Tag Archives: patient

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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Waiting times.

It’s a month since my counselling assessment and I’m still waiting for my first session. I expect to wait another month, until the first week of March, but I haven’t had a letter yet to confirm when that appointment will be. It’s two months since I first went to the GP about my mental health (or 21 months, if I count it from the actual first time I went, but was too anxious to disclose).

Before that first GP appointment, I wrote:

I expect that I will either not be offered any help, or if I am, it will be either antidepressants or a referral for a few sessions of CBT that I may have to wait months for.

The reality hasn’t been that far off my low expectations and I’m starting to wonder why I even bothered. I’m pleased that I’ve been offered integrative counselling, not CBT, but the wait for it to start is draining and I’m ambivalent about the antidepressants after taking them for two months.

At my last appointment, the GP told me to come back in three months, but that I could come back earlier if I needed to. I don’t know what that means though. How bad does it need to be for me to come back? I’m feeling worse again, but then depression does go up and down anyway, and I’m not sure whether I should expect that pattern to be different on medication? And what will the GP have to offer anyway, besides an increased dosage?

I’m also concerned that the Citalopram is now making things worse. I’ve been having night sweats; I get them anyway, but now they’re almost every night. I wake up between 3 and 4am, throwing off soaking bedsheets, slippery with sweat, my heart pounding and feeling terrified. It’s not easy to get back to sleep after that. This leaves me exhausted during the day, exacerbating the feeling of concrete in my limbs.

In seeking professional help, I was under no illusions that I would receive high quality treatment. What I’m surprised to realise now though, is that despite that, I didn’t really have a plan for what I would do when my low expectations were realised. I think I still thought that after trying unsuccessfully to treat myself for so long, professional help would be the answer. I would get help, and although it might take time, I would be moving towards recovery.

Now I’m not so sure. My suicidal ideation has pretty much stopped, which is good, but beyond that I can’t see any real gains. I’m sure that eventually I will get to see a counsellor, but right now I feel isolated and more lost than before seeking help. At least then, I still had my psychological ‘last resort’ of seeking treatment.

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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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