to wonder.

Luck is not my lady in the day or night - its going to be a long one

The conference ends and I am so relieved I want to celebrate by sleeping  for a week. I actually request some annual leave on that basis, and my boss looks baffled but agrees. My low self esteem thought filtering is at an all time high, and I spend quite a bit of time re-running things over in my head. I work hard at letting it go, but I've got too tired so it seems to be off and running on its own steam. I feel rubbish and I'm hoping catching up on some sleep will help me out a bit, but my mood is definitely going downhill and although I'm trying my CBT techniques, resting and eating well, it isn't working.

We begin the week with my son going to see the hospital fracture clinic for a check up,and his arm is fixed. Its slightly bent but we are relieved that he seems ok and they take off the plaster cast.  Its only been 4 weeks but the consultant says that it is common practice. They do the regular post fracture chat, saying not to hang off his arm like a monkey, no high contact sports etc, and that he is at risk of re break as the bone is soft, but don't worry. Take it easy and all will be well.

The following week at work, if I were to rank my self on the scale of mental wellness from 1 - 10 (10 being fabulous), I'd say I was about 2. My mind is racing, racing, racing and I cannot concentrate or make decisions, and I'm so agitated I feel like I'm constantly jumping up and down on the spot. A colleague comes to my desk and asks me to do something for him in the next hour, and basically I turn round and say, "Oh just fuck off!" My fellow work bank members stare at me, and I realise that I'm at a jumping off place. This is not good. For anybody that knows me well, this is way out of character. I am generally more loving, tolerant and accepting of others, and I would never abuse you so obviously and terribly in front of others or by yourself.

I walk at a fast pace to my bosses empty office and call the mental health team. I request a quick chat with my old CPN as I need to touch base with a sensible person. As soon as she comes on the line, I "Vent my spleen" hardly drawing breath, and when I finally do stop, she tells me to slow down and sit still if I can. All is not well in the garden of sanity, and she tells me that she'll get me an appointment with my psychiatrist as soon as she can. I start crying with relief and she tells me to rest lots, and if I go completely bonkers before she gets back to me (My words, not hers of course)  to call the out of hours crisis resolution team, or, go to A+E (in the little white van, with little yellow wheels as people used to joke in the 1970's). In her words I am "Terribly jumbled."

I spend the weekend trapped in my head. The only way I can describe it, is an internal mind experience of having the whirlies. You know when you drink too much scrumpy cider and you come home only to find everything spinning around. Then when you shut your eyes its actually worse? Well, being hyper manic is like that but in your own head. You cannot hold a thought and it splinters at high speed, and when you think you've caught the thread it disappears. It's like thoughts teleporting around your brain with you running behind it.

When my lovely cpn actually calls me back she says the earliest I can be seen is in about 2 weeks time and can I hang on that long? I take a deep breath and say "ok" but again she stresses that if I am really frightened or lose it completely, that I need to access emergency care. I promise her that I won't do anything stupid and that I'll see her soon. At this point in time, although I feel very ill, I still have insight and I'm still functioning - Just.

I never work on a Monday, so on the Tuesday I go to a multi agency meeting at the ambulance service headquarters. My luck is running short and our car has broken down yet again, so I get the train and walk to HQ. Whilst I'm there I start to feel physically ill. I begin to wonder if I have some kind of nasty virus as physical illness can really effect my emotional and mental health.Maybe this is why I feel so crap. It feels like I have food poisoning as I start to feel very hot, I feel nausea and I have pains in my tummy. You know that weird griping and then the watering mouth when you think you're going to throw up? Well this is how I am, so at the end of the meeting, I politely ask if anyone would volunteer to drop me home as I feel terrible. They all remark that I look a little grey, and laugh and chortle as all the ambulance staff I am currently talking to are off duty! HA!HA! they cry!!!

