As I sit here writing this post, it is almost as dark as night outside. It seems as though we still haven't actually moved into proper Springtime weather. I'm having a lazy day as I can't get out into the garden and after doing some Sudoku puzzles on my DSi (how I love that little gadget) I am about to pick up my knitting to help to pass the time.
I really must have an early night because I have to leave the house early tomorrow for an appointment with my psychiatrist. For some unknown reason I opted for his earliest appointment so I shall have to get up with the lark to get myself ready to go to catch the bus.
It will be good to be able to report that the increase in medication seems at last to be making a bit of a difference in my mood and in my ability to sleep. I'm not exactly filled with the joys of Spring, but neither am I in quite the depths of despair that I was when last I saw Dr M.
So, I shall shortly be making myself something to eat, I'll sit and knit for a couple of hours, and then I shall take my medication and take myself off to bed. One thing that I have learnt is that the night-time medication can work in a matter of minutes. Last night I got into bed, picked up my book to read a few pages, but I didn't even manage to open it before I was asleep.
It really can be possible to fall asleep as soon as your head hits the pillow.
Showing posts with label psychiatrist. Show all posts
Showing posts with label psychiatrist. Show all posts
Wednesday, 7 April 2010
Monday, 30 November 2009
Tackling The Mental Health Minefield Part 3 - The Lovely Dr Hugh
(This post continues the story from Tackling The Mental Health Minefield Part 2 - The Admission Process)
No sooner than I had started to take in my new surroundings than another new person arrived at the door to my room. I dumped my bag with my coat and book on the bed and I accompanied the new person along the corridor. He asked whether I would like something to drink and it was the most beautiful sound that I had heard for hours. "Yes please" I quickly replied and I was offered some toast too. I quickly buttered a couple of slices of toast while my tea was being made and then armed with this sustenance, the new person and I went into another room which contained several rather upright armchairs and a couple of low tables and was somewhat strangely labelled The Quiet Room. I sat down in one of the chairs, my tea and toast were placed within easy reach, and the new person said "Hello, I'm Dr Hugh. I expect that you have probably been through all this several times today, but I need to ask you some questions and find out a little about you, then I will carry out a physical examination so that we can make sure that there is nothing physical making you feel the way you do". For the first time since saying goodbye to my GP I was actually seeing another doctor; it had only taken about 12 hours to get to this point.
While Dr Hugh had been making my tea and I had buttered the toast I told him that this was the first sustenance that I'd had since the cup of tea given to me by the lovely Triage Sister in A&E. So sitting in the 'Quiet Room', Dr Hugh insisted that I ate the toast and and drank my tea during which we just chatted intermittently. Then it was down to business.
There were all the usual questions as a full medical history was taken, the list of medication I was on was quickly dealt with because I had the two tear-off sheets from my latest repeat prescription with everything listed on it. This made making up my chart easy and it was done there and then with Dr Hugh asking what times I usually took each of them so that I could be given them at suitable times to fit in with the ward procedures. For the first time for hours I actually felt that here was someone who really cared about how I was feeling and wanted to make sure that they didn't add to my distress. After answering all the questions about my medical history it was time for the physical examination. We left the Quiet Room and stepped across the corridor to the Clinic. In here Dr Hugh again checked my blood pressure, took my temperature, and took some blood for all the usual tests. He was going to try to take the blood from my right arm but I pointed out to him that I had a really easy vein in my left arm and he would probably find it easier to use that one. On went the tourniquet, the vein immediately showed up and Dr Hugh was able to insert the needle and get his samples within seconds; he remarked how quickly one got out of practice doing things like taking blood when one decided to specialise in psychiatry.
To carry out the actual physical examination we had to return to my room as there was no examination couch on the ward. So after listening to my heart, my breathing, testing my reflexes (which don't actually react), poking and prodding all the other various bits of my body, Dr Hugh decided that there was nothing physically wrong with me. We chatted for a few more minutes and a nurse appeared with what was my normal evening medication. It was now almost 11pm and I was feeling exhausted from the emotional strain, I was sure that I would sleep no matter what thoughts might be rampaging through my brain but Dr Hugh decided that he would write me up for something to help me sleep if the night staff found that I was still awake an hour after going to bed.
