All mental health care, all health care, needs to be TRAUMA INFORMED CARE.

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I’m feeling frustrated about the barriers to receiving high quality, publicly funded, trauma informed mental health care.  Especially the barriers faced by trans and gender non-conforming folks.

I know that I’m blessed to live in a country that has free universal health care, but we still have a two-tiered system.  Psychological care, social work and counseling that happens outside hospital settings is fee-for-service.  There are many barriers for those without finances or work place insurance in terms of accessing mental health care.  Based on my own experiences, I believe that medication alone should almost never be the first line of treatment for mental illness, and that medication should never be used without corresponding counseling of some type.   This does not mean that I’m anti-medication or anti-choice or even fully anti-psychiatry.  It just means that I see mental health as more than just a chemical imbalance in the brain.  It means that I know that supportive, validating counseling can be helpful in treating most illnesses.  I highly value feminist based counseling, intersectional approaches, peer support models and any type of counseling where the patient has a say in what happens and is treated like the expert in their own lives.

I’m personally quite negatively biased against cognitive behavioural therapy.  That does not mean that I don’t think it has a place, or that it can never be useful.  I believe it can be helpful with certain types of issues, such as OCD.   But CBT leaves a LOT to be desired in relation to trauma therapy.  It focuses too much on the individual thoughts, feelings and behaviours and too little on trauma, societal oppression and practical barriers.

When I was younger, and I first entered into the mental health care system, my parents found a clinic and doctors that supposedly were experts in the field of eating disorders.  Now, maybe they were good doctors, but I can say with absolute certainty that they were not trauma informed.  I don’t really remember every being asked exactly WHY I had developed anorexia, or if anything had happened to me.

I’m not an expert, by any means, but I know that young people rarely (if ever) develop eating disorders and self harm just on a whim, out of the blue.  Generally eating disorders are symptoms of a larger problem, generally eating behaviours are coping techniques to deal with something.

I was a smart teenager.  I knew to some extent why I wasn’t eating.  I had learned that it was an effective way to zone out, feel lighter, feel empty and take up less space.  I became addicted to that feeling of zoning out, it helped me cope with the sexual abuse I was experiencing.  It wasn’t about my looks, it wasn’t about losing weight and it wasn’t about existential angst (per se).   I’m not sure if anyone actually ever asked me why I wasn’t eating.  And after a certain amount of time had passed, it became irrelevant to everyone.  Nobody cared why, they only cared about me eating so I wouldn’t die.  I didn’t believe I could die.   I’m not sure I REALLY cared if I died. I think I did at that time, but I certainly didn’t care by the time I started taking anti-depressants.  I pretty much welcomed the idea of death and started to think about suicide at 17.

These psychologists I went to see worked from a CBT model.  I remember being 16 and sitting in the psychologist’s office while he drew diagrams of how thoughts impacted feelings which impacted behaviours which further influenced thoughts and feelings.  I quickly picked up on the pattern of it.  I realized that a very specific set of responses were the desired outcome.  I followed the pattern and started saying what he wanted to hear.  I didn’t internalize any of it.  It became a game to me, not a game to manipulate or hurt anyone, but a test to see if I said what was expected if I’d be allowed to go back to school and stop missing music class for the appointments (which to me appeared pointless).

Fairly soon after that, I became physically starved to the point my brain wasn’t really working rationally anymore.  The physical side effects of the disease confused my brain and the restricting and exercising became obsessive to the point of OCD.  The behaviour self perpetuated and I lost track of why I started doing it.  I lost track of what happened to me.  I lost track of the abuse.  I lost track of everything.  I felt panicky most of the time.  I was always cold.

When someone is that sick, no type of therapy is going to work.  Eating is the only treatment.  I went to an inpatient program, started the process of weight restoration and my mind gradually cleared.  I don’t remember being asked in treatment why I starved myself to the point of near death.  I think people were relieved that I was eating and that I returned to some level of semi-normalcy.   I was still thin.  I still had strange eating habits and anxiety around food.  I still avoided eating with most people.  But I was well enough to “pass” as recovered.

