Strong

Over the last few days it is as though a Dam has burst.

Like the last key piece in a restraining wall has been removed and a HUGE flood of stuff is gushing, streaming out. All the pain I have kept locked up inside, all the struggles the attempts to control my eating, my weight, my shopping, my spending and my drinking, just spilling out in my emotions, in my talking, in my connections. Wave after wave of suppressed sentiment crashing in to my conscious psyche – its like a voice in my head is screaming at me “I’VE HAD ENOUGH, I CAN’T LIVE LIKE THIS ANY MORE”

Its useless to try and put the cork back in or re-lay the stone, the force of the pent up emotion is just far to powerful to make that a possibility, even if I wanted to.

Yesterday was one of the most emotionally painful days I can remember, ever. And that includes the day I ended my marriage or the day my father died. The sheer force of grief and hurt and hopelessness was overwhelming. Quite literally I barely knew what to do with myself, I could think of NOTHING that could take the edge of the rawness and vulnerability.

I think that’s when we are supposed to ‘lean into the discomfort’ but I could not. Partly at least because I had to go to work… I think I would have made a better fist of it if I could have either sat reading or mindlessly occupying myself, but no, I had to see 30 patients at 10 minute intervals and hold the whole thing together.

FFS.

I did it though, and then I wonder why and how I got so good at ignoring what I feel, intellectualizing and hiding it, stuffing it down with binge eating and drinking! Because that ALWAYS what I do. I just get on with what has to be done.

My conclusion from all this, right now, today, is that I am an incredibly strong woman.

My way of dealing with stuff has been totally warped and ultimately very unhealthy but I have been carrying this burden of emotional pain for years. I have coped with SO much, and  have not laid down and given up. No, (at times to my own detriment) I have kept right on going, doing the best that I can, loving my children, trying to help and support my colleagues, friends and family, giving so much emotionally to my patients. I have done all this whilst inside I have been a wreck, a lost, sad, lonely. vulnerable, insecure wreck who has been treated seriously badly by her last two male partners; bullied, abused, frightened, gas-lighted and used.

I deserve to be treated well ( we ALL deserve to be treated well) and I have tried SO hard to do my best and make everything alright. And, you know what, today I really believe it is not I who failed my ex husband or ex Partner. It is THEY who failed ME. They who failed to treat me with respect, kindness or love… They who walked all over my basic good natured kindness and compassion and dealt out disdain, cruelty and lies.

And now I’m going to bloody well sort out this food / control / insecurity / vulnerability /avoidance of feelings bullshit, tiny step by tiny step and I AM going to live the life of contentment and happiness that I freaking well deserve.

beleif

Numbing….

Dear God this is taking me a LONG time.

I sometimes feel I’m so deep in all the psychology and therapy and steps and analysis and recovery programme that I will NEVER get out. It’s all taking such a fucking LONG time … and its SO painful.

Ok.

Deep breath

Now I’ve got that out of the way,  my rational brain tells me that I was really freaking SICK in the head until not that long ago. That I lived for at least 25 years drinking excessively and for 18 years in abusive, scary, frightening and destructive relationships. I have barely had a single day in the last 37 years that I haven’t worried about my weight, lumps and bumps… That all that time I had NO IDEA how to help myself get out of the mess I was in. That this is a PROCESS, that I started it on the day I committed to stop drinking and I cannot stop now. I cannot un-know what I know and I cannot turn the clock back (nor to be honest would I wish to).

I think I began using food as a coping mechanism when I was about 16 years old  (certainly that’s when I remember starting eating and vomiting in an attempt to control my weight). Very soon I was old enough to use alcohol in the same way. Food or alcohol was my way of dissociating from feelings which would have been too overwhelming to experience – feelings such as abandonment, social anxiety, isolation, loneliness,

From the work I have been doing reading Brene Brown and in my inventory I have come to realise that the issue at the bottom of all of this shit is that I have spent my entire adult life running from my feelings. Numbing my feelings. escaping in any way I could from actually accepting what I am feeling. Through drinking, starving, binging, purging, spending, falling in love, being miserable in relationships, all of these strategies have been adopted basically to get me to avoid FEELING. Anything. but especially emotions I was taught as a child were unacceptable.

After a huge binge / purging session I know exactly what Im feeling, no more  confusing emotions. I feel sick because I’m full to the point of bursting and I’m consumed with self-loathing because I’ve “failed” yet again. When I succeed in eating NOTHING at all for a whole day I feel powerful, in control, strong and “good”. When I was drunk of course I felt exactly nothing because I was, well, drunk. Hangovers, and associated self loathing also numbs all emotions other than shame, self disgust and despair.

