Featured

First blog post

This is the post excerpt.

Hi! My name is Rachel. This is a meandering story of my life with type II bipolar disorder, borderline personality disorder, eating disorders, attachment trauma, surviving sexual violence at the hands of a number of men as well as an intimate partner, and the difficulties associated with identifying as an asexual lesbian romantic (that is, I fall in love with women and want to – eventually – spend my life with one, but I don’t want to have sex with her).

Much of what I write about in this blog is known only to my best friend and my team of psychiatrists, general practitioner, dbt therapist and psycho-social therapist. But something makes me want to share my story more broadly so I am keen to write about it for you to read too. I don’t want my family and more distant friends, exes, work colleagues etc to be able to identify me so excuse me for posting a pic of my gorgeous cat instead of myself. He’s a big part of my therapy and right now is asleep on my lap as I write 😌. It’s magic.

Rather than give you a detailed account of everything that’s ever happened to me in a linear way, I’m going to write in themes related to my illness and my life experiences, sometimes briefly and sometimes in detail. As I write about contemporary experiences I will be able to provide more specific details of my thinking and behaviours and of what my team has done in response. Sometimes I’ll state the impact of their response on me, and sometimes I won’t remember so will leave it out. I’d prefer to be accurate and have holes in my account than give a full-but-incorrect account. I’m sure you’ll understand.

How I felt after I told my therapist about my ED

I feel like you must hate me. I know what I told you last week makes me a bad person. I hate myself for it. I hate myself in general. I’m weak, I’m awful, I’m lazy. I’m also scared. I’m scared of being forced to eat something and I won’t have my toothbrush or be able to get to a bathroom or something will prevent me from vomiting. 20 mins after eating is the ideal time to vomit, but what if I have to wait half an hour? What if I mis-time it? How much of the food will I absorb? Will that mean the scales won’t go down the next day? What will THAT mean? I’ll feel terrible. Ill die. I feel scared when I eat big amounts of food. But I don’t binge in the traditional sense, eating a regular meal, like a sandwich, makes me feel like I’ve binged. I also feel scared with small amounts of food- like a couple of berries or an egg. Sometimes I skip meals because I’m too scared that I won’t be able to vomit effectively. What if there isn’t enough food to come out? What if I’ve already digested it? And sometimes I don’t want to vomit because it can be a pain for only small amounts of food so isn’t really worth it. Other times I feel too terrible to eat- like the way I did last time I saw you.

I plan my day around being able to eat by myself – not necessarily in secret, but alone in cafes where no one will challenge what I’m eating. I have a good brunch food to eat with friends – eggs – they’re soft so they come up easily and the bit of protein I absorb sustains me through the day. But I don’t really have good lunch and dinner food. Being able to get to a private bathroom is also critical for me. That way I can take my handbag with my toothbrush in it and vomit without anyone else hearing. When my parents were staying with me I relied on Dad having the tv up loud after dinner, putting the fan on in the bathroom and running the tap to drown out the noise. They didn’t suspect anything. It will be harder over easter – I’m going to Uluru with my parents and am sharing a room with my mum. What if she hears? We’re having dinner one night outside and there may not be any bathrooms – what will I do? Will that be the start of the return to my previous eating habits?

I vomit after every time I eat because I’m scared of not. I’m scared about letting myself eat a couple of berries or some vegetable because it feels like a slippery slope to eating a big amount and not vomiting or to eating like I used to and getting further away from my goal.

I’m also worried about my latuda dose. I take 40mg but it needs to be taken with 300 calories. I’d barely consume that in a day, let alone in one meal. Now that my mood is stable I don’t want to upset the medication balance but am too scared to talk to A (my psychiatrist) about this to get advice on whether I increase the dose to 80mg to compensate for not having the calories to absorb the meds with.

Sometimes vomiting makes me happy. Especially when it’s brightly coloured – like after raspberries or blueberries or blackberries. It’s pretty. I imagine after some gelato flavours – like watermelon – would also be bright and pretty and make me happy too. Eggs are boring but it’s such a good food – it ticks all the other boxes so I’ll have to push through. Sometimes it’s difficult though – it hurts the back of my throat, I push the back of my throat hard with a toothbrush 9-12 times a day. It feels like it’s bruised. On the pro-Mia sites, contributors talk about being able to vomit by tensing their stomach muscles. That would be amazing. I feel like people will become suspicious of me carrying my handbag to the bathroom 20 mins after eating every meal.