I fall into my house and strip as I am burning hot and lay on my living room floor. Any mothers reading this will recognise that this is serious stuff. Mothers, unless they are knocked over by a bus, or strapped to a chair, function in all conditions. My stomach hurts so much I have to roll up in a ball and I cannot straighten my legs very well. I call my  GP surgery and plead for someone to come and see me. I have no car and cannot imagine calling a cab, waiting for a cab, etc etc. Thankfully, they agree for a GP to at least phone me so I can discuss my symptoms. I shuffle to get my pyjamas on and then lay on the sofa with the phone. My husband arrives with the kids, and amazingly, my GP. I have no idea why they actually sent her but she is an image of salvation. After a push and a prod, she confirms my fears. Its not an enormous poo that has got stuck somewhere or food poisoning. Its either an ectopic pregnancy or appendicitis. Shit. She calls for an ambulance to get me within 2 hours. I'm not at the dying stage apparently, so I can get admitted to a ward and be sorted out in real time, not another cut and shut emergency. My husband gets me a hot water bottle as I have the shivers, and we wait. By 9pm I am squealing, "Like a stuck pig" I think is the phrase, and my husband is ringing the number of the non-emergency ambulance to find out where they are. They arrive in the next half an hour, then immediatly fill me with morphine and request I take off most of my clothes as I am cooking. Morphine injections make you feel like someone is injecting concrete into the back of your head, that your eyeballs are rolling and you're falling backwards into candy floss. They pop me in a wheel chair and both they and I complain as the drive is filled with pot holes. They can't push and every time we drop down a hole I yelp. Its not going well.

When I am finally admitted to the ward I am almost beyond communication, so when the registrar comes and pulls my legs out flat and pokes me I almost punch her in the face. She kindly reminds me that she is trying to help me. I kindly remind her that I am in huge amounts of pain. We reach an impasse and decide that actually I need my appendics out. She's going to knock me out with pain relief for the night, and I'll go down to theatre first thing. Well Thank God for that.

When I come round thay have sucked out the wretched and quite frankly, useless part of my stomach, via keyhole surgery. I am done and dusted and home by tea time, although I'm not allowed to do anything for 2 weeks like lifting, driving and all of that. I have great joy in using my work blackberry to e-mail my colleagues about my adventure. They are contrite and apologetic. So they bloody should be! I hope that this medical emergency was the root of my mental ill health and wait for a recovery of both mind and body.

Let the stress take its toll and the madness begin.

My first week back from France is intense to say the least. The work created from the conference is so full on I feel like it has taken over my life. I'm getting up really early, doing extremely long days, doing work and e-mails at home, and seem to be so consumed with the preparation everything else has gone out of the window. I have tunnel vision and excess energy. On the flip side of this mental health coin, my depression is pulling me down very quickly. I am emotionally fatigued, over sensitive, tearful and short of breath most of the time. I'm having terrible nightmares and my sleep is rubbish.

The week leading up to the conference, my boss and I deliver a workshop to a select group of people ranging from regional police officers and local councillors to front line staff and senior managers. It goes well and both of us are pleased with the result. Walking back from the venue, I get a telephone call which begins with, "Try not to worry but..." and my stomach lurches and I feel sick, and start to cry when they tell me my eldest son has come off the slide at nursery and has broken his arm. Immediately I feel terrible, as normally I would have picked him up and hour ago, and the only reason I am late is because of the workshop. Its my fault. Trying not to panic and focusing on what the nursery manager is saying, I attempt to quell the panic and figure out what to do.The manager has called an ambulance and they are on their way. I am already in the City where the A+E hospital is, so staff from the nursery will come in the ambulance and a car following, and we will all meet at childrens A+E.

When they arrive the nursery staff have been crying and everyone is traumatised by what has happend. My husband also arrives and is the epitome of wrath. He wants someones head on a plate. I have to remind him that our son is the one that needs attention and going on a rampage at this point in time is not a good idea. My darling son now has a right arm that looks like a banana and he is visibly in pain and terribly upset. When I reach to take him, the nursery lady finds it hard to let him go. We all want to hold him.

We go to our little cubicle and my husband hopes its not a break, but that's just wishful thinking. All I can hear in my head is, "You should have been there, you should have picked him up earlier, if you had of done this he would be ok." I try hard not to imagine how frightened my son must have been and in how much pain. We get an x-ray and he's broken both bones in his right arm, up high on the forearm toward the elbow. It is a nasty break, and he's going to be in overnight and in surgery in the morning. I'm trying so hard not to sob the whole time and it feels uncontrollable.

On the morning of the operation a lovley lady tries to explain what is going to happen in theatre, but as the time draws near, complete panic sets in and we have to drag our son to the aneasthetic room. He is kicking and screaming, pleading for us to help him. My husband has to go through to the aneasthetic area alone as two adults aren't allowed in, and I can hear the continuous pleas from outside. Its harrowing for all of us. When it does finally go quiet my husband comes out in floods of tears.

