This is the text of an article I recently contributed to an online journal for careworkers. Please be aware that its content is pretty frank.
BY HOOK AND BY CROOK.
Some adventures in mental health.
I have just finished the first draft of my book about my many years of managing anxiety and depression. Although writing the text was not a therapeutic exercise – and I am currently tweaking it so that it reads as fiction, not as memoir – it certainly made me aware that I have learned a great deal about support provision for those with mental health problems. I also discovered that some avenues of help led, for me, to very little. I know that it is not a case of one size fits all and also that, without the forceful intelligence and deep compassion of those in the mental health team in my area, I would either be unable to function or I would be dead. They fixed me, all the while empowering me, prompting and encouraging with the notion that I would be able to find the answers myself and, in time, bed them down so that I could approach life, stress, fears and difficulties in a more manageable way. The text is called The Timely Death of Hapless Annie: it’s about saying good bye to the old self – the one who was suffocating you: ‘Hapless Annie’ was the alter ego of ‘Annie’ – created, by her (and me), to provide an evolving, more palatable version of self: we all have different methods!
Originally, I had intended to set out and analyse what it was that made my year or so of CAT – cognitive analytic (or analytical) therapy – so effective. Then it struck me that the narrator of my book had already done this, so I’ve given some areas of text, below. I had a complex set of things to disentangle: I had been a self harmer since childhood, had twice (not very competently) tried to take my own life; I had persistent, terrifying nightmares which featured both things I thought I had caused – such as terrible harm to others – and things that had been done to me. At the point when I met the therapy that was truly life changing, I suffered from low mood, panic attacks, ruminating thoughts I couldn’t slough off and the sort of anxiety that could leave me laid-out tired. I was becoming convinced that my whole life had been a disaster and what I felt was compounded by the intense guilt at not being the sort of parent I wanted to be for my three young boys.
The initial diagnosis was that this was post natal depression and I was offered CBT; I did not excel at it. I am not disparaging CBT, but it felt like we were scratching the surface. Fortunately, I had a GP who was prepared to try again. I was able to communicate that, inside me, there was a stew of complex and stoutly held beliefs: I felt sick in just the way I had since childhood, cutting and head banging now, as then, to diffuse it. If my GP hadn’t acted then, I doubt I would be here now. How can that be? Because when you get to a trough of despondency, you can see no way out and the thought that you should die is a response both to that and what seems like logic to you then: I should be rubbed out and not inflicted on others. It would be better.
To anyone who thinks depression is something you should be strong minded about and just get over by not wallowing in it, think again. I didn’t have time to wallow: I was clawing my way through teaching and writing and parenting three young kids. But in my head, the response to everything was instinctive; quick as a flash. You’re all wrong. A disaster. You’ve done terrible things. They hate you. You deserved what you got – from beatings with punch and slap to the beatings which ring and reverberate in the mind: mess-up; maggot; we never wanted you; you’re disgusting; can’t do anything: look at you, you, you. That is what it sounded like in my head. All the time. That’s what it had sounded like for a very long time. The point was that it was getting louder. And that’s when the CAT came in: some CBT-type stuff; some analysis – awareness of patterns. You get to talk a lot; eventually you get homework. I wrote to my mother and to my brother; my therapist wrote a letter, half way through, to me; she wrote again when we finished. I wrote back to her. It was detailed, nerdy, sturdy stuff and it fitted me. And the really important point was that it was the gentle humour, warm invitation and incisiveness of “Dr Crook” and “Dr Hook” that brought it out. Their carefully phrased comments. Their determination to get me well. I could see it in their eyes. I am not saying this is all lovely and tidy. I have to be vigilant and I have to use what I have learned. Turns out you can teach an old dog new tricks.
So this was me (well, ok, Annie, in the book):
“In the first CAT session, your writer – Annie – felt obliged to perform in order to present a more palatable version of self. It took her little time to realise that the person she was with, Dr Crook, was hugely skilled and had seen through such a performance straight away and had thus raised a hand to stop it. Her patient sat back in her seat, caught in the act and embarrassed. “You do not have to put on a show for me.” Dr Crook wrinkled her nose and her eyes twinkled like Santa’s – should he ever be a knowing and insightful clinical psychologist. “I’m sorry” said Annie, and drifted off into a place where, for walking down the street, she would be tarred and feathered. Abominable; hateful; no-one wants you. Look! They are all laughing at you. They always knew it was you, you you…..
“Shall we interrupt that chain of thought and then perhaps you can tell me what it was about?”
See, that’s the skill isn’t it? It’s all in the delicate lexical placing of “Shall” and “perhaps.” The direction is clear enough, but it is issued like an invitation not an imperative and the “perhaps” sows not seeds of doubt but seeds of possibility. Annie was awestruck by this fine woman and immensely comforted because Dr Crook didn’t look like she was about to tar and feather. Or just point and laugh.
