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.

 

Can’t make everyone happy.

One of the ways I’ve coped with trauma in my life is to try to make everyone happy all the time.  When I was a child I thought my role was to “be nice” and to “be a good friend” and to take care of others, pay attention to my friends’ feelings, be considerate, be polite and do well in school always.  Essentially to be perfect all of the time.

I took this to such an extreme that I thought it was my responsibility to save, fix and adapt to my abusers.  Somewhere along the way I did not learn that it’s okay to be mean to protect myself.  It’s okay not to be nice to abusive people.  It’s okay to say NO, even to scream it and it’s not something to feel guilty for.  As an adult I STILL struggle with internalizing this.

I’ve spent the majority of my life trying to figure out what part of all my traumas is my fault.   What could I have done differently?  How could I have seen it coming?  Maybe if I’d been a better friend, she wouldn’t have died.  What if?  Maybe people are mad at me?  Maybe I made a horrible mistake at work and everyone blames me.   A good portion of my internal dialogue is convinced that somehow I’m a terrible mistake.  I’m not really a good person.  If only everyone could see!  Then they’d know the truth.

So as an adult, in most areas of my life I try to be the peacemaker.  I try to listen to everyone’s side of the story.  I try to minimize or avoid conflict at all cost.  I feel incredibly uncomfortable, even panicky when people around me are angry.  And if there is a conflict, you can bet it’s somehow my fault and I will feel guilty about it.

The irony, is I support survivors of violence every day.  I’ve told over a hundred or more women that what happened to them isn’t their fault.  I’ve told friends, I’ve told family members.  Heck, I’ve even told my abusers that things that happened to them weren’t their faults.  You were a child!   You couldn’t have known!   You did everything you could to protect yourself!   You aren’t to blame, he’s an abusive person.   You were in the wrong place and the wrong time.  You couldn’t have prevented it.  Your are doing what you can to take care of yourself.  It’s not your fault.  I believe you.

But at the end of the day, I treat myself with contempt and blame.  I feel like literally everything is my fault.  Always.  I try to depersonalize.  I know intellectually that most people aren’t even thinking about me, let alone blaming me for things that go wrong.  But deep down, I fear that I’m just a flawed person and I feel panicky when I realize I can’t keep everyone happy all the time with sacrificing myself.  And even if I do sacrifice myself, people around me have their own feelings and can be mad, hurt, angry and scared and there is not a connection to me.

A lot of women grew up with the message to “be good” and not to show anger.  Angry girls get labeled bitches.  Assertive girls get labeled bossy or rude.  Angry girls are judged.  People like calm, pretty, patient and loving girls.  We are surrounded by this covert and overt messaging from birth.  The labels put on us almost before we take our first breaths.

Why do so many girls and women feel such intense guilt and even shame around saying no?  Why do so many girls and women feel that anger is an unacceptable emotion and that they are bad for having it?  Why do I feel this way?  How do I make room for myself without feeling guilty?  How to say no without feeling afraid and ashamed?

These days, the world has become a scary place.  I’ve had to take breaks from social media and the news because I’m so devastated by the hatred and violence I see.  I feel the urge to isolate myself, connect less, spend more time alone.  Because I don’t feel very safe in the world anymore.  It’s rare that I feel truly safe.  As a survivor of violence, living with PTSD I feel scared most of the time.  But current events have triggered a different level of fear.

And sadness.  Because all the caring in the world can’t fix this mess.  I could be the best person in the world and I couldn’t make all my friends feel safe.  I want everyone to be in a bubble where they feel safe and protected.

I am a good person. I genuinely help people because I care about them and I want to.  It’s not because it’s an obligation or how I was raised.  It’s not just the expectation placed on me.  I think I was always this empathetic person. I always cared deeply, perhaps too deeply.  And it’s always hurt me.

But right now it hurts too much.  I just want to say NO MORE TRAUMA and hide from the world.  My brain feels overwhelmed with conflict.  I’m afraid about everything I do, that it will somehow make things worse.  When I’m alone at least I can think and I only have to monitor myself and my environment, not other people and their reactions.  Sometimes the guilt feels too much and I just don’t want to make a mistake or let someone down.  I’m also terribly afraid of being hurt or betrayed by someone else.  Sadly, this is a lonely way to live.  I just want to be in a bubble and feel safe and protected too.

Being lonely feels safer right now.  Because I can’t make everyone happy all of the time.  Sometimes I feel like I can’t make anyone happy, ever.

I can’t even make myself happy.

Blue Monday.

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Some pseudo-scientific research has shown that the 3rd Monday in January is the most depressing day of the year.  It was even given a name: Blue Monday.

There isn’t any actual research behind this, and of course depression isn’t just caused en masse by a specific date on the calendar.  But, evidence aside, I’m tempted to agree; mid-January is an extremely depressing time of year!  Especially for folks who already live with depression, and even more so for those of us whose depression is seasonally affected (made worse by the darker winter days).

It was a stressful week, the holidays ended too soon and I’m tempted to curl up in bed and stay there until the snow melts in April.

It’s so hard to be cheerful when there isn’t any hope of seeing any green living plants for another 3 months!  It’s hard to be cheerful when it’s – 1 000 000 degrees outside every day and the roads and sidewalks are covered in ice.

