I’ve Been Quite Busy (Falling Apart)

I’m so angry and sad and despairing and I need to hurt myself but I just don’t want to.

I guess I should start at the beginning.

On Tuesday, my session with Alina was mostly about safety planning.

You told me that you came to therapy because you are afraid that you might kill yourself. And I think you’re right; I think you might.” It hung heavy in the air for a moment, then she continued. “So, I need to think about how to set limits on behaviour that is going to interfere with therapy.

She asked whether I’d had any discussions or agreements with previous psychologists about what needed to happen if I had urges to self harm or commit suicide, and I explained the crisis plan I’d been required to enter with Anna as part of the DBT program; if I was imminently about to hurt myself, I had to call her, and if I wasn’t able to start talking to her within half an hour, she would call the police.

Alina contemplated this for a moment. “I certainly would not think that it would be right to call me. Not because I don’t want to know, and not because I won’t care, but if I’m on the other end of the phone line then there is nothing that I can do.”

That first sentence hit me pretty hard. It would have been different if she’d said ‘not helpful‘ or ‘not a good idea‘, but ‘not right’ felt so harsh. I felt ashamed that I’d agreed to do it with Anna, that that had been wrong, and somehow chastised and rejected, even though I hadn’t suggested or even wanted a similar arrangement with her.

The safety plan Alina decided on was that every time I self-harmed, I would have to go and see my GP, and then my GP had to send me for psychiatric evaluation by the hospital. That wasn’t up for negotiation: “We can do work only under these conditions. When I see you next time, you will have to make a decision.”

I was so angry and upset that for a moment it took all my focus to remember to breathe. This plan is not going to keep me safe. Making me miss work and lose income every time I hurt myself is not going to help me stay stable. Making me go through all my history with a strange psychiatrist every time I hurt myself is not going to keep me safe. Last time I was in the emergency department I smashed my head against a concrete wall 28 times before a staff member came in and yelled at me to stop, and they sent me home a few hours later anyway, so really, the chances of them admitting me against my will just because I cut myself are slim to none.

“I guess my question is, since you said you accept that I’m probably going to keep self-harming for a while, why do you want me to be assessed every time I do?”

I think we need to treat each event of self-harm as a potentially life-threatening event and you need to be assessed. That’s one thing. Secondly, I think you need to know that people take it seriously. And I think GP makes it too comfortable for you. She’s nice, she’s supportive, she talks probably very loving to you, stitch you up, tell you goodbye, give you a hug, say ‘be good’. It’s all very comfortable. So you get double comfort; initially when you’re cutting, and then when you get stitched up.

This made me feel awful. I feel awful, reading back over it. Firstly, she’s wrong. I haven’t had many experiences that are more horrible than having to expose fresh wounds after an emotional crisis and then deal with the physical pain of having them treated. I like my GP, a lot, and I have taken comfort from her, but it’s a terrible process to have to go through. And I understand that she wants to avoid reinforcing dysfunctional behaviour, I do, but the logic behind going You know what, I think your GP is making you feel better after you’ve been in emotional crisis, so I think we should instead make the process as horrible for you as we can is just awful.

I went home, crawled into bed, and sobbed while I thought about which method of self-harm I was going to use; if I was going to be threatened out of doing it after Friday, then I had to at least do it once or twice before then.

On Wednesday, I met the psychologist, Nikki, and went home to calculate my savings and try to figure out how to afford to see her long-term. (The answer: I can’t.)

I really liked her. That doesn’t mean she’d be able to help me, but I felt comfortable. (Ish.) She was warm and empathetic and attuned, and the only time we went far enough out of my comfort zone that I froze up and started getting flashes of blood, she verbally acknowledged “I’m pushing you too hard too soon” and shifted topics.

On Thursday, when I arrived at Margaret’s, she had no idea who I was. She didn’t have me booked in for an appointment, but was willing to slot me in in the afternoon.

And she surprised me. She said she’d been thinking about me, and she’d gone to a monthly meeting of psychiatrists and asked them for advice, and they’d recommended I come off Effexor and start taking Seroquel regularly, and suggested that neurofeedback might be helpful for me. She was still as blunt as an old axe, but softer somehow, and I told her how much I’m struggling with work, and with my relationship with R, and I cried when I told her how much I hate having to be in therapy.

And then I went home and held my arm over the stove with the hotplates turned to full, because now I liked Margaret and I was going to have to decide between her and Alina, and I didn’t know what to do or how to choose and it might be my last chance to hurt myself before I had to contract with Alina the next day and should I even agree to the contract and what am I going to do?

The answer, as it turns out, is fuck shit up royally.

After I’d spent every evening this week flooded with thoughts of self harm brought on by the conditions she’d set out on Tuesday, she didn’t even mention them today. At the start of the session she described my self-harm as ‘attention-seeking‘, but when I pointed out that in the first 13 years of self-harming I only sought medical attention once, she was surprised and let it go. The only condition she set is that I call the crisis team if I’m about to act on a suicide plan.

Her rules around contact out of sessions are no texts and no phone calls unless it’s logistical or to inform her that I’ve been hospitalised. I can send her emails, and she’ll read them but she won’t reply. And that’s okay, I don’t think I need more than that, but I was still upset.

I was so proud of how hard I was trying today. When she asked again what my goals are for therapy, I took out my phone and went back to the list I posted here, and I went through almost all of it – I only skipped food and body issues. I’ve never given a therapist an answer to that question before, and I’ve never looked at something I’ve written down to give a really comprehensive answer to something.

