Admission to hospital

20:52hrs 5th September 2008

I have just arrived at ward XXX. It is an adult acute assessment and treatment unit. I cannot believe I am here. They have made a massive mistake, but they believe I am psychotic, and floridly so. I don't need hospital. I need a priest. An exorcism.
A couple of weeks ago I was the nurse in charge - how can things have turned so quickly that they believe that I don't know my own mind. They think the lunatic was running the asylum, but they are wrong. How many people have I done this to. Denied what was happening to them. Didn't believe them. Or believed that it was their perception, but obviously their perception was incorrect and mine was not because they are mad and I am a registered mental nurse.
No-one believes me and i don't know what to do.

I have been greeted my a staff nurse who has gone into the office with the nurses from the Crisis Resolution Service who brought me here. She is probably a bit younger than me, and looks bright eyed and bushy tailed. She talks to me in a way that I am sure is intended to convey empathy, warmth and understanding. How many times have I used that same gentle, calming reassuring voice. It makes me want to smash her fucking head in. But I know that will be a one way ticket to shit loads of meds, a label of being aggressive, and being sectioned. Which must not happen. Under any circumstances. I want to go on holiday to Disney with the kids in 2010, and if you have been sectioned you can't get in the USA without a fight.

She is completely ignorant of what is happening here, and and want her to believe me, but I know she won't. She is treating me to the same gentle and supportive welcome to the ward I have given countless times. Have many people have I done this to? She is totally ignorant of the truth of the situation. And a couple of weeks ago I would have agreed with her.

I am shown into a room which is painted a kind of camouflage green. I am sure that there is some evidence base that it is a relaxing colour. It is the most dismal colour I have ever seen. I have been informed that they will get to me after the handover to the night shift. One of the CRS nurses goes into the office to hand me over to the night staff. The other nurse sits in the room with me. Another nurses keeps peering through the window every minute of so.

There is no more talking. There is nothing to say.

I am waiting for the admission process to begin. I have requested a joint admission assessment because I can't bear the thought of having to go through everything numerous times just so the documentation gets completed. The nurse agrees and I am shown to my room.

I can see where all the cash inn the trust is going- and it certainly isn't clinical psychologists. The unit is immaculate. I am shown to a single room which has an en suit on a mixed corridor. This worried me a bit, but they showed me that I can lock my door, and only staff can gain access. The nursing assistant, (i don't remember her name, but she sounded polish and was wearing nice quiksilver jeans) has worked here for 4 months. Only a few weeks ago, I would have been the senior member of staff, the accountable member of staff. And now I am a patient. How the fuck has this happened?

I do feel calmer now than I have in days. I feel sure that the girls and P will be safe now I am no longer under the same roof, or physically near them.

P cried tonight. I have only ever seen him cry once before, when I had our first daughter. It broke me to see him cry. He cried because he believes that his wife is ill. He doesn't believe me. He thinks I am mad too. No one believes me.

I know that he genuinely believes that he is doing thew right thing, as that is how he sees things from his own distorted perception. He , and everyone else are misperceiving the whole situation, and don't understand what is happening. They are unable to provide me with any evidence that my perceptions are incorrect, however they are expecting me to accept that they are right merely because they are the majority. A few weeks ago I would have been a part of that majority that hospitalises and penalises those who perhaps, see things as they really are. It is they who should be listening to us.

They all bleat the same old pacifying bullshit. "....Whilst I do believe and accept that what you are saying is your experience from your perspective, and it is real for you.........blah........blah.........blah...........but then go on to say essentially -you are fucking bonkers-take these meds, behave and play the fucking game, or we will totally shaft you by detaining you under the MHA. I am informal, which is good. I am here voluntarily, which is good. But the truth of the matter is, if I don't play the game, I will be on a section before you know it. So, I am involuntarily voluntary, or something......this is not an optional stay in hospital, even though it is disguised as one.

So what are my options and non options

1. Stay at home and leave things as they are. I would be there to try and protect my family from Daniel, however I know his determination for me to die by my own hand is becoming increasingly difficult to fight, whilst trying to protect everyone too.
2. Daniel is upping the stakes.
He has killed Amy's best friend Tara, a 32 year old mother of a 1 and 4 year old.
He has killed one of my closest friends, Sarah's father.
He has killed my next door neighbour, John, who was buried today.
He has orchestrated one of my closest friend and neighbours to lose his job.
He has killed my next door neighbour's son-in-law at the age of 33 leaving his wife,
Joanne having lost both her husband and father within months of each other at the tender age of 28.
3. He is playing games with me. Deathly games, in wh

Back from Psychosis.

This is my first entry for a while. I have had a bit of a nightmare just recently. To cut a long story short I became rapidly and floridly unwell, and was admitted, for the first time to an adult acute ward. Two weeks previously I had been in charge of one.
The lunatic had been running the asylum.
Whilst I was hospitalised, narrowly avoiding being sectioned, I kept a diary. This diary was, at the time the most important item I owned because by writing in it, and being able to read the words back to myself, I knew I was still alive. I also wanted evidence for my daughters, my husband, family and friends that if I died, it was not out of any desire to leave them and that if I was dead, it may appear to be of my own hand -but it wasn't -it was forced.
Really weird reading that back now.

I'm not sure how the best way of writing this will work. Whether to write it in real time, as if I was entering the events, thoughts and feelings on the actual days they occured, or by bringing them into current time. The only thing I am sure of, is that I will write it, word for word, how I wrote it whilst in hospital. So here we go.

ACRONYMS..........................

FOFOY (Fuck Off and Find Out Yourself) nurse training (oh and doc training dr. Lake C).....but there must be loads more out there.

