Jules - Interview 24

Age at interview: 61

Age at diagnosis: 55

Brief Outline: Jules has experienced depression and social anxiety for many years. She has voluntarily spent time in mental health units over the past 2-3 years. She is seeing a psychiatrist, taking antidepressant medication and receives psychotherapy.

Background: Jules lives alone and is widowed with two adult daughters and five grandchildren. She is currently completing a PhD. Ethnic background' Anglo Australian.

More about me...

Jules has experienced mental health problems to varying degrees over most of her adult life. She described a family history of depression. Jules returned to study after training as a nurse and has been successful in her academic study and career since returning to study after marrying.

 

Jules first experience with mental health came about when she suffered post-traumatic stress following a traumatic caesarean, where she was given an anaesthetic incorrectly. She was diagnosed in 2004 with depression and social anxiety and, subsequently, increasing agoraphobia. She sees her GP, psychiatrist and an outreach worker each week. 

 

She first took anti-depressant medication on the day her husband was killed in a car accident. After her husband’s death, Jules developed an alcohol dependence that she has since overcome. Jules has voluntarily spent time in mental health units over the past 2-3 years, which she describes as predominantly positive experiences, but at the same time, unhelpful in terms of certain aspects of care and treatment. Jules is passionate about the quality of care for persons with mental health problems, particularly given her background in nursing.

 

Currently Jules is being weaned off an anti-depressant medication that she has not found effective and is unhappy with certain side effects. She will try a different one, which both Jules and her psychiatrist agree is the final anti-depressant medication she will try. 

 

Jules is completing a PhD, which she has found both exhilarating but also stressful because she didn’t have anyone with whom to share the excitement of her research. Over more recent years, she has experienced quite serious depression and social anxiety that means she can spend many days at home and she avoids social activities. Jules considers resuming everyday interactions and activities as part of her recovery.

 

Jules’ hopes for the future include completing her PhD and contributing to the quality of care for people with mental health problems. She would like to return to her previous work as a consultant. She is also looking forward to seeing her grandchildren grow up. 

 

Since childhood, Jules had felt like an outsider in her own family.

The first time I think I realised that there was something different was when I was seven.

 

I felt the outsider in the family, I felt the outsider when I went to school or went out, you know, I just have always felt as if I was an outsider, and I still do feel that I'm an outsider.

 

Other memories of my childhood are of privilege, so I have a memory of my, I'm the youngest of three girls. Actually, that will take me off onto another area – I felt as if I failed at birth. I was the last chance for a son and that was - I grew up knowing that. I grew up feeling that if (sister’s name), if my, either of my sisters had been a boy I may not have been born.

 

And that influenced the way I related to my father, it was almost as if I needed to be the boy. I wasn't a tomboy, but by the time I was 15 I realised that if I was ever going to have a reasonable conversation with him, I would have to learn about classical music, the stock exchange, and cricket.

 

In addition to various traumatic life experiences, Jules identified feelings of loneliness as...

I put on a mask and people say I have been told that I have a presence. Now what, in adverted commas, what that means to them I don't know, but simply that to other people I appear to be very competent, very confident easy to talk to, so where's the depression, where's the tears, where's the anxiety. 

 

And they talk about having a trial a night home, before you go back into the clinic and I think that's false. Why would that work for me because I have no doubt that a big part of my depression is my loneliness. My sense of isolation and loneliness, despite two wonderful daughters, being blessed with two fabulous sons-in-law and the most glorious five grandchildren. Loneliness is a fact, is a huge factor, and I've found that from talking to other patients.

 

Jules was given antidepressants by her GP without asking for them following her husband's death...

They not only had adverse affects, that's why I asked you to go, remind me to go back to the day of (husband’s name) funeral. When I went to bed at two o'clock in the morning, the day after, the day, night, next to the bed was a box of Xanax (alprazolam) and a box of Zoloft (sertraline), and I had no knowledge 

 

I have thought of suing the doctors because what I subsequently found out was that some, a doctor from a surgery which wasn't very far away from the location of the accident, had rung the house, someone had answered the phone, I don't know who, and been asked to come and pick up the script, take the script to the chemist, get it filled and put it by my bed. 

 

Never was I consulted as to whether I either wanted it or assessed as to whether I needed either. And I am so angry about that because 16 years later I'm still on Xanax (alprazolam), 'cause when I went to bed and I saw these boxes, and even with my nursing background I didn't connect that Zoloft(sertraline) was an antidepressant, I just saw it as a, I'd take it every now and then.

 

And then when I was put, and I started dry retching and I would dry retch for years, and then when I was put on Zoloft (sertraline) as an antidepressant and the dry retching, the anger because it all clicked back, that for all that time that I'd been dry retching and going through it because scripts just kept being repeated. And why not? I was looking for an anaesthetic, something to ease, to stop the pain. Something to dull it. 

 

So the antidepressants, the impact that they've had, obviously at the moment I'm pretty angry because after a year of being on Cymbalta (duloxetine), and gaining 13 kilograms in weight, and not having clothes that fit me, the agreement is that it has had such mild impact that it hasn't been worth it and that's been the case with every antidepressant that I've been on, and that's why I said you might as well go through MIMS to see what I've been on. 

 

So I'm going back, I am currently in the process of being weaned over an eight week period, off the Cymbalta (duloxetine), and I'm going into the clinic on the day after Boxing Day, as last chance Parnate (tranylcypromine), a drug that was developed in the ‘50s and has, not used very often because of the seriousness of the relationship between food, certain foods and this drug. So when my younger daughter said well, what are the implications, I said well, stroke or death.

