A psychotic edge

No, no, it’s ok, I don’t mean U2’s guitarist has started believing his underpants are receiving thought-transmissions from Rory McGrath.  (Although, frankly, it would explain a lot…)

The title to this post is a quote from the referral letter sent by Yvonne (the Nurse Specialist who has had the nightmare job of trying to psychoanalyse me) to the general psychiatrist I’ve seen before.  (I’ve decided that’s going to be his pseudonym, btw – General Psychiatrist.)  Regular readers of this blog will know that initially I was told that I wasn’t allowed to see this letter, but, following consultation with a supervisor, it has been decided that showing it to me doesn’t constitute a risk, and so it has been ‘shared’ with me.  Which is nice.  I’m relieved to know that the Trust’s policies have space for this bit of common-sense, and that the full Freedom of Information procedure isn’t required for something so simple.

I actually feel a bit embarrassed for having made a big fuss about wanting to see it, as it’s a perfectly standard referral letter (well, I assume it is – I’ve never actually seen one before).  I think I’d probably started to construct vaguely paranoid fantasies about what would be in the letter, and what it would mean, so it’s something of a relief to see that it’s nothing more than an admittedly incomplete, but still fair and reasonably accurate summary of the issues of concern that have come up during therapy.  I’d like to say that my thinking has settled entirely back to normal, but I do still have a back-of-the-mind question about whether I was actually given a copy of the real letter, or a hastily-written fake designed to pacify me.  Like, you know, toddlers who have an irritating habit of playing with the phone are given a Fisher Price Chatter Phone in the hopes it’ll keep them quiet…

Anyway, it’s been an interesting experience to see things about me written down in black and white.

Mr Unread is very disabled by his symptoms.

I guess no one likes to read the word ‘disabled’ about themselves in an official medical document, but I can’t really argue – given that I’m quite often unable to do something as simple as read a book or watch the telly, I wouldn’t have a leg to stand on if I tried…  (Apologies for sick humour.)

Mr Unread is an intelligent man who rationalises and minimises his symptoms in order to feel he has some control.

When I first read this it gave me a lovely reading-a-good-school-report glow – “Look, mum!  The teacher thinks I’m clever!”  But then it occurred to me that, from a wider perspective, this is probably just a ‘heads up’ to General Psychiatrist – “this patient has a habit of speaking about his problems in a way that might make you think they aren’t really a problem.”  So that would be more of a ‘Could Do Better’, then…

Mr Unread … describes being very fearful of illness and described a complex system of avoiding contamination.

Now, if I was being an annoying pedant, I’d point out that it’s actually a ‘system for avoiding contamination’ not ‘of avoiding contamination’.  But of course I’d never be that petty…

Actually, I shouldn’t joke about this because I think this is a brilliant job of summary by Yvonne.  This is a very deep-seated fear of mine, and one I find it very difficult to talk about.  To be honest, I wasn’t sure how much of it I’d been able to get across to her, and I certainly couldn’t have come up with such a succinct summary if my life depended on it.  I am seriously impressed.

Anyway, it’s at this point that Yvonne notes that

Mr Unread’s difficulties as he described them seemed to have a psychotic edge.  I […] wondered if he might benefit from antipsychotic medication.

Obviously I’ve done a certain amount of wandering (and wondering) of my own around internet sources of information on MH issues, so I can’t claim it comes as a surprise, but seeing the word ‘psychotic’ there is … unsettling.  (I sat for ages trying to think of the right word to use there, and unsettling is the best I can do, but it doesn’t really express the oddness of the feeling.)

The reference to antipsychotic meds has me wanting to run for the hills screaming “You’ll have to section me first!!!!!!”  I am aware this is not an especially rational response, but I am very wary about going on an antipsychotic unless it really is absolutely essential.

The letter then moves on to talk about my auditory and not-auditory hallucinations.  The auditory ones you already know something about (although the one I have mentioned most frequently here is not identified as significant by Yvonne).  The other ones you don’t, but (in a reversal of the way things have usually worked with this blog) I don’t feel ready to tell you about them just yet.  They’re not overwhelming, and, like the auditory ones, I tend to find them faintly comical, so it’s not anything that anybody needs to worry about.  Certainly Yvonne isn’t worried:

I do not think Mr Unread is more unwell than he has been in the past or in any immediate risk.

I believe this roughly translates as ‘I will be very surprised if in the next few weeks Aethelread is found running naked through the streets shouting “It’s the Asklafarr!  They’ve gefizzilated!!”‘

She is, as far as I’m concerned, right in that assessment.  We had a bit of a ‘discussion’ about this issue (it was more of a rant on my part, I’m afraid) when I first outed my hallucinations.  I was arguing that I’ve been perfectly capable of recognising them for what they are up until now, so as far as I’m concerned there’s no question of them being a ‘risk’.  Yvonne was of the opinion that my ability to recognise them isn’t as foolproof as I think it is, and that people will be concerned that they might become a problem in the future.  This is another aspect of the Scary Antipsychotic Question, which is why I was a little insistent on the ‘everything’s fine, now leave me alone’ angle.

