PSYCHIATRY AND THE JEDI

I know she (the clinical psychologist) meant well. I know her presence there was designed only to make me feel more comfortable. But I wonder how he felt (the psychiatrist), having his diagnostic interview scrutinised by her (a senior psychologist).

Was he behaving naturally? Or was he putting on a show for her? as well as patient me.

It’s difficult, I imagine, to be someone’s psychologist (who has known and worked with pre and post breakdown in therapy), and to watch on passively while someone tries to psychiatrically interview/ diagnose your patient.

She (the senior clinical psychologist) knows me so well. He (the psychiatrist) has known me, by contrast, for somewhere approaching four hours. Yet he yields ALL the diagnostic and decision making power.

He is the one asking me the questions, and I am the one telling him what I think is important to describe, but what did that third party observer actually think? She jumped into the conversation and helped me out a few times. She added bits which were right to be added; bits that I was too mentally and emotionally overloaded in that situation to say. She also reinforced bits that I said, by saying words to the effect of “yes psychiatrist man. Definitely include this in your diagnostic report- this particular shit matters very much.”

But I guess she might have felt a little powerless? Not used to being in a situation where she was not the primary mental health professional leading the clinical patient/professional dance.

So what is the difference between clinical psychologists and medically trained psychiatrists? Psychologists in the UK (and I assume worldwide) are not allowed to make diagnostic decisions about their patients or clients. They can offer suggestions, but they cannot impose their professional opinion to the extent that they can make an official mental health diagnosis that adorns your medical records. (They also cannot prescribe meds).

That is the diagnostic power only reserved for the Jedi. (The psychiatrist/the person you call Doctor.)

“The Jedi” was the main nickname for my previous psychiatrist….

The psychiatrist is a professional that yields their power like a DSM/ICD aware light sabre. Whoosh. Whoosh. I have the power! etc etc. (The DSM and ICD are the manuals listing the criteria for each subtype of mental illness).

But it is the clinical psychologist that usually knows you way better than the diagnostic power yielding light sabre-ish doctors of mental health medicine-the psychiatrist.

Clinical psychologists offer the therapy that is there to facilitate improvement in your management of your illness. Doctors usually only offer prescriptions and their opinions.

Clinical psychologists are the class of professionals in the mental health world that I admire the most. Is that only because I’m a psychology graduate myself? ūüėõ Am I just biased towards protecting my own discipline or school of study?….. Well, I don’t think so. I have the upmost respect for them because they help me the most. I have worked with three of them now, and they satisfy me emotionally and intellectually in a way that just doesn’t apply to community psychiatric nurses (CPNs), support workers, person centred counsellors and psychiatrists.

But the psychiatrist has the power. They can detain you under the mental health act (in other words ‘section’ you). They can change your medication. They can take away your driving license even.

The doctor ALWAYS has the most power. Yet they spend the LEAST time with you! and understand your complexity and set of symptoms THE LEAST.

Usually in a community mental health interdisciplinary team, or a hospital equivalent- the psychiatrist is invariably the lead professional (in ultimate charge of a mentally unwell patient), but who said psychiatrist’s must be in the lead. What race did they ever win to determine they would be the designated top dog of mental health care?

They don’t spend fuck all time with you! So how can they be most critically important in a interdisciplinary team of mental health professionals?

A medication review can take as little as 15 minutes. A full psychiatric history can be taken in as little as an hour and a half. I spent 4 hours with this psychiatrist in this case, spread over two appointments, but that was only because he TALKED SO FUCKING MUCH HIMSELF!! I would estimate about 70% of the time spent with me with him talking! And not only that, he yields 100% of the power.

He has the power to talk at length about what the hell he wants to talk about. He has the power to the set his own diary of appointments and manage his time. He also has the power to change your diagnostic assessment appointment into his own wannabee TED talk! Which brings me onto the key hypothesis of this post (which may well offend psychiatrist’s or partners of psychiatrist’s, so please stop reading now if you are associated in any way with this breed of Jedis).

I think it is maybe impossible for a psychiatrist to do their job, without, over time, developing certain personality traits of narcissism (if they are not already a narcissist)

Boom. I said it!

I will let my (provocative) hypothesis sink in for a moment…..

I have not so far met a psychiatrist that I have NOT detected some evident narcissistic traits in!

