So I went for my visit. I don't see my psychiatrist that often, maybe every 4-6 months unless I'm in crisis. Then, I see the crisis team and other psychiatrists for a short period of assessment and care until the crisis has passed. We then return to normal format of very little. So When I do go I try and be focused, direct and not ramble. There isn't time. I am fully aware that services are financially stretched, staff rotate, leave or move sideways, and things in mental health are particularly tough. So today I knew my established psychiatrist had left and a locum was in post. I had to be understanding and flexible.
A huge part of my illness and lack of initial engagement with treatment was about trust. Before getting help, I trusted absolutely noone, told noone what was in my head or my heart, was pathologically hostile to institutions and people of "Control" and was a self contained moon unit floating about in society. Over time, I have learned to open up and to practice trust in all areas of my life. Sometimes that bites you in the backside, but generally, it has been fruitful. So when I got to an institution, to talk to a stranger, exposing my inner most being, I feel quite anxious and try really hard to manage my expectations. I have to build myself up to it and walk myself through it. My underlying motivation is wellness and recovery.
So I spend the next 40 minutes feeling totally conflicted. The whole episode is an effort. Psychiatrist X I will name them, is running on time I am told. Good. I get in their office and spend 15 minutes sitting there whilst psychiatrist X talks on the phone to an IT engineer as they cannot log on the system and read my notes. Finally the system boots up and psychiatrist X reads from a letter from my paper file about my last visit. Verbatim. Finally I am asked how I am. I'm on the clock so I keep it brief but direct.
Not manic or suicidal
Intrusive thoughts quite noisy
Mood erratic and motivation sporadic
Anxiety high
Doing anything out of my basic routine throws me totally and my mood vibrates wildly
Lithium side effects are quite annoying
Not sleeping well
Other than that I function quite well but I would really like to feel better.
What do you mean about "Noisy intrusive thoughts"? I assumed psychiatrist X understood intrusive thinking but maybe it needs explaining for them to judge my wellness. But are you actually harming yourself? Er no, but intrusive thoughts aren't about me hurting myself it's about raised anxiety and distress affected by mood. Are you suicidal. Er no I said I wasn't. Excuse me, please can you tell me if the IAPT service contacted you about anxiety therapy after they rejected my application due to me being in secondary care? No. Well can you help? I don't know. I can talk to MDT and see what they say. Come back in 3 months and I suggest you just do less and see what happens. Oh and don't work.
Chocolate tea pot springs to mind. The local postman could have told me that. So I waited four and a half months to get some help and input and received zilch. I suppose what bothers me the most is that I am expected to spill my guts to a complete stranger, make myself totally vulnerable and "Engage" with services, only to be told that actually there wasn't much point in you coming. Basically, as you are not at the point of hanging yourself or hurting someone else, I'm not in a position to offer you constructive input. Not set up for that. Probably too expensive, and not available for 2 years even if it was. I actually want to be well. The government bang on about the cost of mental ill health both to employers and the welfare state, but they have cut budgets by £600 million in real terms over the last 5 years. (http://www.nhsconfed.org/-/media/Confederation/Files/Publications/Documents/)
If you can't get treated, you can't get well, you cannot work and pay back in to the system for other poorly folk. Fucktards. It's not rocket science! Sorry. I'm feeling angry. Now I'm crying with frustration.
I wish sometimes that I could be on the other side and understand why things are structured the way they are, why it is I cannot access help without jumping through ridiculous hoops, why it is that I'm in secondary care and ill, but not ill enough to warrant some kind of regular support. I am not privy to the club rules.
Anyway, tomorrows another day. I will continue to plod and reach out for wellness regardless of you lot and the rules. I'm going to nurture my inner child with an ice pop and a Disney film. Cheerio!
Wednesday 26 October 2016
Sunday 23 October 2016
Employing strategies
I have recently been on holiday for a week, and it reminds me that any change in environment triggers unmanageability in my brain. I have to employ strategies to keep myself on an even keel, and recognise what is needed at any given time to balance me out. Triggers for me are things like lack of sleep and/or change in sleep patterns, therefore, chronic tiredness, stress, physical illness, fear, raised anxiety, forgetting to take my medication at the right time, new chemicals/glass/sharp objects/cliffs etc. that trigger intrusive thoughts, and being given free shots after a meal out (AVOID).
I take my metaphorical strategy tool box with me wherever I go. It's filled with all sorts of quirky stuff that actually really helps if you deploy it when needed. Sometimes you have to find a quiet toilet in order to get to your toolbox, but essentially you can use it on the go. Let me share some of my toolbox with you.
