You know that episode in Sex And The City, where Carrie Bradshaw's dating that guy, and she's blissfully happy, thinking it's all going swimmingly – but then she wakes up the next morning to find that she's been dumped – on a post-it note? Well, that's kind of what my diagnosis felt like.
Drama, drama, drama!
I've always thought that my life only seems like it's full of drama because of the way I like to tell my stories. I'm a writer, after all, I have a big imagination, I like to embellish ...
... but upon closer inspection, I appear to have in fact told the whole truth, punctuating dark stories with jokes just to make them more palatable, easier to digest or relate to, and also to disguise my own, for want of a better word, craziness.
I'll be honest, I've always felt that something was a bit off about me. I often feel like when I try to behave, think, and feel like a rational adult, that I'm basically faking it.
The truth is that most of the time I relate to being an adolescent with raging hormones, living in a world that doesn't understand me. I am in fact nearly 40. I know that rationally speaking, I should have grown out of being so damned melodramatic – and so this is where the storytelling, but more importantly, the humour comes in ...
... I try to hide my natural melodramatic tendencies, you see, with an extra topping of – well, melodrama. My trick is to always have an entertaining story to tell, especially when I'm talking or writing about myself. Because that's always a bit cringe.
I find that a dash of suspense and a generous helping of humour disguises what might otherwise appear to be self-obsession. My awkward confessions are wrapped up and tied with ribbon – a gift to those of you who are desperate to know that you aren't the only one!
It's also of course, my way of feeling more comfortable about sharing things that are very personal, often embarrassing, and sometimes even shameful.
The thing about struggling to manage a mental illness is that you do become hyper self-aware. This is because you know deep down that something's not quite right about you, even before you've received a diagnosis.
Injecting humour and more drama into my stories has helped me to feel more comfortable, as I don't have to take myself too seriously – these terrible things have happened to me, but don't worry, because it's hilarious. No need to laugh with me love, go ahead, laugh at me, I'm totally fine with it!
Alas, my therapist often met my jokes in session with a blank face so that I was not able to detach from how I actually felt about what was happening in my stories. That was rather disconcerting.
I often feel like I'd be much more comfortable if my life was a sitcom, and I could be the main character acting out my own distressing sketches with nervous Miranda-style glances at the camera.
I look back at my life sometimes and it does seem that ridiculous. We're talking about ongoing, repetitive failure, and total self-sabotage. Nobody I know has been through as many homes, jobs, or relationships (complete with excruciating break-ups) as I have.
My point is that since I was in my late teens I have felt that life shouldn't feel the way it does to me ...
It shouldn't be so up and down, or round and round. I shouldn't be so flakey and inconsistent, distracted by so many pointless whims, or moody because"it must be her time of the month again" as my mother would so often say, even though that wasn't always the case.
There must be more to my life, and more to me. Surely I'm capable of more? Thankfully, all of this despair, or at least, most of it, was pre-diagnosis. Now that I understand more about the way my dysfunctional brain operates, I'm better able to manage my mood swings and the ways in which they impact my life.
I do still find myself trying to lighten the mood with funny stories about my wonky way of being, but now I'm also more about telling it how it is.
Mental illness isn't easy, after all, and it's not even remotely funny, for me or anyone else.
Opening my mind to mental illness
A few years ago I found myself having to temporarily move in with my sister after a big painful breakup that left me homeless. 'Temporarily' turned into 6 months because there are no pet-friendly landlords in London. But during this time my sister had the opportunity to witness some of my ups and some of my downs.
I finally found a studio flat and moved out. Then she brought it up.
She'd read something online that had reminded her of me, and said I should look into it. The condition she had read about was called BPD or "borderline personality disorder". Many of the symptoms are quite similar to those of cyclothymia. I've always been the sort of person who has felt embarrassed to use the word 'depressed' to describe how I feel. I think this was because my sister was diagnosed with 'chronic major depression' and I would have felt like a complete fraud comparing my own feelings to hers.
'Gloomy' was one of my favourite comfortable words to describe my periods of low mood, alongside 'fed-up', 'tired', and 'probably due on (my period)'.
