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As Psychologist I’ve tried to reduce the stigma of mental health difficulties in my work, yet when faced with my own difficulties I suddenly feel the weight of the stigma on me and am unable to reduce it away. There is also the shame that as a Psychologist I have become a mental health service user…

The last post was written in the past tense which made it sound like I have come to full acceptance of my unwell-ness. Truth be known I have yet to reach that stage and as you continue to read my chapters you will see how denial, my defence mechanism, is just around the corner waiting to creep back in. 

Having written what I have done so far has caused memories to stir and unsettled the dust but they aren’t causing chaos as I feared it would. I’ve been noticing green cars but it’s not paranoia, just attention bias.

Previous chapters were written from memory but the chapters that now follow will be based mainly from my husband’s recollections and outpatient letters. My memory is foggy for the last couple of years but I believe this to be another of my defence mechanisms at play. The mind tries to forget painful memories.

One phrase that often crops up in conversations with professionals is my level of insight.

I changed psychiatrist and care coordinator after my second hospital admission because I had lost trust in them. The new psychiatrist was very traditional and old school psychiatry and I wouldn’t have been surprised if he was nearing retirement. As a Psychologist I was not fixed to the medical model of solving what was going on with me but he was.

One day at an outpatient appointment I explained to him that just because we don’t agree on my mental health does not mean I lack insight. He responded with”So what would you say is wrong with you?”. I replied “Nothing”. He retorted “Well there you go, you lack insight”.

It has been hard for me throughout this journey to accept that anything is wrong with me but that is what everyone around me was saying. If there is something wrong with me physically; that is, my brain, what does that say about me. I’m flawed? I’m broken? I’m not good enough? Why did the word “wrong” have to be used at all?

So why did I not seek help from a fellow Psychologist? Most likely pride but also fear of being found out by work colleagues. I could have sought help out of area but the risk of being found out was still there. The psychology world is a small world. Plus I didn’t think they would tell me anything I didn’t know already. I decided to try and do my own therapy.

With a clear head I did a timeline of all the events that had happened to me and wrote a psychological formulation based on Garety et al. (2001) model of psychosis. To me this explained better the experiences I was having rather than there being a chemical imbalance, which my new care coordinator said it was. The truth is, a combination of both explanations was more accurate…

And whilst I am able to reason this, it did not conclude with complete acceptance. I still fell into a vicious cycle of acceptance followed by denial.

When I was entering recovery I was more accepting that I was unwell although my recollection of my unwell-ness was foggy to say the least. As time passed I would start to think I didn’t need the medication and I would be fine without it. I become a broken record and would say this to my care coordinator every time she gave my depot. Poor woman went through dejavu every month with me.

A mental block was always reached where I denied I had a problem and everyone else was failing to see my point of view. I wanted to try other non-medical ways and couldn’t accept medication was needed. The medical perspective was that medication, when I’m concordant, correlates with me being well and when I’m not taking the medication I become unwell. I couldn’t fully accept this.

I would go through the acceptance and denial cycle several times to the point my marriage was at risk…

One thing I promised on release from hospital was to go on a depot so that there would be no uncertainty of me being compliant on medication.

Another reason that pushed me towards going onto a depot was the fact I felt guilty about what I had put my husband and mother through with this recent admission to hospital. Whilst I was in hospital my granddad (my mother’s dad) died. My mother was having to help with baby boy and in her words I needed to pull myself together. In her time of grief I could not be there with her and she could not mourn in peace. I was also denied permission by staff to visit a church the day I found out grandad had died. I knew in that moment my mother was right- I had to pull myself together and do what people were saying to me but..

I like to be in control and having something done to me felt like it was out of my control. It’s not a nice thing to be injected in general. It’s not a nice thing when you don’t believe you need it. One of my fears was that I would have to have it administered in the gluteal muscle, but thankfully my arm muscle was good enough.

I was put on the antipsychotic injection, paliperidone. One of the common side effects of this is increased prolactin levels which can lead to lactation and no periods. This is what happened to me. I continually asked to change medication but there was reluctance as I was “stable”. At one point it was increased further due to “symptoms only 75-80%” controlled.

I was referred to an endocrinologist who had to rule out if a pituitary tumour was the cause of these symptoms. The MRI was very claustrophobic and I was on the verge of a panic attack during it. I was using all my psychological knowledge and skills to remain calm and not move.