I began to recover some memories around the age of 18.  But they weren’t concrete at first.  They were flashbacks, physical reactions, nightmares.  I remember talking about it indirectly to my boyfriend at the end of high school.  Telling him that something had happened with my last boyfriend.  I don’t remember if I shared many details.  I think the idea was only slightly formed in my head.   I didn’t connect the dots and fully disclose until I was 20.

Then I was thrust into the psychiatric, medical model.  I was drugged and drugged and drugged more.  The worse I got, the more drugs were given.  I was medicated to the point I could barely stay awake during the day time. I felt foggy.  I gained weight.   I was diagnosed with PTSD, but I still didn’t receive trauma informed care.

I did an inpatient program for PTSD.  It helped a LOT.  I learned a lot.  But I couldn’t fully actualize the learning because I was on too much medication and I was in an abusive unhealthy relationship.  I knew by then that the trauma piece was at the centre of my struggles, but I didn’t fully comprehend that my current situation was a major factor.

All this to say, that my life story is a testament to the perils of practicing medicine without considering the impact of trauma on physical and mental health.

I’m so passionate about looking at the roots of why people cope in the ways they do.  What societal circumstances and traumas caused them to cope in the ways they do?

Now I’m a parent.  My children struggle with anxiety.  My younger child is transgender.  She has secrets.  There are things she won’t talk about to anyone.  She struggles with focusing sometimes.  I see a lot of signs of trauma and of the impacts of things she has lived through.  Experiencing transphobia in and of itself is trauma.  Being misgendered, people using her old name, being treated as less than a real girl, being told that her mom is crazy for “forcing her” to be a girl….I could go on, but it’s a lot.  A lot for a child.  Rejection by a parental figure is one of the clearest predictors of mental illness in trans children and youth.  Acceptance is the highest predictor of mental health.

Again.  It’s not rocket science.  Of course a child will feel safer if they are accepted.

Now I’m the one trying to find the doctors, trying to access the care, trying to get referrals, wait on lists, be taken seriously.  20 years later, I’m still fighting to find a mental health care provider who truly understands the impact of trauma on a child and who is willing to practice trans positive, trauma informed care.  I don’t want her forced into CBT.  I don’t want her to be medicated.  I want someone to help her feel safe enough to express what is on her mind.  I want someone to hear why SHE uses the coping she does.  I don’t want doctors to guess and assume.  I don’t want them to misdiagnose her as well as mis-gendering her.

She deserves to be heard.  I don’t want her to be writing a post like this in 20 years.

Kids will say what they think adults want to hear.  They may do it consciously, or unconsciously or for their own reasons.  They do it to please, to stay safe, to feel a sense of control and many other reasons.  It takes a special type of doctor or counselor to help a child feel safe enough to tell their truth.   Because after enough time hiding, even she will be confused about what her truth is.

Mental health care for children should be free.  The practitioners should be trauma informed.  There should be enough funding that kids can access the care they need without lengthy wait lists.  There should not be a two tiered system where those who can pay can access things those in poverty cannot.  Poverty is a risk factor as it is, without it also limiting access to care.  Ideally there should be a system that is easier to navigate, where parents don’t feel they are fighting and advocating to the point of exhaustion.

Mental health care is a right, not a privilege.

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Photo: https://makingmomentsmeaningful.blog/2017/04/13/trauma-informed-care-values-youth-worker-values/

How to accept a compliment.

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I went to the dance tonight to celebrate the end of an almost 4 year long legal process.  A 4 year long ordeal of leaving my ex-husband.

I danced.  I felt happy.  I enjoyed the music.  I smiled.  I forgot about my problems.  I lost myself in the moves, the beat and my dance partners.  It was a good night.  Swing dancing is an amazing healer.