You asked me why I was telling you when I told you. I’ve reflected on this and know I didn’t provide a very compelling response. I feel like that question had two parts – why YOU and why NOW. I can answer you better now. Why you – because I thought you’d take me seriously and you’ve believed other things that I’ve told you in the past. And I needed someone to listen to me while I organised this in my head. It feels chaotic and incohesive. And if I tell my GP she’ll try and change me; I don’t want to worry my best friend; I’m not sure how A (my psychiatrist) will respond – he might try and change me too and I don’t want to change, I’m happy on this path. And why now – because making a public commitment is more likely to see me reach my goal. If I’m the only one who knows about it I can become weak and give in. If you know, you’ll expect my body to change so it’s incentive to keep going. I have to keep going so you don’t think I’m weak. It’s like an accountability method.

I’m also addicted to weighing myself. I’m still only doing it once a day. I’m scared to weigh myself at the end of the day – what if I’ve gained weight or haven’t lost as much as I thought? I love watching the numbers reduce. It’s addictive and rewarding. Sometimes I lose 1.5kg over night. I know a lot of this will be fluid but some of it must be fat too. It’s so satisfying when I drop into the next number bracket.

I’m looking forward to reaching my goal. I feel like then people will accept me and I won’t have to feel ashamed. I feel like my life will be better. I won’t be judged. I won’t feel guilty. People will like me. People will love me. I’ll be a better person. I’ll be smarter, stronger, harder working. I just need to stay strong and focussed.

You asked me about the hunger, and the reality is I don’t really feel it much. It’s like a switch has flicked inside me. I feel so disconnected from my body. This is bigger than me. I’m not in control. I feel too guilty to eat, and the vomiting is automatic. Not like it happens naturally, but in the way that I walk to the bathroom on autopilot after I eat and push the toothbrush down my throat. I also think because this isn’t pure restrictive eating that I’m able to control my hunger better through satisfying it – it’s the perfect balance – in the past I’ve only been able to fast for 5-6 days. That’s a hard way to go. Even in 2016 when I lost 30% of my body weight in 6 months I nibbled on small amounts of food once a day. This time I am eating, it’s just small amounts and then I’m vomiting. I don’t think I’m vomiting it all, maybe 30%. I feel ashamed to admit how small that is – some girls spend half an hour in the bathroom vomiting til it’s all gone. They have complex systems of marker foods etc. I don’t have time for that. Maybe I’m not as committed as them. Maybe as I get closer to my goal I’ll need to do that, but right now what I’m doing is working for me. My theory is if I restrict AND vomit that will give me the best chance of reaching my goal. It isn’t the fastest rate – the fastest rate would be to go full restriction, only eating once every few days. But this is sustainable. I still get to feel satisfied, but the food doesn’t get a chance to get absorbed so I can see myself moving towards my goal. I also sip water and Coke Zero through the day, this way my stomach always has something in it. But at other times I quite like the hunger sensation. This is what it was like in hospital. I didn’t eat for days and it felt really good – made me feel really strong.

I’m really struggling with whether the amount I vomit is enough. If I eat 120g of raspberries (60 calories) for lunch, wait 20 mins and vomit twice, am I removing enough from my stomach to reach my goal? I wish there was someone I could ask who could provide technical advice. I can look on promia sites but they all refer to binges – like 2000+ calorie binges – and mine are max a couple of hundred (like when I eat eggs). I feel like I could ask a dietician but I’m worried they’ll tell me to stop vomiting and I’m too scared to stop. I don’t think I can. I’m scared of loosing control of my eating.

It also makes me feel really strong. Like when I eat with my colleagues and I lie about needing to make a call or go to a shop after and I go to the bathroom in the cafe across the road to vomit instead. When I come back and I know my stomach is basically empty but I’m functioning normally with my manager and my colleagues. I like this hidden part of me. I don’t want to share it with people. I like that people would see me as bright and bubbly even though I’m completely obsessed with avoiding my next meal and where I can vomit. It’s a strange, but addictive, way to live.

Exciting news: my first successful vomit!

Ive struggled with eating disorders my whole life. My earliest memory is of my mum explaining how weight is gained and lost (through exercise and eating) and I’ve been obsessed with body image since I was about 12. It was around then that I was weighed every morning by my parents in the kitchen and forced to explain why I’d gained weight. This was despite being in the healthy weight range. The result was the development of Bulimia – whereby I’d binge on food then purge through not eating/ fasting for days then binging again.

I did this for years and kept my weight in the healthy range (I was never super skinny). When I turned 17 I moved interstate and my eating became more regular (and I gained weight). I put on even more weight over the last few years when I was treated with olanzapine and seroquel which made me ravenous. I put on around 30kg in 10 weeks or so. I lost it all in a depressive episode when I couldn’t eat because I was so depressed but recently put it all back on.