There was now only one problem left to be solved. I had nothing with me other than that with which I had left the house so many hours ago; this meant no nightwear and no toiletries. But this posed no problem. the nurse who had brought my medication returned a few minutes later with a blue gown (the sort that is open at the back) and some green pyjama trousers (to take care of the problem of the gown being open at the back), a couple of towels, a toothbrush, a tube of toothpaste, and sachets of shampoo and shower gel. The nurse and Dr Hugh said goodnight to me and I was left to get myself ready for bed. I put my clothes on the chair at the foot of my bed, donned my strange night attire, and climbed into bed. My room was cold, but it took me just a matter of minutes to warm up in the bed and I was asleep a few minutes later.
I was now a patient in a mental hospital.
To be continued.
No sooner than I had started to take in my new surroundings than another new person arrived at the door to my room. I dumped my bag with my coat and book on the bed and I accompanied the new person along the corridor. He asked whether I would like something to drink and it was the most beautiful sound that I had heard for hours. "Yes please" I quickly replied and I was offered some toast too. I quickly buttered a couple of slices of toast while my tea was being made and then armed with this sustenance, the new person and I went into another room which contained several rather upright armchairs and a couple of low tables and was somewhat strangely labelled The Quiet Room. I sat down in one of the chairs, my tea and toast were placed within easy reach, and the new person said "Hello, I'm Dr Hugh. I expect that you have probably been through all this several times today, but I need to ask you some questions and find out a little about you, then I will carry out a physical examination so that we can make sure that there is nothing physical making you feel the way you do". For the first time since saying goodbye to my GP I was actually seeing another doctor; it had only taken about 12 hours to get to this point.
While Dr Hugh had been making my tea and I had buttered the toast I told him that this was the first sustenance that I'd had since the cup of tea given to me by the lovely Triage Sister in A&E. So sitting in the 'Quiet Room', Dr Hugh insisted that I ate the toast and and drank my tea during which we just chatted intermittently. Then it was down to business.
There were all the usual questions as a full medical history was taken, the list of medication I was on was quickly dealt with because I had the two tear-off sheets from my latest repeat prescription with everything listed on it. This made making up my chart easy and it was done there and then with Dr Hugh asking what times I usually took each of them so that I could be given them at suitable times to fit in with the ward procedures. For the first time for hours I actually felt that here was someone who really cared about how I was feeling and wanted to make sure that they didn't add to my distress. After answering all the questions about my medical history it was time for the physical examination. We left the Quiet Room and stepped across the corridor to the Clinic. In here Dr Hugh again checked my blood pressure, took my temperature, and took some blood for all the usual tests. He was going to try to take the blood from my right arm but I pointed out to him that I had a really easy vein in my left arm and he would probably find it easier to use that one. On went the tourniquet, the vein immediately showed up and Dr Hugh was able to insert the needle and get his samples within seconds; he remarked how quickly one got out of practice doing things like taking blood when one decided to specialise in psychiatry.
To carry out the actual physical examination we had to return to my room as there was no examination couch on the ward. So after listening to my heart, my breathing, testing my reflexes (which don't actually react), poking and prodding all the other various bits of my body, Dr Hugh decided that there was nothing physically wrong with me. We chatted for a few more minutes and a nurse appeared with what was my normal evening medication. It was now almost 11pm and I was feeling exhausted from the emotional strain, I was sure that I would sleep no matter what thoughts might be rampaging through my brain but Dr Hugh decided that he would write me up for something to help me sleep if the night staff found that I was still awake an hour after going to bed.
There was now only one problem left to be solved. I had nothing with me other than that with which I had left the house so many hours ago; this meant no nightwear and no toiletries. But this posed no problem. the nurse who had brought my medication returned a few minutes later with a blue gown (the sort that is open at the back) and some green pyjama trousers (to take care of the problem of the gown being open at the back), a couple of towels, a toothbrush, a tube of toothpaste, and sachets of shampoo and shower gel. The nurse and Dr Hugh said goodnight to me and I was left to get myself ready for bed. I put my clothes on the chair at the foot of my bed, donned my strange night attire, and climbed into bed. My room was cold, but it took me just a matter of minutes to warm up in the bed and I was asleep a few minutes later.
I was now a patient in a mental hospital.