Why is this? why have my feelings and emotions been so shut down, that I cant bear to feel them, acknowledge them ? why does how I truly feel seem like a completely obscured vista, where all I can see are some strong shapes which represent shame, self disgust and self loathing?

Am I just extremely sensitive? A person who ‘feels things’ so intensely that they become unbearable, and as a young person I literally could not bear it?

Is it partly the societal expectation that encourages us  to show our best selves to others and to appear strong, independent, and upbeat. See the whole ‘Facebook’ horror …which goes something like this ….we look at our friends Facebook feeds and everything looks amazing; adventurous holidays, smiling happy families, perfect BBQ parties …

We then fall into the trap of comparing our real, messy, imperfect lives with “highlighted snapshots” of others , which adds to a pressure to keep up our own “everything is great” exterior. But these images we portray to others don’t show the whole picture. We might be depressed, or anxious, or alcoholic, our kids may have problems, we may be in debt etc etc . Others see that burnished shiny happy exterior and we hide reality.  This all leads to us to feel isolated from other people.

One thing I know for sure after the last 796 days. I cant do this alone. I cant be isolated. I NEED to have meaningful connection and honesty in my life. I have to be vulnerable and truthful with people I trust to have a hope in hell of surviving.

So yesterday I have  called my sober sister, I had a therapy session and I also met  with three women from AA, women I feel proud to call my friends, women who ‘get’ this whole messy addicts world. And I talked, and listened and talked and talked and talked. And I connected, and felt less afraid, less vulnerable and less lonely.

And I survived the day. Sober.

And today, later today, I will collect my beloved first born son from the airport, and tonight all three of my boys will be safe, under my roof.

wierd kids

Step One

We admitted we were powerless over alcohol and that our lives had become unmanageable

Yes.

No problem.

I have been powerless over alcohol my whole life, and I could have admitted it every day for at least the past 20 years. No big issue for me. I arrive at this day in my life with a complete certainty that I cannot drink normally. I simply cannot. I tried for many, many years, in every imaginable way, to moderate and control my drinking … and inevitably, as inevitably as the rising of the sun, I failed.

Every Single Time.

You know that phrase, that the definition of insanity is doing the same thing over and over again expecting a different outcome? This is me and alcohol.

If I drink, I will drink too much. I will be ashamed of myself, I will hate myself.

Not maybe, this will happen.

So just don’t do it. Simple. I accept that I can’t drink, I really, truly do.

Step one done.

Except that it’s not quite that simple.

Reading the stuff about step one, and absorbing the other ‘stuff’ about other addictive type behaviours – in my case issues around eating and food, love and relationships, shopping and spending …. these things are also all under the addictions spectrum and I have reluctantly been forced to accept that these things have not been ‘cured’ by my not drinking alcohol.

They are ‘better’ certainly – my issues with food have improved and I am no longer constantly starving and binging;  but its very far from normal. I swing between standing on the scales every morning and weighing up the calorific content of the (skimmed) milk in my coffee, to buying a whole vanilla cheesecake and eating the entire thing in one day. I am obsessed (and really no other word will do here) with my weight, and the value that I put on myself is directly related to my weight. The thinner the better. This is profoundly unhealthy but I have absolutely no idea how to shift this thinking. TBH just admitting it feels really really hard, harder than admitting to having no control over drinking. Ugh. SHAME, and you cant really go cold turkey on food… I know, I’ve tried.

I’ve become wiser when it comes to relationships, I know I’ve truly stuffed it up in the past so now I avoid. Completely. Although actually I don’t. I still have the fantasy in my head of a nice partner so periodically I download a dating app to my phone, spend 48 hours messaging various men, and then get terrified and delete the app. Bonkers. I don’t actually DO anything, but I’m hardly approaching the opposite sex in a calm, rational balanced way.

My financial situation is better now than when I lived with ExP. But it should be better than it actually is. Late night amazon shopping sprees are less frequent and less impulsive, but they still happen. Shoes, handbags and clothes have become an antidote to feeling horrible. The urge to ‘get away’ on holiday comes over me VERY strongly, and the urge to just spend on anything is not unknown. Sound familiar?

I feel sick. And cold. And exhausted

This is step ONE, I look at it and it looks EASY .. I’m an alcoholic, yes yes yes, Next …

Now I am not only an alcoholic I’ve got a whole fucking array of ‘holics’s’  and ‘isms’ … and I’m powerless over them all ? And my life is unmanageable because of them ? Great. Just fabulous, fantastic. hoo-bloody-ray.

Its true though.

Sigh.