I do a Low self esteem reaction to the situation, and tell my husband that I should give up work and never let the kids leave the house again without me. I can't get it out of my head that its my fault and it's crippling. When my son does come out from theatre, he has a lovely smile on his face and a lovley plaster cast to match. Our relief is palpable. We have to bring him back to fracture clinic on the Wednesday to see how its setting. Immediately my husband and I flinch as he has all day meetings and I have the conference. Its on days like these you realise you really can't have it all, no matter how hard you try. We decide to do a split visit. Hubby will pick up son and meet me at the clinic. We'll both stay for the appointment and I'll take our son back to pre-school.  This means leaving my own conference for 2 hours. Its not ideal but its less important than my son. My stress level is through the roof, my anxiety is ridiculous and my sleep is active nightmares all night long. I'm buring out and I appear to have lost control of my internal steering wheel. I'm begining to feel quite frightend.

France part 2 - Adjusting to holiday living

The first 5 days are really hot and fraught with shopping trips and trying to sort the silly car out. Thankfully my husband has a french work colleague who does some phoning around for us and gets our car booked into a garage. What I often forget is that when I spend a reasonably long time with a group of people, I have to get used to being around them. Its an emotional form of exposure therapy. Family dynamics can be difficult to interpret, whether it's passive body language, or outright war. Some people just shout at each other a lot and for them that's normal. For me that would be quite scary and I'd probably want to hide. To paraphrase, what this means is that for the first 5 days I feel absolutely terrible in my mind. Thankfully, I have my mobile phone and can text people about the carnage in my head, get some perspective and survive. It's hideous when you realise that everyone else seems fine and you want to throw yourself under the nearest croissant making machine.

When the madness in my head slows down I begin to relax and get into the groove. My extended family are happy, clean, food centred and terribly indecisive. They'll laugh when reading this as their faffing drives me to distraction and  I'm always telling them to get a bloody move on before we all die of frustration or starvation! Going to the supermarket can be a trial. My mother-in-law dawdles and loves all of the food, cooking pots and produce shelves. I just want to grab it and go. I'm damn impatient really and am a shopping spoil sport.

We barbecue, splash about in the pool, bath the kids in the laundry sink and play cards at night. Granddad tries to teach the kids cricket, but my youngest keeps running off with the ball which makes it nigh on impossible. We share the preparation of meals out, with one family doing lunch, and the other doing BBQ. It all works well and washing up is done on a natural rota where noone is requested to do it, it all just happens together. I feels good.

After about 5 days, the heavens open and it rains and rains and rains! We still go out places and have fun, but its difficult when you only have a caravan to come back too. It's at this point I start to feel a little bit of cabin fever, and depression wise, I feel erratic. My mood is all over the place and I'm certain that it can only be bad news. The amount of people that said to me before I came on holiday, "You'll feel much better after a break". Those people obviously have no children and a serious mental health condition. Holidays with family for me are not a break. Going on my own to Majorca for a week on holiday would be a proper break, and no that isn't going to happen in the near future. I think my husband would divorce me if I left him on his own for a week with our two kids.

The rain abates and the last few days are sunny, peaceful and good fun. We have a "Twilight zone" moment down by the sea front the day before we come home. We meet some people who, it turns out, live in the house that my mother-in-law was born in in England. It was very queer to say the least. We wistfully pack up our gear and make it to the ferry with no breakdowns (Well, not of the car variety at least) and when we come up on deck and sight land, we all feel slightly reflective but pleased to be back.

Depression is a nasty creature as it infects what ought to be good and honest with cynicism and fear. A 2 week holiday, spent in a peacceful part of France with loving family, should be a happy and joyful time. I did have a good time, but my constant companion tries to drag it back to gloom the whole time. It fills you with guilt, as really, you have no reason to be terribly miserable. Depression is a thief. Its a distraction burglar that tears you're eye away from the sunshine and when you look back to see it, you missed it. It's a life of "if only's" and my biggest fear is soon to be realised. I'm on the greasy hill down into madness.

