Why are psychiatrists so ignorant about eating disorders?

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I recently accompanied a friend to an intake appointment at our local eating disorder treatment centre.  The program operates out of a psychiatry program at a major hospital in our city.  It’s a medium sized city, and a fairly well known treatment program which is publicly funded and free to access.

I was completely disgusted by a good portion of what the Dr said.   Sadly, many of the things he said were things I have personally heard from other doctors.   I found it pretty triggering and it wasn’t even my appointment.

Let me share a few thoughts about what NOT to say to someone in recovery from an eating disorder (especially if you are a Dr who is supposed to be an expert!):

  1. Do NOT ask people about their history with traumatic events and then proceed to tell them that their abuse is connected to their eating disorder, but that your eating disorder program does not treat trauma.   This makes absolutely NO sense.  If aren’t willing to help someone address the roots of their coping techniques, don’t bother asking intensely personal information.  It comes across as invasive, asking questions for the sake of personal curiosity rather than to actually help someone.

Instead:  All eating disorder programs and specialists should be willing to help patients cope with the traumatic events they have survived.  If they hadn’t experienced those traumas they likely wouldn’t have turned to eating disordered ways of coping in the first place!  You don’t have to be a trauma expert, you just need to be trauma informed.  Validate!  Believe people!  Let them talk about the links between their traumas and their eating disordered behaviours.   I can almost guarantee that nobody will achieve lasting recovery without addressing the root causes of their problematic coping techniques.  Conversely, do not refuse to allow people with eating disorders to access PTSD services.  Do not forbid patients from discussing addictions either.

People don’t exist in boxes.  Someone often copes with PTSD, eating disorder AND addiction.  They shouldn’t be forced to lie about some things to access services for other related issues.   Services NEED to be intersectional or they are borderline useless and can further stigmatize vulnerable people.

2.  Do NOT shame people about their weight, body shape or the foods they eat.  People of ALL shapes, sizes, genders, races and socioeconomic statuses can suffer with eating disorders.  Do NOT promote restrictive eating by underestimating what a healthy amount of food is.  Do NOT set goal weights so low that someone will still be underweight when they finish treatment. Conversely do NOT assume that everyone who has a BMI over 25 is unhealthy.  Fat people can be healthy.   Encouraging someone who is fat to drastically restrict causes shame and further disordered eating.  All bodies look different, people can be healthy at different sizes.  The goal should be to reduce body shame and increase normalized eating.  This will NOT look identical for each person in recovery.  Do NOT place moral values on food such as labeling certain things as “junk” and “unsafe” or off limits.  Believe me, the person with an eating disorder has enough of these nasty thoughts in their head already.   This attitude needs to start with children from a very young age, where they can be taught that food is not something that makes them good or bad.  Our value as humans is not correlated in any way with the food choices we make.  All people have inherent worth or value, no matter their body shape, size or food choices.

Instead:  Promote body positivity within eating disorder treatment.  Do not assume that all recovered bodies will be a certain size.  Encourage people to gradually learn to return to intuitive eating, and trusting their bodies.   Explain that some people in recovery from restricting eating disorders may be extremely hungry while they restore their weight.  This is normal.   It’s okay to eat slightly more than your meal plan if you are genuinely hungry.   Focusing only on BMI, weight and portion sizes can turn into another type of obsessive compulsive eating behaviour.   Teach people that normalized eating can vary from day to day and that is okay.   You aren’t a bad person or shameful because you ate 3 cookies instead of 2.  You aren’t broken or weird if you are still hungry after a 1 cup serving of cereal.  Meal plans are important in early recovery, but they are NOT the be all and end all of treatment.     Don’t treat people who are thin as morally superior to people who are overweight.  Ideally, don’t make comments on people’s bodies at all.

3. Do NOT assume you can tell whether or not someone has an eating disorder based on their appearance.  If someone is struggling with disordered eating symptoms, they deserve care, help and compassion.  It makes NO sense to only provide services to the very sickest people who are basically on the verge of death.  By this point the health consequences can be severe and the behaviours are SO entrenched it can be extremely difficult to recover.  As with most illnesses and mental illnesses early intervention and prevention are KEY.   Providing services based on how medically unstable someone is only encourages people to compete to see who is the sickest.  It makes people who have larger bodies feel they don’t deserve help or aren’t sick enough to MATTER.  It perpetuates the stereotype that only young, white, rich VERY thin women can have eating disorders.  An eating disorder is a serious mental and physical illness and ALL people who suffer, regardless of race, gender, size etc deserve treatment.