Luckily I didn’t have a tumour and as I had always believed, it was antipsychotic medication induced hyperprolactinemia. I was also sent for a bone density scan due to my low vitamin D levels and I was diagnosed with osteopenia. All these things made me hate being on antipsychotics and the frustration of not being heard by the psychiatrist was getting to me. Eventually he halved my dosage to reduce the symptoms but my care coordinator didn’t think this was a good idea. She was right.

I started to become unwell again. This combined with me missing sertraline doses meant my head was all over the place. Due to my adamancy of not wanting to be on a depot anymore, it was decided I would come off the depot and changed to oral medication.

The nursing and healthcare assistants at this hospital were not as professional or as kind as the Unit staff had been. In fact I witnessed bullying of patients by staff. It was disgraceful and made me realise how lucky I had been with the Unit.

On one occasion I witnessed the nurse pre-filling medication into paper cups and when I stood by the counter for my medication, what seemed like a random selection of a paper cup by the nurse, made me suspicious. I queried whether he was messing with my medication. He told me I was being paranoid. Maybe I was but it was also a reasonable question to ask given he had several paper cups with various medications in them unlabelled for who they were for.

Nightly med administration was usually done with burly men standing on guard. I felt like I was in prison and unsafe.

When it came to the end of the week for discharge I had my bags packed. The psychiatrist informed me that the CMHT were very concerned about me. He said I knew all the right words to say to convince him to discharge me. I later found out through requesting my medical records that in fact my CMHT psychiatrist had gotten wind that they were going to discharge me and emailed the hospital psychiatrist asking him to not discharge me. He said that on average people on a section 2 stay in hospital for 2 weeks. I replied it’s an average.

He discharged me. 🙂

Whilst in the hospital I saw a mental health advocate. We talked about our families and he gave me insight into what my husband may have been going through.

Through all of this I worried about how my husband was but it never crossed my mind to think what he thought about me being unwell and more importantly suicidal.

The mental health advocate said if he was in my husband’s shoes he would be deeply upset that his wife didn’t want to be alive for him and child. I felt bad that I never thought about how husband felt of me being suicidal and not wanting to be with him anymore.

It was from this conversation that my eyes opened up to the affect I was having on our lives and I knew I had to focus on getting better.

I felt well and truly stuck in the mental health system. I felt helpless after feeling not heard during the MHA assessment. I felt in despair. This time I was without baby boy as he was over 12 months old. I had been split up from my protective factor.

I arrived at the out of area hospital with just my handbag. They didn’t have much to check. I was given a sandwich, assessed by a Psychiatrist and went to sleep in the clothes I arrived in.

This hospital was nothing like the Unit I was in. It was awful. I stayed in my room 99% of the time and due to the side effects of Aripiprazole was agitated and would pace in my room. On one occasion a nurse found me standing in my room in the dark as I was pacing. The Stanford psychology experiment by Dr David Rosenhan in 1973 under the title “On being sane in insane places” came to my mind. What was an innocent event would be interpreted as mentally unwell behaviour.

Unfortunately my admission into hospital fell on a bank holiday weekend so I had a longer wait to see the psychiatrist assigned to me. I made it clear to the nurse in charge that I wanted to be seen as soon as possible as I did not belong in hospital.

When ward rounds finally happened, my husband was present with me with a notebook and pen to hand. As we sat at the table my husband swiftly sat down, opened up his notebook and got ready to write. The psychiatrist not knowing he was my husband, must have thought he was my solicitor. I certainly thought so as I observed my husband do this. The standing in the dark in my room was mentioned by a different psychiatrist present and made out to sound like I was being mad. Thankfully the other psychiatrist who was assigned to me ignored the observation and moved the conversation along. I was going to stop Aripiprazole and start on Risperidone. He promised I would be reviewed again at the end of the week and could possibly be discharged.

My husband and I both believed I was not that unwell to warrant an MHA. We believed the Crisis Team were panicking and acting on their anxiety. Rather than working towards caring for me in the community, they no longer wanted to hold the risk I imposed. I was reacting badly to the change in medication of Olanzapine to Aripiprazole ( I had requested a change as I had enough of the weight gain) and they felt I was paranoid and actively suicidal.