Failure to address /deal with the other addictive, avoidant type compulsions  is probably whats preventing me from achieving what I desperately want. A peaceful normal life. A balanced response to stimuli (of all types)

The second part of this step “our lives had become unmanageable” I only really clocked when I started doing the ‘homework’ which involves a whole load of thinking and inventory making. Much as I disliked admitting it, and struggled to deny it, my life was completely unmanageable when I was drinking and living with exP.  By sheer force of will I held on by the skin of my teeth but in constant screaming, searing emotional pain and with little respite from gut wrenching anxiety. I can accept that my life was unmanageable with a combination of alcohol and that relationship, but both are now gone. Why do I not have serenity, peace and positivism washing around me? It IS better, life is SO much calmer, and there are moments of real joy… but, BUT despite my work with Brene Browns stuff, and my conscious efforts to ‘love myself’ – there is still far too much self blame, internal hostility and struggle … I think, and I will d/w Angela, that this is due to the unaddressed issues above. Sigh, more work, more heartache and more horrible emotions.

So, taking the whole thing ALL of it ..in what ways has my life become unmanageable ? In what was / IS my life unmanageable …

  • Emotional Consequences:  I have felt hopelessness, despair, guilt, shame, remorse, depression, paranoia, anxiety, loss of self-esteem, loneliness, emotional exhaustion, fear of going insane, feeling like two people (living a double-life), suicidal thoughts, , fear of the future.
  • Physical Consequences:  for me these include  high blood pressure, weight loss & weight gain, unintentional injuries from falls, multiple bruises I have no idea how I got, abuse by others which I allowed because I was drunk, trouble sleeping and trouble waking up, physical exhaustion, abnormal blood tests, cutting myself accidentally when cooking, burning myself when cooking,
  • Spiritual Consequences:  feeling disconnected, feeling abandoned, feeling anger toward God, emptiness, lack of faith ( I have always deeply envied people who have faith) , loss of values and morals. Living a life against what I believed to be right and the dreadful cognitive dissonance that ensued from that.
  • Family and Partnership Consequences: Lots of unhappy relationship strife, loss of respect for myself, alienation from my children esp son 1,  jeopardizing my family’s wellbeing, scaring the kids by being drunk; loss of emotional control, shouting at children, inconsistency in parenting,
  • Career and Educational Consequences: actually not much in this category. I’m in a stable job and have been since before my alcoholism was a huge problem – I was always VERY conscious of how easily it could all come tumbling down though. Ive coped quite well with the stresses and could be said to have built a successful business. Still feel like an imposter and so very tired of it at times.
  • Financial consequences  I’ve borrowed a heck of a lot of money. I’m only ok because I earn extremely well , but I have NO savings and am one salary away from disaster. Even now. I also have pretty poor pension provision due to earlier fiscal stupidity. Not great really for a 53 year old woman.

So, my step one, previously thought to be easy easy easy – not quite so much now. I feel terrified, panicked, exhausted at the thought and there is a very small nagging voice at the back of my brain that my primary addiction is not in fact alcohol (although as I said I am clearly alcoholic) but food …..

Oh shit.

eating disorder

 

 

Sponsor

Ok. so I’ve decided to go with the AA programme and work the 12 steps.

So I needed a sponsor. As many of you will know, women sponsor women so that was a good start. In the same way that I looked for a therapist with certain characteristics, I wanted (or more specifically did NOT want) certain characteristics in a sponsor….

  • I wanted a woman of roughly my age or older
  • A parent
  • kind
  • not too dogmatic about ” this being the only way” … or demanding about what I must do eg 90 meetings in 90 days ….

So, after quite a lot of thought I contacted a woman who I actually met at the second meeting I ever attended. Im going to refer to her as ‘S’ (for sponsor) on this blog, as I imagine she will appear occasionally (! ) and using this initial distinguishes her from all the other people who appear under their (real) initials…

I had absolutely NO idea how I thought this would proceed. After I sent her a message asking her if she would be prepared to sponsor me, and she accepted – what next? Fortunately she seems to know what to do, and we met at a mutually convenient time. We agreed we would do this most weeks, same time, same place for the foreseeable future ( I like this predictability so that pleased me)

She told me a little more about her background, it was very interesting to me because she grew up in an abusive home. She ‘gets’ the cycle of abuse and understands why women don’t necessarily leave. I hadn’t known that but I was grateful to her for sharing that with me.

And then we worked ! We read some stuff, and discussed what we read. We looked at a pretty terrifying ‘addiction and recovery’  graph and I was truly horrified to realise how far down the slop I had progressed. (But then cheered to see how far UP the other side I have come in the last 26 months) She asked me to buy a book , and set me some ‘homework’.

I found it quite tiring but I left feeling good. Uplifted and positive. Less apprehensive and very very determined to do this once, do it right, and  shore up my recovery. To stay long term sober and never ever relapse.

I think Im at middle recovery right now. I have successfully stopped drinking, and maintained that for a while, BUT …. there is more, I know there is more around working through other emotional issues, addictive type behaviours (food and spending) codependency and acceptance of myself.

