Saturday, 12 December 2009

Whose story?

I haven't written here for awhile. It's not been for want of material but because most of what I have to say involves other people and it's hard to disentangle ownership of "stuff". We're all so meshed with each other's lives, how much of my life story is actually mine to share?

I have kept company with this question over many years and it's a big reason why I barely used to talk to anyone about anything. If I talked it implicated other people, or maybe showed them in the wrong light, or maybe they'd find out I'd said something. If I talked it made my version of events more important than I thought it should be, it made it real if I said it, or it showed up the "fact" that I was making it all up. Either way wasn't worth the risk. My most important dialogues as I grew up were with my cat and the inside of my body, the blood that flowed or the food I could "express" instead of digesting it.

These days things are usually somewhat different. I am more self-confident, more self-possessed and less afraid. I was even quite astonished to hear someone describe me as outgoing not so long ago! I would still mostly rather write than speak and I still tend to reflect on things before talking about them. But usually these days people's questions get straightforward answers without angst or evasion and usually if I need to talk I talk.

But not with this. I am vulnerable again from a source I never suspected and for reasons I can't easily share. This source, this person, is pretty much oblivious to the problem, which, in itself, is part of the problem. I can list the issues at stake: distorted perceptions of reality, overstepping boundaries, not listening or believing, not emotionally literate. Where do I keep finding these people? Because each new one brings the others crawling back out of the woodwork to cluster round and haunt me again. All the old doubts and fears resurface, all those well-intentioned betrayers who refused to see. Most of all I betray myself because I let myself dissolve at the core, see that I'm overreacting, making it up, not worth being taken seriously. I have to hurt myself to punish myself for these made-up worthless feelings and also to have some kind of tangible pain to attach them to. It has been some years since I've seen self injury as any kind of punishment, I thought I'd left that behind long ago.

I wonder what to do about it, with which ghost of the past to join forces. For now, while I do nothing, they all parade around me with their accusations and incitements to self-destruction. Surely hitching myself up to any one of them would be better than trying to deal with them en masse? So this is option 1 - avoidance, turning inwards, depression and self harm. Option 2 is to just stop seeing this person. It would be tricky socially but possible, and I could set this episode behind me. But that option hitches me up with the ghost of the one who did that to me, and to taking on responsibility for inflicting that kind of bewilderment and pain. Option 3 - act as normal, pretend all is well. I keep my friend and eat myself from the inside, hitching myself to the ghosts of my childhood, the adults who turned out to have so many more blind eyes than me. Option 4 - I try again to explain, to reason, to sort things out, knowing that in all likelihood I won't be heard, believed or understood. That links me up with the ghost of my marriage and all that that entailed, entails still in my mind. I had an option 5 which eludes me for now, but for what it's worth it didn't get me any further on.

I can only really reach one conclusion from that paragraph - that I am indeed overreacting, making it up; and yet the soothing sight of bandages wrist to elbow on both arms gives me some hope that I can at least have some belief in myself.

And, you know, if this was the only thing I had to sort out in my life right now, things wouldn't be so bad!

Thursday, 29 October 2009

Asleep awake

I am not sure why I feel so inclined to write on a subject which is so intensely boring. Although actually the subject itself is interesting enough, it's the process which brings about the - well maybe boredom is the wrong word. The subject matter is insomnia, but maybe that's wrong too. Everyone knows that insomnia is not sleeping, what more is there to say? So it's about the effects of insomnia.

I am leaving that first paragraph mostly unedited because it's illustrative of what I'm talking about. At the moment most of everything I write has to be written disjointedly, slowly, considered, reread, rewritten because it makes no sense, and so on. Sending texts is taking me forever! I am aware that I've described my current writing practice in a way that's probably close to normality for many people, but for me writing is something that usually requires very little consideration. This struggle to get my words set down in order feels incredibly odd.

I'm not sure how long it's been this time. Time gets weirdly out of shape when so little sleeping is going on. I've had trouble sleeping from time to time over many years. More recently I had a period of sleeping quite well. At some point that changed and sleeping for about 1 to 4 hours each night became normal again. Such nights are interspersed every so often with a night when I sleep for perhaps 12 hours but through those hours I wake every 20 minutes to an hour.

It's boring partly because there is just so much time. Extra hours of wakefulness which I don't really want to fill with activity because I want to be asleep, and to give myself a chance of sleeping I do need to be in bed. It's also boring because, although I know there are people out there doing night shifts or awake for all sorts of other reasons, it's so dark and quiet that it's easy to believe I'm the only person awake. And I can't really go anywhere or ring anyone so to all intents and purposes I am the only one awake.

