My story of therapy; on being a #patient

For years now I have suffered from intermittent episodes of depression and, for the last year, very marked anxiety. I was shaking, having nightmares, poor sleep, catastrophising. In the last 3 years I almost died and had a cancer scare.
So it was unavoidable that this would all come to a head, and around 3 months ago I started therapy (CBT ..ish) with a wonderful therapist we can call Sam. She was kind, inquisitive and very perceptive. Suffice to say, my walls were up from day 1.
The initial meetings were very much about learning how to communicate as a patient, and recognising how I would prefer to utilise intellectualisation instead of speak about how I felt. She buffered this and listened, and slowly guided me toward appreciating the emotion.
I learned that I had developed patterns of behaviours that had endured for over a decade, in response to things from long ago. In essence, I had built a retreat behind intellect and control and gradually removed myself from experiencing life as if it was new.
This had seeped not only into my dating life, but also my day to day. The defense mechanisms that had protected me had become a trap, and the thoughts of change easily snagged by the commiseration of potential happiness. And I realised that I could change it.
The first steps were listening to the emotion and learning to live with it being natural, realising that I could exercise choice over response, and spot patterns in myself the same way as I could with others. I started by treating myself like I would them, address the problems..
As such I was able to empathise with my own feelings, and realise their worth. At the same time the defense mechanisms began to fall away. I noticed that at work I was doing better, connecting more, and generally, enjoying it more.
Hope began to creep in, and I noticed that I was making little changes without even thinking. I would eat better, spend more time on things that were nourishing, read again, enjoy movies, see the world as bright and colourful instead of yellow and black lines.
In two weeks I say goodbye to Sam. But in essence her empathy and guidance has shown me that we are never alone in this world, and that even the most wounded of us can feel valued and develop the value for ourselves. She taught me to recognise my own challenges.
I will be generally sad to see her go, as she has become a link from an old life to a new, but in the same way the end is a natural process, and the time walked alongside made footprints pointing in the right direction. Therapy is something truly wonderful.
Anyway, I hope this helps people who may be starting it, or even nearing the end, or have never considered it. As a psychiatrist, I am a true believer of psychology first, medication second. And as a patient, I am damn sure to agree with myself.

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More from @drjanaway

19 Sep
One of my favourite misconceptions about psychiatrists is that 'we don't know medicine.' Buddy, I did medical school, I am the first line for any physical illness that arises on the ward, the assessor and planner. I control 90% of it, and the rest I refer after intervention.
Psychiatric patients have higher rates of physical illness than the general population. They are also treated in hospitals with lower timely access to tests, drugs and interventions that are commonplace in general hospitals. We rely on our clinical decision making skills 24/7.
Often our patients may not be able to communicate their symptoms in the same way as others, so we have to be good at pattern spotting and escalating concerns. We also have to advocate for them and shoulder the risk of any decision we take.
Read 11 tweets
19 Sep
You are standing on the edge of a cliff, below there is a 100-foot drop onto jagged stones. You are there for the view, because the view is beautiful. A gust of wind touches your back and you shake slightly, but the view is worth the risk. Its not like before.
A month ago another person came up here. He had not read the weather predictions and a fierce storm hit. The great wind forced him over the edge. But that was months ago. You have been careful, and watched the weather reports.
The reports were at first 24/7, as it was a fresh tragedy. But the view was important, and over time the reports relaxed. The weather was improving, according to the reports. You trust the reports, others don't. Others say that reports can be wrong. You don't trust them.
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14 Sep
Responding to anxiety: a thread.

As a trainee psychiatrist, I often find myself the 2nd line in responding to anxiety in service users/patients. Nurses are a fantastic first line, but sometimes extra help is needed, so in these situations it's worth thinking about a few things
Anxiety is a natural response to threat, but ancient and designed as a blunt instrument to work in a very narrow time window with very dichotomised outcomes, death or survival. As such, the response is very strong and takes several forms; the classic fight/flight or freeze
In the fight response we gear ourselves up for battle, our heart and respiratory rate increase, our aggression builds, our complex decision making reduces, and our actions and perceptions sharpen. This is all secondary to hormones and brain chemistry.
Read 24 tweets
8 Sep
Dont let anyone ever judge you for surviving pain, or carrying it. Pain is what makes you strong and empathetic. Pain allows you to understand the worry and weakness of others. It allows you to better form a connection with the weary. Without my own, I could not do my job as well
The reason I am able to understand my patients is because we share something unspoken. I feel it in my bones. It shortcuts the rhetoric and tells a story without words. It brings clarity to chaos and shines a light on the way forward. It has value in its universality.
The difficulty is in establishing boundaries for self-protection, not to lose myself as I once did. But that is where the strength resides, in realising that recovery is becoming a guide as well as a fellow traveler. It is sublimation with insight.
Read 9 tweets
6 Sep
How to undermine a Conspiracy.

Conspiracy theories are like smoking, once you try you can be hooked. The reasons they are so powerful and so confluent are myriad, but can be boiled down to just a few simple points, all of which are fallacies.
1) Conspiracy plays on emotion to convince you of a story. The general scientific approach to data is to review what is available and refute the null hypothesis, i.e that there is no change in rules based on new observations. Scientists can never make fully causal claims.
Science, ideally, should be without emotion in data analysis, as emotion clouds judgment. We look at the data objectively and see what it doesn't say, and what it may suggest. Further research may refine or obfuscate, but the general trend is toward share objective agreement.
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30 Aug
Trolling and abuse; a thread.

Having been a subject of multiple campaigns over the years, I thought I would share my experience with you in hope of finding some parallels and sublimation. Full disclosure; I used to be very into politics, a big risk for this kind of thing.
Twitter is a useful tool for networking and understanding people, forging new relationships and developing communication. It also provides an avenue for the sidelined to raise concerns and find cohesion in a universality of shared experience. It can be good thing.
However, it is also a place where those can hide behind pseudonyms, flags, and memes and interact with you in ways designed to destroy you, push their own agenda and ruin your life. Sometimes this goes as far as threatening your or life. I have had both.
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