To be continued.
Wednesday, 19 November 2008
Why Aren't GP Mental Health Referrals Hitting The Spot?
Today has been another day of blurred vision and very sore eyes. Reading has been difficult, and knitting all but impossible. All of this means that I've been feeling low again.
I have, however, been able to keep up to date with the blogs that I read on a regular basis, mainly because I can enlarge them enough to make reading them easy. Two of these bloggers, Jobbing Doctor and Geepeemum have written about the difficulties of referring patients with psychiatric problems to see consultant psychiatrists or getting help from mental health crisis teams. These are problems that are often written about by bloggers with mental health problems too.
I have been relatively lucky when I have been referred for specialist help, but I am well aware that this has been the exception rather than the rule as far as mental health patients are concerned. In the early days of my problems I was living in Cambridgeshire. Whenever my GP referred me to see a psychiatrist I saw one, but that was in part because the psychiatrist was a personal friend of my GP, who was also the psychiatrist's GP, so my referral possibly did not have to face the hurdles that other referrals may have encountered. But even though I saw the consultant psychiatrist whenever my GP considered it necessary, it did not mean that I necessarily got the best help from other mental health professionals. This was particularly the case with the CPN who caused me so much angst that I came close to suicide after seeing her for a number of appointments.
Since moving back to London I have been referred by my GP for psychotherapy, and again I have been lucky. I happen to live in an area of London which is served by a well known psychiatric hospital which happens to have a fairly large psychotherapy department. Even so, I was warned when my GP made the initial referral that it could be a long time before I had an assessment, let alone received psychotherapy. Luck was again on my side because I had an appointment for assessment within a few weeks of the referral and once it was decided that I was a suitable case for treatment (such a brilliant film title, and one that I have always wanted to use when writing on this subject) I was again warned that it would be many months, perhaps even a year, before a psychotherapist was available. Fortunately I didn't have to wait too long for a psychotherapist to have a vacancy, and I have now been going for psychodynamic psychotherapy for six months now.
I know that I have been very lucky with the referrals and the treatment that I have received. The problem is that not everyone who needs this kind of help is quite as lucky as I have been. If certain cancer drug treatments are considered to be a post code lottery, then specialist treatment for those who suffer mental health problems is even more so. Treatment should not be a last resort; it should not be necessary for someone to have to admitted to hospital in order to get the treatment that they should be getting as a right.
If the money that has been wasted so far on the infamous Connecting for Health had been put into Mental Health, then perhaps there might not be quite so many bloggers bemoaning how they feel that they have been abandoned by the NHS because they have a mental illness rather than ordinary physical illnesses. And the problem is that we are only the tip of the iceberg as far as people who need this help are concerned.
The government keep telling us that it is wrong to discriminate against those with mental health problems, and yet they themselves are doing just that by not making sure that this country's mental health services are properly funded and available to all those in need of help.
Thursday, 13 November 2008
It Really Isn't Fair
I should be on a bit of a high this morning after achieving a minor triumph in front of an audience of doctors, but this will have to wait for another post. Instead I have found myself wanting, perhaps needing would be a better description, to write on an entirely different subject. It is a subject that most of us with mental health problems feel very strongly about and we are not alone because the people that we need to be able to have access to also feel as we do. The subject is the poor level of mental health services in this country. The reason that I find myself writing this post is because I have, this morning, read the latest post from Hannah at Coloured Mind. I urge you to read it for I am sure that you, too, will be moved.
The level of support is not poor because of the calibre of the people who are employed in this area. The problem is that there really are not enough facilities and staff there to support the number of people who require to use them. There truly is a lottery for access to whatever services are available for we are left to fend for ourselves until our number is pulled out of the hat. That is not to say that we don't get support from our GPs, because in most cases the support that we receive is superb, but GPs have neither the time nor, in most cases, the expertise to give us the help that we require.
I am sure that Hannah's story is not unique. When she lived at home she got the help that she needed, but having moved to university in Manchester she has found herself back in the pot waiting for her number to come up again. This sort of thing would not happen if she had cancer, so why should it because her problems relate to her mental health? Perhaps the reason is that mental illness is invisible. You wear no plaster cast, you don't need crutches or a wheelchair to get about, very often you appear completely normal to those around you. But what others cannot see, and if they have never suffered from mental illness themselves cannot understand, is the turmoil that goes on inside you.
