How to ask for help? If mental illness was treated like physical illness…

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Photo credit Hyperbole and A Half Blog

I’ve been struggling recently with trying to figure out how exactly to ask for help.  How do you even tell people around you that you are not okay when you are struggling with an invisible mental health disability?  How do you tell people that the disability which you live with daily and generally “manage” is currently in a crisis state?  How do you tell people that you are struggling with thoughts of harming yourself?  How do you tell people that you need help because you are suicidal?  How do you even bring up the topic of suicide?

It’s not easy.  Half the time I drop the topic casually into conversation the person I’m talking to thinks I’m joking.  They might even laugh, then awkwardly realize I’m not laughing and say “Oh wait, were you serious?” and when I say “Kinda” I hear…

<crickets>

That’s right…nothing.

A lot of the time when I disclose thoughts about harming myself I hear:

<crickets>

Or people keep talking.  Or they assume this is normal for me and say “that’s too bad” and move on with the conversation.

I’ve learned that most people don’t know how to handle disclosures of thoughts of suicide.

If I walked up to you right now with a serious physical medical emergency, for example signs of a heart attack and said “I need help, I think I’m having a heart attack”  I can pretty much guarantee the response would not be:

<crickets>

Someone would do first aid, they’d call 911.  They’d drive me to the hospital.  They’d stay with me.  I’d get flowers and cards, meals delivered.   I’d get time off work, more cards.  People would visit me at home as I recovered.  Friends and family would be so glad I survived the heart attack, they’d offer to help with child care and housework and cooking.

People KNOW how to help with a medical health emergency.  So why do they respond with

<crickets>

to disclosures of thoughts suicide, self harm or other signs of a mental health emergency?

Why is it so hard for me even to disclose the struggle?  Why is there SO much stigma?

I’m afraid to ask for help because of the risk of two things

  1. The person will overreact (call 911, police, hospital, panic, lock up dangerous items)
  2. The person will under react (see <crickets>)

What I really need when I ask for help is for someone to:

  1. Believe me that I’m actually suicidal and that things actually feel THAT BAD
  2. Trust me that I’m not actually going to do anything dangerous, but that I need some help in the moment to achieve that
  3. Listen to me.  Validate my feelings.   Let me know that they can hear I’m in pain.
  4. Remind me that I might be experiencing flashbacks, triggers or emotional flashbacks and that they are real, but I might not be seeing things completely clearly and I might need time to get safe and get grounded
  5. Keep me company (text, phone, go for coffee, take a walk, cuddles)
  6. Remind me that people care about me and that I’m not a bad person.
  7. After validating my feelings, offer some hope that things will improve one day and that I have the strength to carry on until then.  Remind me of some of my strengths (but be realistic, don’t go over the top with praise)

I really believe that you can help people around you who might be struggling with suicidal thoughts.  You can help them by listening to them, believing them and keeping them company.  You can also offer to do some of the same things you would for someone who is physically ill.   Offer to help with child care, meal preparation, cleaning, picking up groceries, running errands, drop by for a visit (ask first), call to check in, text to say hi, send a thinking of you card, send flowers etc.   In my own experience, the worst thing you can do is…

<crickets>

I wanted to share my favourite  blog Hyperbole and a Half and their post about depression:

http://hyperboleandahalf.blogspot.ca/2013/05/depression-part-two.html

Gaslighting. Part 2. The lasting impact.

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This might be a disjointed post, but that mirrors the state of mind I’m in when I’m experiencing the impacts of gaslighting.  Gaslighting is a term for prolonged emotional and psychological abuse which is designed to make the victim doubt their own perceptions of reality.  It’s a particularly harmful type of abuse and the impacts of it can last for years after the abusive relationship ends.  The lasting impacts of gaslighting can be invisible or vague to the outside eye, but are extremely powerful and terrifying to the survivor.

Much gaslighting and emotional abuse is perpetrated by sociopaths and various types of narcissists.  These folks lack empathy.  They lack the ability to understand the feelings of others.  They can exhibit levels of cruelty that are difficult to fathom, but they often “pass” as normal, functional human beings.  They often have good jobs, and often live ordinary lives.  They can often appear to be quite charming, especially in short controlled (always by them) interactions.  The cracks in their normalcy only begin to become evident when you get to know them over longer periods of time, then the signs of missing empathy and humanity begin to peek through.  But by that time you are quite likely hooked, trapped and unable to escape.  For those that have only short interactions with the sociopath/abuser, they may continue to think that he is a basically “good person,”  model employee, good father etc.   This can add levels to the gaslighting, because the victim/survivor has difficulty being believed, when her abuser has so much “street cred” as a decent person.

My abuser regularly spreads lies about me.  He tells anyone who will listen how crazy I am.  He also tells people in the community, including people who interact with my children, how crazy I am.  He tells them how I never took care of my children, how I never bonded or attached to them (they were both raised with me as a stay home mom, exclusively breastfed etc), he even lies and says they were in daycare from birth!   He tells people what a good caring person he is, how sad it is that despite his love, he just wasn’t able to cure my severe mental illness and the marriage ended.  These are the type of lies he tells to others.

While we were together, he used my PTSD against me.  Basically saying that it was because I was crazy (from being abused as a teenager) that I didn’t like what he was doing (abusing me) and that any “normal woman” would be okay with it.  He used me being “crazy” as a trick to keep me trapped for years in the relationship.  When I tried to get away he threatened me saying that the police wouldn’t believe me because I was “crazy.”

All this is emotional abuse.  It’s all gaslighting.  It all made me and makes me doubt my own reality.