Wish me luck

Terry-Gorski-Model-of-6-Addiction-Recovery-Stages-1

The neuroscience of recovery

As part of my commitment to working the 12 steps, my sponsor asked me to buy this book

It duly arrived from Amazon yesterday and I started reading it.

The first  pages are concerned with some of the neuroscience of dependence and recovery which has been well researched especially in the last 20 years.

Interesting stuff. My sponsor thought it would interest me with my scientific background, and she was right.

Essentially, and I’ve tried to summerise and write in non scientific jargon (when I tried to read some of the original papers by Nutt and some others my brain got scrambled, much too technical and complex)

1.Addictive behaviour can be shown to cause hundreds of changes in the brain anatomy, chemistry, and especially in cell-to-cell signalling,  We know, from many studies, that messages passed between brain nerve cells are the molecular basis for learning and memory. Neurotransmitters (chemicals that pass messages between nerve cells) are also heavily implicated in mood disorders and behaviour, Deficiency in, for example. the neurotransmitter serotonin leads to depression, which can be successfully treated by increasing serotonin levels.

2. The brain is amazingly good at adaptation.  Called “neuroplasticity” this is an umbrella term for a sequence of processes that occur in your brain over time in response to any incoming stimuli. Your experiences, behaviours, thoughts, and emotions physically change the form and function of your brain. In other words, based on life experiences and repeated behaviours, emotions, and thoughts your brain remodels itself and especially its inter-connections.  This is particularly obviously seen when for example a person who is right hand dominant loses their right hand and learns to write with the left.

Are you with me so far ? makes sense to me so far ….

3. Because of neuroplasticity, what you do habitually – both good and bad – literally gets hard-wired in to the structure of your brain. from writing with your non dominant hand, to remembering to check your mirror before you pull out in the car… we all know this yes? when you learn to drive you think about it ALL the time, but with practice it becomes instinctual. I tell this to my trainee doctors, … whilst you are worrying about HOW to examine the heart you will hear nothing abnormal. Only when you have done it thousands of times , so the actions and processes require no conscious thought, is your brain free to pick up the abnormalities. So similarly, repeatedly worrying about finances, catastrophising about mistakes at work, drinking alcohol to relax, placing a bet,  using cocaine …. all of it, is laying down hard-wired pathways in the brain.

Equally important as this creating of new neural pathways by repetitive drinking or drug taking is the role of neurotransmitters. e.g. dopamine

4. Dopamine is particularly interesting  to addictions scientists because it is the major neurotransmitter manipulated with drug / alcohol use. When something we perceive to be “good” is taken/done , that’s when dopamine is released. Different people need different pleasures and rewards to get enough dopamine. A food addict’s neurones get activated with the bite of a juicy hamburger, Similarly, an alcoholic gets that same rush of dopamine when that first drink is sipped. Dopamine surges produce a euphoric effect that rewards and reinforces the addicts behaviour. Unfortunately this dopamine high gradually becomes more difficult to achieve on the amount of the drug / stimulus they used to take, which is why the addict winds up taking more of the drug than previously to achieve that same feeling.  The addict may not realise it but they are affecting the functioning of their brain and altering its chemical structure (through neuroplasticity) to achieve that high.

5. In addition, the manipulation of serotonin, (another neurotransmitter like dopamine but which instead regulates mood)   leads to the laying down of behavioural circuits that create irritability and depression when the addict abstains from drug / alcohol / addictive behaviour. Hence the come down described by so many addicts. It’s psychological yes, but it’s also a physically motivated sensation.

6. Your nucleus accumbens (which is part of the limbic system in the brain – think emotions center and memory bank)   craves the dopamine hit that it knows goes with what it has learned to be pleasurable (see new pathways laid down that associate alcohol with a nice dopamine rush)  The thing is, the first time you do something, the dopamine rush comes after the action. In the future, the dopamine is released earlier and earlier until just thinking about something in anticipation causes a dopamine reward. So, the dopamine released before the action and along the way actually motivates you towards the behaviour, and a bad habit is born.

Every time you follow the same path, a specific pattern is activated and becomes more defined in your brain – it forms a kind of circuit, and it becomes easier to activate the circuit the next time and so on. Pretty soon, the bad habit neuronal pathway becomes the unconscious default, and your brain, wanting to be efficient, just takes the easiest, most familiar route.

By taking advantage of the brain’s plasticity, addiction remodels neural circuits to assign supreme value to cocaine or gin or gambling, at the expense of other interests such as health, work, family, or life itself

Ok. Thats the neuroscience. It makes sense to me in many ways, but It doesn’t however explain why I am an alcoholic / addict and my brother is not. Thats somethings I will need to look into further.