1) Recognising unhelpful thinking styles
CBT techniques get you to challenge your thought processes such as black and white thinking, catastrophising, inappropriate mental filtering, over generalising, negative labelling and emotional reasoning. Yes I do all of these. Basically you have to practise listing reality and redirecting your brain to that. It stops you speculating and getting lost in the forest of your own ridiculous thoughts.
2) Sleep hygiene
Sleeping properly. At the same time each night, with no stimulation like TV or mobile phones, no reading, no caffeine, appropriate wind down like meditation and a nice warm bath, cool room, darkness and not getting overheated. If I don't sleep properly, my mood nose dives. Chronic fatigue is also a mania trigger. Insomnia for me is very bad news.
3) Exposure therapy techniques
This helps me to challenge hideous intrusive thoughts, helps me to move through any avoidance and desensitises me to the trigger. With an intrusive thought your head tells you it's really going to happen or you are really going to do it. So for example, the kids are walking along the path near a cliff that has a wall about 2 feet high. The drop on the other side is steep and rocky. They want to jump on and off it, push each other around and generally be a little unsafe. Intrusive thought head sees dead children, broken and covered in blood at the bottom of the cliff, which in my whole body sensation feels real. I start to hyperventilate, heart races, clammy hands, major panic sensations and mild hysteria. This can result in screeching, dragging children away from the edge physically, really over reacting and children feeling slightly confused about mental parent. Exposure response is to go with children, lay across the wall on our chests, look over the edge and experience weird tingly bum sensation of vertigo, discuss general safety and walk away. Let them do some jumping. I will breathe through it. I have also had to do the whole knives in the sink with wine glasses, drinking tea next to a bottle of bleach, flirting with the fabric softener and sharing with my husband that my head just told me to poo in a plastic bag and leave it in the glove compartment of the hire car. It is random and totally unhinged. Thankfully I don't act out on it! I know I'm bonkers.
4) Mindfulness
This helps to slow down and refocus the "Head traffic" that I get on a regular basis. It gives me a place to detach from the noise and keep it simple. I can step back, observe the thoughts and allow them to pass without engaging with them.
5) Doing something physical and/or challenging demotivation
When things are off balance, I can feel very demotivated. I have to force myself to do something, or try to do something, even if it's very simple. Walk, swim, do the washing up, cook, say yes when really you want to say no. This makes your endorphin's start swishing around a bit and makes you feel more uplifted and positive.
6) 12 step program
I could write about this for the rest of my life. Very simply, I cannot drink/use like other people. I accept this and on a 24 hour basis I do not use mind altering substances, I work on my behaviour, I am compassionate to myself and others, I trust that my higher power will guide me spiritually, I help others out when I can and I make a concerted effort to not be an arsehole.
7) Singing very loudly
Do I really need to explain this? I do this usually on my own in the kitchen when cooking and cleaning, or, in my car. This means I am alone and can pretend I am amazing at singing when quite clearly I am not! Really helps to channel my emotions.
8) Asking for a cuddle
Sometimes gentle physical contact and affection can make all the difference. It warms you, helps you to feel loved as well as held physically and emotionally.
9) Body scanning and mood/thought monitoring
This is really important for me in managing anxiety. Anxiety for me is a whole mind and body experience, and when I am in it, I need to anchor myself to a practical framework to help me scale myself down. So I check through what my body is doing as well as what my mind is trying to sell me at a particular time. Slow down the breathing, move to a quieter place to sit down, touch something tangible and mindfully feel it, reality check myself to reduce fear, what is real and what is fiction.
10) Humour
Humour is a God send and a life saver. My illness is life threatening and very serious. If I get too caught up in all of that I might as well give up. I cannot take myself too seriously and humourising my situation can make it feel more acceptable to me and others. And it is laughable some of the stuff that goes on in my head.
You know I have a choice as to how I live with my illness and I think from very early on I knew that I would have to work at being well. And I do most of the time. Sometimes things are too difficult and I seem unable to use anything to help me. I'm just in it and have to ride it out. Other times I am like SAS recovery bitch and I am slapping the illness down and batting away symptoms like flies. Mostly though I am somewhere in the middle, flailing around a bit and getting through every day. And that is good enough. I give myself the chance every day of having some enjoyment, being emotionally available for those who need me and not giving in.
Now where is that toolbox......