So they were off. There is little in what Annie said to Dr Crook that she would not have said to some others, in strange silent rooms or to the darkness before sleep. But it was clear certain themes were going to come back again and again. There were buckets, where Annie should rightly have been left at birth, lilies on dead fathers, mothers dead in armchairs; terrible dreams for years and years. “He did nothing to you. Silly girl. My bitch-daughter. It’s all in your dreams.”
There were vituperative holidays in rickety caravans with parents spitting “you are not here through choice” and rough sex with men who hated her and shame. Up came the embolus of fear: horrid dreams of hands and arms being on her where they should not have been. There were people who laughed, people who spat and people who pointed; the strange family homes of childhood and adolescence, with their sepulchral cold and damp – and frightening eyeball pickles in grandma’s pantry. Annie saw Nativity Baby Jesus and Crucifixion Jesus from the years she had tried to make God want her: one Jesus was screaming and the other was yelling, but both were insistent in what they communicated: “Go away, Annie. We are for others; we are not for you – dirty girl, rot, maggot!”
Also there were the People of God who spoke in tongues and the people of church who rightly saw the nasty blot of the true sinner: the child murderer, parent murderer, bad mother, poor wife screw-up. It was ugly and raw and exhausting. And the poor Doctors Crook and Hook had to disentangle this lot, with its crazy hops between incongruous images. Sometimes Annie was so lethargic, sentences came laboriously and missing a subject, object or predicate; now, she was all flapping hands and extreme – almost joyous nervous energy.
They met most weeks and then Annie also became acquainted with Dr Hook, new GP still on rotation and, as Dr Crook had it, particularly insightful of, of…err, “Nutters?” interjected Annie.
Both seemed to their patient to be able to see the world clearly. Dr Hook was giggly and quite outspoken and when questioned “How do you know?” by Annie, she would look her square in the eye and say “Because I just know.” Annie never doubted her. Dr Hook, too, had the gift of careful placing of words. Words matter. And so does knowing how to do things with words. She issued invitations and Annie accepted. This other good doctor had the quiet, smiling confidence of the clever and generous: for the patient it was a winner; a panacea; a cure. And, over the year or so, Annie learned really useful things. She learned about ‘Traps’: the striving trap; the trying to keep things in perfect order trap; the trying to be a certain way around others trap. She had spent a lifetime so far trying to impose some order on her messy and precarious world; it was truly helpful to unpick some of it and find that the sky had not fallen in.
Once, when Annie returned home from a vigorous session at the House of Fun (as we shall call it), some words of Dr Hook reverberated in her head – in the car, out through the window and into the world around. “How do I know I haven’t damaged my children with my ups and downs and my instability?” Dr Hook wrinkled her brow and told Annie that, despite her wobbles and the mad bowling match in her head, a doctor would have no doubt that her children would have the best chance to be happy and healthy individuals.”
“But you can’t know that. You haven’t seen me with them.”
“Oh, I just know that. I see many, many people. I see you. So I know.”
It didn’t sound very scientific, but she was firm and it looked like she must have compelling evidence from somewhere. Perhaps they both had a kind of psych-cam in Annie’s house. And Dr Crook and Dr Hook did something else. As a duo, they both assured her, this time with bookish proper scientific evidence and a firm look – despite the screaming and blue murder that was coming out of Annie’s mouth and the blood on her palms as they did it – that she had not and could not have killed a girl, however wrong her actions, age five.
“The day they said I pushed the girl; my mother said it could have made her die and ten years later she did. A fear – an embolus of fear, waiting to dissect and kill – held for thirty years, in cold silence.”
Setting that out into the room was terrifying, so long and so tightly had it been clutched. They told her, instead, that she was “lovely” and Dr Crook added that she was a model patient, engaging and grappling as she did with what was laid on. It was an avalanche of compliments. Annie was both delighted and mortified. She could only look down and shake her head. Then Dr Hook said, “You are a fully functional human being. You just need to know that.”
Annie sat looking at Dr Hook and crying and shaking and saying “Oh thank you thank you are you sure thank you thank you but are you sure?” Dr Hook met her insistent, questioning look with her limpid chocolate-coloured eyes. “Oh, I am sure.” Annie had heard it – but now something in her was open and she could begin to feel it – feel all of it –too. And this is called happiness.
And so I want to say, don’t give up. A life can be saved or changed. Press for help that works for you, – or your loved one, patient or service user – if you possibly can. I might be naive, but I am living proof that help’s out there. And, also, these days I’m just plain Annie – not so Hapless any more.