Bangkok Shocks!

I’m off to Bangkok tomorrow, for just over three weeks. I’m going to be blogging over here  so my friends and family from all over the world can keep in touch with what I’m up to; this is a cordial invitation for you to join me on my travels. I’ve NEVER ben out of Europe, I’ve never flown long-haul, I’ve never been anywhere that doesn’t use the standard western alphabet (with or without a few funny characters!); so yes, it’s going to be a big one for me, especially in the light of everything that’s been going on lately.

I’ll catch you when I’m over there…

Thordora’s Interview Meme – Question 1

Thordora’s Interview Meme Rules:

1. Leave me a comment saying “Interview Me.”

2. I will respond by emailing you five questions. I get to pick the questions.

3. You will update your blog with a post containing your the answers to the questions.

4. You will include this explanation and an offer to interview someone else in the same post.

5. When others comment asking to be interviewed, you will ask them five questions.

* * *

The Five Questions From Salted Lithium To tempest carousel:

1. What events and/or behaviours led you to your latest attempt to find psychiatric help?

I was in the supermarket with my girlfriend and our housemate, and I began to feel strange. Very strange indeed. As I described it to my psychiatrist the other day, it was like I was wearing a helmet, a heavy, iron helmet, and I was straining to peer through a very narrow eye-slit. I’d had a moderately stressful day at work, but then most days there are challenging in one way or another. I’d been aware of an increasingly pervasive headache as the afternoon drew on, but by the time I’d reached the supermarket it was all-encompassing and my anxiety levels had risen dramatically. I remember bumping into one of my staff in there, and having this vague, distant, other-worldly conversation with her, where she recounted her recent holiday. I can recall thinking I really hadn’t a clue what on earth she was talking about.

By the time we’d reached the tills I was in full-blown panic mode. I’m no stranger to panic attacks in the supermarket, but I felt totally threatened – physically and psychically. I became so desperate to get home that I shouted at my girlfriend when she stopped to have a cigarette on the way to get a taxi from the nearby rank.

When we got home, I started wailing. The last time I can remember wailing like that was when I was delivering my son. There was a hideous bellowing wail in the distance, and as I lay there in the maternity suite I was thinking, Someone must stop that woman screaming, someone must help her. Then I realised that woman was me. And it was the same when I got home after the supermarket. It was like the wail came from somewhere else: that’s the only way I can adequately describe it. It’s pertinent to mention here that in the weeks leading up to this my girlfriend had been swept up in fairly traumatic circumstances; she was recovering as well as could be expected, but in retrospect I can see I’d prioritised her wellbeing over processing my own feelings. And I have no doubt that was the best way to cope with the situation, but inevitably it left me emotionally fragile.

I woke the next morning, after a restless night of paranoid dreams, with my mind racing and the uncontrollable urge to do something, anything, quickly and with urgency. My body was fizzing with so much electricity I could almost see the sparks zapping out of my fingers. I had enough presence of mind to know that All Was Not Well and while my girlfriend slept beside me I picked up my mobile phone and called the surgery to request an emergency appointment with my GP.

This was – what? – five or six weeks ago, maybe. Without a calendar I’m not exactly sure. My GP suspected that I was on the threshold of hypermania and immediately stopped my antidepressant, Duloxetine, which I’d been taking for the past nine months. Ironically, those nine months had probably been the consistently mentally well months I’d had since I was about sixteen. I’d been living with depression for twenty years or so and thought I’d finally found a medication that was effective and tolerable. In retrospect I can identify episodes of hypermania/mania in my past; last summer I was definitely elated for several months, and I was self-medicating with alcohol whilst I wreaked havoc on several valued friendships, my health and the Creative Writing Masters course I had nearly finished. My thesis remains unwritten. The episode was incredibly mixed, though, and I was on such a nihilistic trajectory that my GP and I concentrated on treating the depressive symptoms. I remember asking her, “Am I bipolar?” and she reassured me that it was unlikely, but offered me a psychiatric referral. Inevitably, because I thought I could cope, and because I worked for the same mental health services as the psychiatrist, and possibly because I wasn’t ready to start really facing facts, I turned her offer down.

And here we are, twelve months on, and oh! how things have changed…

Depression: new research suggests depression is the ‘most disabling’ of chronic illnessess

Newly published research has found that depression – compared with four chronic physical conditions – is the ‘more disabling.’

