Books as Therapy

Not long after my appointment on Thursday, I found myself standing outside Waterstones wondering what the hell I was doing.
I walked in, my anxiety a little higher than usual, knowing I was going to face something that usually made me more anxious. The first thing I did was look for a book I knew I wanted – Tom Reynolds‘ brilliant “Blood Sweat and Tea”. I had been waiting to get it from Amazon, (with something else to qualify for free shipping) but I needed to buy a book for my therapy, and this was going to be it. Tom might be amused to learn that he’s had a little bit of community psychiatric input, there! I found it (in amongst the biographies, not on the 3 for 2 tables as it should be) and asked Mr D if there was anything he wanted so we could take advantage of the 3 for 2 offer. As we both looked around, I found myself inadvertantly looking at the till area. I was already gauging what was going on there. I realised that I’d also been looking around to see how busy it was and whether there was anyone or anything that was going to make my anxiety worse. I was so acutely aware of it, that I suddenly smiled to myself. Sometimes, this is like looking in from the outside…
Mr D chose a book (I can’t even remember what) and I was pleased to see the classics were included in the 3 for 2 offer, so I picked up HG Wells’ “The Time Machine“. Our local Waterstones isn’t very wide, so I instructed Mr D to stand where he was, which was about 18 feet away from the till on the opposite side of the store. He was close enough, but I was doing this on my own. At the till, a young mum with a pushchair was being served (why do mums think that pushchairs don’t take upany room, and park their ‘wheels’ horizontally?) and had a small girl in tow, who was pirouetting round the pole that holds the “please queue here” sign. In a way, I was pleased someone else was being served – it meant that I could do the whole queueing part of this exercise. My focus was on the mum and her kids – I didn’t want to trip the little girl up, nor did I want to be run over by the pushchair. Another assistant beckoned me over to the till, and I went through the motions. Put my books down, got out my purse, watched her scan them and say “that’s £14.98, please”. Handed her my debit card, and obeyed the instruction to put it in the card reader myself. (As an aside here, I wish shops would make their sodding minds up – either take the card from the customer, or all of them become almost self service. It drives me nuts when you hold out your card and they give you this “oh, no – you do it” thing. What happened to customer service?) To be fair on the girl, she was pleasant and smiling, asked if I wanted the receipt in the bag, which I did, and she waited for me to put my purse away, then handed me the bag with a smile.
There. That was easy. Maybe too easy? Maybe I should have done this on Saturday when there’s more likely to be a queue to contend with, and more people. But, as they say, I have to take baby steps. Two things have come to mind while writing this – firstly, I didn’t get flustered when she waited for me to put my purse away. Usually, I can’t organise my bag so that my purse slips down to the bottom, I’ll just stuff it in my pocket or take my goods and sort my purse out later. Secondly, I’m a sod for saving the environment, and always have a roll-up bag with me. For the first time in ages, it never occurred to me to say, “I don’t need a bag, thanks” – and I feel a tad ashamed.
However, Part One of my ‘homework’ is done. Because of the fact that Mr D works during the day and there’s no daytime opportunity to do this again before my next appointment with J, we have decided to wander into Borders book store during the week. It is at a large retail park nearby, and open late in the evenings.
Now all I have to do is think of some more books I want…

