Hibernating

I'm decided to remove this blog from the public domain for the time being, until I've sorted my priorities out and addressed a few practical issues. There are basically three reasons why I'm taking it down:

1. I'm yet to adjust to the void in my life that unemployment has created. Even though I've increased my subject load at university, it still leaves long stretches of time in which the temptation to get lost in the past is overwhelming. And I'm continuing to question of wisdom of bringing this particular aspect of my life back into such focus, and finding that, at least at the moment, there are things I really don't want to think about right now. So I'm not sure if I want to post further, as an ersatz pearl diver, until I feel stronger.

2. Unemployment carries additional repercussions, surprise, surprise - such as the desire (that will eventually thicken into a need) to find another job. Although I wasn't fired from my most recent position, I left under a bit of a cloud, owing to a rather long and drawn-out breakdown in the relationship between me and my supervisor, a relationship that was always complicated, to say the least. He is aware of this blog and of my online identity - I had confessed all during our happier days. Now that I'm out of there, looking for another job, and relying upon him to provide a good reference, this blog represents the most concrete of our differences - I'm concerned he may pass on the URL and blow my cover; he's less than thrilled with the references to him and the nature of our relationship that pepper it. So, at least at the moment, the mere existence of this blog is something of provocation - and what it does provoke in me, thanks to what it may provoke in others, is an insidious anxiety. Which brings me to:

3. All of the above, but particularly the loss of my job and the relationship breakdown, have made me fairly miserable of late, as can be deduced from my 'K' post. While I think I'm over the worst of it, my demoralisation and resulting self-absorption have affected the quality of this blog, with my most recent posts being little more than exercises in the most cross-eyed of navel-gazing. 'Sharing experiences' is certainly an integral part of what this blog is about, but it is not meant to be a journal, or ironically enough, a place for people in crisis (as I rather stuffily requested in my first post). I have a sense of the Ideal Off-Label, but right now I'm stuck in the cave, watching (my own) shadows on the wall and posting about them as if it they were real and newsworthy. That may not bother everybody, but it sure as hell bothers me. And until I get over my 309.28 Adjustment Disorder or whatever you want to call it, I can't see the situation changing.

None of the above, however, means that I won't be reading and/or commenting on your blogs any longer - no way. In case this is not just the result of a spiking spasm of despondency that will straighten itself out within a few days, I'd just like to say thanks to you all (and particularly to Gianna) for the all the interesting, informative and supportive feedback I've received, and that I look forward to further dialogue, either on your own turf, or even on mine, if this blog should rise from the ashes of my meltdown.

Why I Quit Therapy (Part I)

I ended two years of re-engagement with psychiatry recently. During this period I saw two psychiatrists, both female, fifty-something, and of a psychoanalytic orientation, but by no means ideologues. The first, who had specialist qualifications in child psychiatry but appeared to see mostly adults, would mostly stare at me for an hour a week while I vacillated between a terrified muteness and a more laconic, well, what I am supposed to say? After two months she put me on Xanax temporarily, and after six, Zoloft and Xanax combined. The initial Xanax prescription was occasioned by my terrified muteness mutating into tears one morning, and her threatening to ‘fire’ me unless I started talking. I told her what was bothering me – the office ‘romance’ I was engaged in at the time had ended abruptly again – and out came the PBS pad together with an invitation to call her at any time over the next few days if I felt the need. While I appreciated the offer, I had a dim impression, not quite a recollection, of what happens to patients who call their psychiatrists in the middle of the week. And the Xanax, for which I had no tolerance as a teenager, worked a treat. That day, I was due to head off to one of those corporate-style love-ins, or retreats as they are not-quite-so euphemistically called, and a pharmaceutical Band-Aid was what was really needed, given that I had been responsible for organising the damn thing, and had endless meetings and a three-hour car trip both ways in the company of my ambivalent paramour to look forward to. I sailed through it all, and successfully ignored phone calls from people who had no business calling me the following weekend.

This retreat (from reality) was held, ironically enough, in what was once a large state mental hospital, one of those 19th century monoliths way out in the middle of nowhere wrapped in a ‘Ha-Ha’ Wall, in a part of the country spotted with small towns that all like to call themselves ‘historical’. Our group gathered in what was once a large dayroom or dormitory, complete with seclusion rooms at the back where extra tables and chairs were now kept, and we slept in the nurses’ quarters, me in what must have been the head nurse’s room, complete with fireplace and antechamber that had been transformed into a bathroom that was almost as big as the room itself. Because my room was so big, the younger staff hung out there a lot, playing cards and drinking games. Xanax and beer don’t make for crystal clear recollections, but I do recall one rather astute but cruel boy daring me to say ‘X (the ambivalent paramour, my relationship with whom was supposed to be a secret) gave me genital herpes,’ and me collapsing in a fit of giggles on the floor, thus forfeiting my turn. At some point later that evening, I found myself in bed in another room with another young man (as well as another newly acquainted couple) and succumbing to his urging to ‘rest your head on my shoulder, just there, yeah.’ Not long after that, relative maturity together with the knowledge of another long day ahead kicked in, and I excused myself and returned to my quarters, sweeping them clean of any human or glass debris and toppling into a deep, opaque sleep.

Presumably the Xanax in my system prevented the meaning of my surroundings from resonating more fully, but I was sufficiently intrigued by them to borrow a camera and take a lot of pictures – and I’m someone who travelled right around Italy with taking a single snap, on the grounds that it was just too tourist-y. While it would be an exaggeration to say that at this point in time my memories of my earlier hospitalisations had been repressed, they were certainly not memories routinely accessed, or experienced as having any implications for my safety or identity. As far as I was concerned, I was just curious. Anyway, one of the photos I took eventually inspired my online moniker - click on the photo to see the graffiti:


For those not in the know, rooting is Australian slang for fucking. I certainly felt pretty rooted at the time, both figuratively and literally.

K xx

I wrote the following about two or three weeks ago. I have since quit both my job and Mr K.

I CAN HOLD IT TOGETHER during the day, most of the time. So what if a few tears inadvertently slip from under my sunglasses on the tram on the way to work; so what if people stare - it will start to kick in soon, downed with the dregs of last night's beer. I catch each teardrop with a fingertip, and stare back at those who would treat the world as a gossip rag, its pages to be turned at will. As they leaf past the laughingstocks to the pointlessly lucky, the ticket inspectors get on, and there's a dash for the machine, leaving me stock still in my iBubble, upon my liar's chair. Is there any way, a man yells into his mobile phone, over background sounds of steel on steel, coins dropping and falling orange peel, of getting through to someone like that?

The next eight hours will be punctuated by the unscrewing of the bottle and the counting of the pills (I can never remember how many are left) and the slow lurch down the narrow corridor from my office, gently bouncing from wall to wall like a pinball, in search of something to offset the soporific effects of the stuff. I never used to care that much for Klonopin, never really noticed it before, it was just a fallback boy during football season; a backrub for my lack of concentration; collecting me at the end of the day and settling me into bed, but alone, always discreetly going home and never pressing for any further involvement. But now that to fall in love with me is a mental illness, and now that I've been pushed out of sight by the out-of-mind, I've fallen in love with K. About 8 mg a day just to sit still and face the screen, more to stop crying. What, you want more? I tip the tablets out of the bottle again, take one, and make a pattern with what remains - if forty-five, then a triangle, if thirty-seven, a hexagon, but now there's only thirty-six, a square. The patterns may proliferate, but the prescription is not a repeat one. K and I are in a relationship with a definite use-by date.

And at night, I disappoint myself. At home, alone, I have IDD OCD, which means I roll over repeatedly to ensure that my mobile is switched to silent and that the landline is off the hook. Not that this protects me in any way - voicemail is still there, cupping its ear on my behalf and to ensuring that the words can never be taken back, even if my sleep remains unbroken. Still, it's the memory of being jaggedly hauled out of a dream - and what a dream it turned out to be - by a phone ringing at 3 am that drives my compulsion. Incredible betrayal that it heralded aside, I ask myself if such things will always be distilled and fused into an iconic sound, sight, smell or scene designed to forever haunt me, and demand such accommodating rituals? Why don't my wounds thicken and scar, instead of excoriating me, the auto de flay for the next wrongdoing? I'm a gun, and the whole world is a trigger.

Is there any way of getting through to someone like that?

" ...she said, well, he didn't say exactly those words, but they were having some... some humorous discussion..."

I ran to the bathroom, and sat hunched over on the toilet, not sure whether I needed to throw up or let it out the other end. Eventually I went for the latter. It felt like the bloody bowels of hell had taken up residence inside me, and when I eventually stood up and did the three-year-old's Freudian pirouette, the bowl was full of blood. I vomited and lay down on the cold floor, as the band next door launched into the Ride of the Valkyries, only to fumble and stall after the first few lines. I felt nothing, just sick and tired. Which was good, and I wondered how I could keep it that way.

Enter Mr K.

The heroic sorrower begins by saying, 'You do not love me as I love you', proceeds to saying, 'You did not love me as I loved you' and ends by saying, 'You could never love me as I loved you'. Male supermacy dictates an answer in the affirmative: 'You are quite right. It would be mad to love you as you love me. Keep taking the pills.'

- Germaine Greer, The Whole Woman

Illustration by Edward Monkton.

