A few weeks ago, I saw a GP for an urgent re-referral back to Consultant care. I was embarrassed by my plight. “I just feel like these unseen, malevolent forces are trying to thwart me at every turn,” I told her, crying at the thought of it. “I mean, obviously I know that’s not true. But I believe it is. And I feel like I’m going into crisis and I’m scared.”

“Don’t worry,” she said. ”I’m going make an urgent re-referral back to the community mental health team and I’m going to make sure that happens today. I’m here until four o’clock, so if you’re struggling this afternoon, come straight back, OK?” She reached over and put her hand on my arm. “And you’re very self-aware, so you’re going to be OK.”

Ah, my old friend self-awareness. I distinctly remember the first time I realised that knowing how much pain I was in would make professionals take that pain less seriously. I was 25 years old and acutely depressed, mother to a tantrum-prone two year old and a newborn baby with colic. My GP threw antidepressant after antidepressant at the problem with no success, and asked the Health Visitor to drop round. She asked how I was feeling, so I told her the truth: like the world’s worst mum. “Oh, you’re not!” she said, looking horrified, “you’re a lovely mum! But I think we’d better just do this Edinburgh Postnatal Depression Scale.”

As you are pregnant, the form began, or have recently had a baby, we would like to know how you are feeling. Thank God somebody did. I looked down the list. Had I been able to laugh and “see the funny side of things?” Well, you see, I really wasn’t sure what funny side it was I was meant to see, trapped in a house with two completely dependent children I felt incapable of caring for. Had things been getting on top of me? I ticked the box marked, “Most of the time I haven’t been able to cope at all.” Yes, I’d had difficulty sleeping. Yes, I was miserable and crying most of the time. I paused at the last question, but carried on regardless. Yes, the thought of harming myself had occurred to me “quite often.” I handed the form back and the Health Visitor totted up my answers. “Hmm,” she frowned, rechecking the score, “you’ve come out very high. But I think that’s just because you’re so self-aware.”

I totally get that from a medical perspective, the person who is depressed (or manic or delusional or whatever) but has insight into their condition is easier to treat. It is going to be much simpler to get them on board with a treatment plan, reducing the risk that coerced treatment will be needed. From my perspective, however, knowing exactly what is happening me does nothing to reduce my distress. In fact, having to accept that I am ill again and knowing what is likely to happen next can be terrifying. Have you ever had an experience such as falling over in the street or being involved in a vehicle collision? You know that sense that time suddenly runs very slowly, that you can see precisely what is going to happen? Do you have awareness of the situation? Yes. Can you control the outcome? No. Knowledge is not power, not if it’s without control.

My self-awareness may be a comfort to my care team. For me, it means there multiple layers to my distress. There’s the primary pain, the fear of paranoia or despair of depression, or the desperation of mixed mood. Overlaying that is the knowledge that things may be about to get a whole lot more distressing, because no matter how hard I try and manage my condition, by the time I get to this stage things can only get worse before they can get better. And on top of that is the shame and the embarrassment, shame that I have “let” things get this far, the indignity of the contents of my thoughts and beliefs, embarrassment that I proudly “called” recovery a few months ago and yet here I am, back at the CMHT.

Having marvellous insight is no comfort if the self you’re aware of is not the self you want to be. Very rarely have any of the professionals I have worked with noted that it must, in fact, be scary to realise your mind is yet again being hijacked by your illness. I am aware, as I type this, that I am hypomanic. I am aware too that there are lots of things I can try to counter this. Yet I am also aware that sometimes I do everything right, and things still go wrong, and that next week I could end up back in front of that same GP with the same kind of issues, having my self-awareness praised.

About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards
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15 Responses to Self-awareness

  1. butterflywgs says:

    Excellent post. I get this too. It makes me want to scream and throw things. Yes, we’re intelligent, articulate, insightful, even when in crisis; no, that doesn’t make us any less ill, or make it any easier.