So lets stop wasting out time debating the Tidal Model vs You will Take Your Goddam Meds, the hijacking of the term "Recovery" by a load of knobheads whose main understanding of recovery seems to predominantly relate to the roadside variety provided by the RAC, and address the important and meaningful issues such as how many wonderful psychiatric acronyms do we know?

I'll start.....

1. hmmmmmm..........................................................................bollox - can't think of any thing yet. I'll put the kettle on.

I have recently returned from holiday with my family. I have not been great, but my black and filthy sense of humour seems to be resurfacing which is a good sign. However, thoughts becoming increasingly difficult to manage, and I know that without the medication induced sleep I'm getting I would be psychotic before you could say, " Fuck it -I will have that extra Quetiapine before I go mad as a box of frogs".

I was warned this could happen, but I thought it would be fine because I was hypomanic at the time. I bloody wish the fluoxetine had been left alone until the lamotrigine got up to a therapetic dose though. My CPN has been advising me for the last 5 weeks to take some time off from work, but I've continued (with exception of annual leave) because going off sick makes me feel shit. However, I think I'm going to take his advice now before things deterioate further.

On a positive note the fact that my lovely acronym FOFOY (Fuck of and Find Out Yourself) that was the entire ethos and basis of my nurse training has been so well thought of by fellow bloggers has cheered me up a lot.

Which is nice.

Going down.

I feel crashingly low. Tearful, and totally spent in terms of energy and motivation with myself. Meant to be going to a wedding which is something I would usually be really excited about, but can't seem to get my self together enough physically or mentally to go. Keep get disturbing images of myself handling a gun, and then very calmly holding it to my head, pulling the trigger and watching my brains splat against the wall as I slump to the floor my hand still wrapped around the gun and my finger still on the trigger. I have been getting them over the last couple of weeks, but as my mood continues to spiral downwards the thought and image of this is becoming increasingly frequent and more graphic. Bizarrely, although it's horrible and upsetting, the sense of choice calms me a little. I don't feel suicidal, I have no plan, I have never self harmed and I have never attempted suicide but I just keep getting these images. I have thought about suicide, but this has been when I feel that the situation is hopeless I nothing will ever change. I seriously considered suicide post psychosis after the birth of my first daughter. I felt that I could never love her, and as the situation could not be changed my husband and daughter would do far better without me.

When I was depressed last year there were times when I thought about it as a way of ending the turmoil and the upset caused to me and my family by this demon. I don't feel actively suicidal right now, but I do just want this all to stop and I am scared this is just a runaway train that will never stop, and the only way to get off is to jump off. I'm wondering about my meds too. Would I fair better without them? If I could get to grips with this thing without meds, then at least I would know that they are real swings in mood as opposed to chemically influenced changes. They say the fluoxetine made my high, but it stopped me from getting depressed. It's been halved from 40mg to 20mg. I have started on Lamotrigine but I am not yet up to a therapeutic dose. The quetipine helps me sleep, but it's getting increasingly difficult to get up in the morning. I wish the fluoxetine had been left alone until the lamotrigine had been given a chance to kick in.

Because right now I feel as if I am swimming without anything to keep me afloat. I'm scared of drowning because I can't keep this thing away and stop it from submerging me. Or just giving up and letting it roll over me and suck me under.

Hubby isn't happy with situation. He hates it when I'm low and can't handle it. He just seems to be angry and irritated with me which just makes me feel so much worse and even more alone. I feel so guilty because I know it brings him down which results in him just cutting himself off from me. He's a fixer I guess, and if he can't solve it he ignores it or gets frustrated with it -a bit like DIY. Would would be nice is just a few words of support, and a cuddle. But instead he sits in the lounge watching footie results and I tap away on the computer with tears rolling down my face.

We are meant to be going to a wedding. Hubby says he won't go without me. He has just told me to text friends to say we won't be going. He has told me to "Fuck off to your Mum's", and clear off for the weekend. he is so angry about this. I just can't seem to stop it. I feel even worse now. Images coming thick and fast through my head as if my brain is trying to tell me there is no way out of this unless you jump off that moving train.

So what do I do now?

Letter to Prof Phil Barker

I have decided to write a letter to Prof Phil Barker and his wife Poppy who wrote, "The Tidal Model", to see if they can offer me any advice on how to deal with things.........




Dear Phil, Poppy whoever reads this!

My name is A Truly Registered Mental Nurse and I am A RMN working in a Recovery and Independent Living Unit. I have a diagnosis of Bipolar Affective Disorder which was first suggested to me following a episode of post partum psychosis in 2003. I had a episode of mild/moderate depression following the birth of my second daughter in 2005, and a psychotic depression last year. I rejected the diagnosis of BPAD preferring to stick with post natal illness until spring of this year when I began to research BPAD in order to work with people with this diagnosis. To put it simply I had a moment of insight that hit me like a ton of bricks. I had been asked in the past if I had ever been elated? "No -of course not " , I replied, quite honestly. I took the fact that on several occasions I had managed with no sleep for several days, decorated the entire ground floor of my house in 3 days which I rounded off with a shopping spree that I couldn't afford, went off to France on a whim because I wanted a bottle of wine, and have had many wonderful and exciting experiences as me being well -i.e. NOT depressed - Oops.

The reason I am writing to you is I read your book (The Tidal Model Guide), and it's impact on me was immeasurable. It touched me to the core because it's how I like to work, but my way was kind of undefined and without any structure I suppose. However, my approach and way of working does not seem to be going down too well at my place of employment, and I was wondering if you could give me some advice on this. People keep talking about recovery, but I don't understand their version of recovery, and I am becoming increasingly disillusioned with the feedback I have been receiving both directly and more the subtle undertones that I seem to pick up along the way.

