Not being able to trust your reality

**trigger for talk of suicidal ideation**

I've been thinking about the places our minds can take us and how scary that can be. I sat an exam on Monday & Tuesday (it was in 2 parts), which went quite well actually. However 3 weeks earlier I felt trapped by the thought that I had to sit this exam, and was intensely suicidal, thinking that it was my only way out, as I believed that failing the exam was an inevitability. I wasn't sleeping properly at the time, and was using those extra awake hours to think about suicide, and was just generally in a bad place.

What changed? Well I reached out for help rather than acted on my thoughts, which was incredibly hard to do as I really wanted to act on them. Even though I've been struggling with intense thoughts of suicide on and off for several months, I still get a monthly prescription which is 4x the lethal dose of that particular med... It would be such an easy thing to do...

Anyway I got some 10mg amitriptyline tablets left over, which are really helpful for getting me to sleep, and the simple act of a few good nights rest buried the intensity of the feelings. From being a deer in the headlights, I could actually pick up my books and do an hour or so of revision a day (not much by anyone's standards, but all I can manage), and somehow that paid off in the exam, making me feel like I could answer the questions (time will tell if I actually answered them correctly!!)

I guess what I'm rambling on about is the big difference in thoughts - from 'I can't sit this exam and would rather die' to 'it's just an exam; just try your best' and it actually scares me that my thinking could have been so skewed and me not to realise. I'm a massive control freak and hate having to rely on others, and so to think that my thinking could be so 'off' is quite terrifying really. If I can't trust myself anymore and I don't trust those around me, then who can I rely on???

Anyway I'm just putting this out there in case if gives someone else pause for thought and to remind myself if (when) the suicidal impulse comes back again that I may not be seeing things clearly. And I guess I'm just reflecting on how scary the whole thing is; to look back and think how logical the decision to end my life seemed at the time



*Willow*

Hrm, that's interesting. I was most suicidal AFTER my exams. I wonder what the hell that's about?

I'm glad you're feeling better now, though Do you have any more exams left?

I know a bit about how you feel. A week ago I was considering suicide because of exams. I just didn't think I would be able to do it. But I have 1 finished, and 2 more to go, and I'm feeling quite confident about them now.

No, thankfully. The whole thing was ridiculously extreme anyway. The course was just to see if I enjoyed psychology so the exam doesn't really matter (though my self-esteem needs me to do 'well' or it will take a battering). My MSc offer for Sept is unconditional, so there really was no need to get so stressed about it.

Looking at it now, if feels like 2 different people, which is the bit that scares me...

*Willow*

I'm glad you're feeling better Gigabyte, and good luck for the rest of your exams!

*Willow*

Good luck, Gigabyte!

That's part of why it is important to me to have a T I can trust, so I can bounce ideas off of them when I'm not sure if I can trust my thinking.

That's what I struggle with ickydog. I don't have a T, although I've just got a new CPN (community psychiatric nurse) who I'm supposed to talk to. I just struggle opening up to people, and I also don't want to worry my family, and I'm terrified of ending up in the psych hospital.

I know that I should be able to trust my own family as I should know that they only want what's best for me...but I'm used to making all my own decisions. A few years ago I had psychomotor retardation and I don't remember much from it, but my parents swear that my mum slept in my room to make sure I didn't off myself in the night. I don't remember it and am convinced they're lying but I can't figure out what they would gain from lying to me about that. So I can't trust them (and I feel bad when I say that cos I know it upsets them).



*Willow*

I struggle with that, too. I can't ask my mother for advice with my problems anymore, because I remember the last time she had influence in my problems she used it to have me drugged beyond recognition. I would like to have a mum, I just don't any longer.

