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Psychiatry and Psychotherapy: An Anti-Psychosis Army? NewVCB and C: Week 47

Posted Apr 25 2010 3:05pm

I don’t really see a lot of point in going into great detail about last week’s (15 April) session with C, mainly as we spent almost the entire time together discussing my recent hallucinations which I have already detailed here and here . Furthermore, because I’ve been too lazy, too fuckwitted or too pre-occupied with other inane, probably pointless shite, I have of course forgotten a lot of the session’s nuances and subtitles. ‘Tis my own fault. I should have written about it sooner, but I’ve been existing in a haze of exhaustion and combined Quetiapine/Zopiclone hangovers, so to my eternal disgust the blog hasn’t been as high up my priority list as it should have been. It’s taking all the energy I have left even to write this rambling crap.

C opened the session by noting that it had been a fortnight since I’d last seen him, a meeting during which I had apparently “taken a very brave step” in admitting that I was systematically raped as a child. Brave. He called me brave. He complimented me, or at least I think he did…and my cynical little heart leapt with joy. Pa-the-tic. I hope I managed to hide my internal manic rapture; I know he knows about my attachment to him, but this is ridiculous! (Actually, I think I must have hid it quite well because the next week, when he used the same word, he supposed that I would object to him describing me as such. But more of that in a post or two).

He asked how admitting to the reality of things in session had been for me, and I told him that I was kind of surprised by how calm and measured I had felt as I’d detailed the extent of the molestation. Encouraged by that, he then asked how things had been since that discussion.

I threw my head back and laughed out loud, in what was, on reflection, a hideously maniacal fashion. Sensing his surprised bemusement, I stopped myself and said, quite definitely yet sardonically, “things have been just fine!”

He raised his eyebrow, as well he might have done. He said, “your reaction to the question and your body language would strongly refute that.”

“Well,” I sighed eventually, “let’s put it this way: it’s a good thing I’m seeing the psychiatrist next week”. Then I actually bit the bullet and volunteered the information to him about the ongoing persecution from ‘They’ and fake-Paedo. As I say, there’s not a great deal of point in getting into the minutiae of that conversation, but one point of note was that he decided he would ‘map’ my mind on his whiteboard. He did something similar once before in relation to my behaviour when I feel threatened and on the perennial abandonment anxieties, and the intellect inside me had found it quite fascinating.

C divided the map into two sections. There’s ‘additional’ “presences” in my mind (initially he asked if I wanted to call them ‘presences’ or ‘parts’. I went with the former because ‘parts’ infers that they’re somehow part of me, and whilst I accept that possibility intellectually, that is not how it feels at all), plus there’s the very obvious internal sides of myself, several of whom keep up a running commentary in my head most of the time.

Presences

‘They’ – multifaceted, malevolent, potentially harmful.
Tom – benign and soothing – but does he still exist?
Fake-Paedo – though his ‘existence’ is arguable as he appears outside my mind (as do ‘They’ at times).

Sides of Me

The Bitch – (“I’m only using that term because you insist on it”, apparently). Finds the other sides weak and pathetic. Contemptuous of them.
The Child – scared, hurt, vulnerable – in need of someone to take care of her.
The Intellect – ‘everything can be rationalised’ (though as I said, to C’s amusement, I am a walking quintessence of the ironic falsehood of that statement)
Plus the healthy adult and some others. It harks back to our various discussions on schemas , which he again acknowledged (and on which C has published research specifically on BPD!).

The long and the short of this analysis was that C thinks the psychoses (or, as he perhaps more aptly seems to believe them to be, the dissociative presences) are caused by a splintering of my mind, thanks to having to deal with such graphic and enormous matters in therapy after having repressed them for so many years.

He said, “you are of course extremely intelligent, so I think you know that yourself, don’t you?”

Did he just call me ‘extremely intelligent’? Why, I rather believe he did. EPIC WIN, Pan, epic fucking win! Another compliment!!! Once more my perfidious heart nigh on exploded with delighted glee.

I admitted that rationally it was quite obvious to me that this bout of psychotic symptoms was caused by recent revelations in therapy, especially given the timing of the episodes. “However,” I went on, “that doesn’t keep them from feeling utterly vividly and absolutely real.”

Apparently he had not intended to suggest otherwise, but merely wanted to explore the motivations for their manifestations. The fact that their whinging (“slut, whore, bitch” etc) is in keeping with the whinging of The Bitch seems to provide further evidence for this position – it’s just that ‘They’ have become a more extreme form of a similar thing. In the absence of a compassionate side of myself, Tom had (temporarily, alas) fulfilled that function. ‘They’ are just sort of doing the opposite.

I said to C, “you know that ‘They’ won’t like this analysis.”

“I’m sure they won’t,” he said automatically. “They’ll probably think it’s a load of bollocks.”

For some reason this made me laugh a lot, probably because it was so completely spot-on. I told C that they didn’t like him, and he didn’t seem surprised. He didn’t say it the way A so explicitly does, but something in his body language intimated to me that he doesn’t like ‘They’ either.

