I am constantly tired, due to medication. Today I slept in till 10am so I was late for work. Its a good job that I am doing voluntary work. It makes it so much harder to read YCDI!, a C++ tutorial.

Some friends from Contact are coming round for Pizza tonight - JT, LS, LX and EX (with her daughter because it is so hard to get a baby sitter). It should be ok. Not looking forward to Saturday because its one of my empty days.

The days are ticking away before my house gets turned upside down to install central heating.

I was confirmed yesterday at Mitford. It was good. I think the vicar (David) made the preparatory work simpler for me because of my medicine making me rather tired and dopey. Other people have classes whereas I had informal chats and the task of finding a favourite hymn and a favourite bible quotation, I chose Mark 1 "I will send my messenger ahead of you who will prepare your way" and "Amazing Grace".

I've got to pancake this baby - that is what I kept on telling the Birmingham psychiatric emergency team back in the 90's. Actually I'm not a cannibal, I used to be an aviation geek. At one stage I wanted to fly Sea Harriers for the Royal Navy but I got side tracked into computers. To "pancake" an air craft is to crash land it. So now you know

Clozapine is like a spy satellite - when it is overhead (fully working on my body), my intellect and consciousness hide, leaving me much like a vegetable.

I counteract this by having checklists of thing to do and by waiting for the satellite to go away (and can continue reading things like the classic book I am struggling to review, You Can Do It, by Francis Glassborow. I'm having to work on exercises as I review the book and I have to borrow time on a friends computer because YCDI is Windows based and my house is a Linux  Linux only zone.

I find that 7 hours after I've taken some Clozapine, I can shrug off the daze that descends on me and start thinking properly. Who knows, one day I might be able to think in C++ again, something I haven't done since 2001.

I think I have the right balance. Using Windows at work because that is what people expect to use. And use Linux at home because it is so nice, if a little awkward to set up at times.

I am *so* nearly a vegetarian. When all the meat in my kitchen is used up, I will have a meat free kitchen and diet.

Contact in Morpeth is expanding. I think it would be a good idea if Contact was open on a Saturday because most services stop at the weekend.

Been for a walk with the AOT walking group on Wednesday, walked around a lake and had a soft drink afterwards.

Last Saturday I raised £25 for Contact, shaking a little tin and smiling at people.

It was J's birthday on Wednesday, 21 again.

I think I'll be better when I get discharged from hospital because my social contacts are more robust.

This week I've been mainly eating Clozapine :) In truth, it is a worthwhile medication. While I was on Olanzapine, the meds trashed my concentration. When I moved to Amisulpride, my concentration was still poor. Then I switched, with many misgivings, to Clozapine. I've been on the Clozapine for a while now. When I first started, I had to have my blood tested once a week. Now the initial screening process has finished, I now only get my blood tested once a fortnight. The meds still trash my concentration but, during the day, I get a window of opportunity where I can still have normal concentration.

I've been playing around with my PC (Patience), and started experimenting with the KDE's CD/DVD burning tool k3b. So far everything is ok although I haven't tried to master a CD/DVD, I'v just backed up disks to prove that it works.

I've decided to change my central heating. Its on its last legs. I didn't realise how much hassle its going to be. I've got to move my bookcases so the radiators can be installed, I need to get my bathroom tiled ready for the shower to be fitted.

This week, the Assertive Outreach Team Walking Group went to a pub for a meal at the Dyke Neuk. The food was o.k. and it made for a nice change of pace.

I've been socialising with people from Contact in Morpeth. I've dropped in on Tuesday lunch times and Friday nights. We go for a drink afterwards, generally relaxing.

I've been spending more time in Bedlington, with a view to being discharged in July. We'll see how it goes.

Saturday 3rd July. I got soaked travelling back to the Hospital. First of all. It was raining. That was bad enough. Then a part of the pavement lurched downward, soaking my left foot. Then a car sped through a roadside puddle, soaking my bag and right hand side. When I got back to the hospital I had a nice hot bath and changed into dry, clean clothes.

I was going to go to Edinburgh with a friend from the hospital but he wandered off somewhere else so I decided to go on my own. After all, I wanted to exchange my t-shirts for some shirts of the right size. I got a train to Edinburgh, changing at Newcastle – this meant the trip cost me the best part of £40 – I wasn’t impressed with that – poor service and high prices! We got into Edinburgh about 1pm – I had brought some food and drink with me to east on the train.

When I got to Edinburgh, it was raining as usual. I made my way out of Waverley station, turning left on the bridge and then across the road, up the street to “Who’s Who” (their sign is obscured with scaffolding). They exchanged the t-shirts with no complaint. I had a look if there were more t-shirts that I liked but there wasn’t any more.

After that I went walking, nipping into the cheap book shops and Waterstones. I bought a Renee Mackintosh "Scotland" t-shirt and some history books – got some at Waterstone’s (3 for 2). I could have spent more but I didn’t. During all this shopping, it started raining so I put my yellow plastic poncho on (with “Scotland” printed all over it in blue) but my le,gs still got soaked. I took the 4pm train back, via Newcastle and I arrived back in Morpeth just after 6pm

All in all it was a successful visit, albeit one I won’t be repeating for some time.

Sunday 4rd JulyI was picked up at 9:50 am by a friend (let’s call him “Bob”) from the Alpha course gave me a lift from Morpeth to Mitford. We had the usual service there. And then we reconvened to the nearby river where the Rector waded into the river and baptised a member of the congregation. It was a very special moment.

Well, a lot of things have happened. On Wednesday I travelled (with staff and patients) by train to Manchester to attend the Hearing Voice’s Network AGM. We stayed overnight in a Travelodge near the city centre. The next day, Thursday, saw the AGM. There were some workshops in the morning and afternoon.

In the morning, the choice was between a) the healing powers of crystals and b) setting up Hearing Voices (HV) groups. I went to the HV setting up workshop where we discussed the the charter to be applied to HV affiliated groups. Too much like lawyer work for my liking.

Breakfast wasn’t provided by the hotel so we had a cheap breakfast for £1.75 in Littlewoods.

