Tag Archives: depression

Nearly halfway.

It’s been weeks between posts and I’m now nearly halfway through my 12 counselling sessions. They’ve not been easy, and every Thursday afternoon I decide not to turn up that evening. But I haven’t missed a session yet. And I’ve been on time for every one. Moira, my counsellor, interprets this as me being strong and caring for myself. I think it’s probably got more to do with needing to be ‘good’ and not get in trouble.

I’ve had talking therapy before, and yet still I’d forgotten just how hard it is. How much I hate it. How I always feel more miserable leaving the room than I did when I stepped through the door. After my first session, I felt completely drained. After the second, full of rage. After this week, session five, I was overwhelmed. I knew I was depressed, that I’ve been feeling low for a long time. What I didn’t know is how deep those feelings go.

Moira is a good counsellor. Probably the best I’ve had. And I like her. But trusting her is another thing completely. I haven’t trusted myself enough to be honest about how I feel. Alone, with no chance of anyone hearing me, I can’t say out loud the things that are in my head. So trusting her enough to put those words in the space between us is a big project. I’ve spent five hours of my life with her. Or rather, just over four hours, since we have 50 minute session together. I’ve spent more time with acquaintances on a night out. Why should I trust her?

She’s an expert at building that trust, or ‘rapport‘ as it’s probably better described. And yes, there’s a lot more trust between us after four hours than I would have with an acquaintance on a night out. But it still takes longer than that. And sometimes, the empathy that builds rapport can also create a barrier to opening up.

Yesterday, Moira verbalised that she was feeling an overwhelming feeling of guilt and suggested that if those feelings were being transferred to her, it demonstrated the strength of my experience of that guilt. I was glad she told me, and I understood what she meant. Body-centred countertransference is a concept I know well from my own work. When she said it, it helped me acknowledge the strength of my feelings and accept that they were real. But here’s the thing about guilt: it also made me feel guilty. Guilty for transferring that to her, and scared that I had no control over that transference.

I have another six sessions with Moira. In that time, I want to work towards being able to open up to the people closest to me – and specifically my partner, P – in a healthy way. But what if meeting those needs for myself, what if that process of opening up, actually hurts someone I love? What if I pass on my guilt, my anger, my rage? And if I transferred those feelings to Moira, without me having really opened up, what will happen to her if I let it all out?

So I find myself nearly halfway through my allotted 12 sessions and I’ve barely started saying anything that’s really real. I worry that I’m setting myself up to fail. I’m opening the floodgates, and I’m going to leave myself stranded.

And the most perverse thing? I don’t want more than 12 sessions. I want it to be over as soon as possible. I hate doing it. But I believe it’s helping.

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This is a new day.

This time last week, I felt pretty rubbish. The counselling I’d been waiting for for five months had fallen through after I found out that my counsellor and I knew each other professionally. That evening, I told my partner (P) that I was thinking of giving up on counselling. I felt that that even if they found me a new counsellor who I don’t know, I may run into them professionally at some point in the future. I would find uncomfortable and compromising.

Our conversation went badly, to say the least. Given that I’d admitted that I’d also stopped my medication, P was anxious about me abandoning treatment altogether. He tried to engage me in a ‘rational’ discussion about pros and cons, and challenged me on whether it’s really such an issue if I know my counsellor professionally. I clammed up and the conversation ended when I burst into tears. I felt like he thought I was overreacting and that he was making no effort to understand how difficult the experience that afternoon had been. I felt isolated and alone. The discussion may have been helpful in a few days time, but a few hours after the abandoned appointment, I needed someone to listen to how upset I was.

The following day was a friend’s wedding, which was lovely, but socialising with lots of people I barely know is draining and at weddings I always drink far too much free wine, leaving me feeling even lower for the next couple of days.

I started the week with a plan to call Mind and take myself off the waitlist. I figured it would be weeks before another evening slot came up anyway and I didn’t want to risk the blurring of my personal and professional life again. But before I got around to it, the counselling coordinator called me with an offer for a slot with a different female counsellor, starting next week. It caught me by surprised that this felt like good news, and I accepted the appointment. I start my 12 weeks of counselling with Moira* on Thursday, and I’ve been feeling more positive since then.

And I got some more good news: a job interview. It’s a dream job and I’d submitted an application with the attitude of ‘you’ve got to be in it to win it’, but not expecting to ever hear from them. But I’ve got an interview. And if I was successful, I would be much less likely to run into my counsellor in that role. I know it’s still a long shot, but it reminded me that there are other jobs out there and that abandoning counselling because of my job is probably not the most rational solution to my problems.

