13 years ago…my last admission at South Street

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Photo credit: http://www.lhsc.on.ca

For me, PTSD is extremely linked to anniversaries of dates.  January into February is a difficult time, with the memories of my last extended hospital stay in 2005 and my family law trial in 2016.  I often have flashbacks, memories and symptoms, and then notice the date and realize what is triggering them.

My last admission to South Street was in early January 2005.  I was there for about 5 weeks, my longest admission at that facility.  I was transferred in early February to the Regional Mental Health Care facility, the former London Psychiatric Hospital, where I stayed until sometime in March.  Since then, I’ve largely been free from in-patient admissions.

In my mind, I can walk through the buildings at South Street, especially the main building.  The large stone steps which led to the main entrance.  The single stall washroom off the lobby where I cut myself on a number of occasions, with sharps I brought back inside from walks.   The smell of institutional brown paper towel, and the cheap, strong soap found in hospitals everywhere still brings me back to South Street.  The smell of adhesive first aid tape and band aids, bring back the rusty smell of blood harden on towels during long emergency room waits.

Past the lobby was a small gift shop on the right side of the hall.  I would go down there to browse sometimes or to buy a magazine.   Just past the shop was a cafeteria.  It was more of a snack bar, I suppose they had meals there, but at that time I rarely ate more than a muffin or rice krispie square.  Being in the hospital was an excuse for Ana to get away with restricting more, when nobody was watching me eat or expecting me to do so.  I remember walking through the line style cafeteria.  I’m not sure what I bought, maybe cookies.   A little further, past the first set of elevators was a Tim Hortons kiosk.  It was small and didn’t carry a full selection of items.  It was open longer hours than the cafeteria, which shut at the end of the office hour work day.  I remember it being more dimly lit in the evenings.  There was a second set of elevators, the only ones which went all the way to the 7th and 8th floor: psychiatry.   If you kept walking to the rear of the building, there was a door to the “patio” which was where people went to smoke.   It was also the place where psych patients who had off unit privileges but not full privileges to leave the property, went to get fresh air.   The hallway split into a Y shape at this point.  To the left was the admitting department.  You could walk down a long hallway and exit there as well.

That last time I was admitted, I was a patient on the 7th floor.   There was an orderly who sat at a desk at the entrance to the inpatient unit, which was to the left side of the Y.  The stem of the Y had offices and the right hand side of the Y had other departments, like occupational therapy, and a patient dining room.   The hall was carpeted.   The carpet was dirty, even though it was vacuumed daily.   Patients and visitors had to sign in at the desk.   As a patient, passes off the unit were awarded in increments.  Maybe a 15 minute pass, lead to 30 minutes, led to 4 hours and then to an overnight pass.  Smokers were given 15 minute breaks at intervals throughout the day.  Visiting hours ended at 8pm and at that time the orderly went home and the door to the unit was locked.  Patients returning after 8pm had to ring a bell which alerted the nurses to let us in.  I remember coming back after an evening home, or out with my ex-husband.  The hospital was quiet, the main floor abandoned with the exception of security at the main entrance.  The elevator ride was quiet, the halls semi darkened.  It was easy to believe the building was haunted.  I would be buzzed back onto the unit, check in with the nurses to get my evening medication and then get ready for bed.

The rooms all had reinforced glass windows, many of them had metal grills covering them.  Some of them opened a tiny crack and others did not.   The hallway seemed impossibly long, with the nursing station 3/4 of the way towards the far end.  For all intents and purposes, it wasn’t all that safe.  The nurses were quite far away from most of the patient rooms.   They didn’t search us when we came back from passes.  It was quite easy to smuggle in anything.   On a different admission, I had a roommate who used cocaine and cut herself in our shared washroom. Another time, a patient who was supposed to be recovering from an eating disorder continually smuggled in laxatives which she took by the handful.   A third patient, being tube fed and struggling with bulimia would order large amounts of food and then purge.

It wasn’t exactly a safe place.