The data, collected by the WHO, compares depression with angina, arthritis, asthma and diabetes. Being a greedy sort of person, I live with not only the spectre of depression, but also osteoarthritis, and I have to say I’d never actually thought about ranking them until just now. Mental pain vs physical pain? It’s a tough one. My depression has always been cyclical, and for the most part, treatable. However, I await surgery for my arthritis which will prolong the use of my hip, if not provide a cure per se; osteoarthritis remains a degenerative condition. However, the severity of my depression has increased over the years. There is, of course, no surgery that can reliably cure depression. Psychosurgery is one branch of psychiatry that serious research has failed to bother: the numbers performed in the UK nowadays are literally a handful, and even then the legal processes involved are complex due to ensuring the patient has the capacity to consent; it remains one of the few treatments (along with radium implants) that demand patient consent.

But as usual, I digress. My depression comes and goes, and has done since I was about fifteen. My osteoarthritis stems from congenital hip dysplasia which led to me spending most of the first three years of my life in an orthopaedic hospital, having bizarre and ‘pioneering’ surgery and treatments. For thirty three years I had no further trouble from it – well, apart from being bullied at school for being crap at sport. Depression, though, has affected big chunks of the last twenty years in an unpredictable and insidious manner. It’s like someone randomly splattered black ink over the family photo album. Days, weeks, months, are spoiled, indistinct, occasionally totally ruined.

My girlfriend has promised me that when I can no longer walk unaided she will make me the fanciest, dandiest walking stick ever. I have no doubts that it will be a work of art, a work of art that will inevitably include battery fairy lights somewhere in its construction. I am not sure there is anything spangly at all that she could make me – even with her incredible creative powers – that would ease the chronic nature of my depression, and so, based on my entirely subjective opinion and anecdotal evidence, the research seems to be pretty much spot-on.

Oops! I forgot!

I cancelled the Staff Wellbeing Services appointment. My head is smooshed from today’s appointment and I’m in no mood yet for counselling. Especially when it involves five hours on a bloomin’ bus. Anyone would think we lived in the bloody outback or something.

So no, tomorrow I rest up and enjoy a rare and precious day off with my girlfriend, which, unlike today, will be free from psychiatric intrusion.

Update

The psychiatrist just visited. She rang me with twenty minutes notice and we cleaned the house in a frenzy. Thank heavens for going-too-fast combined with obsessive cleaning needs. It looked beautiful.

But yes, Bipolar II, although I think we knew that anyway, didn’t we?

Relieved, exhausted and yet strangely calm sums it up for me right now. So much easier to deal with something when it has a name.

Stressed? You will be…

I woke up this morning and felt like my body didn’t belong to me. I was having to deliberate about each footstep and mentally tell myself what to do next. Even for really simple things like washing my hair. I just tried to call my friend, and she’s one of those people whose number I’ve been calling for years; it’s one of those numbers that my fingers know off by heart and I got it wrong. I had to stop, take a breath and then say the number in my head and concentrate hard on where to put each finger. Hanging out the washing and bringing in the dry laundry has been a severe challenge to my co-ordination.

It goes without saying, really, that this is testing my patience somewhat. In fact, even sitting here typing this is testing my patience severely. I’m – what?- a hundred words or so in and already I’ve had to use the spellchecker umpteen times. Usually my fingers fly over the keyboard and I can beat out paragraphs nearly as fast as I’m thinking them. Today, the effort involved is incredible.

It’s making me think, though, about how ineffectual print is to convey the act of writing. It’s hard to express the effort and thought and agony, sometimes, behind each word. My brain is mushed. Seriously. I just typed ‘between’ then, when I was trying to write ‘behind’. When I started writing the previous sentence, I couldn’t spell ‘brain’, either. Part of me wants to leave all the mistakes in, to demonstrate just how rubbish my physical ability to transcribe my mind’s wanderings is, but I am too vain and too much of a perfectionist to do this. I may feel like a retard today but i have no intention of giving anyone else the opportunity to think that.

I can only imagine that these are side-effects from the Lamotrigine. When my GP first said she wanted me on a mood stabiliser, she gave me a week to think about it and told me to go and do some research. Off I went, and looked at all kinds of things – the manufacturer’s statements, which of course are just glorified sales pitches written in reassuring medicalese; I looked at countless users’ and ‘survivors’ websites, I looked at the NHS NICE Guidelines for Bipolar Disorder In fact, I looked at so much, and read so many books that my head went a bit potty with the weight of it all. But yes, the overwhelming concensus appeared to be that Lamotrigine was going to be nicer (I use that word with a hefty dollop of irony) than a lot of the other medication available.