I took two weeks off over Christmas.  I was burnt out and exhausted.  I was grateful to have the time off, but it wasn’t enough.  It’s very difficult to relax on demand.  During the second week of the holiday break I took a vacation on my own.  While I was away I walked for hours every day, as much as 20 km per day.  I took photographs of all the beautiful green plants and I stood by the ocean.  I walked and walked and walked to clear my head.  It seemed amazing that plants, flowers and trees were growing and blooming in January and that the air was warm instead of freezing my face.

Since I came back I’ve been struggling.  Work has been stressful and I don’t have any more certainty or answers in my personal life.  I’ve been having a lot of memories, flashbacks and PTSD symptoms.  A year ago this week my family law trial started and my PTSD has always been very sensitive to anniversaries of traumatic events.

Since I stepped out of the airport last weekend, into the -25 C air, whenever I’ve felt overwhelmed I’ve been thinking of the images from my vacation.  Specifically, the lemon trees.  Inside my head I’ve been saying to myself, “lemon tree, lemon tree, lemon tree”  like a mantra.  Visualizing the yellow fruit and the succulent plants surrounding it.  Trying to bring back the warmth into this frozen, cold, blue world.

I’ve never been particularly good at positive imagery.  My mind is exceptionally skilled at recreating negative, scary or traumatic imagery!  But something about this lemon tree seems to be working for me.

It’s a grounding technique I’ve taught to my service users at work, but one I’m not good at using myself.

So if you are feeling blue this week, dark and hopeless about the world.  Maybe try imagining a time or a place in your life when you felt safe.  An image from a vacation, a childhood memory, your favourite place to relax.  Breathe deeply and slowly and visualize that safe, happy place.  Try to imagine yourself there.  Escape, just for a moment.

Because I have a feeling this is going to be a difficult week for a lot of us.

Sending out much love and support to you all.

 

If depression were treated like a physical illness

The holidays can be a difficult time for people struggling with invisible illness such as mental illness or chronic pain.  During the holidays we are “supposed” to be happy.  We “should” relax and have fun.  We are “meant” to connect with friends and family.  It’s happiest time of the year, right?

But what if you aren’t happy?  What if you want to be happy and connected more than anything else, but you can’t be?  What if depression is stealing the happy, the relaxing, the fun and the connection right out of your holidays?

People all around me have been cancelling plans due to the flu, a cold and other winter illnesses.  This is acceptable and even expected in the winter time.   It’s even considered polite and good manners to stay home and keep your germs to yourself.  It’s understood that you aren’t feeling your best and that you have no energy when you have the flu. It’s okay to stay in bed and eat soup and sleep for hours.  People are sympathetic and nobody expects you to just “cheer up.”

I can’t even tell people that I’m sick. I can’t cancel plans.  I can’t stay in bed.   I feel disapproving looks from people around me when I’m not smiling and when I sit quietly or lose my temper  more easily that usual.  I’m exhausted, and I won’t feel better after a few days in bed.  Even if I could spend a few days there.

It’s Christmas time and I’m living with depression and anxiety.

Yes.  I’m sick.  I’m more severely depressed and anxious than I’ve been in a long time.

I want to call in sick to life.  I’m not even suicidal, I don’t want to die.  I just want to give up on “acting normal” and “keeping up appearances.”  I can’t imagine going back to work next Monday, the thought makes me panicky almost to the point of tears.  I have fantasies about developing some serious physical illness…nothing TOO serious, just enough to get me about a month off work with no questions ask, but not SO serious that I’d be in the hospital.  I want someone to take care of everything and take all the stress away.

This is what happens when society doesn’t acknowledge mental illness in the same way it does physical illness.  People who are depressed are lowered to the point of imagining horrible illness as a reason to be “justified” in taking sick leave, or even just taking the day off to rest.

Because when you are depressed you get treated like a misbehaving, whining child when you are not happy and not feeling connected.   When you are depressed you feel like a shitty parent when you don’t want to play with your kids, or you can’t enjoy your time with them.  When you are anxious and don’t want to leave the house you have to push yourself through it, even when you don’t enjoy a single minute of the activity you are doing.

When you are depressed, a “good night’s sleep” won’t fix it.  When you are depressed, “just cheering” up won’t work.

When you are depressed, you can’t just “lighten up” or “just relax.”

Believe me.  I WANT to relax.  I WANT to lighten up.  I want to laugh with my children.  I WANT to have fun with you.  I WANT to feel connected.  I WANT to feel like more than an empty shell marching through the tasks of the day.  I WANT to have energy.  I’m fully aware that I’m not acting normally and I’m terribly self conscious about it.  I feel guilty all the time about how depression impacts me and those around me.

I didn’t ask for this, any more than you asked for that cold, flu or stomach bug.

I didn’t ask for this, any more than anyone ever ASKS to be ill.

I don’t need to be fixed.  I don’t need suggestions on how I can help myself.  I don’t need to be told to look on the bright side.  (by the way neither do people dealing with chronic physical illnesses!)

