Tag Archives: psychology

Ready for this Jelly: part 1:: The overview.


This is a blog post I believed I would never write.

In July of this year I weighed myself on a scale in my parents bathroom. I looked at the number and felt quite sad. I had been looking down at scales since I was in my teens and feeling sad for a number of reasons.

Sometimes the sad feeling had been because I felt self and numbers on scales were intertwined truths, or perhaps the number I saw was an echo of some truth about me. The larger the number, the greater the likelihood that I was a lazy, worthless, ‘bad’ (oh that word) person. Ugly, undesirable. Fat. Fat, for so many of us, has become a catchcry in our heads for outright disgust for ourselves, and our certainty that others share that disgust.

Often the sad feeling around my weight was a convenient catchment for self-destruction, depression and deep bitterness. It was a convenience that allowed me a trench of sorrow in which I could hunch and glare out.

As I got older, I stopped feeling so bad. At some point in 2009, I started to go easier on myself, and by 2011 my mental health was improving. Bipolar is a wacky ride fitted with highs and lows that exhaust you, and spates of starving myself and overeating (with lots of self-justifying behaviour, of course) went hand in hand with mood changes. I was the King of Everything one day, in charge of my breakable body, captain of the fragility of my living ship. The next day I was a furious storm of cooking, eating and living large – a nutty Nigella decrying moderation.

This is a good place to say: I believe in Fat Pride. I believe in being the people we want to be, and for many, that is being fat and fucking proud of it. I champion this.

The truth is, it always felt a little hollow for me. I was not proud, I was not being the person I wanted to be. I just made really good activisty fat pride sounds. I had a spinal injury and it hurt, and the weight was making it worse. I did not want to be fat because it was making me ill. And I did not feel able to run and jump and bend and fuck as I wanted to; I felt constantly inhibited by my fat body, that I no longer resented as fat, but merely quietly acknowledged as fat. With the endless possibilities of fatness came certain limitations that I was no longer enjoying.

So in July, I stepped on the scales – having not weighed myself in a long time, generally hating the process – and saw a number that I felt sad about. This time it wasn’t so much the number, but the feeling that I was doomed to my fat, my future of ever-expansion because my many attempts at ‘getting healthy’ as Mum has often put it, had petered out before. I was the Queen of giving up, and felt each loss of drive through the lens of a keen sense of anger at myself. I wanted the fruit but for some reason I couldn’t ascertain, I was unable to scale the tree. It was fucking irritating and reinforced all the feelings of hopelessness and failure I’d been mired in, years past.

I knew my partner loved me just as I was. I had pretty good self esteem, lots of friends, work I enjoyed, was educating myself. My fatness was only a factor in that it was making my daily spinal pain much worse, and so my seeming inability to pull myself up drove me crazy.

Sometime in August, after my partner had left for Canada for many months away, I called my psychologist. I wanted intervention, I wanted to feel I was helping myself and moving forward in some way. No matter how token.

Jo said several things that felt so controversial that I didn’t know if I could actually comply with them. Firstly, she told me to make friends with my hunger, because at the moment I was oversupplying my body with energy and I needed to stop doing so. My body would argue while I adjusted to smaller serving sizes, so I needed to make friends with it, with that feeling. That felt so anti-feminist that I wrangled with it in my head for weeks. Being told to be ok with a feeling of starvation seemed like the opposite of good advice. For a while I think it did disorder my eating – I took it on board to the point that I was enjoying my hunger too much, and scaring myself by eating too far below my lower calorie intake margin. Soon I got back on track and self corrected by talking to some friends and Jo about it, and I also got used to eating about a third of my previous servings. Making friends with my hunger was more about reconciling myself to a transitional period of serving size adjustment, and not about being ok with deprivation as a rule. Unless you’re a monk, deprivation is not a principle to live by.

Secondly, she made a couple of flat guidelines: no fried foods and no softdrinks (not even diet drinks). I have observed the first one and found it to be a good idea, because even the scent of fried foods makes me want to dive face first into a bucket of oil in total abandon. It’s like sprinkling a little coke on someone’s nostrils and expecting them to be totally fine and able to control themselves if you then plonk a cup of it nearby. It’s a sensory overload that opens a gateway to undoing the most important weapon I have had: focus.