I have been advised against getting "deep" or encouraging people to talk about the future if they are in a more acute stage of their illness, or in crisis. I've been advised that we need to get people to take there meds, stabilise them, and then we will have something to work with. It comes across to me as that their vision of recovery is succeeding in making someone adopt our way of doing things because "we know best". I reject this vision of recovery completely. I am also a bit worried that my colleagues think my approach is because I have a mental health issues, and that I am simply a lunatic attempting to run the asylum, a novelty, nuts, nurse. I don't want to compromise myself professionally, but I don't think that their way of doing things is best and I don't want to go along with it although I sometimes feel it would be easier as I'm a bit thin skinned at the moment. There are lots of other concerns and worries I have, and I am going round in circles in my own head trying to make some sense of it all!

I have started writing a blog which reflects my thoughts and feelings in regards to how I nurse, and managing my own feelings about my own issues which are not yet sitting comfortably, but I am trying to come to terms with. I am feeling increasingly confused by how to bring it all together to improve both the well-being of the people I work with, and myself. I won't go into any more details as I'm not sure if this will reach the right person, but if it does I would love to hear from you, and I will give you my blog address if and when you get in touch.

Thanks again for putting together such an inspirational book, and for reflecting in such an articulate and understanding way my own thoughts and feelings on what recovery is all about.

Best Wishes

A Truly Registered Mental Nurse

Confused!!!!

I have just come home from work early due to having a bad headache. I think it's probably due to stress. Just feeling very confused and uncertain sometimes about what I'm doing both at work and with my own head. Lots of stuff going round in my brain and having trouble finding any answers. I did however speak to a colleague a work who happens to be a clinical psychologist and I found that so incredibly helpful.

I am working with a patient (I shall call him Carl) as a named nurse who had a diagnosis of BPAD Type I. He is elevated in mood at the moment, however I have been spending time with him in order to develop a good therapeutic relationship. Or, just to hopefully become someone he feels he can talk to and trust. I have spent time with Carl over the course of the last couple of months doing in reach onto the acute ward, and now he has finally been admitted to our Recovery and Independent Living Unit.

Since then I have tried to spend time with Carl in order to learn about his life, his experiences and his views on both the world and how he fits into this world. Due to the fact he is at the moment a little elevated in mood, I have used the Tidal Model Holistic assessment as a template for our time together. Conversation has a tendency to digress as Carl has a viewpoint, most of which are complex and very thought out, on just about everything! These conversations are very interesting, and I feel privileged that he has agreed to share some of his thoughts with me at this time.

During our sessions we have talked about mood, illness, wellness and how he sees himself. He rejects the diagnosis of BPAD and feels that the people who are saying that he is BPAD are merely justifying their jobs. He believes he has lots of potential and could achieve almost anything if he put his mind to it, his ultimate goal creating a Utopian society full of love and peace. His ideas on how to achieve this are in my view naive and over simplistic, but all the same they are principled and show that Carl's morals are certainly in the right place.

I find his hope and optimism about how he believes he can change the world wonderful to listen to in a sense, because his thoughts and ideas seem very pure and ignore all the real life political stuff that would make many of his suggestions unworkable as they do not take into account the certainty that the entire population is not going to agree with him!

The problem I have found at work is that it seems to me the rest of the team do not see this way of working with him "appropriate". I am putting that word in inverted commas because I hate it with a passion, and hate myself if I accidentally slip up and use it. I discussed a plan of care and way forward with the psychiatric registrar Dr. Chilled. He is a very nice compassionate man, and I believe he genuinely wants to do good and promote well being. Basically, when I showed him the work Carl and I had done, and the pictures that we had drawn together, which once Carl explained them, helped me understand where he was coming from, I was advised not to do this "deep" stuff as he was too elevated in mood and we needed to wait for him to take more meds to bring him down. Trying to make Carl develop "insight" was the key to helping him, as he would then take his meds and accept his diagnosis. When I said that I had found out what hobbies and interests Carl had, and I was currently looking at ways in which to facilitate him in developing them I was advised against this as "he starts enough things off on his own without us starting more off". When I said that I had talked about discharge planning with Carl, to find out what it is he wants from his time on the unit, I was basically advised that it was way too soon to talk about any of this stuff -we just had to focus on bringing him down. I'm really shit at putting together my thoughts on why I'm using the approach I'm using because I just come across as someone who doesn't know what I' m doing. So I kind of ended up sort of agreeing with Dr. Chilled, although I did say that I would continue to develop my relationship with Carl by talking about things he wanted to talk about.

Also, I spent some 1:1 time with Carl on Tuesday during the morning which was meant to be 1 hour, but spilled over by 20 minutes. Later in the office a couple of digs were made that, "she (me) hasn't been around all morning", "Can't spend too much time with one patient as there is work to be done", and me developing a horrible feeling it the pit of my stomach that:

a) My colleagues think I'm emotionally over involved

b) My colleagues think that I'm lazy because I wasn't doing what they are doing(?!?)

c) My approach is in fact -WRONG - and I should be doing it "their way"

d) I am emotionally over involved because I am genuinely interested and I do care and think I really understand what this man says to me, even though I don't agree with everything he says. I can SEE where he is coming from -(I think).

e) And finally, am I becoming paranoid about this, which is effecting my own mood which due to recent events and medication changes I am a little more vulnerable than usual.

I gt soooo frustrated and angry at the moment. I have a laugh and have a very black sense of humour, but some of the things I heard said just make me feel so uncomfortable. For example, A staff member telling a patient in a crowded dining room to "eat properly-it's disgusting to watch you eat with food spilling everywhere -like an animal!" The patient then said "Oh fuck off". The patient was then berated for "inappropriate behaviour" and she then stormed off leaving her meal and was in a bad mood for the rest of the shift. This was handed over as the patient being verbally abusive and inappropriate.

