You know that episode in Sex And The City, where Carrie Bradshaw was dating that guy, and she's blissfully happy, thinking it's all going swimmingly, but then she wakes up the next morning to find that she has been dumped - on a Post-it? Well, that's kind of what my diagnosis felt like.
I guess I have always felt that something was a bit different about me - like when I try to behave, think, and feel like a rational adult, I am basically faking it. The truth is that most of the time I relate to being an adolescent with raging hormones, living in a world that doesn't understand me. I am in fact on the uncomfortable side of my 30's, and I know that rationally speaking, I should have grown out of being so damned melodramatic by now.
I tend to hide my melodrama with... er... melodrama. I always have an entertaining story to tell, usually about myself. I find that a dash of suspense and a generous helping of humour helps others to identify with, and perhaps feel more comfortable with the experiences I want to share or talk about. I think it also helps me to feel more comfortable. My therapist often met my jokes in session with a blank face purposefully so that I was not able to detach from how I actually felt about something in the story I was telling her. Very disconcerting!
I have always thought that my life only seems like it is full of drama because of the way I like to tell my stories. I'm a writer, after all, I have a big imagination, I like to embellish. But upon closer inspection, I appear to have in fact told the whole truth, punctuating stories with jokes to make them more palatable perhaps, easier to digest or relate to, and also to disguise my own, for want of a better word, craziness.
How else would I get any one of a sound mind and stable world to relate to me and mine if I didn't at least make it all sound hilarious for their benefit? I mean, we are talking about ongoing, repetitive failure, and total self-sabotage. Nobody I know has been through as many homes, jobs, or relationships as I have. Sometimes I feel like it's so ludicrous that my life should have been made into a sitcom, and I should be the main character acting out my own distressing sketches with nervous Miranda-style glances at the camera.
Even I didn't realise how ridiculous the numbers look until I sat down one day and did the maths. I don't like maths, and I'm not good with numbers, but I'm telling you, it really is as crazy as it sounds. Nearly 30 different places to call home in my lifetime, for example, and I'm only 30-something years old. At least 10 significant emotional relationships, complete with excruciating breakups. I don't think I can even bring myself to tell you how many pages long my CV is.
Moving onto the mood swings. I think that this is where things get real. You can't overlook some of the places my mood swings have taken me. Or maybe we can... yeah let's do that!
My point is that since I was in my late teens I have felt that life shouldn't feel the way it does to me. It shouldn't be so up and down, or round and round. I shouldn't be so flakey and inconsistent, distracted by so many pointless whims, or so moody because "it must be her time of the month again" as my mother would so often say, even though that wasn't always the case. There must be more to my life, and more to me. Surely I'm capable of more?
Sometimes I wish that if it had been recognised early on that there was a problem maybe I could have received the help I needed much sooner. Maybe then I could have understood myself instead of blaming myself for things that I haven't necessarily been able to control because I haven't known what was going on in my brain. Maybe I would even be able to take myself more seriously now, instead of lightening the mood and making everything easier for people to digest. Mental illness isn't easy, after all, and it's not even remotely funny, for me or anyone else.
And here we are in my thirties. A couple of years ago I found myself having to temporarily move in with my sister after a big breakup that left me homeless. It turned into 6 months because I have pets and there are no pet-friendly landlords in London. But during this time my sister had the opportunity to witness some of my ups and some of my downs. She's an observant and analytical kind of person. She also has her own story to tell when it comes to her mental health, so her observations were heavily grounded in what she has learned over the years.
After I had moved out of hers and started to settle into my new abode, she brought up the subject in light conversation by mentioning that she had been reading something online and that it had reminded her of me. She said I should look into it. She had actually been reading about BPD or Borderline Personality Disorder. Many of the symptoms are very similar to those of Cyclothymia.
I didn't take her seriously at first. I have always been the sort of person who couldn't use the word "Depression" in a sentence that referred to myself and had to find ways around it to describe how I was feeling. "Gloomy" is one of my favourite words, alongside "fed-up", "tired", and "probably due on".
Upon developing the relationship with my sister over the past few years and learning a lot about her mental health struggles I had become more comfortable with things like that though, and so I found that I could go ahead and read a few articles, take a few online personality tests, and not feel like a fraud for admitting how many of the symptoms I did actually relate to. But then, who doesn't, right? We all have ups and downs.
The Journey Begins...
It took a little while for me to think that maybe there was something to this and that maybe it would be useful to talk to a doctor about it. When I did come round to the idea my sister took me to see a GP. I say "a" GP because I don't ever go to see a doctor. I have never considered myself to have my own GP. I know that I have a GP assigned to me at the practice I am currently registered at, but I have never met him, and the GP who saw me at this first appointment wasn't him.
I must have either been very lucky or this doctor considered it an emergency because I got put straight through for a referral to have a mental health assessment by a psychiatrist. It all happened ridiculously quickly. I almost feel guilty about how quickly my diagnosis process progressed because I know that most people struggle for years with this kind of thing on the NHS. I was expecting to faff about for long enough with a GP to be able to come to the conclusion that I was mistaken about the whole thing, and that it must have just been a phase.
But a few weeks later I found myself going along to my first ever mental health assessment. I was very prepared! I had done a tonne of research. I had googled the psychiatrist and I knew what he looked like and even what he sounded like because I found videos on Youtube. I had read all of the testimonials. In fact, by the time I finished researching, I felt like I had known him for years. I had also been keeping an in-depth record of my moods going back as far as the beginning of the year by wading through old journals and piecing together information to work out what my moods were doing, what was related to what, and if there were any patterns.
