Placement on an Acute Mental Health Ward

June 30, 2008 at 9:30 am | In Everyday stuff | Leave a Comment
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Well I’ve done four long days so far. It’s very interesting. I’ve definately learned stuff in that time. I’ve learned things I don’t know but didn’t know I didn’t know. That’s good. It’s the first stage of developing competence in a skill, moving from unconscious incompetence to conscious incompetence. I like the way this article applies the competence cycle to nurse training.

A particular situation, well patient, has been a real challenge. He’s acutely psychotic. It’s obvious from how he is presenting that he is extremely delusional, his thoughts are very disordered, he’s feeling paranoid and he’s hearing and responding to voices. He’s also pacing and occasionally running from one end of the ward to the other. He appears to have boundless energy. Every now and again, he’s tearful and has asked one of the male nurses to hug him a couple of times. The man is clearly extremely unwell and seems to be getting worse rather than better.

I’m so aware of having no clue as to how to ‘be’ around him, what to say and what not to say, when to persevere with communication and when to move away and feedback to a trained nurse the way things are going. They seem to be at least partly able to assess how his psychosis will develop over the next few days as the medication is adjusted. They also seem partly able to contain him and encourage him to sit for a while. They can temporarily de-escalate his mood and behaviour. I have, at points, asked him to sit down when he’s been pacing and offered reassurance that he’s safe and it has calmed him for a while. But I don’t feel so confident to approach him when he’s running up and down the ward, roaring. I want to be able to do what they can do. But he scares me.

I had a chat with someone about this guy and how I feel. I was really honest. They basically encouraged me to ask somebody to be nearby while I experiment with different ways of de-escalating situations when I feel ready to have a go. I feel safe with the team here. It’s a good place for students. They are free with the feedback – good and bad – so you really know where you are. So I will take every opportunity to begin to learn ways of dealing with acutely psychotic patients and trying the various methods out.

I want to be a good nurse.

I love this placement.

 

Therapeutic boundaries

June 20, 2008 at 12:09 am | In Everyday stuff | Leave a Comment
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Some nice lady replied to this post about my therapist. She said “he has a very kind face. i like him. i think he is a very clever chap”. Only she didn’t say it in italics. She said it in upright letters.

It made me think about him some more. I think he does have a kind face. It amazed me how he always managed to demonstrate unconditional positive regard and empathy week after week, year after year. He really did ‘get’ me pretty much from the start. Which was good. Because I had no f***ing clue. I should say ‘almost always’ rather than ‘always’ demonstrated UPR and empathy. I think maybe twice in seven years he seemed somehow different, distracted, like he wasn’t really with me in the room. One of those two times, he was trying to suppress yawns throughout the session (my appointments were 9.30am). I don’t think he did at all badly, two non-empathic (or less empathic) sessions in all that length of time. And those two sessions were as important as the others in the bigger picture of our journey. They made him human. And gave me an opportunity to wonder about what stresses and strains might be part of his every day life inside and outside of his work. And they showed me that I cared about him too. Both times, I spent the next few days wondering (not worrying) if he was okay and what it had all been about. I felt more connected to him in a way even though I never mentioned anything.

But his cleverness struck me more than his kindness. He was kind. But lots of people are as kind. And I don’t know how kind he was outside of my one hour sessions. He might’ve been a right old miserable git for all I knew. But he really was clever. I don’t think many people are as clever. The way he demonstrated trust in me and hope for me was clever. I felt as though he respected me and my resources and coping methods. I didn’t respect any of those things in me at first. So what he seemed to believe about me had a powerful impact.

And his boundary setting was clever. And surprising at times. Early on, when I was really quite distressed for most of our time together, he explained his feelings at my distress. I can’t remember his words but he was basically saying that when you see someone so upset you want to hug them. Especially a child. At that time I was probably functioning at the emotional level of a traumatised 8 or 9 year old for the most part. I really couldn’t understand what he was feeling because I didn’t know then how it felt to love someone, let alone somebody extremely distressed. And I had no concept of the love adults feel towards children. I now know those feelings well and understand his need to work it out with me at the time. We had some kind of (terrifying) conversation which basically resulted in an agreement that he would touch my index finger with his index finger when he wanted to comfort me. It makes me smile to remember. Literally. And feel all warm inside. It was a very uncomfortable but healing learning curve about people and the world and me. After a while, probably for the last three years, we always hugged briefly at the end of the session. I’m not sure if that’s the norm for other people but I didn’t expect it within a therapeutic relationship.