Now I entitled this post the ‘neuroscience of recovery’ becaue thats what I’m most interested in… and I think you can guess how this goes from reading the above …

Basically ….

1. What is learned can be unlearned. Because neuroplasticity is fundamentally present for out whole lives, the brain can make changes to support new, healthier behaviours: basically we can retrain the brain,  With intensive therapy and other holistic interventions, esepcially repeated positive behaviour thoughts and actions, we can strengthen the new “recovery” loop within the brain. The brain then learns to enjoy recovery, those things that give us pleasure in our sober lives – family, work, interpersonal interactions. We retrain the brain, by our actions we lay down new pathways that provide pleasure,  and thus we are able to make changes.

BUT, the old neural pathways, the old links between addiction and pleasure are still there. This is why  complete abstinence from drugs and alcohol is essential to addicts. It doesn’t take much to jump start the old habit. Recovery doesn’t remove the old pathways, it just allows them to fall into disuse and no longer be the ‘go to’ response.

Great, retrain the brain… But HOW ? HOW ! what are we doing to do to replace those big dopmine hits ….. There has been quite a lot of work on this, and some people seem to have studied the brains of recovering addicts in quite extrordinary detail! My research is not complete and not from Google scholar (at the moment) but there is some evidence that storytelling, which is a core tenet of 12 step programmes activates the doapmine system, giving the speaker a powerful boost.

There is evidence for mirroring being helpful in rewiring brains – basically if you hang out with clean and sober people you are more likley to be clean and sober, and that this mirroring of others behaviours also give you a dopamine boost . There is evidence that the love and care recovery communities share has a very positive effect on brain rewiring, but I couldnt really work out how.

I think the main things I came away with from having done a LOT of reading over the past few days is that addicts lay down new pathways in the brain which both cause and result from addictive behaviours. That once those pathways are there the positive hit that comes from even anticipation of the addictive behavior makes it hard to stop. That for lots of good scientific reasons only complete absitence will allow those “bad pathways” to wither away a bit. And that recovery, neuroplasticity in recovery, takes time. And it does take time. I can see that. Im 794 days sober, and my new pathways are still pretty baby.

For me the point of doing the 12 steps now (honestly i do not think I could have started before now) is because I can see that as a process it seems to work. And reading this neuroscience stuff, I kind of undertsand why it works: service, storytelling; mutuality … honesty, vulnerability, hard but laying down new pathways of beheviour that will, in time, become the default ones.

 

neuroplasticty

 

Emotional

I’ve been struggling the last few days. So much emotion and such extreme feelings.

On the positive side, my eldest is coming home 🌟🌟🌟

I’m beyond excited, and so happy. He has been away for eight months, first in Nepal and latterly in Vietnam. He’s had a option to stay away till July, but yesterday told me he’s decided to come home now. I feel a bit guilty, I think he recognised the stress in my voice, and asked me how I was. I try not to ‘lean’ on him as a sounding board, he’s only 19 after all, but the stresses of son2, of my desperately unwell friend .. I actually really want him here … so Thursday evening he will land at Heathrow – and I will be there to meet him.

Also good, I asked someone to sponsor me, and she agreed. We met on Friday and started the programme… I found it illuminating and feel positive about this decision.

Not so good.

My friend J. It’s not my story, and it’s not my pain: but it is so hard seeing him die ; inch by inch, deteriorating, his world shrinking , the pain, the fear, the breathlessness the sheer physical breakdown of a kind, fun generous person. Watching K, so strong and so brave, shouldering all the heartache, keeping things together for him, for their son, working .. my heart bleeds and I’m struggling with my emotions. Resentment, anger, frustration childish feelings of “why him, he doesn’t deserve this” : “it’s not fair” ….

Son 2. Public exams start on Tuesday. No work, no study. No effort. I’m struggling with fear, frustration, anger (because total failure will have a huge impact on me in the future) impotence, inability to understand his complete non engagement. It’s hard. Managing his simultaneously rock bottom self esteem, and huge inflated sense of importance (he thinks all my emotional stress is caused by him – which makes him feel shit about himself) it really really drains me.

And I’ve run out of my SSRI. For six days , That is a huge mistake and my first job today is to collect my prescription .

Sunshine

Its a glorious day in the SE UK; sunny, warm and calm… and its  a pretty good day for me too .

Yesterday I rewrote  a post about resentment and anger that I was going to finish today, but you know what, its such a beautiful day I thought I would write a totally spontaneous piece about the GOOD things in my life

  1. I have set up a little office /desk space in my bedroom – you can see it below. I used a table from the boys den that they don’t really need and a chair from the same place. Its not huge but its MY space and I have my laptop, some books, my candle and a desk light. In due course I might put a shelf up too. My bedroom is at the top of the house, you can see the light from one of the skylights falling in… I’m very happy with my new space.
  2. I met D this morning for a coffee. We met only last week, but I feel close to her already. She is earlier in her sobriety than I, but doing really well.