Friends and strangers alike knew I was celebrating tonight.  Swing dance events usually include a birthday jam, a song where those who are celebrating something or visiting from out of town get “jammed” inside a dance circle.

Tonight, I celebrated freedom and victory with a jam I’ve waited for for almost 17 years.  It felt incredible.

After the dance, someone I’ve danced with over the years came up to me and started talking.  He told me that 3.5 years ago when I started coming to the dance I looked like “someone coming out of a long illness.”  He went on to explain that I looked healthier now and that I’d changed for the better.  He said that I had been much thinner and looked fragile.

It was a genuine compliment.  He was right.  I was coming out of a long illness and a long abusive relationship.  I was going out as a single adult for the first time since I was a teenager.  He was also right that I was thinner then.  I’ve gained about 10-15 pounds from the low end of the weight I’d been hovering around for about 3 years.  He’s probably right that I look healthier.  I am healthier mentally.

But as anyone who battles an eating disorder knows, compliments can be treacherous.  Any comment about a person’s weight, size, shape or healthiness can be interpreted by the eating disorder voice as an insult.

I tried to be present as he gave me this kind feedback about my health.

But inside my head Ana was screaming at me to get away from the conversation.  Ana was telling me…”he thinks you are fat.”  She was telling me “it’s so obvious you’ve gained weight even a stranger can notice.”  She was telling me “you are fat. you are disgusting.  you have no self control. you are weak. you are shameful.  you are ugly.”  She was having a yelling match in my head as this shy man struggled to explain what he’d noticed.

I’m trying to sit with the compliment.

Factually it is true, I have gained weight.  No, I’m not comfortable with it.  Yes, I’m constantly thinking about restricting and exercising and ways to lose weight.  Yes, I put myself down far more than anyone would realize.

But honestly F#@K Ana.

That man wasn’t telling me I looked fat.  That man was telling me that I look healthier after escaping from an abusive relationship that almost killed me.  He was telling me I looked more alive and happier.  He was complimenting me, even if Ana couldn’t understand.

People in recovery from eating disorders might always interpret compliments about their health or their body in a negative light.  Generally it’s safer NOT to talk about a person’s weight or size.  It can be a trigger and very uncomfortable, especially in early stages of recovery.

But for tonight, I’m happy that I’m still alive.   My body is okay.  It allowed me to dance for almost 3 hours tonight, despite my chronic pain issues.  My body has been through so much.  It’s okay to give Ana a break once in a while and just appreciate the steps I’ve taken towards health and recovery.

Your body is okay too. Whatever your shape or size.  You are beautiful and strong and you deserve to love yourself.

Banish body shame.  It’s okay to accept the compliment.  You are worth it ❤

Body distortions.

I’ve struggle with distorted perceptions of my body since I was 9 years old. I vividly remember the first time I felt hatred towards my body.  I was 9 and I was sitting on the floor in the upstairs hall of my parents’ house.  I must have been getting ready to get into the shower.  I was sitting with my legs out in front of me and all I could think about was how fat and ugly my stomach was.  I thought it looked disgusting.

I remember during my years as a dancer how much I envied the other girls who were thinner and had more delicate frames.  I was always cast in the role of the boy in the group choreography and I assumed this was because I was the largest, tallest and least delicate.  Intellectually I knew some of the girls were younger and hadn’t gone through puberty yet, but emotionally it hurt.  I didn’t want to be in the boys costume, pants, vest and button up shirt. I wanted the flowing dress.  The main reason was because I assumed my body shape was to blame.

I remember feeling slightly more confident in my body for a few years, at the beginning of high school.  My style changed fairly dramatically over the years, from dresses, to jeans and baggy sweatshirts, to grunge plaid shirts and doc marten boots, to short kilts and boots, to hippy long skirts…in high school I wore skirts and dresses the majority of the time and I never felt comfortable in shorts.

When I was sexually abused, I started linking my female body with being assaulted.  I wanted to take up less space.  I wanted to disappear so I couldn’t be abused.  I changed my style again, and stopped wearing skirts and dresses and more feminine items, expect for special occasions.