CBT Song

I fear I may have missed the deadline for the Birmingham & Solihull Mental Health Userwatch competition for the most truthful poem, since the winner's already been announced. Oh well, I thought they might accept a late entry, which is, as usual, my bastardisation of someone else's carefully arranged outrage:

CBT Song (with apologies to Eric Idle)

Fuck you very much for CBT
Fuck you very much for reminding me
That the way I feel has no relation to what's real
And that no one really cares what happened to me
So fuck you very much for CBT
For trivialising and reducing me
To an emotional bureaucrat in my crisis management hat
I shouldn't say shouldn't, and even ought at that
I should make my bed and comb my hair in my railroad flat
So fuck you all so very much

Below is the original 'FCC Song' as performed by Eric Idle, and the complete lyrics can be found here. I'd welcome some additional verses and if someone who can sing and play the guitar (in other words, not me) feels like recording it and uploading it onto YouTube, that would be way cool. (But remember, it's just a feeling.)

School daze #1

One thing I rarely think about these days is high school. I know I've made barely any reference to it on this blog, apart from noting that my reluctance to attend was one of the factors that precipitated my induction into the mental health system. But my high school experience was critical in a number of ways - not only was I deviating from my prescribed role as an adolescent in Western society by skiving off, playing hooky or wagging, but I was also incurring the wrath of individuals in positions of authority, and last but not least, I was very distressed by what was happening when I was there. A triad which was a perfect inducement to psychiatric intervention if there ever was one.

In contrast, the shortcomings of the education system within which we were trapped continue to preoccupy some of my contemporaries. I suppose I'd be looking back in anger too if all that other stuff that was going on at the time wasn't getting in the way. But while my boyfriend expresses his irritation at not being allowed to take extra subjects to increase his university entrance score, and my high school friend Rose blames Catholicism for the mind-numbing conformism and anti-intellectualism that we had to contend with, all I can really think of is how scared I was of not being let out of hospital in time to sit my exams, and thus of being kept back for another year.

I did most of my time in the Catholic education system, but completed my final year at a state school. What happened to me at primary school is something best left for a session of EMDR followed by the intravenous administration of massive amounts of Valium. What happened at high school is well documented, as I was a compulsive diarist and letter writer at the time. I suppose one day I might sit down and read what I've kept and dredge up everything I've suppressed, but even without doing that I can say that back then I was very angry with the situation in which I found myself. A bit like some of my friends are now, but they generally weren't back then, something which rendered me very isolated in my opinions and thinking, and thus vulnerable to pathologisation.

What I mostly remember now about high school is the cold, or at least that's what I talk about when such reminiscing is called for. The heating system would often grind to a halt at the most inconvenient of times, usually the coldest days of the year. I brought a rug to school and Rose and I would wrap ourselves in it as we sat at paired wooden desks still covered in graffiti from the 1960s. The temperature in this classroom is not conducive to learning, she once wrote on the blackboard in her scythe-like handwriting just before an English class was due to start. The more extraverted types sat in rainbow-striped sleeping bags and gossiped through the mouth-holes of balaclavas, while the rest of us learned to write neatly wearing mittens. School rules forbade the wearing of socks, no matter how discreetly, under the regulation brown stockings, so during my first few months there my feet raged with chilblains. Of course I was always going to break that rule. The principal's secretary ordered me to remove the socks. I refused. It was the first of my many battles with teachers and other authorities, and is notable for being the only occasion on which my mother took my side.

I also remember how in Year 9 they made us do a six-kilometre run in gale force conditions, ostensibly to choose a team for the inter-school cross-country competition, when in fact the team had already been chosen. I remember trees being bent into hyperbolae by the wind, my clothes being soaked through, and that it was dark by the time we got back to school. I stumbled inside and saw panic in the face of the principal. The foyer looked like the corridors of the Louisiana Superdome, packed with drenched and stunned teenage girls. Somebody's mother drove me home, I think, and I spent the next few days in bed, in a kind of half-light, not knowing whether it was morning or evening. I took a pissy little overdose of aspirin and paracetamol, most of which I vomited up and then slept the rest off. I remember how a girl in the year below me stood up in class one day and started screaming Well, you're perfect, and you're perfect and you're perfect, pointing her finger at various other girls, and got carted off.

Rose and I have had many discussions about our school and what was wrong with it. She's still processing it, and needs to talk about it still, which is sometimes hard for me to swallow since back when it was actually happening and I wanted to talk about it - look, Rose, can't you see what's going on - she'd just tell me I was paranoid. She's right about the mind-numbing conformism and anti-intellectualism, that's for sure - we spent double the amount of time on the domestic sciences we did on the physical sciences and were told that the school's main goal was to produce good Catholic wives and mothers. There was no such thing as dux or valedictorian, and the only prize was the one given each year to a graduating student deemed by the teachers as being the most "Mary-like". (As I never managed to fall pregnant while still a virgin, I was unfortunately never a contender.) But while I'm no apologist for Catholicism, I don't consider it to be the root cause of the phenomena Rose describes. For relatively poor Catholic schools such as the one we attended were very dependent on the Federal Government for funding, and as responsibility for policy, curricula and so forth was delegated to the states, the thinking of the sitting State Government was highly influential as well. Our school could dress their policies up as "Gospel Values" all they liked, but it was politics - that of the governments, teacher training institutions, and teachers' unions - not religion, that fundamentally dictated them. And the politics at the time, er, weren't good.

I've always preferred to conceive the political spectrum as circular, with totalitarianism and democracy occupying opposite poles, as opposed to a linear left-right continuum. So we can create a totalitarian state either by moving sharply to the right or to the left. Now, it would be a gross and irresponsible exaggeration to say that Victoria, Australia, under the Labor government of 1982-1992 was a totalitarian state. But policy-making for education at the time was heavily influenced by Joan Kirner, a former school teacher and member of the party's socialist left faction, who became Minister for Education in 1988 and Premier in 1990. While Minister for Education, Kirner initiated a series of reforms aimed at reducing what she saw as the class-based inequity of the education system. As noble as this may sound, what Kirner tried to establish was a system that valorised "equality of outcomes" over "equality of opportunities". The concept of failure, along with any healthy competition, rapidly became verboten, and the notion of striving for excellence attained a decidedly elitist air. But one of the most pernicious and absurd implications of the "equality of outcomes" doctrine was that intellectual potential was, or at least should be consistent across the school population - that any variation in it was due entirely to class-based inequity, which of course had been scheduled for extirpation. This combined with the good old-fashioned Aussie tall poppy syndrome (that applies to just about everything but movies, pop music and sport) meant that many of us were encouraged, or even forced, to tone it down academically. To be something we weren't. To participate in the denial of the obvious that we are not all the same, and that our differences cannot wholly be attributed to class-based inequity.

It's not hard to explain this to Rose or anyone else. What is difficult to explain is how the denial of reality that is characteristic of totalitarianism, whether subtly or not so subtly enforced, manifests itself in epistemological terms, and how it replicates itself insides the minds of those required to participate in it. Essentially, some ideology - or theory in its ossified form - that was once presumably developed via a process of induction, is used to determine reality itself through the process of deduction. So the hardened theory ends up taking precedence over reality, when it was once a mere extrapolation of same. Educationalists observed that socioeconomic standing influences performance in school (induction), therefore any differences in performance were due to differences in socioeconomic standing, and nothing else (deduction). According to the dominant ideology, kids like me and Rose were just a bunch of spoilt rich brats, who needed to be cut down to size. Little matter that some of us came from families that were really battling, and not in the sense that 'battling' is used in the contemporary Australian political vernacular, that is, to describe people for whom it is somewhat a struggle to afford plasma screen TVs, five bedroom houses and SUVs.

Another example of this process, which will be familiar to many readers of this blog, is the habit of psychiatrists fixating on a particular diagnosis, and viewing your symptoms entirely within its framework. The diagnosis itself - a constellation of symptoms - might meet certain conditions of validity and reliability for it to be considered reflective of a tendency for such symptoms to co-occur, but rarely is a particular symptom indicative of a single diagnosis, and psychiatrists prone to leaping to conclusions will consciously or otherwise ignore any evidence that either contradicts or fails to confirm them. A patient who cuts can be diagnosed as borderline; another who hears voices can be diagnosed as schizophrenic - it usually isn't too difficult to extract from the miasma of psychological distress that accompanies these phenomena evidence that the patient meets the remaining criteria.

When this is going on outside, what happens on the inside? The message, loud and clear, was that I was a constellation of attributes and circumstances that couldn't, indeed didn't exist. In the face of this, my self contracted like a pupil, refusing to let the light in. Terrible memories I thought I'd gotten a handle on suddenly overwhelmed me, knocking me sideways into dissociative trances, which eventually became my stock response to any strong feeling whatsoever. I'd wander off between classes and 'come to' an hour or so later in the Botanical Gardens, in a nearby park or even at home, not recalling how I'd gotten there.

Then, owing to a complicated series of events, meetings and circumstances, I woke up one morning at the centre of the universe. I felt as if I was trapped in a glass cage, moving through a world populated by puppets and androids, dancing to my discordant, uncooperative tune. I was the tablecloth upon which the crockery and cutlery and the finest Waterford crystal was laid out - pull on me at your peril; it all hung, or sat, on me. Of course, at the same time I was told we're trying to change things, you and I, so don't fuck this up with your disappearing acts, Ruth. Are you listening to me? I'd go to the bathroom for a smoke and to inspect the nascent bruising on my upper arms (where my co-conspirator had grabbed me) or my shins (where he'd kicked me) or all over when he'd enveloped me in a rib-crushing hug. You can't go to the school up the road. There are boys there; they'll hate you, they'll call you a lesbian because you're good at maths.