Being abused over a long period of time is complex.  Because the abuser is also someone you are in a relationship with.  You never really know when the abuse will happen and when things will be “fine.”  You never know when you’ll sleep through the night and when you’ll wake to be assaulted.  You never really know…

Thus for many survivors (myself included) waiting can be a huge trigger.

One way that I try to cope with ongoing fears of abuse is by never upsetting anyone.  This means that I worry a great deal that anything I say or do, or don’t say or don’t do, or might say or might do, or might not say or might not do…might have terrible consequences for me or someone I care about.

Gaslighting has conditioned me to believe that everything is my fault. That I’m potentially to blame for everything around me.  And it has made me unable to adequately determine what is and is not my fault.  It has left me with very poor conflict management skills.  In a conflict situation, I freeze.  I say or do whatever I think will get me out of the situation quickly.  I say or do whatever I think will be safest in that moment, which isn’t necessarily the best option long term.  My PTSD brain kicks in and I don’t behave in a rational thought through manner.  I don’t have control over this.  I’m not being passive aggressive.  I’m not being manipulative. I freeze.  Or I’m trying to stay safe.  Even if there is no ACTUAL danger, in my  mind there is.

Gaslighting and triggers related to gaslighting leave me doubting myself in every possible way.

I can go to work, give a presentation, feel good about myself, feel I did an adequate job and then go home.  An hour after arriving home I can be completely convinced that I made a horrible mistake, said something offensive, said something my coworkers would not have said, said something that could cause irreversible harm to someone, embarrassed myself, brought shame on my organization, made all my coworkers hate me etc…

It’s an extreme reaction!

I’ve spent entire weekends ready to quit my job, convinced that a single email I sent has ruined everything I’ve worked for in 4 years.  That everyone will hate me and want me fired.

These are trivial examples, but they illustrate the impacts of gaslighting that still remain in my brain.  I literally doubt reality ALL the time.  I somehow think I’ve done something wrong, even when I have done nothing at all.

I need a lot of reassurance.  This isn’t entirely because I lack confidence or skills.  It’s because I can, at a moments notice, begin to doubt everything I knew to be true a few minutes early.   I can get to a place where I even doubt I was abused.  I can believe that maybe I’m exaggerating.  Maybe I made things up.   I need reassurance about things most people consider self evident.  I know it’s frustrating for those around me.  I know it doesn’t always make sense.  I know you wish I could just love myself.  But I can’t.  I need your patience and reassurance.  I need to hear that you believe me.  I need to hear that it’s not my fault.  And I’ll need to hear it again tomorrow.

These are the lasting impacts of emotional abuse perpetrated by a narcissistic abuser.

How to cope with chronic suicidal thoughts…

People who don’t struggle with chronic suicidal thoughts sometimes imagine suicide as the type of crisis that happens in the movies.  And it can happen this way, but not for everyone.  You know the cliched scene (we’ve all seen it) someone loses their job, breaks up with their partner, makes a terrible mistake, suffers the loss of a loved one etc. and they spend a dark night contemplating ending it all.   Maybe they reach out, a friend comes over, makes them tea, stays up all night and talks them through it.  Or maybe they are taken to a hospital emergency room, where staff admits, them and they are released a few days later, on medication and thankful that they are still alive.

Yes, single episode suicidal crises happen.  They are terrifying and frightening and can be medical emergencies.  If you are struggling with this type of crisis, you are not alone.  Suicide is a permanent solution to a temporary problem.   There is help available, even though reaching out can be scary.

But what if this isn’t your experience.  What if, like me, you struggle with chronic suicidal thoughts, on and off, for decades?   What if suicidal thoughts and suicidal impulses became, during times of trauma, part of your coping mechanisms?  What if suicidal thoughts, ironically and paradoxically both threaten your life and help keep you alive?  What if it isn’t just “one long dark night”?  What if it isn’t something that a trip to the local emergency room and a short psychiatric admission can even touch?  What do people like me do when they hit a rough patch?

It’s complicated.  It’s complicated for a number of reasons.

  1. It’s very hard to even talk about suicide.  It’s not an easy subject to bring up.  I’m always afraid that people will either overreact (ie. treat it like the suicidal crisis described above and call emergency services) or under react (and ignore my disclosure or not offer support).  Let’s face it, most people aren’t comfortable talking about suicide.  If someone asks me: “How are you doing today?”  they don’t want to hear “Actually I’m dealing with suicidal thoughts at the moment, thanks for asking.”  It’s just not something I can say.
  2. If I do disclose that I’m having suicidal thoughts, most times people just sit there awkwardly.  Try to figure out if I’m joking or serious.  And then change the subject.  Meanwhile, I’m sitting there, just as awkwardly, feeling guilty for making the situation awkward and not just saying “I’m fine.”
  3. See point #1.  Talking about suicide is a societal taboo.  I’ve had these thoughts for 20+ years.  I’m still alive and I’m still finding it difficult to talk about them.  There is something about this that doesn’t quite make sense.
  4. There is an incredible amount of shame related to this societal taboo.  This means that not only do I feel suicidal, I also feel ashamed about it.  I also feel afraid about the consequences that could occur if people find out and misunderstand what chronic suicidal thinking means (aka…911 calls, police, hospitals).
  5.  Suicidal thoughts are not a “cry for help” or a “way to get attention.”  Most of the time I deal with suicidal thoughts alone and people aren’t even aware that I’m having them.  Even when I do disclose, I generally minimize how bad they are.  I try to cope by myself as much as possible.  Self harm has also been a very private thing in my life.  For something to be a “cry for help” generally other people need to actually know about it!  It would be more accurate for me to describe the suicidal thoughts as a way to gain control, the ultimate control, over an overwhelming or out of control situation in my life.  It’s also related to obsessive compulsive thinking, and in that way can be circular and very difficult to control.  Sometimes I have intrusive thoughts about suicide that are obsessive and not related to anything in particular in my life.  They are disturbing to me and they are  unwanted, arriving in my brain suddenly and then leaving.