  2. justme75 says:

    Your blogs so often ring true to me …not because I’m bipolar, I’m straightforward long term depression with good spots, but in other aspects. I too am aware of my problems, can see the peaks and troughs coming now, but it’s never helped me as far as care is concerned – in fact, despite suffering to one degree or another for what I now realise has been a quarter of a century, it was only when I saw a new doctor earlier this year in one of my deepest troughs yet that I even got an official diagnosis or any offer of treatment, because previously I was considered too aware of my mind, too knowledgeable (it helped me to research what might be happening to me while in the good spots), therefore I must have been over-exaggerating it, especially when ‘hormonal’. It helps to know it’s not just me out there getting these reactions – and hopefully it helps you and others too.

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  4. Arrived at your blog via your comments on the Bedlam documentary on Twitter. Very good post and at the risk of sounding like a bad joke, very perceptive too. I can vividly imagine the difficulties experienced with your Health Visitor.

    I would hope however that your mental health professionals are better able to reflect the emotions that you are going through and am disappointed to read that they are not doing so. I don’t claim to be the world’s greatest CMHN and I know that we’re constrained for time and around demands for bureaucracy but that’s where a mental health professional (outside of the psychiatrists) should be placing themselves; in amongst the distress and hopefully the cause of it too if there’s anything that can be addressed about that. It’s the lived experience that’s important here.

    I hope things get better sooner than you think and wish you well.

  5. Elizabeth Cave says:

    I don’t have the energy to spell anything out (got home yesterday), but many many thanks for this piece.

    Love, Elizabeth

  6. Nick Kiddle says:

    Reminds me of my GP, who I’m sure is very good with children who’ve just broken out in spots, but is absolutely terrible with me and my mental. He’s always cracking jokes about football and trying to cheer me up by pointing out that wow, I managed to get dressed and leave the house, I’m not doing too badly at all.

    I told him once about an incident when I became convinced based on a tweet that one of my friends hated my guts. I knew logically that it was much more likely to be a simple misunderstanding but emotionally I couldn’t shake the feeling that he was secretly thinking what a jerkface I was. When I told my GP, he just said “Well that’s good! You’re thinking logically.” Yes, I’m thinking logically and it’s NOT HELPING. That would seem to be rather a problem.

  7. anouarpac says:

    Thanks a lot Your posts really ring true to me

  8. whirl_y_gig says:

    Yes. And you’re articulate too, which can’t help your case. My “coping with things” has been a double-edged sword. I’ve kept working – even had success in my career, and I’ve provided myself with a roof over my head and a semblance of a life. So things “can’t be that bad” for me… that has been the attitude I’ve encountered with various GPs I’ve had over the years. I didn’t get the help I needed for decades but then finally I did from a good NHS psychiatrist – but I had to do something quite extreme first before my distress was visible to anyone. I told the psychiatrist this and he said that his other patients have said the same thing to him – that they have to exhibit extreme behaviour to be “taken seriously”, and that this has to escalate sometimes for them to stay in the system.

  9. missiekaboom says:

    I was actually told at one point, three years after being diagnosed, that I was “making it (being bipolar) up to get attention” because how I described I was feeling sounded like it had “come straight out of a pamphlet”. I was then told that I “didn’t look depressed” and that they were going to tell my GP to stop prescribing me medication. Luckily my GP knew me better and sorted things out but at the time it seriously messed with my head!

  10. doublenutty says:

    What a great post. So full of insights. Thank you.

  11. doublenutty says:

    This post is so insightful. Thank you. I valued it very much.

    All best,


  12. Pingback: Unexpected knowledge – Things I’ve learned since being sectioned | Sectioned

  13. You’re writing about the precise reason I was ignored for so so long for treatment. I am hyper-aware (the perks of being a dancer) of everything I’m thinking and feeling and it scares me when I’m told that I’m too aware of my thoughts. It means they think I can’t be as ill as I say I am because I am aware of it. I completely understand you here. X

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