Insomnia is not just boring at night though, it also casts its shadow right over the day. I'm so zoned out from lack of sleep that most of the time I don't feel properly awake. I am frustratingly, annoyingly awake in the night but whether it's night or day it doesn't feel like real awake. Everything is dull, off-key, distorted somehow. Thoughts start then trail into nothing, organised activity becomes very confusing. It's like being permanently stoned. Except every so often there's a shaft of proper awakeness which is shockingly intense and stressful, like having a bright light shone in my eyes. I think this is probably just what it's like to be awake normally, but in my stunned sleepless state I have become unused to it and it's as excruciating as pins and needles.

I heard once that after a night of less than five hours sleep your reactions will be slowed to the same extent as someone who's once over the limit for drink driving. I found it hard to believe until I subsequently had a sustained period of sleeping well and realised what a difference it made. I certainly don't feel capable of anything that particularly requires me to have my wits about me at the moment.

I suppose I should own up and say that I had neither a warm bath nor a hot milky drink before I went to bed some hours ago. I have done those things before bed on occasions, though I much prefer to have a bath in the morning than right before bed. I don't do them because they don't actually make a difference, and also because I get so sick of everyone telling me at far too regular intervals that if I do these things all will be well. It's so simplistic and banal, and they all tell it like it's news.

It is now 4am, I haven't slept yet. I woke this morning at 5am having slept about 1 1/2 hours during which time I woke twice. I went to bed for a few hours earlier but thought I'd have a change of routine and get up for a couple of hours. Now I think it's time to make another attempt on sleep.

Monday, 26 October 2009

"Assisted" self harm

I came across this article via a friend on Facebook and have a bit more to say about it than would fit in the comment box. The article, which can be found here, details approaches being used in psychiatric hospitals to try to reduce harm brought about by self injury and enable service users to self injure more safely. Many of these strategies are not new, though they're probably unheard of in most mental health establishments. I think some of those described are very helpful, others quite dubious, and it may surprise you to find out which I think are which.

Everyone who's admitted to a mental health unit has a care plan drawn up, usually with their participation. That is a standard procedure and copies should be held by both the staff and the patient. A good care plan for someone who self injures should include a section on how self injury might be managed. The general aim is to reduce the incidence of self injury, though that aim may not be shared by the patient. That's because self injury can be a life-saving coping strategy and removing a person's means of coping can put them at risk. However, self harm reduction strategies do need to be put in place because they may provide an alternative and more effective way of coping at some times. For example, being given the opportunity to talk to a trusted member of staff can be helpful in managing self harm, though staffing limitations on the ward often make this unworkable.

In addition to looking at reducing self harm, however, this article details ways for patients to continue to self injure but to do so more safely. The provision of dressings on wards is usual, though they are not usually directly accessible to patients, being kept in a locked room. Usually dressings will be provided as needed, and sometimes additional dressings will be provided, ostensibly for when dressings need to be changed, but effectively they can be used for new wounds too. The contraversial aspect is the provision of clean blades. The rationale is that, deprived of their usual means of self injury, people will look around for something else to use, and that something else will be more likely to cause infections than the clean blade they might have used otherwise. This is completely true. I have known people use broken glass off the pavement outside the ward, used blades discarded by others, even staples from magazines when on 1-1 supervision. None of these items are clean and some may carry serious health risks. A clean blade would certainly be preferable to any of these. There are, however problems, which I will come to shortly.

Some years ago I encountered this dilemma myself. I was in hospital for several months and self injuring frequently at the time. It was general practice for staff to remove blades from us if they found them on us, but there are many ways to hide a blade if you're determined enough. I had a friend who also self injured and she knew I had blades. I had been to the shop earlier and bought a pack of five. She asked me to give her one of them. I was unsure what to do. On one hand I felt that she had a right to self injure and shouldn't have had her means of doing so removed. I was also aware that she was trying to contain her stress and that she might do something more life-threatening if she was unable to cut. I also felt that it was somewhat hypocritical to stop her cutting when I was doing the same. On the other hand I didn't want to be responsible for her hurting herself, especially as this particular kind of blade was different, and probably sharper, than what she was used to using. I was worried that she might injure herself more severely than she intended with this unfamiliar blade. But it was clean and new and therefore preferable to what she might resort to using otherwise. I gave her the blade. I told her it was sharper, I made her promise to use it safely, and was very relieved that she did.