I liked the doctor I saw, don’t get me wrong. He was very helpful at times, very sweet and considerate, and also very personable and engaging, dare I say charismatic. I don’t dislike him at all, and this post is not a personal slur on him, per se. I am merely making a sweeping generalisation (which may or may not be true ūüėāūüėā) that grandiosity is a trait I have seen time and time again in all the doctors/Jedi’s I’ve come across.

From their point of view, I think it must be potentially very difficult to perform that role and yield that level of power over others on a daily basis without eventually starting to actively enjoy that power and basically starting to believe your own hype. Patients and other clinicians and organisations deferring to you and obediently responding to your requests and listening to your opinions as though they are fact, AT ALL TIMES, must evidently go to your head after a while.

You are the doctor. Therefore you are the ultimate god/goddess of mental health professionals. Truth. Sorted. No questions asked. End of sentence. Done.

Psychiatrists, in my experience, tend to present opinions as though they are facts.

Sometimes they will even fall back on the classic clich√© of saying “I’m a doctor”. [Ergo I know this to be true?]. They will typically remind you they are a doctor, either before or after they state their OPINION, and they think we will therefore respond to their opinion as though it were truth; an unequivocal fact.

TRUST ME, I HAVE A DEGREE IN MEDICINE. THEREFORE I AM ACTUALLY AMAZING AND INVINCIBLE AND BLOODY FANTASTIC.

But most clever people know that there is no such thing as a fact. There are instead multiple truths, and multiple angles, and multiple hypotheses which all need and demand our attention.

In my blog, I will admit to often presenting my opinions in a very definite style, but this is blog life, not real life, and the only humans I really exert any proper influence over in my real life are my children (and husband in times of PMS!).

I am not a doctor or practising psychologist. I have no power. I only have blogger power, by stating my words as though I mean them, but most of the time I simply present my opinions in definite ways when blogging just because it’s my blog innit- my place to express myself in a very self-expressive cathartic way. But doctors do blogging (not literally, but metaphorically) by expressing their opinions as facts in their professional lives every day. No wonder they develop a grandiose sense of their own importance as they play doctors with their sectioning/diagnosing/prescribing light sabres.

It is IMPOSSIBLE for me to meet a psychiatrist without getting a comical picture in my mind develop of them yielding a light sabre, complete with whooshing noises, as they make a point of psychiatric importance, in their’ doctor-ish I’m in charge’ way. It makes me want to giggle and blurt out my hypothesis that they are some of them mainly all of them are total narcissists, and this makes me wanna LOL.

This is how I visualise them. (I am the unicorn).

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I have a brother who is a doctor, and also a narcissist, so I have observed a doctor’s narcissism at very close quarters. I have the insiders view of narcissistic doctors, because I listened to all the narcissistic bollocks he used to say away from the consulting room, about his patients. He was not a psychiatrist- he was a GP, but a narcissist he most definitely was. And that is what I see in all the psychiatrists I’ve ever seen, therefore it MUST be true!

To sum up, psychiatrists are Jedis, and narcissists, who present opinions as facts, who believe they are the best, who never tire of reminding people “I AM A DOCTOR, don’t you know,” before they make their educated guesses about what is wrong with you and how you can be helped, as though there is no other option available, and meanwhile, the clinical psychologists, who actually KNOW YOU and spend decent amounts of time with you, and understand you inside out, do not get awarded that same level of respect.

The psychiatrist I saw, did a whole lot of stating the bleeding obvious, making patronising suggestions to my clinical psychologist/therapist about simplistic treatment strategies that she started doing FOUR FUCKING YEARS AGO, as though they were startling revelations, and not only that, he prefaced every sentence he said by saying I AM A DOCTOR, as if it were possible for me to forget. He is a doctor, therefore he is God, and the Jedi, and clinical psychologists and patients must do the fucking obvious things he says we must do, and then I will get better and all will be well.

For a doctor who claims to be the expert, my faith is in my psychologist, who has a clinical doctorate but does not call herself a doctor. She quietly goes about trying to help me week in week out, with no fanfare, no prefacing everything she says with I AM A PSYCHOLOGIST, THEREFORE THIS IS SURELY TRUE, and she does not have that narcissism that seems to me to be reserved for the doctor of medicine.

What do you think of my cheeky hypothesis? Do you observe grandiosity and arrogance in the psychiatrists/doctors you see? What is your view of the usefulness of psychiatrists, relative to other mental health professionals? Is your psychiatrist a Jedi? And next time you meet them, will you be visualising them showing off, yielding a whooshing I am a dfoctor therefore I am most clever and important light sabre? I know I will ;)

WHOOSH!

