self harm

Restraint

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In the summer of 2001, I overdosed multiple times.  Some of these stories are described in other blog posts.  After the last of that series of suicide attempts, my psychiatrist put me on a Form (sectioned me, 72 hour hold).  He refused to release me from the hospital unless my parents came to collect me.   I remember my father driving down to pick me up.  I don’t really remember being released, but I ended up back home at my parents house, many hours away in another city.   The past few months felt like a bad dream.

I remember my parents had hidden all the pills in a bag in their bedroom closet.  I remember that there wasn’t a lot of trust, and for good reason.  I tried to relax, but the thoughts of self harm were propelling me forward.  I was caught in a vicious cycle, medication induced self destruction.  I would feel unsafe, hurt myself, go to the hospital seeking safety…then after a few days panic, feel trapped and beg to be released.  It went on over and over.  I always wanted to be where I wasn’t, I was chasing the feeling of safety, of quiet in my mind, of escape.

I remember walking up to the plaza by my parents house.  I bought an exacto knife at the dollar store and sneaked it into the house.  I was always buying, hiding, and throwing away tools during those years.  I often hide them in various places for safe keeping.  Intellectually I knew that having them in the house was the opposite of safe, but somehow their presence simultaneously calmed and panicked me.   It’s rare, even today that I don’t have something hidden.  Even though I don’t use the tools, I sometimes feel compelled to buy and keep them.   Sometimes I’ve called friends and asked them to help me throw them out.  I’ve handed them over to therapists and doctors.  I’ve hidden them and felt ashamed.  Even writing this brings up a feeling of shame inside me.  This is the power of addiction, the constant push and pull between the promise of safety and the threat of disaster and destruction.  Back then, I thought I was in control.  I thought the cutting kept me in control, but in reality the urges controlled me completely.

I had the knife at my parents house, I cut myself with it.  Deeply, but not deep enough to require medical attention.  I told my parents and asked them to take me to the hospital.  I told them I felt suicidal and I wanted help to control the urges.  I remember sitting in the ER waiting room, in a different city.

I don’t remember everything that happened.  I remember talking to a Dr, I was sitting on a stretcher, it wasn’t a special psychiatric emergency, just a regular bed.   The doctor agreed to admit me.  Then nurses came and gave me a gown, they took my clothes and items and put them into a white bag with a plastic drawstring labelled “patient belongings.”  This was different, the anxiety began, “why are they taking my things?”  Apparently this was the protocol at this hospital.

I was taken up to the 4th floor, to the Mental Health Unit.  It was a different layout and different style that the hospital I’d been in only a few days before.  It seemed larger and was laid out more like a large rectangle, rather than a long straight line.   I was shown to my room.   Outside the room was a cupboard and the nurse locked my things in there.   I was allowed to keep my teddy bear, but not my clothes.  In this hospital there were 2 beds to a room and each room had it’s own bathroom with a toilet and shower.

I stayed in the hospital for a few days.  It was the last week of June.  A few friends came to visit me.  I was given my clothes back and allowed to leave the hospital on passes.   During one of the passes I went to visit the psychologist who had treated me as a teenager.   To be honest the appointment was not helpful.  I don’t think she had a good understanding of me.  She didn’t understand why I was sick (because I’d been abused) and she didn’t understand why I was cutting myself and suicidal (because of the abuse and the medication cocktail).  I felt that she shamed me and threatened me to stop my acting out.  I don’t really remember exactly what was said.  I only remember feeling desperate when I left.  I think my parents dropped me back at the hospital.  I was in the lobby of the hospital, where there was a pharmacy and I considered buying a giant bottle of the medicine I had been told would kill me if I overdosed again.  I felt hopeless.