The lunch was nice. There was a lunch time workshop which discussed the pros and cons of coming off medictation. There was widespread feeling that you should do it slowly and under medical supervision.

In the afternoon we had more workshops and I went to the “Away with the fairies” work group. It discussed the role of myths and legends in psychosis. We talked about Shakespeare (Midsummer Night’s Dream) and Marlowe (Dr Faustus).

After the afternoon we bought some provisions for the train and headed back to Morpeth, arriving late at night in Newcastle train station. A car gave us a lift from Newcastle station.

On Saturday I went to Edinburgh with a friend and bought 4 T-shirts – 2 the right size (XL) and 2 the wrong size (S) so I need to swap them with a friend. The ok T-shirts were “FBI : Female Body Inspector” (Wishful thinking) and “I hear voices and THEY don’t like you”. The too small T-shirts were “Rehab is for quitters” and “You’re just jealous ‘cause the little voices are talking to me”.

Lots of things have happened since I last wrote anything. It .looks like we will be pulling out of Iraq (I hope). Hopefully they will eventually enjoy their taste of democracy.

My clinical psychologist and I have worked out a spectrum of mental capacity, ranging from being unable to listen to music to being able to read article to being able to read technical books to being able to function as a software engineer / programmer in a normal commercial environment. At the moment my intellect is a bit like a sine wave, it has troughs where I can’t do anything and it has peaks where I can read a heavy weight text book over a long weekend.

I’ve been buying a lot of computing textbooks from cheap and not so cheap places. There is a method to my madness. It’s all to do with paradigm shifts in computing. Let me take you back to the early 80s. I was stuck in a sports crazy boarding school and calculators were being introduced as tools for use in mathematics classes. My father gave me a Hewlett Packard Hand Held Computer (basically a programmable calculator that ran using RPN – Reverse Polish Notation). So I learnt how to program using a stack based architecture and a very primitive instruction set. All of the programs were number crunchers. Then a friend of mine showed me his dad’s business microcomputer.. Try as I might, I could not program it. All my Hewlett Packard experience was useless. Soon, one Christmas, my father bought me a 16KB Sinclair ZX Spectrum – to be honest I wasn’t interested in getting one, I was more interested in Hewlett Packard Portable Computers. Well, I tried doing a bit of programming but ZX Basic was a massive paradigm shift. It introduced a high level language (ZX Basic) and a machine language (Z80 assembly language). I stumbled around in the dark for a while, trying to get to the new technology – and I even tried playing around with Forth (interesting but all I managed to do was dabble in that language) and microdrives (an ill fated experiment that was a dead loss).

Later on (was it 1985?), Sinclair released a brand new computer with a brand new processor (Motorola 68008), a brand new language (SuperBasic), multitasking (in a primitive way, it didn’t really take off until the introduction of the Qjump Pointer Environment in 1987ish), networking, a user group (Quanta) and basic networking. When I had my Spectrum, I spent a lot of time reading and researching other computers and architectures – I am grateful to Coleraine’s library for introducing me to new ideas in computing. So I decided to buy a Sinclair QL – or rather bug my parents into getting me one. It took several years – then when Sinclair slashed his prices down to £145 my parents relented. So I got my hands on what would be recognised as a reasonably modern computer. I think I stayed with my Sinclair QL for seven to eight years, sharing knowledge with friends, writing programs and giving them away for nothing or just enough money to contribute to the cost of writing software (simply buying compilers or development tools). During my travels in computing, I came across the occasional Unix book in the library but the only Unix clone I knew of, Mini, required proper money for new hardware (Atari ST etc) and peripherals (hard disks). So I stayed with my QL for years, upgrading it occasionally (Miracle Systems in particular brought out expansion cards like disk interfaces with extra RAM, 40MB hard disks (which turned out to be quite temperamental), and a replacement processor board so we leaped from a 7ish MHz 68008 with 896KB RAM to a 16MHz 68000 with, if I recall correctly, 2 or 4 B of RAM. The expanded QLs were quite capable machines and the Quanta software a delight for people to tinker with. I expanded my QL every so often but the biggest drive to upgrade my QL was the hardware demands made by the GNU C compiler which had been ported to the QL and called C68. So I tried to port Unix tools (written in C) to C68 and the Sinclair QL. I also tried to write GUI programs using Qjump’s Window Manager. But I was out of my depth and instead of developing mega applications, I dabbled in programming but wrote a lot of articles explaining how non technical users could get the most out of using a Sinclair QL.

After I graduated from University, with a 2:1 Honours degree in Information Technology, I had a bit of a shock. All of industry was using technologies I’d never heard of - Novell Netware for networking, Unix sockets for networking programming (QL networking was so much easier), MS-DOS 6.22 for an operating system (quite a disappointment compared to the QL). Anyway, the breadth of my QL experience impressed my future employers so I moved from Sunderland to Berwick Upon Tweed, to work as a C programmer. The company used Watcom C and the first task I had was to port the Opac from 16bit Turbo C++ to 32bit Watcom C. The Watcom environment relied on make files and was, in general, familiar ground to someone who had GNU C experience on 32 bit computers. After a few months working, my Dad encouraged me to buy a flat and get a mortgage. All this “real world” stuff was a bit heavy to me. But it meant that I could have somewhere to keep my network of Sinclair QLs, my collection of second hand science fiction novels and somewhere to play Dungeons and Dragons. Well that job lasted about 6 years and in that time, I joined the ACCU (Association of C & C++ Users), most of my Dungeons & Dragons friends left Berwick, the Opac was re-engineered to handle interlibrary loans for most of the UK (Unity). After the collapse of that company, a competitor, BLCMP, bought the intellectual rights to Unity/Opac for £5000, a pittance and hired me to work on the Opac/Unity business they were starting to pick up from ex-Libris customers. It was after about a year of tight deadlines and working away from home, that I had my first psychotic episode. I was taken off work, given a sick note that said “mental instability” and eventually withing 4 to 8 weeks, my employer made me redundant. Not a nice way to do business. Well, I moved back from Birmingham to Berwick, with the help of a friend who also worked in Birmingham.