 

summerSHINES©

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MY [EMPTY] SELF

I’m bored of myself. Bored of my [empty] self. Bored of what I write.

I am really sorry my blog posts lately have been so uninspiring in tone. I feel actively and most passionately mundane, supressed, deflated, dull, pedestrian and un-shining.

The last time I was inspired was yesterday, which seems both not long ago while simultaneously VERY fucking long ago.

On Tuesday I wrote my piece for the local paper about mental health. I felt inspired then. I also felt proud yesterday when the charity CEO asked for my permission to share what I’d written with the team and when my social media idea was launched on world mental health day. But today, all that pride and gratefulness and positive feeling has drained away, and this is sadly the way it seems to go.

I cannot grasp hold of those amazing euphoric warm fuzzy feelings that I get and keep them.

They slip like sand through the hourglass with the passage of time…and not very much time elapses, usually.

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Emptiness is my ‘usual’.

I am feeling acutely aware of my unmet emotional needs just lately. I know why this is. It’s since the whole Facebook saga where I caught a glimpse of photos of a family wedding that I remained uninvited to and left out of.

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I saw evidence of their life going on, and I wondered why mine was not. That has made the inner emotional emptiness absolutely un-ignorable (I’m hoping that’s an actual word?!).

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Long-term therapy is what I need to get anything close to “well”, but as I can’t afford to pay for a therapist privately, I am reliant on my NHS psychologist not dropping me off her caseload too soon.

I said to her that therapy is okay and great and all that, but it is nothing like as nice as the warm fuzzy feeing that comes from having an attentive family; people who are there to stay and to love and support you as long as you need them. My therapist cannot maintain what she does for the rest of my life. She is here for a period of time that she will never ever tell me the proposed length of. I cannot know that I have a few more months, or a few more years or any kind of estimate. She simply refuses to do this.

She claims that I will not always need her, and I will naturally want to break away from her when the time comes. I tell her that is BOLLOCKS and will surely NEVER happen! I just can’t see it. I can’t envisage EVER feeling that her addition in my life is unnecessary or counterproductive or counter-therapeutic.

I am uncomfortably attached to a pretend mother figure who isn’t really my mum and never will be! and I know she isn’t really my mum, and she knows she isn’t really my mum, and we just basically play a weird dance of pretending that she is re-parenting me and teaching me psychological life lesson stuffs, and I go to the office weekly and have a good old cathartic cry, and then miss her inbetween so email her as I want to tell her psychologically relevant stuff that she MUST know that second, and then she finds me bloody intrusive and annoying (I would imagine) as I am eating into her time, and I know I’m eating into her time so feel awful and stupid and pathetic and demanding and fucking guilty, and then she knows and I know that the whole fucking shambolic mess of pretences and client-therapist exchanges would never be happening if I’d have had a less shit childhood, and at the end of the day it is all BOLLOCKS, but bollocks that if I didn’t have would cause me to become very fucking unwell, which is hard to imagine really isn’t it? as even with therapy and shit I am still fucking miserable and recurrently suicidal and fighting off impulses to do totes dangerous things like jump out of windows and carve into my skin with blades and swallow more tablets than I should be swallowing….and I really should be stopping this grammatically poor and overly LONG sentence NOW.

And breathe.

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I’m sick of having a empty space in my empty self.

I want to feel full.

Food doesn’t do it.

Booze doesn’t either.

Or sex.

Or Netflix on demand.

Or beach walks.

Or candle lit evenings with hubby.

Or meditation.

Or shopping.

Or writing.

Or drawing.

Or cleaning.

Or bleeding.

Or talking therapy.

Or coffee with good friends.

Or reading.

Or learning.

Or music.

Or nature.

Or hugs.

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Or praise.

Or reassurance.

Or expressions of love.

The only thing I’m full up with, is my own inner emptiness.

I am crammed full with emptiness, and weighed down by the weight of my (empty) self.

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summerSHINES©

 

INTO THE BLUE

What I sent to my therapist just now….I’m publishing it, because when I email my therapist I feel more comfortable expressing my vulnerability than I seem to on my blog. With her I can lay it all out. It’s a release. I found this because it helps me in the moment.

Also this is my official blog reintroduction to my renamed blog ‘Into the Blue’.


Trigger warning- This is a #no filter letter. **Refers to self-harm and suicidal ideation.

“I’m feeling the need to email you again, probably because I’m feeling vulnerable.