I'd learnt more about my sister's mental health struggles over the years though, and so I found myself reading a few articles, taking a few online questionnaires, and not feeling like a total fraud for admitting to how many of the symptoms I did actually relate to.
Reaching out for help
It took a little while for me to admit that maybe there was something more to this, and that maybe it would be useful to talk to a doctor about it.
My sister came with me to an appointment with my GP, which was lucky because I couldn't bring myself to say a single word about why I was there.
It's surprising how tongue-tied you can get the first time you try to describe your poor mental health to a health professional.
After my sister helped me to get started and I managed to explain why I was there, the GP referred me to have a mental health assessment by a psychiatrist.
I think this was quite unusual as I've heard many stories about how difficult it can be to get seen by a psychiatrist in the UK. I almost feel guilty about how quickly my diagnosis process progressed because I know that most people struggle for years with this kind of thing on the NHS ...
I was expecting to faff about for long enough with a GP to be able to come to the conclusion that I was mistaken about the whole thing, and that it must have just been a phase.
Preparing for a mental health assessment
A few weeks later I found myself attending my first ever mental health assessment. This time I was to go alone.
I decided the best way to deal with what was happening was to be very prepared. So I did a load of research:
I googled the psychiatrist. I knew what he looked like and even what he sounded like because I found videos on Youtube. I read all of the testimonials. In fact, by the time I had finished researching, I felt like I had known him for years.
I also created an in-depth study of my moods going back as far as the beginning of the year by wading through old journals and piecing together information to work out what my moods were doing, what was related to what, and if there were any patterns. If I'm honest, I was a bit hypomanic leading up to my appointment. I've noticed now that stress seems to trigger elevated and mixed mood states in me.
I absolutely refused to get misdiagnosed though. I didn't want to have to go on an epic journey to find out the truth, like so many other people looking for a diagnosis for mental illness so that they can get the right treatment.
And I certainly wasn't going to waste this appointment. Preparation was key.
My first mental health assessment...
The psychiatrist was very professional. Perhaps a little too professional. Actually, he seemed a lot colder than I had anticipated from my in-depth research of him, and I felt somewhat offended that he was treating me like a stranger.
He listened, he made notes, he asked standard questions. He also ruled out BPD completely, which annoyed me, as I had put so much effort into trying to understand the disorder.
Then he grabbed a Post-it note and drew a graph on it. He titled it 'cyclothymia' and briefly explained that the squiggly line represented mood swings. This is the Post-it note ...
The highest and lowest points of the dips and peaks refer to bipolar disorder's episodes of 'depression' and 'mania'. The smaller peaks and dips refer to normal mood fluctuations that everybody experiences. The areas in between that have been recklessly struck out with horizontal flicks of the psychiatrist's pen are the mysterious realms of cyclothymia.
In my opinion this is a terrible illustration of the differences between cyclothymia and bipolar types 1 and 2. If you want a much better description read my blog post - What is cyclothymia?
Apparently, my mood swings are not within the normal bit, and they are not up and down in the extremes of bipolar depression and mania ...
I am in no man's land. A place of uncertainty and confusion, belonging nowhere, just floating about in the middle. Purgatory. Waiting for something terrible to happen, and terrible things do happen, but they are not quite terrible enough.
Cyclothymia if left untreated can develop into bipolar 1 or 2 according to some sources, but when and if... those are the questions. In the meantime, I'd have to try and explain all this ambiguity to the people in my life. Luckily, there aren't many people.
The psychiatrist told me I could keep the post-it note. Er, thanks? I was just baffled.
Denial and resistance
I went home and let it sink in. And then I got mad.
Well into the throes of hypomania now, and with grandiosity rearing it's ugly head, I stayed up all night crafting a 20-page letter to the psychiatrist in which I went into great detail about everything I could think of in my life that had made no sense to me before, and how it all related to the symptoms of BPD, and not the diagnosis I thought he had so flippantly chucked at me.
I didn't want to have anything to do with this strange word - cyclothymia. Everything I was reading about cyclothymia was making me cross. Google was taunting me, suggesting it was just a mild thing, nothing to shout about. Well, if that's the case, then my diagnosed simply couldn't be right!