When I went home to Berwick, I started applying for jobs and painting my flat. I kept up to date with programming gossip & ideas on the accu-general mailing list. I applied for various jobs and was turned down. Eventually, I spotted a tiny advert in the Scotsman. I didn’t think it would be worth a try but some friends of mine encouraged me to apply for it. Surprisingly, I got the job (after all I was a C programmer and they used Borland C++) fand that lasted for just over a year. During that time, I aggressively learnt new things about software development, reading Stan Lippman’s C++ Primer 3e and Multi Paradigm Design for C++ - Jim Coplien. And I attended the ACCU conferences and in particular I found Kevlin Henney’s (curbralan.com) lecture on substitution to be particularly enlightening. Anyway, that job disappeared in February 2001 and soon after that I had a psychotic episode and was admitted into St George’s, something I’ve already covered in previous entries on this blog.

To recap on paradigm shifts. I started with RPN on Hewlett Packard Handheld Computers. Then I migrated to the Spectrum that introduced a much larger (colour) display and memory and text handling. Then I shifted from the Spectrum to the Sinclair QL. Then I shifted to MSDOS 6.22 with all its limitations. Then I shifted to Windows by porting the Opac/Unity to a 32bit Windows SDK application – the same source code base handled both 32 bit DOS (DOS/4GW) and 32 bit Windows (Win32 C SDK). Then I shifted from C (in which I had, using structs, been using in an object based way) to C++ where I had better facilities for objects / user defined types. During my time in Birmingham I had been learning how to design C++ programs – any old text book can teach you the syntax but it took the help of the Association of C & C++ Users (www.accu.org) with their email correspondence and regular conferences to get me up to speed on C++.

These days, my concentration and mental faculties are something I can no longer take for granted. It is either my illness, schizophrenia or its treatment, Clozapine which makes it hard to concentrate. So that’s the down side. The positive benefit is that I have more time to study and at the moment, I am working on yet another paradigm shift. In 1998/99 I was quite happy using Watcom C/C++, Visual C++ and Windows NT. But then I read in the Register that Microsoft was going to get stricter with licenses. And I heard that there were simply tons of free software being made available over the internet. So I thought : fine, I’ll continue using Windows at work because anyone can use Windows and I’ll branch out to new technologies at home by getting to grips with Linux.

My hardware has been giving me some hassle as well. I can’t quite get SuSE Linux 9.1 Pro to install on my P166Mhz Pentium-MMX PC, Theology (called that because only prayer power keeps it going) and my 1.3GHz Celeron (Patience) – where I’ve had both a faulty memory module – found that by downloading a memory tester, memtest86 – which took me a week to track down – and I may have a faulty 80GB hard drive as well. Linux appears to be a good way to stress test a PC and its components. It will all come out in the wash.

I’ve been reading about free software, especially “The Cathedral and the Bazaar”, “Homesteading the Noosphere”, “How to be a hacker”, all written by Eric S. Raymond and downloaded from ESR's home page
LAMPJ is the latest paradigm shift. Instead of using Windows and proprietary software, I’ll become a LAMPJ developer at home and a Windows RAD C++ (Borland C++ Builder) programmer at work. LAMPJ is an acronym that stands for “Linux / Apache / MySQL / Perl, Python, PHP / Java. It is basically a free software stack used to write client/server internet applications. So I have been spending my savings on text books, magazines (Linux Format, Windows XP Official Magazine, Cvu, Overload) and a little bit of hardware, all with the aim of becoming a LAMPJ developer. I still haven’t quite managed to completely shift from Windows NT to Linux. I’ve no idea how to compile a Linux Kernel, how the shared libraries work, how to upgrade the Gnu Compiler Collection, how to produce RPMs, etc. It all takes time and patience.

Well, what can I say. I am in hospital (still), with more medication. I've been very sleepy in the evening so I now get my medication at 8pm. And I've been drooling quite a bit so I've eventually been put onto patches which have medication in them. We'll see how it works.

I've been going home on occasion and its been a bit freaky. Kind of bouncing off the walls. I've rearranged my old PC at the hospital. I've got 3 drive bays at the front of the computer and one drive bay hidden within the computer. The hidden bay is my first hard disk, and the three front bays are for a removable hard disk, a SCSI hard disk and a SCSI CDROM. I couldn't get SuSE Linux 9 to recognise my SCSI interface but I might get it going with a later release. At the moment I am using SCSI Linux 7.2 which, if I can configure to collect my email, should be ok. I'm waiting for the next version of SuSE Linux to come out so I can have a setup that has Kernel 2.6, KDE 3.2.x etc.

I've been going to an Alpha Course, meeting people and discussing religion. One of them gave me a copy of "The Message", which is a copy of the Bible translated into contemporary English. I've been reading it quite a bit and I've got even more awkward questions to ask.

Oops. I've been readmitted again (as of 8th November) and my thoughts aren't exactly sharec by other people so they might be called delusions. The trouble is they seem so real and I was *just* about to act upon them when I was readmitted into hospital. So it seems the system might work. I get to go home occasionally when the outreach team takes me back to my house and check things over. Who knows what the future may hold? I don't and to be honest, I'm not sure if I dare guess. There's the possibility of me having to sell my house to fund my entry into supported housing where an attendant can keep an eye on me to make sure I'm not going over the edge. I've been staying in Delaval ward, not Otterburn ward because that is the catchment are for Bedlington. Delaval does things differently and sometimes I prefer the Otterburn way of doing things. Despite my misgivings, I am staying on Delaval. I've also hav my medication changed from Amisulpride to Clozapine. This is a big climb down by me because I didn't want to have Clozapine because of the regular blood sample taking that has to happen. But my thoughts were so over the edge that they scared me into trying it despite the blood work.

Well, I've been discharged since last Tuesday. So far so good but things aren't going as smoothly as they could be. Going back to East Loan for the night provided some respite for me from living in the community / real world. I wasn't going there much but I still miss it.

What happens to those schizophrenics that take a good look at reality and decide its not for them? They get discharged anyway on the grounds you have a higher quality of life out in the community than in hospital. I respectfully beg to differ.