If just a small percentage of the money that has so far been spent on Connecting for Health, the infamous computer system that the government is intent on forcing on us, had been spent on mental health services, then the long waiting periods that we have to endure to be seen by a psychiatrist, to be assessed for and offered psychotherapy, or to get any of the other services that we require, could be reduced to the time (from referral to treatment) that is now being heralded as what we can expect as the norm within the rest of the NHS.
There is a huge campaign being waged by the government at the present time to reduce the discrimination that mental health sufferers experience in the work place, and yet it is the very fact that we do not get the treament and support that we require that marks us out as different and leads to much of that discrimination. By ensuring that we have access to the specialists who can diagnose our problems, implement, monitor and adjust drug regimes that enable us to operate at a level that means that we can study or work at a normal level, and recommend the additional treatment and services that will make our lives more bearable, we would probably be able to exist in a manner that would put us on a level playing field with the rest of the population.
Is this too much to ask? I don't think so and I believe that it is about time that we were treated more fairly so that we can enjoy something approaching a normal life.
The level of support is not poor because of the calibre of the people who are employed in this area. The problem is that there really are not enough facilities and staff there to support the number of people who require to use them. There truly is a lottery for access to whatever services are available for we are left to fend for ourselves until our number is pulled out of the hat. That is not to say that we don't get support from our GPs, because in most cases the support that we receive is superb, but GPs have neither the time nor, in most cases, the expertise to give us the help that we require.
I am sure that Hannah's story is not unique. When she lived at home she got the help that she needed, but having moved to university in Manchester she has found herself back in the pot waiting for her number to come up again. This sort of thing would not happen if she had cancer, so why should it because her problems relate to her mental health? Perhaps the reason is that mental illness is invisible. You wear no plaster cast, you don't need crutches or a wheelchair to get about, very often you appear completely normal to those around you. But what others cannot see, and if they have never suffered from mental illness themselves cannot understand, is the turmoil that goes on inside you.
If just a small percentage of the money that has so far been spent on Connecting for Health, the infamous computer system that the government is intent on forcing on us, had been spent on mental health services, then the long waiting periods that we have to endure to be seen by a psychiatrist, to be assessed for and offered psychotherapy, or to get any of the other services that we require, could be reduced to the time (from referral to treatment) that is now being heralded as what we can expect as the norm within the rest of the NHS.
There is a huge campaign being waged by the government at the present time to reduce the discrimination that mental health sufferers experience in the work place, and yet it is the very fact that we do not get the treament and support that we require that marks us out as different and leads to much of that discrimination. By ensuring that we have access to the specialists who can diagnose our problems, implement, monitor and adjust drug regimes that enable us to operate at a level that means that we can study or work at a normal level, and recommend the additional treatment and services that will make our lives more bearable, we would probably be able to exist in a manner that would put us on a level playing field with the rest of the population.
Is this too much to ask? I don't think so and I believe that it is about time that we were treated more fairly so that we can enjoy something approaching a normal life.
Friday, 15 August 2008
Fridays Are Hard; It's Psychotherapy Day
I have mentioned several times in this blog that a significant proportion of the population of this country don't know how to deal with meeting someone with depression. In recent years there has been a lot of emphasis on the fact that depression is a form of mental illness, and it is mental illness that people are scared of.
My first encounter with depression was more than 25 years ago, when I suddenly started to suffer periods of unstoppable crying, night after night of being unable to sleep, a total loss of appetite, and a loss of interest in my work, which was totally out of character for me. I was serving in the RAF at that time, so eventually I paid a visit to the Station Medical Centre (SMC) and saw the Senior Medical Officer (SMO). The SMC acts as a GPs surgery for service personnel on the unit, and the SMO is the equivalent of the senior partner in the practice. I was prescribed anti-depressants and the SMO requested my boss move me to a less stressful job for a few months so that I could regain my equilibrium and pleasure in my work. It all worked, less than four months later I was back to my old self and the depression was something that I forgot all about.