He never remembers their name. He keeps calling them ‘Them’ or something, then he ends up berating himself for not getting it right. “It’s not your fault,” I exclaimed defensively at one point, “it’s their’s! They’re the ones that are gramatically challenged, not you!”

I mean, what kind of sad tossers go around calling their collective selves ‘They’? Do they think they sound hard or something? Come on, ‘They’ – it’s not like it’s the fucking Crips or Bloods, now is it? Why can’t you at least assign names to each other?

Anyway, I digress. I don’t know how we got back on to the sex abuse topic specifically, but at one point C said something about getting me to articulate some of the actual minituae of the incidents. I (literally) recoiled in horror at the suggestion.

However, I knew that I, for once, had the upper hand; we had talked so much about the psychoses that I knew there could be very little time left for anything else, let alone something so difficult to address. So I said, “you don’t seriously expect me to do that today, do you?”

I watched as his eyes shifted from me, to the strategically-placed clock behind my head. He looked at it for a few seconds before conceding that no, he didn’t expect me to do it today.

And that was that really. I got a “take care, all the best,” on the way out, which always brightens my Thursdays, pathetic as they and I are.

The ‘S’ and ‘H’ Words

So onward to the psychiatrist, on Wednesday 21 April (also the anniversary of the day I met A!). In a stylistic homage to her predecessor, NewVCB kept me waiting for nearly 20 minutes after my allocated time. I was interested to note that, before summoning me, she came into the waiting room and handed some old git an envelope (which I assume was a prescription, as she did the same for me before I left). I didn’t care in any way that this occurrence took place.

Sounds innocuous, right? Of course it does. Why even mention it, Pan, you stupid, pedantic cow? Well, the thing is, if C had come into the waiting room and interacted with one of the assorted mentalists in front of my face, I would have had a complete shit attack, and probably throttled him (and the relevant mentalist too for that matter). I give you Attachment in Action, my friends. C is not allowed to have anything to do with anyone but me, least of all some other bloody mental. I am the focus of his world. He has no other patients. He has no other life. It is only me. C and me. Me and C. He exists only in those 50 minutes each Thursday, because he exists only for me. That is the way it is.

Oh, what a LIFE FAIL as I have.

Anyhow, again I digress. NewVCB showed me to her office and asked how things had been, and I just sort of collapsed in a wobbly mess in front of her. No tears or anything, but lots of agitated, highly disturbed rambling. Somehow, amidst the virtual delirium of my babbling, I managed to convey what had been happening to me.

The first thing of note was that NewVCB used the ’s’ word in front of me. She had done once before, but on that occasion had absolutely refuted its relevance to me. On Wednesday, however, she said, “in the past – the fairly recent past at that – you’d have been diagnosed with a schizophrenic illness.”

I had, at one point, decided that I had schizoaffective disorder (given my asinine tendencies towards self-diagnosis), but nevertheless – hearing this kind of comment from a consultant psychiatrist unsettled me greatly. ‘Schizophrenia’ is a big word to have thrown at you, even though I can see why I would once have been felt by the discipline of psychiatry to have it. I don’t know why it sounds so daunting; after all, I am effectively medicated for it, or at least a sub-threshold version thereof. Still, her use of the word struck terror in my heart (which by this point most assuredly wasn’t leaping with joy or threatening to explode with delight or whatever other sickly metaphor I used above regarding C’s quasi-compliments).

Anyhow, she continued: “but we now know, thanks to much research in the area, that there’s almost two types of psychosis. There’s your traditional schizophrenic, firmly-believed and long-term psychoses, and then there’s this other branch that is often seen in severely traumatised people like yourself.”

Point of Interest II. Severely traumatised like [me]? Severely traumatised? Rid-ic-ulous! Cue silly internal ruminative roundabout of denial-like idiocy: What the hell is she talking about? I’m not traumatised – I’m a little whore that got justly punished for the disgusting thing of fetid-ness that she was and is. Trauma. Scoff!!! lolz like innit (all this notwithstanding the fact that I diagnosed myself with ((and gained confirmation from NewVCB that I have)) complex post-traumatic stress disorder. Go figure. I’m a walking contradiction).

Of course, the Me that was in control of my voicebox at the time didn’t make use of it, and I therefore found myself simply nodding every so often to acknowledge the fact that NewVCB was speaking. She said at one point that her “instinct [was] to throw medication at [me],” but that she knew logically that this was stuff that, in the main, needed to be worked through psychologically.

Not surprisingly this led on to a discussion about the imminent-ish end of therapy. I don’t remember exactly what she said, but the inference was that useful work can be done in the remaining – what? Eight or nine? – weeks. She said, “you have to stop viewing it as some sort of countdown.”

I laughed in her face. I laughed in her face with barely concealed bitterness, contempt and irritation. “Don’t you think,” I began, through gritted teeth, “that if it was possible to not view it as a countdown that I would be doing so?”

Some non-committal response.

“I have tried, NewVCB,” I told her, very definitely. “I have tried, and I cannot not view it as a countdown. I can still work well with C despite that, but that reality is not going away.”

To be fair, and to my surprise, she backed down and appeared to accept this. Then she started rattling on about breaks from therapy which are only temporary.