Another thing that I didn’t expect was the whole ‘ending the session’ thing. I pretty much always ended it, as far as I can remember, not him. Sometimes a couple of minutes before the allotted time, sometimes a few minutes after. If I went on a bit longer, it was only to finish off what was going on and put it all back in the right boxes. And it was with much apologising. But I always felt as though he trusted my motives and knew I would never go far over the time.

And he always sent me postcards from holiday. I’ve still got them.

The last boundary-related surprise I shall mention relates to the end of my therapy. I was ready and happy for it to end. I’d only been seeing him monthly for ages anyway. But I knew I would miss the sessions. And I knew I would miss him even more so. It’s not the norm to let someone in so deeply and then never ever see them or hear from them again. We had a lot of conversations about it. Occasionally he had read stories to younger parts. And somehow we agreed between us that he would read a story and I would tape it. So somewhere, I really don’t know where, I have a mini-cassette with him reading ‘the tiger who came to tea’.

The end :)

A good friend came to see me today

June 12, 2008 at 1:00 am | In Everyday stuff | Leave a Comment
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We had a good chat about all sorts. I really enjoyed spending time with her. I like her a lot. She’s the only person off my (mental health nursing) course that I actually want to spend time with in the holidays. She’s easy to be with. She’s clever. She’s interesting. She’s funny. And she’s human. The hours flew by. About 4 of them. And I could’ve easily chatted for another 4.

I was slightly worried about her if I’m very honest. She’s doing too much. And she seems to be dragging herself through each day without much to look forward to. I don’t think that’s great. And I don’t think you can do it forever. I hope she takes good care of herself. Soon. xxxxx

Tomorrow I will find out my shifts for my next placement which starts in about 10 days. I am expecting a struggle. I am expecting to be a bit dissociative at times. I am expecting (at times) to feel like a six year old abandoned far from home. That’s how I generally feel when the agoraphobia kicks in. That might be because that’s when and how it all started. But I think I will survive it. And I think I will function okay on placement. I think I will be able to contain the trauma to times and places where it is acceptable not to be okay. That’s good enough for me.

If and when I qualify, I don’t intent to get a job outside of the city in which I live.

Agoraphobic’s Dream Holiday

June 12, 2008 at 12:02 am | In Everyday stuff | Leave a Comment
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I never used to enjoy going on holiday much. It was never really worth the effort. Usually it was one long trauma. Me and my friend (who I live with) have some ‘fond’ memories (NOT) of specific attempts at relaxing away from home for a few days many moons ago. One such vacation involved driving round for hours on end in search of a chemist and buying up enough Kalms to bring a herd of elephants to a standstill. Didn’t bring me to a standstill on that occasion. Unfortunately. For both of us.

Nowadays I enjoy going on holiday. Thanks in part to a little caravan off ebay. I reupholstered the cushions in fabric I like and made curtains to match. I put a few bits and pieces from home inside. Before going away the first time, we spent a couple of nights in the caravan at the bottom of our garden. It was bloody freezing. Did the trick though. We’ve been away in it loads now. It’s home from home. I do get anxious at times. But if it gets a bit more than I’m comfortable with, I can sit in the caravan with the curtains shut and I’m basically back in a place I’ve been loads of times and know really really well. I don’t even take a bottle of kalms these days.

Thankfully my ever so slightly wierd friend doesn’t mind. She doesn’t have any desire to venture outside of the UK anyway.

Tomorrow we go away for three nights. I’ve sorted out some bits and pieces to do. Some reading for my course. I might or might not look at it. I don’t have to. And some crafty stuff to get on with. It’s a lovely little campsite. And there’s a couple of little villages nearby. With pretty shops.

(Just for the record, I don’t sit there for three days with the curtains shut pretending I’m at the bottom of my own garden).

Therapist

June 11, 2008 at 11:26 pm | In Everyday stuff | 2 Comments
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This was the man I saw every week for a while, then every fortnight for a while longer, then every month for a bit. Then we said goodbye. That was 15 months ago. All in all, I saw him for about seven years. I think about him every now and again. Sometimes I miss him. I loved him. And I trusted him. I asked him if he loved me too. That kind of proves how much I trusted him. I asked him all sorts. And I told him everything. One night I stalked him on the internet and stumbled across his address. I told him about that. He didn’t seem too phased. I never went to his house and I never would. Even though I’d love to tell him what I’m up to now.

