Therapy in the time of Covid

First published on MadCovid, 19 June 2020

Throughout the years I’ve been under mental health services, I’ve been through many courses of therapy.

None of them have proven particularly helpful, and nor did I expect them to. I firmly believe that my mental illness is down to screwy brain chemicals and not some deeply repressed past trauma (spoiler: I don’t have any, and have always felt I’ve disappointed my therapists by not having a ‘Eureka!’ moment).

But therapy, I’ve found, is used as a bargaining chip by secondary services. ‘Engage with it, otherwise we won’t help you.’

And so, just before lockdown stopped the world, I ended up agreeing to yet another course of therapy, under duress. My psychiatrist had written those accusatory words in my notes – ‘has not engaged with therapy’ – conveniently ignoring the 12 recent-ish months I spent having weekly one-to-one ACT sessions.

This latest round of therapy – four weeks of crisis management – was forced on me almost by stealth.

I’d managed to get my psychiatrist to remove the BPD diagnosis from my notes, after two other psychs – one private, one working in the NHS day patient unit where I was being treated – refuted it entirely.

But when I agreed to (another) psychology assessment, it transpired that I was being directed down the PD pathway.

I was NOT impressed, but to get them off my back, I agreed to do this short, DBT-based crisis management course.

It was supposed to be a group course, but Covid changed all that. Instead, I was told, I’d be given one-to-one sessions via video call.

Now, I don’t like video calling at the best of times, so this development didn’t thrill me. I find it too intense – conversation doesn’t flow in the same way, body language and silent cues are impossible to read, and I find myself spending all my time trying to avoid looking at my ugly face.

I don’t like group therapy, either (spotting a theme here?) but at least in that situation I can hide in the background: more confident people can take the lead, and there’s less pressure to be the one with all the answers.

Yesterday, I had the third of four crisis management sessions, and I hated it. Their value, for me, has decreased steadily: week one was quite useful, week two was a bit rubbish, and yesterday was awful.

I won’t go into all the details, but the focus was on self-harm and how to prevent it, and the assumptions of why and how people self-harm were completely irrelevant to me.

The therapist was adamant that all self-harm is spontaneous and impulsive, whereas I’m a meticulous planner and always know exactly when, where and how I’m going to do it.

So, the content of yesterday’s session rather missed the point – and I guess it showed. It was rather like being in the Mastermind chair and forgetting everything about your specialist subject.

I found it impossible to give the answers the therapist wanted. I didn’t agree with her theory (or the DBT theory) of why people self-harm. I didn’t identify with the thoughts she assumed were in my head. And I couldn’t provide her with the list of pros, cons and protective factors that she wanted.

Besides, I haven’t self-harmed for several weeks, and it was really not something I wanted to be talking about.

So yes, I was disengaged. I didn’t mean to be rude, but clearly that was how it came across, as the therapist said, in a chastening tone, ‘I get the feeling you don’t think this is helpful.’

Nail: head.

The problem is I’m a people pleaser, a teacher’s pet, and a perfectionist. I hate feeling that I’ve upset someone or that they’re disappointed in me. And so I found myself back-pedalling at speed, enthusing about how great these strategies would be and how they’d undoubtedly save me from self-harm.

In non-Covid times, this wouldn’t have happened. I’d have been doing the sessions in a group, and letting others do the talking when I had nothing to say. When asked for my thoughts, I’d have felt more able to be honest, knowing that someone else would likely be feeling the same.

But with nowhere to hide on a video call, I’m left feeling both guilty and inadequate, and I can already tell that in next week’s session, I’ll feel obliged to make up for this week’s shortcomings. I’ll feel compelled to tick the ‘very good’ boxes on the post-therapy feedback questionnaire.

I’m pretty sure this isn’t the point of therapy.

Still, I’ve proven that I can and will engage, even in the excruciatingly intensity of Zoom counselling. I’ve been a good girl, and no one can say I haven’t tried.

Until the next time they decide that because I’ve not been scrutinised by a psychologist for, ooh, about 12 months, and therefore it must be time to force me to ‘engage’ again.

The next time, though, I won’t. What’s the point? Wouldn’t that coveted therapy slot be better used by someone who might actually find it helpful?

