Back to work and a bit on personality disorders

I’m pleased to be able to report that as of 12:30 today I’m back in the saddle; catching up on nearly a week’s absence has kept me busy enough that I’ve not really had time to think about Tweeting or Pressing until now. My CPN was very encouraging that I should come back and get some routine in my schedule. Part of the issue of the last few days has been being caught between not-coping-with-work and not-coping-alone-at-home.

This morning’s appointment threw a curve-ball at me. We chatted a bit about what’s been going on and ways to mitigate dangerous situations and then she said the team thinks I have a personality disorder going on in the soup I like to call my mind. They are referring me to a specialist team, who will do an assessment, and then from there I am likely to be offered talk-therapy; this is fab news really, but the idea of having another label kind of freaks me out too. I know it shouldn’t, but whoever decided to call them personality disorders needs a good spanking – your personality is a key part of your identity and saying there’s something wrong with it is a bit like being nut-punched in the mind.

Of course, being me, I’ve now been reading up on the various types of personality disorder (there are ten of them). I have known people with Borderline Personality Disorder and know how difficult a condition it is to live with for them, but I have never really identified with this disorder.

Here’s a super-brief rundown of the ten types:

Cluster A:

  • Paranoid PD: irrational suspicion and mistrust of people
  • Schizoid PD: social detachment, apathy
  • Schizotypal PD: social interactions are uncomfortable, unusual or eccentric beliefs.

Cluster B:

  • Antisocial PD: lack of empathy, grandiosity and manipulative behaviour
  • Borderline PD: unstable relationships and self-harm is common
  • Histrionic PD: attention-seeking behaviour, excessive emotions
  • Narcissistic PD: grandiosity, need for admiration, lack of empathy.

Cluster C:

  • Avoidant PD: social inhibition and sensitivity to criticism
  • Dependent PD: psychological need to be cared for
  • Obsessive-compulsive PD: sticks to rules, perfectionism and control.

I am feeling a lot of anxiety towards Histrionic Personality Disorder; I know this is because I’ve been accused of attention-seeking in the past and I think I would feel like a fraud in every aspect of my life. It almost feels like that diagnosis would invalidate the last three years of ups and downs, and that makes me nervous.

All I can do is wait for the referral and see what comes of it. I am keen to access talk-therapy again as this was helpful the last time I did a course with a psychologist.

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Back to work and a bit on personality disorders

So What’s Good About This Anyway?

There’s a lot of publicity surrounding mental health awareness, and the mission to bring the general public to a better understanding of mental illness grows stronger every day. The fact is that mental illness sucks, but it’s not all doom and gloom. Here’s a few things that make it a little better for me each day (unfortunately they are in no way a reward for the struggles we face).

Depression has taught me empathy.

I am highly creative when manic.

My productivity and output at work benefits from hypomania.

Understanding delusional beliefs gives me insight into my own psyche.

I have a passion to make the world a better place.

My supporters have shown me true love (parental, societal and romantic).

I can relate to my father in a real way by understanding what it means to be depressed.

Writing is my outlet and I’ve been getting better at it.

Therapy has given me great skills and taught me how to be kind to myself.

I learn a lot about anger and sadness through my ‘alter’ – I am able to observe her pain and talk to Her about it. (Still not comfortable calling Her an alter, but I guess it’s as good a word as any!)

I get to see the world as a vibrant and exciting place.

When depression lifts I get to feel pleasure in things in a meaningful way.

What are the benefits you see in your mental illness? I think it’s harder to see the ‘good’ in relentless depression than it is to see it in bipolar disorder. And I’ve not got personal experience of any personality disorder, so I’m definitely not qualified to comment there!

So What’s Good About This Anyway?

The People Who Help

I wanted to write a little bit about the people in my life who have supported me over the last three years. Without them I believe I wouldn’t be here to tell my story.

The primary supporter in my life is my husband Luke. We’ve been together since we were in our late teens and got married in Dec 2011. When we first began getting serious (i.e. after about a month!) I explained my struggles with depression from my early teenage years and the anxiety that had gone along with it. He made a promise to always be there for me when I need him, and he’s gone above and beyond that time and time again in the years that followed.