Somehow I managed to go back upstairs to the ward without incident.  I remember a few days later I wanted to leave, as was my usual pattern.  It was the weekend, I believe it was July 1 and I wanted to go home to see the fireworks.   I did as I would have in the other hospital, starting convincing them I was okay.  But somehow it backfired.  They didn’t believe me and they said I couldn’t leave until my doctor returned the next day.  I started panicking and becoming angry.   They told me they were holding me involuntarily because they thought I would just leave.  I was crying and banging my head.  I went into the washroom in my room, took off my earring and scratched my skin with the sharp end.  It wasn’t even enough to draw blood, just to cause pain and leave angry looking scratches on my body.   I remember being at the nursing station.  I was given a cup with liquid medication inside.  I was told it was Nozinan, a medication I’d used for panic before.  I drank it and soon after I realized something was wrong.  I became extremely drugged and when I asked the nurse had given me 5 times my usual dose.  They took away my clothing again and gave me a hospital gown.

Before I fell asleep or settled into my bed I realized what had happened.

I’d been chemically restrained.

They didn’t want to deal with my acting out and so they drugged me.

I felt betrayed, I felt scared.  I felt like I couldn’t trust anyone and I felt like my life was out of control.

The next day my doctor returned and agreed to release me.  The only useful part of that hospital admission was the doctor switched my medication to one that I still take today.  One of the few I’ve found over almost 20 years that actually makes me more, rather than less, sane.   For that I was thankful.

I soon went back to my home.  The cycle continued.  Looking back I realize an important lesson.  It’s not possible to keep someone else safe.  If someone is determined to harm themselves they will find a way.  Short of restraining someone and drugging them, it’s impossible.  The person has to want to help themselves, and they have to find both a purpose for living and a direction to move toward.  A goal, a passion, a reason to fight.  This is unique and can’t be forced or given to someone.  Believing in myself happened over time.  The psychiatric system is a crisis management system and nothing more.  The true help I’ve received over the years has come from other places entirely.

 

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.

 

 

I don’t care if it hurts, I want to have control…

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20160522_220818[1]“I don’t care if it hurts, I want to have control,  I want a perfect body, I want a perfect soul”

-Radiohead

One of the worst parts of living with anorexia is also the part that is the most difficult for others to understand.  Body dysphoria or distorted body image.

In the context of an eating disorder, and in my own case, this basically means that I’m never really sure if I’m seeing my body accurately or not.  When I look in the mirror sometimes I see a lot of things I don’t like.  I don’t like the majority of the middle of my body for example.  Lots of people can relate to that.  But for me what I see in the mirror can sometimes change dramatically from one day to the next.  Sometimes I look at myself and I can see the parts of me that are slim, sometimes thin even.  But when I’m stressed, upset or triggered I see myself as big…too big…taking up too much space.  I hate the way certain parts of my body look and feel.  I get upset at the feeling of clothing touching my body and I sometimes have to change my clothes a few times in the morning before I feel okay to go out.

It’s important to know that 90% of this is not about how I look to other people.  It’s not about vanity.  It’s not about wanting to look like a model in a magazine or an actress on TV.  It’s not a life style choice.  It’s not a choice, period.

Distorted body image and body dysphoria are symptoms of many eating disorders.  Eating disorders are medical illnesses.  You don’t have to “look sick” or be extremely thin to be medically at risk from an eating disorder.

Sometimes I want to scream because if I could get rid of Ana and live a “normal life” around food my days would look very different.  I don’t want to waste even one more minute obsessing about my fat stomach, or how much I should or shouldn’t eat.

I’ll tell you something about Ana…she is a total bitch.  She is also incredibly boring.  Probably the most boring person I’ve ever met.  Ana is abusive too.

Who is Ana?  She is my eating disorder.  I personify her and I experience or imagine her as a young girl, maybe about 15 years old, with dark hair and pale skin.  She never looks happy and she is never satisfied.  She’s often full of rage and full of anger and she seems to want to destroy the both of us.

Ana talks to me like this:

“Your stomach is fat. You are out of control.  You are so disgusting. You don’t even deserve to be alive.  You probably shouldn’t eat very much because it’s the only way you will feel better.”

Ana lies. Ana is cruel.  I’ve been living with her for almost 20 years now and she rarely gives me much of a break.

Because of Ana I have a hard time remembering what it is like to eat and feel relaxed, just enjoying the flavours.  I have a hard time imagining eating without obsessive thoughts and rituals.  Ana has this idea that by controlling food and controlling the size of our body she will solve all our problems and make us feel in control and safe.