I take my metaphorical strategy tool box with me wherever I go. It's filled with all sorts of quirky stuff that actually really helps if you deploy it when needed. Sometimes you have to find a quiet toilet in order to get to your toolbox, but essentially you can use it on the go. Let me share some of my toolbox with you.
1) Recognising unhelpful thinking styles
CBT techniques get you to challenge your thought processes such as black and white thinking, catastrophising, inappropriate mental filtering, over generalising, negative labelling and emotional reasoning. Yes I do all of these. Basically you have to practise listing reality and redirecting your brain to that. It stops you speculating and getting lost in the forest of your own ridiculous thoughts.
2) Sleep hygiene
Sleeping properly. At the same time each night, with no stimulation like TV or mobile phones, no reading, no caffeine, appropriate wind down like meditation and a nice warm bath, cool room, darkness and not getting overheated. If I don't sleep properly, my mood nose dives. Chronic fatigue is also a mania trigger. Insomnia for me is very bad news.
3) Exposure therapy techniques
This helps me to challenge hideous intrusive thoughts, helps me to move through any avoidance and desensitises me to the trigger. With an intrusive thought your head tells you it's really going to happen or you are really going to do it. So for example, the kids are walking along the path near a cliff that has a wall about 2 feet high. The drop on the other side is steep and rocky. They want to jump on and off it, push each other around and generally be a little unsafe. Intrusive thought head sees dead children, broken and covered in blood at the bottom of the cliff, which in my whole body sensation feels real. I start to hyperventilate, heart races, clammy hands, major panic sensations and mild hysteria. This can result in screeching, dragging children away from the edge physically, really over reacting and children feeling slightly confused about mental parent. Exposure response is to go with children, lay across the wall on our chests, look over the edge and experience weird tingly bum sensation of vertigo, discuss general safety and walk away. Let them do some jumping. I will breathe through it. I have also had to do the whole knives in the sink with wine glasses, drinking tea next to a bottle of bleach, flirting with the fabric softener and sharing with my husband that my head just told me to poo in a plastic bag and leave it in the glove compartment of the hire car. It is random and totally unhinged. Thankfully I don't act out on it! I know I'm bonkers.
4) Mindfulness
This helps to slow down and refocus the "Head traffic" that I get on a regular basis. It gives me a place to detach from the noise and keep it simple. I can step back, observe the thoughts and allow them to pass without engaging with them.
5) Doing something physical and/or challenging demotivation
When things are off balance, I can feel very demotivated. I have to force myself to do something, or try to do something, even if it's very simple. Walk, swim, do the washing up, cook, say yes when really you want to say no. This makes your endorphin's start swishing around a bit and makes you feel more uplifted and positive.
6) 12 step program
I could write about this for the rest of my life. Very simply, I cannot drink/use like other people. I accept this and on a 24 hour basis I do not use mind altering substances, I work on my behaviour, I am compassionate to myself and others, I trust that my higher power will guide me spiritually, I help others out when I can and I make a concerted effort to not be an arsehole.
7) Singing very loudly
Do I really need to explain this? I do this usually on my own in the kitchen when cooking and cleaning, or, in my car. This means I am alone and can pretend I am amazing at singing when quite clearly I am not! Really helps to channel my emotions.
8) Asking for a cuddle
Sometimes gentle physical contact and affection can make all the difference. It warms you, helps you to feel loved as well as held physically and emotionally.
9) Body scanning and mood/thought monitoring
This is really important for me in managing anxiety. Anxiety for me is a whole mind and body experience, and when I am in it, I need to anchor myself to a practical framework to help me scale myself down. So I check through what my body is doing as well as what my mind is trying to sell me at a particular time. Slow down the breathing, move to a quieter place to sit down, touch something tangible and mindfully feel it, reality check myself to reduce fear, what is real and what is fiction.
10) Humour
Humour is a God send and a life saver. My illness is life threatening and very serious. If I get too caught up in all of that I might as well give up. I cannot take myself too seriously and humourising my situation can make it feel more acceptable to me and others. And it is laughable some of the stuff that goes on in my head.
You know I have a choice as to how I live with my illness and I think from very early on I knew that I would have to work at being well. And I do most of the time. Sometimes things are too difficult and I seem unable to use anything to help me. I'm just in it and have to ride it out. Other times I am like SAS recovery bitch and I am slapping the illness down and batting away symptoms like flies. Mostly though I am somewhere in the middle, flailing around a bit and getting through every day. And that is good enough. I give myself the chance every day of having some enjoyment, being emotionally available for those who need me and not giving in.
Now where is that toolbox......
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