Almost 10 years ago, my husband died very suddenly a few days into our holiday abroad. Fortunately, my parents were on holiday with us, and we were staying in a hotel where we had stayed many times before, so the staff knew us very well. We also had a number of friends who live on the island, and hotel manager phoned them to let them know what had happened.
The next few weeks passed in a bit of a haze for me. Some things I can remember as though it was yesterday, while there are other things that I cannot remember at all. About two months after my husband died, some of my colleagues began to get very worried about me. I would walk about as if in a trance, I would fall asleep at my desk, and they noticed that I was rapidly losing weight. They were ready to tell me to go to see my GP when something happened that scared me so much that I made an appointment myself.
I was diagnosed as suffering from depression caused by a grief reaction; something that was not unexpected considering what had happened. Anti-depressants were prescribed, at a very low level to start with but being increased over a period of a couple of weeks. I had to see my GP every week so that he could assess how I was doing. After a couple of months it was decided to change the anti-depressant as the first one did not seem to be having much of an effect. This change seemed to make a big difference and I started to look less haggard, began eating a little better, and being able to sleep at night rather than at work.
About a year later my last remaining great-aunt died, and her death was followed a few days later by that of her brother, my great-uncle. I hadn't been sure whether I would be able to cope with one funeral, but a double funeral was out of the question and my parents decided that it was best if I did not attend. At about this time, my GP decided to refer me to see a psychiatrist at the local Mental Health Trust.
This was the first time that I started to be really afraid about what was happening to me; after all, psychiatrists look after mad people, don't they? To this day, I really don't remember too much about this meeting with the psychiatrist, although I did find it disconcerting that the door to the building had an intercom entry system, and that I had to sign myself in and out of the building. The fact that it was a dark and dingy Victorian building, that in no way looked inviting, didn't help to alleviate my distress at the situation either. However, the psychiatrist turned out to be a very nice man, and although I can't really remember much of what I said in answer to his questions, he did tell me that he thought that I could benefit from counselling from a CPN.
A week or so later, I received a letter giving me a date for my first counselling session. I attended at the time requested and found myself being asked to fill in a questionnaire that seemed never ending. I can't remember how many questions there were, but it seemed that many of the questions seemed to occur several times, each time expressed in slightly different words. I might have been depressed, but I wasn't stupid. Anyway, after I filled in the questionnaire, the CPN asked me some questions and then asked me to start talking about myself and my life with my husband. It was difficult, but I tried. Further appointments were made for me to see her weekly, and I attended another three or four sessions, but a very close friend and colleague at work saw the effect that these sessions were having on me and after careful questioning decided that I needed to see my GP. An urgent appointment was made and I saw him less than an hour later; the result was that he decided that the counselling should stop because it was obvious that it was having a very detrimental effect on me and my depression was becoming worse. Although I saw the psychiatrist several times over the following years and always benefited from seeing him, counselling was not suggested again.
When I moved to London I registered at a new practice and saw the senior partner. After a slightly dodgy start, caused by him making a comment without realising the effect that it was going to have on me, we got along well. He was concerned that I had been suffering from depression for so long without any real sign that I was getting better. I seemed to have sunk into a depression after my father died that I just couldn't climb out of, so towards the end of last year he decided to refer me to our local MHT for psychotherapy. He told me that the service was severely stretched and that it would probably be some considerable time before I got an appointment for assessment to see whether they could offer me anything, and that it was likely to be a year or more before I started to receive any treatment.
Although so much of the population suffers from mental health problems and so many could benefit from the so called 'talking treatments' they are incredibly difficult to get from the NHS. There are many psychotherapists in private practice, but how do you choose one, how do you know what type of psychotherapy is right for you, and how much will it all cost? For most of us, this just isn't an option that we can afford to even look at, and I knew that it was impossible for me, so I resigned myself for a long wait for treatment on the NHS. Perhaps the most worrying thing about all this is that I live in London, and London is one of the few places in the country that you stand a reasonable chance of getting the psychotherapy without having been admitted to a psychiatric hospital first.
About 10 days after my GP referred me I received a letter from the hospital inviting me to make an appointment for assessment for suitability for treatment. So six weeks after my GP set the ball rolling I went for assessment, and after about an hour and a half talking with one of the senior psychologists he decided that another assessment appointment would be worthwhile and that it was likely that I would be offered psychotherapy. The next appointment was a month later, and at the end of the process it was decided that individual psychodynamic psychotherapy was the treatment that I was most likely to benefit from.