Ana wants to be safe more than anything.  Unfortunately, she is young and she doesn’t know that controlling food makes her MORE at risk, more vulnerable and certainly more unhappy.

If I could live one day without Ana…

  1. I would get SO much done.  I’d have more energy because I’d be eating more regularly and more healthfully.
  2. I’d be able to actually concentrate because my body would have all the energy it needs AND my mind would be de-cluttered and not distracted by obsessive thoughts about food and weight
  3. I’d be able to relax and enjoy social time.  Until you live with Ana you never realize how much of society centers around food
  4. Did I mention how much more energy I would have?  Listening to, or fighting off Ana’s abusive inner monologue takes so many spoons.  It leaves me exhausted and on bad days depressed and hopeless

But even knowing all this intellectually, I have a hard time letting Ana go.  She does sort of keep me company, and she does sometimes give me the illusion that by controlling food, I’m controlling my life and managing overwhelming problems.

At the end of the day the truth is that Ana was born during the time I was being abused as a teenager.  Ana promised me things, and she deceived me into thinking that if I was smaller and took up less space I’d be safer.  But I wasn’t safe, I almost died.  And then when I was in imperfect recovery, I was abused again and again.

Ana doesn’t keep me safe.  Eating disorders have the highest mortality rate of any mental illness, especially among young woman.  They aren’t a choice and they do destroy lives.

I hope one day Ana will leave me alone.  I hope I will be able to look in the mirror and like what I see.  I hope  I will be able to eat without fear and guilt.  I hope I will pick my clothing based on what I like and not what will allow me to tolerate the body distortions for that day.

I still have some hope that I will let Ana go, instead of fumbling along in imperfect anorexia recovery forever.

Scars.

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What is it like parenting two children when you are a psychiatric survivor?

Pretty damn scary.

I remember when I first got pregnant and for the first 2 years of parenting my kids, my biggest fear was that someone would call Children’s Aid and report me as an unfit parent.  I worried that my first baby would be taken from me at birth.  You might ask why would someone whose baby isn’t even born worry so much about being an unfit parent?

My body is covered with scars from self inflicted wounds.  I was terrified someone would see this, make assumptions about me, and consider me a danger to a child, especially my child.

I’ve been parenting for almost 10 years now and so far this fear has never materialized.  I still worry about being considered “crazy” and thus “dangerous” and thus “unfit.”  In fact, this is the weapon my ex-husband has used against me since the time I began leaving him.  Just accusing someone of being crazy tends to impact the way others view that person.  My ex-husband took moves out of Dr. X’s playbook and began telling everyone, including the children’s health professionals, our neighbours, the kids’ school AND Children’s Aid that I had borderline personality disorder.

Despite the fact that my own doctor and many other doctors have testified that I do not have borderline personality disorder, this label is still haunting me 15 years after it was first, incorrectly, applied by Dr. X.

Let’s just break this down for a minute.

In the days of insane asylums, a man could have his wife committed against her will since she was essentially his property.  I’m sure asylums were full of women who were wrongly diagnosed as “hysterical” or something, just because they spoke out against the men in their lives.  Maybe they were being abused and dared to say something, maybe they didn’t conform completely to patriarchal societal standards, but one way or another they were put away.

The days of asylums are gone, but the stigma of diagnoses like borderline personality disorder remains.

It’s a very convenient excuse to deflect responsibility for perpetrating abuse.  “Oh, she’s crazy don’t you know.  You can’t believe her story because she’s mentally ill!”

Sound familiar to anyone?  Yes, accusing survivors of being “crazy” is an aspect of rape culture.  Survivors are not crazy.  They are speaking a truth that many in society do not want to hear and thus they are labelled, marginalized and stigmatized.

Every spring when the weather gets warm and t-shirts start to appear, my fear returns.  In the winter I can usually “pass” as “normal.”  My scars are safely hidden under layers of winter clothing.  In the summer, I stand awkwardly with my hands behind my back when I meet new people and when I pick the kids up from school.  I keep a cardigan at work to throw on before meeting with service users.  I see the scars myself, day after day, and sometimes it triggers me and makes me think about a time in my life I’d rather forget.