I visited Rose, uninvited, not long after the first time I was hospitalised as a teenager. She was wearing her "Yay Team" school t-shirt and wasn't particularly pleased to see me. She gave me her usual lecture about how paranoid and negativistic I was, and when I told her I'd been in a psychiatric ward, she began talking about Sylvia Plath and Janet Frame and asked me if they'd given me any shock treatments. She seemed disappointed when I said no. We didn't speak to each other for a couple of years after that. The next time I saw her she was coming out of the building where the university's counselling service was based, doing the depressive shuffle.

In her early twenties, Rose spent a year or two doing nothing but watching daytime television, swallowing a now-banned anti-depressant, and ricocheting between the couch at home and the one in "shrinky's" office, where she pondered her need to infantilise him and everything, while being eaten up from the inside by a vulturous guilt. (I know that guilt well. It kicked in when I was 19 and I rode it out for a few months before resorting to Prozac, after which I completely nosedived.) Another girl, who'd been the quintessential quiet, polite type at school, suddenly lurched to the opposite end of the spectrum when she started uni, ranting and raving about nothing and everything, alienating all of her old friends, and putting off potential new ones. Another actually tried to set fire to the place. (Out of all of us, she's the one who's gone to enjoy the most social, academic and occupational success.)

In 1992, the Kirner Government was voted out in a landslide victory to the opposing Coalition parties. To a certain extent they were carrying the can for various major cases of financial mismanagement that had occurred both within their ambit and without, but they left a $2.2 billion budget deficit and $33 billion public sector debt nevertheless. The new Liberal Premier, Jeff Kennett (note that 'Liberal' has very different connotations in Australian politics to what it has in America and elsewhere; when we want to use the word the way Americans do, we say "small-l liberal") immediately took to the State's budget with an economically bone-dry scimitar, sacking public servants, closing down schools and privatising everything from utilities to prisons. While these had obvious economic benefits, there was an inevitable backlash, with thousands of people left jobless and many questioning the social costs of his initiatives and decrying his arrogance. He was re-elected in 1996, and remained popular for a while, but his cavalier attitude to criticism, his attacks on formal mechanisms in place to ensure accountability and his apparent failure to recognise that there was more to Victoria than its capital city, all led, gradually and then suddenly, to his then utterly unanticipated downfall at the 1999 election.

I've spent a bit of time on Kennett here because of his adjunct role in the mental health system in Australia today. He is chairman of an organisation called beyondblue, a "national depression initiative", and was one of the driving forces behind its establishment. A lot of people find this puzzling or hypocritical, given the devastating consequences his economic policies must have had for the mental health of the thousands who suddenly found themselves redundant. But while it's not exactly NAMI or TAC, it does promote the mainstream, medical-model approach to depression (to the extent that some local consumer groups have complained of censorship by moderators of its online forums), so to me his position there doesn't seem particularly incongruent with his earlier activities. After all, the mainstream, medical-model approach to depression localises the pathology within the individual, not in his or her social circumstances, such as being laid off by give-a-fuck economic rationalists.

Things are very different now, needless to say. The current Labor state government carefully puts one foot in front of the other in the middle of the road, as if auditioning for a certificate of economic and ideological sobriety. Meanwhile, enrolments at state schools are in decline, with those still operating perceived in very black and white, 'good' and 'bad' terms. Lying about your address to get your kid into one of the 'good' state schools is commonplace, as is the private schools' practice of 'poaching' talented athletes or the academically gifted from the state system, offering generous scholarships as enticements.

In a curious irony, the day I began drafting this post I got home to find that I'd been mailed a promotional magazine of sorts by my old school - God only knows how they got my address. Sixteen glossy pages of oh-aren't-we-fabulous, produced by a Fundraising and Public Relations Committee that certainly didn't exist sixteen years ago. The brown tights and serge dresses have gone, the nuns have been replaced by a lay principal with peroxided hair and a crocodile smile, and at least a couple of last year's graduating class have gone on to study medicine or law. The gangly Adams-appled history teacher I had in Year 8 now looks like Liam Neeson; about the only thing that hasn't changed is its domination of local inter-school sport. Then again, this being Australia, we were never expected to doubt the reality and desirability of excellence in that particular endeavour.

Romance Lesson

I received this from Yahoo's 'Humour Against Psychiatry' List, and thought I'd pass it along for those who don't subscribe:

Folks,

I heard this one from one of my colleagues at the postal service where I work in mail delivery:

Last week Eli Lilly sent an unsolicited mailing to the private homes of physicians to promote its look-alike Viagra drug, called Cialis. The mailing consisted of a bright orange-colored package the size of a box of copier paper. On the front, above the physician's address label, was written in huge white letters: Romance Lesson. On the back was extensive product information of the kind one would expect to find on a package insert, together with praise for the product.

A member of my colleague's sports club lives on his route. This member isn't well-liked because he's always picking arguments. As the disliked member's wife is a doctor, my colleague had to deliver an orange box to his address. So he rang the bell, and the conversation went like this:

Club member (from behind closed door): "Who is it?"

Colleague: "Mail service?"

Member: "Whadya want?"

Colleague: "Mail for you that doesn't fit in your mailbox."

Member: "What is it?"

Colleague: "A lesson kit to help with your impotence."

Member (opens the door, yanks the package out of my colleague's hand): "This isn't for me, it's for my wife."

Colleague (just before spinning off to his next address): "Well, please give it to her. She's probably waiting for it anxiously."

The way my colleague told it, it sounded pretty hilarious. But seriously, it must be awfully embarrassing to receive such a package in the mail. I might almost feel sorry for the doctors.

Yes, my heart goes out to them. This morning, I scratched my name on my last ever Medicare form (as far as 'therapy' is concerned), using as usual, a token ink-stick of appreciation from a pharmaceutical company. I'd never even heard of the medication being advertised on the pocket-clip. Some new atypical, I was told. Typical.

Last post... past the post... post about the past... mumble, mumble, drool...

No, not really, just for a little while. I've just finished exams and am currently struggling to wind up a work project that is already months overdue, hence the paucity of posts in recent weeks. I'm aiming to get the project done, or at least reduced to matters of post-production and fine-tuning, by the end of the month. So I'll be keeping a low profile until then.

I plan to make several significant alterations to the way I spend my time in coming weeks, which will have implications for this blog. Once the work project is complete, it's highly likely that my employment arrangements will change. I might work part-time, either here or elsewhere, or not work at all, but it seems clear that continuing in my current role under the current conditions is untenable. But while this means that there will be little or no money coming in (which won't be a problem - at least in the short-term!) it will give me the opportunity to take on extra subjects at school, and hopefully also to post here (as well as comment elsewhere) more often, and in a more thoughtful and systematic way, as well as follow up on contacts and catch up on existing correspondence that this blog has generated.

It's rather disconcerting to reflect upon that fact that, as recently as eighteen months ago, I rarely even thought about the kind of stuff I post about on here, let alone discussed it with anyone else. While I wouldn't say that I'd 'repressed' or 'forgotten' about it in any wholescale or all-encompassing way, now that I am thinking about it, the many minor memories that embroider the relevant experiences are resurfacing, a process which is sometimes painful, but more often than not, just vaguely vertiginous. Now, how the fuck did I manage to forget about that?

It's just that I have to wonder how and why, given that I had so successfully managed to excise this aspect of my past from my sense of self for so many years, it has reasserted itself so stridently - and resulted in this blog. And to wonder whether or not this is actually a good thing, from the point of view of my mental health. Will I drive myself mad thinking about how the mad-doctors and others have driven me mad? Oh, the convolutions...

But back to work for now.

Undead #3

Monday is D-day, dole day; the form for claiming my allowance comes every fortnight and I'm supposed to fill in the jobs I've applied for and take it down to the nearest Social Security office, which has recently started calling itself something even more euphemistic and making copious use of green and orange toner. Every Monday I have an appointment with my GP, a softly spoken Greek man whose office walls are a patchwork of kids’ paintings on butcher’s paper, pap smear reminders and black lungs. His practice bulk-bills and is just a few blocks from the hotel, which is one of two reasons why I go there. The other is that Alex knows, for the most part, how to mind his own business. Each fortnight he writes me a medical certificate saying that I’m too sick (“depressed” is the word he uses) to look for work. Usually I go straight from Alex’s office to the dole office, which means I’ve rinsed my mouth out but not much else. I can’t afford shampoo, but can hardly be bothered anyway; a bit of liquid hand soap every couple of weeks is enough. I keep my hair, or what’s left of it, hidden under a black scarf, which I don’t wash, because it shrinks. So it stinks. Like most of my clothes.

“How’s your drinking?” Alex asks, perfunctorily. He smelled it on me the first time I saw him and I denied it, but of course he’s not that stupid. I’m never quite sure how to answer him; in a world where more is better, only a response like Great! Really going great guns. A whole bottle of gin in one sitting! seems fitting. I mumble something about not sleeping and feeling uncoordinated, that I’m having difficulty negotiating the narrow passage between my room and the toilet. He’s been over the options; AA, detox, rehab, and I’ve been over being a misanthropic atheist without private health insurance.