Instead:  Stop using BMI alone as a measure of health.  The newest version of the DSM has removed BMI criteria from the anorexia criteria.  Doctors need to follow suit.  Even if someone is at a BMI of 19.5 or 20, or even higher, they can still be struggling with anorexia. Being weight restored or reaching a minimum BMI of 18.5 is NOT the only indicator of recovery.   Ideally body positivity should be encouraged and fostered at all stages of the recovery process.  Governments need to increase funding for eating disorder treatment to make it more readily accessible to folks who are at risk or at the early stages of illness.   Fight fatphobia and discrimination based on weight (and class) when you see it happening around you.

4. Do NOT make negative comments about food at ALL.  I can’t even count the number of times I’ve heard people say things like “I’m so bad for eating this cake”  or even “I feel so guilty for eating a sandwich instead of a salad.”   Don’t promote fad diets.  Don’t promote cutting out whole food categories. Don’t promote the idea of “clean” eating as morally superior.  Don’t imply that eating a salad is virtuous and eating cake is dirty.  Just stop.  PLEASE.  People around you are listening.  Impressionable people. Young kids whose opinions about food are just forming.   Friends and family members who may be struggling with eating disorders themselves.   This may be controversial, but unless you have a food allergy, there is NO need to obsessively eliminate particular foods from your diet.  Everyone has preferences, but that is NOT the same as conferring MORAL value on food.

Instead:  Remember that food can serve many purposes including enjoyment, nourishment, connection (sharing a meal with friends and family), ritual, celebration etc.  but food’s purpose is NOT to cause shame and guilt.  Be vigilant about situations when food is given a moral value (good or bad, clean or dirty).  If you feel confident, let people around you know that judgmental comments about food are not welcome and can be triggering for those in eating disorder recovery and those who are predisposed to developing eating disorders.

We all deserve to have a positive relationship with our bodies and the food we eat.

No Need to Argue.

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“There’s no need to argue anymore. 
I gave all I could, but it left me so sore. 
And the thing that makes me mad, 
Is the one thing that I had, 

I knew, I knew, 
I’d lose you. 
You’ll always be special to me, 
Special to me, to me. 

And I remember all the things we once shared, 
Watching T.V. movies on the living room armchair. 
But they say it will work out fine. 
Was it all a waste of time. 

‘Cause I knew, I knew, 
I’d lose you. 
You’ll always be special to me, 
Special to me, to me. 

Will I forget in time, ah, 
You said I was on your mind? 
There’s no need to argue, 
No need to argue anymore. 
There’s no need to argue anymore. 

Special.”

-The Cranberries, No Need to Argue, 1994

My 15 year old self is crying inside me right now as I read the news of Dolores O’Riordan’s death.  The Cranberries WERE the soundtrack to my life for many years of my teenage life.  I still have their album No Need to Argue in my car, and their songs on my playlists.  I remember listening to their CDs with my friends, at parties, and on my Discman taking the bus to and from school.  It was THE music of that moment in time, for many teenagers I knew.

I saw them play live in Montreal,  August 30, 1996.  I was 15 and it was my first stadium concert experience.  I remember being taken a back by how absolutely tiny Dolores O’Riordan was.  Her voice was unique, powerful and occupied an immense space in my life.  But in front of me, she was dwarfed by her large guitar.

I attended the concert with X, my boyfriend at the time.  We used to listen to the cranberries together all the time that year.  That concert is one of the positive memories I have of our relationship which was largely abusive.

I remember being younger (maybe it was earlier in 1995) at a party at my friend’s place.  Those were THE parties.  Some of the best memories of my high school years.  Teenagers all throughout the house.  It was just before some people started drinking and doing drugs.  High school, the joy of a party, without the ending of the innocence of childhood, when peer pressure began leading to alcohol and complicating situations.

Everyone had dumped their coats at the bottom of the staircase.  I remember lying there with the person I was dating.  The cranberries CDs playing on repeat in the background.  It was warm and dark and I felt safe, happy and at ease.  I remember laughing and talking with him, content in the knowledge that we were in a safe place, surrounded by our friends.  Life felt simple in those moments.  I knew where I belonged.  I fit in and was a part of a larger shared experience of being a teenager at a particular point in time.

The cranberries were the soundtrack to those happy times with friends.  The cranberries were BELONGING.

And they were one of the soundtracks to the abuse that followed.  Their CDs on playing on his stereo, in the dark navy blue of his room, while he touched me and forced me to do things.  They on the beloved stereo system that I got for my 16th birthday, while he abused me on my bed and on the floor of my room.  We talked about the music, we listened to the new CD “To the Faithful Departed” together.   The sense of belonging was also departing from me, as I became increasingly tied to, and faithful, to him.  I no longer felt safe and happy.  I felt trapped, guilty, ashamed and alone.