France part 1

Considering I travel badly, going on a holiday that involves extensive driving and a ferry ride fills me with a sense of  trepidation. I have no idea why I agreed to this vacation but everyone else seems ok with it. I'll just have to take motion sickness tablets and abandon parenting for a considerable amount of the journey.We are going as a large family group with 3 cars in convoy. There will be 6 adults and 3 children on a holiday for 2 weeks. We are being joined by my husbands parents, his sister and her husband and their 7 month old son. Between us we'll have two large caravans on a small site with a shop, swimming pool, children's play area and a 20 minute walk to the beach. Sounds Idyllic. As we board the ferry all I can think of is the scene in titanic where the Irish woman is sitting on her bed reading a story to her 2 very small children, knowing any second she is about to drown in freezing cold water. I am definitely nervous and try to talk myself around and not infect everyone else with my projection of a catastrophe. Its like that film "Final destination" trying to cheat death. I need to get a grip quite frankly.

Finally we all gather on deck to wave goodbye to blighty and then everyone decides it's time to eat. I try hard not to gag and think of burning vomit coming out of my throat. I'm not enjoying myself yet. Everybody keeps banging on about brioche and crepes, and all I want to do is pass out and hopefully either wake up when we're there, or, die of drowning in my sleep so I never know of the catastrophe I've been so dreading. I  look like a grey, ashen faced rabbit in head lights against everyone else's glowing excitement. Saying that though, my gorgeous sister-in-law is struggling with her baby who has decided he no longer needs sleep and is playing up a treat. First holidays with children are a traumatic affair. Its like normal parenting nightmares in a different country and climate. Its not a holiday - its hell on earth.

In the morning I wake up, obviously not dead, and gratefully make it up to the cafe to eat pastry. The kids are very excited and when we finally depart from the belly of the beast, we all trundle along nicely following our pre-prepared map to our destination. 20km from the site, our car packs up. Totally dead. Something has gone wrong with the wiring and the whole thing is locked. No power, no nothing. As we are in convoy, we deploy children to other cars and wait for international rescue. I try to reframe the situation into a positive theme, like, "Oh, 30 minutes of free time in the sunshine." Before international rescue arrive we are visited by an old French man shouting and urinating on the hard shoulder, then a English speaking French man offering help, and then the Gendarme. They try and move the car but can't, and then to my relief the tow truck turns up. They literally drag our car off the road and deliver us to a very shoddy garage with a fat lady and a smelly dog. However, things turn out well. We leave our car there, get a hire car and arrive 3 hours later than planned to our new caravan home.

The next 24 hours will be a test of my serenity and CBT techniques. I'd forgotten that change, stress and dealing with other people can send me a bit doo-lally! It isn't their fault, I'm just wired up like our car.

Feeling dodgy on the way to La-la land

Imagine you are juggling 3 balls comfortably, but then someone throws in an extra ball. It throws you off your step, but you manage to keep a hold. But then another ball gets thrown at you and you start to drop balls all over the place. This is what its like building up to a manic episode. Your tummy feels fluttery a lot of the time and you have a bubbling stream of weird excitement jogging along with you. You know its there but its like a lid is pushing down on it, and for now at least, it gently propels me along at a pace I can just about manage. I have a curious sensation of being attached by a wire to the body that is separating out in front of me. The body in front is the one that is rushy, taking at 100mph, taking on far too much work and generally being a bit loopy. The trailing body is the one that watches on in despair as it predicts the hideous crash that will inevitably happen, but feels completely powerless to intervene. The thread of connection becomes more stretched and tenuous the more I speed up.

I remember seeing my psychiatrist at the begining of May and telling him I didn't feel quite right. It was definately the odd before the storm. That little orange nylon covered chair that pushes up next to his desk is a comforting safe place. I wasn't keen on leaving after our 20 minutes, but he said, "If you have any problems before your next appointment, just telephone."  Famous last words.

So during May things start to pile up. I'm trying to organise a conference for approx. 100 people, using a whole new approach (the whole systems approach) and I keep having to have extra meetings with a woman we all fondly begin to call chlamydia because we can't pronounce her name correctly. People are going off sick too, or, being redirected to other work instead of helping me. I am under lots of scrutiny from up the 3 line whip and everything is feeling a little bit unmanageable. The stress also increases as I have 2 weeks holiday booked, which will parachute me back into the chaos 2 weeks before the conference actually happens. Oh yeah, and I'm meant to be doing a workshop for 25 people with my boss as well as attending meetings and mediating between the variety of tossers who think being a strategy manager is an easy job and involves doing nothing. I ask for extra help or for someone to keep an eye on my e-mails etc. in my absence. Every ones looks at me as though I just popped a shit biscuit in my mouth. I'm on my own.