I'm not at all sure about this.

There are so many incidents of this it's unbelievable. If a patient swears they are told to "mind their language" or that its "inappropriate". Put their feet on a table it's "unacceptable and disrespectful". And then the staff proceed to go in the office, swing their own legs onto the desk, and punchuation their conversation with swear words and "inappropriate behaviour". Now I swear and have a laugh, but I try not to be a hypocrite and "tell off" patients who do it. Don't we all have a right to express ourselves in our own language? I suppose I am able to identify when it is OK to act like this, but from the patent's point of view, they must see us as behaviour police, or feel like naughty kids at school. I'm so frustrated at all of this because I don't know what is right, and if I am right in this I don't know if my skin is thick enough to handle this.

Last week I was told I would be having management supervision by my manager. I had been very confused by how to handle another patient I shall call her Joanne )in a way that would promote her recovery (she was very hostile and verbally abusive) and on discussing the situation with several colleagues and looking at careplans it transpired that no-one had a clue what we were doing, and there was lots of different personal feelings about this individual and her behaviour and personality vs illness. So I put my thought down, and asked others to add to it. Apparently this was a BAD IDEA because

a) it was treading on other peoples toes.

b) no-one else had mentioned there was a problem, so there wasn't a problem.

c) As i only started in early spring so i didn't understand the situation.

d) i should have asked for clarification from the named nurse team (on annual leave by the way).

I cried. How pathetic is that. I cried because I thought I had upset other people, which was the last thing I had intended to do. My manager did say that it was a good piece of work, but I later found out that it hadn't even been referred to during a case conference held at a later date. Perhaps this was because it contained too much of the patient's views, and put some of the teams negative feelings about this patient on paper. I still don't know even now. I was told that the TEAM had a very clear view of where things were going, and that was just to get her through the crisis. When i said that I had talked with her about discharge and future, I was told that we (the team) had no idea what was happening there and to just focus on the crisis. I said that I felt if the crisis was handled with an eye on the future this may have a better outcome for the patient. I was told that I was focusing to much on the BIG PICTURE yet I should just focus on the moment. I continued to try and restate what i was trying to say but felt that my manager though that I really didn't have a clue and I was probably one to watch. (For the wrong reasons).

I ended up apologising, and saying that I'm just getting used to their way in working, and in acute we were less precious about the named nurse system, and even on admission we began to consider discharge.

So I feel alone at work. With exception of the clinical psychologist who reassured me that the way in which I was working was a good thing.

I told her that I felt like a fraud, I felt more comfortable with the patients than the staff, as if I could be myself. I felt more accepted by the patients, and enjoyed their company and conversation than the staff. That I love hearing their perception of the world, and thinking of ways in which I could help them perhaps see things in new ways which might mean they are more likely to achieve their goals in life.

I told her I felt like I was hiding. You are either a patient or a nurse. So you are best to put yourself across as a nurse because you can't be both. I feel ashamed of this shame I have. I would love to reach a point where this whole mental illness thing and my diagnosis sits comfortably with me, as a nurse and as a patient. I don't want to become an aggressive campaigner, I just want to feel comfortable with my own brain the way it is. I want to be able to say "I'm a nurse and I have experienced mental illness", to colleagues and patients alike.

The wards Consultant Psychiatrist. Dr. Hippy I shall call him, had a chat with me about these thoughts I had been having, and the fact that I was worried that my own experience and the fact that I was currently trying to deal with my own problems would mean I was a not so good nurse. He suggested that I see myself as duel qualified - a term I liked.

Carl asked me why I seemed to understand what he was saying. He said I was like him. He asked me if I had BPAD as I seemed to know a lot about it. I laughed it off because I couldn't bring myself to say no. I lied to him. He told me to be careful or they will lock me up too if I don't stay boring like everyone else.

Maybe he's right.

Feel really pissed off. Hubby read my blog last night which I was OK with, however I had said to him that it was just my thoughts and feelings at the time and was to help me to sort my own head out. He read it and focused only on the sex. He basically said to me that he thought that I'd probably had sex with different people every night I went out; the way in which we met was probably because I was hypomanic at the time (possibly some truth in that); and what the hell I have been up to in our marriage.

This just upset me that he had judged me and made me feel shit for writing my thoughts down to try and clarify things for myself.

I'm not sure what to do about it now though.

Have an appointment on Monday with CPN and Consultant Psychiatrist Dr. Smile-a-lot. Plan is to start on Lamotrigine. I have VERY mixed feelings about this. I do want to even things out a bit but I don't want to lose what makes me "me". Don't want to lose my sparkle and zest for life. I love my sense of enthusiasm and joy over the silly things in life, and I don't want to say goodbye to that part of me. However, I do know that sometimes I feel dangerously capable of anything. Invincible even. I shall have to see how it goes eh?

I called my CPN last week as I was worried that I was becoming low in mood, but mind was racing and was experiencing intrusive thoughts. Scared about getting in a right state again, but I took on board his view that this could be a 'blip' and to try and work through it, which I kind of have a bit, I think?! He will be calling me today so I am thinking about what I will say to him so it actually makes sense. My concerns are

• mood a bit low
• thoughts racing -don't stop all day until my medication kicks in at night
• taking ALOT longer to drop off to sleep even with medication and waking in the night.
• few weeks ago I think I was hypomanic/manic due to several things. On occasion an increased vividness and intensity of colours, sounds and images. Everything had a magical cartoon like quality to it which was fantastic. Filled with total and utter joy by silly things like what other people were wearing, cars driving along the sea front, music etc. I felt like I was a on a glorious film set. Lots of things felt very significant to me. And my body was fizzing as if I was a sherbet lemon, or effervescent tablet dissolving. Tingling and internally overwhelming -as if I was going to boil over.
  
