Iatrogenesis

Iatrogenesis

I know I’m not the only one who dreads a visit to the doctors. I generally dislike GP surgeries, although I’m not phobic of them in the way I am of hospitals, but it isn’t the sitting in an overly-warm badly decorated waiting room surrounded by sick people, or even the mind boggling rudeness of the average receptionist that fills me with dread. It’s the fact that I always, always end up feeling worse upon leaving than when I went in.

I’ve been consulting my GP (ha! Actually many because it is a group practice and I have never successfully managed to book successive appointments with the same doctor), primarily about the significant weight loss I’ve undergone over the last year. I am now underweight by some margin and look and feel like death. I’ve had a bunch of blood tests to rule out anything nefarious and thankfully, my body doesn’t seem to be the cause: I had been worried that my thyroid had been playing up again. I stepped on the scales again and my weight was the same it had been four weeks ago – that it hasn’t gone down further is a reassuring sign.

While that is a relief, it also means that my weight loss is tied to either my anxiety, or breastfeeding, or most likely both. I have been calorie tracking and I do eat ‘enough’, but probably not enough if we factor in lactation and the high metabolism that comes with anxiety. 

I have been receiving CBT with an aim to challenging the anxiety and OCD since June. I will probably only have one or maybe two more sessions. My PHQ9 and GAD7 scores show that I haven’t made significant progress, and while the tools I have been learning (or rather relearning as I’m no stranger to CBT) are useful,  they haven’t made a big difference yet. So I ask my doctor, what can we put in place for when these sessions end? 

His response was firstly to explain CBT and anxiety to me like I didn’t understand what I had been experiencing, and then summed up by saying that I had to wait until I had a crisis and then request further therapy. I pointed out that I have two very young children and that I was not willing to let myself get to that point, especially keeping in mind it had been a six month wait to get this lot of therapy even though I was supposedly a high priority patient. 

‘Hmm’

I sigh and bite the bullet – does he think it would be sensible for me to perhaps restart on an SSRI? I had not taken any since being pregnant with my second child, but now she is well over a year old I have less misgivings about potential effects on her. Oh yes! That’s a good idea (it was by this point clear he’d not actually looked at my notes at all, and knew nothing of my long history with mental illness or even if I was taking medication). He then tried to put me on a different SSRI than the one I had taken successfully before but I managed to persuade him to stick to the old drug as I know I have almost no side effects on it after the initial few weeks. 

When I ask for a note to send off to the DWP to make sure my ESA payments continue for the next four weeks, he pouts, and doesn’t look me in the eye for the rest of the appointment. He requests I book another appointment in four weeks to assess the SSRI dosage. He doesn’t say goodbye as I leave the room.

At no point did he attempt to make any kind of human contact. No, how are you? How are you finding it? What are your worries? How are your kids? A prescription and an instruction to call the crisis helpline if I relapse further once my therapy is cut off. 

I left the surgery feeling like the biggest pile of shit. I was more convinced than ever that I was somehow going to have to fix myself because no medical professional (therapists not included) I have seen has seemed remotely interested in my actually getting better – they just want me out of their hair. It’s like they know it’s hard, that it’s outside of their comfort zone, so they don’t even extend the courtesy of trying. Take the pills and bother the non-existent MH team. This can’t be because they don’t care. I think they are probably good people. But because they know there’s fuck all they can do they just put a barrier up to protect themselves. 

But it left me feeling entirely worthless. Like I was totally on my own. I’ll take the meds but I know from before they just leave me pretty vacant – they don’t alter my thought patterns or anxiety symptoms. If I’m hung out to dry with no access to further therapy I am really scared about how I’m going to get through the winter.

This isn’t a competition…?

This isn’t a competition…?

It’s been a difficult few days. Not in the grand scheme of things, there’s no war, famine or pestilence, but certainly they could have been better.

Firstly my eldest has been ill. Only a cold, but it’s knocked her little socks off and given her a high fever and made her very out of sorts. Three days in and the baby is also snotty and miserable. None of us have had very much sleep. Apart from their dad that is, who can sleep through anything and has been happily snoring away in the other room while I deal with two snotty, radiating and squirmy babes.