I love meetings , but I love meeting people who “get it” on a one to one basis too, and for me that’s one of the best things about AA, a room full of women who get it! I felt really happy after that coffee, accepted for just me 🙂 I hope we will see do it again.

3. A lot of my anguish about my patient has settled. Yesterday’s heart felt dump on the blog, and talking with D helped me realise that it’s mostly Shame that’s stalking me. I’m ashamed that I have done something wrong (colluding with the psychotropic medication changes) in the scheme of things it’s a little wrong, a small thing- but perfectionism is one of my big failings, and I have been less than perfect , and worse, other people know!

4. I have found myself a sponsor I think. I have met this lady a few times, and having thought about it quite a lot – about what I would like from AA, I decided that ‘doing the steps’ would be a useful and probably revealing exercise. After Anne’s recommendation I bought the ‘women’s guide to the 12 steps’ by Stephanie Covington (and the workbook) I think a sponsor to help me along would be a good idea. The woman I have asked is also a mother, works in a high pressure job and seems not TOO evangelical about the whole thing ! We will see, but I’m Comfortable with that decision so far.

5. My poor stressed anxious son2 is talking to me fractionally more. Just a little bit, but it’s progress. Yesterday evening we had 10 mins together , the three of us, playing badminton in the garden. It was fun and I’m holding on to that positive.

6. I’m having my hair cut and the Grey dyed out today !

7. Son 3 and I made a conscious decision to try and eat better – we started about 2 weeks ago. Nothing too extreme, just increasing our vegetable intake, limiting white flour and sugar and cooking together from scratch every evening. He has been really enthusiastic and positive – and has tried several things he would previously have rejected. I feel like , at last, I’m setting a good example on the nutrition front.

8. I clipped the dog ! She’s a collie and this hot weather is not much fun for a black and white fur ball .. the dog groomer we used to use has closed down, so I did it myself 🙂

9. Son1 has sorted out his visa problem in Vietnam (not the country to piss about with visa’s) I managed to send money to him via western union (his bank card was stolen / lost) and he’s now in Ho Chi Min city for a few days before leaving for Cambodia. He will be home soon which is SO exciting !

10. I am SOBER. Still bloody sober. 789 days sober. And clear headed and GETTING THERE. What a gift and a recurring joy to wake every morning with no hangover, intact memory and no messy behaviour to be ashamed off. That should be number one really !

So I hope everyone else is having a good day, that’s my gratitude list for Tuesday and right now I’m feeling optimistic, enthusiastic and positive

🌷

Manipulated

Writing about being blocked yesterday, seems to have let some stuff go and I completed, to some degree, the ‘stuck’ posts yesterday. This, and what I’m planning to post tomorrow, strike me as the two major themes right now.

This is quite a hard post to write for two reasons. Firstly because I must be careful to maintain the anonymity of my patient, and second because this episode has reinforced to me a) how fragile my sense of self is, b) how heavily I rely on my work and ‘being good at my job’ for self esteem, c) how hard I find it to self validate – feel ‘good enough’, d) and how difficult it is for me to assess what is a proportionate reaction to something ‘wrong’.

So, in a nutshell, and having changed some details to protect anonymity. I have been the GP for a patient with mental health problems for many years. About 18 years in fact. This person is a health care professional which is relevant because a) their area of specialisation means that they have greater specialist knowledge about some aspects of their illness than I, as a family practitioner, do,  and b) I think we tend to accord colleagues a higher degree of autonomy over decisions regarding their health care than we would to a member of the lay public. Over the last 18 years I have gone above and beyond in my support of and care for this person. (is this a problem in itself?) I’m going to specify gender, because I hope it makes it clear (given that I am straight) there is no hidden sexual motive in my kindness.

I think its fair to say that there have been a number of problems between this person and their treating specialists over the years. Frequent changes of Consultant and clashes with many of them. Its not easy being a patient, and I have had some sympathy with this. I have seen her very often, sometimes twice a week and tried my best to be non judgmental, collaborative and sympathetic to her difficulties. At times I have been asked to prescribe treatment slightly different to what the Consultant has recommended and I have (unfortunately in retrospect) agreed to this. Partly because the patient will do it anyway, partly to maintain a positive relationship and partly because as I said, I have tried to be the patients advocate. Nothing I have done has been strictly ‘wrong’ and no boundaries have been overtly crossed, but subtly they have been eroded; for example, she calls me by my given name ; she has my (work) email address, I have booked appointments for her myself, I almost always see her for longer than the routine 10 minute consultation – all privileges I would grant as a matter of course to a colleague, but not to a patient.