I need you to keep me company while I shuffle through this dark period.  I need you to be there for me and to not judge me.  I need you to remember that I’m sick and not malingering or misbehaving or ungrateful or lazy.  I need you to remember that I’m trying my best and sometimes MORE than my best just to get through each day.  I’m using every ounce of energy to hide the depression from you, from my kids, from everyone.

I’m in pain.  I’m tired.  I don’t feel hopeful.  The world seems like a dark place and I can’t see the end of it because my thoughts aren’t clear.  Just as a runny nose and cough are symptoms of a cold,  depression makes me think that everyone hates me, that I’m worthless and that I don’t deserve basic things.   Just as a flu causes a high fever and aches, anxiety causes me to imagine horrible things and obsessive irrational thoughts.

These are symptoms.   It’s not a choice.

I’m depressed and anxious.  I’m sick and that is not a choice.

I had the best holidays I could, while not feeling well or happy.

 

Depression.

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Depression doesn’t always look the same.  Sometimes it is most clearly described by how I feel when it lifts.  When I’m depressed I’m not actually myself and when the depression lifts I wake up and I’m me again.

When I’m depressed, I am physically exhausted by social contact and social situations, but at the same time I don’t always want to be alone.  One of the reasons social situations are so difficult is because social anxiety is a symptom of my depression, and depression is fueled by my social anxiety.

Over the past few weeks, interactions with others leave me drained. Probably because half the time I’m spending with people I’m hyper aware of whether or not I’m behaving appropriately.  Because depression blunts and numbs some feelings and amplifies others, I’m constantly monitoring myself and thinking:

Am I acting normally?  Can this person tell I’m acting?  Am I smiling enough?  Am I smiling too much?  What should I do with my hands?  Stop picking at your skin! Remember to make eye contact!  Not too much eye contact!  Stop fidgeting!  Is my facial expression appropriate for what they just said?  Make sure your face is responding like a normal person! That was a joke, laugh.  But don’t laugh too much.  Did that sound stupid?  Do they hate me?  Did I make a mistake?  Is my facial expression appropriate?  Oh my god, did I even hear what she just said? Smile.  Act normal

After a short interaction I’m exhausted and I want to flee to a place where I can just be.   This usually means being alone.  I’m completely relieved to be alone.  I often hibernate under quilts and blankets where I feel safe.

But then the loneliness hits.  I text.  Texting is much easier than phone calls or in person hang outs.  When I’m texting I just have to think about the words and not all the other complex social dance behaviours that I’m sure I’m completely mangling.  Texting is safe.  Texting breaks isolation, without crowding me or making me self conscious.

When I’m lonely and depressed, I start to believe I’m literally the only person on the planet who doesn’t have plans at that moment.  All logical reasoning to the contrary is dismissed by my social anxiety brain.   I start to think that nobody likes me, that I’m boring or annoying, that I’ve said terrible things to offend everyone I know.  I feel jealous about the plans and social gatherings of others.  And yet, ironically, I often cancel plans or say no to things I am invited to.   The contradiction of depression is frustrating and impossible.

Depression is panic attacks in crowded places.  Panic attacks about choosing food, or anxiety about eating around other people.   Depression is feeling “fat” when my body hasn’t changed. Depression is anxiety that everything I say or do might get me into trouble or make my situation worse.  Depression is reading my emails over and over and over and over, obsessively, worried that I made a mistake, said the wrong thing or was oppressive.   Depression is paranoia that the email was accidentally sent to the wrong person, somehow ruining my life.  Depression is knowing I have to do something at work, but feeling incapable, afraid and ashamed to ask for help, thus procrastinating and avoiding.

Depression zaps energy.  I’m literally exhausted almost every minute of the day.  It’s not something that can be fixed by more sleep.  Though less sleep makes it much worse.  My body feels heavy and I struggle to get out of bed in the morning.  My bed feels warm and safe in the mornings, but physical pain and stiffness in my body prevents me from lying down for too long. Sometimes I’m drained and have to lie down after taking a shower in the morning.  But somehow I push through it.

I feel like robot, automatically going through the motions of my day.  I check each task off against a mental list.  Breakfast, check, kids to school, check, commute to work, check.  Each day moves through a series of tasks to be completed.  I’m always counting time until the next time I can be alone and rest.  I’m often watching the clock, but I’m never comforted by it. Then after about one day of a weekend alone, I’m lonely and waiting for my kids to return.  It’s a terrible feeling, like you have nothing to look forward to, but are always looking forward to something unimportant.  Maybe the next day will be brighter, maybe the next _____ will break the cycle, maybe I’ll wake up tomorrow and feel better.

Depression is being unreasonably and intensely irritated by innocuous things.  Like the sound of someone chewing near me.  I could scream.  My whole body is tense, I can hear every sound.  Depression is losing patience in a split second, in situations I would normally be able to cope with.  Depression is feeling frustrated when people repeat themselves or take a long time to get to the point of their stories.  Depression is hating myself because I know I’m not being as kind as I should be.  Depression is losing my temper at my children, when they are barely doing anything wrong and my rage is uncontrollable like a volcano, then dissolves into guilty desperate tears.  Depression is intense compassion fatigue.  Not having enough energy to have empathy for others and then beating myself up with self judgment afterwards.