So how do I cope with these chronic, obsessive suicidal thoughts?  I use some combination of the methods below, depending on what type of thoughts I’m having, how long they last and how severe they are.  It can be helpful to make your own “safety list” with various ideas that you can use when your suicidal thoughts make an appearance.  I suggest that you create a variety of coping ideas, because chronic thoughts of self harm are very persistent and won’t likely go away with the use of just one distraction or grounding technique.  If you are lucky enough to have a supportive partner/friend you can give them a copy of your safety list and they could help you use some of the skills in a crisis situation.  For some folks, taking medication or calling a support line can be items on their lists.

  1. Delay. Delay. Delay.
  2. Distract. Distract. Distract.
  3. Remind myself of reasons why I need to stay alive (aka my kids)
  4. Listen to nature sounds on Spotify.
  5. Get in a safe space (aka my bed, under lots of warm blankets, away from anything potentially dangerous.  This works best for the most severe thoughts when other techniques may not be safe)
  6. Take a walk outside, ideally in nature.  Breathe, move my body.
  7. Drink a hot beverage (tea, hot chocolate, coffee)
  8. Reach out to a trusted friend (I may or may not tell the person I’m struggling)
  9. Blogging (others may use journaling, art or other creative outlet)
  10. Helping others, volunteer work, helping a friend in need (this works very well for me, but caution as it can lead to burn out if this is your only coping tool)
  11. Disassociate or zone out (ensure that it is safe to do so)
  12. Pay attention to your environment.  Count things you can see, feel, touch, hear.  Ground yourself in the present moment.

If you are coping with chronic suicidal thoughts, I hope that reading this post helps you to feel a little bit less alone.  If you don’t struggle with them, I hope it helps you to understand them a little bit and maybe allows you to help others around you who might be living with them.  Many people live with suicidal thoughts for years, it’s exhausting.  So very exhausting and nothing at all like what is presented in the movies.  But it has to be better than the alternative.  So I keep trying and keep breathing!  Keep hoping that it will get easier for all of us!

How are you?

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How are you?  How are you doing?

Fuck.   They feel like SUCH  loaded questions right now.

99% of the time people want to hear the standard answer:

I’m fine thanks, how are you?

But I can’t lie.  I’m not fine.  That being said, I know that 99% of people don’t have the time or energy to listen to how I’m really feeling.  Maybe they don’t care, maybe they are busy, maybe they don’t have spoons, maybe they are at work, maybe they were just asking to be polite.

I’ve started answering this question with:

The same.  It’s always the same.  I’m always the same.

Until I get the verdict, I’m not going to be fine.  I’m probably not going to be feeling better, and I don’t have the energy to lie about it.

I’m feeling grumpy today.  I’m feeling grumpy because I just want to cry when people ask me how I am.  I want there to be space for me to not be okay.  I want there to be space to just not function for a while.

I came home after a long day.  It’s cold outside, unseasonably cold for May.  I was shivering.  It was time to eat.  I decided to make myself grilled cheese. Comfort food.  What could be simpler?

I burnt the shit out of that sandwich.  So burnt it wasn’t even possible to scrap the black bits off the edges.  Throw it in the garbage burnt.   I wanted to burst into tears.  “You can’t even make a simple sandwich!” screamed the self critical voice in my head.  Somehow this burnt sandwich became a symbol for everything I feel isn’t going right today.

It’s difficult feeling lonely.  It’s difficult feeling like the one who is never “fine.”  I feel like I’ve been losing friends or driving people away from me because my life is complicated and I’m not always easy to be around.  I feel like I’m whining, complaining, self-absorbed, wallowing, not being grateful…lots of self criticism.  I know I’m doing the best I can.  It just never seems like enough.

In all likelihood, there are only a few more weeks of waiting left.  Things are going to shift in my life soon.  Potentially in major ways.  I’m so close to the end of this chapter of the journey.  I’m so close I can almost see the finish line.  I can almost reach out and touch my new life.

But it’s just out of reach.  It’s blurry and uncertain.  After 3.5 years in court and almost 14 months of waiting…a 16 month long total (and counting) trial process…it’s actually no longer possible for me to clearly visualize or imagine it being over.  I used to fantasize about getting the verdict.  Where will I be when I get the call?  Who will I tell first?  How will I feel?  What will happen from there?  So many unknowns.  In a way, waiting has become normal for me.  In another way, it has never felt normal.  I’ve never adjusted to having so little control over my own life.

It’s a unique situation.  Very few people in my life can relate.  It’s gone on for so long, very few people still have time to listen to me talk about it as much as I feel I would like to or need to.  Everyone around me is tired and frustrated too.  Nobody knows quite what to say. I understand.  It’s been a long journey.

I’m so close to the end.  But I’m not fine.  I’m burn out and I’m afraid.

Medication Fog.

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For whatever reason, my migraines have been out of control the past few weeks.  It’s been incredibly frustrating and painful.  I started seeing a neurologist about 9 months ago and have been getting nerve block injections which had been significantly reducing my number of severe pain days per month.  I was really pleased.  The neurologist is a great doctor, he believes me, doesn’t treat me like a drug seeking addict, and the treatment he offered was helping.  A rare positive medical experience for me.