Secondly my dad, who I’m very close to, got some bad news from the DWP. They’ve cut his welfare payment by £100 a month, despite him having COPD and mental health problems. So as a family we’ve had to do a lot of consoling/problem solving/reassuring to try to figure out how we can ensure he has enough to eat and a roof over his head. Fuck you DWP.

Thirdly, my partner and I have started couples counselling and as expected, it’s brought a lot of stuff to the surface that has been bubbling away. My constant stream of intrusive thoughts now have additional ones that seem harder to dismiss: “Are we going to get through this?”, “Are all our problems my fault?”, “God, he’s such a bastard” etc (spoiler alert: he’s really not a bastard at all).

My tentative steps towards adequate self care measures (eating/sleeping/doing stuff for me) have gone out of the window and I’ve been navigating the last few days through a fug of extreme tiredness and malnourished hyper-awareness and anxiety. Those sound like they should be mutually exclusive states but trust me, they ain’t.

Today when I was walking my girls back from feeding the ducks, my eldest (who is finally on the mend) was dragging her feet and insisting she take her coat off. I was thinking about money problems and how pathetic it is that my partner and I can never talk about the subject properly. I could feel my temper rising and I tried to cajole my daughter gently through gritted teeth, but I was aware I wasn’t being as calm and understanding as I should have been. I had the thought that my kids would be better off if I just handed them over to my partner. Then they went something like this:

“They’d be much happier with him, he’s very calm and patient and better with them than I am.”

“And then he’d see what it’s really like having to deal with two under threes twenty-four seven”

“No he wouldn’t: he’d go back to his mum’s and make sure he had his family around to help. He’d get off Scott free.”

“Plus, that’s what he wants anyway. He’d give anything for it to just be him and the girls. He never wanted to be the breadwinner and he resents me being the one at home. That would be letting him win.”

What. The. Actual?

Letting him win?! Is this a competition? Is that actually how I feel? That somehow I’m being unsupported because I’m being set up to fail? Could that possibly be true or is this just the ravings of a mind existing off two hours sleep in forty eight hours and half a packet of fig rolls? 

It’s certainly given me something to take to therapy next week anyhow…

A rambling note to self 

A rambling note to self 

I am pissed off because I’m tired.I’m tired because I have been ‘working’ – either managing a household, caring for one or more children, actually working a job, or all of the above, every day for the last three plus years. I have not slept for longer than four hours in that same period. 

This makes me feel resentful. Resentful when my partner goes away for days on end, makes his own schedule, books himself a massage, takes a nap…

I’m told I should put myself first. I should take rather than wait to be given. But I am hamstrung. Hamstrung by poverty and economic dependence. Hamstrung by anxiety that makes me feel I have to constantly be in control to mitigate against risk I see everywhere. Hamstrung by depression which tells me I’m not worthy of the things I want or feel I need. Hamstrung by my beautiful children who cling to my body and demand it’s presence twenty four hours a day. Hamstrung by the bullshit Disneyfied  notion of romantic love that tells me that those who truly care for me would put me first.

I martyr myself but no one lights a candle in a dusk vigil – instead I just wear myself down into dust while my family look on, concerned eyebrows and tight lips. They mutter that I am ‘difficult to look after’, excusing themselves. They acquiesce to my ‘irrational’ demands for some semblance of order, cleanliness, predictability and calm. With a roll of the eye and a sigh of frustration which further underlines my own feelings of inadequacy and unlovability. That’s probably not a word but it works well enough.

