Monthly Archives: November 2014

Purging, the less glamorous side of EDs

Too often media representations show eating disorder patients to be pretty, thin girls who only restrict and exercise. It’s rare you will hear an account of vomiting or laxative abuse, and if you do it’ll be a passing remark quickly glossed over.

For me my purging is the most shameful part of my ED. Even when I was inpatient there was little understanding when it came to dealing with vomiting. I was able to get away with throwing up almost every single thing I ate the entire time I was on the unit and no-one knew how to help me stop it, myself least of all. Other patients found it incredibly difficult to deal with and I often found myself at the receiving end of community meetings discussing the impact it was having on the ward. I never even mentioned my laxative abuse, I was so ashamed. And yet as soon as I was granted unescorted leave I would walk five minutes up the road to the local sainsbury’s and buy hundreds of laxatives then smuggle them back into the unit and desperately swallow 10s of them at a time to undo the awful damage I perceived the food to be doing to me. I sat through many supervisions and community meetings with a torch lancing my insides and my guts twisting in agony whilst desperately regurgitating food up into my mouth in an attempt to stop my stomach digesting it then running to the bathroom before losing my dignity to the toilet bowl. Glamorous eh?

I’ve struggled with purging since I was 13/14. Most of the time vomiting but over the last few years laxative abuse crept in too. It’s not the neat trick some would have you believe, or the miracle pro ana/ bulimia websites peddle out. It has caused me long lasting damage. My hands are blistered and calloused from the acid and rubbing on my teeth, my teeth are crumbling and thin. My oesophagus is inflamed in patches from the acid and the strain of vomiting, I sometimes throw up blood. I suffer from IBS, probably as a result of laxative abuse and my stomach doesn’t know how to keep food down. I risk heart failure or a stroke whenever I vomit and suffer from transient episodes of oedema when my electrolytes are out of whack. Throwing up up to 15 times a day means you smell of your own vomit by the end of the day, that you’ll have inhaled your own vomit multiple times and found yourself covered in vomit and toilet water. And all for what? Vomiting only gets rid of 30-50% of calories. Laxatives even less.

And yet when I eat all reason leaves me. I become desperate, like an animal backed into a corner I will do anything to get rid of the calories. When I was a daypatient at VS I’d power home, vomiting in bins and alleyways as I walked. Holding vomit in my mouth for the 45minute walk to stop myself digesting it. I knew all the places that had public toilets. And I was, and still am, so ashamed.

In all honesty, I’ve lost hope that I’ll ever stop purging. It’s been a constant for 9 years and now I can’t unlink food and vomiting. When I eat I’m looking at the food and seeing how easy or hard it’ll be to purge. I’m desperately working out the calories and how many I can get rid of. My body doesn’t know how to keep food down and food doesn’t stay down easily even when I’m not purging deliberately. I can’t imagine a life without throwing up. And I’m so ashamed, I almost never talk about it at home and when I do I gloss over it. But that needs to change because it’s a part of my disorder and I shouldn’t be ashamed of that.

You should get a boyfriend, then you wouldn’t be depressed

As said to me by the crisis team doctor a couple of days before I was sectioned…

There’s been a lot of discussion on the #crisisteamfail and #crisisteamwishlist hashtags on twitter about peoples’ experiences of being under the crisis team. It makes an interesting and at times shocking read. I’m not going to bash the crisis team in this post. I don’t think it’s helpful or constructive. Instead I’m going to share my experiences of being under the crisis team, nothing more or less- simply my experiences from which you can draw your own conclusions.

I first heard of the crisis team when I had my first brush with mental health services age 13. However I never had any involvement with them until earlier this year. I had just been discharged from a week long hospital admission and had no follow up care except my regular eating disorder therapy appointments. My ED therapist was my care coordinator but my care was a bit complicated because I fell under one areas CMHT and another areas ED services and for some unknown reason that made liaison between services complicated. I saw my GP later that week, still very wobbly and struggling to cope and was referred to the crisis team.

My very first experience with them had been a week prior when I was admitted to the ward but that had been the extent of their involvement with me. I was lucky that my referral took only two days and I was almost immediately seen by the CMHT doctor and assessed for treatment under the CMHT. However it was decided that I needed a higher level of input and I was asked to stay and be assessed by the crisis team and it was agreed that they would visit me daily and take control of my medication, starting from that day.

