The potter's wheel

I am truly a product of stigma. I'm made of the misshapen clay that is spat out by a culture of silence. 

Perhaps you are mildly irked by the melodrama of those two sentences, and probably rightly so. I could list the friends that will read that opener, and think of any of the thousands of times I've behaved like a hormonal teenager, only without the excuse of puberty.

Yesterday I went to a psychiatrist for the first time in ten years. He came with high recommendation from a couple of colleagues and friends, both with their own struggles. I always like a road tested doctor, so I had high expectations - of what I had no idea - but I felt positive about it just the same. Keep in mind that I also recently saw someone I had been led to believe was a consultant psychiatrist through the NHS, but who subsequently turned out to be a trainee GP with very little experience in diagnosing mental health conditions. It's at this point I want it noted on the record that I have absolutely no issue with people dedicating their careers to working in the NHS, least of all on the frontline of mental health. I've done it myself (let's ignore the irony for now, shall we?). But given my long and jumbled history, I would've thought I'd be the least suitable candidate to be foisted upon some poor sod still learning the ropes. He was angling to either diagnose bipolar, or not, and I'm definitely not bipolar. I even told him so. I mentioned possibly a touch of cyclothymia, but I felt that it didn't fit either. I hinted at my previous diagnosis as a clue, but he still managed to come away with an inaccurate account of my life, and a diagnosis of mild alcoholism, not before calling my long-suffering other half and frightening him silly by asking probing questions about how fit I was to care for my son. 

When I hadn't heard a peep over a month later, I called the centre, who informed me that he was only a trainee, and he had now left. They had no access to my records. Then I got a voicemail from him (he'd called during working hours, so of course I'd not picked up) asking me to call back - only when I did, a very befuddled chap on the other end of the phone told me that despite this being the number of 'integrated psychological services', I was definitely not through to the right place. After several similar exchanges and further bafflement, I gave up. I imagine that due to the pitiful lack of funding for NHS mental health services, many less bull-headed than me would've thought this was indicative of the treatment they may (or may not, as it's questionable whether persistence would've resulted in any sort of suitable care plan) consequently get, and fallen deeper into whatever mental ailment they were experiencing. 

To give you a bit of a flavour of just how wrong that appointment had gone, here's a summary of the 'facts' he'd managed to make up: 'Her father was violent' - he wasn't, never has been, and. I sure as hell didn't say he was. 'They had little contact after the divorce' - nope, I saw him regularly. 'Helen has no contact with her step-siblings' - not true at all. 'She was on a heroin detox programme in 2007' - categorically, I have never taken heroin, and never will. As I explained very carefully and in great detail, I was put into a detox because I struggled with the physical side effects of coming off over the counter codeine, and rather than help me with a weaning plan, my GP somehow thought that sending me to a heroin clinic for hardened users of illicit street drugs would be the best course of action. There I was given Subutex (a synthetic opioid that is usually given to aid withdrawal and for very short amounts of time) for over A YEAR completely unnecessarily, and I've been since told by a doctor that this was abuse. I agree. I spent a month unable to eat, drink or sleep and lost a third of my body weight in the process. They refused to give me anything to help with this. That black hole in my life also lost me a relationship, although that would have inevitably happened anyway.

Let me clarify here that I don't judge addictions based on what the drug of choice is - what I do do, however, is judge someone who works in a heroin clinic based on their ability to decide how to treat what is essentially a very minor physical dependence caused by a lack of accurate diagnosis or adequate pain management. If you read yesterday's post, you'll know what I'm referring to here. It stands to reason that you don't treat someone who takes a measly 8 non-prescription codeine tablets a day (I.e. The recommended dose) with the same blunt instrument approach as you do a person who takes £100 worth of heroin a day, and then leave them with a new addiction to a drug with such a long half life, it takes them a month to detox in cold turkey, alone, with no medical supervision of any kind. I've never come as close to suicide as I did at that time.