You know, I still haven’t received a formal diagnosis. I am also not one to advocate the risky process of Self-Diagnosis With Internet Help. But really, I’m a mental health professional. I’ve worked with people in every state of illness imaginable for over ten years. Technically, my GP can’t make a diagnosis: I have to see a specialist to get one. Have I seen the specialist? Have I chuff. My GP mentioned cyclothymia, but as I understand it – and indeed as all the clinical guidelines instruct the doctors – depression in cyclothymics is ‘subclinical’ rather than severe. I know, and my GP knows, that my depression is not ‘subclinical’ in any way. Last year I was seriously bloody ill and posed a major risk to myself. God forbid anyone would read this and think that what I’m saying is [adopts Cartman voice here] ‘Nehhh. My depression is bigger than your depression,’ because I’m not. But what I am saying is that my depression is bigger than cyclothymic depression and therefore I need to see the specialist.

Gah. I am sitting here getting het-up and frustrated, and not just because it took me three tries to spell ‘sitting’ just then. I am going to ring the GP’s surgery now and ask what’s happening about me seeing the psychiatrist, because the NICE guidelines say that I should. And I’m being prescribed medication which I have only ever professionally observed to be used to treat epilepsy or bipolar disorder. In fact, in the US, it’s specifically licensed as a treatment for both these conditions. The UK licensing issue is sketchier, because neither the BNF nor the patient information leaflet make any mention of any mood disorders whatsoever. Glaxo SmithKline’s clinical trials register is interesting, though. There is a part of me (mostly the vain woman part) that is extremely concerned that they felt the need to be researching the emergence of PCOS -type symptoms in female Lamotrigine users.

But I digress.

I am Not Well. Today I am also Not Well due to the medication I am taking because I am Not Well.

* * *

I just had a phonecall from a guy who’s an occupational therapist with the local Primary Care Mental Health Team. This is a new team that works with GP services. My GP had referred me to them to explore options for counselling and support. The guy – we’ll call him Dave – said that he was loathe to work with me directly because I’m a member of staff and because there might inevitably be occasions where our paths would cross in the future. He then directed me to my employer’s Staff Psychological Wellbeing Service, who have an appointment for me tomorrow to see a counsellor there.

It’s a two and a half hour bus journey away. Plus a taxi to the place. Then two and a half hours home on the bus. All because I’m a member of staff and local services are ‘loathe’ to see me. the knock-on effect of this is that I have to cancel my GP appointment in the morning, and oh! joy of joys! the next available appointment is on Friday 14th, by which time I will have run out of all my medication. I have the option of calling every morning at 08.30h to see if there’s an ’emergency’ appointment, but they can’t guarantee which doctor I’ll get to see. To say I am well and truly cheesed off with all this is an understatement.

The secretary at the Wellbeing Service asked me the reason for my referral. She said, ‘Is it stress?’

I almost laughed.

If I wasn’t stressed before, I certainly am now.

Move over, Britney, it’s Amy’s turn…

I know that ‘column inches’ are literally used to calculate the media impact of certain stories. Occasionally you see counts where rather than inches, specific words are counted instead. This week the adjective du jour
appears to be ‘troubled’. Which of course means heavy-drinking/ drug-abusing/ victim of abusive spouse/mentally ill or all of the above.

This week’s ‘troubled’ celebrity appears to be Amy Winehouse, whose descent into drug hell (as the papers love to describe it) is neatly summarised here. Claims abound that Ms Winehouse is ‘clinically diagnosed with manic depression’ but has chosen the self-medication route rather than succumbing to the medical model. Anyway, here’s a picture of Amy not looking a state, because I’ve seen enough of those this week and frankly they served as neither a warning nor a source of morbid fascination.

So typical

I started this blog with the brave intention of chronicling everything that was going on, charting my moods, sharing my wisdom and all the rest of it, and it didn’t happen. There are a number of reasons, all valid in their own ways, but mostly it was just due to me being totally knackered by having to deal with being unwell and all the accompanying rubbish that’s come with it.

I’m in a weird situation. I don’t know if I mentioned this already, but I’m a nurse, and I work in Wales for the NHS as a ward sister on a busy hospital admissions ward. A busy psychiatric admissions ward, in fact. I’ve always been reasonably open about my history of severe depressive episodes, and the general consensus has mostly been that my experiences have furnished me with additional skills and empathy which can only enhance my job.

Earlier on this year my family experienced quite tragic circumstances which rocked our world immensely for a while. I suspect it was dealing with this that led to the stress that started to tip the balance for me. In addition, I had my 15 year old son home for the holidays; he has Asperger’s Syndrome and is a weekly boarder at a residential school about 70 miles away. His behaviour can be, and often is, challenging to say the least. But he is great, too. So yes, we had a lot going on, and I suspect that was probably what had triggered my elated episode. I was cleaning constantly, had extreme pressure of speech and flight of ideas and was prone to doing some strange and funny things. I’m going to save those for humorous entries, I think, so they can be savoured in their entirety.

