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.