Needless to say I’m miserable about the way I look, but I have really low self efficacy on the whole clean eating and exercising regime so I’m giving Bulimia a go again. This time with vomiting. And I just succeeded!! I ate salad, some lean steak and a banana for dinner and I just vomited the banana. Not a great effort but not bad for a first effort either. I’m addicted. All I want to do is sit in there and puke. But my parents are here and I don’t want to raise the alarm bells. I feel so good!!

My 2018 wobble: crisis admission, letter to psychiatrist and winning against the odds

I’ve previously written that 2018 heralded a year in which I thought I wouldn’t have a psychiatric hospital admission. That’s how well I felt. But on 15 January my mood took a turn for the worst and I was readmitted.

My day had started off well. I woke up to go to dbt, had a shower, put on makeup and got dressed nicely for my date that night. I drove to dbt and went to my regular cafe for my regular brekky – avocado and feta on toast with a soy latte. Yum.

I ate my brekky feeling well, then, like a cool change in the weather, my mood plummeted. I felt depressed and acutely suicidal and planned to kill myself at 5pm that day by taking all the prescription drugs I’ve accumulated these past 4 years.

Looking for a way to pass the time before my death, I went to dbt. But wasn’t my usual self. I wasn’t able to talk, smile, make eye contact, eat lunch. I just sat in the corner quietly crying. I left the group and sat in the foyer space and one of the therapists came and spoke to me. I told her my plan. She planned a crisis admission. I was admitted a few hours later.

My regular admitting psychiatrist, S, was on holiday so I was admitted under C. C prescribed my usual medication plus 30mg of olanzapine prn and put me into icu.

I spent a week asleep from all the prn, he was about to force an admission to the nearby public hospital for feeding by gastric tube and involuntary ect because I was refusing to eat and drink.

S came back from leave on Monday 22/1, took one look at me and said I wasn’t depressed, I was experiencing a borderline switch. My mood changed from one extreme state to another in an instant but would switch back just as quickly. She took me off the olanzapine and got me out of bed.

She was right. By the next day I was bright and bubbly, I’m back on the regular ward and attending group programs. I’m being discharged on 29/1 and going back to work the following day.

This time around I really don’t feel like I’ll be readmitted for a while. I’ve written S a letter thanking her perseverance these past 2 years:

Dear S

Apologies that I’m contacting you outside the professional context – I know you like to keep strict professional boundaries – but I really do want to say thank you for managing my inpatient admissions over the past 2 years.

I feel better – more calm, more in control, more content – than I ever have in my life. While I recognise my own role in persevering and putting in place strategies I’ve learnt speaking to my team and through dbt, plus the ect and meds, you’ve played a significant role in getting me to here.

You’ve nailed the meds and prescribed the right amount of ect and tms, and I’ve found the psychotherapy you’ve provided to be really helpful too. You’ve helped me glean insight into myself and identified particular aspects of my personality, developmental history and biochemistry that cause me to react to circumstances and relationships the way I do. I always feel safe when we speak because you are non-judgemental and compassionate but always honest, professional and have clear boundaries which I find really helpful.

As I said when I last saw you, I have a feeling I won’t see you again for a long time because I feel so on top of things, thanks for that.

Sincerely

Rachel

 

I’ve had to reflect on what triggered my mood switch. I think it was thoughts of my date scheduled for that night. My history of sexual violence has left me feeling vulnerable to other people’s sexuality. I’m torn though, I’m lonely and would ultimately like a relationship, but know that other people expect sex to be a component of an intimate relationship. I’m going to have another go at dating, I won’t let the three people who took this from me win.

Meeting my psychiatrist for the first time

This is a post all psychiatric registrars should read when considering how to build rapport with new patients. I experienced a manic switch about 2 days after starting pristiq. I switched from being hysterically, suicidally depressed to bouncing off the walls. I couldn’t sit still, I couldn’t sleep, I was energised, excited, engaged, I even wrote a letter to the drug manufacturer thanking them for curing my depression. I got out of bed at 4am, ran to the supermarket, bought ingredients to make pancakes and lemon curd, cooked breakfast for the house and then washed the windows. Days before I couldn’t stop crying, planning my suicide or get out of bed.

My GP had also prescribed diazepam – she said it was a precaution because in some instances people’s energy increases before their mood on antidepressants and they’re at a higher risk of suicide because they feel low but suddenly have the energy to act on their urges. She said to take the diazepam if I felt at risk. I didn’t feel at risk but I did feel out of control on the pristiq so I started taking the diazepam. No matter how much I took it didn’t have any effect on my hypomania. It was crazy.