I haven't yet decided what to do with the letter containing all these wrongs - it's also gone to my GP - and I may send a copy to my GP myself, highlighting these inaccuracies in my horribly pedantic fashion and suggesting they do their own investigation into what's going on at the centre. God help anyone who gets referred there in crisis, that's all I can say before I get so angry I bang out a load of expletives...

So, on to yesterday's private psychiatrist - there couldn't be a more stark contrast frankly. This guy sauntered in to the oddly decorated waiting area to collect me about 30 minutes after my appointment time, and led me to an upstairs room with one of those giant desks old school doctors have. I noticed that one side of it was wonky. I wanted to be annoyed by his tardiness, but as soon as he started speaking I forgot to hold that grudge. 

I had a hunch he might ask me the popular ice breaker: "What do you want to get from this?", and he didn't disappoint on that score. This is my least favourite part of any appointment. I don't know what I 'want', I've never experienced it before. I've experienced plenty of things I didn't want though. That's exactly the sort of question that trips me up in job interviews too. He asked me if my referral letter was accurate, so we went through my chequered medical history, and he asked me about each entry in detail. We corrected all the fabricated parts, and then he began to delve, enquiring into my life chronologically as well as asking very specific questions that would've normally made me very uneasy. Something told me to just give it up though, and I told him all the gory details, knowing that this time it might actually help.

He knew the last doctor I'd seen, the one who'd diagnosed 'multi-impulsive personality disorder' before I'd turned down my chance of treatment in favour of pretending for a few more years. I wasn't ready to move into a clinic for a year where you had to eat alone and shit in a commode for the first fortnight, and then ask to use the toilet after that. I was residing alone at the time, doing my own thing, indulging in my self-harm however the heck I wanted and I wasn't about to give that up; besides that, I asked if I could bring my rat with me - the answer was "No" - so of course I didn't go. I didn't care that the NHS had stumped up £60K, and yes I'm aware how stupid that sounds. But I had, and still have the emotional intelligence of a teenager and I'd already decided to go back to study in the time it had taken to get this one appointment (and that was about 2 years, FYI). I know now that it wouldn't have been the right treatment programme anyway - it was an eating disorders unit, and I didn't have an eating disorder - at least that wasn't all I had.

Back to the new psychiatrist. He asked me what treatments I'd already had. He asked me if I felt I had an 'empty void I was trying to fill'. Basically, he got it. At the end he just looked at me with raised eyebrows and a knowing look, and said "Borderline personality disorder". I laughed nervously. I'm not sure why, because I already knew that he'd say that. Reactions are one of the parts of social interaction I struggle to make sense of. Then I asked how severe I was in comparison to his other patients with the same diagnosis; "I knew you'd ask me that" he replied, "You're at the most severe end of the scale, but you've got some balance at the moment". He went on to use an analogy of a lump of clay on a potter's wheel - the hands shaping the clay in one's formative (note the 'form' part of that word) years, are the hands that make what should be a nice symmetrical smooth vase. They might be family, teachers, peers etc. Only sometimes they poke holes in, or press into it too much instead. BPD is a vase with one side much shorter than the other. The taller side is cognitive development (I'm not lacking in intelligence at all) and the shortened side is emotional development, which is stunted. When I say I'm still 16 in my head I'm not joking. I never left secondary school.

My disorder is most symptomatic during periods of stress in my life, and those of you who know me will also know that I'm one of those unfortunate souls that people describe as 'unlucky'. The new psychiatrist described BPD sufferers as living a 'life of chaos'. We attract crazy. I'll gladly let you into some of those events later on - but for now rest assured that you couldn't make it up.

After that, he enquired as to whether any family members had mental health problems; and this is the point here - 'I am truly a product of stigma. I'm made of the misshapen clay that is spat out by a culture of silence'. The generation before me suffered in silence, enduring chaotic childhoods, teenage years rife with bullying, and less than happy adult lives; this led to many an ugly vase. There's nothing I can do about that, but what I can do is help my generation to break the cycle.