There are many different types of psychotherapy, some individual and some conducted in groups. Many people are offered short periods of cognitive-behavioural therapy (CBT), but neither this nor group psychodynamic therapy were considered suitable for me and my problems. Having been told that individual psychodynamic psychotherapy was what was being offered to me, the senior psychologist who conducted my assessments gave me details of what the therapy would entail and that I would probably have a long wait before a psychotherapist would be available to add me to their list of patients. One of the benefits that I had, was because I am unable to work at the moment, when a vacancy did arise, it would be possible to accept the time offered.
Having steeled myself for months of waiting, I was somewhat surprised, and my GP was absolutely stunned, that I was offered an appointment with a psychotherapist to discuss the possibility of starting therapy, just two and a half months later. I accepted the appointment, went to the hospital on the appointed day, and met the doctor who was to be my psychotherapist if that particular day and time were acceptable to me. As Friday at 10 o'clock was fine, without further ado the therapy started. It rather caught me on the hop, because I really wasn't expecting it to be so soon, and certainly not that day.
For those who don't know what psychodynamic psychotherapy is about, I will give this particular patient's view of what happens. Psychotherapists may be psychologists, some are doctors (in fact psychotherapy is now a compulsory element of the specialist training for psychiatrists), and some may be social workers who have undergone additional training in psychotherapy; mine is a doctor. My appointments are at the same time, on the same day of the week, and take place in the same room each time. Each session lasts between 50 and 60 minutes; the time varies slightly so that a convenient stopping point can be found. The relationship between the therapist and patient is somewhat strange, in that the patient is expected to reveal all about themself, while the therapist reveals nothing of themself. This may make the therapist seem remote for some people, but accepting that this is what the relationship should be is the first step to a good therapeutic relationship. For many, psychodynamic psychotherapy offered by the NHS is time-limited from the start; this means that it is decided that you will have a certain number of sessions, often 20 or 30, and that the therapist will move the process along so that certain stages in the process occur at specific times. I am lucky because I was offered psychodynamic psychotherapy that was not limited by time; in fact I was told from the start that I would probably be attending for more than a year.
At first the thought of talking about oneself for 50 minutes can be very daunting, and I found it particularly so as I had never been someone who let much out about themself to other people. Part of this was shyness on my part, and part a reluctance to talk about my work (which is the subject where many social conversations start) because I was not allowed to. This type of psychotherapy is not a two-way conversation; the therapist will often only speak if the silence at the start of the session is prolonged (and even after attending for three and a half months now, I can rarely start talking without prompting) or to suggest the possible reason for feeling the way that you do about some particular thing.
To start with the sessions are all about you, and your feelings; they are the way the therapist gets a feel for who you are, what your problems are, and hopefully what has caused these problems. They can be very traumatic, and can delve far into your past. You find out things about yourself that you never realised, and you start to understand why some things that have happened to you, occurred. Many things that occur in childhood or early adolescent years can be what sets the seed for mental illness in later life.
Some weeks ago, I had a particularly traumatic session. I found out something that had never occurred to me before. It has already helped me to understand why I am the way I am and it is helping me to talk about more things that have happened in my life, and how they have affected me, at subsequent sessions. One thing that you should always do is go with a good supply of tissues, for it is certain that the sessions will be emotional. I have actually managed one session so far where I have not cried, but it gets easier to talk each week as I bring out things that I have forgotten about or never realised before. To show how far I have progressed, I have been able to write this post without becoming emotional; just a few weeks that would have been impossible.
I hope this helps you understand why Fridays are hard for me, and that it gives you a little insight into something that you may have heard about but always wondered what it involved. Feel free to ask questions if you want, but be aware that I will obviously be quite careful how I reply.
My first encounter with depression was more than 25 years ago, when I suddenly started to suffer periods of unstoppable crying, night after night of being unable to sleep, a total loss of appetite, and a loss of interest in my work, which was totally out of character for me. I was serving in the RAF at that time, so eventually I paid a visit to the Station Medical Centre (SMC) and saw the Senior Medical Officer (SMO). The SMC acts as a GPs surgery for service personnel on the unit, and the SMO is the equivalent of the senior partner in the practice. I was prescribed anti-depressants and the SMO requested my boss move me to a less stressful job for a few months so that I could regain my equilibrium and pleasure in my work. It all worked, less than four months later I was back to my old self and the depression was something that I forgot all about.