This month the pain came back with a vengeance.  Last Monday, I came home from work and cried for over an hour.  I took my emergency codeine pill to take the edge off the pain for a few hours and it made me feel a pleasant sort of relaxed high.  Taking any type of medication is always risky for me, because what will relax me one day could agitate me another day.  Anything that has the potential to be psychoactive can cause unwanted adverse effects.  I don’t like feeling high and I if I use substances it’s in an attempt to feel normal.

Tuesday by the end of the work day I wasn’t feeling well.  The pain was terrible, my heart was racing, I felt weak and dizzy and dehydrated.  I had pain at the base of my neck which was new for me.  Normally my migraines are around the supra orbital nerve and focused behind my right eye, blurring the vision there and causing visual distortions.  To be honest, I was a bit scared I might be having a stroke.  Often by the 3-5 day mark of a severe migraine I begin to worry that something is really wrong, it seems hard to believe that SO much pain and so many strange symptoms are caused by “just” a migraine.

I was afraid and a bit desperate for the pain to stop so I drove myself to the ER.  I have a lot of trauma around the medical system (see earlier posts in this blog) and I was pretty reluctant to seek care at the hospital.  At triage my file was marked as emergent (I think they were worried about stroke too!), and I didn’t wait too long before seeing a doctor.  Luckily, the doctor reassured me that there wasn’t likely anything more serious going on, “just” a bad migraine.  He offered some IV medication and IV fluids because my heart rate was really too high.  I was relieved.  He believed me.  He didn’t treat me badly.    The nurse came to start the IV and I figured things would be pretty much okay from there.

I was wrong.

About 5 minutes after the IV medication ran through, I got suddenly hot.  I had an intense sense of panic and agitation and I knew I had to leave.  I couldn’t really think clearly.  My IV was attached to the ceiling and I couldn’t walk around.  I knew intellectually I could ring the bell and a nurse would come and probably unhook the IV or move it onto an IV pole so I could walk around.  But in my panicked mind, I became triggered to times I had been held against my will in hospital.  I started thinking that maybe the nurse wouldn’t let me leave, or that she’d make me wait for the doctor and that I’d flip out.  Then she’d know I was completely panicky and wouldn’t allow me to leave.  I was afraid.  I pulled out the IV and I ran away.  I fled.  I just left the ER and didn’t look back.

That was a rough night.  I was scared they would send the police after me so I got a friend to call the ER to explain that I’d left due to a panic attack.  It took a full day for all the anxiety symptoms to resolve.

And the migraine was back within 3 hours!

Two days later I saw my neurologist for another nerve block.  He told me that severe anxiety and agitation is a side effect of one of the IV medications in about 2% of people.  He told me not to take that medication again.  No shit!  I was angry that the doctor at the hospital hadn’t informed me that there could be potential psychoactive side effects. I would not have consented to the treatment as I know that I’m extremely sensitive to this type of adverse effect.  I’ve experienced versions of the same from SSRIs and from anti-anxiety medications.

My neurologist wants me back on another medication that can control migraines.  It’s called topamax and it’s one I’ve taken before.  I reluctantly agreed because it can also help with some of the other chronic pain I have which might be fibromyalgia.  The only problem with this medication is that it causes a lot of side effects, especially at the beginning.

My body feels like a toxic soup of drugs.  I have a hard time processing it all.  And I still have a headache.

The side effects when starting medications that cross into the brain can be triggering for me.  Not only do I feel dizzy, nauseous, off balance, foggy and exhausted, it also brings me back to times in my life when I was taking high doses of psychiatric meds.  It brings me back to times I overdosed on them.  It brings me back to the nights where I was sexually assaulted.  When I woke up, drugged, half asleep to find him touching me.  Fighting to stay awake, but the drugs dragging me back into sleep.  The feelings of confusion between my nightmares and what was really happening to me.  I don’t like that feeling.

So the side effects and adverse effects aren’t just unpleasant.  They aren’t just an annoyance.  They don’t just impact my ability to function smoothly at work.   They are frightening and they remind me of being completely unable to control being abused.  Being helpless, frozen, confused and afraid. They remind me of not having control over my body and not having the capacity to consent.

So if I’m complaining about adjusting to this medication or if I seem not quite myself.  It’s more than just a bit of dizziness.  It’s a lot of vulnerability and processing not feeling in control of my own body, both the pain in the present and the abuse in the past.   It’s all interconnected.

What does “fully recovered” mean?

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I’ve been reflecting on what it means to be “fully recovered” from an eating disorder.

The best books I’ve read on this subject are “Life Without Ed” and “Goodbye Ed, Hello Me” by Jenni Schaefer.   These books promote the message that it is possible to be “fully recovered” from an eating disorder.  They give me hope that anorexia isn’t something I will have to struggle with for the rest of my life.   I’ve read the books at various times when I’ve felt overwhelmed or hopeless and they have always helped me stay positive.  I truly admire the author’s dedication to having a life free from ED, or in my case Ana.

But if I’m 100% honest with you, I’ve never even TRIED to be fully recovered.

I’ve been in imperfect recovery for years.  At times this has meant being at a healthy weight, but still struggling with unhealthy thoughts and habits related to food and restricting food.  At times, this has meant slipping back into controlling my body,  purposefully eating less and obsessing about taking up less space.  I know how imperfect recovery works.  It keeps me “functional” and sometimes even “looking healthy,” but inside I am never truly free.  The thing with imperfect recovery is that Ana still controls my life to varying degrees, depending on how much I’m struggling.

It’s not possible to tell by looking at a person whether or not they have an eating disorder.  Being at a “healthy” or “normal” weight means nothing.  Being at a “healthy” weight doesn’t even mean a person is medically stable or in recovery.   In my current situation, my weight is higher than it’s been in  years, but my eating disorder is causing me MORE trouble, not less.  I feel exhausted mentally and physically most of the time.