At that point I was seeing my GP twice a week until we got on top of my “depression” so I saw her later that same week and declared that I was cured. I remember her looking at me, intensely, asking “I can see you feel good, but do you feel too good?” I had to admit that I did. She took me off the pristiq and prescribed a low dose of sodium valproate and made an appointment for me to see a psychiatrist to get a proper diagnosis.

She continued seeing me regularly until I could see A. My mood kept cycling rapidly. It was awful, up one day and down the next. My wife and mother in law were intolerant.

The day came when I went to meet A. I was anxious. I had to open up to a complete stranger and answer all sorts of questions about my inner world. I was also concerned that I wouldn’t know what was relevant and I’d waste our time. My GP had written in her referral letter that I was living with my wife and mother in law. I didn’t know how that would go down, whether he’d judge me or not. I remember him opening his door and my chest was pounding. What he did was perfect. He shook my hand, introduced himself by his first name, and asked me where I got married. I replied and he told me not to tell his boyfriend because his boyfriend wanted to get married but he didn’t. He was in a same sex relationship too! I felt immediately at ease. I asked him how long we had (90 mins) and told him he’d need to ask all the questions because I didn’t know what was relevant and what was superfluous. He said that was fine. As he conducted the consultation he listened, provided opinion, and concluded with a diagnosis and a new, more aggressive medication regime. At no time did I feel judged or humiliated. He was warm, compassionate, respectful, non-judgemental and professional.

I continue to see A monthly and he coordinates my care across my inpatient psychiatrist, S, (A doesn’t do admissions), my GP and my psycho-sexual therapist. I feel lucky to have someone so generous to be my psychiatrist.

Eating disorders

Growing up, my parents always emphasised my appearance (and weight) over all other attributes. They never discussed whether I was a good friend, a kind person, persistent and resilient, creative – any of the things that I think really matter. Everything came down to one thing: how thin I was and whether boys found me attractive.

I was always a pretty average size – around 55kg at 160cm tall. When I told Mum my bmi was in the healthy range she said that that was the health definition of weight, not the fashion definition, and I should focus on the fashion definition. She even took me to a dietician to get advice on how to lose weight. They also used to make me weigh myself in the kitchen every morning and explain why I’d gained weight if I had. I was humiliated and felt ashamed every day. At other times, Mum would suggest I look at myself in the mirror and criticise my body as motivation to slim down. To this day I can’t look in a mirror.

The impact was dramatic. I went through periods of not eating or binging on exercise, at one point I developed an 11 calorie diet – 2 pieces of celery and some lettuce was all I ate each day. At other times I’d fast and not eat at all. The pressure they put on me was terrible.

I knew it was the reason why I was so depressed as a teenager, but I was too ashamed to talk about it so just deflected any attention and questions about what might be triggering my mood.

Today I have the opposite problem. I eat too much and don’t exercise enough. I wonder if part of it is a sub-conscious decision to keep myself unattractive so I don’t experience any more unwanted sexual attention. The other part of me wonders whether it is rebellion against the pressure I felt as a teenager. I still hate my body and still struggle to talk about it with my team, even though I trust them and feel safe with them. It’s tough.

 

 

My history

I have a long history of mental illness. I was first hospitalised with psychotic features at 16. I’d been smoking weed with my friend and her brother, I’d had a small amount and although they were fine, I had hallucinations during which I watched myself jump in front of cars and die, for days. It was terrifying. I had the good sense to call my dad and he picked me up, took me home and to bed and the next morning my Mum took me to the doctor. My doctor was concerned so organised a hospital admission. With some medication, and time no doubt, I came out of my psychotic state and spent two weeks in hospital before being discharged to an outpatient cognitive behavioural therapy program.

Before that episode I’d had a history of mood swings. I’d always been an average student. I was engaged at school but more by the friendships and extra curricular activities I was engaged in. When I was 15 though, something came over me. I became focussed, driven, hard working. Stayed up late, studied hard, and pushed my marks up from the 70%s to the high 90%s. I did all of this while working all weekend, playing netball, swimming, doing gymnastics, drama, debating, Japanese. Everything! Retrospectively I think this was my first hypomanic episode. But who goes to the doctor saying they feel ‘well’ and ‘energetic’??