• I suggested to my husband that we have an open marriage and came very close to driving into town with the intention of going out on my own and finding someone for sex. When he said no basically I told him that he was boring and ignored his concerns about what I was saying and he thoughts that I was elated.
  
• Felt sexually very powerful even Goddess like, and researched working as a prostitute as I felt I could probably earn thousands of pounds from something I liked doing and was very good at. Very excited about the prospect of having a double life, and the different walks of life my "clients" would come from.
  
• I have been considering some past events in my life. For example -In my early 20s I decorated the entire ground floor of my house over 3 days with no sleep whatsoever. On the the 3rd day, when it was finished, I had a shower and drove to a town about 50miles from where I lived. It was so early the shops were not even open so I wandered round window shopping all dressed up to the nines and then went and bought some breakfast. Then I went shopping and spent about £500 on clothes by getting store cards in different shops.
• Sexual pursuits of the past of which there are too many and too cringe worthy to mention but a constant theme of believing that I was the most attractive individual and fantastic shag in the whole wide world. I would walk into a nightclub and believe that all the men wanted me even if they were paying me no attention whatsoever.
• Medication review -would I fare better on a mood stabiliser?
• Psychologist -will I ever move up the waiting list?! I asked to be referred 1 year ago!

So there we have it - I am sure I will think of some other points but they will do for now I reckon.

Letter to Jason Pegler, author 'A Can of Maddness'

I have just read the book 'A Can of Madness' by Jason Pegler, and it prompted me to write to him this morning after he responded to a brief message.

Dear Jason,

Thank you so much for your reply! I am a 32 year old mother of 2 who has fairly recently been diagnosed with bipolar disorder. My first serious episode (well first contact with services any road!) was 5 weeks after the birth of my first daughter in 2003. Immediately after her birth became elated, irritable, distractable and couldn't sleep amongst others thing. This escalated to not sleeping for 3 days and being pretty psychotic believing she had been possessed by a 23 year old man called Daniel of all things. I had zero insight, which I felt terrible about owing to the fact that I am a registered mental nurse. Yes - one of those awful people who appears to pretend to care, but more interested in the tabloids! Hopefully I'm not one of those nurses, but I am painfully aware of the presence of these people throughout the world of mental health, and the negative impact they can have on both service users, their families and colleagues.

I'm trying to make sense of things at the moment for myself, as well as nursing people who have severe and enduring mental illness in a NHS recovery and independent living unit. (Rehab). I work with predominantly young blokes in their 20s who have a diagnosis of schizophrenia and bipolar disorder who have essentially been through a very tough time due to the both nature of their illness, lack of insight, and a medical approach that often seems focused on managing the crisis, but not equipping people with the skills to help themselves because we are not very good at really trying to understand each individuals experience of their illness. I get the feeling these people feel written off, and due to being treated as their diagnosis, their diagnosis has become absolutely central to their identity, but in a rather negative way. I am fortunate now to work win a place were most of the staff are signed up to true recovery, which has both helped me but also brought lots of my own thoughts and feeling to the surface. I get very frustrated by all the politics, bullshit and self justifying pompous arseholes who talk nothing but reassuring jargon, but in my view appear to be feathering the own nest in a positively self serving way.

I'm also in the process of challenging the Association of Post Natal Illness that their policy of rejecting applicants to telephone volunteers who are either 1. on psychotropic medication and 2. Have a diagnosis of BPD or other enduring mental health problems cannot volunteer. It seems they regard a person being off medication as an indicator of an individual being well -a view I oppose.

I am also writing a blog to try and monitor my thoughts, and mental state, and try to piece together the puzzle of my life. It's also preventing me from making lots a scribblings which i then look back on a bin because i think it's all crap. My only rule with my blog is not to delete anything i write, no matter how toe curlingly shite it is! I'm thinking a lot about how I can use my own experiences to positively influence the care of others, but I haven't got my head round my own 'stuff' yet. The worrying part is the more I try and get on with trying to get my head round it I become more driven with reading more, research, and writing which my husband worries is the beginnings of hypomania (again!) Bollocks.

So should I sit, accept and move on? Nah - I'll take the risk. Just hope I can stay focused enough and avoid going off at too many tangents and actually get something achieved. Also, another issue I am having problems is getting my head around being a service user and provider, and feel a bit guilty about this. Feel like a hypocrite for keeping my diagnosis a secret, but scared of being judged. I worry that people will doubt my professional judgement, and I will loose my credibility which I know in my heart is utter bullshit, but it is how I feel at the moment. I guess it doesn't sit comfortably with me yet, and I need to feel at peace with it first.

Do you feel a peace with who you are now? I feel like I don't even know who the real me is? I always thought that the real me, from my late teens, was what I can now see was a state of hypomania. Anything else was a bit boring and unconfident. Or was I just being teenage shit? God knows. Have you sorted it out in your head now? Do you know when your feelings and behaviours are just appropriate to your environment, or do you still wonder if your going a bit high or low. For me, insight had brought with it a hyper awareness of my moods, and a fear that I could tip over the edge at any time. Walking a tightrope in some ways. I periodically struggle with the overwhelming desire to just go with my mood if I'm on the up. It's like going on holiday and I love it. Those feelings are so very seductive eh? I just love how I feel then and wish that could be the permanent me instead of the horrible feeling that I'm turning into a self obsessed neurotic twat who gets on my own nerves.