Walking around the place, blitzed out of your mind on antipsychotic medication, still having to cope with everything else has to deal with is not a level playing field. Schizophrenia is a disability in itself and the medication is another key part of the disabling process. If you're on antipsychotics, you won't scare the horses and you still get symptoms. If you're not on antipsychotics, you get a much clearer thinking abilities with increased symptoms. Also, I've got a "living will" instinct which means the worse my antipsychotics pummel me into the ground, the more likely I am to take an overdose to end it all. Well why not? I'm trapped in a foggy hell moving slowly through reality not in full control of my faculties - my memory is shockingly bad and my reasoning is up to scratch but nowhere near as good as it used to be.

Well, they do say you're never alone with schizophrenia. And they're wrong. Nothing is more lonely than being on your own with voices in your head giving you telepathic commands to attack people before they attack you. The medication helps, both the prescribed stuff and the additional PRN for emergencies. But it does make you sleepy. And less worried about the police reading your mind. Its difficult maintaining a critical mass of fear when you're on anti-psychotics (they're also called major tranquilisers) so you're much more controllable on medication. But you can't help feeling you're going to fall between the cracks in the system as your mind wanders away from reality, the paranoia takes hold and you can't easily go outside any more afraid that you might attack someone in a pre-emptive strike. The PRN meds are an older antipsychotic, Promazine and so far I'm not experiencing any major side effects from them. Even though therer are some pretty ferocious side effects. I'm due to be discharged in the middle of October so we'll see how that works out. I'm already spending more and more time at home and that is o.k. I've got Sky TV to watch which is nice and I make sure that I video documentaries making sure I've got a supply of distractions whenever an emergency or weekend happens. And the Assertive Outreach team comes round and says Hello on days that would otherwise be empty and so far that has been a life saver. Sometimes when the voices are too bad to cope with I just go "hull down", waiting it out in my house, not going out, not interacting with the public, thinking this is mad it can't be happening to me, not again, not again. Why me?

I think I'm institutionalised. Don't exactly know what it means and various NHS types may leap at this saying NO!, you're far too independant. But my life revolves around the hospital and its an awfully steep gravity well to escape from. There's this debate about quality of life for schizophrenia patients and it still isn't resolved. Psychiatric hospitals everywhere are downsizing, with more care in the community schemes being implemented instead. Discharge after nearly two years out of the community - its not an easy thing to cope with.

Sean from the AOT says that my blog should be published somewhere, maybe in the Nursing Times, saying that my experiences can be used to improve nursing practice. Well for one thing, the practice of having acute wards and just CPNs and social workers need to go. The acute wards should stay but they need to have some element of rehab built into them so that people get taught about coping strategies effectively. I reckon I could have saved my job in Berwick if I'd known about coping strategies. If there is to be care in the community, there needs to be more than one overworked CPN covering a broad patch. Instead there needs to be more outreach teams. If care in the community is going to work, you need these teams. It seems a bit strange, me arguing the case for more outreach teams, especially as I don't want to be in the community. But to further integrate myself in the community I have decided to buy a Sky Digital satellite system. I've gone for the £18.50 a month version, its got enough channels for me and I've paid for installation - £100. So far, I'm still not on DLA so it may turn out to be an expensive white elephant but if I get DLA it may prove to be a wise investment. I'll be able to drink tea and watch music television at home, something I do in the hospital when the voices get too loud or when I can't think of anything else to do. Hopefully I won't turn into a couch potato, constantly watching TV all the time.

Last week I took an overdose. It didn't do any lasting damage so maybe God was looking after me after all. The voices and thoughts of self harm just got too much to bear while making breakfast so I ditched everything and took two days worth of medication then phoned East Loan while I was taking another day's worth. Drusilla on East Loan got me to stop taking the meds and I flatly refused to call an ambulance. So she said Dr Strangelove had just come in, could she call me back? She did so and then told me an ambulance was on its way. The ambulance came round to my house, thankfully switching its lights and sirens off once it had come into my street. Before we started off, the ambulancemen (paramedics) asked what I had taken (3600 mg of amisulpride and 3 days worth of reboxetine, whatever that was), took my blood pressure and then we were off.

Casualty was really strange. Everyone was dressed in those strangely fitting blue trousers and shirts, just like in Scrubs on Channel 4. And everyone was very calm. My blood pressure (b.p) was taken again and I was eventually put on a trolley. After a while I began to feel very tired. Then Dawn from the CAOT turned up and she chatted for a while. It was nice to have a friendly face. Then she went away. Every so often someone would give me an ECG to check my heart out. After a brief lunch break in which I was given a sandwich, I was taken to the medical admissions. After a while Drew from the CAOT turned up and chatted, expecting to be able to take me home. It turned out that I wasn't going to go home due to an irregularity with the beating of my heart (caused by the amisulpride). Just after Drew left I threw up and I felt nauseous and ill until 10:30 that night. So I was wheeled off in a wheelchair to ward 2. It was full of really ill people - I was in for observation only. They were groaning, coughing and spitting all night long, the sound of nebulisers was deafening so I didn't get to sleep until well after 11:30. I asked myself what would Salam Pax do? He's probably trying to sleep in the desert, lieing on a thin sheet sheltering under a HumVee somewhere, dodging scorpions. Maybe I shouldn't things are so bad. During the evening I'd had visions of a proper English breakfast for some reason.

Anyway, breakfast arrived and it was continental - that's what you get for joining the E.C. - cornflakes and a bread roll. I was told I was going to be discharged that day and then I waited and waited for Dr Quatermass to turn up. We had a discussion about things and she asked some medical questions about my heart irregularities. Then, when that was over, I waited for someone from the assertive outreach team to come and pick me up. As it turned out, Willow, the O.T. who is taking over from Fuchsia turned up and gave me a lift back to my house. I stayed there for a while and then later, when Willow phoned and offered a lift to East Loan, I gladly accepted and ended up back on East Loan again.

