Bloodletting (18 page)

As for the CBT, that was a different matter altogether.

The CBT course meant spending two weeks, from nine to five, Monday to Friday, in a room with seven other depressed, obsessed and anxious people. The first morning, we were told that cognitive behavioural therapy was about understanding that emotions, thoughts and beliefs were all connected.The way we thought, as well as what we thought, could make us feel better—or worse.

We were given folders with worksheets and exercises to do.We talked about balances, strategies, resources and support networks, as well as looking at how to identify styles of thinking, such as black and white, over-generalisation, jumping to conclusions, and catastrophising.

Very quickly we learnt that the key to CBT was not to trust our instincts. For me, this was the hardest part.

Once, several years ago, I’d been spending a few days with my parents. It was during the time that things in my life had been going unusually well. I was living in Melbourne, loving my work, and they were proud of me.

We were at the dinner table talking about what we’d done during the day. I’d been in the bank, and was chatting to the teller when her face went pale and her jaw, literally, dropped. I turned around to see two men with sawn-off shotguns and balaclavas running through the door.They yelled,‘Get down,’and,as the only customer,I did so.So did the bank staff.

After they’d left, a woman came down from upstairs from the administration section.‘It was worse for us,’ she said, shaking her head. ‘We couldn’t do anything.’

Everyone at the table had laughed at this story, and the fact that I’d almost parked-in the getaway van. Illegally. (The police kindly agreed not to give me a ticket.) We then moved on to the next event, the next story, and the robbery wasn’t mentioned again.

I hardly ever think about it now. I don’t like men in tracksuit pants and balaclavas, but then I never did.

In terms of the CBT course, it showed clearly how I’d been taught to deal with anything that was unpleasant: make light of it, then forget about it. Or, if that proved difficult, then force yourself to forget about it. Don’t give in to anything, especially emotions.‘Rise above it,’ was our mantra.

This technique seemed to work for my parents, and had sometimes worked for me, but had its dangers, as I finally began to learn.

When we were asked to write an honest list of self-criticisms I was surprised by what I actually wrote down. I felt lazy, overweight, boring, untidy, ungrateful, unmotivated, unable to concentrate and unhappy. Clearly I hadn’t successfully dealt with the way I felt about myself by ignoring it. Ignoring something, and dealing with it, were not the same thing at all but for some reason I struggled with this concept.

What was wrong with a coping strategy of not thinking about something?

And what did all this have to do with the bloody images? I was getting impatient, as I just couldn’t see the connection.

Ray,one of the therapists,had firm ideas about it.‘Don’t you think that these images, these urges, that are making your life so difficult, may be a result of your beliefs or thoughts?’

No, I replied.The thoughts came out of nowhere.

Ray shook his head.‘I disagree,but let’s put the issue of the images aside for the moment.’

It was easy for him to say.They’d lessened since I’d been admitted to hospital, but they hadn’t gone away.

The first few days of CBT didn’t make me feel better, but worse. I had arrived with what I thought was one problem, and then uncovered a whole lot more. Most disturbingly, my whole approach to dealing with life was being questioned and I really didn’t like it.

As I lay in bed one night, tossing, turning and yawning, I remembered the doctor’s letter in which I’d been described as having illogical thought patterns.At the time I’d been insulted. I was many things, but I wasn’t, I thought, stupid. But CBT wasn’t about intelligence, or lack thereof: it was about unlearning bad habits. Like a lot of people, I was rather attached to my bad habits.They were comfortingly familiar, if nothing else.

The intensive nature, small size and specialised structure of this course meant that it was unlike any group therapy I’d done before. Previously, in other hospitals, I’d got the feeling that ‘groups’ were something aimed at keeping patients busy and I’d gone because I had nothing better to do, not because I thought they might actually help.

Here we even had homework, often set by other patients, who were also members of the group. During the first week, when I was set the task of writing down all my self-criticisms, I was also asked to write about my expectations, and how I could lower them. I’d sat at the desk in my room after dinner at around 6.30 pm, feeling frustrated. There was nothing wrong with my expectations of myself and I didn’t want to lower them.That was giving in. I wrote:‘If I were to lower them I would feel disappointed in myself’.I knew that this wasn’t what I was supposed to do, I was supposed to say that if I wasn’t so hard on myself, so demanding, that I’d feel better, less stressed. Something though, made me want to argue. Similarly, when it came to the second half of the exercise, writing down my good qualities, I left the section blank.

The following day, the blank section caused an uproar. None of the other patients agreed with me. Of course I had good qualities, everyone did. I was caring, kind—they’d seen this already. Why hadn’t Iwritten anything?

Why indeed? I wasn’t sure entirely, only that I didn’t feel that I had any good qualities. Or rather, than none were good enough. Nothing I did or said was good enough but I couldn’t make anyone understand the way I felt.The conversation moved into a discussion about how it was impossible to be perfect, to expect over 100 per cent of yourself. It was illogical.

I felt trapped: wasn’t it normal to want perfection? Even if you knew you couldn’t achieve it?

Claire, the other therapist, asked me why I wanted to hurt myself.

I didn’t know. I still didn’t know.

She tried again, was there a trigger? Did something make the thoughts happen? Surely I didn’t have them all the time?

There was something.‘Stress makes them worse.’