Depression means rarely living in the moment.  Depression is being caught in a tangle of awful memories from the past, or absorbed in worries or thoughts about the future.  Or more often, ping ponging back and forth between memories and worries.  In the moment, there is often zoning out, disassociation, numbing and that floating feeling of being something less than human, unable to connect with anyone.  Feeling like my essence of humanness is just beyond reach.

Depression is either crying too much, or (this time) not being able to cry at all.  Depression is either all the feelings right at the surface every single minute, or all the feelings pushed down and boxed up into controlled spaces inside me.

Depression is the darkness in the Fall and Winter months.  Depression is waking in the dark, coming home from work in the dark and forgetting what the warmth of the sun feels like.  Depression is like sitting at a dirty window, watching the normal world proceed just outside my grasp.

Depression is feeling suicidal, obsessing about death and dying.  Sometimes it is destructive impulses, or sometimes, wishing I hadn’t been born at all.  Sometimes it is a passive thought of just not wanting to be alive.  And then the torturous, trapped feeling of knowing that suicide is no longer an option.

Depression is boring.  Like this blog post feels boring.

It’s a world without light.  Depression is obsessive, recurring thoughts.  Depression is feeling like a bore to others, feeling self-obsessed, immature and uninteresting.  Depression is feeling unlovable and like you will always be alone.

Depression lies.

Even if I know that depression lies, it’s not so easy as just snapping out of it.

When I’m depressed I’ve learned that the best I can do is to stay as safe as possible, sleep regularly, eat and drink regularly, self care, be patient with myself, lower my expectations of myself and just do my best.

Because depression always lifts.  It’s not forever.   But it feels awfully bleak.

Zombie.

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Pushing through trauma.  Trauma layered on more trauma.   Decades of trauma.

Brain shuts down.  Eerie quiet and an empty space inside where my thoughts should be.  Ears ringing.  Body feels heavy and difficult to move. Words come slowly, sticky in my mouth.  Sometimes movement and speech is impossible.  Days blur together.  Conversations become difficult to follow.  Confusion.  Short term memory loss.

When disassociation is the only way to get through the day.  There isn’t even enough energy left to panic.  When stress is something that can’t be changed, when there is no solution, when the fear is overwhelming and I am helpless.  Panic is scary, but there is motion there and emotion.  The blank space is less human somehow.

It’s not a choice.  It’s like a switch is flipped.  My brain says “NO!”  That’s enough, time to quiet down.  Anxiety becomes a physical reaction rather than worries, feelings or thoughts.

I feel like a zombie.  I’m walking around, doing day to day tasks.  I know from experience though that I’m only part there.  I know from experience that days or weeks from now my memory of this time will be divided into two extremes.  Traumatic memories, seared into my brain for life…and blank space, nothing, no memories at all.  Part of the day will be remembered for ever and part of it…it’s like it never even existed.

When stress levels are chronic and traumatic memories from the past are re-enacted in present life, new traumas in the present are linked in the brain to old traumas.  They are no longer separate events.  The brain stores them all together and confirms the facts as PTSD knows them:

“You are not safe”

“You can’t trust anyone”

“Nobody believes you”

This shifts along into another layer of faulty PTSD thinking:

“You are fat.  Your body is disgusting.  Your stomach is too big”

“Nobody likes you.  You are bothering people with your existence”

“People think you are doing a bad job.  People think you are not capable”

“You are letting everyone down”

“It’s all your fault”

In a way the thoughts and the blank space are flashbacks.  They are here, in the present moment, and they are flashbacks to times similar to this one.  The past and the present are linked in PTSD.  Like invasive vines taking over the brick wall of me.

I can’t cry.  I have to feel safe to cry.  There are no tears in the blank space.

I shrink away from being touched.  I jump and startle.

What I want most is to be held.  To be comforted.  To be kept safe.

What I can’t do is let anyone close enough to do this.  The blank space is so large, the buzzing is so loud.

 

 

PES (Psychiatric Emergency Services)

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I’d been in the psychiatric emergency rooms at South Street hospital more times than I could count.  But that was an old hospital. The rooms were basically just regular rooms, except the chairs were bolted to the ground.  One of them had an ugly green tiled floor.  One of them had a stretcher in it.  There were chairs just outside for the security guards to sit.

In July 2011, I was in a different hospital emergency room.  This hospital was newer and had an updated PES (Psychiatric Emergency Services) department.  The door to the department was locked at all times.  There were 4 small rooms, similar to the one in the picture above except the chairs were bolted down, and one washroom.  In the washroom the toilet was metal and had no seat.  The sink was metal and attached to the wall.  In the central area between the 4 rooms there was a water fountain and two telephones attached to the wall.  In the central area there was also a stretcher with restraints on it. Separated by another locked door was the nursing station.  Each of the rooms had cameras in them (except the washroom).  The nursing station had a window which looked into the department.  The washroom reminded me of what I imagine a jail looks like.  In fact the whole experience was like being in jail.