Last week she asked me for a medication to treat a (new, physical) condition for which she had been seeing a specialist. The request was for  dose considerably higher than is usually prescribed. I asked specifically if this dose of medication had been recommended by the Consultant they had seen, and was told that it had been. I prescribed. This is something we never usually do until and unless we have seen written conformation of the dosage from the treating specialist. Again I stepped outside my usual practice because this person is a “colleague”.

Unfortunately, when the hospital letter arrived I discovered the specialist had in fact recommended a different treatment regime and the patient had lied to me, to get what she wanted based on her independent research.

So, what of it?

I am beyond upset. I’m angry & agitated, I feel guilty and ashamed.  I don’t know if this is reasonable or if I am overreacting to a stimulus that has poked me where I’m vulnerable.

I’ve been wrestling with my emotions surrounding this for more than a week now. I talked about it in therapy last week, I contacted a close friend H who is a psychiatrist to share my shame, and felt supported and validated by doing so. I contacted both the treating consultants of the patient to explain what had happened and to suggest a professionals meeting to try and work out the best course of action. I ranted on a closed GP forum of which I am a member. I’ve tried to de-escalate my emotional response, but a week later I’m still agitated, not sleeping well and I can’t seem to let it go.

So, what is this about?

I’m trying to deconstruct it a bit, honestly…

  1. I feel stupid. I am a very experienced GP. I train other GPs. I’m the lead GP for governance and the medical director. Im the “go to” person for other doctors difficult situations and I’ve been manipulated like a trainee.
  2. I feel ashamed. see above, but also because I have allowed myself to undermine the specialist psychiatrist which is just not cool.
  3. I feel angry and resentful. I have tried SO hard for this person. Honestly I have gone above and beyond for years, and stressed myself by doing so. I carry the risk when she tells me she feels suicidal , but wont tell anyone else. I am angry that she has showed me up, has demonstrated that despite my care she doesn’t trust me to act in her best interests and resentful that she has exposed me to censure.
  4. I feel vulnerable not because I have done anything awful, I haven’t, but because Im now agitated, restless and thinking about drinking (I wont) because I have allowed this to get right under my skin.
  5. I feel frustrated It is my belief, backed up by the evidence of a battery of tests, that the majority of this physical illness is functional in nature. That is, it does not have a physical measurable cause like infection, or inflammation. I believe strongly in the effect of the mind on the body (you only have to think about blushing when embarrassed or palpitations when anxious about something) to recognise that emotions are frequently translated into somatic symptoms. [As an aside, for anyone who is interested in this I read a fantastic book, written by a neurologist. Its called “Its all in your Head” here subtitled “true stories of imaginary illness.” She explains it so much better than I …]  even the most gentle attempt to explore this with my patient leads to a complete shut down and refusal to engage …and this also, at least on a  subconscious level makes me angry.  She comes to see me for my advice, but doesn’t actually want my genuine opinion, in any form….

Lastly, I’m struggling to work out what is a proportionate response to this, one that another doctor would make in the same circumstances. On one hand I want to refuse to see her any more, hand the problem over, deregister her from my list, refer her to a regulatory body – (I know this last is an overreaction) on the other I think maybe its not that bad, that its not a drug of abuse, that she’s worried and maybe others would do the same.

Im trying to self care. I have reached out to people I can share this with, I’ve talked to Angela about it, and unusually I also emailed her between sessions, I’ve shared, ranted, cogitated and reflected …. and  I just can’t seem to get peace with it, or come to a point of stability.

The bottom line is of course, that the problem is not HER but ME. I’m over invested and over sensitive … and I really do NOT know why. You might theorise that I’m so fucking arrogant I can’t cope with rejection (of my ideas / my care) ; that I NEED to be right. That its devastating to my fragile but puffed up ego to be manipulated like everyone else when I have tried so fucking hard. That I believe I’m ‘better’ than everyone else – at my job- and this proves I’m not ….

GGGGGGGGRRRRRRRRRRRR and AAAAAAAAAGGGGGGGGGGHHHHHHHHHHH

All i know is that I’m bothered, agitated and not settled  and it reminds me, not in a good way, of my drinking days ….

Maybe this will help !

 

 

Writers block

I havent had this before.

Usually an idea for a post comes to me, sometimes in a flash, or as the result of an experience or conversation; other times over a few days I realise I’m musing on something and I need to write it out. There have been times when I have not written much, and this has been related to one of three things, 1. Too gloomy / flat to have a creative thought 2. Not able to catch which thought is nagging at me 3. Overwhelmed by experiences…

but generally, once I start writing, the words just drop out, via my typing fingers until the post is written. I don’t edit much (as you can see) because I find when I do, the emotion behind what I have written (and it’s ALL about emotion) gets diluted and fades.

this feels different. In the last few days I’ve started 4 posts, but none are sufficiently coherent to publish. Even on a personal blog.