That sounds awful fish Sorry for the late reply, I just haven't felt like going online for a few days

I do wonder how my parents would react if I became unable to make decisions about my health...which scares me to death! My parents try to understand, but it seems to be outside their realm of experience and so incomprehensible to them (well my mum has had depression but never this bad, or for this long, or with voices/'delusions'). My parents would probably go along with whatever the doctors thought and I'd be drugged up to my eyeballs. I think they'd be unhappy about the effect but wouldn't know what else to do to 'help'... This is scary! Maybe I should look into some kind of living will so that they (the drs) couldn't do anything I wouldn't want......

*Willow*

Welcome back! How are you feeling? And how's that faaaabulous bag?

Living wills don't work/exist in the UK. And they really don't work for refusing mental health care. But you can look at an advance directive:
http://www.direct.gov.uk/en/governme...on/dg_10029429

But maybe you could write your parents a letter, or have a chat with them. If you were to be sectioned, they'd have the ability to make treatment decisions as your "nearest relative" (technically, the elder of the two would) and so if they know what you'd want, they could probably fight for it.

I spoke to my mother on Monday about some crazy people stuff, which she'll never understand but I think she's starting to get how harmful all the drugs were. She said that she "feels sick" about all the discrimination I get because of the label. For whatever reason, she also said she felt bad that the drugs made me really fat, but I'm actually thin and pretty when I'm not on (much) of them. Of all the things to worry about, eh?

Haha, I started digging around some more in the directgov website and I found a brochure that is called "What to do after death in England and Wales". Think they mean "after A death" or do you really think they wanted to make a travel guide for the afterlife??

I'm feeling pretty nauseated since stopping my med, but it's my own darn fault so I'm not complaining (much!) lol Hopefully it'll have worn off before I see my pdoc next week (If she tells me off and that I should've just 'eaten less and done more' I swear to god I will punch her in the face!!) Since stopping the meds though my appetite, especially for sweet stuff, has definitely chilled out and I've lost 2lbs this week - yey! I tried looking at all the atkins and paleo stuff but not sure how I'd fare without carbs (I need SOME junk food!) and it really isn't feasible whilst living with my family as they're big into carbs. So I'm just minding my calorie intake and cutting back the junk food, whilst still allowing myself a little treat everyday. But from 2wks ago when on imipramine and I physically couldn't stop myself from gorging sweet/junk food, I am now satisfied with just a taster which is a huge relief.

Living wills - as you can tell I'd done no research on it! Oops! Anyway I will check out advanced directives. My new CPN wants to do a new care plan with me (as opposed to my last one which was just done so they could tick the audit box and is a load of crap I never even said!), and I was wondering if there was a section in there about what you are and aren't happy having/doing? I'll have a look at my old one to see the template, but I don't think there is but there really should be. Psych is the main area where we may not be able to decide what happens to us, but they don't seem to push the fact that, when we are more compus mentus, we are able to put this kind of thing in writing... They probably don't want their hands tied though - ugh!

I do talk to my parents, well more my mum, about this kind of stuff. Like she knows I'm terrified of going into hospital and don't want ECT etc, but I know that she would override my wish to NOT go to hospital if she believed it was "in my best interests", and so I don't know what else she could be talked into 'for my sake' if you know what I mean...

I guess I'm worrying unnecessarily about this stuff right now because I keep having nightmares about being admitted to the psych ward and no-one listening to me and my parents just telling me "it's for the best" over and over. Scary stuff. The thought of that loss of control *shudder* Can you tell I'm a control freak yet?! lol

Oh and I went to have my hair cut yesterday and the hairdresser was blathering, as they do, and asked what I'm up to next and I said about my MSc in psychology, to which she asked, surprised, "Oh you want to work with (quieter) mental people?!" If I wasn't such a coward, I would've announced that I am, in fact, a 'mental person' too and that made me no different from her but I just sat there and said "yes I would actually!" I should've said "they're the only interesting people I know!" lol but I only come up with clever things to say after the fact I'm afraid.