It took many years for me to make the link between being abused and hating my body.  I believed all the negative thoughts Ana was screaming at me.  I believed I was fat, even when I was deathly thin.  I saw things that weren’t there.  I struggled with body dysmorphia and distorted body image, never seeing myself as others saw me.  I became so used to this that I stopped questioning why it happened.  I became increasingly invested in hating my body and blaming my body for being abused.  I forged an even stronger link by engaging in severe self harm for many years and abusing my body by overdosing and attempting suicide.  All my destructive behaviours distracted away from the root causes of my eating disorder and self harm.

I remember the moment the link became crystal clear to me.  Up until that moment it was a complete mystery to me how my view of my body could change so drastically from day-to-day.  One day I might see myself as thin, or even worry about my weight and health and the next day I’d wake up feeling obese, disgusting and unwilling to eat.  I had a hard time intellectually believing that it was impossible for my body to change that much over night.  I tried to control the dysphoria by altering my eating habits and/or exercise.

Around 2011-2012, during the years leading up to me leaving my ex-husband, I had a sudden realization.  My weight was low towards the end of 2011, partly due to the ECT treatments and lack of appetite and partly due to Ana and depression.   I remember feeling like I’d lost too much weight.  I remember feeling concerned about how low my weight was (this was during the brief time period I owned a scale).  I went to sleep one night and my ex-husband touched me sexually when I was asleep and drugged.  Quite likely after I’d said no while awake.  I remember us fighting about it in the morning.  I went into the en suite bathroom and got ready to shower.  I remember and overwhelming feeling of being fat. I hated my stomach. I felt massive and ugly.  I wanted to harm myself and restrict food.  I felt disgusting and shameful.

Then a light bulb went off in my mind.

Wait a minute, just yesterday you felt you were too thin.  Just yesterday you were worried about your weight being low. It’s impossible that you have gained that much weight over night.  These self-destructive thoughts are linked to being assaulted and to the argument.  You feel fat and dirty and shameful BECAUSE of what happened.  It has nothing to do with your weight.  Your weight hasn’t changed.

Things started to shift for me after that realization.  I suddenly had a clear intellectual understanding that I needed to try living alone before giving up and completing suicide.  I realized that I hadn’t truly “tried everything” to recover because I hadn’t tried removing myself from my marriage.  I think this realization saved my life.  I began to slowly get stronger, to seek different types of help (from a rape crisis centre) and to talk to a few trusted folks about what was happening in my marriage.

It took me a full year to get strong enough to leave.  But the leaving started with that realization.  For a moment, I stopped blaming my body and myself and started blaming my abuser for my ill-health.

In the last two days I’ve had some incredibly frustrating text interchanges with my ex-husband.  Trying to co-ordinate co-parenting with a narcissist is impossible.  It is like pushing a spiky boulder up an icy hill, where you are blamed for the ice, the spikes and for not succeeding in getting the boulder up the hill.

Yesterday, Ana was screaming at me.  Ana did NOT want me to eat.  Ana was telling me I was fat and I’d gained too much weight.  Ana was telling me to hurt myself.  Ana was making me paranoid that my ex could see things on my computer, or hear things we were talking about at my house.  Ana was activated and was not letting me rest.  Noises startled me, I had a hard time relaxing to sleep.

All of this happened because of a 5 minute text exchange with him.

Co-parenting with an abuser is enough to make anyone miserable.  But I need to remember that my body is not to blame.  In fact, the healthier I am, the stronger I can be at resisting his abuse.  I need to be healthy to take care of my kids and protect them as much as possible from his lies.  Ana tells me to hurt myself, to shrink myself, that it’s my fault.  But Ana lies.

I’m willing to bet that if you have an abusive voice in your head, it is lying to you too.  Ana never makes us stronger.  We are not to blame for the abusive patterns of another person.