In 1997, I had escaped from X.  But I was spiraling deeper and deeper into the isolation of anorexia.   I listened to the cranberries, on repeat, on my stereo.   I was alone in my own room at that point, listening and writing by candlelight.   Listening while I did my homework and long into the evening.  I was detached and slowly fading into invisibility.

The cranberries came with me throughout the rest of my life.  The iconic sounds of Zombie transport me back to 1995, every time I hear them.

The cranberries are simultaneously belonging and safety, along with abuse and isolation.  The cranberries represent what being a teenager meant to me.

Dolores O’Riordan, gone too soon, but her music never forgotten.

 

Internalized Stigma.

 

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

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

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

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

As it turns out, a lot could go wrong.

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

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

I’m going to blame this on stigma.

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

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

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

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

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

These pills help me.

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

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

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

 

Night Bears.

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Someone told me a story about her daughters, who woke up at night and looked for the “bears” that were scaring them, having misheard the word “nightmare” as “night bear.”  It was a sweet story and I loved the imagery.  I took to calling my PTSD nightmares, night bears.   It makes them less scary in a way, because I think of bears as being soft and cuddly rather than threatening.

Night bears are something I’ve struggled with since I was a small child.  I still remember some of my recurring childhood nightmares.  I remember a dream where I was Red Riding Hood, walking along a dark path between tall, thick, dark shrubs.  I heard sounds and I reached my hand through the hedge, only to find a giant, grey, terrifying wolf grabbing at my hand.  I would wake up terrified and frozen.  I tried to call out but my voice didn’t work. That paralyzed feeling happened often as I woke from dreams, I felt I couldn’t move or speak.  Eventually I would be fully awake and run into my parents room.

When I was a teenager I took some medication to prevent malaria while travelling.  I was 16 and it had a very negative impact on me.  I’ve always been sensitive to strange side effects from medication.  I began to have even more vivid dreams.  They were full of all the sensations.  I remember having a dream about being on a battlefield during World War Two.  I could actually smell the smoke from the fires burning around me, I could feel it in my nose.  The heat was burning and I woke up sweating.

As a teenager I also began to have precognitive, predictive dreams.  This may sound bizarre and ridiculous to you, it sounds strange to me too, but it happened.  I had a friend in high school who struggled with self harm and suicide attempts.  I would have vivid dreams about her.  When I arrived at school she wouldn’t be there.  I remember calling her house, frantically from the pay phone in the hall.  Every time I found that she was in the hospital after harming herself, often in similar ways to my dreams.

In my 20s and early 30s, I had another friend who I had a similar connection with.  I’ve written about her in some of my other posts “MJ.”   We lived in different cities, but the precognitive dreams were eerie.  She could never figure out how I knew she was in trouble, or in the hospital, before she even contacted me.  It happened so many times that we both began to trust in the strange premonitions I had about her.

Because of these experiences, when I have vivid dreams about death and violence I am often afraid.  I worry that something bad has happened to someone I care about. I worry that there will be bad news.  I worry that it’s a sign.  It’s a horrible feeling, and I try to reassure myself that precognitive dreams are not real and that my brain is just expressing stress and worry through images of violence.   I’m never 100% reassured though.

In the last few years of my marriage, I had vivid rape and sexual assault dreams.  I would wake up screaming, thrashing around in bed.  It would wake up my husband too and he would comfort me.  But I often felt confused and afraid.  The person who was abusing me, perhaps triggering the dreams, was the only one there to protect me from the nightmares.  I remember having one particularly bad dream in the months before I left him.

In the dream I was attacked by a man on the street.  I was trying to fight back and to scream but I was pinned to the ground.  There was a chain link fence beside me as I lay on the ground, on the side walk.  I was trapped under his weight as he raped me.  The only part of my body that I could move was my right hand.  I somehow grabbed a stick and frantically banged the chain link fence with it, trying to attract the attention of someone who could save me.  I remember waking up, my right arm hitting out in bed, strangled cries coming out of me.  I used to worry it would wake up my children in the other rooms.

As long as I can remember, nightmares have been a feature of my PTSD.  When I am under too much stress, the nightmares return.  They cycle through various themes over a period of days to weeks, and then they relent for a while.   I rarely have the dreams which are so intense I wake up shouting and fighting imaginary enemies anymore. I do still occasionally wake up in a sweat, from deep sleep to intense panic attack, then back to sleep again.