TO DO: Info on discharge:

3rd DISCHARGE : forthcoming discharge with Assertive Outreach Team cover.
Discharge
Discharge is when you finally leave hospital. After you've been in hospital for a while either you're chewing at the door to get out, you're not bothered one way or another or you want to stay on. I've got mixed feelings about discharge, not being sure about losing 24 hour nursing cover which is where the Assertive Outreach Team comes in. There are some very obvious benefits to being discharged. You get back your privacy and ability to do what you want. During a medium to long term stay in hospital your state benefits get reduced drastically by the social services. This can be a very difficult time if you are trying to maintain a dwelling outside the hospital and is an added form of stress. Leaving hospital results in your benefits being restored to normal levels and the chance to apply for DLA - Disability Living Allowance.

Assertive Outreach Team (CAOT)
This is a multi-disciplinary group of about 14 people that cover a certain geographic area. Berwick, where I was living, doesn't have a CAOT. Bedlington where I moved to, does - I moved house to be able to retrain and to get better health care. The people in Berwick (especially Florence my CPN) tried very hard but there are limitations as to what they can do. The people on the team are support workers, Occupational Therapists, Technical Instructors, Approved Social Workers (the approved bit means they have some sort of mental health training) and RMNs - Registered Mental Nurses. They visit people in the community a couple of times a week, sometimes once a day and talk to them, go for walks and help them with their lives - going on trips or sorting out shopping.

Occupational Therapy and the Outreach team (CAOT)
The CAOT has its own occupational therapists (OTs) and technical instructors (TIs) who are taking over Fuchsia's work. So far we haven't done much apart from chat but one of the TIs has been very helpful with household chores - things like fixing a leaking tap or installing a doorbell.

Early Intervention Teams - things have changed
When I was first psychotic, there was no follow-up after the episode. This has been described as a mistake already. However, things are different these days - when someone is psychotic for the first time, the person is looked after maybe in the community, maybe in hospital - it depend's on the individual's case. They are looked after for the first two years by the Early Intervention Team which is similar to an assertive outreach team but deals with cases where the initial cause of the psychotic episode is unknown.

The acute ward.
If you are seriously unwell you get a trip by ambulance from Berwick to the acute wards. Its a long way to go by ambulance and it feels spooky looking out through the back windows of the van seeing Berwick slip away, over the bridge and far away. The acute wards are called Otterburn and Delavel. Otterburn looks after rural Northumberland's patients and Delavel looks after urban Northumberland's patients. Thats a rough guide to patient distribution.

What life is like on acute.
Life on acute is quiet usually interspersed with rare moments when someone is "kicking off" - getting violent and the personal alarms start wailing and staff come running in from other wards to help out. Like East Loan, it is the perfect environment for dealing with psychotic symptoms but they are so short staffed that they can't go in to coping strategies and therapeutic activities as much as East Loan can. Which is a pity but a fact of life. If you are well then a mental hospital has got to be the most boring place in the world. Anyway, the first time I was on acute I spent most of my time listening to my hypnotically induced messages and telepathically implanted personalities (idea from Iain M Bank's novels) - I was hearing voices in other words. I don't remember much of my time there as it was a very confusing time. I remember a few people - the friendly lady who looked after the dinners and reminded me to eat when I was too far gone to know it was tea time, the doctor (SHO Senior House Officer?) and consultant who listened to me occasionally, furtively making references to "the gender thing" and seemingly completely ignoring it, basically being intent on targetting my positive symptoms and getting rid of them. Later on life on acute was spent listening to music, walking about the ward, going to O.T (Occupational Therapy) sessions, going swimming once a week, sleeping, eating, going into Morpeth for a walk. Most patients put weight on because the anti-psychotic medication typically makes the patient hungry and you end up eating more than is particularly sensible. This can lead to weight problems and ultimately result in diabetes. Sex in the hospital is frowned upon but couples do tend to (rarely) disappear into the toilets for a bit of nookie. It can't be stopped but they give out antidepressants which diminish your sex drive while making you relatively happy about it. Drugs in the hospital are a big no no, really frowned upon but there are potheads all over the country so you're bound to get a few dopey people doing their best to buy and smoke pot. Another thing you notice about the hospital is that everyone smokes. Staff smoke like chimneys and so do the patients. I am a non smoker and I used to be allergic to cigarette smoke but I've been exposed to so much of it now that I can tolerate it.

Scizophrenia can be controlled but not cured. That means that falling unwell with schizophrenia means a long sentence of taking medication. Normally you don't have schizophrenic symptoms but sometimes they come back, usually in moments of stress and its not fun. I go through periods where I'm hearing voices again, they're telling me to do things and there has been, over time, a wide variety in the voices that I hear. So far I've heard acquaintances, friends, policemen, Satan and a load of unidentified people.

To recap positive symptoms are : Restless, noisy and irrational behaviour (not me), Sudden mood changes (not me), Inappropriateness of mood (not me), Disordered thinking (definitely me), Feelings of being controlled by outside forces - having one's thoughts and actions taken over (definitely me - I thought I'd been programmed with Buffy the Vampire Slayer's combat skills and to attack policemen. It scared me to death when I saw policemen & women walking down the hallway), Delusions (plenty of those), Hallucinations (initially only auditory), Lack of insight - no awareness of the abnormality of one's thoughts, experiences and behaviour (not me I knew something was wrong but what do you do? People don't stop with a "core dumped" error message in general they just muddle on as best they can, Suspiciousness, which in some cases can become paranoia (definitely me, I had two conspiracies chasing after me, the Berwick Conspiracy and the Conspiracy To Keep Me Alive and both of them had implanted artificially intelligent agents in my head to control my body at key moments). The positive symptoms can be controlled by medication.

Negative symptoms can't be controlled by medication and they include tiredness (me - I've been virtually comatose in some of my meetings), loss of concentration (me - I haven't read many books since 2001) and lack of energy and motivation (me). The negative symptoms can be made worse by medication and how the individual reacts to medication is very much an individual thing. I reacted to Olanzapine by slowly becoming someone who ate more (the medication increased my appetite by an incredible amount. At one stage I ate a whole serving of NHS cauliflower cheese and I hate cauliflower and the cheese sauce was incredibly bland).