Dealing With It

It was only a matter of time before J was going to ask me to do a practical CBT exercise.
For a few weeks, we’ve been dissecting individual places and events, what causes the anxiety, what makes it worse, what helps (safety behaviour) and where I could be in that place to ride out the panic rather than running away. I’d always visualise myself in these places with the thoughts and feelings I usually had. Going into detail has been difficult, partly because I don’t really think about it at the time, (there’s a lot of times I’ve had a panic attack and not even remembered much of what went on) and partly because it’s hard to admit every little detail. It’s validating the fear, making it more real.
So far, J and I have come up with a list of places with scores between 0 (completely calm) and 100 (full blown panic). Most of these places are shops, and although I said “cinema” and “going out for a drink” I don’t think they count because they happen so infrequently. The last time I went to the cinema was when “Harry Potter and the Goblet of Fire” was out… We picked a choice place, somewhere halfway along the list so it wasn’t too easy and wasn’t going to be the exotic pet store where the tarantulas live. ‘Scuse me..
*throws up a bit*
I hate spiders.. Anyway, the place we chose was Waterstones. I’d already figured that my anxiety is less in there because of my love of books, and if I get anxious I know there is usually a seat nearby where I can flick through a knitting or photography book to distract myself. I guess there is the possibility that this knowledge means that my anxiety is lessened before I even get there. Plus there’s the benefit of a bookshop actually selling lots of things that I really want, rather than popping into Sainsbury’s for a pint of milk.
J asked me what part of the store would make me more anxious. This was easy – either standing by the front door, or waiting in a queue at the till. We looked in more detail at what I’m like waiting at the till to be served. He asked me about my behaviour – what’s going through my mind, what am I doing, where am I looking – that sort of thing. At first, I wasn’t sure – some things I do automatically, and some things I’m sure most people do, like check their purse, keep an eye on the till to see if it’s their turn yet. As we talked, I realised I do as much preparation as possible. Not only do I get my purse out, I get my debit card out (or cash, depending on how I’m paying) and I have a tendency to watch the sales person. I try and figure out what mood they’re in – are they chatty or efficient? Are they trying to get customers to fill in stuff or have a catalogue or store card? These things are important, because in my head I have everything in order. I know what will happen, and if I get to the till and they say something that throws me, it really increases the anxiety.
J and I then discussed my safety behaviour. What do I do to take my mind off the anxiety? There wasn’t a huge amount to say here – if my anxiety is high, I often tell myself not to be so silly, and that I’ve done this a thousand times. I try to focus on the task at hand, and not get distracted by anything or anyone. Maybe this is partly why I avoid eye contact with people. I don’t want to end up enganging in some (verbal or nonverbal) diatribe which ultimately would give me too much to think about and deal with at that moment. There’s also the fact that Mr D is rarely too far away. He’s convinced he doesn’t do much – but just knowing he’s around is a huge comfort. My biggest dread is having a panic attack when I’m alone.
What J picked up on is that I’m very negative about the whole thing. I hate my anxiety. I remember clearly what it was like to be ‘normal’ me, and this makes me feel like I die a little bit inside every time I do something ordinary and my stupid disease means that I freak out. The negative rebuke is now automatic, and J suggested that I need to approach it a different way. I can hate my anxiety as much as I want, but I need to accept that right now, it’s okay to feel this way. Hence my new motto:
   “I’m anxious, and I’m dealing with it.”
It looks like some new-age motivational speak, but it is right. I’m accepting the anxiety, rather than fighting it (I have a habit of saying “I’m fine” which Mr D knows means I am anxious) and I am reminding myself that I am doing something positive about it. I need to practice it, though. I guess the way it’s worded is also helpful if the “I’m so stupid” thoughts come into my head. I can say “hey, fucko, back off – I’m dealing with it…”
What J said next made my heart race. “D’you think you could do a practical exercise?”
What J wanted me to do was this. Go to the bookshop and buy a book. Gradually drop my safety behaviours, and get Mr D to back away. This should be done over several times until I go into the shop and buy a book myself.
“When do you think you can start this?” J asked. “How about this afternoon?” I ventured. I always go into town after an appointment to ‘treat’ myself. It’s an unspoken reward for dealing with my shit. This time, I could go and buy a book instead of a cream cake.
This was on Thursday. I have written about my experiences, and shall publish them tomorrow…

Let’s hope Mr Hutton doesn’t read this…

don’t get any ideas, Mr Secretary of State for Work and Pensions…
Granted, this is based in the US, and the person in question told her disability company about her blog, but it’s still something to think about. I’m quite proud of this blog, and the fact that I did a lot of the coding myself, and it wouldn’t take a genius to work out that it’s neither updated with great frequency or full of comments that could make me look like a fake, but you never know. Just look what That Doctor thought in December…
Good luck to “Madrigal of Agony”. It’s shit enough having a disability without having to prove it all the time…

Belay that worry, ensign

My two main fears about how the CBT is going have been lifted.
Last Thursday, I asked J about the dihydrocodeine and whether the knowledge of how my panic attack disorder and subsequent agoraphobia started would have changed the direction in which my treatment was going. I didn’t explain it too well (thanks to only 2 hours sleep the previous night) and he thought I meant “would he have had reservations about treating someone who got addicted to opiate analgesics?” Eventually, we both got our heads round what I was trying to say, and he told me that regardless of how it all started, the principle of the CBT is the same. *phew*
I then said I was worried about how long we had left for appointments. J reassured me that I wouldn’t be “chucked out the door” half way to getting better, and that if needs be, I can be referred to his supervisor, D, who did my initial assessment a year ago. He also said that he could offer me weekly appointments instead of fortnightly, which I have accepted.
I feel a bit better about it all, although I still feel like I’m doing one of those orienteering things where you have to fall back into someone else’s arms and trust that they’ll be there to hold you…