It was Luke who first noticed my mental health deteriorating in early 2012. As you’ll hear a lot from people who have been psychotic especially, it’s those around them who notice it even before the sufferer. I was living in an alternate reality in which it was perfectly normal to be hearing voices, not sleeping and suffering paranoia over the people living next door. Amazingly, and thankfully, the paranoia did not extend to my husband. Although I’d visited the GP on my own to get help for the anxiety, the warning signs of mania and psychosis had not been picked up.

Luke has since stood by me through thick and thin. He has sat with me in the hospital following overdoses. He has accompanied me to appointments and talked to the mental health team on my behalf when I couldn’t speak for myself. He is my carer; I still struggle with being out in public without him if it’s not part of my routine, and he makes sure I take my medication morning and night. When I’ve been unwell he’s kept the house clean and us fed. The stress I have put him under is unbelievable and he is still his jolly, jokey self.

What do I owe him? Everything – and nothing. What he does for me comes from a place of true love. I couldn’t be more appreciative, and I have no idea how I can repay it all. But he tells me regularly that he did it because he loves me and couldn’t imagine being without me – that he’d do it all again in a heartbeat.

My family have also been there for me in an entirely supportive capacity. My mum has driven me to the hospital a few times, and never judged me for it. She is a lovely, warm and caring woman and I am so lucky that she’s supportive and understanding. Never one to shy away from anyone in need, she makes sure I know she’s there for me any time I need her; as she says, her kids come first.

I didn’t speak to my father for three years following an argument in the run up to my wedding. When we got back in touch early last year I debated with myself for a long time over whether to tell him everything or not. I decided that honesty was my best course of action and wrote him a letter that described what had been happening with my mental health. I was terrified that he would see me differently once he knew everything, but there was nothing to worry about. He told me he supported me.

Unfortunately there is so much stigma surrounding mental health issues that there’s no guarantee that people will be supportive of those who suffer. I used to feel ashamed of my diagnosis, that the important people in my life would somehow blame me for what I was going through. The fear of them taking it personally was huge; I was worried that my parents would wonder what they’d done to cause it, or that my husband would think my suicidal ideation was proof I wanted to leave him behind.

I am so thankful to those who have supported me over the last few tumultuous years. I have learned that I have nothing to feel guilty for; no guiltier than someone who’s suffered a heart attack feels. It is my hope that this blog is not just for those with mental illnesses, but that the people supporting them will read and understand that the best thing they can do is be there for their loved one.

The People Who Help

Sometimes It’s Good To Reflect

I’ve just walked the door after 10 hours away at work. I’m sitting with the laptop, in the recliner chair in front of the fire (mostly because I didn’t wear a coat today and it’s still only March). My husband will be home in around 20 minute and I can’t wait to see his smiling face and have a nice big hug. All in all, I am very content. Sure, there’s things that went wrong today. But instead of being a disaster as I would have seen it three months ago, I am able to shrug it off as just one of those days.

It is when I pause to reflect that I see just how far I’ve come. My care co-ordinator always reminds me to acknowledge my achievements and be proud of myself. So although this post may seem indulgent, or self-congratulatory, I actually don’t care. Today I am in a place where I can sound my own trumpet from the rooftops and I’ll be damned if I don’t do it.

In my eight years of working life I have worn many hats. I have been a minimum wage administrator, and I have been a customer services manager. I’ve spoken to many people, answered millions of emails and worked under lots of bosses. Currently I am working with a tech giant of a company, and although I am a contract worker, I feel good about the job. Compared to some of my permanent positions, I’d still rather be on contract and happy. Maybe that says something about what I have learned to value over the years, especially since I became unwell.

