Primary Care of the Psychiatric Mental Health Client I
Psychiatric Interviews for Teaching: Self-Harm Video Transcript
Hello. Jane Evans?
Yeah.
Hi. My name's Dr. Bedi. I'm one of the psychiatrists who work here in the Department of Psychological Medicine, and I'm seeing you today because you were referred up from A&E. I understand that you were there a couple of nights ago, having cut your arms.
Yeah and I think that was you'd come in after your relationship had ended. Is that right?
Yeah.
Okay. Okay. Can I just check? Have they bandaged you up, and are things settling down there?
Yeah, it's fine.
Okay, okay. How have you been, Jane, since we last saw you in A&E?
Crap. I mean, I just can't believe that he's gone.
Right and this is your boyfriend, Mark, is that right?
Yeah.
Okay. Okay. How long had you two been together?
I mean, it was only a couple of weeks, but you know, things seemed to be going really, really well. I don't understand. I can't believe he's just gone.
Right. What was it that happened, Jane, to bring that relationship to an end?
Well, it was like I said. Because it was going so well, I asked him to move in.
Right.
And he said that he didn't want to, and we ended up arguing and getting into a big fight, and then he said he was going, and you know, I begged him not to, but he still went anyway.
So was it after he had gone that you cut?
Yeah.
Right. Can you tell me a bit more about what happened when you cut?
Well, he'd gone, and I just felt so… I just couldn't bear the pain anymore.
Right and like, the voices were just incessant.
Right and I just, you know, wanted to get rid of all the pain, all the voices, and so you know, I just cut myself.
Right and did that help with the pain and the voices?
Yeah.
Right.
You know, it was just, yeah. I mean, it took the pain away, and I don't know, it was just something about seeing the blood, really. It [inaudible 00:02:49].
Right.
I don't know, just made it feel better.
So, with the cutting, is this something that you've done before?
I've been doing it since I was, I don't know, a teenager.
Right. Okay and it sounds like there are times when you do it when it helps.
Yeah.
Right.
Yeah, it takes the pain off.
Right and are there any downsides to the cutting?
Well, yeah. I mean, there's been a few, but I suppose the main thing is sort of… I don't know, me arms and legs are a mess.
Right. Okay. Okay and you mentioned, Jane, voices.
Mm-hmm and I know you've spoken to doctors about them before.
Yeah.
But can I just ask you a few more questions about them, please, if that's okay?
Yeah.
Okay. Can you tell me, how long is it that you've been hearing the voices?
About since I was a teenager as well.
Right. Okay and, do you know how many voices are there, or who they are?
Oh, I know who they are. It's mainly my stepdad.
Right.
He, I don't know, just tells me how dirty I am, and how horrible I am.
Right. Okay and I don't know, sometimes it's my mom as well, but and what kind of things does your mom say?
I think mainly she thinks I'm a liar.
Right. Okay and how often is it that you get these voices, Jane?
They're not there all the time.
Right.
But you know, generally, they're sort of like sitting there, but I don't know. Just sometimes, they're louder than others, and it's like the other night, they might as well have been in the room.
Right. Did you think they were in the room?
No. I mean, I know that they're not there.
Right. Okay.
But it's like they're just so loud in my head.
Right. So can I just clarify that? Do the voices seem as though they're inside your head, or is it like my voice coming through your ears?
No, it's like inside.
Inside your head?
Yeah.
Okay. Okay. Okay and am I right in thinking that they trouble you more at times when you're stressed out?
Yeah.
Right. Okay. Okay. Can I ask you a few more general questions about how you are, and your mood? How would you say that you feel generally, kind of in yourself?
I hate myself.
Right.
Most of the time, I just don't like being me.
Right. That sounds as though it can be very difficult sometimes.
Mm-hmm and it sounds like you've used cutting in the past to help.
Mm-hmm.
Are there any other things that you do to help when you feel really bad?
Drinking.
Right.
I have smoked a few spliffs now and then, you know?
Right.
Yeah. I don't do it so much now, but in the past, I don't know, I just had a funny thing about food.
Right.
You know, I'd sort of like binge, and then just throw it back up again.
Right. Okay and that was in the past, but not recently?
I haven't done it recently, no.
Okay and can I ask, Jane? It sounds like when you cut the other night, you were doing it sort of to kind of get rid of the pain.
Mm-hmm.
Can I just clarify. Were you doing it to try and kill yourself?
No.
Okay.
No.
Have there ever been times in the past when you have tried to kill yourself?
In my late teens.
Right. What happened then?
Probably around when I was 19, I don't know, it just got to the point where I didn't want to be here anymore, so took some tablets.
Right. Okay. So that was in your late teens, and at the time, you took the tablets because you wanted to be dead. Is that right? Okay. Okay. But you've not wanted to be dead since that time in your late teens?
No. No.
Okay. Can I ask you a few more general questions about your home situation? Who is it that… Is there anyone at home with you?
Well, not now, but-
Right.
My daughter used to live with me.
Okay.
But she's gone to live with her dad now.
Right. So she's gone to live with her dad. Is that quite a recent thing?
About a year ago.
Right and what was that about?
She just couldn't cope with the fact that I was cutting myself.
Right.
I mean, I didn't do it in front of her, but she knew it was happening.
Right and I suppose one of the big things as well, was the relationships I had.
The relationships you had?
Mm-hmm.
Can you tell me a bit more about that?
Well, it's like the one I've just had with Mark, you know? It starts off being great, and then I get really scared. I just get really scared that they're going to leave, and then it turns into a big fight, and they end up leaving anyway.
Right and it sounds like your daughter struggled with that.
Yeah. I mean, I suppose she didn't know whether she was coming or going, really.
Right. Okay and were there lots of relationships like that?
Yeah.
Okay. Okay. You've seen, Jane, a few people in the past. You've seen a couple of psychiatrists and a couple of counselors.
Yeah.
Has anything that anyone's done for you before been particularly helpful?
They've all been crap.
Right.
I just feel I've been passed from pillar to post.
Right. Right. So you've not found anything that people have done particularly helpful in helping you to manage your relationships, and your cutting, and the things that seem to go wrong for you?
It's like nobody's listening to me.
Right.
You know, I think you're the only person who's actually sat and listened to what I've got to say.
Okay. Well, do you think it would be worth, given that this has been such a longstanding problem, clearly does get in the way of quite a lot of aspects of your life, do you think it would be worth us meeting again one more time, and perhaps having a think together about how the service could best support you with this?
What do you mean one more time? Can't I see you, you know, sort of properly?
Well, the way that we work here in this department is that we see people once or twice, and try and think with them about the best place for them to be, and then refer them onto the most appropriate parts of the service, so it wouldn't be usual for me to see you more than once or twice, Jane.
Yeah, but like I said, you were the only person that's listened to me.
I know it's very difficult to open up to people, and I know that you have opened up here today, and it can feel quite hard that you're not going to continue to see me, but it is the way that we work here, is to pass you on to somebody who is perhaps a bit more appropriate for your needs, Jane.
Right.
So, would it be okay for me to book you in to come back and see me, say next week, for a second appointment, and we can perhaps have a think of where to go from there? Would that be okay?
Yeah, I suppose so.