If they kick me out of services, so be it, but I’m done with therapy – especially Covid-friendly Zoom therapy.

Tried it, hated it – and for my own wellbeing, I’m not going there again.

‘What even is normal any more?’

First published on MadCovid, 11 June 2020

As Covid-19 restrictions slowly ease, I find myself wondering whether we’re still in lockdown.

In some ways, it no longer feels like lockdown now I can see my friends and family (albeit at a 2m distance and not on a rainy day unless we’re willing to get drenched in the park), go to the garden centre and pick up a takeaway Starbucks.

But it doesn’t feel like the new normal, either: not with my children still at home for the foreseeable future, and hugs with anyone outside the household still outlawed.

Rather than lockdown, we’re in limbo, and while it’s undoubtedly better for my mental health than the complete enforced isolation of March and April, it’s unsettling and destabilising in an entirely new way.

We’re allowed to see friends in groups of six, but what if they don’t want to see me? I’m scared to ask in case they feel obliged to say yes when they really mean no – and in case they say an outright no, and I crumble into a small pile of rejection and loneliness.

We’re allowed to send some children back to school, but not all of them – including mine. I love them, but the thought of having them at home even into the autumn term fills me with dread.

I’m not equipped to be their teacher, and my eldest in particular is falling behind on his home learning. Every time I receive an email from his school telling me his work is incomplete, I’m overwhelmed by guilt. I’m a terrible parent, failing my children. They’d be better off without me.

I could send them back to school on the basis of my mental illness; the school nurse has told me as much. But how can I when the rest of their friends are still off? How can I explain to them that I’m too mental to keep them at home?

I’m working from home as usual, and as well as the kids being ever present, my husband is now into his fourth month of working from the kitchen table.

Sometimes, I’m glad to have them around, but at other times, I want to scream. I miss my silent, peaceful house where I can work without interruptions. Sometimes, I’m so overwhelmed by their omnipresence that I can’t even cope with them touching me.

I’m angry, too.

I’m angry that my husband, who has given his company 17 years of service, loyalty, hard work and talent, is now at a 50/50 risk of being made redundant, which will blow apart life as we know it.

I’m angry that from next week, we’ll be able to spread our germs all over Primark, and soon be able to have a drink in a beer garden or even go to bloody Legoland, but my kids can’t have the education they deserve, I can’t see my psychiatrist in person, and I can’t have a cup of tea and a proper face to face chat, with my friend.

How is this fair? How is this right? I’ve never felt so politically enraged.

The scientists, doctors and politicians are all in agreement that the pandemic will trigger a spike in new mental health problems, but there’s no acknowledgement of us who already have severe mental illness: those of us who have had intensive treatment cancelled, face to face appointments replaced by phone calls, and prescriptions overdue.

We can’t be ‘cured’ by going for walks, taking long baths, and maybe having a short course of counselling, but when we try to seek support, that’s all they can offer.

I’ve often wished for a magic wand to make my illness disappear and now, greedily, I want another, to make life go back to normal.

But what even is normal any more? What is this ‘new normal’ that we keep hearing about? Will it (eventually) mean washing our hands more often and keeping a respectful distance when queuing, or will it mean months or years more part-time schooling and not being allowed to stay at my parents’ house?

Will it mean my husband is out of work and struggling to find new employment in a sector that’s been hit hard by the pandemic and the government’s mishandling of it?

Will I ever be able to see my psych in person again, or will Zoom appointments become routine?

Yes, I do feel a bit better since lockdown has been eased, now that I can have a walk with friends and drive to the coast or country for a change of scene. But with ongoing isolation, possible redundancy and months more homeschooling hanging over us, I’m having to put everything into not unravelling in this weird state of limbo.

Normal? It’s anything but.

Isolation is slowly killing me

First published on MadCovid, 27 May 2020

Is it Week 8 of lockdown? Week 9? I don’t even know any more. All the days are blurring into one, all as bleak as each other.

Life may be the same, the same, the same day in day out, but I’m all over the place. I’m hanging on by a thread.

I’m in lockdown with my husband and kids, but I feel so alone. I have no one to talk to. I can’t burden them. I can’t pick up the phone and ring a friend; they all have stuff going on, and I can’t pour my own misery on top of theirs.