He doesn’t mention the last time I saw him, the day I was woken by a searing pain in my sternum, and a sense of chemical suffocation, as if I were an asthmatic trapped in a perfumery. My face bloomed scarlet and I began to panic, thinking now I’ve done it, my luck’s run out and now I’m fucked. I threw on my smells and smalls and began the agonizing trek to Alex’s office, head down and mind out, taking one step for my mother, two for my father, three for my sister, four for the white walls, five for its time to get up, six for the six weeks, seven for the standard drinks, eight for the hate, nine for the nightshift and ten for the ten fucking years it took the first time and will probably take again. I hope you know that this will go down on your permanent record, Peregrine mocked me; I shook my head clear of the memory. In the waiting room I cradled a kidney-shaped bowl in my lap. I heaved and spat, expecting to see blood, but there was only pain and more pain.

“You have indigestion, basically,” Alex told me, as poker-faced as ever, when I finally got in to see him. I rocked back and forward, which by then was the only way I could table my disbelief. “No, I mean it. How much did you have to drink last night?” Well, I’d blown the last of my dole money on a bottle of Vat 69, which was my idea of drinking in style. That much I remembered. Earlier on, there was something about a can of deodorant – Impulse, I think – that Dawn was spraying around the TV room to neutralise the cigarette smoke, and the smell of it grabbed my face like a giant hand, hooking its fingers into my nostrils as if my head was a bowling ball, and slamming me to the floor. Then there was no use my being there because she had her lines crossed with someone else's and it wasn’t her fault that the message didn’t make sense. So I went upstairs to my room but the Impulse followed me: not only had it invaded my sinuses but it had got past the blood-brain barrier as well, having been transmuted from a saccharine mist into a set of associations. There were no thoughts, no words, only a feeling, the smell of Impulse feeling, and images; the crossed lines now scratches on film stills, stitches on a skin graft. My memories are like Frankenstein's monster, and Dawn had inadvertently breathed life into them. Footsteps on thin carpet over loose floorboards. Impulse sprayed in an arc down my torso under my t-shirt as the door is flung open. It’s warm in here. My arm hurts. Just stop it, I say, you’re getting boring. My voice is tired. Perhaps I don’t really care that much. But not caring is like body temperature, there are only a few degrees separating imperturbability and death. So wine me, dine me, Vat 69 me. Make me care, make me scream and yell and get it all out of my system. You're all not-so-innocent bystanders. The sunrise of the glass over the golden sea is a warning; you can never fully rely on anyone or anything. You’ve got to go out and fend for yourself.

“I had a bottle of scotch. And, uh, then, I think I had a couple of beers – to help me get to sleep, you know.” I smiled sheepishly. My purported insomnia was something of a motif of our circular conversations: he would take great pains to point out that alcohol makes insomnia worse, when it was just a red herring, something to complain about in the absence of a hangover; in reality I felt safer staying awake as much as possible.

“So, we’re looking at about 25 standard drinks, over how many hours? Six? Twelve?” I shrugged. “You’re lucky you’re not in a coma. What’s happened is that you’ve had so much to drink that a fair bit of it is still in your stomach being digested. And the pain in your chest is caused by the fumes from the alcohol floating up into your oesophagus from your stomach. And you can fix that with some over-the-counter medication.”

“That’s all?”

“Yes, that’s all. For now.” Nose clean, but not always subtle. Today, Alex tells me that my drinking might be affecting my cerebellum, and that the damage could be irreversible. This is merely remarkable to me; soon it will become something interesting that someone said to me the other day, and he knows it. He hands over the medical certificate; as I said, he knows how to mind his own business.

It's My Lunchbreak and I'll Blog if I Want To

When things are going badly, you need a near-nerdish devotion to detail to pick out the little monads of mirth, those quirks and serendipities that make life worth living while waiting for homeostasis to work its subtle magic, or failing that, for the meds to kick in. You've got to have your metal detector hovering over the shifting sands and your binoculars at the ready to watch those trains come in or those birds fly away. And when something happens, write it down. If big birds make small birds, why don't big trains make small trains? 'Cause the big trains pull out on time. Ha ha ha.

The crew at Bipolar Chicks Blogging recently posted hilariously about some of the search terms entered on their blog... think 'poontang', 'fat sex', 'boob poking' and 'monkey butt itch' among others. So in order to self-engineer a similar level of amusement, I investigated the ways in which people have managed to google their way here, anonymously, that is - I haven't linked search terms to particular IP addresses. Naturally, faeces smearing, Jerry Falwell and good old borderline rage have made an appearance (more on the latter in a minute). But one of the more intriguing search terms was 'locking pants in a mental health ward'. I assume this refers to some kind of restraint technique or device, which I wouldn't know much about, since according to my medical records, I routinely "resisted restraint". (Somehow I'm pretty sure that when they wrote this, they weren't referring to any long-gone martial arts expertise on my part, but merely my reluctance to lie very still and quietly, whether it was in relaxation therapy or when I had two guys sitting on top of me while someone else had the much cooler job of pushing a big red button. My intransigence under the latter circumstances hardly needs explaining; but my inability to lie still on a mattress while some healing-power-of-crystals-proselyte asked us to contemplate the conduct of our own funerals probably had something to do with the guy lying next to me whispering "They'll bury me with a bottle of beer".) Gosh, I am rambling; I must be feeling better. Anyway, I just had to google 'locking pants in a mental health ward' myself, and the first hit was the Birmingham & Solihull Mental Health Userwatch blog, at which

Sue Turner, CEO of Birmingham And Solihull Mental Health Trust now offers one to one virtual (CEOBT) Chief Executive Officer Boxing Therapy for Mental Health Service Users who are getting plenty of rounds of useless treatments elsewhere in Birmingham and Solihull ....

Users who wish to indulge in this completely free therapy can use their keyboard to throw punches and create real laughs.....The Dept of Health is looking closely at combining their failing CBT programmes with this new costless therapy in an effort to save themselves from an eventual public beating ...

And there's a Flash game where you get to left jab, right jab and uppercut her until her eyes blacken and her lips bleed. Now, I don't know anything about this woman and punching her in the face sounds a bit like borderline rage to me, so I've instead generated a similar game in which you can throw cream pies at E Fuller Torrey:

Link: PlayMyGame

You can also spongecake your grandmother if you want, but I think you lose points for that. I trust that the folks at TAC won't consider a bit of sticky slapstick fun as further evidence of violent tendencies among the mentally ill, and hence for the need for broader involuntary treatment provisions. So, please do enjoy this bit of penny arcade arcana. Because, personally, I'm going to head back to Birmingham & Solihull and punch out that Sue Turner chick again, since, come to think of it, she does bear a striking resemblance to my shrink. Ah, never mind, it's just that borderline rage thing I mentioned. Why the fuck did I get up at sparrow's fart yesterday morning to spend ninety minutes commuting to see someone who has become increasingly obsessed with whether or not I like to hang around in bars in the hope of picking up strangers for sex? Not that I would necessarily pass judgement on those who do do that kind of thing - if that's your thing, then play it safe, keep it real, and good luck to you. I was just unable to grasp, as I sat in one of her farting leather recliners, why she would ask me if that was what I was trying to do, after I'd mentioned in passing how I'd gone to my favourite bar in the city after work the night before, ordered my favourite martini and curled up in the corner with a book. I mean, it's not as if I frequently regale her with lurid tales of anonymous liaisons conducted in alleyways under airconditioning units or in one-bedroom flats in one-supermarket suburbs. But how dumb can I get? Back on the train, I'm smacking my forehead:

4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

I suppose the martini (glass lined with Cointreau, and garnished with anchovy-stuffed olives) counts as substance abuse. And she did ask me about the 'self-mutilating' behaviour separately... "Er, no, why would I do that?" Fortunately the possibility of any symptomatic 'spending' was obviated when I told her I wasn't prepared to pay for CBT.

It's this cookie-cutter crap again. I've been fingered, and now it's her job to squeeze the incriminating evidence out of me. The me(n)tal outline of a gingerbread man is pressed down into a reality rolled as flat and permeable as tissue paper, and everything external to it is torn away, rolled up and rolled flat again to serve as the template for the trivialisation of someone else's experience. If you're in the dayroom and you're reading a broadsheet newspaper while sitting on the floor, because there's not enough room on the table to open it flat, that's called 'regressing'. And I do recall with affectionate bemusement the Secret Symbol in Blue Ink incident, where I was interrogated for hours about the real, talismanic meaning of a bit of scribble in the margins of said newspaper next to the crossword (my pen had run dry and I was trying to get it to work again).

Tsk, tsk, now I've gone and gotten myself all worked up. But all in all, what a splendid and absolutely necessary waste of time this has been, writing myself out and in and out again of the mood from hell. There are people out there who have happened on my blog 'feeling rubbery from Geodon' and looking for 'illicit sexual experiences' with a 'socially isolated genius'. But out of all of the search keywords used to locate my blog, my personal favourite has to be 'bipolar boss idiot'. You know how the song goes, now, don't be sad, 'cause two out of three ain't bad.

And if you've ever had anyone quote that Meatloaf song to you in a ham-fisted attempt at either justifying or consoling you regarding the withdrawal of their affections, you'll know how rotten I felt when I started writing this post.

