If you’ve been following me on Twitter, you may have heard that I have a new CPN, due to the long-term illness of my previous one (I suspect she’s off with her own version of madness, based on a few factors, but who knows?) Those of you with the password to my previous post (email me or DM me on Twitter if you would like it) will know that there is a shake-up in the psychiatry system meaning that I’m probably going to lose this CPN in the near future too; it’s very frustrating that I’ll be getting a third within maybe eight months or so, but my psychiatrist wanted me to see this woman anyway since she has now reduced my Seroquel intake to a maintenance dose of 300mg, which could potentially have dredged up our old friends of mood instability and psychosis. Better to have someone rather than no one, my consultant suggested. Fair enough.
Anyway. The short version? My new CPN seems nice.
The long version? Let’s see…
First impressions were good. She arrived only about three minutes late, and apologised for this. It reminded me of the time when The Man and I were in Germany, and they apologised when the train left exactly 31 seconds after its scheduled departure time.
She’s not from around here, judging by her accent – my best guess is that she’s from the Derry area. This is good; Derry people tend to be very easy-going, friendly types, and she did seem to fit that description. She had her hair dyed an obscure red colour, which got her extra points, as I routinely do the same, and it’s usually a mark of a vaguely interesting human being.
I found it interesting that I sat down and just started talking to her as I had the previous one. After some rambling on, I stopped myself – not because of discomfort around her, but of discomfort with myself. Over the last few months, despite the recent reduction in Seroquel, I feel that I’ve been pretty euthymic (at least by my own standards). Although I’m still weighed down by tonnes of avolition (lack of motivation), I have found that my thoughts have been speedy, that I’m overtalkative, that I have flights of ideas and that I randomly dance around the room and squeal like a child. I asked The Man the other night if he had noticed; he had noticed, alright, but saw no cause for concern.
Neither had I particularly, but I’m a naturally cautious person these days. I’ve learnt the hard way that if I ignore warning signs in relation to my health (physical and mental), then I severely reap the consequences. Sometimes alarms are false, inevitably, but it’s worth hearing them on a just in case basis.
The new CPN sort of thought that if my mood had been low for a while then I might notice an ‘up’ period more than I normally would, but I don’t think I have been depressed – not clinically severely depressed – for a few months now. Still, she was willing to accept that this could be a climb upwards, and that it shouldn’t be ignored. This is good. I’ve heard of some of them whinging about “pathologising” or “over-reacting” or throwing around accusations of “hypocondria”. Personally, apart from one twattish therapist, I’ve not been exposed to such annoyances, but I’d like that trend to continue.
She nearly did annoy me at one point when we got to discussing what I do during the day. This irritated me in the first place, because they ask this question and then, when you answer that you don’t really do anything, they ask if you’ve tried this, or tried that. Er, no, I really hadn’t thought of doing stuff. I woke up this morning, as I did yesterday, the day before, the day before that, and the day before that and thought, “I know! I’ll just sit here all day!”
As such, I approached the question defensively; yeah, there might be just a bit of hypomania here (might) but that doesn’t mean that I can get myself to do anything, despite how much the two things may appear to contradict each other. Meh – isn’t most mental illness contradictory in its own way? To my surprise, she understood that the states of mania and avolition can co-exist. A few more plus points.
Minus points for the inevitable CBT* question:
So, Karen, if you can’t motivate yourself to do anything significant during the day, I’m assuming you rarely go out?
Well, I’ll go out with the man at weekends, and if I really have to, I’ll go out with my mother or close friends only at other times. But I have to be with one of them.
Okay. Why can’t you go out alone, should you have reason?
I can come here [to the CMHT], or to my GP or whatever, alone, because I know these places well. But elsewhere, I’m at risk of panicking due to crowds or unfamiliarity or God knows what.
Okay. Have you ever tried CBT?
