New Psychiatrist

I spoke to my new psychiatrist for the first time today. He was assigned to me because the old one is too busy and needed to decrease her caseload. At first I was pretty pissed that I'd been assigned a new psychiatrist without prior notice - I only found out when I asked my old one a question about medication. Then on Monday I heard from a nurse that the new one's Dutch is pretty poor, so I was like: how in the world does someone who doesn't speak a country's primary language earn a doctorate?

Fortunately, the psychiatrist's Dutch is better than I expected. He uses a lot of medical jargon and sometiems has trouble coming up with the right lay term. In that sense it's good that I studied college-level psychology.

I can't remember all that he said. My question was for a review of my PRN medication and maybe my antipsychotic. In the end, nothign was changed. He explained about the PRN meds that even with effective drugs, 50% of effectiveness is still placebo. That made it understandable that I don't notice much effect even from the non-addictive promethazine (Phenergan) after a while. He asked which drugs I'd tried before, and I mentioned having been on most benzodiazepines. For a while, he contemplated prescribing a very low dose of Seroquel XR for sedation, but when I said I was already sleeping a lot, he decided against this. In the end, he advised against meds but recommended I exercise more, sleep less and get a better day-to-day structure. I'm not too sure this will work but it appeals to me. I am not too much in favor of tranquilization, especially since it's usually the first thing a nurse will suggest when I'm irritable even when other strategies work better. Maybe I'd have had a different attitude had my experience with tranquilizers been positive.

Six Years

On Saturday, November 2, was the six-year anniversary of my mental health crisis. I haven't really been remembering every detail of this crisis this year. What has been on my mind this year, is how it could've been interpreted so much differently had I had the diagnoses I have now. I mean, I made a suicidal threat in a public place. I didn't know right then whether I was going to follow through, but knew that I wasn't several hours later. Of course, those hours would've been enough for harm to have occurred had I been left alone, but even borderlines with suicidal ideation aren't left alone if they're in a public place. I don't think the police would have left me alone had they known I had BPD - it's not their job to do mental health triage, after all. The crisis team, on the other hand, would likely have sent me home. Instead, they knew I was autistic and diagnosed me with severe adjustment disorder, which together means they had a reason to hospitalize me.

It frustrates me sometimes how borderline personality disorder is so often viewed as attention-seeking by mental healht professionals (and the general public, but they can't help it). A desperate cry for help is often interpreted as manipulation. I remember, long before my BPD diagnosis, reading a book on how the Dutch system deals with people who are a pain in the ass due to mental illness, delinquency, or a combination of these. In the book, a crisis team nurse was quoted as saying something like: "Those pesky borderlines, they frustrate me to no end." This statement was made in response to a BPD patient who'd taken an overdose calling the crisis team to request hospitalization. Now I, too, could see how the demands this person made were excessive, but it's not like a diagnosis of BPD means a person taking an overdose isn't serious.

Last night, I was working on my crisis prevention plan with my named nurse. She asked whether I'd discussed my diagnosis with my therapist, in relation to the prevailing idea that borderlines need to be allowed to take responsibility for their own situation even in a crisis. She meant it kind of positively, as in the nurses not dictating what I should do in a crisis, but as an example, she said if I run off, should the staff just let me and not intervene until I make my way back to the ward? Hell, no! She got to using my blindness as an excuse, but I don't feel this in any way changes the situation. I just can't take full responsibility for all my actions, and, the worse I feel, the harder it is for me to communicate what I need. I'm working on developing more autonomy and signaling my emotional state before it escalates into crisis, but you can't expect me to master this skill without having learned it. I'm pretty sure a lot of borderlines agree.