[TW: Self harm and suicide]
I hardly know what to say, how to articulate myself. The truth is I haven’t really been well since 1st September when I reduced my quetiapine from 600mg-500mg under Consultant supervision. It only took a couple of days to see that things were going wrong and although I put the dose up again quite soon after, the damage was done. Since then I’ve been close to crisis a couple of times and considered asking to see my psychiatrist more urgently than our planned appointment at the end of November, but on both occasions I managed to pull things back. Last Friday (9th October) I realised I couldn’t handle things myself any more and contacted my Consultant who extremely kindly fitted in a consultation with me the following Monday.
It was an odd appointment in that no matter what I said to him over the past years, none of it made him seem as concerned or as sad as what I told him on Monday. I explained that there was so much going on in my head but underneath it all was a pulsing idea, like the slow beat of a steady drum, that I don’t want to be here. People had started to ask me about Christmas but it feel remote, irrelevant, because I didn’t think I would be around. I admitted that I had been Googling possibly fatal doses of my medication (although I had already asked my partner Tom to take my meds and hide them somewhere, which he has done) and tormenting myself by looking at pictures of the Dignitas assisted-suicide clinic. I told Dr S that what I wanted was to be able to go somewhere quiet and supportive to end my life, that I did not see why because my life-long disability was mental I should have to do violence to myself to end my life, violence that would be needlessly distressing for my family and emergency services personnel. The look on his face when I said this haunts me, as does the knowledge that I had managed to make an experienced psychiatrist look so sad.
On top of this I was experiencing wild, impulsive, intrusive ideas. I am not a self-harmer yet I was plagued with impulses to cut or otherwise damage myself. I was also inexplicably drawn to doing things which felt like suicidal impulses yet would nowhere near do the job. Jumping off my balcony is a good example, I felt my body was twitching towards doing this, but what would I achieve? We’re only two floors up. Nothing would come of it other than a couple of broken legs, maybe, and a period in an orthopaedic ward. I was baffled by these urges, but did not feel safe, scared I might do something ridiculous but drastic and end up with horrible injuries and the inability to return to the work I have built up.
The inevitable questions of admission or Home Treatment Team arose. I explained that I had a problematic relationship with the HTT Consultant before because I do not feel he listens, but my own Consultant seemed more willing to intervene if that becomes a problem again. He also reminded me that the referral to the National Affective Disorders Service (made in April of this year, despite which none of us heard a word) had originated from the HTT and might be better chased within the HTT. Admission was also mentioned in rather more concrete terms than usual, and this was not something I wanted to hear, so I agreed to return to the care of HTT.
My initial induction/assessment was with one of my favourite nurses, D, and took place the following day. On the way I picked up my meds for my physical health problems, and found myself wondering how many sedatives I could easily buy over the counter. Waiting for the bus to the hospital an ambulance screamed past me, headed for A&E and I experienced a strong impulse to leap into its path. This, I felt, was a new low for me, an act that could cause someone inside the vehicle to lose their life. Despite these ideas I felt surprised how concerned D seemed about me, because another part of me was starting to believe that I was making everything up and HTT would think I as a waste of space. Instead, I found myself having to fend off quite serious talk of admission by agreeing to daily HTT visits (last time I only had to go every other day).
HTT seems more helpful this time around in that I am so confused and desperate that the sheer fact of seeing kind people with familiar faces is helpful. The HTT Consultant’s away this week, so I saw the Registrar, who I’ve also met before. The “med review” that was undertaken was pretty unimpressive, however. I don’t know if he was unwilling to do much in the absence of his Consultant, or until the referral has been chased, but his only advice for today was to try exercising for ten minutes every day. I was supposed to have a lithium blood test too, but somehow there was no one to do it, so I have to tweak the time of my dosage for a second night and hope someone can take the blood tomorrow.
In between I am swimming in a soup of confusing, conflicting emotions and thoughts. Usually when I don’t know what mood state I am in (a situation which leaves me baffled and scared) I am in a mixed mood, so I’m going to go with that. I am still thinking about suicide. A lot. Today I should have been at the Royal College of Psychiatrist’s general adult psychiatry conference as a service user rep, but I had to give my free ticket back to Mind because I was too ill to use it. Seeing others live tweeting something I had so looked forward to attending brought home to me, immediately and painfully, how unpredictable my life is, how many disappointments and how much suffering it is charged with.
Had I had access to that box of meds I feel that this afternoon would have been extremely risky for me. I have reached a point where I don’t even know if want to get better, because what is the point? Looking at my life, it’s littered with things I tried or wanted or started to do/achieve/try. Why bother to work at getting better, when it’s inevitable that all I’ve worked towards will come crashing down again at some point? Even over the summer while my mood was stable and good, I could not let go of the feeling that it might still be better to end things, before I could relapse again.
And yet part of me still thinks I’m not really ill. I had to draw this diagram for myself just to remind me that actually there is a hell of a lot going on (I’ve never tried to make a Venn diagram of my symptoms but it actually worked really well). I don’t know how to get out of this soup. I’m taking my meds and attending my appointments like a good compliant patient. I’m using prescribed diazepam to manage things; it doesn’t stop the thoughts or the feelings, but it blunts them. Only all the time, underneath it all, I hear the steady beat of the drum.