I had lunch with a father and his daughter from my NCT group before I dropped my baby boy to my mums and made my way to the CMHT building. I remember feeling self assured I would be going back home after the meeting and they had no grounds to detain me. Little did I know that they had already made up their minds, although they would argue they hadn’t, and I was going to be sectioned.

The Crisis Team Psychiatrist introduced himself and I asked where the other psychiatrist was (the one I had seen previously and thought was fairly reasonable). Unfortunately he did not work on Fridays. I repeatedly asked if this was an assessment and he denied it was. As the meeting progressed I argued my side and pleaded with my care coordinator who was also present to help take my side. She did not. As the meeting started winding up, the psychiatrist asked my care coordinator whether he should escalate things. She said yes. I pleaded with the psychiatrist that I would do whatever he wanted and take whatever medication he wanted. He stopped listening to me and left the room.

I started to panic. I was losing control over the situation, decisions were being made not by me and I wasn’t being listened to. Things then took a turn for the worst.

Instead of letting me go home and the AMHP and Psychiatrist attending there to do their assessment, they kept me at the CMHT building. As the AMHP entered the room, I got up in anger as I recognised the AMHP to be a former colleague I used to work with at the CMHT from another locality. This was not right and said he couldn’t do it. They ignored me and said they could. In the end I gave in because it became obvious that they would be doing the assessment whether I liked it or not.

I tried to reason with the AMHP who I knew but it became clear that he had also made up his mind on the outcome of the assessment. He asked if I would go into hospital. I outright refused. They left the room to have their discussions to decide what would happen. I would be waiting for over half an hour before the AMHP returned and told me I was being sectioned. My husband arrived not long after. I was being transferred to a hospital out of area. I told him not to follow and to go back to our baby boy. Come tomorrow I said. It was afternoon when I had entered that building, it would be late evening when I left it.

Two 6 foot plus men arrived to escort me to the ambulance and drive me over an hour away to the hospital. I was numb and had emotionally shut down. I made pleasant chit chat with the man sat with me at the back and he said I would probably be out in a week. Everyone is an expert nowadays.

My husband was very supportive throughout my becoming unwell. Unfortunately I was not truthful in return. I messed about with taking medication but would pretend I was taking it. As I became more unwell it became obvious that something was amiss. My deceitfulness was putting a strain on our marriage but I was too stuck in my head that I didn’t need medication and I was fine, that I didn’t learn from my mistakes.

Eventually Crisis team became involved. I had heard many stories from patients in my work as a CMHT psychologist and most of them were negative experiences. I knew to expect an overstretched service. At first they visited to supervise me taking my medication for a week. Later they became involved again at the request of the psychiatrist, as I deteriorated further. Their visits didn’t last long (less than 10 minutes on one occasion) and I wondered what was being accomplished by their visits.

One day some post arrived and a parcel to me had been opened by the post office and placed in a plastic bag explaining they had to open it due to insufficient postal information on the parcel. I didn’t believe this because my address was complete and accurate on the front. I started to think the government was tampering with my mail.

Alongside the paranoia, I was becoming depressed again and having fleeting suicidal thoughts. I thought my baby boy would be better off without me. I was struggling and before I knew it an MHA assessment was being arranged though I was not told at the time this was going to happen. My husband was contacted and he was the one to tell me. A year had yet to pass and I was being assessed again.

Non-compliance. A word that would become synonymous with my name at the CMHT.

I begun to think I didn’t need medication anymore and the weight gain was getting me down. The Olanzapine was also so very sedative it made it hard to get through the day. As a result I started to miss medication and slowly the paranoia crept back in.

I was back at work but was soon signed off due to being psychotic. They asked if I would consider going on a depot but I refused. I held a view that the most unwell patients ended up on depot and I was not one of them.

I was at the unit for 3 months… I remember at Halloween putting up decorations and thinking I better not be here in December putting up Christmas decorations. I was…

The unit was lovely and in the end I came to realise the staff were just as lovely too. Towards the end I no longer needed to see the medication coming from the box before I took it. I no longer thought I was being followed or there was a conspiracy against me. My mood had lifted and I wasn’t actively suicidal.

I was discharged in the new year and best of all I could look forward to going to the toilet without being interrupted by staff checking I was alright. More importantly I made friendships in the unit that would become lifelong. We had shared experiences and memories- some of which we would want to forget but on the whole there were more worth remembering.