Back to acute. It is basically a long hallway with individual bedrooms leading off it for women and some men, there are lounges at each end of acute - the smoking room and non smoking room. There is a dormitory for men to stay in with two individual rooms adjoining the dormitory. There are people on acute for substance misuse (drugs and alcohol problems), personality disorders, depression, manic depression (bipolar) as well as that old chestnut, schizophrenia. I got on ok with most people, generally I kept out of the way of people. At the time, I couldn't handle cigarette smoke so I stayed in the non-smoking room which was always virtually empty with hardly any conversation. It had a telly and a hifi which was nice the telly was rarely put on till Sky was donated by a grateful patient and then suddenly we were always watching music TV. The hifi was a nice luxury until it kept on getting vandalised. The smoking room seemed much more lively than the non smoking room, with the radio on the hifi on all the time and conversations ebbing and flowing.

Occupational Therapy (O.T.) on Acute.
Fuchsia has been part of the furniture on acute for ages and she has many talents. So what do you do when you're with Fuchsia on acute? Well, the most common group O.T. sessions are art/creative work which for me turned out to be colouring things in with felt tip pens. There were more ambitious art things available to do. Another not quite as popular O.T. activity was relaxation, where you listen to some relaxation music, put your feet up and listen to Fuchsia reading out a relaxation script like being a leaf in a forest stream or visiting a tropical beach. And to do O.T. you don't just turn up and wait to be given a felt tip pen. Oh no, you have to be referred to O.T. - not every patient on acute will benefit from O.T. according to Fuchsia, only patients who have "mental health problems that affect their ability to; socialise, carry out their work, get out and about, look after themselves, manage domestic tasks, develop leisure interests" will benefit from O.T. I initially tried O.T. because I thought it stood for Object Technology - imagine my confusion expecting C++ and Smalltalk discussions and birds of a feather sessions and I turn up and everyone is colouring things in. The OT department believe that "by the use of activity - good mental health can be promoted and maintained. The sessions offered by OT depend very much on the needs of the client - but
hopefully 'colouring in' is not really an accurate reflection of what goes on here!!!".


Individual activities are just as much fun. For instance there was (supervised) access to a computer so I could catch up with Hotmail emails and read The Register. Then there was activities which involved getting out & about on buses - going shopping in Newcastle, getting to know various bus routes etc. Baking was another popular pastime, I'd go to O.T., bake a pie and take it back into acute where the patients would quite happily eat it all up. The O.T. department also had a digital camera so once we went around the grounds of the hospital, taking pictures of the old houses that are due to be demolished when the new hospital is built. Finally, sometimes we just had a chat about things, being ill, music etc.

How things progress from admission to discharge.
What my admission was like.
I was admitted - let inside the hospital. At about 1.30 in the morning, I think. It was dark and I was really surprised to find that they had a doctor there. Actually, when I got out of the ambulance I thought I was going to be murdered and buried in a field somewhere so to find out I was in a hospital was a bit of a relief. I thought it was a big mistake but figured I'd find things out before rocking the boat. Then I started getting hints that I was actually ill - how bizarre, people were trying to kill me and these crazy people were trying to tell me I was unwell.

What life was like with schizophrenic symptoms for the first & second time.
In 1999 I fell unwell with schizophrenia for the first time. It was a full blown psychotic episode and I scoured Birmingham University for help, getting very little. In the end I was seen by a nurse there and she phoned a friend to come and pick me up. I had voices telling me they were going to arrest me for various things I hadn't done, delusions of being kidnapped and it was very scarey. I was put on tranquilisers for some time and in the end BLCMP made me redundant so I went back to Berwick. There I told my GP that I'd had a nervous breakdown and that was that. No follow up. Apparently that was a Very Bad Thing and a CPN should have been involved at least that's what Florence, my CPN in Berwick told me. She kept on apologising for it. I didn't know any better but it seems that the treatment of psychiatric patients outside of Northumberland isn't as good as the treatment inside of Northumberland.

In 2001 I fell unwell again, this time after AESL made me redundant. Not a particularly nice thing to do, I'd been having a great time working as a C++ programmer writing systems in Borland's C++ Builder. My only complaint was that I seemed to be the only person in the place who seemed to read C++ books in order to improve my programming skills - everyone else was too busy shipping products and having a personal life to do that. Anyway while there I wrote a few articles that got published in ACCU's Overload magazine and in general, life was ok despite some major problems like power cuts in Berwick bringing the place to a halt and the trains to Berwick being screwed up by landslides and flooding. I don't know how quickly I fell unwell but it was an acute episode and my next door neighbour got a doctor in when I went to him for help. Thanks to his experience and helpfulness, I was put in an ambulance destined for Morpeth. This time all the voices and delusions of the first episode came flooding back, with more delusions stacked on top of them. It took me a while in Morpeth to come to terms with reality.

Discharge.
Eventually I was discharged into the care of Florence my CPN and Ermintrude my social worker. They made sure I was kept on a maintenance dose of Olanzapine which was gradually reduced.

Life on a maintenance dosage without stress was fine. I read messages on the accu-general mailing list, keeping up with programming.

Re-employment and relapse
Eventually I lucked out and got a job in Berwick at Simpson's Maltings (in 2001) where I was to implement an automated office system. That didn't work out too well in that the stress of work triggered my psychotic symptoms again and I became unwell and readmitted to hospital in Morpeth. I spent even longer in hospital, still getting paid for it despite my contract saying that payment was optional, something that was very generous on behlaf of my employer. Unfortunately, when I got better again they made me redundant. Later on (in 2002), because of the redundancy and the seemingly impossible situation I found myself in I tried to commit suicide but my neighbour intervened and I was taken back to Morpeth in an ambulance again.

More on East Loan, the rehabilitation unit.

Contact. If you have something to say about this blog then send a message to Schizopanic@hotmail.com. BTW Contact is also a charity for people with mental health problems run in Morpeth that meets at the Bridge Street Centre on Tuesdays and Thursdays. Its seems ok even if the average age is way above what I'm used to on the wards.

I've been asked to keep the NHS people completely anonymous. So I will use Magic Roundabout names for some and more apt code names for others.