The last question I ever asked was ‘can I take your photograph?’.

Cortisol

June 5, 2008 at 8:08 am | In Everyday stuff | 1 Comment
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I just thought I would come and say hi. I don’t feel very dissociative anymore. And, to be honest, it’s pretty excruciating to read this blog. When I’m not dissociative, which is most of the time, I have a fairly integrated view of myself. I see myself as a whole unit. I feel whole. I’m not saying I never feel slightly younger, older or a bit spacey. But I think it’s at about the same level as everyone around me. It’s how I imagine everyone else feels. Personality is a bit fluid anyway I think. I don’t find this blog triggering. It doesn’t upset me. It makes me feel slightly ashamed. Not because I feel bad about what’s written. But because I have no awareness of feeling that way. Which makes me a liar. I think I must’ve been playing games. For attention or something. Exaggerating it all for effect. That’s basically why I stopped participating on dissociative communities – online and real life. Because the freedom to be very honest is there, everybody is very honest. I was very honest. I would go back the next day, see words next to my user name, feel like a liar, then hate myself for a bit. All very bizarre.

Even though I’m much less dissociative, I’m still pretty vulnerable at times. Sometimes it really impinges on life. Mostly, I don’t cope well with severe stress. I overreact in the first instance. I need to eliminate all stress factors. There’s no concept of reducing stress and navigating my way through it. I feel totally overwhelmed. And I can’t think. All the worst case scenarios go round and round in my head in a loop. Nowadays I do know what I’m doing. I do know my thoughts are the problem. I know it’s the way I’m looking at things that’s causing the panic, not the situation. Most situations in life are do-able, one way or another. There’s usually a realistic satisfactory outcome to be found.

I’m really looking forward to the day that I can bypass the agonising traumatic process and go from recognising the problem to finding the realistic satisfactory outcome. I’m not sure I’ll ever be able to do it without a level of anxiety. All to do with cortisol. Apparently, the research says that people’s wiring is affected by repetative trauma. You really can’t help some of the response. Loads more cortisol is released under stress. Some of it’s just biology. I find that strangely reassuring.

Who am I?

May 21, 2008 at 12:44 pm | In Everyday stuff | Leave a Comment

I’m feel soooo much better. Settled. Calmer. Than I have done in the last few weeks. Things have slowed right down.

But I feel tired and confused. I’m exhausted. And quite low. I don’t feel like I’m shuffling through identities like a pack of cards anymore, shifting from one to another. I just feel vague and unsure. I have no idea who I am.

But I feel better. It’s definately better.

Is everyone else making it up? Trying to appear more cohesive and whole than they are? Are they, half the time, making up the values and beliefs they live from? Do they really care about the same people a lot of the time? Because I could make it up. Easily. I could make it look like they never change. I often have to. Sometimes to avoid grief. And sometimes to keep things in place for when I switch again. But I don’t really think or feel the same at all. But, so what? I’m never really bad or anything. And I can still function okay. And I probably don’t seem all that different unless things are really going pear-shaped.

It’s ok.

In the end.

May 19, 2008 at 4:48 pm | In Everyday stuff | Leave a Comment
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Today I went to make an appointment to see the mental health nurse at University. I’m going to see her tomorrow at 11.30. I think it would be good to chat to a someone about the last couple of weeks. Well three. Only the first week I didn’t feel dissociative, I felt overwhelmed. I took the week off Uni to catch up. I couldn’t cope with the idea of even one more single thought being put in my head without putting some kind of order to the ones that had been crammed in over the preceding weeks. That week was just odd. Then the dissociation kicked in the next week. Out of the blue. I don’t want an opinion. I just want to cover my back. So if it happens again, I don’t have to try and remember what happened this time. Second opinions are good. They stop you feeling dishonest. And worrying what people would think if they knew.

If I struggle loads, I’m wondering whether I may need to consider a different career path. I can’t see that happening to be honest. But I’m a great believer in going with a job that suits you and your skills and resources. And it wouldn’t be the end of my little world. There I go, looking on the bright side again. I like that. It’s me. And I don’t feel much like me very often at the moment. But I would be pissed off if I had to let go of it because of idiot opinions about who can and can’t work in mental health.