My family was out of town visiting my ex-husband’s extended family.  I was in my last weeks of the practical placement that would complete my Masters degree.  Ironically my placement was in a psychiatric hospital.  The depression that had crept back into my life in the Fall of 2009 had worsened.  There were many reasons for this.  I felt desperate and I had tried all the medications that were available.  I began to seriously consider ECT (electroconvulsive therapy aka shock treatments).  This had been suggested to me in the past around 2004, fairly early on in my psychiatric survivorship story.  At that time I felt it was too soon, I hadn’t tried a whole class of medications.

In 2011 I felt like my options were suicide or ECT and I preferred the ECT.

I wasn’t coerced, I wasn’t pressured into it.  I sought out the treatment myself with the support of my outpatient psychiatrist.  Since he has no privileges at the local hospitals my best bet was to go to the ER and ask for a consult.

My plan was to do this as an outpatient.  But things went awry.   When I told the psychiatric resident how much I was struggling and how suicidal I was she wouldn’t let me leave.  The doctor on call told me I had to be admitted to the hospital and that if I didn’t agree to stay she would admit me on a Form, involuntarily.  At this point, locked in PES, I decided my best option was to cooperate.   I hadn’t brought anything with me, and there were no beds open on the Mental Health Unit, so I was forced to spend 24 hours locked in PES.

I can’t remember exactly when I cracked, but I phoned a friend.  I told him where I was and that I wasn’t allowed to leave.  I cried to him on the phone. He was a friend from school and I was so embarrassed to be calling him from the hospital.  I felt like it was my one call to the outside world after being arrested.   I didn’t want to tell my parents, but the next day I finally did, so they could bring me some clothes and items.

Staying overnight in PES was not a pleasant experience.  The lights were always partially dimmed in the center hallway.  There were no windows to the outside world.  This place was literally a prison.

The white sheet on the bed left lint and little pills all over my lululemon yoga jacket.  They are still there to this day!  Also to this day the smell of the soaps and sheets in hospitals triggers me.  Hospitals have this very specific smell, a mix of bleach and antibacterial soap (the cheapest kind).

Meals arrived on a tray, but there was nothing I wanted to eat.  Somehow in the morning, after almost no sleep and nothing to eat, I convinced the nurse to let me go to the cafeteria to buy a snack.  I argued that since I was a voluntary patient I should be allowed and for whatever reason they reluctantly agreed.  I ate a muffin and drank some hot coffee.

The doctors came back the next day, and eventually I was moved up to the 4th floor.  I stayed for one night on the unit.  I told the doctors what I wanted: outpatient ECT.  We called my ex-husband and discussed this with him.   Everything was agreed upon and I was given an appointment to meet the doctor the next week.  I convinced them that I would be safe at home and they discharged me.  They wanted me to stay but I wanted to leave.

The hospital always seems like a good idea from the desperation of home.  But once you are there you realize that it isn’t a very safe place either.  A good part of this is because you are at the mercy of others and have very little control over your own life.  That and the doctors have the power to hold you against your will at any time.

I wonder…why do they make PES look like a prison?

Why are psychiatric patients treated like criminals?

Surely someone could design a safe and secure section of the hospital that actually looked and felt healing.  I’m willing to bet the person that designed PES had previous experience designing prisons.

I’m not a criminal.  I would heal and relax more quickly if I was in a hospital environment that felt welcoming and relaxing.  The very environment of PES conveys a lack of respect and a perspective on the status of the patients/prisoners.  PES brings up a deep sense of shame in me.  I begin to feel crazy because I am trapped and forced to comply with the orders of the staff.  In PES, you feel you have hit rock bottom.

“You are crazy.  You can’t be trusted.  We think you are going to hurt us.  You need to be locked up for our safety and for your own.  Behave or you will be locked up here indefinitely. We couldn’t be bothered to make this place welcoming or comfortable.  Because you are crazy your comfort is not our priority.  Get used to it”

This is what mental health stigma looks like.

 

Darkness and Light

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It’s been almost 3 years now since my last full-out episode of major depression lifted.  It started to shift about 4 years ago and lifted when I moved away from my ex-husband.

The last 2 months I’ve been struggling a little.  I developed low iron and I was feeling burnt out and stressed.  For a short time I was depressed again.

I wanted to write a little bit about my experiences with the difference between depression and a clear mind.  Usually the shifts are subtle, but startling, and it’s all to do with darkness and light.

The last few days, I felt startled, caught of guard by the brightness of the colours around me as I drove through the city.  Granted, it is spring and the leaves, buds, grass and flowers are growing, but this is something more than noticing natures beauty.   Today I was driving home with my kids and I saw a set of traffic lights across a field.

My mind: “Wow, those traffic lights are SO bright, so colourful, so orange yellow, they are jumping out of that field”  They looked almost psychedelic and other worldly to me.  Yesterday, as I was driving, the green grass looked almost neon and startled my eyes.  It’s a striking yet not unpleasant feeling waking up from a time of depression.   Suddenly there is light in the world, when you were not always aware of the depth of its absence.

When I get depressed I also struggle with varying levels of disassociation related to my PTSD.  Depression tends to blunt feelings at the best of times, while disassociation can leave you numb.