I walked out of work on Friday evening, the sky was blue and the sun was shining. I was listening to Sally Seltmann, and with this song, I felt like things might just get better.**

 

* Still not her real name

** On the borderline is a pretty problematic song. Seltmann says that she wrote it as an ode to Princess Diana, who apparently had BPD. Whether Diana had BPD or not, the lyrics suggest Seltmann’s complete misunderstanding of what it feels like to have problems with low mood, seeming to prescribe to the notion of ‘drag yourself out of bed by thinking happy thoughts.’ Nevertheless, for some reason, it worked for me on Friday so I’m putting it here anyway.

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Today is the day.

Today is the day: my first counselling session. I would like to write about how I feel, but truthfully, I don’t feel anything. It’s been nearly five months coming, and today, I feel much like I did five months ago. Numb. Empty. And exhausted. Exhausted by the daily grind of depression, the heaviness of trying to get out of bed, the dissonance of putting on an enthusiastic face for the outside world, and the pressure of wanting to be ‘getting better’ for the people in my life who were so relieved to see me getting professional help.

I ran out of citalopram a week ago and can’t find the prescription slip to order a repeat. I could go back to my GP to get a new prescription,  but I’ve explained to myself that since I didn’t want to be on medication anyway, this is a good opportunity to see whether psychological treatment alone is enough. That’s the rational explanation. The truth is, the thought of seeing him again makes my heart beat through my chest, so I’m avoiding it.

Now today, I have to talk. But what to say? My life is good. I have a well paid, interesting job; a partner who I love deeply and have fun with; a nice flat in an area lots of people wish they could live in; good relationships with family; and lots of friends who I love and who care about me. There is no good reason for me to be unhappy. I could dig out supposedly traumatic events from throughout my life, but in my experience, that’s true of pretty much everyone. So that leaves me back where I started: what to talk about? In my last go at psychological treatment, I remember endless silences because I didn’t know what I was meant to talk about.

A couple of months ago, I requested a copy of my patient file from the psychiatrist I saw in 2004-5. It was hard seeing things written down about myself, things that I didn’t recall being spoken in the room. Words like “anorexia nervosa: partial remission”, “drunk today”, “borderline personality traits: see for further assessment”. There were also the letters between my psychiatrist and my GP, which I’d not seen before.

I feel she is suffering from a mild to moderate Borderline Personality Disorder. She describes a long history of labile mood, and has been self lacerating for the 2 years. She also bites her fingers to cause pain, and can also be reckless with spending and sex.

And a year later:

If she remains engaged in therapy she should continue to make slow but steady progress.

I dropped out of treatment a month after that last letter was written.

I feel reassured that this time I am seeing a counsellor without an official referral from my GP, so they won’t share information about me. But I know I suggested in an earlier post that it would be useful for them to share information. The point is, I want information shared in a way that includes me. I want professionals who are collaborating in my treatment with me. If they communicate, I should be copied in. Instead, I get a choice between uncoordinated treatment from two separate professionals who don’t know what the other is doing, or coordinated treatment in which I have no voice.

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#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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Booking an assessment with Mind.

The day after my first GP appointment, I called Mind to arrange counselling. I made the call sitting outside in the cold on my lunch break, trying to find a place where no one would hear me. I was anxious. The first time I saw a GP about my mental health, in 2003, I was also given a number for counselling. Back then, I was similarly sitting on a park bench making the call from my mobile. The receptionist who took my call insisted that I do an assessment over the phone, including the question: “Do you have any suicide plans?” I did. It threw me to be asked it so blatantly. I now know to be prepared for that, but back then it was my first ever contact with mental health services. I didn’t want to discuss my suicide plans over the phone, in a public place, and I was living in a house with 7 other people so there was nowhere I could go to make a private call. I asked her whether I had to answer, she said yes, and I hung up. She hadn’t taken my contact details and I didn’t seek help again for 6 months.

This time, the Mind receptionist put me straight through to the counselling coordinator, but I got her voicemail and left  a message. I was nervous about that because it meant I then couldn’t control when I took the call, but I didn’t want to put it off. Ten days later, I hadn’t been called back so I tried again. Again, it went to voicemail, I left my details again and waited for a callback.

This time, the coordinator responded the following day. Apparently she couldn’t make out my number in the first voicemail, so she was glad I called back. This seems likely: my phone is on its last legs and I’m hanging out for an upgrade. She took some basic contact details and said they can offer out-of-hours appointments if I can “make the time” to come in for an assessment during working hours. Because of the Christmas break, the next available appointment wouldn’t be for three weeks.