Undead #2

I came to this hotel because it was the closest place on the list to the train station. Little more than a shopfront on the corner, it was dilapidated, verandah-less, a hole to crawl into. Instead of a sign, there was a blackboard: ROOMS TO RENT, LONG OR SHORT STAY, REASONABLE RATES, TV ROOM, and squashed in the lower margin as an afterthought: FRIENDLY ATMOSPHERE. The ground floor windows were boarded up. I pushed the front door open, nudging my suitcase in ahead of me. The front desk and its keeper were suitably retro; a sliding glass window and landing strip tie. A filing cabinet, a fan and a Thank You For Not Smoking sign that had gone yellow around the edges.

Because the refuge I’d come from didn’t charge any rent, I had enough saved to put down straightaway and obviate any serious inquiry into my age, history or lifestyle. But because I was dressed in head to toe black during the fiery end of February, and even had my coat on - since it didn’t fit in my suitcase - the landlord or his lackey picked me for the particular kind of refugee that I suppose I was. “We don’t want any trouble, you hear? No disturbances, no making a nuisance of yourself, nothing broken. Understood?” “Yes, of course.” I said, staring blandly at the clock behind him. He let himself out of his glass cage and I followed him up the stairs, being careful to maintain a tranquillised tempo. My room smelled of cigarette smoke and shell shock; the fallout of a thousand divorces. George, the man with the keys, grunted over the stuck window like a ravaging soldier and I was careful to remain between him and the open door. After he’d gone, I pushed the chest of drawers in front of the door and lay on the bed, a thing that thinks, making a sweaty angel in the stale bedclothes. I waited for a while, as long as I could stand, then stripped down to my underwear and got the whiskey out of the suitcase.

The booze gets you to sleep to start with, but it’s a sleep like deep end of a swimming pool; sink to the bottom and you’ll rise up again soon enough. Even when your head’s above water you can’t breathe; the air is thick with the air molecules discarded by those who have discarded you, making breathing as intimate as kissing. I turn my head, hold my nose and clench my teeth shut, resisting. The edges of my vision become charred, a bubble rises in my head and I black out momentarily before letting go and sucking it all up: words in blood and a blue fountain pen; tennis balls aimed at puddles, a lost tennis match that I have to thank for all this; threats, tethers and tiredness; that morning on the roof, dancing and dodging the helicopter; a declaration and a long gone flight to Sydney. Waves of despair, nostalgia, betrayal, humiliation and plain old disbelief wash over me; I grab the bottle before the tsunami of shame and heartbreak can kick in.

Psycho-the-rapists

My psychiatrist likes to remind me that no treatment is risk-free, including talk therapy. She can be rather snotty like that, but that's another story.

Another story still was told on a website, that has now been taken down as far as I can tell, so I'm relying on my less than perfect recall here. The story was that of a woman, whom I'll call Jane, who was referred to an eminent psychiatrist, whom I'll call Dr X, after experiencing some difficulty sleeping. Dr X provided psychoanalytically-oriented psychotherapy, and by Jane's account, chose to ignore her presenting problems and instead focus exclusively and obsessively on the developing transference. In particular, Jane accused Dr X of deliberately fostering her dependence on him by forcing the transference - putting it to her that she had sexual fantasies about him, encouraging her to talk about them, assuring her it was appropriate, and so forth. This, according to Jane, had the effect of producing such sexual thoughts and feelings where none had existed before, culminating in her own obsession with Dr X and the therapy, and driving her to the brink of an emotional breakdown. Jane did not, however, allege that any sexual contact had actually taken place.

Such was the gist of Jane's complaint to her state medical board. Predictably, it did not find in her favour - Dr X received a slap over the wrist for not adequately documenting his sessions with Jane, but no further action was taken. (Psychiatrists, take note... take notes, preferably accurate ones. If you even suspect you are within a fifty metre radius of one of them darn borderlines, whip out that pen and paper and note down the fruits of their futile efforts to seduce you.) This sent Jane into a frenzy of righteous indignation, enough for her to decide to make her complaints public, setting up a website onto which she uploaded copies of her email and other correspondence with Dr X's lawyers, and otherwise exhibiting the kind of behaviour that tends to prompt reactions like hard luck, but isn't it time to move on or, more crudely, just get a fucking life.

Some psychiatrists will do their best to force the transference, which is both pointless and inappropriate. At the more benign end of the spectrum, you have shrinks who do a big song and dance just before they go on holiday, in grandiose anticipation of you doing likewise while they are away. Any arguments or other unpleasant moments that might occur in the periods immediately before and after the shrink's time off are are automatically and relentlessly interpreted as expressions of the patient's resentment of the shrink having a life of his or her own.

Then you have the shrinks who will quite openly suggest that you want to sleep with them, and who will do their best to cajole you into believing it. These guys will really fuck you in the head, insisting that you're fucking them in your head until you're fucked in the head. They may justify their behaviour to themselves and others by reference to some theoretical underpinning - the it's just part of your treatment excuse - but it is nevertheless clearly predatory, narcissistic and self-serving. By Jane's account, this is what Dr X was doing. It seems likely that at the very least he mismanaged the transference, and when the situation became too intense and he had to refer her to someone else, she was left feeling blamed for the unfolding of a dynamic that she had not even anticipated, hence her subsequent outrage.

But let's not talk about sex for a moment, and just talk about talking, and the risks that go with just talking.

For confession or disclosure can be so much more intimate than sex. When you tell somebody something you can't take it back once you’ve done it, like you can with a part of your body, leaving the other person with nothing more concrete than the memory of some diffuse physical sensations that do not vary too much from one encounter to the other. Confession is specific, and the range of conclusions that the confidante may draw about the confessor extend well beyond that allowed by the usual insulting sobriquets.

You are always bound to your confessor; even if he abandons you, or disbelieves you, the larva of confidence he once inspired grows into a tapeworm that eats away at your insides until your outsides cave in and what is hidden has prolapsed for all to see. Or the binding might be, in essence, an intersection: you become Siamese twins. You share his heart, liver, lungs, kidney; he shares you with the footpath, you’re a piece of gum stuck to the bottom of his shoe. Only he will survive the separation, which is why you know, deep down, that some things must never be revealed. On pain of death. Confession is, in a sense, losing one’s marbles; like a kid on the first day of school you don’t know that you’re supposed to exchange them, not just give them away. Or else they roll into drains, cats-eyes following their namesakes, iridescent meteors meeting their liquid selves in puddles of petrol; galaxies disguising themselves as birds’ eggs, clownfish masquerading as candy, blue jays as lost to you as NASA’s Big Blue Marble. You barely have time to grasp the entropy of the spheres, the distortion of your narrative, as a sharp shooter is catapulted into your forehead. Confession becomes indiscriminate, indistinguishable from small talk. Needless to say, friendships dry up, as do invitations to parties, as the marbles are picked over by filthy hands and the tapeworm eats through your brief career as a risky raconteur and leaves you wallowing in a state of total self-absorption.

Jane's story resonates with me tonight, her unshakeable belief in her own rectitude providing a stark contrast to my intuition that no one in the world could truly understand what happened to me when I was 'in the system'. I believe that if I try to describe it to a friend or professional or anyone, the feeling I will be left with is that they just don't get it; that they'll be waiting for some further violent denouement; that they will think that all I have endured is, as Maureen Dowd once put it, the "ordinary brutality" of love and life. I still have access to all the old feelings, rising and turning like seals in that hypnopompic state between dreaming and waking, but not the words that could adequately convey them, or the precipitating incidents; the original sins.

At first, there was just guilt, shame and more guilt, what ifs and why nots. It wasn't until I was 21 that I began to perceive, in the face of crippling agoraphobia, some (very ersatz) nobility in what I did, and some months later, I found myself in a dim bordello-style boardroom, discussing "some stuff that happened" with a sombre lawyer and a gung-ho social worker who had every free set of steak knives out, urging me to sue, sue, sue. The lawyer went through the options - civil action, conciliation, mediation, and warned me that I'd be dealing not with individuals but with institutions, with deep pockets and a legal policy of offense rather than defense. He also pointed out that any civil proceedings would possibly attract the attention of the tabloids and all their ilk. He was just doing his job, and no doubt his advice was sound. But the contrast between his demeanour and that of the rabid social worker was disconcerting, and at some point I said, "This is stupid, nothing really happened, let's just forget it." I was still shuttling between the extremes of experiencing a strange kind of gratitude towards one of the people involved, and even a (very hypothetical) yearning to see him again, and the understanding that something very inappropriate and damaging had taken place. Later, when I got a letter from the lawyer saying "Thank you for your courage in telling of your experiences", I felt like he was making fun of me.

It's so easy to be rational about these things on paper. The mediation of keyboard and chewed fingernails, coupled with the aesthetic impulse, leave bottles drunk dry and thrown only at the bin. Time destroys all things, as the paedophile butcher says at the beginning of Irreversible, but for the things that it leaves covered in ash and waiting to be excavated, I need a drink to destroy time. It renders everything fragmented, devoid of context. Psychiatrists want to know where I’ve come from, friends and intimates want to know where I’m going, and I don’t know how to make them understand that history has stopped, that all that’s left is an interminable present, and the only way to break time up, to prevent the accumulation of the crust of dead experience, is via the bottle.

I Wanna Be Bipolar

Yeah, and shoot twenty foot of jism too. And fuck up the Jews.