Then-me would have had kittens over a day like today. I thrived in the high-pressure crock pot of the customer services world, and even one slow day would see me climbing the walls with the anxiety of not being active. I needed to go go go to feel like I was earning my keep. Now-me sees things differently. I am a lot more relaxed and value quality over quantity. I work to the beat of my own drum, and I am lucky to have a manager who is only interested in the end-results. Then-me would have needed lots of direction and praise and feedback and management in order to move in the right direction at work, especially in my manic phases where I would start 20 projects all at once, and see none through to fruition. Now-me has a nice, manageable number of spinning plates and hasn’t dropped any (yet! I’m only human, so if I do happen to lose one or two I will learn from it, forgive myself and move on).

It’s not just at work that I’ve changed for the better. I wrote a guest article for Stigma Fighters today and wrote in it that I miss the manic energy. Which is true, except… do I? I miss feeling like I can conquer everything that’s thrown at me, but I’m in no way incapable of doing that whilst I’m stable. In fact, I would wager that although I used to feel that way it would actually be the opposite. I can probably handle more of life now and enjoy it along the way.

Other positive changes include a new interest in actually looking after myself. I mean sleeping enough, eating enough and not abusing alcohol. So really, I am saying that I seem to have remembered the benefits of moderation. Not too little sustenance and not too much booze. Even if I’m in a social situation now I don’t find myself hitting the inhibition lubricant hard. I can go out and enjoy a drink or two without overdoing it.

And this thing called a social life seems to have re-appeared from wherever it was hiding. Up to December 2014 I became something of a social caterpillar (definitely not a butterfly anyway). Since everything has calmed down I feel better equipped to cope with being in a pub, seeing friends and having a nice chat. Funnily enough, it’s a lot easier to hold a conversation with someone when you’re not being distracted by your alter or the voices.

My relationship is on a lovely even keel. The husband has stood by me through some rough times, and has been my carer in so many ways – making sure I take the meds, keeping on top of the housework, listening to many, many incoherent rants and taking the brunt of my rage. I finally feel I am able to repay some small part of what he’s been doing for me for the last few years (he would argue that I don’t owe him anything though). The nice thing is that doing little things to make him feel good also makes me feel good about myself.

I am better connected with my family now that I am trusting them to love me unconditionally – which they always have done, it’s the ‘trusting’ part that’s key here. We have argued, fought and screamed at each other over the years but we’re at a mutual meeting place now as adults and friends. Now I’m no longer ashamed of myself and my struggles to be well, I can see they were never ever ashamed to call me their relation.

So this has been a rather introspective bit of writing – I am sharing it because I want to let the world see how far I’ve come. The changes are down to finally being on the right medication, and having surrounded myself with the right kind of support. Also, it’s partly because I’ve accepted that I don’t have to fight to accept this reality anymore. I am proud to say I am me and this is my life.

Sometimes It’s Good To Reflect

Spotlight on Early Intervention in Psychosis

OK, so it’s been around a while now, but Early Intervention in Psychosis is still one of the more modern approaches towards treating psychotic illnesses.

An EIiP team is made up of care co-ordinators, psychologists, psychiatric nurses and psychiatrists who deal specifically with people who have experienced their first episode of psychosis. They typically work with people within a certain age range (such as 14 – 35 years old) and typically work with the service user for 3 years.

Their function is to facilitate recovery from psychotic episodes and illnesses. As studies have shown that the longer a psychosis goes untreated the worse the prognosis is, the aim of the team is to intervene as soon as possible and provide treatment in the form of assessment, medications, psychological services and social care. They will also support a return to normal social function, such as returning to work or education.

Here in the UK the EIiP team is a part of major service reform in treating mental illness. The guidelines state that as well as working with 14 – 35 year old for the first three years of their illness, they should aim to employ one care co-ordinator for every 10 to 15 clients, with each team taking on a caseload of 120 to 150 cases.

I’ve been under the care of the Surrey EIiP team for coming up on three years (we’ve just started to talk about where I’ll be signposted next), and my experiences with them have been great. Unfortunately the team I’m with seems to have a high turnover of care co-ordinators – I’ve had six in three years, some changes were due to circumstances such as a change of work location and a house move though – but despite the regular change of staffing, I’ve had the same psychiatrist throughout. I’ve also found that every care co-ordinator has taken the time to read up on my notes and get a thorough understanding of my case before meeting me for the first time.