I’ve been in hospital treatment programs in the past.  Inpatient programs where I was “forced” to eat large quantities of food.  I was supervised after eating, a staff member watched me to make sure I ate all of my meals and snacks.  I followed the rules because I had to, even though I was there voluntarily, I was able to comply because it was required.

But let’s be honest.  I never attempted to be fully recovered.  I have never, in 20 years, been even willing to CONSIDER giving up Ana as a coping technique.  I’ve used it to varying degrees at various times, but I’ve never committed to letting Ana go.

I stayed in treatment until I was functionally recovered.  Until I could eat without panic and physical discomfort, until I could have the energy to get through a day, until I could think more clearly and re-engage in life.  Then I discharged myself every time.  I wanted to be healthy and eat, but I didn’t want to gain too much weight or give up my obsessive compulsive thoughts and habits.  I wanted to be in control, even of the recovery process.  I told myself I could do it by myself, I could do it my own way, I didn’t NEED the program.

I was told again and again that I needed to follow a meal plan and eat mechanically for at LEAST a year before trying things on my own.  I was told again and again that I needed to gain to my goal weight and maintain it for a year in order to recover.  I was told again and again that I needed to stop controlling food and my body in order to heal.  But what did I do?  I poured out my juice when nobody was looking.  When I got out of treatment I stopped drinking juice altogether because it was unnecessary!  I cheated in a million little ways.

When I was younger, I thought I knew better.  I thought I could do it on my own.  I thought I could let go of the horrible life threatening aspects of Ana, but hold onto the comforting habits that kept me slim.  I thought I would be happy about 10-15 pounds below my “goal weight” and that I would be medically stable.  I thought Ana and I could dance together this way forever.  I thought I could have Ana on my terms, not hers.

But I’m not a teenager anymore.  I’m pretty close to my “goal weight” now, but I feel worse physically than I have in years.  I can’t push my body the way I used to.  I get migraines, physical body pain, exhaustion and lack of patience.  I don’t dance with Ana anymore…instead we are plodding, dragging through life, in a way that has very little meaning to me.

Because I have never embraced “fully recovered,”  I have instead remained sick.  Because let’s be honest about this too, if Ana is driving, I’m sick regardless of my weight.

For a long time, imperfect recover was enough for me.  It was such an improvement, I was proud of myself.  People stopped bugging me about gaining weight.  I was able to eat most things without panic.  I was able to eat around other people.  I was able to attend social events.  I was more relaxed.

But even at the BEST of times, there were always rules, calculations.  I always felt that I deserved to eat only as much as I needed to survive each day.  Never more.  I wasn’t starving myself literally, but I was starving my soul.  I was depriving myself of more than food, I was depriving myself of joy, connection and abundance.

Recently the stress in my life has been almost more than I can bear.  I’ve been waiting for 5 months for the outcome of a year long family law trial.  I’m waiting for a stranger to decide the future of my children.   Many important aspects of my life are quite literally out of my control.

I struggle daily to accept my body at this weight.  I struggle daily feeling like I am too big, seeing parts of my body as fat, living with body distortions and hating myself.

I struggle daily with the lack of control and the waiting.

And quite honestly, I CHOSE to let Ana start driving again.  I saw it as a necessary evil, to help me keep functioning and keep moving forward through each day.  I opened the door and let Ana right back in.  I welcomed her. I almost felt happy that I had a way of modulating and distracting from the unbearable stress.

I changed a few things here, a few things there.  Nothing drastic, but small changes.  I felt okay about it.   Maybe I could lose just a few pounds.  But it isn’t really about the weight, though I might say that it is.  It’s all about feeling in control of my body and thus, my life.

Irrational.  Magical thinking.  Self-destructive.  Self-punishing.  Illogical.

But even though I’ve let Ana drive many times before, always with varying degrees of disastrous results, I STILL believe deep down inside, that she is my friend who will NEVER leave me.  I love Ana for getting me through years of sexual and emotional abuse.  I love Ana for never letting me down, for always being there.

But Ana is an abusive partner.  She isolates me.  She makes me say no to eating dinner with friends because she makes me ashamed and afraid to eat in public.  She makes me tired from restricting food.  She makes me impatient and she makes me struggle to connect with those around me.  She helps me to disassociate by numbing out through the physiological effects of semi-starvation.  Ana is abusive even when I let the door open a crack.  Ana is abusive even when I’m not emaciated.  Ana is abusive even when you see me eating.  Ana is abusive right now.

Ana tells me that I don’t deserve to eat.  That I don’t deserve to take up space.  That I’m bad or weak for needing food to survive.  Ana tells me that the high of restricting food means I’m strong.

Ana lies.  She lies like any abusive partner.  She gaslights me.  She lulls me into thinking she is caring for me while she is trying to destroy me.

Today, I am at the stage of contemplating full recovery.

When Ana drives, I eventually feel like life is not worth living.  I can’t imagine living another 20 years this way.  Half living, half dying.  I’m tired.

To me, full recovery means more than changing my eating habits.

Full recovery means letting go of giving meaning to food.  Letting go of believing my food intake or weight has anything to do with my worth.  Letting go of trying to control my body as a means to feel safe in this world.  Letting go of believing that being thin will protect me from being raped again.  Letting go of trying to disappear to stay safe or avoid hurting anyone.

