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......