The last thing she asked me to think about was saying to myself, when I felt panicky and hungry because I wasn’t eating as much or as often or as instantly as I would like was ‘this is not an emergency. I will get food soon. It’s ok, body. We are not going to die.’ And this worked, as a wee mantra, and continues to. It’s a form of mindfulness I guess – I see the hunger and panic and understand why I’m feeling it (horribly self-abusive attitudes to food as I grew up due to unstable homelife) BUT I just let it go by. And it does, and I am ok.

I have found this whole trek to be hard slog, but I’ve made solid progress towards reducing spine pain and yes – I’m also aesthetically happier in this body than before, even though there are many who watch my diminishing curves with despair (D, S). I feel more free in this body to do what I’ve wanted to, but this is not to say that my bigger body was inherently bad. I think apologising for our desire to inhabit a certain form is just as bad as the critique of those opposed to fatness, so I won’t do that, for my body and my journey with it is mine. Choosing to change your body is not an inherently anti-feminist position. Choosing to think you have the right to school a woman on how she handles her body IS.

I will be fat again when I bear children and that will be a challenge even greater for my spine. But I’ll face that too, and I’m sure I’ll be ok.

At the moment the greatest task in front of me is to consolidate my self confidence and work on trusting myself. I feel a strong sense sometimes of worry that I will fall off the horse, be unable to keep going, and so many other concerns. I am working right now on trusting myself, being gentle with myself, and quieting the yucky self esteem demons that are constantly pouncing out from under my quilt to poke and prod me. Being able to be mindful and let the eating and exercise maintain themselves each day, without emotion attached is an unattainable goal I think. But the striving towards it is so worthwhile.

I am able to appreciate the gifts of health this is giving me, and not in that ridiculous hyped sense of LIVE YOUR BEST LIIIIIFE!!1!, but instead in a quiet understanding that these things I do daily make a pregnancy more viable, make an overseas walking tour easier, make bending to lift up a pen less giddyingly painful. It is also nice to see my waist and hips do brain-bending tricks in a very tight black dress but though I may emphasise this to Facebook, it is not the grail.

To live well is always the grail.

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How you do it: navigating mental health services in NSW


*In this post, I am talking about experiencing mental illness/craziness/non-neurotypicality as someone who works within the medical model. I am not discarding the importance of the experiences of those who choose a different path. I am also using the word ‘crazy’ to self describe as it is shorter to type and is how I identify.

This is a rough guide to accessing crazy-services in NSW.

I’ve been diagnosed as crazy since I was 19 – almost ten years – so I’m at a point where I’d describe myself as an ‘old hand’ at navigating the NSW mental health care system.

I’ve never been admitted, so I can only speak about how to navigate services pre-admission.

WHO IS THIS FOR?

To the pre-diagnosis, or ‘pre-treatment’ crazy person, it can be overwhelming to try to understand how to go about getting help. It can be tiring when you’re already so tired, so ill, so worn down. Maybe you avoid seeking help because it all just feels too daunting. This is for you.

Quite possibly you don’t and won’t identify as someone with an ongoing health issue – you’re just having a rough time in your life and need some support while you get through it. This is for you too.

I am sorry you feel horrible. I hope this helps you feel better soon.

THE MOST IMPORTANT THING

Do NOT listen to friends or relatives or the media who tell you that the ‘system is fucked’ and there’s ‘no help out there’. This is actually bullshit.

The system is deeply flawed, but there are lots of (often free) services waiting for you. They are not perfect but the most important thing to remember is that they ARE there.

If you’re feeling unwell, it can be super easy to focus on all the pitfalls of any action you take. If you can, avoid thinking about how services will fail you before you’ve even started.

THE EARLY STEPS TO GETTING HELP 

If you are in crisis or immediate danger

If you are in crisis: (suicidal, extremely unwell to the point of being debilitated/dangerous to yourself or others or just not coping) contact your local Crisis Team. Each area in NSW has a Community Mental Health service, with an attached Crisis Team.