I spent a lot of time sleeping, resting and talking to other patients.  I filed out my menus and looked forward to the muffins and cereal at breakfast.   I ordered peanut butter and jam sandwiches for lunch.  The vegetarian and vegan options for dinner were largely inedible.  Sometimes I went home for dinner, sometimes I just didn’t eat.  The meals arrived at 8am, 12pm and 5pm on trays, covered with burgundy or dark blue coloured domes to keep the food hot.   There was a fridge with cheap Colt Ginger ale cans (regular and diet).   Sometimes I brought cereal from home.  I often went for a walk to the Tim Horton’s down the road where I would order caramel coffee cake and black coffee.   They don’t make that cake anymore, but you could order extra caramel sauce drizzled over it.

I coloured and read books.  I waited, sometimes what seemed like endlessly, for the doctor to arrive.  Sometimes the doctors checked in with you ever week day.   Sometimes they didn’t appear for days.  They appeared at unpredictable intervals.  Much of the time they spoke to us in our rooms, even in ward rooms with 4 beds, affording us little privacy.   If we were lucky we might get 15 minutes to talk to the Dr.    That last admission I had a very kind doctor.  He spoke to me in a private room.  It wasn’t his office, just a room for meeting with patients.  He believed me.  He talked about referring me to the mood disorders program at the RMHC.  He didn’t think I was borderline.   Sometimes there would be medical students or nursing students.  I liked them because they were allowed longer to talk to us.  It was lonely and there was little actual treatment in the hospital, aside from medication and medication adjustments.  The medical students gave each patient a physical exam within 24 hours of being admitted.  Even when I was in and out of South Street, I got the check up every time.  In reality, these 1st year medical students were just using us to practice doing physical exams.  But I didn’t mind.  I liked the attention and the chance to speak to someone.  The days were often long, and even the nurses were busy, assigned to multiple patients each shift.

Sometimes, if I was having a rough night, my nurse would bring me into a small room attached to the nursing station.  We would talk about how I was doing.  Mainly I talked about the urges I had to self harm.  Even in the hospital I generally harmed myself on an almost daily basis.   Looking back it’s hard to see exactly how I was helped by these admissions.  Once I even ended up needing stitches, while I was admitted.  I cut myself in the ground floor washroom, then went up to the 7th floor to confess.  A different medical student, maybe a psychiatry resident stitched it for me in my room.

In the sad, lonely state of mind I was in, there was something about the ritual of having my cuts sutured, that comforted me deeply.  I think it was a moment of literal relief to have something FIXED.  The inner trauma I was struggling with was coming back to the surface with frightening intensity.  I was in a new relationship that had rapidly become all consuming, emotionally and then sexually abusive.  I felt trapped.  I felt numb, depressed and hypomanic, agitated and anxious all at once.  I was in a frantic state which was triggered by SSRIs and other antidepressants.  I wasn’t thinking clearly for over 4 years.  I was afraid all the time, and yet I felt invincible in a way.  I knew only peripherally that my impulsive self harm and suicide attempts were extremely dangerous.  I both wanted to die, and felt like I was not at risk from the self harm.  I felt torn, tangled and pulled down, like I was drowning in trauma and suicidal thoughts.  I felt like a mechanical robot, and a wind up toy spinning out of control.

When I look back at myself during those 4 years, I barely recognize any aspects of my true self.  I was changed, and not in a positive way.

I was so young.  I was 20-24 years old.   I felt like a child, colouring, whining for help, begging for someone to SEE me.  I didn’t feel truly SEEN by anyone at that time.  I think I’d felt invisible and misunderstood for so long, that I actually was disappearing, even to myself.  I felt like I’d aged decades in a few short months.  I felt like a child trapped in the body of an older person.   My health was poor, due to medication side effects, self harm, self starvation and lack of structure and routine.  I became more and more socially isolated.  I lost connection with the “normal” world and I became a full time psych patient.  I filled out and inhabited the role of a sick person.  So much so that I no longer realized I was playing a role.  It became all I knew of ME.  I lost myself.   I lost myself in more ways that I can express in words.  I wanted to be rescued.  With all my heart I wanted to be rescued, but I learned to carefully shut people out.  I was also being isolated by my abusive partner.