And my bag is absolutely faaaaabulous darhling! My Dad got a bit pissy when he saw the dog on it (knowing they're expensive), but we've avoided the price interrogation this time, thank god!! Oh well, best be good the rest of the summer now to make up for it.

Hope you're well fish Take care

*Willow*

I bet it includes all the hip and trendy places to haunt! I mean, you don't want to be seen just anywhere!

*Willow*

I just visited that website you gave fish http://www.direct.gov.uk/en/governme...on/dg_10029429

What's the point of one for mental health conditions then, if the MHA still overrides it?!

It says to talk to your care co-ordinator for more advice - since my new CPN is apparently now also my care co-ordinator (whatever they are!), I will ask him next week.

*Willow*

I don't think there is much point to it, but I think (you had better check) that you can absolutely rule out ECT and neurosurgery regardless of the MHA . . . Also, it might have guiding force. If you said you didn't want a very specific medication, they're not bound to follow it (i.e., you can't sue if they don't), but they might take it as persuasive. I filed one with my psych against clozapine and he wasn't really keen on it, but he did put it in my file -- so hopefully they'll pay attention if they ever decide to assault and wrongfully imprison me again!

Also, NHS record-keeping is shite (some of my records say I'm five years older than I am ) and I have no idea how they EVER monitor advance directives.

Eugh, yeah, coming off is almost worse than going on -- especially when the docs won't titrate you down! Glad your appetite is more normal, though!

I used to review them when I was a social worker (not write them) and I think they're always utter shite. You can't believe the number of ones I've read that make no sense or have the most banal crap on them . . . There was one CPN who felt the need to report under the "threats of self harm" section everyday injuries ANYBODY could get: "So-and-so often burns himself whilst boiling the kettle," or "So-and-so has unidentifiable rash which she reports is from nettles/detergent allergy/sunburn".

The NHS just published a new report, "No decision about me, without me". http://data.parliament.uk/DepositedP...ewithoutme.pdf

It made my blood boil. I submitted a response here:
http://consultations.dh.gov.uk/choic...160044382/view
Saying it's a load of utter ******** until they repeal the Mental Health Act.

Also, 'compos mentos' in the UK is wholly different from "able to be forced to take psych drugs under the MHA". You can be mentally competent to do almost anything -- including refusing physical medical treatment -- but you can still be forcibly drugged. It's utterly insane. Reforming that was one of the big reasons I wanted to become a lawyer.

You should look here re: ECT
http://www.mentalhealthlaw.co.uk/Add...ed_in_new_s58A
Also, another thing to check out is that you may be able to displace your nearest relative under the MHA to someone you trust more to make medical decisions that you want. I think it can be done both whilst you're sectioned (though your statutory nearest relative will have the power until the court agrees to displace, and they won't always (often) agree) or before you're sectioned.

I don't really think it's a control issue that you want to avoid being locked up and tortured. I have so much trauma from being sectioned I can't even talk about it all. You know, I haven't slept in an actual bed since my first section, when I was put in physical restraints for sixteen hours.

You should have told her you'd rather work with mental people than idiots like her :P
I'm not always the most polite person, can you tell?

It seems like they only help if you're an informal patient (which I would never be), and if Drs wanted ECT and you were under section, they could do it even with the advance directive. Seems completely pointless then?! Plus, yeah how would the hospital know what you wanted when your pdoc (who would have a copy) wouldn't know you were admitted. There seems to be no escaping the power of psychiatry

*Willow*

I gave you another link in the next post re: ECT. They changed the law (now Part IV, s58A MHA 1983) so that you still have to give your valid consent if you're mentally competent. You can be mentally competent and still subject to a section.

Usually, you give a copy of an advance directive to lots of people -- consultants concerned, GPs, your family. Hopefully somebody would have a copy of it and bring it to the hospital's attention, though it might not prevent them treating you with stuff you don't want for the first few hours/days.

Have you ever been under a section?