I still worry that people will view me as an unfit parent because of the coping choices I made.  But I wear t-shirts, because it’s hot outside in the summer.  I won’t hide under clothing everyday for the rest of my life.

If you have used self harm to cope, don’t be ashamed.  You survived and that is the most important thing.  Your scars tell the story of your survival.  If I could tell you a hundred times that you aren’t crazy I would.  But honestly, I’m spending a whole lot of energy reassuring myself that very same thing these days.

My scars tell my story.  Sometimes I wish my story was different, or that I had the privilege of having an invisible mental illness, but that isn’t my reality.

And believe it or not, some people think my scars look pretty damn cool.

 

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.

 

Post-it notes

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Possibly one of the saddest moments in my entire story revolves around a post-it note.

During a particularly dark time in my life, sometime in early 2011, I wrote a series of 3 suicide post-it notes.  This is something I haven’t really shared with anyone.

I was completing my Master in Social Work, I was about to start my final placement.  I was working as a Teaching Assistant, attending classes and taking care of my kids.  On the outside I was functioning, but on the inside I was consumed with depression.  Looking back, I know a good part of the darkness was being caused by my increasing unhappiness within a sexually abusive marriage.  I began to feel like I had exhausted every option for recovery, every medication, every type of therapy, every treatment program and as a parent of two young kids I felt I had even fewer options.  I felt trapped and disconnected from myself and the ones I loved.

I don’t remember why I was upset or what happened that day, I do remember I wanted the pain to stop.  I was home alone, the kids were at school or daycare.  I saw a pad of yellow post-it notes one of the kids had left in my bedroom.  On it I scrawled three separate notes, one for my husband and one for each of my kids.  The notes basically said “I love you ___” and had a heart drawn under the words.   They looked like innocent little notes, the kind family members leave for each other to wish them a happy day.

But to me those were the most tragic post-it notes in existence.  In that moment where nothing was really making sense, I was saying goodbye.

I did hurt myself that day, but I went to the hospital to get it taken care of.  I didn’t tell the hospital staff about the post-it notes or about my despondent thoughts.  I let them fix me up and I went home.  I rarely discussed my suicidal thoughts in the Emergency Room unless I wanted to be admitted to the hospital.

When I got home my family was there and so were the post-it notes, unassuming and cheerful yellow papers.  But seeing them reminded me of my dark plans.  I hated those post-it notes with great passion.  They made me angry every time I saw them, but luckily anger was at least a feeling and not just numb emptiness.

The post-it notes stuck around the house for months before I finally threw them away.  I won’t ever forget them though.  They are a symbol of just how little anything ACTUALLY makes sense when you are severely depressed.  Things that seem logical in the moment are completely ridiculous and nonsensical when you are feeling brighter.  Choices that seem like the only option are revealed as unhelpful and fatalistic when you are recovered.

It’s important to hold onto this realization.  When you are severely depressed you are not thinking clearly.  When you are starved from an eating disorder you are not thinking clearly.  When you are triggered and in the middle of flashbacks you are not thinking clearly.

Don’t make decisions that could harm you or someone else when you are not thinking clearly.  Chances are you might regret it when you are calmer.   If possible focus on grounding and self care, or get help from others if you realize you are not thinking clearly.

Suicide wouldn’t have solved the problems in my life, it would have passed them on to my children, my parents and my close friends.  I can say this now, but I know for a fact that in a dark place I just won’t care.  The only thing I will think about is getting the pain to stop.

Luckily, in recovery, I know that depression is temporary and impulses to harm myself are passing thoughts.  Suicidal thinking and gestures are symptoms of depression and PTSD for some people.  Thinking about suicide can be a normal coping reaction to surviving violence.  Just thinking about suicide is not necessarily dangerous.  Sometimes it can be a way of feeling in control of something, which is actually a method of self preservation.  It is necessary to challenge the self destructive behaviours, but I try not to judge myself for the thoughts.

At the end of the day there is no difference between a person who sometimes thinks about suicide and one who does not.  There is not a special “crazy” class of folks who contemplate dying.  Suicide doesn’t discriminate.  Anyone can have the thoughts and it doesn’t make them weird, dangerous or a person to be feared or shunned.