In all honesty my first visit from the crisis team was terrifying. Not because anything particularly noteworthy or interesting happened but simply because there is something inherently frightening about letting two strangers- both men- into your house to sit and talk about your feelings when you’re already feeling vulnerable. I was too scared to let them any further into the house than the kitchen- we were a maisonette- and we spent the next awkward 10 minutes sitting in the kitchen, me hoping my flatmate wouldn’t come out of his room and them watching me as I twisted my hands and jiggled my leg with anxiety and barely spoke. They watched me take my meds and then left. This style visit was pretty much the norm over the next two weeks. There was one visit where I talked a bit more but that backfired and ended with me in floods of tears after a nurse told me the reason I was gaining weight is because diet coke has loads of calories in it….

Usually two people came but then I had a visit where S came on her own and it was probably the most helpful visit I had from the London CT. She talked to me like I was a person, not a diagnosis and seemed to understand me a lot better than the other team members I’d bet. It helped that she was young and female, I found it hard to connect with the older male CT members I’d been seeing. Although the meeting ended up with me being in A&E after I admitted I’d overdosed it was the first time I felt I’d been heard. S came to A&E with me and waited until I’d been checked in to make sure I actually went. A week later S was also the one to be involved with calling the police on me and resultingly the sectioning but despite that she was still the best member of the crisis team I’d seen.

In all honesty I’m not really sure how the crisis team works in keeping people out of hospital. For me it seemed that they just watched me falling and then when it looked like I would end up killing myself pulled the plug and hospitalised me. I never really felt they helped me find better coping methods (other than ‘make a cup of tea’ or ‘get a boyfriend’) but instead just made sure I took my medication and checked I was still alive each day. Maybe I wasn’t in the right place to use them to their actual purpose and maybe that was all they could do to me, but in many ways those few weeks seeing them were torturous. I was falling down the rabbit hole faster than I ever had before and I knew it and I knew they knew it but it felt like they were stood at the top of the hole looking down, occasionally calling my name, as I plummeted to the bottom.

That period with the crisis team ended the night I was sectioned, which I blogged about before (Losing my freedom). But when I moved back to Oxford after being discharged I was once again placed under the crisis team- or “Step Up” team as they call it here. They were okay. I hate the word ‘okay’ but it’s the only way to describe them. They were primarily an end-of-the-phone support service. The idea being that when you were distressed you should phone them before self harming/ ODing etc. Problem is i’m terrified of the phone so it never really worked for me. I’ve seen them face to face two or three times and they’ve been helpful but it feels like the service is overstretched and underfunded.

This is not my best post and depression is clouding my ability to write right now but if you’re interested it’s definitely worth checking out the twitter hashtags #crisisteamfail and #crisisteamwishlist for a far more eloquent view of being under the crisis team.

Courage is a person

There are some people who you come across and you just know you’re going to be friends for the rest of your life.

For me, Caz is one of those people. Caz is one of the bravest people I know, she’s fought so many battles and has grown into a strong, beautiful and courageous young women who I couldn’t be prouder of. She has seen me in some of my darkest moments, newly admitted to Vincent Square and later sectioned on a general psych ward fighting desperately against everyone who was trying to save my life. Caz is never one to mince her words, she’ll tell me outright when I’m being an idiot and ask me the questions no one else dares to ask. And I love her for it.

I spent this weekend with her. We laughed and shopped and watched Disney films. She put the first real smile on my face in a long long time. There is something about her joy in the little things that is infectious: standing on the hill looking across at the city lights, finding a new little corner of the university to explore, walking down by the canal and readings the boat names, chasing pidgeons…

She reminds me to see the beauty in the everyday.

With Caz I ate burger and chips and pasta- some of my biggest challenge foods and if anyone else had suggested I eat them I’d have screamed, shouted or cried. But with Caz, I ate them without a fuss and enjoyed every delicious mouthful!

Everyone needs someone like Caz in their life. Someone strong and completely unaware of their own brilliance. Who shines so bright she lights up everyone around her. I feel lucky to know her.