The last few months I described my feelings as “being a zombie.”  Going through the motions of my day to day life, functioning on the surface, but feeling like I didn’t care, wasn’t connected, wasn’t engaged and wasn’t happy.  Depression feels like living in a world without colours.  Everything pleasant is muted because I cannot connect with my feelings or my environment and then I start to feel hopeless.  It’s like looking through a dirty lens and being wrapped in a blanket that prevents me from feeling things fully.  I can see people around me, I know how I “should” be acting, but it’s an effort to complete the actions in a genuine manner.

For many years, I was severely depressed and this became my “normal” state.  I remember in 2012, I had been depressed consistently since 2009, with 2011 being a particularly bad year.  In July 2012 I was in England on a family holiday.  One day we were at the beach, my family, my cousins and my cousin’s children.  It was a warm day, not hot, but sunny and very pleasant.  We were walking by the seaside along a rocky beach.  I sat down on the stones and I placed my hand on them.  I remember the moment so vividly because I was aware that the stones were warm.  I sat soaking the warmth from the stones into my hand and I felt alive.  I felt something that probably saved my life (again).  I felt hope.  It was the first moment I truly felt connected with the world around me in all its vivid reality in many years.

That moment was one impetus on the journey towards finding my path away from my abusive marriage.  Just those smooth warm rocks and a single moment of the depression cloud lifting and hope streaming in.

People often wonder what moments have changed your life, and sometimes the truth is that the most simple, unplanned moments can elicit major change.

Christmas 2013 I had another moment of hope, it was bittersweet though as I realized how dark my world had been.  We were at my parents house and my younger cousin and her boyfriend at the time were teasing me about someone I was dating.  I was laughing and laughing because the situation was funny, hilarious even.  My children were playing in another room and my older daughter ran in, looked at me confused, then ran into the kitchen shouting “Grandma! Why is  Mommy laughing?”

My daughter needed reassurance that I was happy, she hadn’t heard me genuinely laughing in years, maybe never.  Connection.  In that moment I was connected with the world and I was enjoying my life.   During a dark depression I don’t laugh very much, I feel isolated in a room full of people, I feel like a shadow with clouds hanging over me.  I sometimes don’t even feel like a real person!  My memory is terribly bad after a period of depression.  I think I’m functioning normally, but later, because of disassociation, I realize that I didn’t form proper memories of the events.  I’ve realized that without connection, sometimes memories aren’t completed and stored correctly.

Seeing those yellow traffic lights today felt similar to the stones on the beach and the Christmas laughter.  Yellow shining beacons of hope and connection!  Maybe the opposite of depression is connection?

I’m very lucky that my periods of depression are much further apart now and usually very brief.  They don’t last long enough for me to truly lose hope.  I can always hold onto the memories of those moments of connection.

Even if you are struggling with depression you feel will never lift, please don’t lose hope.  Look for small moments of connection in your day to day life.  It could be as small as noticing a flower that has bloomed, feeling the warmth of the sun on your face, feeling the cool water while you are washing your hands, enjoying a smile with a friend.  I believe you can build on those moments and slowly build a path to recovery.

 

 

Misdiagnosis.

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This is the piece of paper I was given as a “formal” diagnosis back in 2001.  It was the first time I learned about PTSD.  It was also the first time I was misdiagnosed with Borderline Personality Disorder.  In reality, my PTSD is severe, my current Dr told me it was one of the worst cases he had ever seen.  But Dr. X, in his wisdom, after knowing me for a only a few months decided the impact of my trauma was “mild” and instead the main factor in my illness was untreated borderline personality disorder.  As far as I can see, this assumtion was made due to my self cutting behaviour.  He failed to take into account that before being abused I had no mental health problems.  He failed to take into account that self harm and anorexia are common coping techniques for sexual abuse, especially in young women.  He failed to notice that my out of control self harming behavior and suicide attempts began only AFTER taking a cocktail of psychiatric meds. He failed to see that I have almost none of the diagnostic criteria for BPD, except the self harm.  I had long term friends, stable relationships in my life.  I was not impulsive or risk seeking, except with regard to the self harm.

Over the next few months Dr X also placed a value judgment on this misdiagnosis of Borderline.  He was the first person I talked to about the sexual abuse, and as such I trusted him and looked to him for support.  This was a mistake.  I didn’t have a choice as to what psychiatrist I saw, he was the one assigned to me.  He gradually saw me less and less in his individual practice.  I would show up for appointment only to find he had left for the day or was on call in the ER.  Then he changed his practice to work solely in the urgent psychiatry clinic.  The only way to get an appointment was through the ER.

I had no family Dr and nobody to renew, monitor or change my medications.  He told all the psychiatrists at South Street that I was borderline and so they would not take me on as a patient.  He refused to give me a referral to a community psychiatrist and I had no family doctor.  I felt betrayed.  I felt rejected.  I felt worthless.

I started to use the ER on a regular basis, mainly after cutting myself.  I would ask for a psych consult about 50% of the times I cut myself.  I would ask the doctor on call to please assign me a regular psychiatrist to follow me.  I begged.  I pleaded.  I was rejected.  I was sometimes given an appointment at the urgent psychiatry clinic, where I knew I would see Dr. X again.  No way to break free, systemic barriers and misdiagnosis kept me trapped.  The more I protested, the more I harmed myself, the worse the situation got for me.

