Monthly Archives: January 2013

#TimetoTalk

I few days ago, I posted a tweet that got quite positive feedback, using the hashtag for the Time to Change campaign #TimetoTalk.

Screen shot 2013-01-27 at 14.51.48

Over the past couple of months, the process of talking to my partner, seeking professional help and starting this blog has increased my confidence about talking to my friends.

The friend from my tweet, C, was aware I was experiencing low mood from a brief conversation we had back in August. She’d said that she’d also been feeling low, but neither of us had spoken about it since. Even though she’d disclosed, to me she always seems strong and able to cope and I felt embarrassed to tell her that I wasn’t coping.

C has been away for a few weeks and during that time I’d finally disclosed my mental health problems to a mutual friend, S. I didn’t ask her to, but I knew S would probably tell C.

On Wednesday evening, I’d just left my last meeting and was heading back to the office. C rang my mobile and I ignored the call. In the office, a colleague mentioned that C had popped by to say hi. Again, I ignored it. I was supposed to be going to an event but decided I couldn’t face seeing people and headed home. Halfway home, C texted that she had another commitment but would be coming for the end of the event and did I want to go for a cup of tea after? I started typing that I wasn’t going, but then told myself that I need my friends, forced myself to change my mind and texted back to say that would be perfect.

The event was inspiring, but most of all, a cup of tea with C afterwards was exactly what I needed. She gave me the space to talk, but left it open for me to make the decision as to whether I wanted to.

C: So how have you been?

Me: I’ve been okay. Have you spoken to S?

C: Yes.

And then she just waited and let me speak. And when I eventually moved onto another topic, she didn’t press it, but moved on with me and we had a laugh and a chat like we normally do.

C had sent me two emails earlier in the week that I’d ignored, and I later realised she’d messaged me on Skype too. I also found out that she wasn’t planning to go to the event at all, but my colleague had said I’d be there, so she went specifically to see me. I’d ignored her several times and yet she persisted. I feel lucky to have a friend who is secure enough in herself to not take it personally, and who cares enough about me to push the issue.

Which brings me back to #TimetoTalk. There’s a similar campaign in Australia, called R U OK?, which I’ve always disliked. People have asked whether I’m okay before and it always makes me defensive. It makes me feel that it’s obvious that I’m not coping. When someone asks, “Are you okay?”, what I hear is, “What’s wrong?”, and that’s never a helpful question.

Time to Change have created some films for the #TimetoTalk campaign. I particularly like this one, Isaac and Aronda. Aronda says, “I’d say, get the kettle on. Create a space where you can just focus on that person and ask how they’re feeling.” That’s exactly what C did for me, and it worked.

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Six weeks on Citalopram.

It’s six weeks since I started taking Citalopram. As I’ve mentioned, I track my mood on Mappiness. The graph below shows how happy, relaxed and awake I’ve felt between the end of November and mid January. Overall, I think there’s been a slight improvement, although it’s not particularly clear.

Mappiness 2012-13

A comparison to the same period last year provides even less clarity (there’s more data here, as I was tracking twice a day): I had a more pronounced upward trajectory this time last year, when I wasn’t on medication.

Mappiness 11-12

I saw the GP for a second follow-up on Thursday and mentioned that although I felt a bit better, I had noticed a similar pattern last year so wasn’t confident the change was due to medication. He didn’t really accept that explanation:

GP: I mean it can be a combination of things. Normally around the winter months, there’s less sunshine of-course, it affects people’s moods. And if you are pre-disposed to developing low moods anyway, probably it can make it a bit, exaggerate its effect. Now, ah, the other thing about the tablets is that ah, sometimes you don’t see the effect because it’s so gradual and what tends to happen is the only time that people realise it’s working is when they come off, and then they realise that it was working. So I think, you know, they’re actually working.

It’s winter now and I was telling him that I’m feeling a bit better, so his explanation made me feel that he wasn’t listening. From our previous conversations, I feel like he is very confident in the efficacy of SSRIs and that it would be very difficult to change that belief.

I’ve also felt in my two follow-up appointments that he’s not really interested in psychological treatments, and has only offered it as a complementary treatment because I wanted it. This time, I don’t think he would have even checked in about the counselling he’d referred me for, except that I brought it up.

GP: You still feel bad about yourself, self esteem?

Me: Yeah, that’s, yeah that’s still there. I’m gonna start counselling with Mind, but that’s not for a few weeks.

GP: Okay, okay. You managed to get hold of them.

Me: Yeah, yeah. So I had my assessment but I’ve just got to wait for them to allocate me a counsellor.

GP: Right. Great. Concentration?

He didn’t change my Citalopram dose, but gave me a repeat prescription and told me to come back in 3 months. I left my third appointment feeling frustrated. In my own line of work (a different health field), we talk constantly of “partnership-working”. In my first appointment, the GP gave me the phone number for Mind, but he drastically under-estimated how long I’d really have to wait to access counselling, didn’t know they offered evening appointments nor the actual cost, and he couldn’t tell me what type of counselling they offered. Now, he knows I’ve accessed the service but he’s not interested in knowing anything more.

It strikes me that once I start counselling, my counsellor will probably have the best insight into how my mood is changing. But there will be no discussions between my counsellor, my GP and I about these changes and my medication. This leaves me stuck in the middle, responsible for coordinating my treatment, and trying to communicate with a GP who believes that antidepressants are the best answer.