I do worry that hospital issue blades might escalate the severity of some people's injuries. If someone is admitted having been cutting with a penknife, and is issued a supply of razor blades they're not going to go back to using the penknife when they get home. On the other hand it was when in hospital that I started what became years of burning myself because my blades had been taken away.

It seems to me that by far the most sensible thing is for staff to supply the dressings but let people keep their own blades. If they weren't taken off us in the first place the whole issue of whether to replace unhygeinic salvaged "weapons" with hospital issue blades would go away. That measure in itself would probably reduce the level of self injury because it would reduce the build up of anxiety and the desperation it leads to.

Now onto the part of the article that really worried me; that being the practice of nurses sitting with patients while they self harm. Maybe this is some sort of covert prevention strategy because I can't imagine myself or anyone I know self injuring when anyone else is there. This is an intensely private activity, not to be seen by anyone, whoever they may be. One of the big reasons people don't seek help for injuries and learn to do their own dressings is because they don't want anyone to see the wounds, let alone the act itself. In my view the main preoccupation would be how to get rid of the nurse so I can get on with the self harm! I can't see how encouraging a patient to self harm in front of a nurse is going to help anyone, in fact I had not been prepared for the degree of horror I experience just by writing about it. Maybe sitting with the nurse before, or, even better, after self injuring, would help. But during? Ugh!

So my conclusion: let us keep our blades, help us to use them less if you can, give us the dressings we need when we need them and don't even think about sitting there while we're cutting.

Sunday, 4 October 2009

Finding the right pace

This is an issue that I return to again and again, and I know I'm not alone in this. Throughout our lives we all need to adjust our pace of living from time to time, and mostly it's something we can do without too much thought. We find ourselves doing less when we have flu, more when we have children to look after, we make adjustments for holidays, visits from friends and families, deadlines. Sometimes life circumstances bring about less welcome changes - we have too much to do and get stressed and exhausted, or find ourselves with too little to do and become dissatisfied and unfulfilled. Then we have to think a bit more about finding our way back to a pace of life that feels more natural.

For those of us with conditions which fluctuate, where our energy levels vary more frequently and extremely, the art of pacing ourselves becomes an issue that we have to give a lot more attention. For example, I have a number of friends with fibromyalgia whose energy and pain levels vary unpredictably and dictate that their pace of life has to slow down, and then speed up a little when symptoms recede - not too much though, or those symptoms are back again. In my case, with bipolar, my activity levels can vary hugely. When I'm low I do little more than lie in bed most of the time. When I'm high I do very little staying still. When I'm somewhere in between I find it very difficult to find a balanced pace.

When I'm low I know I need to try to do a bit more than feels comfortable. Sometimes this is because of something very basic, such as having been thirsty for hours and needing to get myself down to the kitchen to get a drink. It doesn't sound much but that can be quite a big change in pace. Sometimes it means making the effort to leave the house most days, see friends regularly, put washing in the machine. It's tricky because too little activity exacerbates the depression but too much is overwhelming and that can exacerbate it too. It's very hard to form opinions about how much activity is right because what's right on one day might be wrong the next.

When I'm high the opposite applies. They say when you're low do more, when you're high do less, but doing less is very hard. 3am seems about the right time to get up and start the day - if I've gone to bed yet - and doing several things at once seems the best way to go about it. At these times I think it's a good thing that I smoke because it means that I do actually sit down for 5 minutes every couple of hours. It's difficult to focus on finding the right pace when high because pacing yourself is sensible and sensible things are boring. Boring things are beneath my notice because I am doing much more important and exciting things with my time!

When my mood is more stable there is more scope and motivation for finding the right pace, not least because it's one of the main ways to try to prevent relapse. But how is it done? This week, for example, I started to feel a bit better on Wednesday. It was quite a novelty to want to do things and have energy to carry them out. For 3 days I kept myself quite busy, relative to what I've been doing of late. By Friday evening I was crying with exhaustion and had to admit that although the will was there, the stamina was not. 10 weeks in bed really does for your fitness levels and I hadn't taken that into account. So, back to bed for most of the weekend. Clearly I need to take a more gradual approach, but I'm not sure what that involves and how long it will be the case. Sometimes I attempt this by making structured plans, other times I play it by ear. Sometimes I don't trust my judgement, and sometimes I have good cause not to. Sometimes I rebel because I don't want to have to think about it. Very occasionally, I get close to getting it right - for awhile.

Wednesday, 30 September 2009

Is better really better?

I have started to wonder this recently. In recent weeks I have been so depressed that I ceased to care whether I ever got better or not. They say, and they're right, that when you're depressed you can't see anything different. Times in the past when I've been OK seem, at best, like a dream. Mostly I feel that I must have just imagined them. Rarely can I see that there is any possibility of feeling better in the future.