Right - I'm going to press the send button because I know I will delete it if I think about it too long. Sorry about the "Inappropriate language" but it conveys perfectly how feel, and after having read your book I feel that you will understand.

Best wishes

x

PS. I don't actually know why I've written this as I'm not sure about writing a book coz it might make me bonkers. This always happens when I start writing, and talking, and reading. Don't know when to stop. Hope what I have written makes sense even if it is just a bit of a stream of consciousness......

The Marce Society

That nice lady I spoke to earlier from the APNI told me about The Marce Society, which is an international professional group that is focused on the assessment, treatment, research and everything to do with post natal illness. She said that she thought they may be interested in my experience of PNI. So, I cracked on and found the site and filled in the application form so I could log in............
..............to be informed that to join this society you had to part with £70.

Bollocks.

Too "mental" for the Association of Post Natal Illness and too broke for the Society who is trying to work out how to reduce the illness and its effects. Hmmmmmmmmmm..................................................now there's a challenge I like the sound of.

Incidentally, I'm feeling a lot better today. I feel that by starting this blog I have found a way of focusing all the different things I do into some kind of order. I feel I have got my new project and feel so excited about the limitless possibilities it presents. Although my thoughts continue to race, they are more focused and less random than before. I honestly feel that this is going to be the beginning of something really positive. I'm smiling as I write this because I'm so glad I finally decided to write some of the stuff in my head down -it gives my thoughts a sense of reality and meaning whereas before the thoughts just crashed on without ever being developed and then are gone forever.

Hubby says it's just my new obsession. He thinks I'm incapable of just having an interest or a hobby, he argues that I become obsessive. I tell him that he's just not as focused as I can be. I've always been the same though -when something catches my imagination i run with it, fly with it, chase it and don't let go until I have exhausted it. I'm just very highly motivated and like to follow things through to the absolute best of mine or any one's ability.

If a jobs not worth doing properly then it's not worth doing at all.

Take for example Facebook. Fucking hours spent on it. I LOVED IT!!!! Loved finding more and more people and talking to them all, and even setting up a whole group site and posting pictures and organising a big school reunion that about 60 or so people are going to. And now I can't really be arsed that much. I'll check my email but don't really go on there at all now. However, look at the positive gains from my Facebook phase. I've got in touch with loads of old friends, had a really good laugh, and arranged a big get together. Why is that so bad?

I know Hubby is worried that I'm not doing to well, but today I do feel better. The only slight thing that is worrying me in the depths of my mind is that I keep hearing things and I'm not sure if I'm hearing them for real, or I'm imagining them. It's not voices or anything specific, just odd hushes, whispers or what sound like a muffled talking. But no words. just really annoying sounds that cause my ears to prick up, and make me feel as if I look like a deer in the woods hearing the crack of a hunters boot on a twig.

Hubby said something tonight and I wasn't sure if he had spoken or if i was just imagining it. It happened a work yesterday as well when I thought someone had asked me a question and they said they hadn't said anything at all. But I do think that does happen sometimes. I i shouldn't become over anxious about it because if I do that it really will come up and bite me on the arse!

Association for Post Natal Illness(APNI) response

Well, I thought I would follow up the email I sent to the APNI with a little phone call and got directed to their voice mail. However, someone called back, and they felt that the points I raised in my letter were valid -yay!!! So, she gave me the number of someone more senior who I immediately rang. She also thought the points I had raised were valid, and asked if she could present my letter at the next 'big wigs' meeting in July. Of course - I said yes. Then she asked me if I could slightly amend the letter so it kind of skimmed over the whole little issue of bipolar disorder as she felt the professionals and doctors on the board might think that my experience of post natal depression just wouldn't be that relevant my main problem being BPD, and I may be best directed to Depression Alliance or something. Clearly the big wigs prefer their volunteers to have only suffered with a nice clear cut case of PNI. Oh dear. However, she didn't say to not mention it, just to play it down a bit. She genuinely seemed to understand where I was coming from, but basically felt that due to fact that I had a diagnosis of BPD and I remained on medication the big wigs who decide what the policies are might think that I wouldn't make a very good volunteer for several reasons.

Reasons I Might Not Be A Good Volunteer

1. Firstly, a mother who needs reassuring that they will get completely better and that the whole PNI thing is in fact just a temporary blip, might not be significantly cheered up by the fact that their telephone supporter was diagnosed with a serious and enduring mental illness after her post natal episode. Okydoky.

2. Also, the fact that I had been diagnosed with a mental illness meant that I was more fragile than those without a diagnosis, therefore more likely to be tipped over the edge by talking to someone else with a similar experience which would NOT BE GOOD FOR ME.

3. The fact that I was on antidepressant and anti psychotic medication would not sit comfortably with the "judges" as I shall now call them. It would be a bit dodgy having some medicated, mentalist advising on getting through post natal depression by yapping on about that one time when she thought her baby was possessed by a 23 year old called Daniel, especially if they just had a bit of baby blues and main problem was not being able to get up in the morning.

4. Another concern was that as a telephone volunteer you are basically left to get on with providing the support, and filling in the APNI admin office on how the mother is doing via a report card every couple of weeks. Basically, I would be lone working with no supervision and if I went bonkers it WOULD NOT BE GOOD for me or the poor depressed mother I was meant to be supporting. Fair one.

So, I shall mull these points over, and then I will begin in putting together a letter that could be presented to the Judges which will reassure them that I might be quite a good volunteer. Watch this space........................

A bit paranoid today..................