Recently, I’ve been having a lot of nightmares.  I think it is because of the stress of the court case and the triggers related to my marriage, the unfairness of the system and the stories I hear at work.

This week I’ve been dreaming about death, violence and natural disasters.  When I wake from the dreams I’m disoriented and confused.  When I’m alone it’s very difficult to feel safe and calm.  Sometimes I turn my cell phone on, just to ground myself in reality and remind myself that I’m not alone.  That I could call or text someone if I needed to.  I open the window, I listen to the wind and the leaves.  I cuddle my teddy bear.  I breathe and I let the semi-medicated, blurry sleepiness take me back into sleep.

Last night I was feeling unsettled and struggling.  I’d gone up to bed early but had some trouble relaxing.  I had the window slightly open as usual.  I woke up in a complete panic, startled awake by the house shaking from the strength of thunder and lightening nearby and wind howling through the window, rain pounding.   It was so intense that I was afraid.  I usually love storms.  But I hate being startled awake.  It’s a trigger to the abuse.

I was dreaming about being in a hotel by the beach.  There was a giant tsunami crashing onto the beach.  I was running from room to room in the hotel, as it filled up alarmingly quickly with water.  Somehow all the rooms were sealed and there were no windows to open.  There was not enough air and eventually no place to run.  It reminded me of the passengers trapped on the sinking Titanic, right at the end.

Last week I dreamed about being at the strip mall near my house, at dusk.  I was alone.  I found a severed head on the pavement, blood everywhere.  I was shocked to realize that the head was alive and speaking to me. I called 911 on my phone and ran over to the head, trying to comfort what was left of this person.   At the same time, my mind was screaming at me that it was impossible for a head to be alive without a body and that something supernatural or unnatural was happening.  I was calling out and calling out for help and then I woke up.

That same week I dreamed about an old man dying while I held him in my arms.  His face was hollow and his breath rattled as dying people’s do.  I woke up so sad, and the sadness stayed with me all day.

That’s the thing about PTSD nightmares.  They don’t just fade when I wake up.  Bad dreams fade, neutral dreams fade, but PTSD nightmares stay with me…sometimes for years after.  They can put me into a mood before I’m even out of bed in the morning.  They also make me feel exhausted, as if I’ve lived a whole day instead of sleeping through the night.

They are difficult to talk about.  I expect to hear “don’t worry, it was just a dream,” but they don’t feel like dreams to me.   These nightmares are resistant to medication, to therapy, to the power of positive thinking.   They have a life of their own and I can’t control them.  That also feels triggering.

To everyone who struggles with PTSD night bears.  I hope you have a restful sleep tonight.  I hope you have someone to comfort you when you wake up afraid and disoriented.  I hope you can comfort yourself too.  Nightmares aren’t “just dreams,”  they can be traumatic, draining and incredibly frustrating.

Things to do instead of self harm

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I’d like to share some ideas for readers who have struggled with, or currently struggle with, self harming behaviour of any kind.  Self harm can include physical injuring, substance abuse, eating disorder habits, workaholism, over exercise etc.

Personally, I find harm reduction models to be the most effective in reducing self harming behaviour.  Because self harming is a coping method, and has served a purpose, it is often difficult to abstain from doing it.  I also believe that the majority of habitual self harming behaviour is shame and avoidance based in at least some ways.   I have found it easier to live with the idea that I will sometimes engage in behaviours that are not 100% beneficial to my health.  By acknowledging this openly, I reduce the level of shame I feel when I do make a mistake, slip or relapse.  Relapse is a part of recovery in a harm reduction model.  I don’t need to feel ashamed if I go back to my old way of coping in a crisis.  Those ways worked for me for a long time and they are  habitual and comfortable to slip into.

If I have a slip, I don’t make a big deal about it.  I just move forward and try to make a different more self caring choice in the future.  Removing the intense lens of self judgment from the situation has been helpful for me.

When suggesting alternatives to self harming behaviours, I acknowledge openly that not all options are available to all people.  This is not  a list that says “you should do this” but just some options that have worked for me personally.  Using the word “should” can increase feelings of guilt and shame if you do engage in self harm. I highly encourage you to use this as a model, and make your own list that feels right for you.  Give yourself permission to explore different coping options, keep the ones that work and leave the ones that do not.  Personalizing your recovery plan is another factor that will lead to greater success within harm reduction.