My key worker Emily, I've anonymised in honour of Emily Pankhurst the suffragette - this is because she has a sticker which says "women who seek equality with men lack ambition". Emily is an experienced mental health nurse who takes a lead role in deciding what happens to me - she looks after my weekly planner deciding what's going to happen during the week, co-ordinates some things does other things that I don't remember or even know about. The things that "happen" on my weekly planner are therapeutic activities (typically handled by a nurse, nursing assistant, occupational therapist (OT) or technical instructor (TI) ). If you're dealing with symptoms then activities are an interesting diversion but they've got a long term aim of helping you when you leave hospital. Other things that end up on my weekly planner are meetings. Meetings with Drs. Meetings with OTs, TIs, clinical psychologists. At the moment me & my clinical psychologist are covering info about hearing voices and are looking into the Hearing Voices Network.

All nurses write things down in confidential files like manic privacy obssessed bloggers - except instead of using 1024 bit encryption they decide that computers aren't secure enough for them and write everything down in pen.

The uber-blogger would have to be my consultant psychiatrist Dr Quatermass. Encounters with her are currently rare because of a car crash and pressing matters but she does seem to know an awful lot about people and probably posseses something like Dungeons and Dragons magic item which makes her so perceptive. She writes things down, determines medication and has another Dr, Dr Strangelove, who keeps an eye on the East Loan unit for her while she is away. Dr Strangelove is amiable and gets on with people ok but people miss Dr Quatermass when she is away.

Catherine (the great) runs East Loan, looking after the manic bloggers, sorry nurses and the nursing assistants, sorting out shifts and generally running the place. She's frequently stuck in manager's meetings and stuff like that.

The nurses run East Loan in three shifts, night shift, morning, and afternoon. Although its a little more complicated than that, this simplified model is sufficient for some one asking for milk and tea bags - critical supplies in the great game of drinking lots of tea. Some staff seem to prefer working on night shifts - pale faced creatures that are seen by me at the beginning of the night, preferrably to tell some dodgy joke that I've picked up from work and never seen again for the next 24 hours.

Morning shift people are rarely seen by some patients Oh BTW terminology warning. Patients aren't called patients anymore they're called clients and they use hospital services. Strange I know especially as most clients spend an inordinate amount of time just waiting for things to happen - appointments, trips to somewhere, for medication to be dispensed - that calling them patience would be really really apt. Except they are called clients. Some clients wake up really early and go for walks or go to East Loan's clubhouse to watch music TV or read the newspaper (Daily Mirror or the Journal). Most clients get up around 10am which is when the first batch of meds (medication) is handed out. People stay in houses listening to music, drift around having conversations, go into No. 1 (the clubhouse) to watch music TV or drink tea/coffee. It can be quite a hectic life, getting up at 10, getting dressed, having breakfast, taking meds and then setting off to No.1 to read the paper to see how the Normals are trashing the planet. If clients ruled the world, nobody would get out of bed before 10am and everyone would watch music TV drinking tea or coffee. No work would get done but then neither would crime, wars or political parties so there's something to be said for such a system.

Lunch is at 12 mid day. When you go to East Loan you're typically on hospital food so you don't have to think about things like logistics or cooking. Eventually you get moved onto a system called self catering where initially for a couple of days you do your own cooking then eventually you have to do your own cooking 7 days a week. You get 3 pounds a day spending money for food so you have to budget carefully. Typically this involves shopping at Lidl's (cheap food supermarket) as well as Safeway (expensive food supermarket). The hospital menu is repeated every two weeks so the food can become pretty boring after three months. But if you're busy thinking about other things then hospital food is great because you just eat when you are told and you've got one less thing to think about in life. Useful if you're going through a psychotic episode and you think people are transmitting messages into your mind with high tech equipment and that people are out to get you. Incidentally, I have been kidnapped by little green men. During my 2nd psychotic episode - in 2001 - I was taken to a "place of safety" (the hospital) by paramedics who just happened to be dressed in green overalls. The afternoon shift tend to do various things like go on trips, take people shopping etc. So it seems to be a more active shift than the others. It knocks off about 8:40.

"Meds" are served in stages. There are different stages, starting off with people giving you medication at the appropriate times. My meds kept on being changed so this turned into a bit of a lottery with people forgetting that I had to take medication at 2pm (hardly anyone takes meds at 2pm).Ultimately you are given the responsibility of looking after your own meds. They have these little packs called "dosettes" which contain enough medication for a week. Each dosette has 7 little daily "fingers" which can easily be slipped into a pocket. The finger has compartments for meds at breakfast, lunch, dinner and bedtime. If the patient wants to check if they've taken their medication then all they have to do is look at their dosette finger. To reduce the risk of confusion, each dosette finger is labelled with a day name. The system works and is simple.

Oh, and lets not forget the nurses blogging ritual of the handover. Three times a day (I think) they Can Not Be Disturbed as they gossip wildly on the clients activities and scribble endless notes down in confidential files. No, they discuss the shifts events, pass over relevant information to the following shift and generally debrief. The handovers occur at regular times in the day which I can never remember.

In general clients lead a docile, stress free life. Which if you're suffering from schizophrenia is an ideal thing because you can tackle delusions much more easily if you're not having to struggle to deal with day to day activities. The disease has ironically named positive symptoms which include hallucinations (typically auditory) although for ages I was walking around the place incensed saying "I do not hear voices! They're hypnotically induced messages!" but that was a long time ago on the acute wards and delusions which are the thing that really tripped me up. The brain is a fairly fault tolerant device (Dr Strangelove doesn't like my idea of the brain as an artificial intelligence implementation - "the brain is not a computer" etc well if the brain is not a computer, how come I'm running Windows 3.0?). So far my delusions have included hypnosis, sex, mind control, kidnapping, gender dysphoria and conspiracies. If its alright by you I don't think I'll go into the details because it would shock some acquaintances of mine who weren't conspiring against me but I thought they were. In fact I had memories of it and flashbacks and hypnotically induced messages from them about it. You've probably figured now that a psychotic episode is a very troubled, occasionally dangerous part of life that most people don't want to experience again. Well if I'm truthful, dealing with life in the community after a psychotic episode is just as bad as a psychotic episode for me because you've got a chance to see just how far down the ladder of life you have fallen and its a long way up. There are more +ve symptoms but I'll not go into them. They're the kinds of things that Emily or Fuchsia have noticed, here are my early warning symptoms of relapse I'm sullen/withdrawn, abrupt, make inappropriate comments to other people, don't show consideration to other people's feelings, poor concentration, isolate myself quite a bit, sleep pattern changes, paranoid/suspicious of other people, looking at inappropriate job applications (usually in other parts of the country).