At work at the moment and struggling. Feel a bit paranoid and on the verge of tears and trying to control my thoughts and think straight. Received a letter this morning regarding a medication error and I instantly thought that I was the only one who had got a letter and everyone would be talking about me and what a shit nurse I was. In actual fact every trained nurse got the same letter. No big deal then. Also I got a bit panicked when I heard another nurse wasn't happy with a decision I made regarding my dealing with a the behaviour of a patient. I worry that everyone is slagging me off and how I work. I think I'm just being a bit over sensitive about this which I keep telling myself is normal in a new job.

I just feel terribly caught between my own mental health problems being a pro or a con when it comes to my job. I wish I could be one of those campaigners who is accepting and ease with their diagnosis and don't feel ashamed of it. I claim that I'm non-judgemental but all I do is negatively judge myself. But also I hate the idea of letting this whole bipolar thing become central to my identity - me becoming my diagnosis. I just want to feel at peace with it and move on. I just feel that at the moment is really hard trying to appear to be the same as everyone else - it's exhausting.

Racing Thoughts

My mind is quiet honestly racing at the moment. Thinking about so much, and feel desperate to try and apply my thoughts to something productive but every time I try to I end up not being able to do it properly because I get distracted and Paul moans at me for being obsessive. I think I just need to focus on something. I registered to two Open University courses today to get my BA/BSc in Nursing. also, I have looked into going on a WRAP course with MIND in June hopefully for free. Also, there is a bipolar disorder support group meeting in town and I might just attend. But I might not. I'm just trying to focus as it honestly feels as if it is all getting out of control. My brain feels like a giant Tony Buzan mind map and there is so much going on that no amount of paper could be enough for everything that is in my mind. I sent the Association of Post Natal Illness (APNI) a letter regarding them turning me down as a volunteer. It really pissed me off so this is what I wrote.

Dear Sir/Madam,

I received a letter from APNI in January of this year following my application to work as a volunteer for the APNI. It was explained that currently it was your policy not to take on volunteers who are still receiving psychotropic medication therefore it would be appropriate that I contact you when I had been off medication for 6 months. I have given this a great deal of thought, and I have finally decided to write back to you in order to suggest that this policy could be reviewed as I believe it may serve to exclude those who despite remaining on medication, could still be of value to both you and your service users.

I had a post partum psychosis following my daughter’s birth in 2003. Following discharge from the maternity unit I had a period of mild to moderate elation, which escalated into total sleeplessness and florid psychosis. Once the psychotic symptoms were managed I was left with a dark depression I felt that would never leave me. My illness was managed by the use of antidepressant and anti psychotic medication, and support by a Community Mental Health Nurse and regular review by a Consultant Psychiatrist. I recovered and returned to work and grew to love being a mother to my daughter. Following the birth of my second daughter in 2005, strategies were put into place to prevent a re occurrence, and I was fortunate to remain reasonably, though not entirely well during the initial post partum period. However the following year when my youngest daughter was 1 year of age, I suffered from a period of psychotic depression, which was followed by a period of hypomania. It was at this stage I was diagnosed with bipolar disorder type II. Once this diagnosis was made, lots of things began to fall into place, and I could begin to make some sense of the events of the recent years, and those years prior to having children. I also became aware that had the diagnosis of bipolar disorder type II been made prior to my having children, the increased risk of a psychotic episode during the post partum period would have been identified, and appropriate preventative strategies may have been put in place.

I currently work as a Registered Mental Nurse for a NHS Trust, and since this year I am working in the Recovery service. Prior to this I was working in on an NHS Acute Inpatient Unit, employed as a senior staff nurse for five years. In my job I nurse people with serious and enduring mental illness, and as a senior staff nurse I am responsible for taking charge of the ward and managing any situations that arise during the course of my shift. My manager, some colleagues and occupational health are aware of my diagnosis, and the fact that I am currently on both anti psychotic and antidepressant medication. They are aware that I am under the care of a Consultant Psychiatrist and CPN who were also both fully supportive of returning to work in my full capacity as a Registered Mental Nurse. They understand and support the fact that it is likely that I will need to take medication for a long time, perhaps for life, and it is the fact that I take this medication that helps to keep me stable and functioning at an optimum level of mental health. I feel lucky to be employed in a Trust is truly working towards the de-stigmatisation of those with mental illness, and shows it values, respects and trust the judgement of people like me employing me in a professional role, and trusting me to do my job. My employers understand that like a diabetic needs to take insulin to stay well, some individuals need to remain on psychotropic medication long term in order to stay well, and this is not to be seen as a weakness or a indicator of being unwell.

So, the point I am attempting to make is that although I understand that for some suffers of PNI, the sign that they are truly well is when they are medication free, this is not true for all. Some women who suffer from PMI also suffer from recurrent depression, and it is possible that they will need to take medication for many years. Those with bipolar disorder type I or II are also much more likely to be required to take medication for the long term in order function at an optimum level and prevent relapse. These two groups of women are more likely to suffer from severe PNI and psychosis than those with no previous history of mental illness. And these two groups of women, who may be on medication for the long term, could still make fantastic volunteers for the APNI, myself included. It is well reported that if you have a previous history of a mood disorder, the risk of PNI is significantly increased therefore it is likely that many women who have suffered from PNI will remain on medication for the long term. It seems to me to be a real error of judgement to turn the experiences and understanding of the women away purely because they remain medicated. I understand that you need to be sure that a woman is fully recovered to volunteer, but I don’t think that being medication free is the best indicator of wellness.

I hope this letter goes some way to explain why I think your current policy needs review. I feel that I, and many other women who remain on medication could be a great asset to the APNI and its service users, and I believe women like me serve to reduce the stigmatisation of mental illness and medication, and reinforce that despite mental illness you can have a valued and productive life.

I look forward to hearing your thoughts, and I sincerely hope to join you as a volunteer in the very near future.

Yours sincerely

So, I shall wait and see.............................................................