  1. Give yourself permission to struggle.  It’s okay that you feel bad right now.  Your feelings will have a beginning, a middle and an end and you can survive them.  Sitting with your feelings is an option, even if it is very uncomfortable
  2. Get safe.  Often urges to self harm are a red flag for me that I’m not feeling safe or I’m feeling overwhelmed.   Reduce any stress you have control over.  Relocate to an environment that feels secure.
  3. Spend time in nature.  The trees are not oppressive, nature is forgiving.  Nature can just mean getting outside, walking around the block, sitting in a park and breathing deeply.  Noticing the colours in the leaves outside.
  4. Wrap yourself up in warm blankets, quilts, cozy sweaters etc.  For me feeling safe often involves feeling warm and wrapped up tight.  Sometimes even the weight of the blankets is calming to me
  5. Prepare a hot or cold beverage.  The warmth or chill of the cup in your hands can help to ground you.  Focus on the temperature of the glass, and the feeling of the cold or warm liquid in your mouth.  Taste the flavours in your drink and take time to breathe.
  6. Draw, scribble, write, paint -express your feelings.  Artistic self expression has helped me avoid self harm.  You don’t need to be an artist to do this, you don’t need expensive art supplies.  Sometimes just a piece of paper and pen is enough.  Feel free to destroy your creation after.
  7. Reach out.  Call a friend, a family member, a support or crisis line.  If you don’t feel comfortable calling anyone, try going to a public place like a library or coffee shop and just break the isolation by sitting there with people around you.  Talking to a safe person is often a good way to work through urges to self harm.  You have the choice to tell the person you are struggling or not.
  8. Distract yourself with an enjoyable TV show, youtube video, magazine, book or music.  Lose yourself in another world for a short time.  Choose something that will cheer you, not something triggering.
  9. Exercise.  Use your large muscle groups.  Walk, do jumping jacks, stretch, yoga, lifting cans in your kitchen, anything you feel able to do and have access to.  Moving your body can help you process intense feelings like anger.
  10. Connect with spirituality, meditate, religion etc.  Connect with a higher power.  For me this means visiting nature and getting in touch with how small I am compared with the power of the natural world
  11. Spend time with someone very young or very old, or a pet.  Volunteer, connect with a family member, visit a neighbour with a new baby, offer to pick up groceries for a senior living in your area.  Walk your neighbour’s dog, take care of your own pets. Helping others, even in small ways, can be an option and alternative to self destructive coping.  For me, being able to help another person reduces my sense of shame and hopelessness and increases my connections.
  12. Hug a stuffed animal.  Sometimes I need comfort and stuffed animals are a good option for me and help me feel safe.
  13. Spend time around water.  Take a bath or shower.  Walk by the river, ocean or lake.  Go swimming.  Run warm or cold water over your hands and wrists.   Flowing water can be very calming.
  14. Use positive affirmations, ideally ones you have prepared yourself.  Sometimes self harming is driven by negative self talk and negative shame based messages you are giving yourself.  You can find ideas for affirmations on the internet and rework them to suit your purpose.  If an affirmation seems unrealistic try adding “I’m learning to…” at the beginning.   For example, “I’m learning to love myself.
  15. Remind yourself that you are doing the best you can.  That you are surviving and sometimes that is enough.  Some days all we can do is survive and that’s okay.

These are just a few ideas I’ve worked with over the years.  I hope you find them helpful.  Please feel free to comment with your coping ideas!

Why I sometimes miss self harm…

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<trigger warning for description of self harm>

It’s a strange thing to admit, but if I’m 100% honest with you, I still miss self harm.  As a coping mechanism it has to be considered one of the worst.  Almost my entire body is covered with permanent scars.  The scars cause me to be self conscious and feel shame.  The scars also result in social stigma, and difficulty in being taken seriously by health care providers.  They itch as they heal and sometimes they hurt.  They are constant reminders of parts of my past that I’d rather forget.

Usually when I think about self harm, what stops me is remembering two things

  1. The self harm only ever helps for a brief moment
  2. I will have to hide the wound and feel intense shame about this, as well as worry about the consequences if anyone sees the injury

This usually works, but sometimes I feel bitter and angry.   Sometimes I have thoughts like “If society didn’t consider self harm to be SO AWFUL, I could just keep doing it, because I wouldn’t feel ashamed and I wouldn’t worry about the potential negative consequences on my family.”  I get angry and I feel like my coping mechanism is being taken away from me.  I get angry and think about how some people get fall down drunk on a regular basis and society thinks this is acceptable.   Why isn’t MY coping mechanism acceptable too?  I feel like having a tantrum like a 2 year old child!  I want it and I want it NOW!  But most of the time I refrain from self harming, not just for my children, but for myself too.  It’s not a lifestyle that I want to return to.

I do want to write about some of the complex reasons I miss self harm.  Some of this might sound completely ridiculous to you.  I’m worried about being honest and just writing this down.  I’m worried about being judged for liking some aspects of this self destructive habit.