But this little bit of my life has been fairly constructive. Not only have I learned loads at Uni. I mean loads. It’s been really really interesting. And this little not-doing-so-well bit has given me food for thought. For one, I’ve come along way over the years. It’s kind of highlighted that. The golden rule years ago was never let anyone know what’s going on for you. Never. At any cost. That took some shaking off. For the last few years, I haven’t lived by that rule anymore. Although I have still felt pretty mortified at times, presuming that people think I’m pathetic or whatever. I just didn’t let it stop me. But I haven’t felt that at all lately. Partly, I don’t believe people will think I’m pathetic. Well, not many of them. And not the ones that are worth taking any notice off. And secondly, what difference does that make at all to me if they do? That’s their problem. And thirdly, some of my very best and favourite people are a little bit pathetic every once in a while. So pathetic ain’t all bad. I do worry slightly about the tutors and what they think. Mainly because they have power to stop me qualifying. Not because I worry about their opinion of me. This whole power thing is a bit shit in mental health to be honest. Having to lie or at least not be open and honest because you can’t trust the system of things to protect your interests equally. I’ve got to go and see the Occupational Health person soon. That’s gonna be crap.

It’s also been a bit of a reminder about what some people have to live with all the time, or a lot of the time. Because you do forget. Even if you try not to. I’m not talking about ’symptoms’. They can be unpleasant, very unpleasant at times. I’m talking about feeling different. And having to be careful with your behaviour and language because it needs to be contained. You know if you don’t contain it, it won’t be socially acceptable. Trying to fit in with what’s expected of you and with the standards you normally live from. When they just aren’t your standards right now. It’s okay but it’s hard work. I’m very lucky I didn’t really get into the system and have all the crap from that on top.

I’ve also made some good friends. Some people who were friends last term have become more important to me. I love them whereas I liked them. Other people who I really didn’t think much of at all last term have become more like friends. I like our group a lot. There’s one person I really like loads. She’ll be a brill mental health nurse. Mostly, we do have a good laugh. I think next year, it might feel a bit more serious as we get into it. I hope the idiots leave. The ones that think people are nutters. The ones that think people should be locked up if they’re hearing voices and forcibly treated. I feel torn about the people that aren’t bright or struggle because English is a second language. No offence, some of them are lovely, but really not grasping anything. And my allegiance is with the people who turn up at services needing help. I’m just not sure some of them could cut it. And people deserve a reasonable level of skill as well as warmth and respect. We’ll see.

 I do actually feel like my little old head has stopped the meltdown process. I feel manic. I feel impulsive. I feel like I don’t really need anything from the world. I don’t need people. I don’t need food. I don’t need sleep. But I don’t feel like it’s getting worse. And my head’s quieter. And I’m starting to think about things I want to do when Uni breaks up. I’m going to be creative. I’m going to spend time with a wonderful eight year old I know. I’m going to read bits of stuff I’ve been interested in from the module we’ve just done but not had the time. I might start looking at bits for the next module in a leisurely fashion. Because it is actually interesting. I might write a little of the reflective essay on branch exposure. It doesn’t look difficult really. I’ll probably look up Gibbs and Johns models of reflection and try and follow one of them. Mostly, I’m going to enjoy my days doing what I need to within my resources but with a load of doing what I want to thrown in.

I’ve got a feeling it’s all going to be pretty much fine and dandy.

In the end.

 

Untitled

May 17, 2008 at 1:11 am | In Everyday stuff | 1 Comment
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Why is dissociation so hard to put into words?

All day yesterday and most of today I didn’t feel like I was in my skin. I felt broken but not in any kind of emotionally painful sense. As if my skin had opened and bits of me had fallen out and bits of me were still inside. Broken in that sense. Like a living vase that’s fallen of a shelf. And is in bits on the floor.

Sometimes, that’s how I think of myself. I mean generally. When life’s grand. I think the vase fell (got pushed) off the shelf years and years ago and it got glued back together pretty well. It holds water and it looks okay. It’s generally a pretty happy little vase. Sometimes even kind of proud of its visible joins. But it maybe doesn’t want to sit too near the edge of very high shelves. Unless it doesn’t mind keeping still for a bit while the glue sets. I think there’s a fair few living broken vases around.