The treatment that I received at South Street was appalling. I know I am not the only one and I know this hospital is not the only one with issues.  Women survivors of childhood sexual, emotional and physical abuse are often misdiagnosed with borderline, a diagnosis I see as basically a wastepaper basket label.

I remember during my second last year at South Street, 2003, I attempted suicide again.  This time I cut myself extremely deeply, diagonally across my arm.  I remember lying on the floor in the hallway of the apartment I shared with my boyfriend.  I was dizzy, almost blacking out.  I felt the quiet empty feeling in my head and I tried to decide whether or not to keep pressure on the cut or let it bleed and let myself give in to the pull of unconsciousness.  I lay there for a while, I’m not sure how long.  I finally decided to go to the hospital.  I think I took a cab, but I’m not sure.

At the hospital, the medical doctor that first assessed me actually put me on a Form.  He got a security guard to sit in my curtained area to watch over me.  I remember I was studying for my 4th year Health Sciences exams.  Somehow the irony of this was lost on me at the time.  I had just tried to kill myself, I had a security guard watching me and I was studying for a university exam in the ER.  The medical doctors fixed up my cut with stitches.  By this time the routine of receiving stitches was, just that, routine.  I had received hundreds, sometimes as many as 50 at a time.  After I was fixed up I was transferred to the psych section of the ER.  I don’t remember too much about what happened but I do remember I was told that there were no beds, that I could not be admitted.  I told them that the cut had been a suicide attempt, not “just” self harming like I usually did.  I begged to be admitted. But the psychiatry doctor was firm, there were no beds for me.  I couldn’t understand it, the medical doctor had thought I was a risk to myself, so much so he had security watch over me, but psychiatry released me.  I learned over the years at South Street that as soon as a doctor had access to my past charts I was treated very differently.  I was generally taken seriously when a health care provider spoke to me and listened to me.  When that same health care provider saw my chart, I was turned away, disrespected, ignored and mistreated.  This is what misdiagnosis with BPD means to me.

I remember being discharged from the ER that day.  I was desperate.  I still wanted to die.  I remember standing in between the double doors of the ER crying.  I didn’t know where to go or what to do.  I felt hopeless.  It was late evening, it was spring or summer and it was still light outside.  As I stood there crying a door opened, it led out to the ambulance bay right beside the place I was standing.  Our of the door came a gurney, with a black body bag on it.  The door led to the morgue which was also in the basement of South Street.  The body was loaded into a funeral home vehicle and drove away.  The image impacted me and haunted me.  I wondered if my friend Darlene was wheeled out that very same door a year before. I was preoccupied with death.  I felt scared and I felt lost.  I just wanted someone to help me.  I’m not even sure I really wanted to die at that point, I just wanted the pain and confusion to stop.

Eventually I left.  I took the bus home, back to the apartment where I’d tried to end my life a few hours earlier.

I think that people often conclude that because an injury is self inflicted, that the person chose it.  That they are not traumatized by it or impacted by it.  But I believe that self inflicted trauma also needs to be recognized as a contributor to PTSD.  I think that my experiences within the psychiatric system alone could have caused PTSD in a healthy person.  In a person who was already traumatized they were that much more severe.  Sometimes comfort and sympathy are not provided to self injuring people.  We are treated as though we “knew better” and are essentially “wasting time and health care resources” or taking away care from those who “really need it.”  I believe that every person who self harms would have chosen a different option if they felt they truly had a choice.  Self harm isn’t cool, it’s not fun, it’s not something to envy or idolize.  It’s dangerous, it’s terrifying, it is not glamorous in any way.   It leaves lasting scars.  Scars I will live with for the rest of my life, and scars that trigger memories of times in my life I would much rather forget.  I get flashbacks around my self inflicted trauma in the same ways I do to the abuse inflicted on me by others.  And because I was abused in the health care system the two are not distinct.

There is no easy solution to these problems.  People who self harm need and deserve compassion.  PTSD should be taken seriously and not dismissed as a disordered personality.  PTSD is treatable.  Believing survivors is the first step.  Yes, this means as a society we all have to step up and acknowledge that violence and abuse is much more prevalent than we ever imagined.  We need to collectively work to end victim blaming and shaming and fight rape culture.  Because powerful white male doctors, with all their privileges, labeling my personality as disordered is rape culture.  I became sick and disabled because of abuse; I’m not disordered, I am a survivor.

 

Cumbersome.

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“I have become cumbersome to this world…”  Seven Mary Three

Trigger warning

This song was playing on the radio in my boyfriend’s car.  We had parked outside the engineering building at the University of Western Ontario.  I waited in the car while he ran inside to hand in a late assignment.  It was about 3pm in June 2001.  I was deeply depressed and in the grips of side effects of benzos and SSRIs, toxic soup which turned my brain into an impulsive, self destructive, hopeless mess.  I felt like the song was a sign and a message to me that it was time to die.  we drove home and a few minutes later I was in the bathroom, taking my 3rd overdose.  I was serious this time and not messing around.

I remember sitting in my room, waiting to see what would happen.  I started feeling bad fairly quickly and this time I was fully aware of the entire experience.  My boyfriend drove me to the hospital and I remember during the drive realizing that an ambulance would have been more appropriate.