That's not what this is about though. I believe that I have felt good, that I have felt good relatively recently even. I also believe that today I feel very different from the way I've been over the last 10 weeks or so. The belief that I have lost is the belief that it really matters.

People say, almost to the point of cliche, that a baby's smile, a moment with the sun on their face, the ability to laugh at a joke, any one of these things makes all the suffering worthwhile. I just don't think that's true. The thing, the only thing, that makes my continued existence worthwhile is that my family and friends are not bereaved. They don't have a dead daughter, sister, friend, because I am still here. For that reason and no other am I still here, because, other than that, none of it is worthwhile.

Today I woke early and decided to make art. I have been so unable to even consider making art that this might be misconstrued as some kind of breakthrough. Making art is what I'm meant to be doing with my life after all. It's not a breakthrough in any positive sense, it's a breakdown of resistance, a defeat, and the swallowing of increased numbers of orange pills. Today I can make art, fine, but what about tomorrow? What about next week? What about in a few months? There is no way of knowing. Swallowing orange pills is no guarantee, they can push me into hypomania too.

Better isn't better because it breeds false hope. It makes me think that I can undertake a project, decide to go on holiday, promise to do something for someone, and that when the time comes I'll be able to honour my commitments. Maybe I will, maybe I won't. Maybe carrying out one of those plans is the thing that will make me ill again.

Better isn't better because it breeds false hope in others, they are so relieved and optimistic and happy that I'm doing something normal. Fair enough, but when it all falls apart again it's me who has to burst their bubble. And how can I tell them that even today, when I feel better than I have for weeks, I would still much rather not be alive.

Maybe there is some positive element to not being too attached to wellness. With wellness there usually comes fear, because, to the extent that there is pattern, I know it's unlikely to last very long. It's easy to waste a lot of well time looking over your shoulder, looking for early warning signs - which we are encouraged to do, supposedly to maintain our mental health. Maybe indifference to wellness will reduce the anxiety. Today, for example, I forgot to have a bath, twice. I woke up this morning with a project in my head. It wasn't there yesterday but within an hour of waking it was fully formed. It seemed very urgent that I start it right away so I threw on clothes, grabbed the things I needed and set off for the woods. As I left the house I remembered I hadn't had my bath. No problem, I can have it this afternoon before I go to the pub. At the appointed time I duly ran my bath, but I had a few things to do which seemed important so I got on with them while the bath ran. Mercifully I remembered to turn the taps off before it overflowed. But I was still busy so I decided to finish a few things before getting in. Next thing I knew I should have left the house ten minutes ago. I still have a bath full of cold water because I had to run out of the house to meet my friends. So was I just being scatty within the realms of normality or is it an early warning sign of going high? I don't feel inclined to worry about going high when I have been so depressed up til yesterday. And I don't know how to know the answer anyway. And even if I did, and if it is an early warning sign, wtf am I supposed to do about it? Better is not better, it's just a waiting game.

Tuesday, 29 September 2009

Not beginning

I have been here before, but you haven't, so welcome. You will have been at your own not-beginnings, your own versions of "here we go again", so you know where I'm coming from when I say that this is so not new. But beginnings get forced upon us from time to time and a new blog needs some kind of introduction.

I am here because I'm not drawing. It's not just that, but that's as close as I can get to true. If I was drawing or making any sort of art really, I would be over on my other blog doing show and tell. But I have nothing to show and too much to tell, so I'm here instead.

I am assuming I have readers. I don't know if I merit readers, whether there will be anything worth reading here. But the fact that I'm putting this online suggests to me that I assume readers, otherwise I'd just write it in a book, like the tens of books I've filled with writing over the years, then mostly shredded because it was never designed to be read and I didn't want it to be. If there are readers that's OK, but I'm more concerned with formalising my writing a bit, being a bit more accountable to myself because someone might be looking.

So what is this not-beginning? It is the all too familiar process of picking up the pieces. It's a cyclical process and Ive been resisting it but it always gets me in the end. You just can't keep holding out on life, at some point you have to resign yourself to living it because it hasn't stopped yet. In my experience the process necessitates pretence to the point of lying and a good measure of consensual delusion. You have to believe there is a reason, a purpose, a meaning, even though there is clearly not. You have to pretend you want to be alive, pretend there are things to live for - as opposed to reasons not to die yet. You have to do something, anything. You have to talk yourself into believing that what you have in your hands after this scavenging expedition is something worth living for.

It works for a few months, then I'm back to where I was before.