So my assessment is booked for 7th January and I received a confirmation letter to my home address, with a leaflet explaining Mind’s counselling services. It will be £15 per session as I’m working full time (significantly cheaper than if I went private), but there’s a limit of 8-12 sessions. I’m hopeful that will be enough, but if it’s not, I’m concerned that I will have built rapport with this counsellor and then have to stop and find someone else. They offer group therapy after individual counselling is finished, but group therapy sounds like my worst nightmare. My other concern about Mind is not being able to choose my counsellor. If I was going private, I would research counsellors beforehand, but here I have to go with what I’m given.

It’s a week now until my assessment. I still don’t know what to expect; the leaflet says it’s to “assess your needs appropriately”, but who knows what that means? I would have liked more specific information, such as what sort of questions I will be asked. The coordinator was also vague about how long I’ll have to wait to see a counsellor, as it depends on how “flexible” I am. I suppose that means I choosing between a short waiting time and seeing a female counsellor in the evening (my minimum requirement).

But I appreciated that the coordinator was kind, and at least she didn’t ask me to be assessed over the phone.

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My first GP appointment, transcribed.

Two weeks ago, I went to see the GP about my mental health for the first time in 7 years and I decided to audio record the interview. I was conscious that my memory of what happened would be influenced by my experience of it, so I wanted a more objective record of exactly how it went. And I wanted to be able to share it here, to give a better account of how it happened. This is my experience, not necessarily a representation of the service anyone else would get from a doctor in their local NHS practice, but it’s one example.

—————————————————————————————————————————

GP: Hi, come in.

Me: Hi.

GP: Hi, take a seat. [inaudible].

Me: Um. [pause]. I’ve had low mood for about 18 months now and I’m just a bit tired so [laughs], I thought I’d come to the GP and talk about it and see if there’s anything I can do.

GP: Okay. So what’s been going on?

Me: Um [sighs]. I don’t know if there’s anything in particular that’s been going on, it’s just, um [pause], yeah, I dunno, it’s just kind of [pause] continuous, so I don’t know [laughs].

GP: Right.

Me: It kind of goes up and down and it’s not as bad as it has been, but…

GP: Hmm.

Me: Um, I think, last time I came to the GP it was a while ago…

GP: Yep.

Me: I was going to talk about it then but I didn’t feel able to…

GP: Right.

Me: So it’s taken me a while to come back.

GP: Okay, right.

Me: Um. [pause] I’ve had depression in the past but that was quite a while ago.

GP: Okay. Were you on medication?

Me: Yeah. I was on Zoloft, and then on Citalopram.

GP: Okay. And how long was the treatment for?

Me: Um, it was probably, I think I was on it for a couple of years.

GP: Right, okay. And then did you finish the last treatment?

Me: Um, it was 2005.

GP: 2005?

Me: Yeah, a long time ago.

GP: So you’ve been okay since then?

Me: Yeah, ah, yeah, I’ve been okay, yeah. I was fine for a long time and so, yeah.

GP: Okay. So when did this current low mood start?

Me: Um, about 18 months ago.

GP: And ah, are you able to sleep okay?

Me: Um, it, it comes and goes. It’s not so bad at the moment, but it, sometimes it, I’ll wake up in the night. Like I’m fine falling asleep, but it’s just that I wake up quite early.

GP: Right, okay. So how many hours of sleep would you say you get?

Me: Um. At the moment it’s okay, I’m getting about 7 hours of sleep at the moment…

GP: Right, okay.

Me: But other times it will be 4 or 5.

GP: Right, okay. And your appetite?

Me: Appetite is fine.

GP: [inaudible]

Me: Ah, I have lost a bit of weight, but I think that’s just because I’ve been exercising.

GP: Okay, okay. Right. And any thoughts of self harm?

Me: Ah [pause]. I think about it but it’s not something I’m doing.

GP: Right. How often do you think about it?

Me: [pause] Um. Quite a lot, like it’s always sort of there, but I.

GP: Okay, right. But you haven’t got, haven’t got any kind of plans or anything? No? Okay. But have you self harmed, cut yourself or…?

Me: I have in the past, but not this time.

GP: Not now, okay. Are you in a relationship currently?

Me: Yes.

GP: And does he support you?

Me: Yeah. I’ve spoken to my partner about it, but only recently.

GP: [inaudible] right. Now, how are your energy levels?

Me: Not great [laughs]

GP: Right.

Me: I’ve just got that feeling of being kind of heavy, all the time.