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A counselling assessment.

I had my counselling assessment on 7th January. Here’s what I posted on twitter straight afterwards.

Twitter 7Jan2013

I’d been referred to my local Mind, but I had a flat bike tyre and it took me 40 minutes to get there. It was an area I’d never been to, in a bleak housing estate. I was buzzed into a courtyard where a group of older men were smoking; I had to ask them for directions to reception. As I walked in, the receptionist signalled for me to wait while she finished a counting task. She finally asked my name, rang up for the counselling coordinator and asked me to wait. I sat down on the one seat available, squashed between a cupboard and a second chair which was taken up with a huge carton of sugar. Several more people came in. The tiny space got crowded and everyone else was standing, so it felt like they were all on top of me. The door was open; the room freezing. I took some notes as I waited:

This feels like a place for people who are sicker than me. It feels like all the places I walk into through my work. I want to walk out now, go to work, find myself a private therapist and ask P to help me pay for it. This doesn’t feel like a place for people who work, it’s a place to go during the day if you have nowhere to be. I feel claustrophobic and like I want to cry.

I’m aware these feelings seem judgemental. What they reflect is my anxiety about being displaced from the position of ‘professional’, with the status that comes with it, into the vulnerable position of ‘service user’. This was part of the reason it took so long for me to seek help, and sitting in that reception, I felt out of control and wanted to run.

Perhaps the receptionist picked up on my discomfort, because she sent everyone else outside to wait and asked if I was cold and needed the door closed.

Eventually Liz* came down to collect me. She looked younger than she sounded on the phone, and seemed friendlier. She took me upstairs to a small but comfortable room. I noted that she positioned herself closest the door. I know that she does that is so she will have an easy escape if I turn violent. Liz told me that the only reason any of my notes would be shared would be if they were subpoenaed, which was a relief given concerns I’ve had about information being on my medical record. She asked detailed, difficult questions, but was gentle and empathic and I trusted her. I disclosed pretty much everything, and I cried a lot.

She asked if I’d been diagnosed in the past and I told her about the Borderline Personality Disorder. She later asked whether I’d been angry at that time. I said yes, and that I suspect that’s why I got the diagnosis: women aren’t supposed to be angry. She laughed and nodded, which I liked, and said, “We don’t do diagnosing here.” She clarified that their counsellors work from an integrative approach, which means they draw on a range of theories in their practice. I’d been worried they would offer cognitive behavioural therapy, which I’ve found unhelpful, so was glad she agreed that CBT wouldn’t be appropriate. As she said, I don’t know why I’m feeling the way I am, so I need therapy that allows me to explore where my feelings are coming from.

The assessment took 35 minutes and Liz offered me 12 sessions of counselling. I need a female counsellor in the evenings or on the weekend; she thought she would be able to allocate me an someone next week, but would call to confirm. I left wishing that Liz could be my counsellor, but feeling hopeful that her approach is reflective of the ethos of the service. She called back this week, but unfortunately can’t offer me a counsellor for another five weeks. I’m going on holiday then, so I won’t start counselling until the first week of March: three months after my first GP appointment.

*not her real name

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Self help.

It’s been just over a month since my first GP appointment and today is the day of my counselling assessment with Mind. The new year was a reflection point and helped me to think of 2013 as the start of a journey towards recovery. I would have liked to access counselling quicker, but in the meantime, 1st January provided an opportunity to set some self-help resolutions aimed at taking responsibility for my own recovery.

I use Mappiness and because I’ve been using it for a while, I have good statistics in there about what activities are associated with me feeling happier. I used this to devise these strategies and I’m recording my progress with them using Evernote. My iPhone is a great tool to keep track of my mood and what works in stabilising it.

1. The Good List: record one good thing that has happened to me every day. It doesn’t need to be big, just a reminder that my life is full of good things. This was inspired by Facebook’s Year in Review, which reminded me that although last year was tough emotionally, it was full of incredible experiences.

2. Listen to music for half an hour a day: music has always been an important part of my life, but when I’m down I often forget to use it as the positive soundtrack that it can be.

3. Read a book every day, even if it’s only for 10 minutes: when I’m feeling low, I can spend hours reading ‘stuff’ on the internet that often makes me feel worse. Putting the screen away and reading a book creates a different space in my life and I feel like it stimulates my creativity. And it doesn’t have to be ‘happy’ reading (I’ve just finished The Bell Jar).

4. Only 1 hour of TV per day: I can get sucked down the hole of endless hours of crap TV, which helps switch my mind off but encourages my feelings of emptiness.

5. Cook 1 new meal from recipe per fortnight: I love cooking for pleasure, I hate cooking when I have to. This is designed to bring back some of the pleasure of cooking into my life and I’m looking forward to exploring Hugh Fearnley-Whittingstall’s Veg.

6. Four days off alcohol per week: I often end up drinking frequently, generally tied to social activities, but I know that alcohol really impacts on my mood. I need to learn to go to the pub and order a soft drink or juice.

7. Get to the pool or gym three times per week: Exercise does help me sometimes, but when I get into it I can get a bit obsessive. A goal of 3 times a week is also about keeping it moderate. I’m training for a 7km run in a few weeks, so the fear of embarrassing failure should help motivate me (still not quite sure if this resolution is a positive coping strategy?).

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