As part of my treatment plan with EIiP I’ve spent time attending sessions with a psychologist. The EIiP approach is holistic and looks to solve underlying issues as part of the treatment of the illness. Therapy involved a lot of talking and examining patterns of behaviour as a result of learned beliefs, which is typical of the CBT (cognitive behavioural therapy) approach.

Getting referred to an EIiP team was a speedy process for me as I was in crisis at the time of my referral, but typically a referral can take up to 21 days. Whilst in crisis, the team works hard to keep the service user out of hospital. This can mean involving the Home Treatment Team (who make daily home visits to monitor the client’s state-of-mind and can refer on to inpatient care if necessary), or making use of Crisis Beds in mental health care homes.

Studies have shown that within two years, people who have used EIiP services have fewer relapses, less admission to hospital and have less severe symptoms. Feedback from service users suggest that EIiP teams are effective and have been rated highly for the support they provide.

My personal experience has been positive, and I am not looking forward to moving on from the support I’ve received whilst under their care. I can highly praise the team for what they have done for me in the last three years.

Spotlight on Early Intervention in Psychosis

‘Coming out’

“Coming out” about mental illness is nerve-wracking! The stigma of society’s uneducated opinions on the subject weighs heavy on the shoulders of someone holding back on sharing their illness with friends and family. But being open and honest about the issues you face with your support structures can also be incredibly freeing.

That’s not to say you have to go around proclaiming your illness from the rooftops. An asthma sufferer doesn’t necessarily tell every person they meet about their asthma. But in the same vein, neither do asthma sufferers hide their inhaler. If they need to use it, they don’t go and hide in the bathroom first.

For me, the biggest change has come from being honest with my employers in particular. In a previous job, I did everything I could to hide what was going on for fear of people’s reactions. And of course, when things deteriorated with my behaviours in relation to being manic and psychotic, I found I had no support – because no one understood the root of the problem. When I needed people to be tolerant and forgiving I came across brick walls.

The first time I decided to share with a manager my hand was somewhat forced by a major depressive episode that saw me going into crisis care for a week. I had to come up with a reason for my absence and after a lot of deliberation and discussion with my husband I chose to tell the full story. I had left work at midday for an appointment with my care co-ordinator and by 4pm had been granted a bed in crisis accommodation starting the following day. I spent the next hour writing and re-writing the email to my line manager, fretting about what she might think or do in reaction to my revelations. In the end I kept it brief – I summarised that I was in a severe depression and feeling suicidal; that I needed to take a week off to get myself back to being myself. At this point I had been in the job for about eight weeks and was still on my probation period.

Around 10 minutes later my phone rang. It was my manager and I tentatively answered the call, my mind filled with all the awful possibilities. I needed have worried however, as she proceeded to tell me that I had her full support and backing, and finished by saying that if I needed her all I had to do was call. It was such a huge weight lifted to hear her saying that. On top of this, once I had returned to work she arranged for me to speak with an occupational doctor to review my working environment and check if I needed any adjustments made to accommodate my needs.

Fast forward a year and you find me where I am writing this from; a new desk, a new company and a new boss. In my first month working here I started having problems with paranoia and anxiety. Within another two weeks it had ballooned into a psychotic and mixed-mood episode. This time I didn’t wait till the last possible moment to tell my manager. With the help of my husband I drafted up an email and hit send; an hour later I was in a meeting room listening to the boss tell me that I have him behind me all the way. Once again I felt that burden lift – I had felt like I was carrying a dirty and shameful secret around with me before telling him (the irony being that I had nothing to feel shameful over).

I just want to share a few resources with you to wrap this up. First off is the Equality Advisory Service who have been brilliant at answering my questions (such as “Is asking to change my working hours considered a reasonable adjustment?”). Next up is Mind’s Mental Health at Work section. And finally the page on workplace support on the Time To Change site.

As always, I welcome your thoughts, comments and questions, whether you post them here, on Facebook or on Twitter @justdontsayimcrazy.

‘Coming out’