Apparently what “quite often” happens is that patients leave therapy, for a matter of months, maybe even in excess of a year. During that time they put their newfound self-understanding and training for ‘real’ relationships and situations into practice. Then, some time later, they’re referred back to therapy to build on the work they had previously done, both in and out of session. How did that sound to me?

“In principle I have no strong objections, though it does seem curious to cut the process short when one is in the middle of something so important as this, especially given how rushed and forced into things I feel,” I told her. “Whatever the case, though, what I could not stomach is being referred back to therapy, only to be forced into some wanky C- or DBT. I promise you, that would be a very bad idea. Any therapy with ‘BT’ in the title will not work for me, and will only serve to make me very angry indeed.”

To my amazement, rather than defend the health service’s little alleged panaceatic wankeries of non-loveliness, she nodded in agreement with me. Score.

I went on. “Besides, it’s not just about the type of therapy; it’s an issue of personalities. I saw Christ knows how many people before I met C, and he’s the first one that has been of any real help to me. I know that literature on this matter agrees that the therapeutic relationship is absolutely fundamental to healing, insofar as healing is possible.”

Again she nodded. “There are no guarantees; things change in the health service just like they do in any place of employment. C could obviously leave his job here for another one. But, assuming there are no such changes, we try to put people back with the folks that have previously treated them.”

Point of Interest Mark III. That was very interesting. C has made no reference to anything of this nature. Additionally, it seems slightly at odds with a comment NewVCB made when I first met her – she said something along the lines of her being sure that C would extend things now if he felt it was necessary. C had, rather obviously, made no reference to that course of action either.

Part of me has wondered since C imposed this ending if he has been doing it to force me into talking. If he would change his mind later in the contract because he was getting somewhere – which he now is, of course. I had always thought that what he wanted me to think was that the cessation of the process was about (a lack of) resources. But if what NewVCB says is true, how can that be? Maybe he wants to end things because of my attachment to him, an issue of which he is fully aware. But surely the antidote to that is to fucking work through it with him, rather than find myself thrown out in the deep end that is the cuntified, horrible, real bloody world?

Anyway. Anyway. Siiiiigh.

Anyway. Eventually discussion with NewVCB centred around medication; she did exactly what I’d expected her to do and told me she would increase my dose of Quetiapine from 300mg to 400mg. She warned, however, that she intended this to be temporary.

Her rationale for this dose and its probable temporary nature is primarily that she wants me to get through this particularly difficult period in therapy, of course – since the drug had had such a good effect in its 300mg dose, it would be hoped that once this current spell is dealt with psychologically, that that dose would once again be effective. Secondly, though, she wants to leave herself “room to play with,” in case the dose needs to be increased further, which she suspects it eventually might. She had already warned me that she’d be reluctant to take me over about 700mg, so she felt that she needed to leave a reasonable gap between that maximum dose and the present one.

And here she scared me.

She said, “I don’t want to over-medicate you [fine], but we do need to make sure you don’t go further downhill and that you can continue to do this work with C [still fine]. If I didn’t increase the medication, then that could slide [OK]. At the end of the day…[dramatic pause]…[looks me straight in the eye, her left eyebrow slightly cocked]…our priority is to keep you safe [clears throat guiltily, shifts gaze].”

Her euphemism, especially when accompanied by such powerful body language, is clearly psychiatristspeak for HOSPITAL. Yet another point of interest, though in this case one I would rather not have had.

No fucking way, no way no way no way. I will kill myself first. I. WILL.. KILL. MY. SELF. Do you fucking hear me, you bitch?

Of course, rather than make any such protest – which may well have been interpreted as a borderline strop anyway – In-Control Me just looked at her meekly, and even fucking nodded.

I was, however, determined to steer her away from continued thoughts around this subject, so I took the opportunity to beg her for sleeping tablets. She agreed, to my considerable satisfaction (and in hilarious defiance of Twathead GP . Interestingly, Twathead had accused me of insubordination vis a vis the consultant’s advice on Venlafaxine, but now the shoe’s on the other foot, Twathead; he refused to give me Zopiclone, and hey presto – look what the consultant is now doing! Hahaha! Mwhahahahaha!!!).

I actually got really lucky with the Zopiclone prescription, owing to an administrative mistake at the GPs’ ’surgery’. But that, along with the entire comedy of errors that was obtaining my prescriptions, is a story to be told on another day.

In conclusion, I suppose there’s some encouragement to take from this appointment, especially re: the cessation of therapy issue. I think, whether C will admit it or not, that NewVCB probably has some influence on how he proceeds – and if the courses of action that she has mooted are indeed possible, well, that’s better than the alternative of complete abandonment. The question remains though – does C know about any of this?

She was going to talk to him after my most recent appointment with him (blog upcoming) so we’ll see what, if anything, comes of that. In the meantime, I’m a vertiable walking pharmacy and glad of it, and think I am ready to continue the anti-Paedo / anti-’They’ fight with C. All of the non-existent bastards are still hovering about for now, but Quetiapine has served me well in the past, and I have faith that it can do it once more.

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