Almost 10 years ago, my husband died very suddenly a few days into our holiday abroad. Fortunately, my parents were on holiday with us, and we were staying in a hotel where we had stayed many times before, so the staff knew us very well. We also had a number of friends who live on the island, and hotel manager phoned them to let them know what had happened.
The next few weeks passed in a bit of a haze for me. Some things I can remember as though it was yesterday, while there are other things that I cannot remember at all. About two months after my husband died, some of my colleagues began to get very worried about me. I would walk about as if in a trance, I would fall asleep at my desk, and they noticed that I was rapidly losing weight. They were ready to tell me to go to see my GP when something happened that scared me so much that I made an appointment myself.
I was diagnosed as suffering from depression caused by a grief reaction; something that was not unexpected considering what had happened. Anti-depressants were prescribed, at a very low level to start with but being increased over a period of a couple of weeks. I had to see my GP every week so that he could assess how I was doing. After a couple of months it was decided to change the anti-depressant as the first one did not seem to be having much of an effect. This change seemed to make a big difference and I started to look less haggard, began eating a little better, and being able to sleep at night rather than at work.
About a year later my last remaining great-aunt died, and her death was followed a few days later by that of her brother, my great-uncle. I hadn't been sure whether I would be able to cope with one funeral, but a double funeral was out of the question and my parents decided that it was best if I did not attend. At about this time, my GP decided to refer me to see a psychiatrist at the local Mental Health Trust.
This was the first time that I started to be really afraid about what was happening to me; after all, psychiatrists look after mad people, don't they? To this day, I really don't remember too much about this meeting with the psychiatrist, although I did find it disconcerting that the door to the building had an intercom entry system, and that I had to sign myself in and out of the building. The fact that it was a dark and dingy Victorian building, that in no way looked inviting, didn't help to alleviate my distress at the situation either. However, the psychiatrist turned out to be a very nice man, and although I can't really remember much of what I said in answer to his questions, he did tell me that he thought that I could benefit from counselling from a CPN.
A week or so later, I received a letter giving me a date for my first counselling session. I attended at the time requested and found myself being asked to fill in a questionnaire that seemed never ending. I can't remember how many questions there were, but it seemed that many of the questions seemed to occur several times, each time expressed in slightly different words. I might have been depressed, but I wasn't stupid. Anyway, after I filled in the questionnaire, the CPN asked me some questions and then asked me to start talking about myself and my life with my husband. It was difficult, but I tried. Further appointments were made for me to see her weekly, and I attended another three or four sessions, but a very close friend and colleague at work saw the effect that these sessions were having on me and after careful questioning decided that I needed to see my GP. An urgent appointment was made and I saw him less than an hour later; the result was that he decided that the counselling should stop because it was obvious that it was having a very detrimental effect on me and my depression was becoming worse. Although I saw the psychiatrist several times over the following years and always benefited from seeing him, counselling was not suggested again.
When I moved to London I registered at a new practice and saw the senior partner. After a slightly dodgy start, caused by him making a comment without realising the effect that it was going to have on me, we got along well. He was concerned that I had been suffering from depression for so long without any real sign that I was getting better. I seemed to have sunk into a depression after my father died that I just couldn't climb out of, so towards the end of last year he decided to refer me to our local MHT for psychotherapy. He told me that the service was severely stretched and that it would probably be some considerable time before I got an appointment for assessment to see whether they could offer me anything, and that it was likely to be a year or more before I started to receive any treatment.
Although so much of the population suffers from mental health problems and so many could benefit from the so called 'talking treatments' they are incredibly difficult to get from the NHS. There are many psychotherapists in private practice, but how do you choose one, how do you know what type of psychotherapy is right for you, and how much will it all cost? For most of us, this just isn't an option that we can afford to even look at, and I knew that it was impossible for me, so I resigned myself for a long wait for treatment on the NHS. Perhaps the most worrying thing about all this is that I live in London, and London is one of the few places in the country that you stand a reasonable chance of getting the psychotherapy without having been admitted to a psychiatric hospital first.