 

I would prefer not to be going on the Parnate (tranylcypromine), but as my external psychiatrist, who is very keen to see me finish my PhD, has said it would be a pity if it's the one thing that works. So let's just rule out whether it does or not. As he pointed out, there isn't an antidepressant in the world that will motivate me, give me the motivation to finish but it might get me feeling good enough about myself that I get to it, that it, that it is finished.

 

Jules actively maintained a strong sense of self in hospital, adopting an assertive relationship...

And my external psychiatrist said stop the antidepressant over the three days, and he said we'll readmit you next week. And as I came off that antidepressant I felt better so when I got into the clinic the next week, that was when they were asking the questions about being happy, because I was too happy.

 

And then there was an ongoing dispute between the two psychiatrists because one said it was definitely the antidepressant, one saying it couldn't possibly be. So then there was the decision to put me on Cymbalta (duloxetine), and the experience of, it was made on a Friday afternoon, and I wasn't yet satisfied I, until there was consensus between the two after the previous experience I wasn't going to start it. 

 

So on the Saturday morning when I went down for meds and they offered me the Cymbalta (duloxetine), I said no, I am declining slash postponing starting Cymbalta (duloxetine) until there's a consensus. So you're refusing? No, I am declining postponing. You're refusing.

 

And this went on all weekend, but that Saturday afternoon a registrar I hadn't met before came into my room and she said I hear you're refusing to take Cymbalta (duloxetine). I said I'm not refusing, I'm declining postponing until there is consensus, and I started to explain why, she said I'm not interested in why. She said you're a voluntary patient, obviously you're well, you should be discharged, and walked out of the room.

 

On the Sunday night, the charge nurse with whom I thought I had got on pretty well, came into my room at 10 to eight and said she wanted 10 minutes of my time.

 

And then she said, and I'm concerned that, about the way you, I think I, you need to be coached in the way you treat the head of psychiatry. And I said why, she said well I'm concerned that you'll damage his ego. So when I met, subsequently met with him, I said to him don't worry I assured her that I thought your ego was sufficiently intact that there'd be nothing I could say or do to damage it. 

 

Courses, groups you can go to on a whole range of topics the, it's called the wellness program. 

 

The first time I went in, oh and you know, group walk in the morning et cetera, I did join in on that, not necessarily every day on the walks, and I did go to some of the groups, I didn't got to all, I stopped going to them, some of them at times because I knew that because of my own academic orientation, which is psychoanalysis but in organisations, not with patients, that there would either be a conflict between the presenter’s point of view or there wouldn't be enough depth and I would have to shut up.

 

What I am desperately worry about is the people in there who don't have a voice. Who perhaps never had the voice, have never had the exposure to the sort of life I've had and the level of operating that I'm used to. So how do their concerns ever get met or known, or if something goes wrong, where's their voice. So I become quite passionate when I'm in there too, about I don't know, righting of some wrongs in the system, that the, I know I have to remind myself that there's it's an organisation like any other organisation, it's not perfect.

But unfortunately the imperfections are relating to our mental health.

 

Jules did not consider herself as being in recovery, and talked about the signs that would...

I'd know I had recovered if I was having a least a cup of soup in the middle of the day, and something to eat every night, preferably planned for but you know. I don't eat junk food though, which is good.

 

If I was getting up and I get up every day, I don't stay in bed, but if I shower and got dressed relatively early, whether I was going out or not. 

 

If the competitions between how messy every room could get, ended and that I wasn't living in fear that someone might call in unexpectedly so that I couldn't go through the pretence that at least the place looks reasonable some of the time. So automatically, I mean basically, just put the dishes from after I've used them in the dishwasher, instead of letting them get around the kitchen. Taking the rubbish down, wanting to, when I was most productive on the PhD was, I would get up and I would do three hours before I'd do anything else, doing that, getting back into that. 

 

Doing more work, if I could, working with groups, which is my favourite type of work, in organisations, and writing the books that have been accumulating, finishing (future book title), wanting to go over to my daughters'.

 

I do see me finishing the PhD. I do see me writing. I would like to have another relationship, I know I don't have time for one before I finish the PhD [laughs] I do believe I, that I will be able to come back and be earning money as a consultant.

 

I mean this most importantly, I feel that somewhere, I'm not sure what it looks like yet, but there's something I have to do about this, not for - when I'm well, my passion about mental illness, depression, anxiety, the stigma still of it, there's something I've got to do. I don't know what it is, I don't know what it looks like but I want to make use of this experience in more ways than one, and that is to, to be well, to not be living in the way that I have been living for, just for far too long.

 

Jules structured her medical appointments in such a way that most days she had a reason to leave...

I have an appointment, so for example, maybe I've gone Thursday, Friday, Saturday, Sunday without needing to see anyone, so I, then I haven't left the apartment, I haven't taken the rubbish down, I haven't done the dishes. Sometimes it almost becomes like a competition to see how bad the kitchen can look before I'll actually do something about it. How many times I can walk around something then I become almost fascinated that I can do that when, I don't think it helped that up until recently, in the last few years, I've always had a cleaner, so cleaning feels strange anyway but the only thing that breaks it is that I have to go somewhere. 

 

So I see my GP every Monday about 11'30 and I see the chiropractor on the Tuesday. So Monday and Tuesday are fairly safe, I'll at least have a shower and get dressed. Wednesday's variable. I usually see my outreach worker. Thursday's, for every fortnight I see my psychiatrist so I have to go out then. And it is, I have to go out.