I wait for rescue: either the rescue by my sometime lover or the guts to rescue myself. I second, third and fourth guess myself – are my fantasies of escape and autonomy purely selfish dreams that risk ensuring I never achieve the inevitable humdrum resigned contentment of marital union all others see as their lot? Do I have to continue to strive alone for a relationship where communication is open, forthright and honest and basic needs mainly met? Can’t I cut my losses and just build a life where I am answerable only to myself? Where my head might stop echoing with my own screams? Where I could put others concerns aside and just focus on what my children need, and what I need? I live in frozen fear of repeating the mistakes of my parents, existing in my own head and making myself ill while my children try to figure this world out unguided, but realise in my efforts to escape that fate I’m already living it. I problem-solve all day – unsolvable problems, nonexistent problems, potential problems, crucial problems within the confines of my skull but when I open my mouth to spill out the answers I’m silenced by the sight of the cogs whirring behind his eyes: he is figuring out his own solutions. His own not ours. I feel I know this for certain despite zero evidence. Our conversations hover around music, poetry, religion and the ‘state we, the world, are in’. Nothing of substance is said. We are nearly always in agreement. Never arguing.

The dangers of ‘self-help’

The dangers of ‘self-help’

I don’t tend to go in for self-help books. My preference is to read up on things from the point of view of the professional; the therapist, doctor or academic. Even when I was an out-patient in a psychiatric hospital, attending twice-daily group therapy sessions for months on end, it took me a good fortnight to realise that I was just as ill as everyone else in the room (I had been sitting their feeling like an ethnographer, not a fellow-patient). This tendency to pretend I’m the expert rather than the sufferer is, I’m sure, excellent evidence of ‘intellectualisation’. Ho hum…

My partner, on the other hand, has purchased many well known self-help titles over the years. He invariably fails to read them, but they sit there on the bookcase. Over the last year I’ve flicked through a few of them, but this week I read one through cover to cover in 24 hours (no small feat when you’ve a toddler and a baby hanging off you). This book grabbed me. It’s over twenty years old and has a terrible cover, but by the end of the preface it had already spoken some truth to me and I was eager to read more.

I won’t name the book, but it’s one which usefully breaks down patterns of thoughts and behaviours into several types, suggests route causes (usually from childhood), typical manifestations and issues each one might cause, and explains how someone afflicted by these might overcome them. These include cognitive exercises, behavioural experiments, inner-child work and flash cards. 

I’m sure the authors intended the book to be one which spurs the reader into action, inspired by the possibility of change and the feeling of empowerment which comes with doing better for yourself. 

By the time I had read the last page, I pretty much collapsed into a heap of despair.

I could see elements of myself and my own issues in nearly every one of the types described. I had been reminded of previous traumas, personal failures, and current self-defeating behaviours. I’d experienced flashbacks to painful childhood memories. I was filled with anger, sadness and an overwhelming sense that I was doomed to be stuck in a perpetual cycle of fucking up. I felt physically ill. I had no idea what on earth to do with all these feelings that were threatening to completely drown me.

I am lucky that I am receiving therapy, however my therapist is on holiday for the next two weeks. I’ve done my best to talk through some of what I’ve felt able to share with my partner, who is always an empathetic listener (he was a fellow patient in those group therapy sessions many moons ago). I’ve made plans to sit my parents down and lay out some of the memories that have floated up to perhaps achieve some kind of *shudder* ‘closure’. But I’m still left feeling intensely vulnerable and even more dispirited than I was before I picked up that book.

So I guess this is a caution. Be aware that, even the best intended books, or blogs, or podcasts or whatever, can come just too close to home when you’re already in the grip of the big black dog. Be sure to brace yourself for the potential repercussions. Try to have your support network there around you already. Because I know that if I didn’t have my partner and my beautiful girls with me, if this was ten years ago, that book would have had me straight down the local off-licence for a box of wine and I would be in the middle of a major self-pity-wine-crisps-and-Marlboro-soaked-binge. 

Motherhood, containment and emotional contagion

Motherhood, containment and emotional contagion

You might have heard the phrase ’emotional contagion’ bandied around from time to time. It’s a phenomenon that you’ve probably experienced to some degree or other. Sharing a space with someone who is experiencing an acute emotional response (i.e. happiness, anger, fear) can trigger that same emotional response in you. It’s hardly surprising if we consider that we are effectively herd animals. Being attuned to other’s emotional states can help us predict their behaviour and perhaps by experiencing a little of what is going on in other’s minds can motivate us to try to problem-solve it if it is a ‘negative’ emotion, or enjoy it if ‘positive’.