(I should explain briefly: I’ve had cognitive behavioural therapy, and I loathed it with a passion. I doubt its touting as a panacea on two fronts: (1) whilst I am sure there are capable therapists somewhere, as far as I can see most CBT therapists are very much of the “…but have you thought about it like..?” school, which is not in anyway helpful, and which – in fairness – is probably not proper CBT; and (2) even if you could find a ‘proper’ practitioner, mental illnesses are individual – it may work for you, but that doesn’t mean it works for me, and vice versa.)
I shouldn’t have got annoyed with her, because she doesn’t know I think CBT’s a crock of crap. I’d have thought she should have known from my notes that I’d tried it and it failed, though, and that I’d already expressed a strong preference for dynamic/analytical therapy. But whatever; she didn’t, so I apprised her of the facts.
So you’d not want to go down that route [CBT] again?
I actually wasn’t particularly hostile, but I made my views known. Plus points again: that was the end of that. I know that, particularly in the current climate of NHS cuts and hideous remodelling, short-term interventions such as CBT are virtually compulsory flavour of the month – even if a
service user patient should object. Despite this from-on-high trend, as soon as I pointedly said ‘no’, she let it pass. Had she been another person, I may have been ‘encouraged’ towards a six week course phased-in-discharge not-so-cleverly disguised as therapy. Of course, that would never have actually happened given my psychiatrist’s knowledge of and interest in me, but it doesn’t mean that a different CPN wouldn’t have tried it – and made me very angry in the process.
We talked about the whole idea of recovery by ‘little steps’. You may be surprised to learn that despite the fact that I’m extremely cynical, I actually have some faith in this. Not on its own, obviously, but in the sense that jumping in at the deep end – eg. going back to work full-time tomorrow or something – is dangerous (or at least it would be for me).
My CPN appeared to really ‘get’ that the avolition is so strong that it makes even the tiniest things akin to climbing a mountain. I was genuinely pleased when she said that, for now, even making a cup of tea when I get up is an achievement (usually even that’s too much effort, but the vast majority of people just can’t understand that – they think it’s mere laziness which, whilst it’s inaccurate, I can understand. But I’m really encouraged that this woman doesn’t hold the said view.) She understood that leaving the house – even putting phobic issues aside for a minute – is very difficult, and said that she accepts that it’s something that may take a while. She didn’t put a timeframe on anything, which is good, but if tea is my first step, then going to that mythical place called Out is something to build upon in the slightly longer-term.
We talked about the fact that the Seroquel is now down to 300mg, and how that’s affected me. It’s totally screwed with my sleeping patterns, but other than that I feel grand; no dip in mood (indeed, as I said, if anything I’ve had a slight hypomania recently) and there’s been no sign of any psychosis returning. I’m glad that she doesn’t seem to be anti-medication, because I’ve always relied on having relatively heavy doses of the stuff, and am firmly of the belief that it is one of the most effective ways of managing my mental illness. I respect others’ reasons for not feeling that that is appropriate for them, but it has always been helpful for me.
And I suppose that was about it really. Overall, I felt that she was ‘on my level’ and willing to work with me as much on my terms as on her’s. Which, don’t get me wrong, is the way it should always be – but sadly it isn’t. So, so far, so good. Based on this first meeting, I think it’s a real shame that this relationship is doomed to last such a short period thanks to the whimsical attitude of NHS mental health services. It could be weeks, or it could be months, and they’re not even doing their patients the courtesy of being more definite, so it’ll be all change in an instant. This is about the last thing you need when you’re mentally ill.
We’ll just have to see how it goes.
*Whilst looking for a CBT picture to use in this post, I was interested and surprised that Google presented me with a discerning collection of BDSM photographs. Apparently, another form of CBT is ‘cock and ball torture’. The psychological treatment sounds about as attractive as the sexual practice. I edited the image using GIMP, appropriately and amusingly enough 🙂
Picture credits: see outgoing links. The second and third images have been substantially modified by me.
PS. I owe a couple of you emails and/or replies to previous comments. I haven’t forgotten; I’ll do it very soon, I promise! K <;3 xox