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‘We don’t stitch self harmers here’

Being in A&E when you’re in mental health crisis is torment. Imagine for a moment that your head is full of confusing thoughts and the world is at once far too loud and far too quiet. Every noise seems distorted and every instinct inside of you is screaming at you to run. And then imaging that you’re in a noisy department with people in various states of distress around you. Occasionally a drunk starts shouting. Everyone keeps glancing at you as you sit in the waiting room shaking, your head in your hands. You are trapped, if you leave they’ll call the police, but no-one’s told you how long you’ll be waiting. You’re in pain but you won’t accept pain killers because the damage you’ve done is self inflicted. You finally get called in to see a medical professional and what happens next is really luck of the draw.

I’ve been in that situation too many times to count. Sat in A&E waiting to be patched up again after self harm gone too far. Last time I was lucky, I was seen within two hours and the staff although not particularly friendly were polite and professional. I was glued back together again and asked if I wanted to see a psych team (‘no!’) then sent on my way.

Sometimes the reaction is caring as helpful. Whenever I went to Chelsea and Westminster I was treated with respect and dignity. They had a separate room where people in mental health crisis were seated, a quiet place amid the hustle and bustle of A&E. I always received good, if not at times excellent, care. One occasion stands out which I blogged about yesterday where the doctor went out of his way to put me at ease and stitched my wounds with care so as to minimise the scarring. I also had a good experience at Charing Cross once, where the nurse practitioner I saw spent his time not only putting me at ease but putting my mum and escorting nurse at ease too. He spoke to me throughout and stitched my wounds again so as to minimise scarring. In those two incidents I felt a lot more secure and less distressed through the simple acts of kindness. It doesn’t take much but when you’re in a mental health crisis it means the world.

Sometimes though the reaction can be awful. If you turned up with a broken leg sustained jumping off a trampoline you would never be told ‘no, we won’t fix you because it was your fault. You can have a Tubi grip instead of a cast.’ Sadly, with self harm this reaction happens far too often. I’m particularly remembering a time at Charing Cross Urgent Care Centre where I was taken across from the psych ward having being assessed by the on call doctor and told I needed stitches. We got to A&E and waited for several hours, we saw the triage doctor who agreed I’d need stitches, and waited some more. All the while in the public waiting room- me in an utter state and the ward nurse having to keep me calm enough that I didn’t run. We were finally called in to see the nurse practitioner who took one look at my notes and told me flat out that she wouldn’t stitch my wounds, although they needed it, because they were self inflicted and I’ll only self harm again so it’s a waste of time. My wounds were gaping badly and numerous but she flat out refused. When the nurse accompanying me queried we were told again that ‘we don’t stitch self harmers!’ And ‘I will not be stitching you Rebecca.’ I was left with severe scarring because my wounds were not treated. What’s more, the reaction meant I was no longer taken to A&E when I needed stitching as it was a waste of time and was instead left without treatment or with a simple dressing stuck over the top.
The one time I was taken to A&E after this by the ward was when I’d hit an artery. Despite my Obs being off and despite my semi-conscious state due to the blood loss I was (at least) simply stitched and sent back to the ward with no further investigation. A month later I was admitted urgently to hospital requiring a blood transfusion, all due to the blood I’d lost that night. I’d been walking around with a Hb of 5 and an undetectable iron level.

Care like that is appalling and sadly common. And yet imagine if someone who got cancer from smoking or a type 2 diabetic or a smoking asthmatic was treated in that manner there would be public outcry. So why the acceptance, or even ambivalence in the case of mental health problems? We should be celebrating the likes of those first two experiences of mine but they should be the rule- not the exception.

Being assessed under the mental health act- my first time

I’ve been assessed under the Mental Health Act three times now. Whilst my first time did not lead to my being sectioned- I agreed last minute to an admission- it was probably the scariest time.