Suicide survivors walk among us.

Sometimes the best thing you can do for a friend who contemplates suicide is to allow her to talk about her thoughts and impulses and listen without panicking and without judgment.  Validate her, let her know that you are sorry she is feeling SO awful that she feels life is hopeless.  Allow her to explore the thoughts with you, or encourage her to talk to a counselor, support worker, crisis line or doctor.  It isn’t your job to save her, it’s your job to be her friend.  Thank her for trusting you.  Let her know you care. By letting someone talk about suicide, you are reducing shame and creating a connection.

Connection is the opposite of depression.

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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No, you don’t have the right to torture me

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This is what the stigma of being misdiagnosed with borderline personality disorder means to me.  Trigger warning for description of self harm and abuse.

Monday November 8, 2004

I presented to the Emergency Room at South Street Hospital with a self inflicted cut on my arm.  By this time I had been using hospital psychiatric services for over 3 years.  I was a frequent flyer, a regular, a repeat customer and I was not popular.  I had experienced many unpleasant experiences in the ER.  I had grown accustomed to medical students poking at me and asking ridiculously offensive questions.  The worst was “Why don’t you cut yourself deeper so it would hurt more?”

I’m only going to say this once.  In my opinion someone who uses psychiatric services heavily is actually in MORE need, likely MORE desperate and experiencing MORE complex issues that someone who is visiting for the first time.  As mental illnesses progress folks become sicker and more marginalized by society.  What is needed are more individualized care plans, more compassionate care, more empathy and more listening to the survivor.  The survivor themselves is the expert in her own healing.  One size fits all models of care do not work, they have never worked, and will never work.  Each person is unique and experiences a unique mix of oppression and marginalization as they live with their illness.  Social and structural factors are an important thing to consider.  The survivor does not exist in a vacuum.

Believe me, if someone truly had options, they would NOT choose to spend their lives in psychiatric institutions.

Part of the reason I used the Emergency Room so frequently at that time was because I had neither a family doctor, nor a psychiatrist seeing me for ongoing care.  Lack of access to primary and preventative mental health care is a huge issue.  Another major barrier is the existence of a two-tiered mental health care system; whereby folks who have financial resources are able to access private care from psychologists and social workers and economically marginalized people (the sickest and most at risk) often face long waiting lists, lack of affordable housing and gaps in services.

By that time Dr. X had stopped seeing me.  This happened over a period of months.  First he would cancel appointments, then not show up for them.  I was busing across town to meet him and he just would not be there.  Then he switched from an outpatient practice and seeing inpatients on the 7th and 8th floor to working full time in the Urgent Psychiatry Clinic and the ER.  When he switched his practice I was not assigned to another doctor, nor was a given a community referral.  Thus, my only option was to attend at the ER to get a psych consult and an appointment with Urgent Psychiatry.  I begged and pleaded and searched for a new doctor but I was not able to find one.  I found out later that Dr. X had essentially blacklisted me at South Street and no psychiatrist would take me on because I had “borderline personality disorder.”  I was also denied access to the PTSD treatment program, after waiting on their list for 18 months.  I was told I didn’t meet the criteria for the program.  Ironic since PTSD is my main, if not only, diagnosis.

But I digress…back to November 8, 2004.

I waiting in the waiting room for about 1 hour before being brought back into the curtained treatment area known as OR 2.  When I was directed to a bed I began crying and was visibly upset.  A nurse arrived to take my history, but she was interrupted by Dr. P who dismissed her saying “you are wasting your time.”   Dr. P spoke to me in a curt and derogatory manner, asking to see my laceration.  He took a quick look at it and said he was going to staple it.  I began crying and asking him to please stitch the cut instead because staples really scared and triggered me.  Dr. P laughed at me and asked me to lie down and proceeded to quickly clean the cut.  He then held my arm down and proceeded to place 8 sutures into my forearm without using any local freezing or pain relief.  I was sobbing and screaming and he continued offering no sign of sympathy or concern.  I couldn’t understand why he was not following procedure and I was confused and distressed.  I felt as though I was being purposely targeted and tortured because my wound was self inflicted.  I felt like Dr. P wanted to “teach me a lesson.”  I was known to him from previous visits and I got the sense he did not want to see me in “his” ER again.