But really, that metaphor doesn’t capture dissociation very well. That’s part of it. But dissociation’s more than 3-dimensional. Much more. Yesterday I watched my own hands type stuff I didn’t agree with. That’s a bit wierd. And, if I’m honest, a bit unnerving. It doesn’t worry me in and of itself at all. I just think all human beings are pretty complex and everyone has bits of themselves that are out of sync with their overall identity and values. People dress differently or hang around with a different crowd and different bits of their personality become more prominent. With dissociation, the bits separate out further from the centre in varying degrees. It’s all along the same continuum. It doesn’t bother me that bits are more separate than usual. It bothers me that I might have messes to clear up. I really don’t have the energy. The worst situation ever was when one part called Rachel told the WHOLE WIDE WORLD she was gay. That really wasn’t fun. She was gay. But the other bits of me weren’t.

Most of the time, it was nowhere near that bad. I remember countless times where I would have to endure conversations with people who had spent lots of time with other bits of me and related with me as if I was somebody I didn’t feel I was. I just had to make up reactions and try not to ‘blow it’ for the ‘others’. I had my friends. I didn’t want to lose them theirs.

Yesterday, I know the part that I watched typing was doing the same thing, being careful not to mess things up. I know what they wanted to say because none of me is ever that separate any more. I can hear their thoughts in a similar way to the way I hear my own. Like when I’m sitting in lecture and think ‘must buy bread’. I hear my internal voice. Short, sharp, clear and to the point. I jot down ‘bread’ in the corner of a handout and that’s the end of that. To the best of my knowledge, everyone has a similar thing going on. But what’s been going on in my head over the last couple of days is having other internal voices challenging things I’m thinking. For example, I think ‘must buy bread’ and another thought follows it with ‘i hate bread, what would you want to do that for’. Except the responses are less polite with a lot more swear words. And not mine. The other thing that’s happening is I can ‘hear’ what other bits of me are thinking when I’m trying to write an essay and the room’s nice and quiet. Which takes me back to my original point; when the other part of me was typing, I could ‘hear’ them saying things like ‘I’d better not say that and expressing general frustration about not being able to. And I was thinking ‘thank you’ and ‘i really appreciate it’ and stuff like that.

I’m not talking about auditory hallucinations that sound like they’re outside of you so you turn and look to see who spoke. I had that a few times, only nice reassuring voices, but they still made me jump. No, I’m just talking internal dialogue.

The other thing I’ve felt loads is being so totally overconscious of every inch of my skin. It’s horrible. And time has this wierd quality. I look at the clock. I know what time it is. But it doesn’t mean anything. It’s not really to that degree. But it’s an effort to figure out. And even more difficult to explain.

Too much grey…

May 16, 2008 at 8:34 am | In Everyday stuff | Leave a Comment
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Health is a continuum. Mental health is a continuum. Dissociative disorders are a continuum. Nobody’s fully well. Nobody’s completely mentally healthy and everyone dissociates to some degree.

Which leads to the question, at what point does it become a problem?

The art and science of classifying mental health disorders looks at two things: abnormality and distress. Abnormality can be unpacked to consider what is expected within that society and what is unacceptable within that society (i.e. deviance). And there’s something about statistical norms thrown in aswell. Distress is fairly straightforward, kind of the equivalent of physical pain that results from injury, illness and diseases of the body.

As a result of his research, Kraepelin, the guy who decided that all forms of madness had a physical cause, also noticed a couple of other things about the behaviours and ideas of mad people. He noticed that there was some kind of pattern to it all. No one symptom (such as auditory hallucinations) was unique to any one form of madness, but you could separate the forms of madness into groups by the combination of symptoms exhibited and by which ones were the most prominent. This led him to separate out and define both schizophrenia (dementia praecox as he called it) and bipolar affective disorder (manic depression). According to most textbooks, both the ICD-10 (WHO, 1992) and the DSM IV (American Psychiatric Association, 1994) are built on his work.

I’ve been dissociating all over the place over the last couple of weeks. And all this has given me lots of food for thought about the whole classification thing. It’s all very grey, all a bit hit and miss I think. People are just so darn random!

BTW, I do believe in God and I haven’t stopped believing in God! Me and God had a good long chat yesterday as it happens!

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