Anyhow - the house is a mess, the kids rooms and all the toys need sorting out, and I need to speak to my manager about what is going on. It's not that I'm particularly worried about these things -more that my mind keeps moving from one to the next without sorting anything out. I seem to spend long periods of time on things, but really don't sort anything out or get anything dome before I've moved onto something else.

I'm doing my own head in.

In a way I sometimes wish that Hubby wasn't here so I could just get on with it. If he wasn't here I could just scrap the night meds and get this feeling out of my system by getting it all done.

I feel that I could be onto something really big that might really help me and other people like me, but I don;t know how to stay focused enough to express it properly. All the distractions get on my nerves -Hubby, the kids, work, friends, the phone, cooking, the house -EVERYTHING. I just want to hide away and get on with it. I really do think that I may be able to do something fantastic and life changing. But instead I will take my pills and try to get some sleep so I can go to work in the morning.

I fucking HATE the Quetiapine yet sometimes love it too. I love the fact that it lets me actually sleep, it feels like a warm alcohol glow washing over me as it takes effect - and I'm only on a tiny dose. I hate the fact it makes me feel shit in the morning unless I take it so fucking early I loose half my evening as I have to think about bed from about 9.30pm. All I want to do is be able to stay up until 11 or 12 o'clock and get up at 7 without being bolloxed., It does my head in. I feel that it's such a waste of valuable time going to bed when I could be doing other interesting things. I'm not high though. If anything I feel a bit low right now. Some difficult thoughts starting up again. Hubby playing with little one and she didn't have any nappy on and I got a strong visual image of him raping her and her screaming and crying and wondering what was going on but there was nothing I could do.

A man came to my door and gave me a booklet. He said that there were paedophiles everywhere. It really upset me as I keep trying to tell myself that it's just me who think they are everywhere.

I'm just trying to distract myself from all that stuff at the moment as it feels like a slippery slope.

It's strange because my mind is racing, but not in a nice way with nice plans. More in a desperate panicky way. My stomach is in knots as I sit writing this - I have an almost overwhelming sense of urgency that I need to do something, but I don't know what it is. I'm caught between worrying that by doing what I really want to do could draw attention and ruin everything.

Perhaps I should just promise myself that I will try and write down my thoughts and feeling , no matter how stupid or random -just as it pops into my head, and hopefully by writing it down it will turn into something that makes sense. I do sometimes feel that my personal experience combined with my mental nursing could be combined to make something really good. I know it's there in my brain - I just don't know how to get it out in a way that will make sense to anyone, least of all myself. A diary might be a good idea as long as I just keep it to one diary, as I usually end up with lots of different scribblings on bits of paper or separate projects, or separate parts of the same project but creating a system to manage and organise my projects is too trivial and a distraction from the great ideas I'm having and if I sit and try to organise it into a folder with different sections I may forget all the different sections and the potential sections there may be. I feel terrified of giving into some linear type of organisational format because it will cause me to stop me from fully exploring all the possibilities of my mind.

But the downside of this is that I don't usually manage to get anything written down. At all. Which makes me feel like I'm a bubble of amazing knowledge of ideas and theories, but to everyone else I'm just a boring woman doing the school run or the shopping who doesn't think of anything. This feels crippling, like a bird with no wings, and then I feel like a big fraud because I don't want to be doing these mundane things but I do them because I have to. I feel torn between wanting to live as the person I want to be, but knowing that the person I feel like I want to be is ultimately not good for me, and I would get in a mess and have regret and shame. It must be like alcohol, drugs or gambling only with this its choosing to go with your personal sense of direction or putting self imposed fuck off red traffic lights, stop signs and speed cameras up so I stay in a state of wanting instead of doing.

Right -meds kicking in now and feel a bit fucked and can't hold my pen or read my writing. bye x

Intro...

So then, I have decided to give this blogging malarkey a go purely because I want to try and get my head round being both a mental health service user and provider. I often feel uncertain whether my diagnosis of bipolar disorder makes me a better mental health nurse or just a liability. It usually depends on what my mood is doing at the time.

I have a terrible habit of becoming distracted and becoming overwhelmed with the sheer quantity of what I want to try and get down on paper which is another reason to start a blog -it stops me from loosing all the paper, and keeps all my ramblings in one place!

The main aims of this blog are in no particular order to

1. Reflect on my own mental state.
2. Monitor my own mental state.
3. Gain a greater understanding of bipolar disorder.
4. Gain a greater understanding of post natal illness and post partum psychosis.
5. Try and get my own story written down, so I can try to make sense of the person I am today.
6. Reflect on my nursing pratice, and what I actually do at work.
7. Look at bipolar disorder with fresh eyes, and try and work out what treatment programme will keep me well.
8. Try to identify a possible route of treatment tht will help others with the same problems.
9. Try and find something postive in the fact that I have been diagnosed with a severe and enduring mental illness.
10. Look at STEP-BD
11. Look at Recovery.
12. Look at WRAP.
13. Life charting.
14. The Social Rhythm Metric.
15. Interpersonal Inventory.
16. My Life History.
17. Get all those little stories from over the years down on paper.
18. Get feedback from anyone who can be bothered to read my thoughts and ideas.
19. Reflect on Manic Depression Support group meetings I plan to attend.
20. Really try to create a plan of care with the chap I am a named nurse for that is truly individualised and will help him in his recovery.
21. Care planning - look at good care planning for BPD.
22. Reflect on books, journals and articles I read related to BPD or PNI.

SORT MY OWN HEAD OUT AND USE MY OWN EXPERIENCES TO HELP OTHERS AND INFLUENCE POSITIVE WORK AND ATTITUDES REGARDING SERIOUS AND ENDURING MENTAL ILLNESS