After he was finished the nurse came back and tried to calm me down.  She reported the incident to the charge nurse who also comforted me and offered me Advil.  I was then taken to the psych waiting area to meet with the doctor on call.  I was very upset, triggered and in a lot of pain.  I remember curling up into the smallest ball I could make in the uncomfortable plastic chair which was bolted to the ground.  The floor was covered in green tiles.  All the furniture was bolted down, presumably to stop patients from injuring themselves of others.  It was a cold room, I remember I was shaking and probably in shock.

I reported the incident to the College of Physicians and Surgeons a few days later.  The treatment I received was abusive and was physical assault.  I came to the hospital (already living with PTSD) and I was traumatized in a time of crisis.  I firmly believe that if my cut had not been self inflicted and if I had not been labelled within the hospital as a “hopeless case” this assault would not have taken place.

Procedure allowed Dr. P to write a response to my complaint.  In his response he actually admitted to speaking with Dr. X who told him that I “had long standing borderline personality disorder and that none of his colleagues would take [me] because of this.”  Incredible!  Psychiatrists in the hospital were actively denying me care due to a psychiatric misdiagnosis?  I wouldn’t believe it except I’ve seen my charts and I know it to be true.

Dr. P’s explanation for not using freezing was that he thought my arm was so full of scar tissue that I would not be able to feel the sutures.  This made no sense since I was screaming while he stitched my arm.  He wrote that he offered me anesthetic which was a lie.  Luckily the two nurses who were working supported my account of events.  Also the Dr did not note in the chart that I had refused local anesthetic which is standard protocol before proceeding without it.   I found out later that my complaint was not the first one made to the College about Dr. P and his behaviour in the ER.

The College upheld my complaint and Dr. P was ordered to appear before the College for discipline.   I’m not 100% sure what that entailed but my complaint was heard.  I did feel validated by that, but it did not undo the trauma that I experienced.

I experienced torture within a Canadian hospital.   This happened because of the label of borderline personality disorder.  This happened because I wasn’t getting better quickly enough, because I wasn’t acting in a way that was expected of a survivor of violence.

But this should not have happened, not to me, not to any person.  Especially not to a survivor of abuse.  Self harm was a normal coping reaction for me.  My personality is not disordered, I survived ongoing sexual and emotional abuse; as well as dangerous side effects to the very medications the hospital kept pushing at me.

My message to the world:

Please treat folks who harm themselves with care and compassion.  Chances are they are already judging themselves far more harshly than you ever could.  Self harm is a misunderstood coping technique, it is not a way to get attention.  If you haven’t harmed yourself, please don’t judge, you haven’t walked in our shoes.  The reasons why people turn to self harm are complex and layered. By showing love and compassion to the self-injuring person you could be literally saving their life.  We don’t want or need to be saved, we just want to be respected, heard, and valued.

If you do harm yourself, please know that you are loved and important.  I hope one day you will find other ways to cope.I support you and I am glad you are fighting rather than giving up.

The world is a better place because you are in it.

 

 

Day 1 (aka welcome to hell)

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The first time I was admitted to South Street hospital was in January 2001.  I had been in crisis since around October 2000, shortly after meeting a new boyfriend.  I had begun self harming with increasing frequency.  I was struggling with overwhelming memories of the sexual and emotional abuse I had survived as a teenager which I had almost blocked from my consciousness.

I was 20 years old.

When the memories began to resurface one day in the middle of a lecture a lecture hall at the University of Western Ontario I had an intense panic attack.  My brain was overwhelmed with connections being made and I felt incredibly unsafe, wanting to run.  I started having regular panic attacks at school and I became increasingly depressed and socially isolated.

One day I called the local Mental Health Crisis line.  It seemed like a reasonable idea.  The person I spoke to realized that I had no resources in the city and offered me an appointment with the psychiatrist who saw patients once a week at the Mental Health Crisis office.  Seeing little other option, and feeling it was logical to accept any help that was offered to me I went a few days later to meet with the Dr.