CBT Thoughts Part 3

Since my last appointment my head has been swimming with thoughts. Not necessarily about me, but about this “whole CBT thing”. It’s hard to write them down because there’s that telltale little voice yelling “you’re giving up!”. I’m not, though. Just voicing my thoughts.
There are a few things bothering me. Firstly, at my last appointment, my back was really sore, and I was hobbling a bit. J mentioned it, and I said that my old back injury flared up occasionally, but it wasn’t too bad. At the end, as I was getting up to leave, something was said that made me say something about “stupid bloody back and stupid bloody dihydrocideine addiction”. J stopped, and looked taken aback? surprised? one of them. I said, “you didn’t know about that?” and when he looked puzzled, I explained that it was coming off the dihydrocodeine that started the panic attacks. J said, “We can talk about that next time”.
Next time is tomorrow. J has had holidays, so it means there’s been a four week gap between appointments rather than two. In the meantime, of course, my mind has been working overtime over what this means. Part of me is frustrated and annoyed that this has never come up. Isn’t it in my notes? Maybe it’s not relevant, but if sudden dihydrocodeine withdrawal started all this, then surely it is relevant? Withdrawing from massive amounts of an opiate drug as suddenly as I did left me feeling raw – my senses and emotions were heightened to levels I’d never experienced, and I just wanted to hide until it all went away. I developed coping techniques (actually avoidance techniques) to try and stem the horrible feelings, and gradually I learned to cope with them. That’s left me where I am today – panicky and scared when I go out, those raw emotions bubble to the surface and I just want to hide again. That’s why I think it’s so relevant.
Secondly, I’ve been thinking about the fact that J is a psych student, and his placement at my hospital finishes sometime in September. This means that at worst, I have one or maybe two appointments after Thursday, and at best, three. I’m terrified that I’m going to be ‘discharged’ when I still need help. Okay, so this CBT can give me the foundations to work on, but there’s been lots of times lately where I’ve thought “hang on, J said I should do x, what happens if y happens?” Right now, I have the comfort that I will see him tomorrow and I can ask him. However, the fact remains that once those few precious appointments are gone, I’m on my own.
I guess the upshot is, I’m terrified of failure. Again.

Out on the Town

Our town centre is being ‘done up’. The council are putting expensive pavers down, and making the whole area pedestrianised. Unfortunately, they are cordoning off massive chunks of pavement and road while they do it. It will be nicer when they’ve done, but in the meantime it’s a nightmare navigating – both mentally and physically. The gaps they leave between the shops and the barriers are literally only wide enough for two people standing very together, side by side. Someone with a wheelchair, or a parent with a buggy would struggle. It’s no easier for the walking wounded – ie people with walking sticks (like me at the moment – my back went into spasm a fortnight ago) or indeed anyone with mobility problems. Although the council have had to (by law) tarmac the bit where the old pavement ends and the new one begins, it is so uneven that only hill walkers and mountain goats could confidently say they’d never struggled.
Add this to the fact that our town centre gets very busy with shoppers on Saturdays, all of whom have a wandering around agenda that involves aimlessly walking diagonally and changing direction at the drop of a spitwad (they don’t wear hats where I live), and shopping is a nightmare.
Of course, J would say this was an opportunity. Maybe it is, but somehow I want these opportunities to be on my terms. If I’m going to confront* someone in the street who I can’t get past, I at least need to know that I could go the long way round if I wanted. I know there are going to be occasions where I have no choice, but I don’t want the idea of going into town to be my worst nightmare, thank you. At this stage, I am only dipping my toe in the water, I don’t want to be pushed in.
One thing J has said to me is that my avoidance tactics (counting in japanese, reading labels on tins) are not helping. When he said this to me, I almost felt as though I’d been slapped. I don’t blame J for that, as I keep reinforcing, he is only there to challenge my thought processes, but it’s still hard when you think that you’ve found something that helps, and you’re told that “actually, it’s not helping..” I think this could be something to do with my sensitive nature. I am, however, much more aware of how I act when I’m out and about.
I need to be aware of the things around me, but when I’m faced with something that raises the anxiety levels, my instinct is to leave, or hide. J says I need to face the things that could make me panic. On Saturday, we detoured through the shopping centre which was wider, but still busy. Suddenly, my guard was up – a young man was running towards us. My normal reaction to this would be to look down, move totally out of the way if possible, while getting more and more tense. Yesterday, I thought of what J said. Confront it. So, I kept looking at him. I felt a bit spacy**, but not too bad. (In hindsight, I’m wondering what else was keeping my mind off the anxiety). Then I started wondering. What if the trigger was a parent with a fractious child? I’m sure they wouldn’t take too kindly to some stranger staring at them. How exactly do I confront that sort of situation? As always, notes are being made for my next appointment with J…
* ‘confront’ doesn’t necessarily mean an argument – more a situation where I’m forced into a situation where I have to communicate with someone, eg, that thing where you’re trying to get past someone and can’t because they’re DOING A SODDING DANCE and can’t make their minds up which way to go.
** I don’t remember hyperventilating or anything, it just felt strange and disjointed watching this young man running.