I read a quote once…

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This was certainly true in my case.  I realized that hurting myself was not the way out.  There was another way, a sometimes more difficult way, but a more productive one!

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Trusting my younger self.

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I’ve been reading through my journal from the first year of the relationship with my abusive ex-husband.  I’ve been reflecting on how I was gaslighted and how, in a way, I gaslighted myself.  I used the same coping techniques I did when I was abused at age 15. I found myself in another abusive relationship and I immediately began self harming, restricting food, and thinking about suicide.  As a distraction it worked, just as it had when I was a child.  I did what I needed to do to survive. I turned to creative (if self destructive) coping techniques that got me through very difficult situations.  But my inner self, my younger self did know something was wrong.  There was a part of me, healthy me, which was separate from “the voice” or “Ana.”  That part of me knew that my new relationship was deeply and integrally connected to my relapse and worsening psychiatric symptoms.  My wise younger inner self knew that I was in trouble, but she asked for help in ways that distracted and confused other people, even her own healthy self.

This is a concept that is often very difficult for those who have not survived abuse to understand.  It can be challenging to understand that the survivor will do whatever it takes to survive, even if those coping techniques may look like self destructive behaviours from the outside.  The survivor may feel she has limited or no options.  For various reasons she has been conditioned not to scream, tell, ask for help, run away, fight back etc…or maybe she tried those things and they didn’t work. So instead she turned to disassociation, self harm and eating disorders as a way to modulate and live with the abuse and all the symptoms of PTSD.

I was conditioned, maybe almost from birth, not to make a fuss.  I was conditioned, maybe almost from birth, to be a “good girl.”  I internalized this in a way that led me to blame myself for the abusive behaviours of others.  If I was being hurt it was because I wasn’t a “good girl” and if I wasn’t a “good girl,” then I must be a bad girl, maybe a very bad, shameful, dirty and disgusting girl.  Thus, Ana/”the voice” was born.  There was a part of me that split off and became self abusive and self critical.  A younger self, a part that never ages or matures.  A 15 year old frozen in time.

This is how I described “the voice” when I was 20 years old (ironically the description came right after mentioning intimacy with my ex):

February 21, 2001

My body feels too big and uncomfortable right now.  I know it’s because I’ve been eating more normally and feeling hungry.  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 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”

When I was 20 I was able to recognize some of the signs of abusive behaviour in my ex. I was able to identify that I felt afraid.  But I didn’t draw the right conclusions from there. I blamed myself, I thought I needed to work on my depression, my recovery, get better at coping with anger etc.  My younger self tried to problem solve by changing herself, just as she had at age 15.  Just as she had for her entire life.

March 12, 2001  [written after being asked to swing dance with and dancing with a friend, a man I’d briefly dated]

So the evening was going well until one crucial moment…asked me to dance.  I figured one dance wouldn’t hurt and I didn’t think [he] would mind…but [he] did get upset and left the room.  I followed after the song was over. [He] got angry at me saying that I couldn’t stand up for myself and say NO.  He totally misunderstood and overreacted.  I got terribly upset and started crying totally uncontrollably…I was so disappointed that my night was ruined.  I felt so much like hurting I became filled with intense suicidal thoughts. I hate feeling my independence threatened by a relationship. I want the freedom to choose who is in my life.  When [he] gets angry it just terrifies me and makes me want to hurt, with him is when I feel the strongest feelings

My younger self clearly articulated that she felt uncomfortable with being controlled and with the jealous behaviour.  She clearly made a link between the angry jealous behaviour of her boyfriend and the suicidal and self harm impulses.  My younger self was wise on a deeper level, and yet she stayed with that man for 13 years.  It’s difficult to make sense of.  My adult self wants to travel back in time to that night, to go back to the dance with my friends, to tell him in no uncertain terms to F*#K OFF and leave me alone.  My adult self wants to protect that younger me, give her the strength to listen to her instincts and fight back rather than turning to a downward spiral of self destruction that would lead to 4 years in and out of psychiatric hospitals.