That last winter in South Street, I was so suicidal I couldn’t leave the hospital alone.  I was perpetually compelled by thoughts of throwing myself in front of traffic on the busy road near the hospital.  I didn’t trust myself to walk anymore.  I knew all the train tracks that criss crossed the  neighbourhood, and all the shops which sold sharps I could use to harm myself.  I was a dead person walking.  I was more than half dead, I had more than one foot out the door of life.  I had 95% given up.

But somehow that last doctor who admitted me, he didn’t see my case as hopeless.  He didn’t see me as someone who was just “trying to get attention” or “manipulate the system”   I think he realized that it was possible the medication was making me worse.  I think he realized, and actually believed me that my next suicide attempt would be a completion.  He quietly talked to me, and quietly sent the referral to the specialist.  I didn’t have much hope, but I sensed that things were different.  Instead of lying to get myself discharged, I stayed there until the bed became available on the mood disorder unit.

5 weeks later, I was off all anti-depressants and on a new mood stabilizer.  The mood disorder specialist retrieved my life from the purgatory and hell of anti-depressant side effects, including medication induced hypomania.

Less than a year later, I was pregnant with my first child.

I never had another extended hospital admission.

South Street has been demolished for years now.  I visited the site last summer to see for myself that it was gone.

But South Street haunts my memories.  The images are so vivid, but in the faded colours of a worn down, dirty building.  Those years were brightly intense simultaneously to being muted and grey.

I expect they will be with me always.  But 13 years ago, I never imagined I would even get out alive.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Mental health care is a right, not a privilege.

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

You need a lot of energy to be sick.

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Another stereotype or stigma that I’d like to debunk right now is that people living with disability or chronic illness are lazy.  That they have SO much free time and can “do whatever they want” because they are unemployed.  We’ve all heard versions of this abelist stereotype.

It’s just not true.  People living with chronic health issues are as varied and different as people who are well, healthy, neurotypical or able bodied.  They are not lazy.  Being disabled is not a lifestyle choice.  Some people with disabilities are able work/volunteer/attend school and some are not.  Some have varying abilities depending on symptoms on different days.  Some people (like me) are “high functioning” (I HATE this term) and work full time, parent, take care of a house all while living with a high level of chronic pain and various chronic symptoms of mental illness.

But whether you are working or not, raising kids or not, volunteering or not, on social assistance or disability payments or not…I can say with 100% certain that being chronically ill is a lot of work.  I’d even say that it’s a full time job.  So we aren’t lazy, we are warriors.   Our work just isn’t valued by society, and a lot of it is invisible labor just to survive.

Please don’t perpetuate this stigma.  And please trust that each individual person knows what they can and cannot do.  If someone with a chronic illness is not working/volunteering/attending school it’s probably because their symptoms are too severe and they are not currently able.  Or maybe their workplace/school is not accessible for someone with their particular health issue.

It’s NOT because they a) don’t want to, b) aren’t trying hard enough, or c) are lazy.

Tonight, I have almost no spoons.  I drifted through the day, feeling foggy and having trouble concentrating.  I crashed on the couch and struggled to get up again.  I feel mentally and physically exhausted.   I didn’t run a marathon today, I didn’t work out…but I DID expend a great deal of energy coping with my health.

Before work I had a doctors appointment.  It was a new doctor, so there was stress and anxiety last night and this morning.  I got test results that weren’t what I was hoping.  I got requisitions for blood work.  I booked two follow up appointments.

Then I went to work.  Tried to focus, tried to get things done.  Took a break, got the blood work completed.  Went back to work for another hour.  Left at 3:30pm for a counseling appointment.