Lets discuss the business of being busy

Now you may well be wondering why I haven't written so much about the actual bi-polar diagnosis yet, or even got to the point of diagnosis? Its for a reason. A diagnosis can be made on say, 2 episodes of mania in 2 years, or a few short bouts over an extended period of time. So it can actually take a while to capture a patient in a full blown episode and ensure that it is definitely mania and not just an over excited and gregarious disposition. Also mania doesn't always last that long, and some people actually love the feeling and choose to not take medication, advice or action. They stay in it and wait for it to pass. For most of us the hardest thing to cope with is the crippling depression. Saying this though, if you ask any of my friends or family, they will tell you that I am a high speed, energetic person, prone to days running around like the Duracell bunny.

From my initial referral interview with my CPN up until the end of my self esteem CBT course, I have regularly discussed my "rushy" episodes, when they happen and what happens. I kept a diary for a while and they were unpredictable, but significant enough to warrant attention. When my CPN and I first talked to the psychiatrist Darren about it, he dismissed it out of hand. He felt that it was probably a side effect of the high dose anti depressant or taking too many stimulants. In my case that means only coffee. I knocked booze and party drugs on the head a very long time ago. As I mentioned, the run in to my initial contact with psychiatric services involved me being 100mph in the head and verging on suicidal. Sadly the professionals didn't see me like this, all I could do was explain it after the event when I slowed down a bit. I talked to my new psychiatrist about it and he felt that it did need further scrutiny to see if there is a difference between my general upbeat, rather too bouncy and annoying self, versus something even more fast paced and detrimental to my well being. I'm not keen on the waiting game and to be honest, even though I am "well" I don't feel quite right.

So here is how the land lies. I'm doing CBT self esteem course, I am up to 3 days a week in the office, one day at home, taking my anti depressant medication and seeing my psychiatrist every 6 months. It seems ok but then things start to get a little stressful. As I said, something just didn't feel right and during the May things started to go a bit wrong.

Thinking bias, mood contamination and my dodgy internal barometre

So, I've been talking about my inner beliefs about myself, and as well as these low self esteem thoughts I get additional body states, behaviours and emotions that go with it. You know like emotional fatigue, headaches, over eating; perfectionism, people pleasing; fearfulness and anxiety, hopelessness, depression. Low self esteem is not a pleasant state of being. I'm already at war with the depression and it appears that I also sabotage my life by wrong thinking. This is what I mean by thinking bias. My mind has made up its own little rule book of how to interpret information and eradicate low self esteem.Unfortunately, my mind has actually got it all wrong, and what its really doing is keeping me enslaved to the folly that is my bottom line thought - you know the "I am no good" thought. This is only one of a series of bottom lines that I have - I have a low self esteem broad sheet newspaper going on in my head as well as me being its biggest critic! Its very noisy up there in my grey matter.Maybe I am a twin stuck in one body, and the child that is trapped is resentful and won't shut up!

Here are a few thought biases/wrong thoughts that i have:

• I get given 99 positive comments and 1 bad - I only hear the bad (Filtering)
• If I am not good at badminton it means I am bad at everything (Labelling)
• I missed a payment on my credit card; this means we'll get bad credit, lose all credit options, we won't get a new mortgage, my husband will be mad so we'll end up divorced (Catastrophic thinking)
• My friend cancels lunch, which in my head means she doesn't like me I must have done something wrong (personalization and blaming of self) 

I know it's awful isn't it. Thank god you're not me eh?

Thankfully because all of this stuff is just opinions in my head, apparently it can be changed. Ironically all of the group members feel so rubbish about themselves, none of us actually believe that we can change, which is a representation of a bottom line that we all share which is, "Its one rule for everyone else, but it'll never work for me". It becomes a bit of a group joke throughout the course when anyone goes a bit off track or makes a sarcastic or self deprecating comment we all chant in sing-song voice, "That'll be your bottom line!"  The excellent thing about group working is that you can see so much of yourself in others and the mirror never lies.