The next day, March 12, 2001 I was admitted to the hospital.  I wrote in my journal again, but made no link between the previous evening and my suicidal obsessive thoughts.  The self destruction worked as a distraction from his controlling behaviour.  The hospital was a place to get away from him.  The routine and the process of hospitalization was an escape.  I would feel safer in the hospital for a few hours or a few days, then I’d realize that the hospital wasn’t a solution and I’d want to be home.

I think what I really wanted was to be safe.  What I needed to be safe was to exit the abusive relationship in those early stages, when I still had the chance.

Because within a few short weeks I was already beginning to convince myself it was my depression and PTSD causing the issues in our relationship:

March 26, 2001

“The things that I thought were stable and unchanging have become uncomfortable. I can’t tell if it’s my depression pushing [him] away or actually me. It’s so hard to face that possibility. I want things between us to be simple again. I miss how easy we used to be together.  Now I feel distant from our relationship”

April 4, 2001

“I don’t feel as easy around [him] lately. Mind you I haven’t felt easy around anyone lately. I feel withdrawn, like I have built up the walls around me for protection from the storm.  But this is so ineffective because my storm is coming mainly from within. I don’t know how to protect myself from myself. I really am my own worst enemy”

Maybe I was never my own worst enemy.

Maybe the storm was never “mainly” from within.  Maybe I was confused and living with emotional abuse and gaslighting.  Maybe I bought into blaming myself as a coping technique, as a way to survive, and as a way to feel more in control of a scary situation.  I blamed myself and my mental illness rather than facing the reality that I was in an abusive relationship.  It was “easier” to seek help through psychiatry than it was to leave the relationship.

Looking back it all seems clear.  But my 20 year old self had less wisdom, less experience, less resources and less knowledge.  My 20 year old self did the best she could.  She did try to express herself, she just didn’t have the skills to listen to herself or to ask for the type of help she truly needed.  And those around her weren’t able to interpret her self destructive behaviours as, not a cry for attention or a manipulation, but a message.  A red flag waving, signalling that all was not well.  Help was needed, but psychiatry wasn’t the correct tool for the task.

Unfortunately, my younger self wouldn’t cross the threshold of a rape crisis centre for another 12 years.

The roots of an abusive relationship.

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Through some parts of my youth I kept diaries.  Never entirely consistently, but consistently for periods of time, especially when I was in treatment or in hospital.  I’ve been thinking back to this time of year in 2001.  My first year with my abusive ex husband.  My first year in psychiatric care.  My first year engaging in severe self harm.  My first psychiatric admissions (aside from eating disorder treatment).  My first suicide attempts. It’s interesting how all these “firsts” coincided so neatly in time with my new relationship.  At the time I thought it was because memories of the abuse I survived as a teenager were triggered and surfaced when I became sexually active.   That was part of it.  But there was more to it than that.  There was subtle abuse in my relationship with my ex husband that started very early on.  The seeds of gaslighting and emotional abuse were being planted.

It started with showering me with affection and attention.  It started with making me feel special and loved, almost to the point of making me uncomfortable.  It started with planning for the life we’d have together, the kids we’d have, the marriage…within months of meeting me (I was 19!).  It started with gifts, cards, flowers, spending all our time together.  It started with gradually isolating me from my other friends and social outlets.

Then some lies started.  And the lies were repeated so often I believed them to be true.

These lies were focused around my mental health problems and their link to my feelings about his abusive  behaviours.   He would tell me that it was because of my PTSD that I was uncomfortable with something.  He would tell me that a “normal woman” would be okay with it.  He would make me feel guilty, tell me that he felt like there were three people in the relationship: me, him and X.  He made me feel like I was CHOOSING to have flashbacks, like I was CHOOSING to think about X rather than him.  Almost like X was someone I never quite got over, a lost lover, rather than an abuser who had traumatized me to the point I often had flashbacks during any type of intimacy.  Over time, the lies were repeated to the point that I felt crazy.  I felt like I was to blame for the problems with intimacy in our relationship.  We even sought out support from a sex therapist to talk about this.  I had blood tests and was checked to ensure my hormone levels were normal.  I was completely manipulated into believing that the issues in the relationship were entirely my fault.