One of the other patients then interrupted.‘It seems pretty simple to me. If you didn’t have such high expectations, you wouldn’t feel so stressed when they’re not met, and then wouldn’t want to harm yourself.’ Problem solved.

How could I make them understand that if I lowered my expectations, it would lead to feeling disappointed in myself, and feeling miserable. I didn’t want to work as a checkout chick for the rest of my life just to avoid stress. One of the other patients pointed out that checkout chicks also often got quite stressed with long queues and rude customers.

I hadn’t kept going to this point to drop out again anyway: I’d tried that before and it didn’t work.There had to be another way.

Claire stepped in again. What was stress anyway? It could be a reaction to one thing or to many, and it could be a reasonable reaction. It could motivate you, as well as incapacitate you. Everyone had ideas about this, and the focus moved away from me for a time. But the conversation had made me uncomfortable. I wasn’t ready to admit it yet, but there was something in what they were all saying. Increasingly, Iwas getting the feeling that I might have somehow been making things much,much harder for myself.

Although I kept saying—daily—that the program wasn’t dealing with my problem, I knew that it was.The urge to hurt myself didn’t spring, fully formed, from nowhere. It was a response, and while recognising this was helpful for me, it wasn’t enough.What I needed was to understand my thought processes, understand where they came from: once I knew this, perhaps I could control them.

When the idea of ‘positive affirmations’ came up, I shook my head. Irefused to look in the mirror in the morning and tell myself, in a perky voice, that things were great, that I was great, that the world was a good place. It was ridiculous. Besides, I was beginning to wonder if I should ever believe anything I told myself. So far the most important thing I’d learnt in this course was that I wasn’t to be trusted.

Ray was ready when I said that this wasn’t going to work for me. ‘Just choose the ones from the list that make sense to you, and forget about those that don’t.You’re right, they aren’t any use to you if you don’t believe them.’

I didn’t believe any, so skipped the exercise, but as a concession Iagreed to try to stop criticising myself.

The images had worried me for so many years that until the course, I hadn’t even noticed I had an internal critic as well. The blood and violence demanded attention but the voice was insidious. As I got dressed in the morning, I’d look at my thighs.‘Fat thighs,’ said the voice. If I answered a question wrong,‘Stupid idiot’ said the voice, if I dropped something the voice would say quietly,‘Clumsy cow’. It gave a running commentary on exactly what I was doing wrong, every day, all day.

Was this really ‘constructive criticism’or something else? For years I’d listened as my mother told us how fat she was, how pathetic, how weak. She was an idiot, she said, and a fool. She was none of those things—quite the opposite in fact, but I’d grown up believing that was how everyone thought about themselves. Recognise your faults, and you’ll be better, stronger for it; criticise yourself before anyone else gets the chance. This, to me, was normal—so normal that I’d forgotten I was doing it at all.

At the end of the first week, I began to cry and cry and cry. Embarrassed to be seen doing so in the dining room, I’d rush up to my room, or go outside. If I felt tears coming on during the sessions, I’d lash out at one of the therapists. It was their fault I was feeling like this—their fault and the fault of my psychiatrist, Dr P—and I was furious with them all. More than that, I was beginning to understand that I’d spent years suffering unnecessarily. I wasn’t cured yet but I knew now that it was possible.

By the time Melissa arrived on the following Tuesday,I was starting to feel better.The course was having an effect and it did make a difference not having to go into the office, or cook, clean or iron.The antidepressants were also beginning to kick in. My mood, which I had grown used to and thought as normal, had definitely improved. I couldn’t believe that I hadn’t even realised I had been depressed this time.

Melissa brought with her flowers and magazines, the standard kind of presents that people bring to hospital patients. She was also interested in how I was, and whether the treatment was working. She came to the family session, and asked the therapists for reading material.

Archie, meanwhile, had been ringing every second day, and even Jeremy,my ever elusive younger brother, had rung.

My parents didn’t know what had happened and initially I had decided not to tell them. They must have known that things hadn’t been going well, as I’d been ringing them a lot, which was out of character. But I hadn’t said I was unhappy, so perhaps they really hadn’t picked up on it. Or didn’t want to. I’d certainly not admitted to any problems since leaving Melbourne. I’d finally learnt then that it was better not to: they couldn’t help me and they didn’t understand. Their priorities and mine were very different. They wanted me to have a good job, a family and buy a house. I wanted to survive.

My mother would see this new hospitalisation as an example of how I was weak and irresponsible.What would my boss say? Had I thought about that? What about everyone else? My cousins, the family? Did I only ever think about myself?

I was relieved when my father was told, and called me. I wasn’t up to defending my decisions to my mother.When she finally did call, it was a short conversation. I didn’t tell her what I’d decided to do.

Just prior to the end of the program, those of us who were staying in hospital were asked to spend time at home, to help ease us back into normal life. This was a very sensible thing as it was surprising how quickly you became institutionalised.

My house was half an hour away. I was in no hurry so walked slowly, stopped at a café, and took nearly double that time to get there. As I turned the corner I could see that the house next door had now been fully demolished. It had been vacant for several months and then I’d come home from work one evening, just before going into hospital, to find bulldozers there. Luckily all my windows had been shut but my garden along the fenceline was covered in rubble, as were my front steps.