I wasn't gonna go near this with a ten-foot pole until this morning when I was over at Polarcoaster and Soulful Sepulcher and spotted a couple of comments by Jon, the author of the blog Living With A Purple Dog, about the blogosphere's response to the SBD diagnosis:

I can’t decide if all the outrage I’m reading about this is really pointed at big pharma, or if it’s because a private club will suddenly be adding marginal members.

Doesn't it almost seem like many with bipolar disorder are threatened by SBD? Like everything else, it's black and white. With us or against us. Pro or con. Bipolar.

These comments struck a chord with me first and foremost because I was privately questioning the assumption that SBD was all the doing of evil psychiatrists and pharmaceutical companies trying to maximise profits by thrusting evermore constrained definitions of normality down our throats. Of course, Jon's comments don't address the issue of what is motivating shrinks and pharmas to come up with this stuff, but instead go straight for the jugular, attributing the criticism of it to a perceived elitism on the part of those diagnosed with 'ye-old-style' bipolar. I'm actually more interested in the former than the latter, but will return to his most contentious of contentions later on.

For the record, I do have a problem with SBD, largely because I have a problem with the way psychiatry is currently practised. It is practised in a way such that the more exposure someone with mild-to-moderate emotional difficulties has to it, the greater the likelihood that those difficulties will be exacerbated to the point where they do meet the criteria for one or more Axis I or II diagnoses. For example, injudicious use of SSRIs and antipsychotics, coupled with the disinhibiting effects of benzodiazepines, can provoke a miserable but otherwise calm person into a frenzy of restlessness, impulsivity and self-destructive behaviour - in other words, drug-induced akathisia that can easily be taken for some kind of bipolar or personality disorder. Furthermore, one's induction into contemporary psychiatric modes of thinking encourages them to view every form of emotional discomfort as an expression of their 'illness', and thus as a source of panic ("Have the drugs stopped working?"), leading to a diminished sense of their own resilience and the failure of once-useful self-soothing strategies. With the patient now more distressed than ever, the cycle then repeats itself.

On the other hand, I have no problem with the idea that bipolar symptoms exist on a continuum; in fact I find it quite sensible, much more so that the notion that there exists a discrete subset of the population in which a genetic switch gets thrown, causing them to swing from suicidal to berserk with ever increasing frequency. The problem is, as many bloggers have pointed out, when mild, infrequent mood changes begin to be seen as variations on more serious mood disturbances, as opposed to variations on normal. This broadening of the range of emotional and behavioural states that are deemed pathological has a variety of causes and consequences, that are often difficult to disentangle. So what's really behind SBD? Is it really Big Pharma, in cahoots with prescription-happy psychiatrists, or are Big Pharma and friends merely capitalising on an already well-entrenched demand (which, yes, they are probably responsible for instigating and/or perpetuating) for comfortable, non-ego-dystonic, mild-but-somewhat-serious-sounding diagnoses for those for whom something isn't quite right?

Now, no one wants to be a schizo of any stripe; that's no fun. And don't get me started on personality disorders - they probably represent the biggest market for subthreshold bipolarisation. It would have to be so much nicer to be considered to occupy the fringe of a condition with positive connotations (e.g. artistic creativity) that is also taken seriously as a source of occasional disability, than to be called rude names by psychiatrists who just don't like them, and who couldn't be bothered doing their jobs and trying to figure out why they're behaving the way they are. From the lazy psychiatrist's point of view, the arrogant, the attention-seeking, the suspicious and the traumatised can be bundled up and onto medication, conveniently ignoring the fact that diagnosing them as bipolar will only feed their grandiosity by invoking comparisons to Vincent Van Gogh/Lord Byron/Sylvia Plath and all that crap. And of course it is all that crap that makes subthreshold bipolar such an attractive and flattering diagnosis.

I've commented elsewhere about the stigmatisation within the consumer/survivor/ex-user community of people diagnosed with borderline personality disorder. As this is the only personality disorder whose diagnostic criteria emphasise affective instability, it makes it the most susceptible to bipolarisation, and so it wouldn't surprise me at all if some are keen to draw the line between 'us' and 'them', because you know what difficulties those darn borderlines have with boundaries. (Of course, if you're bipolar, 'affective instability' is just 'rapid cycling'.)

But does this go beyond routine borderline-bashing? Is Jon right, and is this a sacred turf war? Will expanding the concept of bipolar to include mild hypomania dilute and sully the sense of positive difference associated with bipolar I and II, and more to the point, would anyone diagnosed with bipolar care enough to wage a false war on SBD by setting up Big Pharma as the sole bad guy?

Sad to say, but many of the people I've met in real life (as opposed to on the web) who proclaim their bipolar diagnosis to the world, especially those I've encountered lording it over consumer groups, make me ever so slightly inclined to say yes.

d has already responded forcefully to Jon's comment at Soulful Sepulcher. But she and the rest of you should feel free to rip me a new asshole.

Unemployment the first time around

Gianna's comments on my post below got me reminiscing about what it was like to be unemployed the first time around.

At 19, I somehow orchestrated my 'escape from psychiatry' as it were, although 'orchestrated' perhaps implies a greater degree of conscious planning than I was capable of at the time. I left my parents' house in the middle of the night, walked to a phone box a few kilometres away and called a friend, who came and picked me up and took me to his girlfriend's - who was less than impressed at having an unexpected house guest. Since staying there was out of the question, the next day they arranged emergency accommodation for me through a local housing program for homeless women. I lived in various safe houses while the social workers got me set up on unemployment benefits and I failed to fill my repeat prescriptions, sweating Prozac, Largactil and friends out onto a bedsheet that even after steam-cleaning looked like the Shroud of Turin. (Excuse the messianic overtones of that simile; it was one that the social workers made.) After a few weeks, I moved to Melbourne, found a share house, and settled into a year of self-medication.

Each fortnight I presented a medical certificate from my GP to the dole office saying I was too depressed to look for work. I may have been theoretically capable of looking for work at the time, but as for actually holding down a job - forget it! I was drinking two litres of wine a day just to stay numb. Casks of rapidly oxidising cab sav and riesling, not to mention Fruity Lexia, the stuff fondly known to Australian teenagers as the demon drink, filled the recycling bin each week, their bladders ripped out and wrung to the last drop.

The following year, as I began to emerge from my stupor, I went back to school (on study benefits), and, as the haze further dissipated, I grew increasingly sick and tired of living in poverty and being subject to the tyrannical ravings of my landlord/housemate. So I decided to get a full-time job - any job - just so long as I could afford to rent my own place and buy some aspirin when I had a headache. (Even the latter was often out of the question while on welfare.)

So, at first, I was motivated primarily by financial considerations. But once I started job hunting - and getting knockback after knockback - like Gianna, I too, suddenly felt like I needed to explain myself to the employed. In fact, I felt like the cast-off cocoon of an especially ugly moth. I eventually became near-delusional to the extent that I was terrified that one particular person I had dealt with in the mental health system was behind every knockback I received - that he was somehow popping up everywhere and saying "Don't hire her, she's nuts." The fact that he was (presumably still) employed, and I wasn't further served to underline what I thought would be my eternal marginalisation. I was in a constant state of paranoia and panic, with no one but me to talk myself out of the myriad stupid things I felt like doing as this idée fixe threatened to overwhelm me. At its worst, it seemed like everything, every window, every copy of every newspaper, every coke machine was his; even my own clothes sat on me reluctantly like a thoughtless shoplifting haul. His fifty thousand brothers and sisters sneered at me from behind the counter at McDonalds, and there was no sooking to Lifeline because he was always posing as the bleeding heart at the other end of the line.

After three months of applying for anything up to a dozen positions a week, breathing deeply in elevators on the way up to interviews and asking myself what are the odds, what are the odds? I finally landed a job as a filing clerk. Apart from a couple of weeks over the Christmas break after I was laid off a few years ago, I've been in full-time work ever since. I don't think I can feasibly swear that I'll never work full-time again, but perhaps I could do with a break now.

21 Ways to be Subthreshold Bipolar

(with apologies to Paul Simon)

"The problem is all inside your head", he said to me
The answer is easy - you just take it orally
I'd like to help you in your quest for normality
For there are 21 ways to be subthreshold bipolar

Have you increased your goal-directed activity?
Are you subject to distractibility?
Engaged in an unrestrained buying spree?
There are 21 ways to be subthreshold bipolar

You been flat on your back, Jack
Making grand plans, Stan
Cheatin' on your boy, Roy
Well, listen to me
Hop on the shortbus
We don't need to discuss much
Just drop this off at the pharmacy
And get yourself free

He said that your pleasure-seeking can cause you so much pain
I wish there was something I could do to calm you down again
I said that's diagnostic bracket creep and I am not insane
In any of your 21 ways

He said I'll give you something to help you sleep tonight
And by the morning you'll have developed some insight
He patted my arm and I realized he probably was right
There must be 21 ways to be subthreshold bipolar
21 ways to be subthreshold bipolar

You been flat on your back, Jack
Making grand plans, Stan
Cheatin' on your boy, Roy
Well, listen to me
Hop on the shortbus
We don't need to discuss much
Just drop this off at the pharmacy
And get yourself free

***************************************************************

There are 21 ways to choose two symptoms from Part B of the diagnostic criteria for Subthreshold Bipolar Disorder as quoted by CL Psych in his critique of Merikangas et al's paper that was recently published in the Archives of General Psychiatry. (Choose more than two symptoms, and you're talking Bipolar I or II.) At Furious Seasons, there is also an analysis of the social implications of this gradual stretching of Bipolar I into a diagnostic black hole.

