As I mentioned in my last post, I really am struggling to cope with my return to work. My anxiety levels are ridiculous, I feel constantly nauseous and exhausted, I can’t think straight, I dread going to work, I’ve had trouble with thoughts of self harming and my mood is quite low.
This is not a) unexpected or b) a disaster. It’s fairly par for the course, really. When I started socialising again post-weight restoration I felt anxious, depressed and out of my depth. When I moved up to Newcastle I felt anxious, depressed and out of my depth. When I moved from a house share into my own flat I felt anxious, depressed and out of my depth. Basically, I have trouble coping with any big upheaval to my life. I am stable and able to function within my normal routine, but any disruption destabilises me and it can take me a good few weeks/months to recover.
No one ever believes me when I tell them that my panic attacks don’t always, or even often, have a psychological trigger. My body seems unable to distinguish between physical and psychological stress, so I react in the same way to hunger or tiredness as I do anger or anxiety. In a vulnerable state anything can set me off – a car backfiring, for example. I have learned over the years to control my reaction, so when I feel that shock of adrenaline and start finding it hard to breathe I just tell myself that it’s a panic attack and I will be fine. I do relaxation exercises or use DBT distraction techniques. That diffuses the panic attack before it can overwhelm me, but what those things DON’T do is stop my body from being terribly over-reactive.
People say that over time, you can desensitise your body and teach your nervous system that there’s nothing to freak out over. This doesn’t seem to be the case for me. It’s probably something to do with my tic disorder (which was diagnosed by a neurologist, not myself!) – Tourette syndrome is a neurological, not psychological problem, which is often accompanied by OCD, general anxiety, sensory over-sensitivity and aversions. Whilst therapies like CBT can teach people to cope with these symptoms, they can’t be cured. I’m mostly quite accepting of this – I spent years looking for the non-existent “root cause” of my anxiety in therapy and no insight ever made a difference to my general physiological sensitivity, before I was finally diagnosed with a tic disorder four years ago. In a way it’s a relief, because it means that I don’t have to beat myself up for being unable to cope with stressors which other people take in their stride. It also helped my parents to know that my problem was not their fault (not that I ever believed it was in the first place, but they did blame themselves) but a random genetic quirk.
On the other hand, it sucks. Every time I go through a big change in my life I have to put up with the embarrassment of seeing my mental health temporarily go south. I say embarrassment because it IS embarrassing, given the amount of time I spend singing the praises of recovery on my blog. Things have improved, slowly. We all know how well my attempt to move to York in 2008 went, whereas when I moved to Newcastle nearly a year ago I DID have a few minor lapsing into eating disordered behaviours, but I got back on track quickly. Even better, since starting my new job three weeks ago I’ve had anxiety and self harm urges, but no eating disordered thoughts and no lapse into SI. Definitely an improvement. Oh look, I was just saying that I feel embarrassed when I start struggling and now I’m trying to cover it up 😛 I am predictable, if nothing else.
Anyway. I am attempting to get over my embarrassment by waffling on about it, which has helped because everyone I’ve spoken to has told me that it’s really hard adjusting back into a working routine. It’s tiring and stressful for anyone, let alone someone with long term mental health problems who has been unemployed for years and suddenly finds herself in a position with a lot of responsibility involved. So I’m not judging myself for having a hard time anymore, and I am not panicking. Well, my body is, but my mind isn’t, if that makes sense. My body is on edge, but I understand what is going on and I am quite happy to put up with it for now, because all the evidence suggests that with time, I will adjust.
However, regardless of my new, relaxed attitude, I still need some support until things settle back down again. Eight months ago when I was struggling to adapt to moving into a flat by myself I saw the local mental health team for an assessment, and they put me on a therapy waiting list. I’ve reached the top of it now, and have an appointment in a fortnight. But in typical Katie style I am having second thoughts.
The therapy I was put down for is CAT, cognitive analytic therapy. In simple terms, the idea of CAT is to go through your life history with a fine tooth comb, find any unhelpful patterns you keep falling into and work out where in your past they came from, and then move on to finding “exits” to these patterns – new ways of doing things which help you stop falling into the same ruts. In theory it’s a good therapy, and there is evidence that it helps people with depression avoid relapses. In practice, I’m not sure it would be helpful for me. For a start, I’ve been in and out of therapy for years, and I know myself fairly well. I can identify self destructive patterns and problem solve them myself. I’ve been doing this for years, particularly the last two. Secondly, I don’t think my past has much to do with my problems. I think certain events (being bullied and raped) definitely made things worse, but they didn’t cause my eating disorder or anxiety. I clearly remember a point (before the rape) when I felt baffled by what was going on in therapy, because I understood how being bullied had damaged my self esteem and I had made peace with the experience – but I was still terribly anxious and self destructive. I didn’t understand that my anxiety was innate, not learned or based in trauma. The tic disorder is far more of a cause than any past event.
Thirdly, the appointment they’ve given me is during my working hours. I’m unconvinced enough of the potential helpfulness not to want to go through the hassle of re-arranging my shifts. And finally, if I strongly suspect that it won’t help, someone else would be much better off using my place, because the waiting list is eight months long.
Here’s the question: would I be better off going to this appointment even if I’m fairly sure the therapy orientation is wrong for me, just so I will have a bit of on-going support, OR should I try to be patient, get myself re-assessed and ask for something I feel would be more appropriate?
I am leaning towards the latter. Before I received the CAT appointment I had already rung the team to tell them that I had changed my mind and would rather be re-assessed, as I thought I had been too nervous to give them a proper idea of my difficulties last time (it was a scary assessment with two professionals vs one me!). I also know that I do much better with low-level ongoing support than with any structured therapy, because my problems don’t fit into the typical therapeutic approaches, being more neurological than psychological. Trying to squish myself into a theory has made me feel uncomfortable and misunderstood in the past. No therapy is better than poorly fitting or bad therapy. I was quite sure of my position until this bloody letter turned up this morning, offering me the appointment! I am stressed out enough to be tempted, even if I know it’s not an approach which will be of much use.
I guess there will always be people who would say “go anyway and see what the therapist has to say”, but I know what CAT entails and I also know that if I started CAT, the re-assessment would be cancelled and I’d have to wait a few weeks to get a new date if I decided that I wasn’t getting on with therapy. I feel like I’ve thought this through, but I just wanted to put it to my lovely blog commenters – can you see any glaring problems with my reasons for choosing the re-assessment? I’m going to phone them tomorrow if I can actually make up my mind…