They will triage you (ask you questions to find out what treatment you need) over the phone, come to your house to check on you, send an ambulance to get you if necessary and also provide follow up care. There are links and numbers at the end of this post.

If in extreme danger to yourself or others call an ambulance – DIAL 000

If you are unwell but not in immediate danger  – welcome to your GP appointment!

If you are unwell but not in immediate crisis: make an appointment with a General Practitioner (GP) to get the ball rolling. Follow these steps.

Book a ‘long appointment’ with your doctor. The first time you make contact with your doctor will take a long time due to paperwork and their taking a ‘history’ of your condition.

If you feel extremely unwell/unable to articulate your needs and condition, take an advocate. This is a friend or family member who can chat to your doctor on your behalf, and provide moral support.

Tell your doctor ‘I am feeling unwell and I need to get help and make a mental health plan’. Make sure you fully describe your symptoms. Try not to leave things out because you are embarrassed. At this time, if you have wounds from self injury that need attention/stitches etc, ask your GP. They are more likely to be gentle with you than ER nurses/doctors.

What’s a mental health plan? This document includes a general description of your situation, and a path forward for treatment. THIS IS A VERY IMPORTANT DOCUMENT. You need the mental health plan to access monetary rebates from psychiatrists, psychologists etc and to keep track of your medication and how you are going.

Psychologists and psychiatrists and meds, oh my!

If you are very unwell and need to see a psychiatrist, your GP should find you one in the public system so it will be either free or less costly. If you need a psychiatrist appointment and your GP doesn’t offer to connect you with one, ask for this.

Psychiatrists are there to fiddle with medication and keep a very general track of your progress. Psychologists are there to help you discuss problems, issues and feelings and work on strategies to overcome them.

Your doctor will look up a psychologist for you in their database. This person will be recorded on your mental health plan. You can ask for one that is queer friendly, or a woman, or a person of colour and so on. This is your right. Ask for a psychologist who is within easy travel distance from you, if you are low on energy.

You pay for each psychologist session up front and get a substantial Medicare rebate back. You need to take your psychologist’s paper invoice into a physical Medicare office to get your rebate. There are a few psychologists who bulk bill, but they are quite rare.

Each appointment with a psychologist runs for about an hour. Try not to be late, because you will still be charged for the time, and psychologists are often quite busy. Ask your psychologist how much notice you need to give to cancel an appointment. Some will still charge you if you don’t give enough notice.

Your mental health care plan allows you six initial sessions with a rebate. Then, your psychologist has to send a letter to your GP reviewing your situation and saying if you need more sessions. At the moment you get another four, then another six after that. The number fluctuates based on changes made to Medicare at a state government level.

Your doctor will give you the psychologist’s number. If you feel unable to call to make an appointment, tell your doctor and they will do that for you. You can also ask your advocate to help you.

Your doctor will want to discuss medication options if appropriate. They may prescribe something for you. The ‘medical model’ is psychotherapy + medication = best general treatment approach. You do not have to take medication prescribed for you, but it may be in your best interests to do so, even if only short term.

Most psychiatric medications take about six weeks on average to ‘kick in’. Don’t expect to feel better after the first pill. It needs time to build up in your body and work.

You have the right to ask your doctor about side effects. Make sure you ask how to use it properly – how often to take it, if you can drink alcohol, if you need to drink extra water and so on.

Make sure you tell your doctor about any other medication you’re taking to avoid clashes with new medication, and to taper off any existing medication if you need to before starting this new one.

Once your mental plan is completed, you should receive a paper copy and your doctor keeps one on file. The mental health plan is usually reviewed once your Medicare allowed psychologist sessions expire.

Make sure you book in to see your GP about six weeks after starting new medication to check on how it is going and if is starting to work for you. You can discuss any problems you are having with it or request a medication change.

Now you should have:

  • access to a psychologist that should hopefully only cost you $40 an appointment or so after a rebate
  • access to a psychiatric appointment should you need it
  • access to some start up medication should you need it
  • access to crisis services should need them
  • a clue-by-four and less confusion!

IMPORTANT NUMBERS AND LINKS:


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