The more alone I feel, the more I shut myself off. Withdrawing from people is disastrous for my mental health, but while I’m longing for my friends, I don’t reply to their messages, I press ‘decline’ when they ring. I’m a burden, a problem. They only keep in touch because they’re kind people – I know that they’re just doing their duty, and must breathe a sigh of relief when I don’t respond. They all deserve this enforced break from me. I expect they’d be happy if they never saw me again.

Isolation is slowly killing me. I start to feel as if I could disappear and everyone would be grateful. The experts talk about ‘protective factors,’ but they don’t know what it’s like when you’re sure beyond any doubt that your protective factors would be better off without you.

There’s a motorway bridge a 10-minute walk from my house, spanning the M25. At the end of February, I stood on that bridge, the wind lashing my face, freezing hands gripping the railings. Who knew that motorway bridge railings are only waist-high? I was anticipating having to climb a six-foot fence, not to be able to just lean forward and fall.

I was preparing to jump, but the cars and the lorries kept coming and coming and coming. I wanted a break in the traffic so I could fall into a gap and not traumatise the driver who hit me.

Then there was a woman behind me, beside me, telling me not to do it. I let myself be led into her car – how weak and pathetic! – and taken home, where the police, alerted to my absence by my husband, were waiting.

Now, my brain keeps dragging me back to that bloody bridge, goading me to just go there, just have a look, just stand. ‘Now’s a better time than ever,’ it tells me. ‘The M25 is so much quieter than usual; you could just jump.’

I try to push these thoughts away, but they have their claws in me. ‘They’re just intrusive thoughts; they can’t hurt you,’ I tell myself, but they can.

Someone from the CMHT rings for my weekly check-in, and I find myself telling them that I’m having dark thoughts. Before I know it, they’ve arranged daily ‘welfare check’ calls, but when they phone I can’t be honest. If I tell them I’m not okay, they can now do a Mental Health Act assessment over the phone without even having to see me, and I CANNOT end up in hospital again.

They tell me to go for a walk in the sunshine, but they don’t know that everywhere I walk, memories of suicide attempts follow me. The reminders are everywhere: the bridge, the riverbank where I was picked up by police having taken an overdose, the pharmacy that sold me enough tablets to kill myself.

I go to Tesco and, observing perfect social distancing, I buy a packet of razor blades. I want to use them on my wrists, but I know I can’t leave my husband working from home and looking after two kids on his own. Once lockdown is over, it’ll be a different story, but for now, I use them on my legs instead.

I earn myself an ambulance ride to A&E, a quieter A&E than I’ve ever been in before. There are three of us in the non-Covid bit, all mental. This pandemic is killing us for different reasons.

The facemask they make me wear is so hot and claustrophobic I can barely breathe. I don’t know how the medical staff survive 13-hour shifts in full PPE. They are warriors. And unsurprisingly, they’re underwhelmed by my mask-induced panic attack. I almost expect them to tell me to man up.

I see the psych liaison team within an hour – so different from the 12 hours plus that I’m accustomed to. There’s nothing they can do, though – no crisis team, no consultant appointment, no acute day treatment unit. I was being treated there pre-lockdown, before coronavirus forced it to shut its doors and leave 30-odd depressed/psychotic/suicidal patients without ongoing care.

Instead, I’m sent home with several new lines of stitches to add to my patchwork, and a promise that the CMHT will keep calling.

I’ve been posting photos of lockdown life on Facebook: happy children, happy cats, lovely nature. But now I’m not posting anything. When I go quiet, it’s a sure sign that I’m not in a good place, but what can I do?

The glue that holds me together is melting and I don’t know if I’m strong enough to get through this.

Having my treatment come to such an abrupt end was devastating

First published on MadCovid, 23 April 2020

There was a shocked silence in the lounge area of the acute day treatment unit (ADTU): a silence that lasted a good 60 seconds.

Then the questions started. Did we have to go home right now? Would we get home visits? What was going to happen about medication management?

It was March 18 – a few days before the UK officially entered lockdown – and we’d just been told that the ADTU was closing its doors with immediate effect to prevent the spread of coronavirus.

I’d been attending the unit for two weeks, having narrowly avoided being hospitalised, and although I was still very poorly, I was benefiting from some amazing care: twice-weekly meetings and meds reviews with an excellent psychiatrist, daily one-to-ones with gentle, kind and caring mental health nurses, and a safe space away from everyday life.

