My assessment with the CMHT was pretty intense. I walked to the centre and arrived ten minutes early. Normally this would have been fine but since the appointment ended up starting fifteen minutes late it gave a lot of time for my anxiety to start building up. By the time I was led into the interview room by a friendly woman I was pretty stressed.
She assured me that there was nothing to be worried about and explained the basics to me. The CMHT employs doctors, psychiatrists, psychologists, OTs, physiotherapists and more. She would interview me, get all the relevant information, then present that to a panel of people from the different professions. Between them they will discuss my case and decide which of them, if any, think I need help and can be helped.
The interview started, predictably, with a risk assessment. Have I ever tried to take my own life? No. Do I think about death or suicide? Rarely. Do I have or have I ever made plans to take my own life? No. Have I ever taken an overdose? No. Have I ever had an eating disorder? No. Do I have a criminal record for violent crimes? No.
Then came the interesting one. Have I ever self harmed? Yes. Cutting. Arms. Blades, glass, whatever is around. But – I take pains to point this out – my self harm isn’t dangerous. I do it rarely, I believe I have stopped now, and I always use clean tools and control the act to avoid deep cuts, scarring, or any real damage. It is a coping mechanism that occurs as a result of my other issues, and if I can resolve them I won’t ever need it again. Do I think about it? Yes. Self harm is like an addiction in some ways, once you have done it once it is always there at the back of your mind as a potential course of action. Once you have opened that door once it is a lot easier to step through it again. What? No I’m not addicted to self harm, that’s not what I said!
Next came the million dollar question: “why are you here?”
Well I guess it would be my concern about my, what I like to call, chronic insecurity. I describe it to others like this: in any given situation if anything anyone has done or said can be possibly be interpreted as something negative towards me, then that is how my mind will process it every time. It takes only the slightest thing to send my mood plummeting into a depression that tends to last only a short time (a day or a few hours) but can be quite intense. I am particularly sensitive around my friends because obviously I care more what they say. This sensitivity is having a negative impact on my relationships.
The meeting then progressed pretty much as you would imagine, with only one question that surprised me. Was I a natural birth or cesarian? How could that possibly have anything to do with anything?? No I was never physically or sexually abused. My childhood was split between two parents, one highly emotional and loving but lacking any disciplinary influence, the other (who I lived with from the age of 12) emotionally detached and authoritarian. Yes I was bullied at school. My depression probably started when I was a teen, but it is hard to distinguish between genuine depression and just teenage angst.
Of course there was a lot more talk and detail than all that, but this post is long enough already! At the end of the interview I was thanked for coming and told to expect a letter regarding the outcome of the Wednesday meeting. Of course I wanted more than this so I pushed a little. She told me she was going to recommend psychological intervention on the basis of her concern that I don’t see a problem with self harming -
Inner monologue: what?! Didn’t you even listen to what I said? Do you know nothing about Self harm? Surely my other issues are rather more serious and worthy of help than a minor byproduct?
I pushed more, wanting to know what she thought of my issues, how she would classify them.
“Well off the record, because I’m not qualified to diagnose anything and I don’t really know you. This is just based on my experience with clients with various issues…”
Yeah, that’s fair enough
“I think you would fall under the personality disorder classification”
Yeah I can see that. Not entirely a surprise – I long suspected that something to do with me has been the cause of my issues. What personality disorder in specific were you thinking of?
“Again this is off the record and based only on our conversation here and what your GP has written, but I would say Borderline Personality Disorder.”
Inner monologue: WHAT THE-?! Are you completely off your rocker? Have you listened to what I have been saying? Did I say I push people away? No, I said I cling to them and do everything possible to keep them close. I am textbook anxious attachment!
So I said: Hm I’m not convinced myself. What made you think of borderline?
“You don’t seem to take responsibility for your own actions or situation, for example you blamed your depression on teenage adolescence”
At this point I am pretty much speechless. It feels like this lady has jumped on Borderline (possibly influenced by my gp’s notes) and is twisting what I am saying to fit her model of me.
Yes there are aspects of me that map onto the borderline criteria. But there are aspects of most things in the DSM which overlap with other things. Yes my relationships are affected by my issues, no I don’t believe I form unstable relationships. I never ‘devalue’ people, and I actually struggle to feel angry even when it is utterly appropriate. I never push people away. Yes I have a history of self harm, but so do an awful lot of people suffering depression. No, I don’t have a weak sense of self. In fact I have a strong sense of self; I know who I am, and exactly what I want in life. I have long term plans and am sticking to them. I don’t view myself as bad or unworthy. I don’t have black-and-white thinking or splitting. I don’t feel unfairly mistreated by the world or victimised. In fact I like to think I am a good person, and “the world” doesn’t treat anyone in any special way. However, yes I am highly sensitive to rejection and I do struggle to feel emotionally connected to someone when they are physically absent.
By my count, and I am being generous and really stretching here, I could possibly be said to match three of the nine criteria for BPD in DSM-IV. At least five must be matched for a diagnosis.
You know what, I’ll just wait to see someone who really is qualified and hope against probability that they will actually listen to me.