Dr X will remain nameless in this blog.  Anyone living in London, Ontario who has accessed emergency psychiatric care within the last 20 years probably knows him and his snakeskin boots well.  15 years later I still can’t see snakeskin boots without shuddering.

As my mental health unraveled in the following weeks Dr. X offered to admit me to the hospital.   The plan was to start me on some psychiatric medication and to stabilize me.   By that time I was barely sleeping or eating and I was desperate.   I believed that doctors helped people who were sick and that the hospital could be a safe place.

My first admission was on 8 East.  The top floor of the hospital, where Dr. X’s offices were located in another wing.  I barely remember going to the hospital or what happened when I first arrived.

What I do remember is being terrified.

My nurse was a kind man named Grant.  He took me to my room.  It was evening and I was handed a bunch of pills.  I didn’t know what they all were but I took them.  The rest of the evening is a blur.  I was told later that a friend of mine came to see me, but I have no recollection of it.  My first experience with anti-anxiety medication and sleeping medication all mixed together and I remember nothing.  At some point my boyfriend at the time must have left, visiting hours ended.

I woke up early the next morning, suddenly aware of my surroundings.  At this point I was beyond afraid, I was almost frozen with terror.  What had I gotten myself into?

It was a fairly small hospital room.  I had one roommate and there was a bathroom with a toilet and sink.  I remember a lot of greens and beiges and linoleum floors. My bed was by the window and my roommate’s bed was by the large metal door.  There was a curtain separation our beds, I think it was green.  There was an antiseptic hospital smell in the air, the sheets smelled institutional.  If you don’t know what institutional smells like, sniff the sheets and blankets in any hospital.

The door to the room was closed.   I was curious about what was going on in the hallway.   Would breakfast arrive?  Was I allowed to leave my room?  How many other patients were there on the unit?  Where was I allowed to go?  What was I supposed to do?  Would the nurse come back to answer my questions?

At last, I worked up enough courage to open the door, just a crack, enough to see out into the hallway.  My heart was racing.  The hallway was empty and quiet.  I could see other doors which looked like mine.  I could see what I assumed was the nursing station, with its glass wall, diagonally across from my room.  At each end of the short, corridor were locked doors.  I knew one led off the unit, to the elevators and freedom, but I didn’t know where the other one went.

I remember going back and sitting on my bed and just waiting, too afraid to leave my room.

Finally, my nurse Grant arrived.  He explained some things, that meals would be delivered on a tray, showed me where the shower was, how to ask for help at the nursing station etc.  He also brought a little paper cup filled with tiny plastic bags, each one contained a single pill.   Morning medication.  He checked my hospital bracelet, matching the ID # to the little bags of pills. I took the pills without questions.   I was here to get better right?  The doctor is an expert, he knows what is best.

I don’t remember very much about that admission except the intense panic I felt and how desperately I wanted to leave almost the moment I got there.

I realized very quickly that the psych ward was filled with other sick people.  This atmosphere was not always the most conducive to my healing.  My first roommate had an eating disorder and insisted on talking about it graphically to me.  She was taking huge amount of laxative pills in our room.  I also struggle with anorexia, which at that time was fairly well managed.  I remember being confused, didn’t this woman want to get help?  Why didn’t the staff take away the medications she was abusing?  Why was she sharing triggering details of her eating disorder behaviour with me?  Didn’t she know I was here to get better?

After less than 48 hours, I had had enough and I learned, during my very first inpatient admission, the vital skill of the psychiatric survivor.  How to tell carefully crafted lies (or sometimes desperate unplanned lies) to hospital staff to get yourself out of sticky situations.

I told Dr. X I was feeling better.  I would take the medications at home and see him as an outpatient.  I was there voluntarily so he allowed me to leave.

Less than 48 hours later, head spinning, on a cocktail of psychotropic drugs I was home.

I didn’t know at that time that this was the start of a vicious cycle of becoming desperate, seeking help at the hospital, experiencing trauma at the hospital, running home, problems unsolved, becoming desperate again and REPEAT.  This cycle continued and escalated for the better part of 4 years.