Some people are more clued in to other people’s mental states than others. You might know someone who doesn’t seem to be able to emotionally read other people at all, and another who super-sensitive. Interestingly, this normal human skill seems to be heightened in mothers, and a recent study has shown that a woman’s brain actually reshapes itself to accentuate this skill during pregnancy, with the changes still visible on brain scans two years after giving birth. When you think about it, this makes perfect sense. A baby has no way of expressing its emotional needs other than by wailing its head off, and if you’ve let it get to that point, it’s already quite distressed. So instead, mothers (and it is mothers, fathers in the study showed no grey matter changes) have to be clued in to extra-subtle cues that the baby may give so that she can keep it safe and well. She is effectively mind reading, and experiencing some of her infant’s emotions as her own. This part of her brain works overtime until her infant becomes verbal and starts to be able to identify and articulate their own needs, which is usually around two years old.

On top of this, a mother also has to ‘contain’ her baby’s emotions. We know, even as adults, our own emotions can be overwhelming. Anyone who has ever held a screaming baby knows that the intensity of infants’ emotions can be overwhelming both for the infant and the caregiver. The caregiver has to keep their own emotional state in check and also take on those of the baby, ‘holding’ them within themselves, to allow the baby to eventually be soothed. This is exhausting work, as any parent, or anyone who cares for children or vulnerable people knows (‘containment’ is not a phenomena solely of the parent-infant dyad – we find it in many relationships and it is often discussed in therapeutic relationships).

I’ve been familiar with both concepts for some time, and have always been someone who might be considered on the ‘sensitive’ end of the scale. But when I read the study above, something really ‘clicked’ for me. During my recent period of mental illness (which started during my second pregnancy and is now starting to peter out approaching my youngest daughter’s first birthday), I began to really, really struggle with anyone else’s emotions. I would get irrationally worked up if anyone was experiencing anything that might be perceived as negative. My partner being tired after a hard day at work, or my toddler’s frustration that she couldn’t figure out a particular jigsaw puzzle, would send my anxiety sky-rocketing. Coming upon someone experiencing a major issue, say a visit from my mother while she was experiencing depression following redundancy, would send me in to full blown freeze mode where I de-personalise and de-realise and would have to withdraw.

I would (internally) rant and rave and be genuinely really fucking outraged that these people had the audacity to not be 100% content all the time. I perceived any discomfort they experienced as a criticism of the care I was giving them. Another thing for me to have to ‘fix’ to add to my teeteringly high to-do-pile. And I already felt I was running on less than empty. I was effectively angry at the people I loved for being humans and not robots. This used to just fuel my self-loathing – what the hell was wrong with me? Why was I such a selfish bitch? But reading that study helped me realise perhaps I could blame the process of pregnancy and early mothering itself. My brain changed and left me like a huge satellite dish. I was so attuned to their emotions it hurt, because I didn’t have the internal space left to contain them alongside my own, and so I just broke down further.

I am thankful that my youngest daughter was, from day one, a pretty chill and content baby. She has a serious pair of lungs on her when she is upset, but 99% of the time she is smiling and amiable. Family, friends and strangers alike comment on her sunny disposition. I wonder how much of this is just innate in her, and how much is because I was in such a state of nerve-stretching hyper-awareness when she was very small that I was actually very good at reading her cues and responding. Maybe these god-awful months of illness have had one positive outcome.

My recovery from this bout of illness is ongoing. I am working hard in therapy and in my day to day life to try to tackle my anxiety, phobias and OCD behaviours specifically. But I still really struggle living with other people. I have to constantly check in with myself if I notice a bad mood coming over me – is this my shit? Most of the time I’m still not sure – it feels like bad TV reception or fuzzy radio static. And I sometimes dream that I would get a lot better a lot quicker if I just took myself and my kids somewhere remote and could get a clear signal. But if the science is anything to go by, things should start to return to something approaching normality in another twelve months. So perhaps I should hold out in society just a little longer.