CBT thoughts part 2

On Thursday, I saw J again, and instead of trying to tell him what I was thinking about our last meeting, I printed out the blog entry that I did last week. It made the most sense, rather than struggling with my words, the wrong word coming out and J taking it at face value. Sometimes, my mouth comes out with some utter shite rather than what I’m trying to say. My brain moves too fast for me, I think.
The crux of it is that rather than me seeking reinforcement – even subconsciously – it’s a case of other people giving me that reinforcement. So, if I feel anxious, it’s Mr D’s instinct to comfort me, but in a sense he’s perpetuating the problem. Coupled with the fact that instead of staying and dealing with the problem, I use avoidance tactics, it all adds up to why I’m just coping with my illness – not getting better.
This week, J and I looked at all the individual places that make me anxious, however at first he wasn’t too impressed with my response of “everywhere”! For each place, we gave it a score out of 100, with zero being virtually asleep and 100 being a full blown panic attack. I looked at my list, which was mostly shops and very local places and said, “God, I have a sad little life…” J suggested that I could hang on to that thought with a view to making my life more interesting when I get better. He’s right. I’ve lost count of the amount of times I’ve turned down invitations or longed to go somewhere. At the time, I struggled to think of a particular place or event that I’d like to do, and came out with “shopping in New York” which I guess is a bigger goal than J was aiming for. When I came home and thought about it, there was one thing. My friend B runs a weaving class. My rekindled interest in fibre crafts means that something like the class would be a perfect next step from knitting and handspinning. The thought of attending makes me want to puke, though.
My fear is not being in new places, but having to deal with people. I have visions of making a fool of myself, not being able to speak properly, people thinking I’m stupid. I said to J that you could stick me in the middle of a field and I’d be okay, but put me in a crowd and I’m a goner. It’s made me think about just how restricted I’m making my life so that I don’t panic – but at least we have something to work towards.

I love my GP

Okay, don’t get a nosebleed or anything but yes, I am posting two days in a row. Someone fan me.
I had my monthly GP appointment this morning, and we chatted a bit about the benefits thing, and she told me about another patient (very vaguely to maintain confidentiality, of course) who was going through the same thing. I told her that my worry at the moment is about the new IB reforms, and how claimants are likely to be sent on training courses etc – see two posts down for the sort of thing I said.
Dr H was as always, lovely and supportive. She told me that yes, it was likely I would be caught up in these new proposals, but my best bet was to tell them in very simple language exactly what I can and can’t do, and if the worst happens she will be happy to back me up with a letter.
I’m writing this for the benefit of the people who read my blog and (as I mentioned before) have emailed me worrying about the ‘what ifs’. I felt better knowing that Dr H is completely on my side and totally understands me. She told me about a patient who had agoraphobia and got caught up in a similar scheme a few years ago. The patient was too ashamed of her condition to say something to the BA, and it resulted in her anxiety levels soaring. People, get a good GP who understands you. Then if you do need to fight the Benefits Agency, you have a damn good weapon.