I see my counselor every 2-3 weeks.  I’d like to see her more often but it’s difficult to fit in around my other appointments, my work schedule, my kids, kids activities and kids medical appointments.  Again, as I mentioned, people with chronic illnesses aren’t lazy.  We often have numerous medical appointments that need to be juggled and fit in around already busy schedules.

Counseling is work.

If you are a survivor of trauma, and your counselor is pushing you, even gently, in the direction of healing, counseling can be exhausting work.   At the end of the hour I feel incapable of more than curling up in the fetal position on her couch and crying.  But instead I drive home and carry on with my day.

My counselor has been fairly patient with me.  She’s realistic about the fact that I have a LOT of current external stress in my life and she’s let me talk about that.  But in the past 6 months she’s begun to push me to talk about my past, my childhood, my core beliefs, and my trauma.  She’s also started to call me out when I disassociate in the session as a way of coping with feelings, memories and flashbacks.

I like disassociating to cope with feelings, memories and flashbacks.

It’s kinda my thing.

Most people don’t even realize I’m doing it.  Even fewer people would point it out.  Nobody else would purposefully try to stop me from using it as a way of coping.  I’ve always thought of disassociating as a self preservation, self protection mechanism.  I always thought I was coping if I zoned out to make a flashback less intense or make it stop.  I was coping.  It helped me survive, but maybe now there are other options…

My counselor wants me to stay present.  She wants me to TALK ABOUT what’s happening for me.  She wants me to describe it.  Or at least she wants me to stay with her in the room while it’s happening.  It’s very uncomfortable.   “But I LIKE disassociating!”  I whine…  “But it works!” I attempt to convince her.

She reminds me that I’m not alone.  That she is there to help me out of the feelings, body  memories and sensations.  That I don’t need disassociation and that maybe by zoning out I’m not actually allowing myself the space I need to heal.  Maybe I’m just stuck in a constant space of just surviving.  Maybe disassociating is actually taking up an intense amount of spoons to maintain.  Maybe zoning out is zapping my energy.

Chronic complex PTSD is exhausting.  Chronic pain is exhausting.

But maybe, just maybe doing the work of counseling and trusting the process might help restore my energy in the long run.  It’s draining work at the moment just trying to convince myself to TRY to approach my healing without disassociation.

I might have many flaws, I know I am not lazy.   Neither are you.  Keep fighting that stigma and keep surviving and thriving.

 

 

The Voice.

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

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

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

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

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

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

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

February 21, 2001

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

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

The answer that comes to my mind is love.

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

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

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

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

March 18, 2001

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

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

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

Can’t make everyone happy.

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

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

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

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

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

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

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

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

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

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

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

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

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

I can’t even make myself happy.

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.

Writer’s Block.

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I haven’t been blogging very much recently.

One reason is that I’m incredibly busy working full time and single parenting full time.

Another reason is that I have both so much to say and so little coherent to say.  I have all these ideas, memories, flashbacks, feelings and thoughts floating and swirling in my head, but haven’t been able to conceptualize a theme for a single blog post.

I started writing a post on Tuesday, which was the three year anniversary of my separation.  The day I told him I was leaving.

I never do well with anniversaries.  My PTSD gets worse, my flashbacks get worse, I think a lot about the past, my progress, where I have been and where I am going.  I am particularly impacted by holidays and anniversaries.  This is common for many people with PTSD because we don’t just remember things, we relive them.   Thus certain anniversaries of traumatic events are literally unforgettable.  I navigate my year around the anniversaries of various traumas, the deaths of my friends and family members, their birthdays, times when I was abused, anniversaries of meeting and leaving my abusers…it’s all stored in there.

The post I started was going to focus on how far I have come and the things that I have gained since leaving my ex-husband.  I was feeling particularly discouraged and demoralized after experiencing re-traumatization and further abuse from CAS and indirectly from my ex-husband.  I was beginning to feel like my entire life would be controlled and navigated by his abuse, until either he dies or I die.