I remember sitting at the triage desk in the South Street ER, the nurse asking me questions: “How many pills did you take?”

Either my answer or my vital signs snapped everything into motion.  I remember her checking the E for Emergent on the triage form and I was taken immediately back into the department.  Things started to go downhill from there.  I was given activated charcoal to drink, this time I was fully awake and the taste and texture was horrific. I still have regular nightmares and flashbacks about this.  Even typing this I’m having flashbacks and feeling nauseous.  The nurses took blood samples and started an IV.  As we had found out on OD #2, I’m actually highly allergic to the antidote to the drug overdose.  This meant I was having a life threatening allergic reaction.

I remember my face getting hot and swollen.  I was receiving IV benedryl along with the antidote.  I was vomiting over and over, the charcoal wouldn’t stay inside me.  Eventually I was vomiting blood.  I was given IV gravol.

My sense of time was somewhat confused but at one point I remember them paging the internal medicine experts.  It was at this point I realized that I had F*#ed up.  I realized that I wasn’t going to die, clearly.  I felt like a failure at everything.  I couldn’t even get this right!  But at the same time I was petrified because I knew my body was not doing well.  My liver was having trouble processing the OD.  The specialist told me I needed the charcoal to absorb the drug and I would need the IV antidote for about 24 hours, I was being admitted to a medical floor.  He also told me if I ever did this again I would die from the allergic reaction to the antidote.

Shortly after the Dr  came back into my curtained area.  A tube was placed down my throat and into my stomach.  I was fully conscious and had no pain relief.  I could not longer speak.  My eyes were watering from the pain.  The nurse was supposed to come immediately to pour the charcoal directly into my stomach.  But for whatever reason she didn’t come and I was lying there unable to speak with a tube down my throat.  Finally the nurse came, poured the charcoal into me and then pulled out the tube.  I was gagging and crying.

Late that night I was taken upstairs to the 5th floor which was a cardiac monitoring floor. I needed a monitored bed because I had been admitted involuntarily on a Form 1 (72 hour psychiatric hold under the Mental Health Act).  I remember waking up, if I had even slept at all, and dragging my IV to the washroom to vomit black charcoal.  I could barely walk. I noticed that this part of the hospital was much fancier and the beds were much more comfortable than on the psych wards.  I remember at one point using the phone in the nursing station to speak to my parents.

In the morning breakfast came on a tray.  There was cream of wheat in a plastic bowl.  A few hours late the psychiatrists came to assess me.  I remember being angry and frustrated because they made me walk all the way down a long hallway to a meeting room to talk.  I could barely walk and it felt like an eternity.  I remember thinking they were punishing me on purpose, but maybe they just didn’t realize how terrible I felt.

I was moved to a bed on the 2nd floor, it was a general medical unit.  Since I was not in a monitored bed and not on the psych floor (locked ward) I was assigned a “sitter.”  Basically someone to sit in the room and watch me, presumably to ensure I did not harm myself again.  It was embarrassing and invasive.  This person just sat on a chair in my room.  If I went to the washroom they would stand outside the door and listen.

I remember the day being overwhelming and scary.  I was not grateful to be alive, I didn’t see it as a second chance.  I felt sick and I felt trapped.  I felt incompetent and alone.

Late that evening I was medically cleared, the IVs were removed.   I was moved to the 7th floor.  I was not allowed to leave the unit.  After the 72 hours passed my Form was extended to a Form 3 which allowed them to keep me for up to 7 days.  Dr. X was the one to sign the papers.  He informed me that things had gone too far and he would not release me from the hospital unless my parents came to collect me.  I had no choice but to agree.

Involuntary hospitalization feels like being imprisoned.  Your right to freedom of movement is removed.  You must stay on the psych unit and you can’t go outside.  Sometimes they will let you go outside supervised but only on hospital property.  Did I need to be involuntarily held at that time? Probably yes.  Would I have harmed myself again at home?  Probably yes.  In fact, I went on to continue harming myself for years after this admission and I would be held involuntarily again.  I couldn’t talk myself out of this one.

It’s very difficult to explain what is in the mind of a person who wants to die.  Sometimes it feels like a terrible emptiness.  Sometimes it feels like looking at the world through dark glasses.  Sometimes it feels like a crushing weight, when you feel like you are separate from all living things, a shadow of yourself.  Sometimes it is racing, impulsive thoughts of harm.  Other times it is absolute quiet.  I’d be lying if I said I don’t still have thoughts of dying.  They come and go, as they have since I was 17 years old.

Thoughts of suicide are a warning sign for me.  They are a giant red flag waving.  Stop! Your stress levels are too high.  You have too few spoons.  You have too many triggers.  You need to slow down and self care.   Suicide is a symptom of depression and PTSD.  Hopelessness is a symptom.  It’s not a sign of weakness and it is not a sign of being “crazy.”  It’s a symptom of depression in the same way sniffling and coughing are symptoms of a cold. Suicide and suicidal attempts can also be a side effect of many psych meds and this was certainly true in my own life.  This is an issue with many layers.  Ironically, suicidal thinking can be a way of coping and trying to survive desperate times.

I am a suicide survivor.

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