GP: Right, yeah, okay. Are you enjoying things you normally enjoy, like going out with friends and things?

Me: Not really. Like, yeah [pause]. Not as much as, everything’s just more of an effort.

GP: Right, okay, okay.

Me: [inaudible]

GP: And alcohol?

Me: Um, I’ve been managing it, it’s not too, yeah. I probably should drink less.

GP: Ah okay, right. Drugs…?

Me: No.

GP: Smoking?

Me: Oh smoking, yeah.

GP: Right, okay. Now, um, the other thing is that obviously, you know, with a history of depression and the way you are feeling as well, I think you would know [inaudible]. Now compared to the last time you started on medication…

Me: Yeah?

GP: Do you think you are feeling the same or getting towards feeling, you know, the same again?

Me: Um [pause], yeah, it’s pretty similar.

GP: Okay. Did you have any counselling or…?

Me: Yeah.

GP: You did? Okay, right. Did you find it helpful?

Me: Um [pause]. Not [pause] hmm. I, well, I had counselling and then I was referred to a psychiatrist as well…

GP: Right.

Me: It [pause]. Yeah. I think I would like counselling again, but I didn’t have a very good relationship with my psychiatrist.

GP: Right, okay. Yes. Now, with the counselling, we can refer you to our psychologist.

Me: Mmm.

GP: And the waiting period is normally a couple of months or something.

Me: Okay.

GP: But then there’s a, a place called Mind.

Me: Yeah, I know Mind.

GP: Then they can give you, you know [inaudible]. And they charge, I think it’s £5 a session.

Me: Okay, so it’s not expensive.

GP:  So I can actually give you their number, and then if you would like I could [inaudible] probably you can do…

Me: Right, okay. I might give Mind a go.

GP: Yes, you’ll get in quicker.

Me: What sort of counselling is it?

GP: Ah, I think it’s one-on-one, yeah [inaudible] they decide the number of sessions you need to do, and then in combination with that kind of treatment I think maybe we’ll start you on some antidepressants as well.

Me: Okay.

GP: Because the last time we saw you was May last year, and if at the time you were having these issues and you couldn’t talk about it and it’s still the same now, then I think we should start you on some Citalopram maybe?

Me: Okay.

GP: But it depends on you, if you want to give the counselling a go first or whether…

Me: Yeah.

GP: …or do you want to, it depends on how you feel, you know?

Me: Yeah.

GP: The thing is, I think that you are probably moderately depressed.

Me: Mmm.

GP: And drug treatment may be beneficial.

Me: Yeah. I suppose I’m not quite sure about antidepressants, I’m sort of [pause]. Yeah. Are they really effective or not, you know?

GP: Yeah they are, they are. Because for somebody who’s had depression in the past, sometimes there could be a physiological reason, or an underlying cause for it.

Me: Yeah.

GP: And it’s due to the seratonin production. Sometimes, for some reason it does not produce enough, and if it does not produce enough, there’s nothing you can do. You can try everything to lift up your mood, but it still doesn’t [inaudible]. Your body for some reason doesn’t produce enough serotonin, so therefore when you do take the medication it stops the breakdown of seratonin and therefore you take that and it elevates the mood. So it will help. The thing is, ah, [pause] you know that people, some people think, oh well it’s…

Me: It’s not a happy pill!

GP: Yeah. But we find, it depends [inaudible] initially it takes about two weeks for it to kick in and then it starts to accumulate and then the way that people realise that, you know, its effect, is when they stop.

Me: Yeah.

GP: Sometimes they’ve been taking it for a while and they’re feeling alright and then they stop and when they start getting depressed again they know, that’s when they realise it was working.

Me: Yeah.

GP: So it’s a slow, you know, kind of treatment. It takes time to build it up. But it depends if you want to give Mind a go first, or whether you want to start, you know, on the antidepressants.

Me: Um. And Mind, they usually don’t have a waiting time, is that?

GP: Ah, I think, Mind’s probably shorter than our psychologist. A week or two.

Me: Ah, okay.

GP: So if you like, you can wait and see them, that would be fine.

Me: And do they have, do you know, do they have appointments only in office hours, or..?

GP: I think probably. I think it’s probably that, 9 to 5. I mean you’ll find all the psychologists will be in office hours.

Me: Yeah. It’s a bit hard for me.

GP: Yeah.

Me: I don’t like, telling people at work that…

GP: Yeah. So that’s what it is. Now ah, it’s entirely, I think you know maybe the antidepressants are [inaudible]. Because you’ve got a strong history, a past history of depression, I think you know you may benefit from, ah, [inaudible].