Fully recovered means eating when I’m  hungry and stopping when I’m full.  Fully recovered means going out to dinner with friends, even if I ate lunch.  Fully recovered means eating lunch daily. Fully recovered means eating 3 cookies.  Fully recovered means breaking all my food rules, even drinking juice!  Measuring nothing, counting nothing, giving food no value other than nutritional.  Fully recovered means not cheating, by holding on to “just one or two habits.”   Fully recovered means committing to staying alive until my natural death.  Fully recovered means learning to like myself, then learning to love myself.  Fully recovered means reconnecting with the world, trusting myself and opening myself up to others.  Fully recovered means healing from years of abuse, by self compassion rather than self hatred. Fully recovered means accepting my natural body shape, no matter what size that turns out to be.

Fully recovered means letting go of fear.

I hope fully recovered means living with joy.  I hope that one day I will experience fully recovered and it will be wonderful.

Today, I still feel lost and stuck in survival mode. If you have tips for finding “fully recovered” please share them in the comment section below.

The Voice.

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I’ve been feeling very young recently.  I feel like Ana is around more than I am.

There is a book (which I haven’t yet read) which talks about structural disassociation and describes the experience of having an “apparently normal part” and one or more “traumatized child parts.”    My apparently normal part seems to be quiet this past few weeks and Ana, my traumatized teenage part is very loud.

Sometimes when Ana is around I do things that don’t make a lot of sense to my apparently normal part.  And my apparently normal part doesn’t make sense to Ana.

I was trying to figure out if there were any particular triggers, anniversaries or memories surfacing for me recently, ones that would bring Ana to the forefront.

Next week will be the anniversary of when I first started being abused.  It will also mark the one year anniversary of this blog!

I started reading through an old journal from 2001:  the year I first was hospitalized, the year I tried to kill myself multiple times and the year I began cutting daily, sometimes multiple times a day.

Reading the journal, my 2001 apparently normal self seems extremely young.  But even at that time, I clearly identified having  a traumatized child part.  Back then I called it healthy me and little girl me.  I also called it “the voice.”  I’ve found multiple segments where I speak about “the voice”  and I recognize what she is saying as Ana.

February 21, 2001

The sensation of hunger is not an easy one for me.  It is frightening.  Like I feel afraid of losing control of myself. And yet I know that the E.D is out of control.  It is a part of me that often deceives and betrays me.  I know that in the end, though it feels comfortable, it cannot be trusted.  The voice which tells me not to eat, tells me to cut my skin, to smash my head against a wall, to step out in front of traffic, all sorts of dangerous and hurtful things.  It speaks to me in persuasive ways.  It is a part of me and yet foreign.  My ally and my enemy.  My strength and my destruction.  But after so many years it is the way I know.  A method of ridding myself of unwanted feelings…I feel like a stranger in my own life.

I don’t know what to do to help my traumatized child part heal.  What does Ana need?

The answer that comes to my mind is love.

She needs love.  She needs acceptance.  She needs to be believed.  She needs to feel safe. She needs to be forgiven for all the years of self abuse.  She needs to forgive her own body.

But I rail against it.  My apparently normal adult self doesn’t feel capable of parenting an angry teenager.  Ultimately, she is me…both the apparently normal adult self and the traumatized child parts are me.

Even in 2001, I can read in my journal signs of this inner battle.  The battle between health and self destruction, between hope and despair.  I’ve been fighting for a long time.

I can read myself trying desperately to convince myself that my engagement was a good idea.  That I loved my partner.  That my own PTSD and issues were the root of the stress in our relationship.

March 18, 2001

I miss having him around me and yet I’m also afraid of our intimacy.  He is at the same time my motivation to get well and my trigger to feel upset.  The strong emotions I have toward him complicate and simplify my life

I can read my younger self trying to convince herself that things would be okay.  I can read between the lines that a deeper part of her knew the relationship was wrong and unhealthy.  I can read how I desperately continued hurting myself, longing to be SEEN. Truly SEEN and accepted for who I was.  I can read my self blame, self hatred and confusion.

And a good part of this fight has been internal, between parts of myself that can’t seem to make peace, forgive and start again.

Meet Ana.

These pictures are of a cartoon girl called Emily Strange.  If I could draw a comic book version of Ana, she would look something like Emily Strange.

Ana isn’t just my eating disorder personified.   Ana isn’t just a nickname for anorexia.  Ana is another part of me.  I experience Ana as an angry teenage girl.  She isn’t just me as a teenager.  She has long straight black hair and very pale white skin.  She has dark eyes which are usually downcast.   Her fists clench when she is angry.  She wears hoodies, dark clothes, army boots and skirts.  She is slim and looks like she could sneak around very easily, light on her feet and quiet.  She is filled with anger and yet she doesn’t take up much obvious space.   Ana is my inner child.  Ana is my alter ego.  Ana is my eating disorder.  Ana is self harm and suicidal thoughts.  Because Ana is a scared, teenage girl.

Ana is the part of me that doesn’t trust you.

Ana is the part of me that wants everything or nothing at all.  Complete loyalty, or no friendship.

Ana is the part of me that feels like nobody believes me.   Ana doesn’t feel heard and when she is angry, she hurts me rather than expressing herself assertively.

Ana acts out, but that’s because she’s  young.  She’s probably only 14 or 15 years old.  She doesn’t have life skills.  Her anger is a mask for fears she is too afraid to share.  Her prickly exterior is a mask hiding deep vulnerability and shame.

Ana feels worthless.  Ana feels helpless.  Ana feels like punishing me is the only solution to these feelings.

Ana acts like a complete spoiled, controlling brat, when she really wants to be rescued.   She makes unreasonable rules rather than admitting she is afraid.

Ana craves safety, yet acts like she does not need protection.

