Cw: mental health shiz. This is going to be depressing. Comes with the subject matter I’m afraid.
The How I Met My Psychiatrist genre of anecdotes isn’t the most chirpy of all dinner party stories.
I am what I might call an intermittently crazy person. You, on the other hand, should not call me this. Crazy is that kind of word: if it isn’t you, it isn’t anyone else either. Over the course of my life I have varied from fully functional to too beset by depression and anxiety to get out of bed. The years from late 2009 through to the beginning of this year were particularly difficult. I had repeated severe depressive episodes, some up to three months, which is less than ideal if you’re trying to hold on to a full time job. And here we reach a serious problem.
The NHS which I, like most Brits, cherish and adore, has been cut and cut by the Tory bastards running this country. It battles on like a champ through hardships it should not face. Mental health services have been particularly hard hit, possibly because crazy people are less likely to fight back against cuts. The current situation is grim.
I remember when it was not grim. Back around 2005 I had an incredible NHS psychiatrist who was available at short notice and whose calming presence and expert knowledge got me through a very difficult time – probably saving my life. In 2007 I had a swift referral to the specialist who diagnosed my ASD. Since then things have changed.
The first thing you notice is how reluctant the service is to take the referral. My GP, like many others, is comfortable prescribing SSRIs, but if they don’t work does not know where to go from there. Patients get flipped from one SSRI to another. I have had fluoxetine, paroxetine, citalopram, escitalopram, and sertraline. None of these has really had much of an effect. What next? She was out of her depth and sensible enough to know it. But the specialist service did not want me. What do you do if you’re a specialist NHS service that has been cut so that it’s barely functional? You focus on the people who are about to die, rather than the people who are merely miserable. It quickly became clear that if you weren’t acutely suicidal or psychotic, they had nothing to offer. There were people who needed to be admitted to inpatient units immediately, and anybody else was not their problem. I don’t blame them; it must be a heartbreaking situation.
So if your GP can’t help and the specialists can’t help, what do you do? You take the ineffective drugs and either get better, become acutely suicidal, or muddle along in a state of misery. When things did get really bad the service would offer help which generally turned out to be social workers.
No shade on social workers here. They do valuable work. But they are also cheaper to employ than psychiatrists are. It becomes frustrating to run through the questions over and over: any problems with housing? Debt? Harassment? Addiction? Domestic abuse? The police? Your non-existent children? Is there any way we can take a non-medical approach to this medical problem? Help us out here. You must have a reason to be miserable that we can fix!* But there wasn’t. I was just unwell; sometimes dangerously so.
A couple of times I had a period of the Home Treatment Team stopping by each day. They see how you’re doing and bring you your meds. If you need to be pushed into taking them they do that. These were lovely, caring people. Most people who work in this field are.** But they are there to check that you’re alive and that you’re likely to be alive at the same time tomorrow. They are there to see if you should really be in hospital. You do not want to be in hospital. The thought of seeing the inside of that place ever again fills you with enough dread to create a state of submissive obedience. Play nicely because these social workers can lock you up. When I did, finally, get to see a psychiatrist and asked to be taken off SSRIs and put onto Venlafaxine, he asked me why I thought it would solve anything. I responded that it had better results in double blind controlled trials than any of the SSRIs and was the obvious choice for the next move. I think that annoyed him but he already had the Venlafaxine information leaflet out so it’s not like he disagreed. He kept asking what I was doing to keep myself safe. I wish they’d be more honest with that question and say “to keep yourself alive” rather than “safe”. If you’re being tortured by your own brain the concept of “safe” is rather silly.
At one point I did see a clinical psychologist who was exasperated by me. Everybody knows that CBT cures depression! How could I have had a course of CBT in the past and now be depressed again? I clearly wasn’t trying hard enough and she wasn’t going to buy into my pessimism dammit! A severely depressed person being pessimistic? Who ever heard of such a thing?
Depression waxed and waned between mild and severe. Eventually I was dragged down by the certain knowledge that nobody was going to help. All of the first lines of defence had been tried. Specialist services still did not have the resources to provide anyone other than social workers. My GP still didn’t know what to do. I had fallen into a gap in treatment provision which is widening every year. People are dying because of this gap. I am certain of it.
I ended up ugly-crying down the phone to my parents just out of the sheer hopelessness of it all. They stepped in and offered to pay for private mental health treatment, which is how I came to meet the man I should not know.
I had my doubts about him. Early on he used the dreaded phrase “you don’t look depressed” – you’d really hope that someone so experienced would know better. But we did establish that my depression was largely triggered by anxiety, and managing the anxiety was crucial. He had a long list of potential meds to try and over the last 18 months we have run through many different options. I currently have four different meds to take every day.
The most recent addition was put in place at the beginning of this year, when I was still in a severe episode. On a low dose, Beloved noticed I was more functional than before. When the dose was put up my depression just sort of… Went away suddenly. After nine years of being a constant companion.