The following year, things became tough for me. I started feeling suicidal and displayed signs of depression. It must have been quite noticeable, my English Literature teacher pulled me aside one day and made a deal with me. If I went to my doctor and told him how I felt, she’d not make me submit my last essay for the term. I jumped at this and my doctor prescribed me Zoloft, he was also worried about my suicidal ideation so gave me his home number in case I was ever distressed/ suicidal and didn’t have any one else to turn to.

That was just before I was hospitalised. I initially didn’t tell my parents about the depression or Zoloft, but they found the meds in my room and I got in trouble for not being open with them (I didn’t feel like I could).

My mood fluctuated through my 20s but my approach to mental illness was to get help only when your mental illness interfered with your day to day life. And mine didn’t. I managed to keep on top of things, until about 6 weeks after I got married. It was at this point that my then mother-in-law told me that I wasn’t coping, was acting irrationally and needed help.

Getting a good general practitioner with an interest and understanding of mental illness was critical. I’d never met her before and I remember sitting opposite her saying “I have something to tell you and you need to take me seriously”. I remember how intently she listened. She’s been great ever since.

I remember having a ridiculous idea that I could manage my ‘garden-variety’ depression with fish oil and vitamins. She gave me 2 weeks and a referral to a clinical psychologist to feel better otherwise she was putting my on antidepressants. I came back later that week, hysterical, pleading for antidepressants. More on this in a later post.

Being admitted involuntarily

One of my worst experiences was being admitted to a psychiatric hospital involuntarily. It was two days before our first wedding anniversary and I was acutely suicidal I didn’t tell my wife, I wrote a note for my psychiatrist to read because I didn’t think I could get the words out. Here’s what it said:

Dear A

I don’t mean to be dramatic, but I’m becoming scared and confused. The things we talked about on Wednesday have been in my thoughts for some time, and are filling my thoughts more and more persistently now. The thoughts are obsessive and used to just prevent my sleep, but now they’re present during the day a lot too. I’d like to die. I used to want to cut my arteries in my wrists and watch the blood drain away. I’d fantasise that I’d be lying in a field of daisies and then the sun would come out, my blood would pump out of me and I’d finally feel at peace as I drifted into light. At first I was less clear on how I’d do it this time, but I had a sense of when. I started a timer last week – it works by counting each time I become focussed on dying, and sometimes I speed the timer if it feels right or if the focus is particularly intense. I’ll do it when the counter gets to 100, but the counter is cleared at the start of the new year. Right now I’m at 30. I was looking at my arteries this morning. They’re small. Perhaps slicing would be the best option? Every time I go to the disabled bathroom at work I think that would be a good space. There’s room, a drain and the door locks. I’m telling you because I’m scared. I’m also confused because I kind of like thinking about and planning it. Do you think that’s just because I’m just attention seeking? If I meant it id have done it?

I don’t know if I’m depressed. I know I don’t feel happy and excited by things. I know when to show happy and excited, but I really just feel terrible and want to cry. Mostly I just think I look awful and am stupid.

I have a sense of isolation and loneliness. I can’t tell family or friends because they’ll worry and stop trusting me. They’ll either think I’m seeking attention, the boy who cried wolf, or someone who needs constant monitoring. Do you think I am? I feel guilty telling you and my GP because you’ve done so much to help me that I don’t want to let you down. I don’t want to appear ungrateful. I’m not being an honest person, but its unfair to burden people anymore.

Although these thoughts are becoming increasingly intense, acting on it would be too unfair to my wife. They’re scary. I’m beginning to feel trapped between my thoughts and feelings, and my obligations to others.

I hope you can take this seriously and not be angry with me, think I’m faking it, or think I’ve taken my treatment for granted. Please don’t tell anyone.

Regards

Rachel

I was so unwell I couldn’t sit in the chair. I came into his room and sat on the floor, back against the wall. He sat opposite me on the floor too and read my note. He asked me to go to hospital but I refused, knowing my wife would be mad for ruining our anniversary. He asked me to sit in the waiting room, went and saw my general practitioner, and arranged an involuntary admission. That involved a trip to the local emergency department by ambulance, a nurse sitting with me all night to make sure I didn’t leave, and getting admitted to a private psychiatric hospital the next day.

My wife was furious. I’d lied to her about my mood and suicidal ideation and I’d ruined our anniversary. But I was too sick to know how to resolve the problem. I was admitted under an awful psychiatrist- he was old, out of touch, and I couldn’t develop any rapport with him. I quickly got myself off the involuntary list and organised to be discharged. The next week, feeling terrible, I went and saw my general practitioner and asked what to do. She suggested another hospital admission but I refused knowing how angry my wife would be. What a mistake.