The stress vulnerability model is used quite a bit. Thats a theory that says that you can become unwell when stress reaches a certain level. That level is reached sooner for people with a mental health problem. The rehab process involves getting used to increased stress levels (caused by normal life events like taking a bus or moving house or by illness events like hearing voices, having visions) by applying "coping strategies" at the right time. Coping strategies vary but some are "grounding self in present" - looking around and telling yourself where you really are and what's really going on around you, trying to ignore panic symptoms or hallucinations, "distraction" - looking out of a window, holding an ice cube tightly, pinging an elastic band against your wrist, "watch TV or listen to a radio" or "use medication". There are other coping strategies as well.

Occupational Therapy on East Loan involved many things but they initially corresponded to travel (on buses & trains), cooking/shopping and talking. Other activities were moving house (packing/unpacking), orientation to a new area, exploring employment options and easing back into employment. We also looked at higher/further education courses but I'm not sure if my memory is up to that yet and developing leisure interests - typically art & crafts related things which I didn't neccessarily jump up & down with joy at. Why are all OTs obsessed with arts & crafts? We'll never know. Fuchsia & I did other things as well like going on the bus to the Baltic art gallery, going to the cinema to see Lord of the Rings, going to Newbiggin Beach to have an ice cream, getting used to Newcastle and eating ice cream in Mark Toni's parlour. When I moved house, Fuchsia & Emily both helped with the practical aspects of the move, doing things like putting up curtains (hammering,sweing and screwing things into place). I'll miss them both when I leave.

The care given to a patient is governed by a "care plan". In the past I've been invited to review care plans to see if I agree with them. I asked Emily what a care plan is and this is what she said "A care plan is an agreement between a named nurse & a client/patient and its about what a client wants to achieve, who is going to be involved in helping the client achieve their goals with detail of how the goals are going to be acheived. It may/may not have a time limit on it and it should be written in language that everybody can understand"

Well, thats enough information for now, I'll try and dig up some info on what my experiences on the acute ward was like.

Well this is it. Me a blogger. We all have labels to add to our names, one of mine is schizophrenic (see NHS Direct http://www.nhsdirect.nhs.uk/en.asp?TopicID=404 for more details and see Google News for recent events concerning schizophrenia). Mental health is a bit of a taboo area even in these so called enlightened days.

I've been stable for 24 hours now. Not as good a record as BSD but then even Windows 3.0 is a paragon of stability compared to me. How can I describe my world to you?

The hospital is a huge sprawling site of various types of building ranging from Victorian to modern portacabin. There's grass and plants all over the place. There's a horseshoe shaped road that runs up one bank, past the acute wards, past Lindisfarne wards, past the Kiff Kaff, past Cheviot, Hadrian and some other ward, curves around past Brinkburn (Dr's offices) meanders past the Occupational Therapy sewing rooms, past the Border Fayre restaurant & hospital kitchens then it curves around again past the main hospital building a Victorian edifice that is impressive and a labyrinth of corridors, offices and strange rooms. Then it goes past the main entrance and the pharmacy past the now abandoned church a couple of other abandoned buildings, past East Loan (a row of terrace houses and a 2 semi-detached houses - home for me for a couple of months) and then it curves down a horribly steep bank into Morpeth.

Then there's Bedlington. Where I do therapeutic work every week, answering phones for a friend of mine in his shop. Bedlington isn't Berwick Upon Tweed and that's one of my problems. Actually Berwick Upon Tweed is one of my problems too in a wrist slashing sort of way. But don't let that freak you out, apparently tons of schizophrenics attempt suicide (40-50%) and 10-13% of us succeed. That's not very nice. I've already been to one funeral - don't know if it was suicide or not but it was death by exposure which I've no idea about - don't know if it is painful although the verdict was misadventure. Actually I'm the worst person in the world for suicide. I don't want my stomach pumped, I don't want blood on the carpet, I mean who cares? Well a number of NHS people do and my family do but when you're feeling suicidal the last thing on earth you're thinking about is the consequences for other people. Sometimes I wish I could press ALT+F4 and move on to a higher plane of existence. Its the voices that make me do suicidal things. When you let on that kind of thing is happening you are offered additional medication (referred to as PRN medicines) to be taken at strategic moments. It (lorazepam,promazine) relaxes me, gets me thinking much slower if at all and disrupts the "kill yourself kill yourself" voices.

The NHS people in my life deserve anonymity because I'm not exactly the best judge of their actions and they do their best with a sometimes awkward person like me. Maybe just using their first names would be good enough. I'll ask Fuchsia (my technical instructor) for advice. OTOH, the NHS people in my life deserve recognition because they've saved my life on numerous occasions by persuading me that my life is worth living.

My family deserve anonymity as well. My sister Elizabeth helps me a lot and I'm really grateful for her help. I occasionally see my Dad and its quite a trek for him to come and see me.

My meds (medication) deserve a mention. There's amisulpride which is one of the newer atypical antipsychotics. It keeps me sane some of the time. And it gives me muscle pains in my back. Other times I get, *ahem*, shall we say unconventional ideas about the government and police and conspiracies. There's reboxetine which is an anti-depressant. There's senna which is meant to cure constipation also caused by my amisulpride but I've been having more luck with my liquorice (77p from the Co-Op, quite a slice of self catering money but worth it).

Well, thats it. Welcome to my world. I'll detail the NHS people in a future post, when I've got Fuchsia to say that first names are anonymous enough. They do deserve recognition so I hope I can do my bit in that respect.
TTFN
Ian