I would be speaking right now if I had gone to London. I’d be there speaking and schmoozing and being all media-ish. But I’m not there, I’m here – where I always am. Limited. Resentful. Sad. Aching. At home. Deep psychological stuff is going down, and I feel horribly alone, (like I almost always do).

The days are ok as I can stay in my bubble, but the evenings are hard. Darkness is threatening. Next week is the full moon. Autumn is here. I feel cold inside, matching the cooler temperatures of the air.

Enough waffling bollocks. Why am I emailing you? What’s wrong? Why am I so threatened? Why can’t I cope alone? Why am I such a grown up underdeveloped child?¬†I feel like I’m heading for a breakdown¬† (how many times do I say that! I feel like this almost ALL the time). Something is in the air, but I can’t quite put my finger on what it is.

The inner panic is quietly building. 

I’ve been trying to explain to the kids about why I can’t do the speech, and they are asking why I always change things last minute and change so much. It made me sad. I want to be stable and not chaotic and stormy and unpredictable.¬†


I am tired of feeling desperate and fighting self harm urges. Suicidal ideation is always there, even if occupying a small space in the very corner of my mind. 

Living with the constant thought of dying is pretty ‘conflicting’ I’d say.¬†


My death wish is strong currently because I feel so despondent.¬†I know I’ve had successes, but there are more disappointments, hurts, and failures than I’m comfortable tolerating. Dealing with the difficulties feels fairly beyond me.


You said to have hope, but it’s draining away and not in constant supply….like a bathtub where new water is getting added but the plug isn’t in, so the draining action offsets the new water being added.¬†

Yesterday I was emotionally flooded. Today I’m dry and empty.

I have thoughts about suicide being beautiful, more than life. Most people would say I’m glamorising suicide. I say instead it is people who glamorise living.¬†

I’ve changed my blog and revamped it all. It isn’t ‘Summer Starts to Shine’ anymore, because all this self-imposed pressure to shine makes me feel like a miserable fucked up failure. It’s now ‘Into the Blue’. That’s where I’m escaping…hopefully out of the black, into the blue, with no further pressure to shine. It’s darker and more mysterious, like a deep ocean.¬†¬†


I don’t know where I’m headed, but I know I can’t stay where I am. So I have to bust some moves….. I just haven’t worked out what they are yet.¬†


That’s me. Stream of consciousness.¬†The younger dissociated parts of me are quiet for now. Right now it’s just me in here. That’s maybe why I feel so empty? I guess I just miss the company.”


SummerSHINES 


DINNER PARTY OF ME

I appear to have lost my writing mojo a bit lately…at least on the blogosphere. I am writing plenty, but it’s for real-life, non-cyber stuff. My volunteering¬†life behind the scenes¬†is BUSY, and for that I am very grateful at this moment, as it is successfully¬†keeping my post-traumatised feet planted¬†securely in the present.

I type this post slightly tipsy on Cava, feeling very very tired. I can’t wholly make sense of what life¬†has been¬†about lately. It’s all so HUGE in it’s hugeness, and unsettling. It’s been emotional and unsettled and tumultuous, but I’ve learned lots and I’m still standing and¬†starting to¬† polish off the smudge that had been dulling my shine.

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All weekend I’ve been getting my head in the game for the charity fundraising event that I’m organising. I have support from various places, which I so appreciate, but¬†it¬†has largely been an individual process. This event is my baby, my thing, my personal contribution to my community. It is my chance to put something back in, when once all I was doing was taking.

I don’t feel guilty for taking when I was very poorly. I don’t feel guilty for taking the support that was offered. I also don’t feel guilty¬†for demanding even more from people than was even offered at times. My very survival was at stake, so taking the help from the tablets, the doctors, the nurses, the support workers, the psychologists- that all had to happen. Still sometimes I need that scaffolding of support around me to keep¬†me whole and safe and in one piece. Feeling despondent about that¬†is both natural, but also, I recognise, a¬†complete and utter waste of energy. What use does guilt serve? Apart from creating secondary suffering on top of the suffering you are already partaking in.

I try not¬†to¬†indulge in¬†guilt these days, and champion action instead. As long as I am¬†taking¬†positive actions, the secondary layer of suffering, namely guilt can ‘do one’, and jog on as far as I’m concerned. Actions¬†are the counterpoint to¬†guilt. Apologies and reparations need not be ruminated too excessively on.¬†Just apologise, learn those lessons, and move on…quickly.