If I am honest, I might have been a little bit hypomanic leading up to my appointment. But at the time I absolutely refused to get misdiagnosed and have to go on an epic journey to find out the truth, like so many poor sufferers of mental illness, and I certainly wasn't going to waste this appointment. Preparation was key.
My First Mental Health Assessment...
The psychiatrist was very professional. Perhaps a little too professional. Actually, he seemed a lot colder than I had anticipated from my in-depth research, and I almost felt a little hurt that he was treating me like a stranger.
He listened, he made notes, he asked standard questions, he ruled out BPD completely, which annoyed me. Then he grabbed a post-it note, I kid you not and drew a graph on it. Yes, that graph you see at the top of this post, that's the one. He titled it "Cyclothymia" and briefly explained that the squiggly line represented mood swings.
So the highest and lowest points of the dips and peaks refer to Bipolar Disorder. The smaller peaks and dips referred to normal mood fluctuations that everybody experiences. The areas in between that have been recklessly struck out with horizontal flicks of the psychiatrist's pen are the mysterious realms of Cyclothymia.
Apparently, my mood swings are not within the normal bit, and they are not up and down in the extremes of Bipolar Depression and Mania. I am in no man's land. A place of uncertainty and confusion, belonging nowhere, just floating about in the middle. Purgatory. Waiting for something terrible to happen, and terrible things do happen, but they are not quite terrible enough. Cyclothymia if left untreated can develop into Bipolar 1 or 2 according to some sources, but when and if... those are the questions. In the meantime, I have to try and explain this to the people in my life.
The psychiatrist then told me I could keep the post-it note. I was just baffled.
I went home and let it sink in. And then I got mad. I stayed up all night crafting a 20-page letter to the psychiatrist in which I went into great detail about everything I could think of in my life that had made no sense to me before, and how it related to the symptoms of BPD, and not the diagnosis I thought he had so clumsily thrown at me. I felt that I hadn't explained everything properly, the severity of my symptoms, the bits I was ashamed of. There was no way he could come up with a diagnosis in less than an hour based on the little information I had given him. No way.
After reading my epic email the psychiatrist was very polite but stuck with his original diagnosis. I got a copy of the standard report that was sent to the GP in the post shortly afterward. The report wasn't even addressed to me, it was addressed to the GP who wasn't even my GP. And all I got was a post-it note! I'm sorry, I can't get over that. Maybe focussing on the post-it is the only way I can make this story express how little sense any of this process has made to me.
I think the worst thing was that I hadn't been offered any kind of support to help me understand anything. The psychiatrist had offered a prescription for a very low dose of an anti-psychotic drug, but he made it clear that this wasn't something that he was suggesting I needed, and that the option was just there if I felt like I needed it.
All I could think was why am I being offered a drug that sounds very much to me like it is intended for someone with psychotic issues? Am I psychotic? Might I turn psychotic? Oh my God, am I going to end up like my aunt who has Bipolar type 1?!
I vaguely remember the psychiatrist emphasising that the extremely low dose may help to balance out my moods, and then he mentioned something about the fact that the drug would make me feel quite sedated, and that for some people it may cause weight gain. Also that if I did decide to take it I'd have to give it at least 6 months before I decide to look at whether it was helping.
Well that put me right off, didn't it? The weight bit, that is. I couldn't bear to imagine what a podger I'd be in 6 months' time! So I basically left the surgery with nothing to fix the problem, and nothing to help me understand it all, except my post-it note. I was indignant. Just like Carrie Bradshaw was when she got dumped on a post-it with "I'm sorry, I can't, Don't hate me -"
My Second Mental Health Assessment...
I couldn't leave it there. I had come too far. I had allowed myself to be pulled into this web and it had hold of me now. I was convinced that I was on this journey for a reason, and this couldn't possibly be the end of the line.
So I contacted the GP and explained that I was very upset and that I wanted a second opinion. I must have just got really lucky with this GP because I was referred for another mental health assessment pretty quickly, this time with a lady psychiatrist. I hadn't asked for it to be a lady, but I have to say that this next experience was SO much better.
Firstly, she actually looked at me when I was talking to her, instead of at her computer screen. That's always going to make a difference. Secondly, I felt like she was actually hearing and feeling me and not just hearing diagnosis criteria. Thirdly, although she did agree with the first psychiatrist that BPD was not an option and that she thought the original diagnosis was most likely to be correct, she actually asked me what I thought, and then she offered me treatments and made me feel like she was actually recommending them, and not just saying well those are the options but it's your funeral.
I won't go into the story of my treatments in this post, I think I have waffled on for long enough. I should also mention that it has been addressed in later therapy sessions that my reactions to the two different psychiatrists probably had more to do with my own need to be "mothered" through the experience, and not the gender or professionalism of either of the psychiatrists themselves. But yes, that is basically the story of my diagnosis. So far at least.
My sister is still not convinced that my diagnosis is correct. She says that she feels there is more to it, and sometimes I agree with her. But equally, there are times when I also feel like this has all been one big mistake and that somehow I have managed to convince two psychiatrists that I have a mental illness when there's probably nothing wrong with me at all. I think it's common for people with a mood disorder to go back and forth a bit, not totally convinced that there is anything wrong until they remember what the wrong bits feel like when they come back around again.
What's Your Story?
I'd love to know how you got your diagnosis, or if you are at the beginning of your mental health journey and have any thoughts, fears, doubts or questions. Please feel free to leave them in the comments below.