But this week I feel a bit more hopeful.  Having a plan of action, even an imperfect plan helps ground me.  I wanted to write a bit about what I have gained through this three year, ongoing leaving process.  But even those thoughts weren’t properly formed and they were marred by intrusive thoughts and flashbacks.

I wasn’t sure if I should just write down a disjointed list of some of the flashbacks I’ve been having.  Because a disjointed post might accurately represent the way I’m experiencing life right now.  On the other hand, I really wanted to write something infused with gratitude.

In the middle, the blog post will meet here: a description of a flashback and why PTSD is so damn challenging, which will flow into some ways in which I am now better able to cope.

I want to describe the utter banality of some flashback triggers, because it illustrates how very unpredictable PTSD can be.   We all think of the obvious triggers, seeing the perpetrator, seeing people who look like the perpetrator, someone smells like the perpetrator, events remind you of the abuse etc.  But triggers can be literally anything.

Last week I was driving downtown and I saw a man walking down the street.  The man was unremarkable.  He was wearing a hospital bracelet on one arm and was gingerly holding his other arm which was wrapped in a clean, white gauze bandage.  He didn’t look unhappy or upset, he didn’t look like my abuser.  It was clear he was walking home from receiving treatment at the emergency room.  Nothing unusual, strange or threatening about it.

But I had an incredibly intense flashback which engaged all my senses.

I was back in time, I was leaving the hospital myself after receiving stitches for self harm.  I could feel the numbness in my arm from the local freezing.  I could smell the gauze and the tape they use at the hospital to secure the bandage.   I could feel the pain in my arm from where the stitches went in, as the freezing wears off and the swelling and bruising begins.  And I was overcome by an extremely intense urge to cut myself.  So intense that I felt dizzy.

Realize that all this took place in a matter of a few seconds.  The only trigger was seeing the man with the bandage and I had a complete physical and emotional reaction. Body memories, emotional feelings from the past and a motivation in the present to harm myself.

It’s quite incredible to me that this happened.  But this is what PTSD is.

And now the gratitude.

Living away from my ex-husband has given me the strength and motivation to resist those urges to destroy myself.

4-5 years ago if I had that strong an impulse to cut, I would have acted on it.  I would have used the flashback as an excuse…I had to do it….I would have given my power away to the urges.

Now, in recovery I can rationalize with the urges and I can ground myself and make an empowered choice not to harm myself severely.

I never could have made these shifts living in an abusive home.  I didn’t realize how unsafe I felt 24/7 until I moved to my new home and suddenly relaxed.

I have so much gratitude for being able to sleep at night without being assaulted.  I have gratitude for being able to make choices based on what is good for me.

I am so thankful for my ability to work.  Essentially, leaving my ex-husband allowed me to go from being psychiatrically disabled, to working full time in a demanding, challenging job, within a little over a year.

I love being employed.  I love having the privilege to help other women survivors.  I love being able to enter spaces where before I never would have been taken seriously, and be seen as a colleague and sometimes even an expert.   I occupy this mysterious space.  I am a psychiatric survivor and a service user while at the same time being a mental health service provider.   This is  a gift and a privilege that  I never forget.  Every single day that I work I am grateful for the opportunity to turn my negative experiences into a powerful way of finding meaning in the suffering I endured.  I find meaning in knowing that what I have survived has allowed me to help others with empathy, compassion, wisdom and joy.

Most people who know me now would have a hard time believing that 5 years ago I was unable to work, dependent, depressed, self destructive, suicidal and being abused.

Sometimes people who know me now forget.  They see me functioning and they forget that I struggle and constantly grapple with PTSD.  I function well with a very high level of symptoms and for that I am also grateful.

Ultimately, the last few months have been extremely difficult for me.  I’ve felt lost, depressed and hopeless at times.  But I have gained so much since leaving.  I have gained not just a career, but job that brings meaning to my life.  I have a safe home.  I am able to keep my children safe much of the time.  I am able to raise them with the values of social justice, equality and openness that I believe is right.

And even if this post is disjointed and unfocused, it is written, and for that I am thankful.