At this juncture, I will not go into a blistering tirade about a crap childhood, trauma or or self inflicted horrors but what I will say is that my low self esteem has been around for a very long time. The more I explore my behaviour I begin to accept that I need to unpick the massive rug of protection measures I've been stitching together, unravel the wool, and make it into a snug cardigan that keeps me warm and held. I must start to focus on my strengths and not my weakness. I've been looking down the wrong end of the telescope and I really need a reality check. God bless me - it's at times like this I wonder how many other people are walking around with this type of dialogue going on in their head.We are all our own little universes, bobbing around and knocking into each other, and  we never truly understand one another. It's rare to meet other brutally honest people who will actually tell you the truth. Many a time when someone has asked me how I feel and reply, "Shit actually", they look at me aghast or fall about laughing. Honesty is very underrated you know, and sometimes I'm sure people think you are saying it just to raise a laugh. Many people can't tell these days if I'm being honest or funny. Openness, directness and frankness are more akin to presents for Jesus than traits of character I swear.

I suggest you go out and try it one night. Go on - Do a CBT experiment I dare you. Be blunt but not vicious.I assure you, it will be a very interesting experiment. People will think you've had some kind of mental episode, which is the paradox really isn't it. Normally we'd be all submissive and polite or lie, which is actually dishonest. Lets hope you're friends are understanding though. They might just think you've lost it. Welcome to my world.

Keeping a lid on it

If I stand still for just a minute and take stock of my situation, I am baffled as to how I keep it together sometimes. I don't know whether its because I am stubborn, courageous or just plain stupid, but I keep plugging away even when an episode of doom lurks over the horizon. I have a vision in my head, and it doesn't include not being able to work, going to hospital, needing additional help to look after myself or abandoning my current life as I know it. This may well be misjudged or unrealistic but it is how I am currently managing my life.

I think I see my illness as the enemy. If you make friends with it you keep it close and always have one eye on it. Its a constant power struggle, where I perpetually realign myself with what comes on any particular day. I have to give myself little milestones as markers to see if I am on top of the game. The hardest thing I think, is trying not to state out loud the whole time, "I am finding everything difficult. Please give me 5 minutes to chill out and catch up."  The irony in this is when I am hyper manic, I feel like shouting, "Catch up for goodness sake! You're all going to slow". Balance and mundanity are not something I am familiar with.

So my day goes a little bit like this:

• Get up and check mood - get out of bed regardless
• Eat breakfast and try not to become overwhelmed with toddler chaos
• Practice laughing at my intrusive thoughts whilst making breakfast and cups of coffee
• Deliver children to nursery whilst being assertive but loving
• Drive to work, ignoring  internal dialogue which usually revolves around "I'm not good at my job, my boss regrets employing me, I must try harder" etc. Actively sing along to the radio to quiet mind noise
• Get into work and choose to be upbeat and engage with people, ignoring negativity and focusing on the positives
• Plan work around times when I am productive and energy levels are good
• Take a proper lunch break even though the office culture tends to promote a lunchless day and try really hard not to spend money compulsively on a load of rubbish whilst out and about
• Attend meetings and work really hard at externalising i.e: Count the windows, recite words from the page, actively listen if zoning out, disregard nasty high level managers attitude and practice taking reality snap shot (getting stuck in my head ruminating is not good for me)
• Have a caffeine break at 2-3 as my energy and mood dip at this time
• Finish off tasks if possible, but leave work if necessary (This is difficult as I am a conscientious worker and a perfectionist). Accept any constructive criticism and focus on accomplishments of the day
• Drive home without rerunning the whole day over and over again in my mind, and picking on the things I think I have done wrong
• Collect children and ensure positive praise and physical affection, even though I feel like curling up under my quilt for 3 hours first
• Arrive home and do some housework, including chemicals, knives, hot water and the like (More exposure therapy) and force myself to be loving and gentle because really I want to have a rant - my mood does not dictate my behaviour
• Put kids to bed, eat a meal and finally sit down
• Go to bed at my regular time, taking medication and respecting the sleep hygiene rules

Exhauting, isn't it.