Today, in 2017, I realize I like some types of sex just fine.  I just prefer consent to be a factor in that sex!  In other words, I like sex, but I don’t like sexual abuse!  It turns out, I’m not physically broken.  I have PTSD.  I have flashbacks, but with a safe, trusted and patient partner I can be okay.  But because of the lasting impacts of gaslighting, I struggle with saying no. I struggle with blaming myself for anything that might go wrong. I struggle with identifying and communicating what I want or enjoy.  And I still fall back into patterns of believing that I’m crazy.

When I left my ex husband, I mainly remembered and talked about the sexual abuse that happened in the last 5-6 years of our marriage.  These were the incidents I felt most comfortable labeling “sexual assault” and “rape.”  When asked, I couldn’t really describe when the sexual abuse started.  I couldn’t really remember the first time.  I couldn’t really say when things started to go wrong.

But reading back in my diary from 2001, the first year we were together, there are so many red flags.  I can hear my 20 year old self trying to convince herself that things were okay.  I can hear my 20 year old self trying to believe that she loved this man she barely knew. I can hear my 20 year old self trying to rationalize that things would be better with him when SHE was better, when SHE stopped cutting, when SHE stopping being so depressed.  I can hear her trying to convince herself it was the right choice, and I feel deeply sad for her.

June 8, 2001

“The evening went well until the car ride home.  Before getting in the car I was feeling panic starting. [He] tried to kiss me but I pulled away.  He got offended.  I tried to explain but he got angry and said he felt stifled like he couldn’t be spontaneous.  He said I only make love to him out of duty.  I got really upset and started crying and I couldn’t breathe. It was like a panic attack and I couldn’t stop hyperventilating. I just was so very scared.  I’m terrified of being with [him], but I do love him too.  It’s such a dilemma all the time. I feel like it would be easier for me to get better without the strong feelings of a relationship.  But on the other hand [he] is my support.  I don’t know.  It’s so tough right now.  I’m so scared of my life and everything in it”

Looking back on the things I wrote, I realize that I was barely more than a child myself. Just turned 20 years old.  I had just disclosed the abuse from my childhood, just started counseling.   I was talking about abuse I’d kept inside for 5 years.  I was in full PTSD crisis mode, complete with flashbacks, hyper vigilance, anxiety and nightmares.  I was on psychiatric medication cocktails for the first time.  I was self harming almost daily and had recently attempted suicide.

It was perfectly normal that I didn’t always want to be intimate with someone.

Perfectly normal.

Today, I choose to forgive my 20 year old self for not knowing this.  I choose to forgive her for not knowing that she was having normal coping reactions to trauma and that she was not crazy.  I choose to forgive her for being tricked into a situation where, instead of healing and support, she found gaslighting, confusion, entrapment and more sexual abuse.

I know I’ll wake up tomorrow, or the next day and feel confused again.  I’ll wonder if the abuse was my fault.  I’ll think that I’m exaggerating or that I’m making things up.  I’ll start to feel the thoughts creep in that I’m not normal.  I’ll start to wish that I had died all those years ago when I attempted suicide.  I’ll start to believe his lies again, because a long term emotionally abusive relationship includes an element of near brainwashing which can take years of healing, therapy, patience, self love and self forgiveness to recover from.

But just for today, I want 20 year old me to know that her reactions were normal.  That she was allowed to say no to that kiss for any reason.  She was especially allowed to say no to that kiss when she was triggered.  She had the right to say no without consequence, without anger, without bullying and blaming.  She had the right to have needs and preferences and anxieties.

It wasn’t her fault that he didn’t understand consent.

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

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!

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.