Nothing much, just life

I had a job interview last week; I suspect it will be the first of many while I try and figure out what to do next. Should I try and get another full-time job, one I believe in, one I can get my teeth into, one that will have me boring people half to death as I go on and on about the importance of what my colleagues and I are doing? A job with a decent amount of pay and responsibility, so I don't have to forgo the comfortable assumptions that go with being part of the childless, debtless partnered middle-class? I don't think I'll have time to go to Europe next year, but if I feel like it, then maybe next year. But, yes, let's go to the opera next week, and let's see if we can get a booking at that fabulous new three-hat restaurant as well.

But then again, what have I always said that having money in the bank is for? It's not just about being able to buy pretty, shiny things, but power, the power to walk away from an unacceptable situation, and not have to worry about where my next meal is coming from. I found myself in an unacceptable situation, so I handed in my resignation, even though, as yet, I've got nowhere else to go. Fine dining, the opera, and Paris will now have to wait, perhaps indefinitely. I can't have my cake and eat it too, especially not at a three-hat restaurant.

Maybe I should look for something soft and part-time instead, so I'll have time to write and study. I could drift in and out the office on Tuesdays and Thursdays, both physically and metaphysically near-invisible to the suits and she-wolves as I answer the phones, file the files, clean the printers and load the photocopiers. The trays would rise into place with a smug whir, as I gather my skirts and staplers and skitter back into the stationery cupboard. You'll be bored, the office manager will warn me. But I want to be bored, I'll implore her, with a wide Maggie Gyllenhaal grin, that endearing confection of wisdom and naivete. I will invest nothing of myself, and thus lose nothing - my self-esteem, my stability, my sanity shall remain intact. I will get nothing either, just a bit of pocket money for occasional indulgences - a properly made martini, or a bookshop spending spree.

I suppose this desire to retreat from the world, to choose not to 'work to my potential', is what that idiot shrink was referring to when he diagnosed me with 'simple schizophrenia'. I also suppose this desire is far from uncommon, perhaps overtaking most of us at some point in our lives, and that I'm not out on a heretical fifth limb in supposing so. Just as I had some deep wounds to lick back then, in the past few years, culminating in the past few weeks, I've sustained the kind of work-related injuries that no health and safety advertising campaign will ever warn us about. Nothing's been dropped on my head, except me, at three o'clock in the morning, and from a distance of ten thousand miles, as the crow flies from Paris to Melbourne. Someone, a senior colleague, former lover, and supposedly close friend, sat on the redial button of his phone on the Metropolitain while treating a mutual friend to a crude psychoanalysis of me, one that unmasked his contempt, disloyalty and lack of discretion even through the thick static and burr of background noise. Confidences were broken in the service of constructing the necessary mise en scène, and actual events were ripped from their context and repackaged as evidence of my incorrigible fucked-up-ness.

Only hours beforehand he had been lamenting my lack of trust. It seems that lack was justified. So of course I don't want to be here, or there, or anywhere; I barely want to be. I trust that, in time, this feeling will pass. But for now I want to keep myself from unfolding, keep my scalded, shrunken limbs, my frostbitten fingers and toes, underneath and behind me, away from the dust and germs and anything else that will slow their healing. I feel unfit for the world of work. My skin is thick, but swollen, and hurts like hell when touched. It's not just that awful phone call, but an accumulation of events, and the accretion of corresponding sensitivities, that have left me feeling like a powder keg - one look, one condescending remark, one more jumped-up arsehole introducing me as his 'executive assistant', one more whinge from the bosses' boss about how he knows it doesn't matter but it just doesn't look good when he knows perfectly well that nobody's even watching could set off an explosion that would appear quite deranged and devoid of all context if it happened elsewhere. Obviously, that's something I'm reluctant to risk. I guess the challenge for me now is to strike the right balance in time between staying at home and hiding under the covers, and re-entering the world of work, so that I give myself time to heal, time for my sensitivity and hardened cynicism to abate, without running out of money or losing touch completely.

Mental Health Days

No, I haven't gone all loopy as may be inferred from my most recent post - I'm just taking a few 'mental health days' off blogging to attend to some rather pressing work and study commitments.

From www.urbandictionary.com:

Mental Health Day

A quasi-legitimate excuse to take a day off from school or work. Although the person who takes the day off claims he needs it to finish up some work and regain sanity from the rat race, he usually ends up sleeping in, masturbating and accomplishing less than nothing.

Sounds like a reasonably accurate description of what I've been up to. In other more exciting news, Neurotransmission is back up, and newly updated. (I mentioned it some time ago in my Thinking Bloggers post.)

The combinatorics of BPD

I was going to write a serious post responding to the issues raised by Polly in her comment on my previous post and in a subsequent post of her own, but as threatened, the language is leaving me - not via disintegrative psychosis as first suggested, but a sad and sorry case of simple schizophrenia, yet another condition I didn't know I had until yesterday. I was going to discuss the diversity inherent in the concept of BPD, and of those diagnosed with BPD, which is something I'd normally do in qualitative terms - and assuming the near certainty of achieving a full remission, I will no doubt get around to doing so soon. But in the meantime, given my 'inability to meet the demands of society', I present the following 'impoverished' observations and analysis.

From DSM-IV, the criteria for Borderline Personality Disorder:

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:

1. frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation

3. identity disturbance: markedly and persistently unstable self-image or sense of self

4. impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.

5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior

6. affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)

7. chronic feelings of emptiness

8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)

9. transient, stress-related paranoid ideation or severe dissociative symptoms

Right, if we require five or more of the above criteria to diagnose someone with BPD, then there are


different ways of being borderline. Cool, huh? But let's assume for a minute that BPD wouldn't be diagnosed in the absence of Criterion 5. Strictly speaking, I've got this the wrong way around, as an impressionistic diagnosis of BPD is often made on the basis of someone meeting Criterion 5, without regard to whether they meet enough of the other criteria. But what the hell, I'm going to assume that all people diagnosed as borderline meet Criterion 5. Which now means that there are


ways of being borderline.

Now, let's assume that we have 163 borderlines who, apart from Criterion 5, each embody a unique subset of four or more of the other criteria listed above. They are all in the day room in 'Borderline House' at Mount Misery:

Then I noticed Blair Heiler, watching from the doorway. He took a first kick-step into the jungle of Borderlines, and all hell broke loose. He reached his office door, turned, and said, 'You poor sonsabitches', and closed the door behind him.

....

Heiler entered and stood for a moment inside the door, staring down at us with palpable contempt. A dismayed shake of his head seemed to set his pelvis in motion, and one leg kicked from his hip, and then another...

Suddenly Thorny was in his face, screaming - 'All you are is a life-support system for a dickhead' - and Zoe too, and then all the others. To their rage, his reaction was a cruel smile. By the time he'd shut the door behind him, the ward had once again been transformed into two dozen Borderlines from Hell, the worst patients in the world, proving the Borderline Theory.

I relaxed. When Heiler was with patients, no matter how they really were, they would act towards him like classic Heiler borderlines, lurching into rage, fear, projection... Not only do psychiatrists specialise in their defects. I thought, they evoke them in their patients...

-Samuel Shem, Mount Misery

In the book, the junior psychiatrists attempt to pair up the borderlines as part of a 'Buddy System', so that they may support each other post-discharge, which is sneakily arranged while Heiler is away. There are


ways of choosing two borderlines from among the 163 borderlines currently steaming up the windows. Take the first borderline, set aside, and allow to cool. Take the second borderline... please. Now, having been allowed some time out, assume that the first borderline meets just four (and and no more) of the criteria in addition to Criterion 5. Make a similar, uncharacteristically charitable, assumption about the second borderline. There are just


possible ways for the criteria set for the second borderline to be such that it does not overlap (except for Criterion 5) with that of the first borderline. So the probability of being able to choose two borderlines from the set of 163 borderlines who, apart from Criterion 5, each embody a unique subset of four or more of the other criteria, such that the two borderlines each meet a subset of the criteria that does not overlap with the other, except for Criterion 5, is


Which is almost as low as 1/200. Yeah, so much for diversity, I guess they pretty much are all the same.

A stigma wrapped in a history inside another stigma - that will probably never make it onto a t-shirt

Polly at Polarcoaster has designed herself a cute 'Bipolar Princess' t-shirt (click here for a photo). She writes 'I don’t know if I’ll ever wear it outside of my apartment or my friends’ apartment, since it’s like wearing something that says “LOOK AT ME! I’M AN ATTENTION WHORE!”'

I might be wrong here, but this seems to imply that the stigma of being perceived as an attention whore is greater than the stigma of being diagnosed with bipolar. Which leads me to ponder... how many people in the broad consumer/ex-user/psych survivor community (hereon referenced as c/s/x for brevity) would be prepared to publicly sport a t-shirt proclaiming 'Borderline Personality' or 'I Hate You, Don't Leave Me', especially in a context where a lot of people would understand the reference?