I had presented to Chelsea and Westminster A&E the night before having self harmed. I remember filling out the form for reception and writing, under the question asking why I had attended, ‘self harm. Sorry.’ I hated attending A&E and always felt I was wasting time. Usually I had to wait in the waiting room for a while but this time I was taken straight through to the mental health cubical- a room furnished in such a way you could cause yourself no harm whilst in there. The on call psych liaison nurse was called to sit with me whilst I waited to be seen. I was seen quickly and stitched by an incredibly kind doctor who treated me with the most respect I’ve ever been treated. Then things started to go wrong. The psych team were called to assess me and they decided a psychiatrist evaluation was required. It was midnight by this time and it was decided I needed to stay the night and be assessed in the morning. There were no beds available though and after a lot of persuasion I agreed to spend the night in A&E.
My night was spent attempting and failing to sleep curled up on a chair being watched by the psych nurse.

In the morning I was told that if I tried to leave I would be sectioned whilst they attempted to contact the home treatment team. As it turned out my postcode meant I was under the WLMHT crisis team instead of the CNWL team (which my ED service was under). I was escorted and transferred to Hammersmith and Fulham mental health unit.

There I was assessed by a doctor and a nurse from the crisis team. At this point I was told I was to be admitted to the unit and I fell apart completely. Sobbing and distressed I completely refused. No way. The crisis team decided to discuss with the whole team and I was told if I left the unit the police would be called. Half an hour later I was told as I had refused voluntary admission I was to be assessed under the MHA.

I was taken through to the section 136 suit which is little more than a police cell with a toilet and a mattress and left in the care of a nurse from the ward. I was terrified and distressed. I didn’t know what was happening or why I was being locked in what was essentially a cell. I did eventually curl up and sleep, utterly exhausted and freezing cold- there were no blankets and I was wearing the same clothes as the night before.

I was woken up when two doctors and an approved social worker entered. I don’t remember them introducing themselves. I sat in the corner, the cold of the concrete seeing into my back, utterly terrified. They questioned me for half an hour- I felt like a criminal, I hadn’t done anything wrong but I felt a thick coat of shame and guilt enveloping me. At one point one of the doctors asked me why I was so distracted, that it felt like I wasn’t in the room with them. Truth be, I was so frightened that I had detached myself from the situation- appearing distant and vacant. I answered their questions like a robot- yes I had thought of killing myself, yes I had plans, no of course I wasn’t going to tell them what they were, yes I had stopped taking my medication, no I would not accept an admission. At the end of half an hour they left to discuss between themselves and once again I was left in the room/ cell terrified out of my mind. When they came back in I was told I was to be sectioned under the MHA. At that point my survival instincts kicked in and I agreed, sobbing, to be admitted, voluntarily. I was escorted to the ward where I spent the next week. I couldn’t stop crying and spent most of my first day stood in a corner refusing food and drink, too terrified to sit down on the sofas.

That first assessment under the MHA was utterly terrifying. I’d never experienced that side of mental health services before and being sat in the 136 suit I truly thought I was being arrested for a crime I didn’t commit. It was probably the worst place I could be in my mental state, my overwhelming memory of that room is concrete grey walls and a blue plastic covered mattress and being freezing cold and frightened. No one explaining to me what was going on and only knowing that I couldn’t leave without being brought back by the police. Already feeling confused and vulnerable my mental state only deteriorated further being kept in that situation.

Two Beccas

I would like to think that I can get to a place where I look forward to the day. Where going to bed isn’t a monumental tussle between being able to switch off and bringing the morning closer. Where my day isn’t spent watching the clock until the next time I can eat/ not eat / binge/ purge.

Something I find very difficult to explain to the professionals is the two sides to Becca. There is coping surface Becca. She has a close group of friends who she talks to regularly. She is applying for jobs and masters degrees. She’s the Becca who turned up every day to the lab and carried out her dissertation work carefully and precisely. Who smiles and laughs at the right times and tries to be ultra helpful.

And then there’s Becca not coping. She’s the one I actually identify with. The Becca who saves up her medication and plans the day she’ll take it all. Who is drowning in her eating disorder and who spends every day curled up in a ball unable to leave the house. The one waking up having had another nightmare about inpatient. She’s the one who is making her family’s life hell and who is struggling to cope.

The two Beccas are incompatible and I struggle to make sense of them. It sounds utterly ridiculous to say I want to kill myself when the same day I agree to go on holiday with my friends or apply for a masters. It’s even harder to explain how I can text my friend, laugh, and then put my phone down and pick up a razor blade or stick my fingers down my throat.