Self harm gave me something physical to take care of, and be taken care of for,  when my inner pain was un-fixable and unreachable.

Even though I experienced a lot of maltreatment and abuse in the psychiatric system and hospital emergency rooms, I sometimes miss having a physical injury that could be fixed.

There were times when I was almost addicted to the process.  The care I received after self harming was almost as important, if not more important, than the ritual itself.  The trip to the emergency room WAS part of the ritual.   To be honest, without this part of the ritual, without the serious self harm, it seems almost useless to hurt myself at all.

There was a predictable ritual to the emergency room visit.  At times, I felt safe and cared for there.  At times it felt like a pause, a break from the day to day stressors in my life, which at that time felt unbearable.   I think there was a part of me that used self harm and suicide attempts as an excuse.  Not a cry for help or attention, but a cry that said: “I can’t do this.  It’s too much.  I need a break.  I need to be cared for.  I’m not capable.  I’m afraid to fail.

I remember some of the times I had multiple serious injuries from self harm.  It took the doctor or medical students a considerable amount of time to fix the cuts.  During that time, the doctor would often speak to me.  I had their full attention.  I was being cared for and I was being symbolically “fixed.”

There was a ritual to the process.  Triage.  Waiting room.  Exam room.  The questions.  The cleaning of the wounds.  The freezing.  The sutures.  The bandaging after.  The conversation.  The questions.  For those hours, if I was treated nicely, it was like being numb and being in another world.    A world where time was stopped, my responsibilities were paused, the outside world did not exist.    I actually FELT better afterwards, like I had been healed, but the improvement was so fleeting.  So very fleeting, that often I was injuring again only a day later.

It was as if the injury gave me an excuse to stop, validation to say “I’m not well.  I’m not coping.  I need help!”  Without the injury, without the physical reason, I struggled to ask for or to accept help.  I still do.

I’ve never really verbalized all this to anyone before.

I remember one time, I cut myself on my stomach.  It was deeper than usual, maybe deeper than I intended or realized, because I was new to injuring in that spot.  Over time I had learned to hurt myself in places I could hide.   (When I first started, I was almost hypomanic from SSRIs and I cut in visible places, places everyone could see and that were very difficult to hide.)

I went to the hospital, as I usually would, alone.  At the triage desk they examined me, discovered the wound was serious and triaged me as Emergent rather than Urgent or Less Urgent.   I was put into a wheelchair and taken back into a part of the ER I’d never seen before.  I think it was the place for seriously ill people. The lights were dimmed and the bed was actually comfortable.  I had my own room, not just a curtained area.  It was quiet and comfortable.  I didn’t have to wait very long and I remember feeling safe and calm and protected.  I felt like my health problem was considered important, legitimate and I was being cared for appropriately.  I had a female doctor and she was kind to me.  She was wearing ordinary clothes rather than scrubs or a gown.  I remember her as being fairly young.  She treated me as if I had a physical health problem, not as a mad, crazy, unworthy self harming psych patient.   I felt bad because she got blood on her clothing while she fixed my injury.   I can’t really describe exactly what happened that night.   But I felt protected and the ritual had worked, my mind was quiet.  The racing thoughts were gone.  It was silent and the room was dimmed, like the thoughts were dimmed as well.  For that time I was in another world.

I’m having a difficult week.  I’m feeling overwhelmed and lonely and scared.  I’d like nothing more than to be cared for.  To be honest, the thought of that quiet, dimly lit emergency room bed is very appealing. But I don’t want to achieve this through self harm.  I don’t want to be “sick” and treated in hospital to get a break or to feel validated in resting.

I want someone to take care of me because they care about me, not because it is their job.  I want comfort because someone loves me, not because they are scared that I might harm myself.

I want to be an adult and not a misbehaving, out of control 2 year old.  This is part of what recovery means to me.  I have to use my words, not my actions to let people know that I’m not okay.

Note: the art was made in 2005

It was “just” sexual abuse…

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I’ve been thinking about the barriers I faced in coming forward about being sexually abused, as a child and as an adult.  For people who have not experience sexual abuse, the most immediate response to someone disclosing is often: “why didn’t you tell someone?”  or “why didn’t you tell someone sooner?” or my personal favourite “why didn’t you fight back/scream/run?”

The reality is I didn’t even realize I was being abused until long after the abusers had intertwined their lives with mine.

The reality is that abuse in relationships does always not look the way you might expect it to.