I can’t write at the moment. I can’t follow a train of thought to create a short written piece. Even this feels forced and unnatural.

There is a lot. Inside there is a lot. But I’ve lost the ability to translate it into the written word.

Shit.

I have relied heavily on this ability to take stuff out of my head. To capture how I feel in a moment and put it on paper. By writing it, I have managed both to unload at the time, and provide myself with a reference to look back on. I can remember how I felt when I read my posts, and I can compare that with how I am now … this has been extremely valuable (and it’s one of the main reasons I keep this blog)

I hope this block is temporary .

 

Interactions…and boundaries

This thought occurred to me when I wrote my last post.

In my life I have literally hundreds of relationships. I am a mother, daughter, sister, Aunt, sister in law, colleague, employer, client, doctor, friend, teacher, parent, appraiser,

I interact with a vast number of people; at my children’s schools, with my patients, our employees, with my cleaner and anyone who comes to do stuff for me in the house, my colleagues senior and junior. I have never been accused of being unfair or bullying, no complaints have ever been made about my professional behavior. I have had good relationships with the staff who teach my children, the lawyers in my divorce case, the psychologist who assessed my children, my colleagues both close and more distant. I manage to negotiate with unhappy angry people pretty successfully. I don’t get walked all over at work, people respect me.

Every 5 years I have to submit a multi source 360 degree feedback for my revalidation as a doctor. I also review others 360 assessments as part of their appraisals. In my experience people are generally pretty honest on these forms because the number or required respondents (> 15) does mean anonymity is pretty good. My 360 reports have always been well above average across all the domains, with common words being approachable, kind, team player and supportive. Similarly my patient questionnaires >40 when compared against scores of other GP’s in the area deliver me a well above average rating. For a pragmatist this is evidence.

So, it really is ONLY in my intimate relationships that I have had a significant problem. There are some stresses between my mother and I, and in the (distant) past there have been a few issues between my brother and I (but that is resolved now) –

On balance given that my ex-husband barely sees his brother and family, and has few friends left; my exP has very strained relationships with his own children and no long term friends at all, (in fact the only person who likes and admires him is his mother) – I think the problem is primarily them not me.

So what is the underlying reason that I can have largely successful, healthy and satisfying associations with family, friends & colleagues and yet have such unhappy, destructive intimate relationships?

Does it in part come down to the issues of boundaries? and more than that, accountability?

At work, I don’t have a problem in holding people accountable for their actions. For example, one of my colleagues was persistently late staring work. This is a problem when they worked at our branch surgeries because the receptionists don’t like to open the door if they are alone (indeed they should not do so, for personal safety reasons), so the doctor being late means patients are left standing outside the surgery as well as being late for their appointments. It is unprofessional and discourteous to be persistently late, so armed with the evidence (log on times for the computer system) we had a conversation about it. Long story short, I made it clear this was not acceptable and needed to improve, the doctor agreed and I discussed the implications (formal disciplinary action) if the lateness continued. No problem. That’s setting a boundary, making expectations clear and holding that person accountable. Not hard.

Personally however it has been very hard for me to do this. And I think there are three reasons,

  1. I have had trouble even knowing what my boundaries are
  2. I have difficulty in believing I have a right to these opinions /needs especially if they conflict with anothers needs / wants
  3. I have been way too emotionally invested in the relationship when these issues arise so walking way seems harder than just brushing it under the carpet.

I first started thinking about this a couple of months ago Here, and have refined and developed my thinking a bit since then. The first two problems I am trying to address at the moment, through attending therapy, reading, reflecting and talking to my friends. I actually feel now as though this is bearing fruit, and that I will get there.

The third still scares the pants off me. I have a history of falling in love very, very fast. Indeed I can’t remember any relationship when I have not done so, way too quickly to have made an accurate informed assessment about the character or personality of my new partner. At times this has worked out fine, my boyfriend when I was a medical student for example was a nice chap, ultimately we were not suited but he was kind, fun and not abusive in any way. The last two times, it has not worked out so well.

I am not sure, and I guess I will not know until it happens, whether I can exercise sufficient caution and emotional restraint to avoid that pitfall again. The optimist in me says I could, armed with my new appreciation of the importance of circumspection and forethought and because I will be sober and thus not afflicted by the recklessness that(for me) accompanies inebriation.

I hope so. I don’t propose to put this to the test just yet, but I hope so, and there is a major shift in my thinking over the last few weeks… I now feel I would like to TRY…one day.

healthy boundaries