One more thing -- maybe this is just the lawyer in me, but if you ever DO get sectioned I can tell you that the best way to get out is to demand your right to have the sectioned reviewed by the MHA tribunal. It's usually very informal. The trick to getting them to let you go is to show up reasonably well-groomed (shower, clean clothes, they seem to like when women wear a bit of makeup) and then say you agree that you're very ill and you need treatment. Say you'll take all the drugs they're giving you and work with them to find a solution, but you find the hospital environment very stressful. It helps if your parents/partner will come and say that they would be fine caring for you at home.

You don't have to believe it in your head, you just have to say it so they'll let you out
I always wished somebody had told me that before I was sectioned. If I ever advise clients on MHA challenges, I want to be able to tell them that . . . even though it's super-duper unethical.

That's what I don't understand. How can I be 'mentally competent' to say I don't want ECT but not competent to deny other treatment or be released from section???

No, never been in psych hospital voluntarily or sectioned. Haven't been in hospital at all since my tonsils out aged 3. Fancy a medical student (ex) who's scared of doctors and hospitals!! I've observed ECT and many outpatient psych clinics, but never spent more than a few hours on a inpatient ward as a medstudent, because I was just too scared of being 'found out'. I'm sorry that they restrained you for so long; that sounds horrible That sort of stuff was one of the things I was terrified of seeing. Of seeing people being maltreated or dismissed by nurses (the drs do very little in my experience once the drugs are prescribed and the ward review done), and being unable to do anything to help the patient (being the bottom rung of the ladder). IDK, I was just really scared of all the things I've seen (film/tv) and read about psych wards and just couldn't spend much time on the wards, eventually dropping out of my psych placement both times.

*Willow*

That's brilliant advice, thank you so much fish!

Wouldn't they just bring you back in though if they released you and you later refused to 'play ball' so to speak?

*Willow*

Mental competence is defined under the Mental Capacity Act 2005, which has a much higher standard for application than the MHA1983.
If you're declared to lack mental capacity under MCA2005, you have to be unable to make decisions for yourself. You can look at the definition here:
http://www.legislation.gov.uk/ukpga/2005/9/section/3
It means (variously/depending on the specific person) you can't do a lot of things - vote/act as an elected official, look after your own money/assets, consent/deny consent to medical treatment, own shares in a business, consent to sex (i.e., all sex done to you would be rape) . . .

The standard to be sectioned under the MHA1983 is lower. All you have to do is have a "mental disorder" that "requires treatment" and for which "treatment is available" and you are a threat "to self or others". Theoretically they will only apply it when there is no better option and you don't agree to go into hospital voluntarily (not my experience, but eh).

And all they can do under it is hold you in a hospital to drug you. I can't make the MHA load on the legislation website for some reason, but the relevant sections are 2 and 3 for the definition of who can be held and for how long, and Part IV for what they can do to you once you've been sectioned.

So you could lack mental capacity under MCA2005 but be out in the community. You could be on a section of the MHA1983 but still have mental capacity. Or, you could be under a section of the MHA 1983 [u]and[/u ] lack mental capacity under MCA2005.
The latter is, mercifully, very rare.

Well, they could do, but you'd still have to be a threat to yourself or others. If you showed up to your appointments and cooperated, and you weren't hurting anybody, honestly I don't think they'd really look into it much.

They can only put you under a community treatment order to really monitor what you're doing once you're released if you've been on a section 3 -- that's the super duper long, six-month section. I don't think I've ever seen somebody get a first admission to hospital on anything other than a section 2, which is the month-long admission.

Yeah, I finally got the nerve to watch "One Flew Over the Cuckoo's Nest" about four years after my last admission . . . I was so ****ed over by it that I clawed a huge chunk out of my leg.
One of my lecturers asked me what being in the hospital was like, and I told him it was like that film. He turned white as a ghost and looked sick for quite a while. I think he felt really bad for me, because after that he only ever gave me Firsts.