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I feel like I’ve moved on¬†bloody well actually. I am not in crisis. I am not upset as I was. I am stabilising and regaining my strength and feeling more and more inner peace again. I am¬†remaining in healthy adult mode without regressions or overpowering dissociative spells. The suicidal feelings are leaving me the hell alone, same with the urges to hurt myself in ways I find strangely therapeutic. All in control. All OK. All good, which is good :)

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I’ve been introspecting a great deal lately about the dissociative aspects of my personality- the multiple parts of me, and what that means for the goals of treatment and my therapeutic journey still ahead. These are big issues (if you are me). But you reading this are ‘you’, and you may think my big issues are small issues. You may not even understand what dissociation is, or dissociative identities, or multiplicity, and because of the cava I’m too tired to explain right now. I’ll leave you in the capable hands of the search engine Google for those definitions.

But this has got me thinking, how crap it is to have a life, and a mental health disorder/life story/traumatic jigsaw puzzle that is¬†SO complicated that I’m too tired to even attempt to explain it in words on the internet (with or without cava). It is tough to have a set of psychological symptoms that are so hard for¬†anyone, let alone a stranger on the internet¬†to get your head around without a dictionary, and preferably also a degree. It is hard because people don’t get it, and even when you try and explain it, it is still not always obvious¬†whether or not¬†they’ve ‘got it’. Anything that is unusual is scary, and anything that is hard to explain is something people struggle to even believe is true in some cases.

Time for some big conversations with my psychologist later this week. I’m going to thrash some issues out with her honestly¬†(in the nicest possible way), because every so often in therapy I believe there needs to be some joint soul searching as to where the hell we are going with all this. I am having long-term therapy. An end point to¬†all this¬†is unspecified. I know the therapy is not unlimited in amount, but I also know she isn’t going to be hurrying me out the door in the next few weeks, so there is still time to make a substantial impact and take the therapy along new pathways.

I know she is the professional. But I also have confidence in my own instincts and self- awareness as an educated insightful patient. I can think critically and originally and independently. I don’t need to be guided on everything, and never will I accept any unquestioned¬†psychological spoon feeding. I will take guidance where guidance improves me,¬†and I will listen to feedback, but I will also¬†stay firm in my belief that therapy is not something done to us, it is something that is two-way, reciprocal, and will work best if both parties communicate honestly and transparently at all times.

That is how I approach life generally, with transparency. I¬†ponder what the truth is, or rather what my truth is, and I express it, in the most simple straightforward way possible. I don’t¬†pussy foot. I don’t remain uncertain for very long. I am decisive and constantly moving. My constant emotion translates to constant energy-in-motion.

Therapy must evolve, just as must people. Stagnancy is the worst feeling ever to me. As is indecision, lack of passion, numbness, emptiness. Therapy can become empty at times…or maybe¬†I might be¬†simply mistaking that emptiness for security, which in itself is alien to borderline EUPD/always stressed¬†PTSD¬†me.

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I need some than safety and stabilisation in therapy. I need exploration, and not just the interpersonal stuff that we’ve already talked though till I’m blue in the face and she is yawning. I need to learn about my multiplicity. I need to revisit all that. My dissociative nature and my fragmented identity is EVERYTHING to me right now.

I want to learn the parts of me and who exactly knows the other parts (co-consciousness) and who communicates with who and what functions those individual but separately functioning aspects of me are there to serve in this spaghetti sauce mess of a person.

Self-examination is needed, and I need my guide to help me, and really delve deep into the muddy mess so we can work out what is salvageable, what bits work, and what bits I just don’t want to entertain in the unruly dinner party of me¬†anymore.

Too many cooks spoil the broth, and personality ingredients, not yet specified, make it fucking hard to follow any recipe.

Sack the waiter, go easy on the salt and seasoning, turn down the infernal noise in the dining room, and let me just work this out- just you and me. Help me to work out how this works. Then, just maybe,¬†I might find some peace. I’m starting to regain it, but I need to get this dinner party of unruly guests under control. I need to get my psychologist on board to help me do that-she is my missing¬†ingredient. I’ve missed her. I’ve needed her. She hasn’t been here. She will be there again- I¬†possess a basic grasp of object constancy, even if it’s just by the very tips of my finger tips.¬†Therapists ARE allowed to take holidays in summer! I do forgive her.¬†I am ready for therapy this week though-that’s for sure.

summerSHINES©

PS. I haven’t proof read this before publishing. I’m too tired and too tipsy tonight. Hopefully it makes sense ;)