The reality is that I spent a long time, as an adult, in counseling, volunteering at a women’s centre etc…stating to other reasonable adults “it was ‘just’ sexual abuse.”  I made all sorts of excuses for why it didn’t count, why it wasn’t important, why it wasn’t real abuse, why I didn’t deserve help, why other people had it worse off, why I was making a big deal over nothing, why I didn’t want to tell anyone and ruin his life etc.

Because they never hit me, it wasn’t abuse.  Because they didn’t threaten to kill me, it wasn’t abuse.  Because I said yes some of the time, it wasn’t abuse.

I was (and am) pretty mean to myself and a lot of my perceptions were just plain wrong.

I think it takes a lot of strength and courage to really come face to face with the fact that your romantic relationship is unhealthy, abusive and actively making you sick.  It’s not something that comes easily, turning your back on the father of your children.

I told myself the abuse didn’t count.  I knew I felt uncomfortable, I knew it very early on in both relationships.  I saw the red flags, but somehow I interpreted them differently.  I wanted to believe that things weren’t really that bad.  I wanted to believe I could help the abusers change.  That they were depressed, that they needed me.  That their needs were more important than my own.  I wanted to believe that love would be enough.

I did start to talk about the abuse.  I did tell people.  In some ways, I wasn’t really challenged by those people.  I think many of them instinctively knew I wasn’t ready to leave.  They knew I needed time to come to the realization that it was abuse and that I needed to get out.  For the most part they didn’t push me.  I was still ambivalent about the abuser and I still wanted things to “work out.”

One day someone I volunteered with called me out.  I mentioned something about it being “just” sexual abuse.  She challenged me.  She sat there and said “what you are saying doesn’t make sense.  It’s not ‘just’ sexual abuse.”  I think it was the first time someone had openly called me out on my own denial.  This was in the month or 2 leading up to my decision to leave.

At the time I left him I still believed it was “just” sexual abuse.  I told almost nobody why I was leaving.  I thought that moving would solve the problem, because since it was “just” sexual abuse I would be safe.

I was wrong.  Sexual assault is not about sex.   It’s about power and control.  It’s about a level of narcissism that exists in this world that allows one person to disregard the consent of another person.  Within any type of relationship it’s about manipulation, it’s about gaslighting, it’s about making the victim feel crazy, worthless, broken, damaged, and most of all dependent on the abuser.   The sex is a tool of control.  It rarely happens in isolation.  Emotional abuse, psychological abuse, physical abuse, threats, coercion…it’s all part of the same package.  Even if the package is wrapped in a disguise that makes you believe that sex is the only issue and that otherwise the person is “basically a good guy.”

At the end of the day, if someone doesn’t respect your consent sexually, they don’t respect you.  They aren’t “basically a good person.”  They are a person who does not value your basic right to say yes or no in a given situation.  They are a person who puts their own needs before yours, and possibly even denies your needs are real, valid or even exist.

It’s a long road back from that place.  The place where you question whether your needs are reasonable, valid or even exist.  It’s a long way back from the place where you believe that your consent is not relevant, where your needs are not relevant.  Where you are blamed for not wanting to consent, even in a situation where there is no trust, no safety and almost no relationship left.

I’m writing this to tell you:

  1. if you have been abused, it’s never “just” anything.  Your experience is valid and real.  If you are uncomfortable, afraid, hurt, feeling crazy then trust yourself.  It’s abuse.
  2.  if you have been abused and even if you have not, please remember that there is no specific way an abuse survivor looks, copes or experiences violence.  There may be no physical marks, there may be denial, there may be almost no signs at all.  Trust yourself, if you have the feeling something isn’t right in your relationship or in the relationship of someone you care about, reach out.  Get help, talk it over, ask gentle questions, be there to support yourself or the person you care about.
  3. believe the survivor.  If you are the survivor, believe yourself
  4. if you still blame yourself, or the person you care about is blaming themselves, tell them it is not their fault.  Repeat step 3.  Repeat step 3 again.  Repeat it again and again and again.

I believe you.  It’s not your fault.  It counts.  It’s is real.  You deserve support.

 

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’m triggered.

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Being triggered is exhausting.

It feels like being in a constant state of fight or flight.  It feels like panic.  It feels like a reduced ability to think clearly and stay calm.  It feels like fog, a buzzing in my ears.  Everything sounds too loud, lights are too bright, smells too strong.  My clothes touching my body make me feel disgusting, fat and out of control.  Ana is screaming at me not to eat, while another part of me is saying that not eating will make me more panicked.  An internal war begins.  I feel like I’m in danger.

If someone tells me to “calm down” or “not worry,” the panicked feeling turns to desperate anger and I find it hard to keep it hidden inside.