Now, I know that this is a diagnosis that has been severely tarnished by its use by psychiatrists as a 'trash can' for the 'treatment-resistant' and as a way of 'explaining' the behaviour of therapists who take advantage of their clients sexually. (The apparently irresistible pull of the 'seductive, needy' borderline and the fear of 'borderline rage' if the patient's overtures are denied, etc etc etc. If borderlines didn't exist, psychiatrists would have to invent them.) I know that BPD often might as well stand for 'Bitch Pissed Doc', and that it has a hot-potato effect, causing the unfortunate patient to be referred from shrink to shrink to shrink, rendering her chance of ever developing a therapeutic relationship with any of them near impossible by the prior communication of the damning diagnosis. So there's a whole stack of reasons why you would want to avoid being lumbered with it, if you have any interest in obtaining the best and most respectful treatment possible for yourself. But, sadly, nothing I've noted above makes the phenomena, each considered individually, of fear of abandonment, difficulties with close relationships, anger management issues, or short-term, highly reactive mood swings, rare or non-existent among those who've spent some time at the mercy of the mental health system. (Heck, if you do have issues like these, your time in 'the system' might even be a contributing factor.)

But few people ever want to admit to them, and so they probably shouldn't, if they're sitting anxiously in the office of a strange psychiatrist. But what about here, where we're anonymous and online, or in real time, talking to other c/s/x people? How many times have c/s/x (particularly bipolar) people declared to me, unprompted, that they've never been diagnosed as borderline? The subtext appears to be: I might be sick, but at least they've never called me that. It seems that not only are those diagnosed with BPD the niggers of the mental health system, they are the niggers of the c/s/x movement as well. And that worries me - a large group that, while rightfully resisting its stigmatisation as a whole, implicitly stigmatises a subgroup of itself, by accepting uncritically the attitudes of some rather weak and callous psychiatrists who, unable to deal with the frustrating but logical emotional and behavioural consequences of intense suffering, have somehow infected their entire discipline, and possibly now the c/s/x movement, with their bigotry.

Don't kid yourself - if you've cut yourself just once, or made a cry-for-help suicide attempt back in the days when neither you or anyone else had the faintest clue what was wrong, or even just argued with your shrink, 'borderline' will have almost certainly made a guest appearance - or even qualified for a regular slot - in your files. If you were young and female at the time, it's pretty much a done deal.

Of course, we're all free to judge individual examples of a person's behaviour, infer a pattern from them, and decide that we'd rather not deal with them if we so wish. But don't do this backwards, and indulge in the kind of wanton borderline-bashing that shrinks do both in semi-public 'places' such as professional journals, and behind closed doors, possibly under the influence of alcohol or other disinhibiting substances - not that some of them would need them, as they're clearly quite happy to let those bitches have it any time.

No more 'I love yous'... the language is leaving me...

Another batch of medical records arrived in the mail today. To my already fairly comprehensive list of misdiagnoses listed below, I can now add autism and, even more curiously disintegrative psychosis, a.k.a. Heller's Syndrome or Childhood Disintegrative Disorder (CDD). This condition is described as an especially malignant, delayed-onset variation on autism, such a that a child with CDD appears to develop normally for the first 2 - 10 years, only to undergo a sudden regression that often results in severe mental retardation. Ironically enough, I am at a loss for words.

The Acronymphomania Pharmacopoetica

Firstly, a big hat tip to Stephany, who originally alerted me to this wonderful parody of a self-help website . Someone has clearly put a lot of effort into maintaining a detailed, intricate catalogue of the many types of juvenile misbehaviour that warrant heavy-duty psychopharmacological intervention, as well as updating it regularly with witty 'posts', supposedly by parents of children who are "oppositional, defiant and resistant to parenting".


The mystery author cleverly satirises those who construct their identities and those of their offspring around the limited (and limiting) notions of saint, martyr, patient, manipulator or victim, by associating each putative poster with a particular 'signature'. The 'signature' lists the diagnoses and medications for every fucking member of the putative poster's family - even the putative pets often get a look-in. Pure genius.

But browsing the website presents a challenge similar to that of reading A Clockwork Orange: just as one is distracted from Alex's awfulness by constantly having to flick to the back of the book for a translation of his quasi-Russian slang, the website is drenched with indecipherable acronyms that ooze through it like a bowl of alphabet soup upended over a naughty two-year-old's head. 'GFG' looks like the notation for a composite mathematical function, which I guess threw my imagination a bit. And to start with I could only infer that DH referred to the man of the house - Deadbeat Husband? Fortunately, however, a glossary is provided.

"Sadly to say my gfg (before being a day student) pooped on the floor in his dorm room, we've found poop under his bed at home and I've caught him smearing his feces in the shower, when I asked him why, he told me he didn't know and then asked if I was mad. And honestly, I don't think he did know why. Thankfully the last episode was over a month ago, I hope it lasts. He also cleaned the shower without me telling him to do so.
I, too, think they just don't think.
_________________________
Joanne anxiety/depression, panic disorder, burner, NVLD, type 2 diabetes, high blood pressure, high cholesterol, arthritis. Geodon 60mg BID, Ativan .5mg BID, Avandia 8mg, Benicar HCT 40/25mg, Lantus Insulin, Zocor 40mg, Norvasc 5mg, Prandin 2mg, Prilosec 20mg, WelbutrinXL 300mg, Buspar 5mg TID, Ambien 10mg at bedtime.
DH 22 years and still strong, believed to have ADHD as a child, but undxd.
gfg: 14/m 98% bilateral hearing loss (he's deaf), mild cerebal [sic] palsy, insulin dependent diabetes, mild MR, PDD, as of 3-16-07 mood d/o NOS, anxiety NOS
meds: NPH & Humalog Insulin, Geodon 80mg BID, Lithium 300mg AM, 600mg PM, Remeron 30mg nightly, Ativan .5mg 3 daily if needed, Zyprexa 5mg nightly."

I must admit that I found this particular parody 'post' rather cruel and tasteless when I first read it, until I remembered that it wasn't a parody 'post' on a site called 'cerebralpalsy.com' or 'hearingimpaired.com', but conductdisorders.com. And at the risk of steaming a runny joke dry by overanalysis, what does give it its satirical bite is the notion that someone would roll their shit under the bed or smear it around in the shower simply out of sheer thoughtlessness. I mean, when people defecate in inappropriate places, it is usually either a deliberate act of extreme hostility or symptomatic of a complete breakdown in bodily and/or mental functioning. But clearly our mystery author, too, thinks that a lot of people just don't think.

GFG is your Gift from God (your problem child)
PC is (are) your Perfect Child(ren)
DH is your Dear Husband
DW is your Dear Wife

Who says Americans can't do irony? Note that the relative lack of DWs referred to in the forum suggests that the author believes the behaviour s/he is parodying is more common in females.

And here's a non-exhaustive list of acronyms of the diagnoses supposedly being made:

ADD/ADHD: Attention Deficit/Hyperactivity Disorder
AS: Asperger's Syndrome
BPD: Borderline Personality Disorder
COBP: Childhood Onset Bipolar Disorder
CD: Conduct Disorder
DAMP: Deficits in Attention, Motor control and Perception
MDD: Major Depressive Disorder
GID: Gender Identity Disorder
IED: Intermittent Explosive Disorder
LD: Learning Disabilities
NVLD: NonVerbal Learning Disorder
OCD: Obsessive-Compulsive Disorder
ODD: Oppositional Defiance Disorder
PANDAS: Pediatric Autoimmune Neuropsychiatric Disorder
PDD: Pervasive Developmental Disorder
PTSD: Post Traumatic Stress Disorder
SID: Sensory Integration Disorder
TS: Tourette's Syndrome

I was having so much fun reading this site that I decided to compose a genre 'signature' that my mother might have used, back when I was 'oppositional, defiant and resistant to parenting'. (I still am, actually, it's just that no one can really do anything about it.)

Me: 40, undx'd OCD, histrionic PD. No friends, hobbies or outside interests to speak of.

DH: 43, married 20 years, sits in front of TV, drinks beer and doesn't answer when I speak to him, but remains supportive by disciplining GFG (will throw her across room if necessary).

GFG: f/16 dx panic disorder*, dissociative disorder, MDD, hx of truancy, failure, flouting school rules. Believed to be prodromal for schizophrenia - have bought her earplugs to keep out the voices. Denies that she has a problem. Will not keep room tidy, not interested in watching TV or attending football matches with rest of family. Insists on reading books and engaging in other anti-social activities instead. Meds: Aurorix 300mg, Xanax 2mg, Aropax 40 mg, Largactil 50 mg nocte for insomnia. Frequently discontinues medications without my or Dr God's permission.

PC: f/14 GID in early childhood but seems to have cleared up. Played only with boys back then but now has no interest in them at all. Has several very close female friends who will hopefully introduce her to their older brothers.**

2 cats, 1 male, 1 female, both strays. One female stray (2 y.o.) has particular attachment to GFG and this is reflected in cat's behaviour. Short bowel with lactose intolerance, often makes mess indoors. Cat ingested 0.25mg of GFG's Xanax the other day and a definite improvement in cat's behaviour was noted. Despite neutering, male cat frequently attempts to achieve sexual congress with PC's leg. Both cats orally fixated, particularly with respect to jewellery. DH says female cat will lick any man's ring.

And yes, the site is interactive, so you can create your own profile and 'signature', and post away about your four-year-old son's bipolar temper tantrums and (I kid you not, there is a precedent) your dog's undiagnosed ADHD.

* Where all the research money was at the time.
** Of course, PC eventually came out, and became not such a PC after all.