But no, I wasn’t well at all- and indeed I’m still not well, really- and I did the right thing and signed myself off sick and took myself straight to the GP, who insisted I came off my anti-depressant – Duloxetine/Cymbalta- straight away in case they’d triggered the hypermania. I’d been well on Duloxetine for nearly nine months, following a very severe depressive episode last year, which itself had followed an equally hypermanic episode which I’d blithely self-medicated with excessive quantities of alcohol until I realised I was making a colossal ass of myself.

Anyway, my GP suggested she refer me to the local community psychiatrist, who is someone I’ve never worked closely with and with whom I felt comfortable. The PDoc – we’ll call her Dr Pleasant – said that she’d see me at home, to save me ‘running the gauntlet’ of the clinic where she’s based, and where I know most of the staff. So that was fine, and I had a week to think about the referral. In the meantime, Dr Pleasant suggested that my GP started me on Lamotrigine (Lamictal), a mood stabiliser from the anti-convulsant stable. Sometime during the next week, my line manager from the hospital called me to see how I was. When I’d filled her in, she was quite stern with me, and told me that I shouldn’t see Dr pleasant, that it would ‘damage our professional relationship’ and that it would be impossible for me ‘to be totally honest with her.’

OK… if you say so, boss. She also raised concerns about the fact that my records would be stored on our trust-wide electronic note-keeping system, which is accessible to all nursing staff, hospital and community based, in a trust that covers a large chunk of mid and west Wales.

Nothing like adding to my existing paranoia, eh?

I got really cross about this. I rang my Human Resources dept, to ask them if there existed a policy on how trust staff should access services that they already worked for. The lady there admitted she had no idea and referred me on to Occupational health. She also added that I had a Sickness Review coming up, where I’d automatically be referred to Occupational health anyway. So I rang Occupational Health. I have to explain here that this service is provided as a ‘favour’ by the general hospital where our psychiatric wards are based (we’re run by a separate trust based 50 miles away). The administrator there advised me that the next available appointment would be in October. This was on August 21st. She also had no idea how else to help me.

I was cross by this point that I rang my union for some advice. They were horrified, and suggested that it looked like I was, by virtue of my profession, effectively being denied access to services. Which is pretty much where I remain. At my most recent weekly GP appointment, the doctor rang the clinic and asked how my referral was progressing; they offered me an appointment with a different doctor (who is male, and gruff and not who I’d be told I could see) but I declined. The secretary then said she’d ‘have a word’ with Dr Pleasant and get back to me. To date she hasn’t.

I just tried to explain to my mum how frustrated I was about the whole thing. She mostly just said, ‘Hmm,’ which is kind of typical for my mum. But we’ll save dysfunctional family relationships for another day. (See, I think I’ve got nothing to write about, when really, there is oodles.)

But yes, right now I am mostly angry. And that’s angry about real things. Other real things I’m cross about include the shitty (literally) side-effects of the Lamotrigine, the loss of my fine motor co-ordination, the fuzzy-headedness which is contributing to my increasing frustration, because my head is still going so very very fast; the ideas and the concepts for stories and poems are flying through so quickly and yet I don’t always have the energy or the inclination to write them down. And my temper continues to be horrific at times. I am well aware that I am testing my girlfriend’s patience beyond most normal limits. This is unfortunate because she, and our housemate, are my rocks right now, and deserve better from me than snappishness and bouts of irrational anger.

Thankfully they do not just listen blankly and then eventually say, ‘Hmm.’

Crazy but it feels alright…

It seems that world and his pop-psychologist wife are all speculating as to whether or not Britney Spears’ recent and well-publicised ‘erratic’ behaviour might be symptoms of her suffering from bipolar disorder. I guess it’s possible; I mean, who am I to judge. I guess it makes a change from people in the public eye being accused of having raging drug problems. Oh wait – they accused her of that already.

Hang on, though. Look closely at the cover of Allure, where Britney poses in bewigged and sultry fashion. This magazine (which I’ve never read but I doubt offers any new angles on the advancement of womanhood) promises to empower the reader to ERASE DULL SPOTS, which is exactly what Ms Spears appears to have been doing recently.

At last then, we have the proof. Reading glossy magazines really is bad for your health.

Are you sitting comfortably?

This is the first one. Except, it’s not really the first one. But it’s the one that officially marks the beginning. I realised while I was writing up my daily journal entry on moodtracker.com that my entries were getting longer and longer and less objective and thus a dedicated place to put all my psychological gubbins made more sense, really. So here I am, and here it is.