Ana blames herself for being abused.   Ana feels responsible and wants to protect me by keeping me alone.  Ana tries to push people away with self harm, suicidal thoughts and eating disorder behaviours.  Ana thinks if we are smaller and take up less space we will be safer.

Ana is me.  At least she is a part of me, but I don’t know how to make peace with her, forgive her, accept her and come to a truce.  I don’t know how to integrate her, so that we become just one adult person again.  I’m not sure how to soothe this angry child inside of me.  We lack compassion for each other and for our younger selves.

I hope one day I can truly feel that Ana deserves forgiveness for hurting me.  And that she can forgive me for not protecting her.

Firsts.

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<trigger warning for graphic descriptions of self harm and eating disorder>

I’ve been thinking a lot about the “firsts” of my mental illnesses.  We all have memories of the first time we did certain things or had certain experiences, but for people who have chronic mental health struggles over a number of years, not all “firsts” are positive memories to celebrate.

When I was experiencing my “firsts” of mental illness I was a teenager.  I was 15-17 years old and I didn’t have any idea that my experiences were those of specific mental illness, let alone what those mental illnesses might be.  I thought that I was going crazy.  I thought I was the only one.  I was afraid to tell others what I was experiencing internally.  Until I was diagnosed with PTSD when I was 20 years old, most of my “firsts” made little sense to me.

The first time I experienced what would become anorexia I was about 16 years old.  I’ve written about it in another blog post.  I was physically sick and hadn’t eaten for a few days.  I felt mostly better and wanted to go to school.  I remember my mother telling me I had to eat something if I was going to school.  I took a granola bar and started walking down the street to meet my boyfriend at the time and to catch the bus.  I remember feeling light, empty and powerful.  I remember feeling the sense of white, blank emptiness that I now associate with disassociation.  I felt like I could take on the world.  I felt like I could survive without food and that I’d actually be more powerful.  I loved that feeling and I chased after it in various forms for the next 20 years.  I believe this moment is the one I chose anorexia as a coping technique for the sexual and emotional abuse I was living with.  At that time I wouldn’t have identified it as an eating disorder, nor would I have identified my relationship as sexually and emotionally abusive.  It was just a feeling I had, of realizing that disassociation was more comfortable than pain.

I remember the first and one of the few times I tried (unsuccessfully) to purge after panicking about eating.  This I described in another blog post.  I remember crying and sitting shaking on the floor of the downtown public library.  My crime?  Eating a whole cookie rather than half of one.  I remember I had been reading books about eating disorders, secretly, trying to figure out what the heck was going on.

I remember my first panic attack.  I was in Grade 12, 17 years old and extremely ill from anorexia.  I was attending school despite the fact that my weight was well under 100 pounds at close to 5’9″.  I remember feeling driven.  I remember feeling an intensity of moving forward that wouldn’t allow me to slow down or calm down.  I had to keep “doing” and trying to be perfect at everything.  I had to follow all my rules or something terrible would happen.  I remember there was one day I had a math test.  I believe it was Grade 12 Calculus or some other horrible subject.  I had been doing well in school despite my illness.  But that day somehow my brain just wouldn’t work.  I remember sitting in the classroom, the desks were arranged in rows, one in front of the other with the blackboard at the front.  I remember all the numbers and letters swimming around on the paper.  I couldn’t breathe.  I couldn’t think of how to solve the problems because everything was spinning and I felt like I was being crushed.  I felt nauseous and I realized that I was about to cry.  I remember bolting out of the room and into a stall in the girls bathroom.  I remember sitting there crying, shaking and feeling terribly upset that I couldn’t do the test.  My thoughts were racing around and I just wanted to go home.  I remember another student from the class coming in to check on me (it was a male teacher).  I remember being somehow glad she was there even though I was embarrassed.  I made up some excuse about being sick and not being able to write the test.  I think I went home.  I wouldn’t have known at the time that it was a panic attack, but it was and it was probably related to extreme lack of nutrition and just pushing myself too hard on no fuel.

I remember the first time I cut myself as a coping technique for stress.  I was about 18 years old.  I had just started taking SSRI medication for depression and anxiety after about 2 years of fighting with my parents and my doctors.  I never wanted to take medication.  I think deeply and instinctively I must have known that my mental health problems were situational, but that knowledge was too terrifying to face, so I blocked it out.  The first time I engaged in cutting I  used a pair of scissors that I kept in my bedroom.  I used to make just one small cut.  I would do it once a week in the exact same place, just under where the band of my watch lay.  So I could hide it carefully.  It was ritualistic, very controlled.  I don’t remember exactly why I started doing this.  It became part of my routine as I gained weight and somewhat normalized my eating behaviour. I needed something else to help block out the memories of the abuse.

I remember the first time I considered suicide.  I was probably about 17 years old, but I might have been 18.  I remember being at a party at a friend’s house.  Radiohead OKComputer was playing in the background.  Music I always associate with the “saddest of the sad” times.  It was raining outside.  I remember sitting on the couch looking out the back sliding door.  It was dark outside, evening.  The rain was falling really hard and there was thunder and lighting. I felt like I was in a trance.  Looking back I realize this was also an example of disassociation.  I remember feeling incredibly alone and disconnected. I was AT the party but not part of it.  I remember being at home that evening.  My bathroom had green tiles.  Small square tiles with white grout.  I remember just sitting there staring at my razor.  Thinking about cutting myself, thinking about dying and ending my life by opening up my veins.  I just sat there for a long time thinking about it.  The images of the green tiles and the emptiness of that moment are burned into my memory.