On balance I think the letter is a perfectly fair summary of the things that had come up and needed to be passed to General Psychiatrist.  There’s more emphasis on the things that had come up immediately before the letter was written than there is on the stuff I’d mentioned longer ago, but that’s only natural.  (It may also be the case that Yvonne considers the older stuff to be less clinically significant, of course.)  I just need to bear in mind when I’m seeing General Psychiatrist that there is potentially a danger of that stuff getting lost, and so I should remember to mention it to him, if I decide I want him to take it into consideration.

Speaking of General Psychiatrist, I’ve had my appointment letter through from him, and was surprised to see that the appointment is only 3 weeks away.  That suggests either that they’ve managed to cut the waiting list by several months since I was last referred to him, or that I’m being treated as a more urgent referral this time around.  I’ll keep you posted on developments, anyway.

(And, in case you were wondering, I haven’t forgotten that I’m supposed to be keeping you up to date with the IB re-assessment process too.  They’re still keeping me suspended in no-news purgatory.  I’m starting to get fairly seriously worried about it, to be honest.  Being kept on tenterhooks by a faceless government bureaucracy really isn’t good for your mental health.)

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10 Responses to A psychotic edge

  1. Alex says:

    >>I shouldn’t joke about this
    Not so. I find levity is a very effective way of dealing with my mental health troubles. On the way to A&E last week, I found myself thinking that, y’know, at least it was getting me out of the house, thus making it a mixed thing at best. Also on a lighter note, ‘General Psychiatrist’ makes me think of this.
    As for the anti-psychotic thing, I think it’s a good idea to be wary. I know I would be, as I understand it anti-psychotic medication is heavy-duty stuff.
    Moreover, much respect for slagging off Lynne Truss, I despise the woman.

  2. Alex says:

    Oh, also. I meant to say this earlier, but read the last comment on your previous post. And then read the commenter’s blog. That’s some scary stuff, man. Takes ‘workaholic’ to a whole new level.
    (/bitching behind peoples’ backs)

  3. E says:

    Crucifixion? Well at least it gets you out in the opem :-)

  4. The Chuckle says:

    General Psych – sounds like a character out of Catch 22, which I’m half way through reading but had to stop because i was identifying way too much with one of the characters! I think you should make a fuss over seeing the letter, it’s crazy not to show patients those kind of things. Good for you!

  5. aethelreadtheunread says:

    Thanks for the comments.

    Alex – i guess what i meant about not joking is that it might have seemed i was being hyper-critical of Yvonne’s prose style, and that felt unfair to me in the context of her having done such a brilliant job of summarising something i would have found almost unsummarisable (is that a word?). In the normal run of things i’m very prone to mocking pretty much everything (but only when i’m reasonably sure i’m not being mean or horrible while i do it).

    Oh, and Lynne Truss always seems to me to be on of those people who never quite manages to “get” the fact that a living language is always evolving, and that rules of punctuation and grammar and so on have to change in order to keep up. She should make a point of only communicating in Latin if she wants to use a language that will never change…

    E – well i guess there’s something to be said for Always Look(ing) on The Bright Side of Life… ;o)

    The Chuckle – Yes, i can see where you’re coming from with Catch 22, although my memories of it are pretty hazy – i read it a few years ago to find out what all the fuss was about and tbh couldn’t really work out why it would be anyone’s favourite book.

    I can see where Alex is coming from with the Monty Python character too. It’s all good anti-establishment stuff, i like it. :o)

  6. s says:

    You are very very brave for reading that letter. I’d hate to think what Evil Shrink has written about me.

  7. Cellar_Door says:

    Am glad common sense isn’t completely dead and that you got to see it in the end! Whilst I can understand their concerns (headlines again…) it should really be decided on a case by case basis. I know very well that some of the notes I write about patients would upset/anger them, but they are as truthful and objective as I can possibly be, and it depends a lot on insight (or lack of) as to how the patient would react if they were allowed to see them.

    Ok, rambling now….

    Glad it worked out ok anyway! :0)

  8. bippidee says:

    oh they love to hear about voices and hallucinations don’t they? much more interesting to them than the bog standard boring old depression. i reassured my doc that i had them under control too, but she was very quick to reccommend an anti psychotic. funny how i’ve managed to avoid stabbing random strangers on the street for the past twenty years without them. i must say though that despite my misgivings, the anti psychotic has helped me a lot in recent weeks. it’s something to bear in mind perhaps, although so far it hasn’t helped stop the gory hallucinations. ho hum, at least it looks good for my dla i suppose.

  9. Pingback: Mental Nurse · This Week in Mentalists (49)

  10. I also thought of Catch 22…

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