Me: Mmm. [pause] Can I take a prescription and then…

GP: Yeah, I can give you a prescription now, start you out on the lowest dose, and then I’d like to see you in a couple of weeks time.

Me: Okay.

GP: And see how you’re getting on [inaudible].

Me: Yeah, okay. Thank you.

[GP typing]

GP: Are you on the pill?

Me: No. I’ve got the coil.

GP: Ah, okay. And how are your periods?

Me: Yeah, they’re fine.

GP: Not heavy at all?

Me: No, they are. But it’s been like that since I got the coil.

GP: Mmm, riiight. Because you look a bit pale to me, you know, you may have anaemia or…

[checks my eyes]

GP: Are you feeling more tired than usual?

Me: Yeah.

GP: I think we’ll just get a blood test done to check your iron levels.

Me: Okay.

GP: Because sometimes a combination of factors, you know, can actually affect your mood. You know, being tired already from iron deficiency, and that can also make your mood a bit lower.

Me: Mmm, okay.

[GP writing]

GP: And how’s your self esteem? Your confidence?

Me: Mmm, could be better [laughs]

[GP typing]

GP: Do you know which antidepressants you were on in the past?

Me: Yeah, I was on Zoloft to start with, then I changed to Citalopram.

GP: Right, okay.

[GP printing prescription]

GP: Now the Citalopram is one a day. If you take it during the day and you feel, you know, a bit tired, then take it in the evening.

Me: Okay.

GP: And then let me get you the number for Mind.

[pause]

GP: [inaudible]

Me: Okay

GP: That’s the Citalopram, 10mg is the lowest dose, and I will see you in a couple of weeks.

Me: Okay, alright, thank you.

GP: Okay

[inaudible short conversation as I’m getting up to leave]

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Making an appointment.

It’s Friday and I’ve got today off work. When I made the decision to seek professional help, I thought today would be the perfect day to do that. I would have the whole day off to myself, I could relax and prepare ahead of the appointment, and if it didn’t go well, I wouldn’t have anyone to put on a brave face for afterwards.

That was the plan. Since my GP practice advertises that you can get a routine appointment within 48 hours, I called on Tuesday to make the Friday appointment. So they could “deal with my call effectively”, I pressed 1 for the automated service. I prefer not to speak to a person if I can help it: people often inadvertently say the wrong thing, putting me off from following through. So I pressed 1 and it rang me through to the automated service. Except it didn’t. It just kept ringing and ringing and ringing. After about a minute, I accepted it wasn’t going to go through, hung up and rang back, this time pressing 2 to speak to a receptionist.

“Sorry, we haven’t got any appointments available on Friday.”

Oh.

“I guess you don’t have anything sooner, then?”
“No, we’re all booked up. Unless it’s an emergency. I can get you in on Friday if it’s an emergency.”

And there it was. The reason I use the automated service. That question I’ve heard from so many GP receptionists, so many times before: is it an emergency?

I never know how to respond to that question. How can I explain that I need help now, that I’ve worked up the confidence and resolve to get help now, and that if I wait, I might lose that resolve? I know that if I wait, I may end up telling myself that things aren’t so bad, that I can manage this by myself, that there’s nothing professionals can do for me that I can’t do for myself.

How do I explain that I have Friday planned out in my head, that it’s important to me that it’s Friday? If the appointment isn’t on Friday then I know I’m less likely to turn up, and if I do turn up, I’m less likely to actually disclose my mental health problems when I’m sitting there in front of the doctor. But the fact that it’s important to me doesn’t make it an emergency, does it?

And if I say it’s an emergency, what will the doctor think of me when I do disclose? I already worry about being viewed as a time-waster, an attention-seeker, a drama queen. I feel these pejorative labels keenly, associated as they are with with the diagnosis I was lumped with 8 years ago: Borderline Personality Disorder.

“No, it’s not an emergency. When do you have an appointment available?”
“I can do Monday for you?”

No good, I’ve got an all-day meeting on Monday, and I can’t be cancelling meetings for a GP appointment.

“I can’t do Monday. How about Tuesday? And do you have an early appointment?”
“I’ve got 9:40 Tuesday morning.”
“That’s fine, thank you.”

It’s not really fine. It’s a week away, 9:40 means I’ll be late for work, and I’ll probably have to put that brave face on. At least I’m never sick – everyone ‘knows’ that about me – so they’ll all assume the appointment’s something routine, like contraception or a smear.

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A blog about mental health & mental healthcare

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