About 10 days after my GP referred me I received a letter from the hospital inviting me to make an appointment for assessment for suitability for treatment. So six weeks after my GP set the ball rolling I went for assessment, and after about an hour and a half talking with one of the senior psychologists he decided that another assessment appointment would be worthwhile and that it was likely that I would be offered psychotherapy. The next appointment was a month later, and at the end of the process it was decided that individual psychodynamic psychotherapy was the treatment that I was most likely to benefit from.
There are many different types of psychotherapy, some individual and some conducted in groups. Many people are offered short periods of cognitive-behavioural therapy (CBT), but neither this nor group psychodynamic therapy were considered suitable for me and my problems. Having been told that individual psychodynamic psychotherapy was what was being offered to me, the senior psychologist who conducted my assessments gave me details of what the therapy would entail and that I would probably have a long wait before a psychotherapist would be available to add me to their list of patients. One of the benefits that I had, was because I am unable to work at the moment, when a vacancy did arise, it would be possible to accept the time offered.
Having steeled myself for months of waiting, I was somewhat surprised, and my GP was absolutely stunned, that I was offered an appointment with a psychotherapist to discuss the possibility of starting therapy, just two and a half months later. I accepted the appointment, went to the hospital on the appointed day, and met the doctor who was to be my psychotherapist if that particular day and time were acceptable to me. As Friday at 10 o'clock was fine, without further ado the therapy started. It rather caught me on the hop, because I really wasn't expecting it to be so soon, and certainly not that day.
For those who don't know what psychodynamic psychotherapy is about, I will give this particular patient's view of what happens. Psychotherapists may be psychologists, some are doctors (in fact psychotherapy is now a compulsory element of the specialist training for psychiatrists), and some may be social workers who have undergone additional training in psychotherapy; mine is a doctor. My appointments are at the same time, on the same day of the week, and take place in the same room each time. Each session lasts between 50 and 60 minutes; the time varies slightly so that a convenient stopping point can be found. The relationship between the therapist and patient is somewhat strange, in that the patient is expected to reveal all about themself, while the therapist reveals nothing of themself. This may make the therapist seem remote for some people, but accepting that this is what the relationship should be is the first step to a good therapeutic relationship. For many, psychodynamic psychotherapy offered by the NHS is time-limited from the start; this means that it is decided that you will have a certain number of sessions, often 20 or 30, and that the therapist will move the process along so that certain stages in the process occur at specific times. I am lucky because I was offered psychodynamic psychotherapy that was not limited by time; in fact I was told from the start that I would probably be attending for more than a year.
At first the thought of talking about oneself for 50 minutes can be very daunting, and I found it particularly so as I had never been someone who let much out about themself to other people. Part of this was shyness on my part, and part a reluctance to talk about my work (which is the subject where many social conversations start) because I was not allowed to. This type of psychotherapy is not a two-way conversation; the therapist will often only speak if the silence at the start of the session is prolonged (and even after attending for three and a half months now, I can rarely start talking without prompting) or to suggest the possible reason for feeling the way that you do about some particular thing.
To start with the sessions are all about you, and your feelings; they are the way the therapist gets a feel for who you are, what your problems are, and hopefully what has caused these problems. They can be very traumatic, and can delve far into your past. You find out things about yourself that you never realised, and you start to understand why some things that have happened to you, occurred. Many things that occur in childhood or early adolescent years can be what sets the seed for mental illness in later life.
Some weeks ago, I had a particularly traumatic session. I found out something that had never occurred to me before. It has already helped me to understand why I am the way I am and it is helping me to talk about more things that have happened in my life, and how they have affected me, at subsequent sessions. One thing that you should always do is go with a good supply of tissues, for it is certain that the sessions will be emotional. I have actually managed one session so far where I have not cried, but it gets easier to talk each week as I bring out things that I have forgotten about or never realised before. To show how far I have progressed, I have been able to write this post without becoming emotional; just a few weeks that would have been impossible.
I hope this helps you understand why Fridays are hard for me, and that it gives you a little insight into something that you may have heard about but always wondered what it involved. Feel free to ask questions if you want, but be aware that I will obviously be quite careful how I reply.
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