I remember my first flashback.  I was 18.5 and with my first love, my first real connection after the abuse and the severe anorexia.  I remember we were in my bedroom and we were kissing.  It was consensual and I wanted to do it.  He was lying on top of me. I think he might have been about to unbutton a piece of my clothing or something like that.  Suddenly I was crying and shaking and it wasn’t him there.  It was my ex boyfriend, who had so many times taken off or unbuttoned my clothing when I’d clearly said now.  It was him on top of me and I was afraid.  I had no idea what a flashback was, I didn’t know I had PTSD.  I just had an intense physical reaction to what was happening.  My boyfriend stopped immediately.  I remember him leaving the room briefly to give me space.  I remember feeling scared and embarrassed.  I don’t really remember the explanation I gave to him.  Some of my memories are less clear, but I think over time I had told him that my last relationship had been difficult.  I don’t think I fully understood myself at that time that it had been abusive, and that this type of reaction was a normal one for survivors.

I remember the first time I cut myself deeply enough to need stitches.  I was 20.  I was at university.  I remember buying the craft knife at the university book store. I remember walking home.   There was  a bridge on the campus and for months I thought about jumping off it every day.  I knew that I was going to cut deeply.  It was planned and premeditated.  I remember disassociating and thinking only about the injuring.  I remember wanted to make sure it was deep enough to need stitches.  I remember walking to the hospital which was on the campus.  I walked across a field to get there.  It was May or June.  I remember the doctor stitching up the wound.  It was a medical student and I remember feeling afraid.  I remember the resident coming to check the work and commenting that the stitches were incorrectly done.  I remember wondering why the resident didn’t fix them, but I assumed that because the wound was self inflicted they thought I didn’t care about scars.  In the end that wound healed badly and caused me chronic pain until it was fixed about 7 years later by a plastic surgeon at that same hospital.   I remember feeling nothing.  I remember feeling nothing about the injury and having no emotional or physical reaction until the day I went to the health clinic to have the stitches removed. I fainted when the doctor took them out.  My body felt the trauma suddenly and all at once the disassociate wasn’t there.   From then on I always took my own stitches out so I could control the process and do it in a way that I would not feel as much pain.  The ritual of the whole thing was an important part of the process of disassociation for me.

It’s a sad list.  Really sad.  Because some of these firsts are clearly in my mind that pleasant memories I would like to remember.  The way that PTSD stores traumatic memories and erases positive ones is deeply frustrating.  Because the long term consequence of disassociation is memory loss, and rarely losing the memories I wish would disappear.

Picture was drawn in September 1999

 

 

 

Internalized Stigma.

 

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Stigma causes me to make terrible choices.  Internalized stigma is dangerous to my health.  This is what I learned over the past few weeks.

Why do I feel so many complicated feelings about taking an anti-psychotic medication, but completely different feelings about taking arthritis medication?  The answer is internalized stigma.

Mental health stigma has taught me to be ashamed that I take psychiatric medication.  Internalized stigma causes me to think that I shouldn’t take the medication, that I should try to stop taking it as soon as possible, that I’m weak and somehow not good enough because I need medication to stay functional.  Basically, stigma lies.

Recently I started an alternative treatment which was helping me to sleep.  Because I was able to fall asleep, I decided to reduce my anti-psychotic medication.  I don’t need this!  I can function without it!  I’ll be fine as long as I’m still sleeping!  I feel okay!  What could go wrong?

As it turns out, a lot could go wrong.

Within a week of reducing my prescription medication, I was having multiple panic attacks a day, having paranoid thoughts, thinking that I was seeing my ex everywhere, afraid to leave the house and almost impulsively quit my job!

I was physically sick, dealing with a lot of triggers and somehow I thought it was going to be absolutely fine to reduce my psych meds!

I’m going to blame this on stigma.

I’m also going to blame stigma for how long it took me to realize that the change in medication was directly linked to my crisis state.

I mentioned it to my psychiatrist over the phone.  We talk very infrequently since I’ve been stable for the past few  years.  He told me to take the medication.  He told me that I have so much going on and so much stress that I don’t need to justify to anyone that I need the medication.  He said, just take it.  Just take it and don’t worry about it.

I thought about it and I realized he was right.  Why was I fighting so hard to reduce the dose of a medication that wasn’t causing me terrible side effects and, in fact, was reducing some of the most unpleasant PTSD symptoms (panic, paranoia, seeing things as a result of flashbacks)?  Why was  I judging myself so harshly?  Why was it more important to reduce the medication and not be “dependent” than it was to keep my job?

The answer was that it wasn’t more important.  That I didn’t need to judge myself.  That I needed the medication to keep the symptoms at bay.  Yes, the anti-psychotic medication (as it’s name implies) was ACTUALLY keeping me functional and not on the edge of psychosis!

I started on the higher dose that night.  Within 2 days I was back at work, within 4 days the panic attacks were reduced and almost back to “normal” levels.  Within a week, I’m feeling more hopeful and less terrified.

These pills help me.

Yes, I’ve had horrific experiences with psychiatry and psychiatric medications.  Yes, some of these drugs have made me worse and almost killed me.  Yes, there is a social stigma associated with anti-psychotic drugs.

But I’m going to work on not internalizing this stigma.  I’m going to work on accepting what is.  Accepting my current limitations.  Accepting that PTSD is a brain injury and it’s logical to take medication if it helps balance things out.

So next time I start talking about decreasing my medication, please remind me to re-read this post.  Please remind me that my health is more important than stigma.  That I’d rather be functioning and medicated, than in crisis and able to say that I don’t take any medication!  Remind me that going off my medication is NOT a good idea right now.  And maybe be gentle with yourself too…do what you need for your recovery.  Do what you need and don’t let judgment (by self or others) get in your way.  You are the expert in  your own healing.  Trust that.