Now this is my day in a very basic format, but what I am trying to show is that I have to work throughout the day to ensure I stay on top of my depression and symptoms. I also have to listen to my mind and body if things start to go off kilter. Now that is the really hard bit because most people have bad days, mood dips, react badly, make mistakes and get narked if someone tells them off. But at least I am living and not existing. I am not letting the beast drag me down. Oh yes, and actually I find out from my colleagues that the individuals I struggle with, the ones who are really horrid to be around, are actually resented and disliked by everyone else. Well thank god for that. I am not alone.

So where were we with the self esteem group?

I'm wearing my guts on the outside

When you have to be blisteringly honest about yourself in a room full of people, it really brings home to you how fragile and vulnerable you feel. After our first session I experience the emotional hangover from hell, and want to cry the whole time. It's like I've been filled up with cement and can't think straight I am wearing a suit with my guts on the outside all raw and exposed. I think that everyone can see my crippled soul.  Immediately I feel resistant to the change, and I can sense my inner voice telling me to run away. I'm caught between a rock and a hard place. I have to go through the pain otherwise I will always have low self esteem and this will exacerbate my depression. I 've got to put myself through this for another 9 weeks. Its going to be grueling. If I don't do it I'll stay in that horrid place of feeling bad about myself the whole time. I've got to grin and bear it as I desperately want to be well. I tell you this now, ignorance is bliss.

Starting any sort of recovery is like taking the lid off of Pandora's box. Once its off you cannot put it back on, and although you know the gratification of wellness and inner peace is only a CBT course away, its like chewing razor blades. When the first session is over, no one can make eye contact and we almost crawl on our knees back to the car park.

I try to pull on my behavioural activation techniques to stop my mood being contaminated, and attempt to do some basic things that involve activity and concentration. It's a disaster and I go home to my bed and a family bag of revels. Next time I need to prepare myself and really dig in, armour up with my hard bitch outfit and begin anew. It dawns on me why they get you to do the CBT course "Over coming depression and learning behavioural activation" first. If you don't have those little strategies you would want to go home and possibly do something silly! I get a distinct feeling that a few people are going to drop out of this course.

Oh yes, and during this I'm tying to hold down a really grown up job and introduce the new more assertive, esteem filled me to my well balanced and unsuspecting colleagues, god bless them! What a nightmare!

Identifying my low self esteem

What is really hideous is the fact that my self esteem is massively better than it ever was. Over the past 12 years I have worked hard at improving how I feel about myself and where I fit in the world. I try to be kind to myself and work hard at not letting other people treat me badly. Most people see me as confident, assertive and friendly. What they don't realise is that it takes loads of practice and its not actually how I feel.If you could read the mantra of my heart, you would see a different me.

The people that I know who suffer with low self esteem don't want to be that way. Its not false pride or martyrdom, but a genuine sense of just not being good enough. Its horrible really and fills you with a distrust of people and constantly attacks your confidence. You question yourself  and your abilities unceasingly, and its exhausting and demoralising. Here are some typical thoughts I have had about myself :

I'm just not good enough
People don't really like me, they just say that to be polite
I'm a crap parent
I am ugly and truly unlovable
People don't really love me, they say that to placate me
Everyone else is better than me
If I try harder maybe I'll be average

Now I could go on, but its not the best, looking at yourself in type and seeing how shite you feel about yourself. The thing is with low self esteem is that you create little rules for living that you hope in your heart, will stop the dreaded feeling happening. I am a perfectionist. I avoid conflict. I will constantly put myself down with self deprecating humour, but what it hides is a genuine dislike or lack of acceptance of self and stops you getting in there first. I'm a sad little git really, but lay off the pity as I'm taking a big bus ride away from the dammed internal dialogue, sprinting joyfully to the fields of glee where imperfection, failure and doing things half arsed is acceptable .

If  I now take a snap shot of my disordered and colourful life, the way I am put together is a bit like a ragdoll. I'm a mish-mash of bits, but although I'm a bit duff, I'm interesting to look at, good to cuddle and play with and a bit more unique than a cabbage patch doll. Yes, that means you normal people with your autonomy and moulded joints and matching outfits! Actually, that is just my perception. You know the one in which I see all the women who drop their kids off at school  as alpha parents who do absolutely everything right and are perfect. I am soon to learn that this is something that I do - its called wrong thinking. I generalise about situations, I filter what I hear, I categorise everything as black or white and I am hideously self punishing. I would LOVE to take a day off from being me - I really would.

Welcome to the CBT course on self esteem.