Having my treatment come to such an abrupt end was devastating. I was less unwell than I’d been two weeks ago, but I was far from stable, and the prospect of suddenly having my support withdrawn was frightening.

The only consolation was that my allocated keyworker – a lovely mental health nurse called Theresa – would be doing daily home visits.

Or so I thought.

The next day, my husband woke up with a temperature, and we knew that we’d have to self-isolate for the next 14 days. And that meant no visits.

Theresa phoned daily, but without face-to-face contact, it felt awkward. I found it hard to express myself, and although Theresa could tell from my voice if I was having a particularly bad day, there was little she could do.

I felt lost, cast aside, cut adrift.

Two weeks after the unit shut, on a Friday, I was discharged from the ADTU back to the CMHT. Usually, this would have been a joint appointment with the mental health nurse and my community psychiatrist, but it all had to be done by phone. And the psych – who, in fairness, is the best I’ve ever had – didn’t even ring me until the following Monday as he was dealing with an emergency.

The past month has been – as for everyone – full of ups and downs.

My meds were changed while I was in the unit, and getting prescriptions has been a challenge. At first, the ADTU nurse was posting them through my letterbox, but since being discharged, I’ve had to get them from my GP. He’s yet to receive my discharge summary so has no official evidence of the meds change, and wondering whether or not he’d prescribe the right things was a worry. And my brain is so foggy that I’ve lost track of what to take and when. Thankfully, my husband is sorting it out for me.

Even though I’d been admitted to ADTU acutely suicidal, I now have no support in the community at all. I previously had an excellent care coordinator who was my first port of call when I was unwell, but she was taken off my case last summer, a few weeks after an inpatient admission, as it felt I was managing well enough to not need her.

I’ve also lost my informal support network. My friends keep me going, but of course I can’t see them now, and although we’re keeping in touch on FaceTime and Zoom, I really, really want a hug.

Compared to many mad people, I’m lucky. I live with my husband and two kids, and as a freelance writer, working from home is normal – although work has been very busy, which brings its own stresses.

My husband was working from home before lockdown as I wasn’t safe to be left alone, and that’s continued. He’s shouldering a lot of the domestic tasks to take the burden off me. But I have extreme guilt about the amount of time my children are spending on screens and my inability to entertain them, reaffirming my belief that I’m a failure as a parent and they’d be better off without me.

My mood has stabilised a lot, thanks to the changes in my medication, and although there have been days where I felt deeply, deeply depressed, days where I’ve lost my rag, and days where I’ve sobbed down the phone to my friend, I’m no longer suicidal, but that doesn’t stop me being scared about what will happen if my mood crashes again.

My next psych appointment is in three months’ time, so who knows whether it’ll take place in person or on the phone. If I need help, I have to negotiate the horrors of the duty team – and no doubt be told that all I need to do is have a nice bath and a cup of tea.

If things get seriously bad, I know I’d be at risk of being sectioned and hospitalised, and this time there’d be no visits from friends and family.

I also feel trapped. I know that if the suicidal thoughts come back, I absolutely cannot act on them. It would be grossly unfair to leave my husband alone with our children at this time, and grossly irresponsible to waste hospital resources if an attempt failed: the last time, I was in ITU on a ventilator for several days. It feels like my escape route has been blocked off.

Covid itself hasn’t affected my mental health – thanks to my ongoing depression, I have a blasé attitude to whether I live or die. But lockdown definitely has.

The lack of certainty, a predicted end point, is really hard. I’m struggling with the juggle of work and kids, and doing a bad job with both. The stress sometimes feels as if it might tip me into hypomania – I’ve been getting that familiar restless, fizzy-headed feeling – and while that would be welcome right now, it’s always followed by a rapid downward spiral into an all-consuming low.

I know this will end, but in the meantime, I have to keep going as best I can: taking my meds, talking to friends, keeping a mood diary, using PRN, and phoning duty if I really have to. I’m trying to focus on self-care, and treating myself to afternoon naps, evenings in my hot tub, and chocolate.

Daily life is a struggle at the best of times, and this is definitely not the best of times, but I just have to focus on riding this time out and coming through it in one piece.