I can’t tell you how wonderful and strange this is. I won’t tell you the name of the drug, although I will say that my GP has told me straight out that she’s not allowed to prescribe it for me. So I’m sort of stuck with The Man I Should Not Know for now. But that’s OK. He isn’t a bad chap.
As I mentioned way back at the beginning of this blog, he uses a fountain pen. An exchange from early on went:
Him: oh, you’re interested in my pen? It’s a Parker I think.
Me: It’s a Parker 88.
Him: How do you know that?
Me: Er… It looks like one-?
The 88 – later rebranded as the Rialto – isn’t a fantastic pen. It’s basically a Vector (those really are terrible) with ideas above its station. It comes in slightly prettier colours, is less flimsy and has pointless gold plating on the steel nib. I have written about it at more length here. With every appointment he would scribble away on cheap photocopier paper, using this 88 with its Quink cartridges in. This was a source of sadness to the world. Did he not know that the writing experience could be so very much better?
Sometimes the world needs a hero. And sometimes you have to step up and be that hero, now that your brain is well enough to do some heroing. The man needed a proper gold nib. And as it happens the very cheapest gold nibbed pen on the market (as far as I know) is one of my absolute favourite workhorses. Also I didn’t have the budget to buy him an expensive one. Combine a Platinum PTL-5000 with a convertor (because REALLY), a bottle of J Herbin Pearle Noir and a pad of Clairefontaine Triomph and you make for a much better experience of scribbling down notes about your patients.
When United Inkdom did their meta-review of the Platinum PTL-5000, they couldn’t agree on anything. It’s great and I will take it everywhere! It’s so bad it’s made the crops wither in the fields and now I will not survive winter!
I fall into the first camp. By which I mean that the first camp is objectively 100% correct and that the second camp should go and sit in the Wrong Corner. I absolutely love this little bugger. It has one of the smoothest, most reliable nibs I own. It’s just a joy to write with. It’s perfect for working on my novel on the train in the morning. It’s a gold-nibbed pen that is sufficiently cheap and easy to replace that I don’t have to break out into a cold sweat at the thought of losing it. Given that I am a total scatterbrain and leave things everywhere all the time, this is a real concern of mine. Although to date I’ve never lost a pen by putting it down and forgetting it. Oh I’ve done that with pretty much every other portable item. Just not with pens. PRIORITIES.
It’s the little sibling of the more widely lauded 3776, which is also a relatively cheap pen with a gold nib. The 3776 is fancier, and I have one, and I don’t actually like it. Partly that’s because I accidentally bought an EF nib, and I don’t like those. It’s useful for the purpose of writing on really terrible paper, but that’s all I use that one for. If you go for the best price; if you are willing to be the bane of UK pen retailers; if you don’t fuss too much about being able to return a pen that doesn’t work well: you can get a PTL-5000 for about £35 or a 3776 for about £60-£70 by ordering directly from Japan.
£35 is obviously extremely cheap for a pen with a gold nib, and as you’d imagine this means that all of the value of the pen is in the nib. The rest is pretty much an afterthought that they only included because they had to. The body of the pen is obviously cheap. It’s no-frills plastic, it’s slim, and it does feel quite light and a little bit flimsy. (It’s not as terrible as the Pilot 78G which really does break the flimsiometer, which then breaks the pen, and back and forth in a kind of Perpetual Flimsy Machine.) If you like a bigger, heavier, more substantial-feeling pen, you’re not going to be happy with this one. However, I like pens on the small side. Well, actually I like them on the TEENY TINY side, as well readers of this blog know. But generally I like having pens that are small and light and fly across the page quite happily without really making their presence known. So the PTL-5000 is perfect on that front. It’s also about the same dimensions as the Parker 88, so it’s not a massive departure there. There’s something quite nice about using a pen that is so well made and writes so beautifully, but isn’t flashy about it. The 3776, by contrast, is bigger, chunkier, and looks a lot more expensive.
I did ask my shrink not to make a fuss about the gift – I’m awfully British about this stuff. I wouldn’t let him open it in front of me. He did send me a nice email thanking me profusely. I don’t know if he actually enjoys the FAR SUPERIOR writing experience I have presented him with, and neither does he, because apparently he’s too much in awe to use his new pen. You can lead them to the paper, but you can’t make them ink.
And now a little Duke Ellington.
Jump For Joy is possibly my favourite upbeat song. It’s also a song that should not, ever, under any circumstances, be sung by a white middle class Brit. I know my limitations and no song with the word “honeychile” in the lyrics is within my remit.
Noz noz noz.
Hey is it OK if my try-hard big brother butts in here and ruins this?
Cut price gold nib buddos
* This is why I don’t for a moment believe Johann Hari in his latest book where he insists that mental health professionals don’t show any interest in the life circumstances that might contribute to depression. In my experience it’s very difficult to get them to focus on anything else.
** There is one notable example, who was so utterly evil in the way she spoke to me when I was in a state of deep distress that I think she was getting some kind of sadistic kick out of it. That experience has probably affected me for life.