So, all of the groundwork was done. She put down her pen, and said “And now we begin“.

The silence stretched on, and she was just looking at me. I started feeling panicky, and like I was about to cry, and the room was too small and I didn’t have enough space and I needed to calm down. So I reached down to my phone, which was sitting on my chair, and I opened my work email.

Alina asked me what I was doing, and I told her.

Are you testing me?

I thought about it for a moment, to make sure, then said “No, just giving myself a break.” Checking my messages or looking at photos was a strategy I always used with Anna to calm down when I needed to, and if she could see I was struggling then she would suggest it to me.

How would you feel, if I checked my email?

If I wasn’t talking to you, I wouldn’t mind,” I said, honestly. There’s something companionable, to me, about sitting quietly with someone while you both do your own thing.

So it’s like me punishing you?

No.

If we are here in therapy, it’s just you and me; there’s nothing else between us. That’s sabotaging, what you’re doing. So we should put that into our contract. No other activity in session, apart from being in session.

I can’t commit to that,” I said, softly. It’s not that I disagree with her point, and I agree with it as something to work towards, but I’m not there yet. It just feels like too much. I don’t know her and I’m not comfortable with her and if I feel like I need to look at a photo of my cat and take a minute to breathe and calm down so I can try to keep going and keep shoving my hands down my throat to pull out some words, is that such a big deal?

Then I can’t commit to therapy,” she retorted immediately.

Mmm. That’s fair enough.”

Is this what you want to do?” she asked.

Not really,” I said, and there were tears in my voice. “But it’s do this or leave.

Well, that’s your decision, but you will have to leave, then,” she said.

So I did. There was still half of the session to go. I don’t think she was wrong to call me out, but to make me leave? I don’t think I did anything wrong and I feel like she’s not giving me any space for this to be hard and I hate her, even though I don’t. Everyone expects more of me than I’m capable of doing and I can’t.

 

I ran out of Effexor four days ago and only got a refill today, so I’m in withdrawal; nauseous, sweaty, dizzy and aching. My head is heavy and my body is light and there is nothing behind my eyes. And I keep thinking that Everest is dead, even though she’s sitting on my shoulder.

I’ve Been Quite Busy (Falling Apart)

Margaret Burke Is Not Fucking Around

If you were walking down the street looking for someone to interview about their first-hand experiences of World War I, you would immediately hone in on Margaret Burke. She is old. She shuffles along, bent over and leaning on a walking stick. When she reached out to pass me a depression inventory, her hand was shaking violently.

Margaret is no soft, cuddly grandma, though. She takes no bullshit.

In the first five minutes, she’d asked a question, I’d answered, and we were sitting in silence, looking at each other.

I feel like you’re looking to me for something,” she said. “You want me to take responsibility for you, and I’m not doing that. I won’t do that.

I struggle with talking sometimes,” I said.

You mean you’re resistant to talking,” she retorted.

Later, I shared that I used to play sport every day and that I knew it was good for me, and I said I’d look into joining a gym to find out how much it’d cost.

I don’t think you really want to do it,” she said dismissively. “If you did you’d just commit to it. You can pretend it’s about money, whatever.

There will be no excuses with Margaret Burke. She called me out every step of the way. Sometimes very legitimately, so I couldn’t help but laugh, and sometimes in ways that seemed to leave no room for depression or anxiety and the barriers they put up.

Like Alina, she pointed out the incongruity of my half-smile and casual tone while I talked about the “horrific things you’ve done to yourself,” and I tried to explain, a little.

I’ve just done this so many times,” I started, and she cut me off, telling me that this was more evidence that I’m resistant and not interested in changing, that I’ve self harmed for years and I’m going to just keep on doing it. I tried to interrupt to explain that she’d misunderstood me, that what I was trying to say had nothing to do with self harm – I was talking about having done “this” (giving my history to a new mental health professional) so many times (more than 30 times in the last year) that it’s lost impact for me, that it’s just reciting things like they happened to another person. But she just raised her voice and spoke over me, then went directly into another question without giving me a chance to respond.

I’m pissed off about that. I get that she’s not afraid to argue with me, and that’s pretty refreshing, but she has to let me speak too.

She was very clear about what she’s offering. “I’m not going to stick around forever,” she said. “If you’re not making progress, you can find another therapist.” I loved this candour, the refusal to make false promises, but it makes her a bit of a wild card. I don’t want to be adrift again in another couple of months because I wasn’t meeting the goalposts.

There’s a lot to like about her. I found it incredibly challenging and confronting, though,so much that I was on the verge of tears pretty much all session. When I walked out of the door and down the street, I suddenly realized my whole body was aching, and realized I’d been tensed tight with my jaw clenched for the last hour. But I’ll always know where I stand with her, and she won’t let me pretend that a spade is anything other than a spade.

I don’t know, yet. I could make a lot of progress with her on a more superficial level, I think – eating better, working out, trialing more medications. But the part of me that likes her is the critical bootcamp part that says “See, you’re just being a lazy shit, you need to stop making excuses and fucking around, if you’re depressed it’s nobody’s fault but your own“. I approve of her approach because it feels like what I deserve, and I felt a lot more need to hurt myself last night than I did after Alina. My instinct is that I could make short-term progress but maybe not long-term change with her, but I don’t know. Maybe that’s just another excuse.

Margaret Burke Is Not Fucking Around