The only way I can describe it is through this:

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That is how I feel. People see the outside of Becca but at the moment it’s the dark inside that is taking over. The scales have found their way out of their hiding place and the weight is trickling off. There’s a stash of pills building up on the side where I pretend to take my iron tablets every night and instead put them back in their box. I struggle to even care that without them I’m risking landing myself needing a blood transfusion again. And yet I’m doing and saying all the right things. I’m making plans with friends, I’m going to Rome in less than two weeks. It doesn’t make sense and I hate it.

There’s Becca coping and Becca not coping. Everyone chooses to see Becca coping and yet it’s Becca not coping who’s running the show.

On suicide

This is what it’s like to know you’re dying: your heart rate speeds right up until your entire head is pounding and throbbing with the beat of your life. And it’s true what they say about your life flashing past your eyes- not how they show it in films but every regret and hurt comes to the forefront of your mind. You see your loved ones. Your vision starts to go, lights flashing at the corner of your eyes and there’s a black most rolling around your head. Your lungs are screaming for air but you can’t breathe past the ligature. At this point your body’s instinct for life kicks in and you struggle. But your mind clicks over again and you become apathetic, ‘good, let me die’. It feels like your ears have been stuffed full of cotton wool and your skin feels like it’s about to split with the pressure of your blood pounding. You retreat inside yourself and everything seems to pass both very slowly and very quickly. And then it’s shouting and a sharp pain in your neck where the scissors Nick your skin. You can’t feel your feet or arms and you fight as they restrain you and as the oxygen fills your lungs again, crying and screaming please just let me die. And then it’s your head slowly clearing and the awful realisation that you failed, again.

Suicide. It’s one of the least talked about subjects and the biggest taboos. And yet it silently affects so many.

I am a survivor of suicide attempts. Plural. And it wasn’t until I was made an inpatient on a general psych ward that I met other survivors or people willing to talk about it. I made several attempts before being admitted, most of the time never telling anyone until asked which might be days or weeks later. The week before I was sectioned I was taken to A&E by the crisis team having overdosed but was allowed to go home later that evening. I was already planning my next attempt, buying packets and packets of pills ready for te 6th June. The day of my dissertation deadline, the final loose end I wanted to tie up before killing myself. Only on the 2nd of June I was sectioned.

By that time I was too determined that I would kill myself. I was livid beyond reason and desperate that i’d been caught out. Very early in my admission I locked the bathroom door on my male 1:1 and ligatured. I was stopped when the team was called and I was restrained back to my room. I tried again a week or so later and once again was caught. It’s extremely difficult to kill yourself on a psychiatric unit when on arms length Obs but that didn’t stop me trying. In my mind living was the worst torture you could inflict on me and the staff were being cruel beyond belief by making me stay alive. I had one more near miss, where I cut an artery on my first night off 1:1. Once again I was caught.

Looking back, it wasn’t cruelty that saw them intervening again and again as I attempted to kill myself once again. Whilst I would be left sobbing and broken with my 1:1 once I’d been restrained to a neutral area and drugged into a haze of unreality as sleep swallowed me again, convinced the staff were enjoying causing me pain and relishing using restraint, in reality they would be debriefing in the office talking about what could have been done differently and searching for ways to break out of this cycle. The other patients would be distressed by having witnessed the team crashing in and pulling me out of my room or the bathroom and left a shell of a girl sobbing. The medication I detested was given to help me deal with the aftershocks of failing, not just a cruel lazymans method of restraint. And the actual restraint and cutting of the ligature was carried out with utmost professionalism and competence. But I couldn’t see that and I often still can’t.

A lot of the time people wrongly assume that because you are still alive you can’t truly want to die. How I wish that were true- killing yourself is not as easy as it sounds and thankfully so. I still often struggle with planning and acting on suicidal urges, but I can sometimes rationalise the effect suicide would have on my family.

Because they’re the forgotten victims of suicide. For every successful or failed attempt there is a family standing desolate in the shadows staring at the shattered remains of life that follows a suicide attempt.

And yet no-one talks about it. Even now, this has been the hardest post I’ve written and I find myself wondering why I’m still alive. Why did I have to survive? And not talking about it makes it worse, because the shame and stigma convinces you you’re the only one. It is that secrecy and isolation that suicide preys upon.