Maybe I hadn't explained everything properly to the psychiatrist? There were bits I had left out, bits I was a bit embarrassed or ashamed about. Plus I instinctively play down the severity of things because I'm so used wearing this bloody mask!
There was no way he could come up with a diagnosis, that essentially sums up who I'm meant to be now, in less than an hour based on the little information I had given him. No way. After reading my epic email the psychiatrist was very polite but stuck with his original diagnosis. I got a copy of the standard report that was sent to the GP in the post shortly afterwards.
The report wasn't even addressed to me, it was addressed to the GP who had referred me. Who wasn't even my GP, by the way. Every single little detail was rubbing me up the wrong way.
And all I got was a Post-it note? I'm sorry, I can't get over that detail. Maybe focussing on the Post-it is the only way I can make this story express how little sense any of this process has made to me.
I think the worst thing was that I hadn't been offered any kind of support to help me understand things ...
The psychiatrist offered me a prescription for a very low dose of an anti-psychotic drug, but he made it clear that this wasn't something that he was suggesting I needed, and that the option was just there if I felt like I needed it.
All I could think was – why am I being offered a drug that sounds very much to me like it is meant for someone with psychotic tendencies? Am I psychotic? Might I turn psychotic? Oh my God, am I going to end up like my crazy aunt who has bipolar?!
I vaguely remember the psychiatrist emphasising that the extremely low dose may help to balance out my moods.
He went on to mention something about the fact that the drug would make me feel quite sedated, and that for some people it may cause weight gain. He said that if I did decide to take it I'd have to give it at least 6 months before we decide to look at whether it was helping. And that was what put me right off the idea of medication. I couldn't bear to imagine what a podger I'd be in 6 months' time. I was finding it hard enough to keep the bulges at bay as I was getting older.
So I left the surgery with nothing to fix the problem, and nothing to help me understand it either, except my Post-it note.
I was indignant. Just like Carrie Bradshaw was when she got dumped on a post-it with "I'm sorry, I can't, Don't hate me -"
My second mental health assessment...
Ah... you thought that was the end of the story, didn't you? No no, I couldn't leave it there. I'd come too far. I had allowed myself to be pulled into this web of perceived deceit and now it had a hold of me ...
I was committed to the idea that I was on this journey for a reason, and cyclothymia wasn't it! This couldn't possibly be the end of the line. The psychiatrist must be mistaken.
So I contacted the GP again and explained that I was very upset and I wanted a second opinion. I was referred for another mental health assessment fairly quickly, this time with a lady psychiatrist. I hadn't asked for it to be a lady, but I have to say that this next experience was much more palatable. Firstly, she actually looked at me when I was talking to her, instead of at her computer screen. That's always going to make a difference.
Secondly, I felt like she was actually listening to me and not just hearing diagnosis criteria.
Thirdly, although she did agree with the first psychiatrist that BPD was not an option and that she thought the original diagnosis was most likely to be correct, she actually asked me what I thought!
Then she offered me treatments and made me feel like she was actually recommending them, and not just saying well those are the options but it's your funeral.
(I won't go into the story of my treatments in this blog post, I think I've waffled on for long enough. I should also mention that it has been addressed in later therapy sessions that my reactions to the two different psychiatrists probably had more to do with my own need to be 'mothered' through the experience, and not the gender or professionalism of either of the psychiatrists themselves.)
But basically, that is the story of my diagnosis. So far at least. My sister's still not convinced that my diagnosis is fully correct. She says that she feels there's more to it, and sometimes I agree with her.
Equally, there are times when I also feel like this has all been one big mistake and that somehow I have managed to convince two psychiatrists that I have a mental illness when there's probably nothing wrong with me at all.
I think it's common for people with a mood disorder to go back and forth a bit, not totally convinced that there is anything wrong until they remember what the wrong bits feel like when they come back around again.
Want to read more? Find out what it actually felt like to be diagnosed with a mental illness.
What's your story?
I'd love to know how you got your diagnosis, or if you're at the beginning of your mental health journey and have any thoughts, fears, doubts, or questions. Please don't be shy... feel free to leave them in the comments below, and let's have a chat!
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