Ellen has been a lifesaver to me. My psychologist, advocate and supporter for the last five years since I moved back to my hometown, but she had been my psychologist before that for some time too.
It is such a relief to have real continuity. Not having to explain everything to a new professional, who is either eager to put their own personal stamp on your diagnosis or strategies for wellness, so that you have to conform to yet another approach’ to get along and to be seen to be trying, or consigning you to the no-hoper cases and giving little time.
Ellen listens. And I talk and talk. And Ellen interrupts me and tells me her perspective and what she thinks. But she’s reached this point by working hard to show me I could trust her. I’ve probably known Ellen for 10 years.
It’s been a long road to building trust. Before my free fall, why didn’t any of the psychologists and psychiatrists I saw for depression have no inkling? Why, despite generally complying with my medication, did I go down the revolving door path? Despite interventions, programs, changes in medication and diagnosis, why did nothing improve? I lost a lot of trust in health care professionals.
Most professionals I’ve encountered are respectful and kind, but in the public health system, professionals are limited resources in a financially constrained system. Luckily Ellen has so far managed to stop me from being flung into that impartial world again.
Ellen knows I am committed to being as well as I can be and manage the symptoms that will be with me for life. Ellen is committed to getting me there. I’ve come to know and trust she’s committed to getting me there.
As I said, it’s been a slow road, this trust.
Because of continuity of care, a psychotic episode unfolded in front of Ellen and my psychiatrist at the time, rather than presenting to an emergency psych ward where staff don’t know me and it is incredibly difficult to tease out personality from illness.
Ellen, from seeing me regularly, was convinced I was having a manic episode although I reported feeling dreadfully depressed. For both Ellen and the psychiatrist my symptoms were classic mania:
• grandiose beliefs
• inappropriate irritability
• pressured talking
• marked increase in energy
This was the first test for our therapeutic relationship. But Ellen suggested it gently as a possibility. Even this challenged my whole sense of self. It felt easy to blame her for suggesting a wrong diagnosis, that she couldn’t understand how awful I felt. Questions that went round my head were: how can I know myself so little? People said I had such good insight – were they wrong? How can I feel so dreadful if I’m manic?
Because of Ellen’s hard work to build the relationship with me, and skills I worked on in DBT with her, I decided to reflect and suspend my disbelief. Because of my trust in Ellen, I made a leap of faith.
Here is another instance where trust enabled me to try something different. I had an abhorrence at the thought of taking lithium, but I re-evaluated the situation with her guidance, whereas I flat out refused previously. I finally went on lithium after Gracie was born.
Because Ellen was convinced of a bipolar diagnosis, it was her advocacy that kept me in continuity of care, but also meant I eventually got a therapeutic level of lithium. When the lithium levels had an immediate effect on my symptoms I think I finally became convinced that I had bipolar. It took a long time to be prescribed a therapeutic level of lithium by psychiatrists who had not seen me in a manic state.
But I still could not understand mania in my experience. It was only as I did research for my blog that I came across mixed episodes and it finally clicked.
Most people with bipolar usually experience the highs and lows over time but a person who experiences mixed episodes “experiences symptoms of both mood “poles” – mania and depression – simultaneously or in rapid sequence.”
“This may seem impossible. How can someone be manic and depressed at the same time? The high energy of mania and with the despair of depression are not mutually exclusive symptoms, and their concurrence may be much more common than people realise… mood episodes with mixed features can last from days to weeks or sometimes months if untreated. They may recur and recovery can be slower than during episodes of “pure” bipolar depression or “pure” mania or hypomania.” (Www.webmd.com)
I’d like to look into mixed episode bipolar in a future post.
I passed my thoughts by Ellen and she agrees. This confirmation, by someone whom I felt, could understand me and my mental health more than myself at some stages, renewed my confidence.
Maybe I can understand myself again. Understanding the symptoms to look for, for myself and those close to me, and how to manage them, is a win.
Of course, we need my psychiatrist to agree to give the official diagnosis, but it resonates for me in a way previous diagnoses haven’t. This has taken about 20 years.
Ellen has gently held my hand to come to terms with less comfortable aspects of my symptoms and personality traits, and the way they have impacted on previous relationships and roles. It’s hard to accept the loss due to my destructive behaviour as well as my deep lack of self-confidence. It’s hard to embark on a journey of self-discovery. But with it comes power.
I thank Ellen for helping me through this emotional minefield and perhaps getting me closer to emotional stability than I ever have had in my life. She’s done it with kindness but also with determination and clarity where necessary, challenging my underlying assumptions, ruminations, obsessions and beliefs. I certainly haven’t always been grateful for being challenged in this way, or initially accepting of it.
When I first discovered I had depression, in my late teens (although I had suffered it all through high school), I read everything I could on symptoms, recovery and meds. When I first had psychosis I felt out of control. The medicalisation of my symptoms felt alien and I shied away from substantial researching about my illness. Reading the side effects of tablets, and all the other complexities of medications, including the varying effects on individuals – I threw up my hands and left it to the professionals to do their job. So I’ve been a very passive patient in many ways.
But recognising I have mixed episodes makes me feel somewhat more empowered.
And now Ellen is letting me know the end is in sight for our relationship depending upon greater stabilisation of my mental health. She’s giving me pointers for being more proactive so that I can be an active participant being fully knowledgeable of my own condition and what treatments work for me.
It will be very sad, and I am feeling very apprehensive, at no longer seeing Ellen. However, I feel I have turned 360 degrees, from a place of complete loss of self to having hope for my future as well as that of my daughter, largely due to the help of Ellen.
Thank you, Ellen. You’ve been such a great support, challenged me and given me faith in myself. Big hug. Xx
Australia’s Mental Health Commissioner, Ian Hickie, has pointed out the community mental health system remains underfunded despite increases in mental health related funding. This was reported in The Guardian, 2 February 2017, Mental health funding ‘locked down in dysfunctional hospital system’.