And now for the mental health update. This might be even more fun than the last update, if that’s even possible. This one’s been a long time in the making, due in part to laziness and also the fact that it’s sodding hard to spend too long on this topic without overthinking in a less-than-positive way, so I’ve been trying to do it in bursts.
Before I start, I’m putting out a general trigger warning for mental health problems, food issues, self harm and suicide.
So, uni forced me to acknowledge that I’m struggling more than others seem to, partly because of the Asperger’s, and partly because my mental health made it damn hard, if not impossible, to do important parts of the course, and so I was having to work harder to keep up.
After a particularly frustrating conversation, the details of which I don’t have the energy to type out – and I’m sure you don’t have interest in reading anyway – I had one of my most productive slumps to date, and typed out almost 2000 words in an application form to Student Psychological Services, the university counselling people. I’m far better in print than in speech – which says painful amounts about my verbal communication skills – so I thought if I was ever going to get Proper Help, it would come from something I’d written.
Anyway, they said they would analyse the forms and get back to you with an appointment time within two weeks, but it was only two days later that they had an appointment for me. I went for my assessment – which was an ordeal in itself because of all the buzzers for entry and the announcing myself and all that jazz – and they suggested continuing appointments of CBT (that’s cognitive behavioural therapy, for those blessed enough not to have come across it before). I was, however, warned that they only do short-term sessions – a maximum of six – and would have to refer me on if I wasn’t cured within six weeks. So, unsurprisingly, I wasn’t hopeful. Maybe that was the problem. I don’t know.
So, after an encouragingly good start, in which I started to believe I was being heard for what I was actually saying, and not what they wanted to hear for ease of treatment, things went downhill quickly. Well, it would have to be quick, I guess, within only six sessions, but still.
We identified goals – shopping was the main focus, seemingly whether I liked it or not – and built up a hierarchy of difficulty; we went out together early on as she’d forced the issue. The whole time, she was asking me (loudly) about my anxiety levels, drawing attention to the problems I was having and – given that we’d agreed on a set amount of tasks to attempt – she extended the excursion much more than she was supposed to, cue freakout early on. We didn’t do that again.
There was a fair amount of drawing things out and faffing about with expressing rather obvious “revelations” on paper, when we could have been working on actually combating the problematic parts instead of highlighting them over and over again as if the key to “curing” my lifelong avoidance issues would be – gasp – knowing they’re there.
Generally, the whole set of sessions went badly, where I ended up avoiding more than ever before, and adding a new Avoidance Area – namely CBT sessions – to my list. Actually, to be fair, I didn’t miss any sessions, but my opinion about further treatment was quite radically affected for such a short-term fix. I felt patronised throughout; in fact, it was my Personal Tutor at uni who’s come closest to understanding this out loud, in terms of intelligence and insight and MH professionals’ expectations of service users. And here comes the rant…
I had worries about starting the most intense set of labs at the end of the second term, and during the session that we focused on that, we made a list of the things that could and could not be controlled, respectively.
This seemed logical enough to me, the List Maker from Hell, right up until I was cut off before I could list many of the “Could” items. From then on, the focus was on the “Could Not” items, which is fair for the purposes of, but then she tried to use the comparison between the length of the lists as reasoning to Let Go. Cue lots of dramatic argumentative points swirling around my brain – goodbye concentration on the present – and, of course, a complete inability to articulate them.
Then she suggested that I “don’t focus on the things you can’t control”. Round of applause for the Blindingly Obvious please. So I prompted her. “How?”
“You just accept you can’t control them.” Well, I’d never thought about just accepting before. Give that woman a banana*.
I never got an answer.
I’m hoping that my short experience of CBT was negative not because of the (validity of the) technique itself, but rather how well (or otherwise) it was practiced.
By the end of the sessions, she suggested I get on medication, and asked if I would be happy to be referred on for more treatment – this time longer-term, and on the NHS. I said yes, purely because I didn’t know what else I could do, and I had a first appointment with the New People a month later.
OK, this one was a one-off for transition-related purposes, but I’m including it because it ended up sort of splitting itself between gender and panic while I was there.
I had help finding the place and announcing myself (from an Awesome Person who continues to be awesome in my direction, Christ knows why I deserve such awesomeness, but I’m not complaining), and then I was led into a room by the most stereotypical psychiatrist I’ve come across so far. And that’s saying something.
NHS clinical rooms are just as depressing as you’d expect. More so, if you have the stomach to imagine it.
We did the usual routine questions, blah blah blah, and I misheard him – to my cringing amusement – several times, also routine for me, before we did The Gender History all over again. I think I’ll have it memorised soon enough.
Then it was social anxiety. Very quick-fire questions, to my surprise, seemed all that was necessary for an official diagnosis. Usually that would have made me nervous in itself, but I already had the answers ready – partly because the symptoms I was having to describe were right there, poking me, as I was talking about them. I don’t know if I already had a diagnosis of social anxiety, because the way it seems to work here is that each professional draws their own conclusions and says fuck all to their actual patients about it – not to mention therapists’ peculiar downplaying technique (depression = “low mood”; panic attack = “worrying” or similar) which I can only assume is meant to reassure the patient. Sure as hell doesn’t work for me.
Moving on. He said that social anxiety of that extent needs much more “intense” treatment, which equated in his mind to at least 18 sessions of CBT and at least 200mg sertraline (that’s Zoloft, by the way, an entertaining word to find excuses to say out loud if there ever was one) daily. And when I asked what I should do if none of it helps, he said they have a specialist unit that I can be referred to, and there are other options. Which I’d genuinely not heard before. By most standards, it seems to be CBT Or Nothing, which is of little comfort to someone who doesn’t think much of it.
Long story short, he said I was fine to be referred on, but it was only a month ago that I found out he hadn’t sent it when he was supposed to – in March – so my GP chased it up, and it’s finally now underway.
Although, a word of warning to anyone going through similar adventures, if you’re at all prone to self-consciousness or reaction to criticism, don’t read psychiatric reports about yourself.
[For me, it was both dysphoria-inducing (there was a section where my height – or lack thereof – acne and facial features were discussed; apparently I was “feminine, particularly around the eyes, but otherwise presented as a man”. Slightly concerning that most people he would be seeing on this basis wouldn’t have started T yet, and so their “presentation” being based on their natural bodily features rather than less permanent things is not exactly comforting, but still) and physically hard to stomach (the way these things are written have a tendency to make me feel ill, partly because they’re writing about me, partly because there will be others reading about me, and partly the sort of sterile form of writing used is often painfully abrasive). Just to add, ‘n’ all.]
I’m going to continue this in a separate post to save on brainspace and patience, and I’ll queue it to give you all a break. More gender updates also on their way.
*as my former German teacher would say. (She was awesome, just in case you wanted to know.)