CBT thoughts

I’ve been writing this blog entry for three er, four days now. It’s not the usual procrastination thing, but a “where the hell am I going with this?” thing. If some of this comes out disjointed, I apologise, because I’m writing down all my thoughts, but don’t want to publish everything. Suffice to say, all of this will be discussed with J when I next see him.
This CBT lark is er, interesting. Imagine me saying that in a guarded sort of voice, because although I really want it to work, it’s challenging everything I ever thought about me and my health. It’s almost like saying the logical and natural behaviour that I’ve demonstrated over the last five years has been (although logical and natural) misguided. I’ve taken the path of least resistance to reduce my anxiety levels as quickly as possible (ie by running away) and by trying to keep myself safe, I’ve perpetuated the problem.
When I kept saying during my benefits appeal that I knew I needed to be in a positive place mentally to do this, I was spot on the mark. To challenge my innermost instincts – ones which have dominated my life for the last five years – is incredibly hard. The therapy is also challenging why I do certain things, and the way I do them. A good example is this blog. Why am I writing it? Is it because I want to give an insight into my experiences (as I’ve always maintained), and to put my thoughts and feelings into a tangible form, or is it because I need validation, or a platform to say “look at meeeee!” J doesn’t make these assumptions, just gets me to think about everything differently. I’m trying to take these comments on board in the spirit in which they are intended – just thoughts thrown out in the air to make me think – but there’s that little bit of paranoia in me that says “where did that come from? he must have thought it to say it, so maybe that’s what he thinks of me – maybe that’s what everyone thinks of me..” But then J has also queried my need to not be judged and my need to know that people like me, purely in the respect of getting me to ask “what does it matter what other people think?”
I suppose I’ve always been that way. Doesn’t everyone have some degree of desire to be loved and appreciated? I believe it’s a rare person who can go through life with a steely “don’t give a fuck what people think” attitude, someone who’s so confident in themselves that they never ask for an opinion. We all have insecurities some are just more prevalent than others. I know my family history has a lot to do with it, and without going into detail, I guess it’s become habit that I seek affirmation in what I do.
However, this is not why I write this blog. Okay, it’s nice when I get messages from people offering cyber-hugs and support, but to be honest, if I have a bad time I have a small circle of friends online who I know I can always turn to. I don’t write a blog that may or may not be read so that some random stranger might feel the urge to write and tell me it’s going to be okay.
This entry has gone in a totally different direction to what I originally planned. I was going to write about the thought processes of panic, and what J is suggesting. I guess this whole validation theory has got my back up more than I thought. Oh well, at least I have a topic in mind for my next entry.

They’re off again…

Yesterday morning, I caught a snippet of BBC Breakfast News where a guy was talking to a nice lady who’d been on disability benefits then retrained as an AA repair person. I didn’t see it all, so I apologise if I’ve missed something crucial in this. Later, I searched the BBC website for the story. It took a while, but there it was, nestled on the side of the page. Unfortunately, it seems to be a rehash of something that was published a few months ago, and contained little further information, aside from “it’s happening”. At the time, I wrote about it, and got a couple of emails from people who were scared that they would end up losing benefits because their health meant that they couldn’t attend training etc.
Yet again, the government is trying to pidgeonhole people with disabilities who are on benefits. Making everything black and white, accountable, measurable. As I’ve shown previously, even just looking at people with mental health problems throws out a myriad of symptoms that cannot simply be assessed with yes or no answers. This whole idea of work based training means that there is every chance that someone who can’t manage that training because of their health problems will be seen as not even trying. They can’t even get doctors who correctly assess benefit eligibility, so who exactly is going to assess the appropriate-ness of a particular training course? How will that assessment be made? Will it count that I’ve managed to teach myself html, css and the like? Or would I be sent to do some basic mundane thing, because the general impression of mental health clients is that they’re stupid? Will it make people’s health problems worse, because the Benefits Agency can’t possibly be expected to understand all the little nuances of their claimants mental health condiditons, and could technically send someone with OCD to work in a dirty garage?
Plus, would job based training end up being like the vocational training courses of the late 1980’s and 1990’s? I did one of them – I got paid my unemployment benefit plus £10, and worked full time for a year. I did it to get work experience in the field that I was interested in at the time, but when my colleagues were getting paid three and four times as much for doing exactly the same things, it seemed that many of my VT peers were doing this because “the dole office said so” or as a last ditched attempt to regain some of their employment dignity at a time when jobs were scarce.
We shall see. I have often said that if the government put more money into mental health services, and accepted that healing from past traumas etc takes time, it would be much better. People can wait up to two years to see a clinical psychologist, and getting to see someone you ‘gel’ with, and learning to trust that person can take a hell of a lot of time In the meantime, my experiences so far of dealing with the Benefits Agency have left me feeling incredibly anxious about all this. I have already proved that it isn’t the case that “genuine claimants needn’t worry”…
More info on epolitix. (which I can’t look at, because I just want to smack Hutton’s smirking face, and might break my monitor…)