If the trigger goes on for a long time, especially if it is combined with actual real life danger or stress, I eventually become exhausted.  I am desperate for the uncomfortable feelings to pass.

And in the desperation I always begin obsessing about self harm and sometimes suicide.  Intellectually I know that this doesn’t make sense, but it’s my brain’s default setting for  TOO MUCH STRESS!  I learned about 4 years ago that my suicidal ideation is a red flag, it’s a signal from my brain that I need to reduce my stress ASAP.  It’s not really about dying, it’s about ending the horrible painful, out of control panic feeling.  NOW.

My main ways of coping with self harming thoughts and suicidal ideation is by trying to tune out.  I do this mainly by surfing the internet, checking facebook, texting, checking my phone and also by blogging.  I find that technology is a good way of tuning out the self destructive thoughts for a while.   So sometimes, when I’m checking my phone too often, even if it annoys you, even if it seems impolite, try not to judge, I might be coping and distracting myself from negative thoughts.

Another great way of coping with triggers is exercise.  Before I developed arthritis I used to cope by running.  That was amazing.  I miss it so much.  Walking can help, getting out into nature can help, dancing can help, moving my body and letting some of the pressure release.   But when I’m at home, my go to coping during the evening (the most difficult time of day for self harm urges) is texting and internet time.

It’s hard to explain triggers to people who don’t have PTSD.  People who live with panic attacks or generalized anxiety can understand parts of it.  But PTSD triggers are a little different somehow, because they are connected very tightly with actual bad events which have happened in a person’s life.  It becomes very difficult at times to distinguish between immediate stressors in day to day life, and abuse/danger/violence.

Triggers can also be emotional.  For example one of my main triggers is feeling like I am not being believed, or even might not be believed when I’m speaking my truth.  Another is feeling like I’m going to get into trouble for doing something which is reasonable and not generally perceived as negative.  These feelings are related to gaslighting, emotional abuse and systemic/systematic institutional abuse and neglect.

When I’m triggered what I need is to get grounded as quickly as possible.  If I can’t get grounded then what I need is to keep myself safe and as calm as possible.  Sometimes this means that I want to be at home, be alone, or be with people I feel safe expressing myself with.  Staying safe sometimes means spending hours online after the kids are asleep, or lying in bed all evening because I don’t trust myself to make safe choices.   I’m not being lazy, I’m protecting myself in the best ways I have learned how.

Sometimes when I’m triggered I disassociate or space out.  I might seem emotionally distance or cold.  I might be more emotional, or my emotions might seem out of proportion with reality.  That’s because they are!  They are a reaction to reality PLUS the past trigger related to abuse and violence.

I know I’m not doing a perfect job at life when I’m triggered.  I constantly worry that others will judge me because my capacity to perform at my highest level is reduced.  My brain will literally shut down, I will have problems remembering things, trouble finding the right words under pressure, I might cry or freeze up, grow silent or suddenly angry.  I might be impatient with the kids when they haven’t really done anything wrong.  I might snap at those close to me, or not be as kind as usual.   I don’t mean to.  Believe me my level of guilt is so high that it contributes to the problem!  I know I’m not acting “normal” but I can’t help it.   Sometimes I need space to get grounded, sometimes I need others to remind me that even though it’s difficult I’m doing my best and that is good enough.

If the triggers are entirely related to the past, and no danger exists in the present, for example during consenting sex, it helps for the other person to remind me “you are safe right now, it’s 2016, you are with _____, nobody is going to hurt you”

If the triggers are related to the past, but there is some threat in the present moment, it helps to acknowledge both sets of feelings are real.  Yes, this situation reminds me of the past, that is difficult and scary.  Yes, there is some threat in the present and that is scary too.   I  might need to get grounded FIRST and then brainstorm solutions to the present situation.  Sometimes self care can play an important role in grounding.

PTSD is invisible, triggers are invisible, all this is happening inside my brain and my body is reacting.  It sometimes feelings as if the past is happening all over again.  Especially when triggers lead to flashbacks.

Please understand I’m doing the best I can.  PTSD is a difficult illness and because it is invisible it can be hard for others to understand.

Compassion helps triggers.  Everyone deserves to feel safe.  But when you live with PTSD, feeling safe can be like searching for the proverbial needle in a haystack.  When you aren’t quite sure what the needle looks like, or if it is REALLY in the haystack!  You aren’t even sure exactly why you need the needle and what you are going to do with it when you find it!

Yes, life can be confusing.  Triggers can be confusing.  PTSD can be confusing.

Tonight I’m confused, but I’m coping as I write.