The leaving.

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When I was 19 years old, I made the biggest mistake of my life.

This mistake potentially changed the entire course of my life until my children are adults and possibly longer.  I was a teenager.  I was in fragile recovery from anorexia and depression and had not yet been correctly diagnosed with PTSD.  I was living in a city away from my family and the majority of my close friends.  I was happy that year, doing well and enjoying life. I had taken up swing dancing and I loved it.  I’d made some friends and we often went out dancing together.  Shortly before my 20th birthday I met him.  He proposed to me after 3 months.  It was one of the worst moments of my life.  I remember physically shaking, thinking frantically in my head “oh my god, this can’t be happening, why is this happening, why is he doing this, why, what should I do, what will I say, why is this happening right now!!!”  In the moment I didn’t want to break up with him, so I said yes.  I honestly figured I had lots of time to get out of the promise, but life didn’t turn out that way.

Thirteen years passed.

Three years ago this week I made the biggest and most complicated decision of my life.

Ironically, the things that ended my marriage came together in a culmination of empowerment and decision for me.  I’d been battling with thoughts of leaving for over a year, slowly gaining strength, processing the ideas and planning.

The soul crushing depression I’d been living with for a few years slowly began to lift about a year before I left him.  I began to see options for myself.

For many years I had seriously considered suicide.  After trying ECT (electro-convulsive therapy) and slews of meds, I believed I had exhausted all options for treatment resistant depression. I was ready to give up and only my children held me to this world.  I had irrational, almost psychotic thoughts, in the depths of that depression.   But in my mind, when I was thinking more clearly, I told myself that suicide was only an option for those who had literally tried everything, people who had no other option.  Sometime in summer 2012 I realized that wasn’t my situation:  there was something I hadn’t tried.

I hadn’t tried moving. Living in my own house away from my partner.  I hadn’t tried starting over, changing my environment, removing myself from the ongoing sexual abuse which I knew was both triggering me and traumatizing me in equal measure.

In 2012, I was experiencing terribly severe migraines which at times left me unable to function.  I remember throwing up in the parking lot of a restaurant on my daughter’s birthday.  I went to the ER at times to receive IV pain meds.  Around that time I began taking a medication called Topimax for the migraines.  And suddenly, my depression lightened.  My obsessive compulsive suicidal and self destructive thoughts relented almost immediately.  I never self harmed in a way that required medical attention again. My migraines improved.  I began to see colours again.  I noticed the world around me.  I began to re-emerge into the world of the living.  And I started to consider my options for leaving my partner

As I grew stronger over the course of the next year, I started talking to more people in my life about the abuse.  I chose very carefully.  I told people who didn’t live in my city.  I told counselors and doctors who were sworn to keep confidentiality.  I was careful, but I started to talk.

I had some good friends who began to tell me that what I was experiencing was not okay.  Friends encouraged me to leave, to tell my parents, to get more counseling and they empowered me.  I started volunteering at a women’s organization. It happened gradually, slowly, almost imperceptibly.

In the end, the last time we had sex was the end of that marriage.  I made the decision the next day and told him a few days later.  That night he initiated sexual touching while I was asleep and drugged.  I woke up with him touching my breasts.  Maybe he had been touching me for a while before I fully responded.  On that occasion I woke up and was lucid enough to respond.  Because he had been touching me (without consent), I said yes to sleeping with him.  I verbally said yes.  We had sex and I felt disgusted.   Even though I said yes to the sex, I knew in my mind that I had not consented to the touching. I knew if he had asked me when I was wide awake I would have said no.   I realized that even IF I said yes, I still wouldn’t feel safe, comfortable or at all okay.  I knew it was over.  I knew that would be the last time.  So many times, when I was lying awake at night after being assaulted, I thought to myself “this could be the last time, I could get up and walk away” but I never did.  I was always afraid and I didn’t want to leave my kids.

There are a lot of reasons why people who are being abused do not leave.

And at the end of the day, it only takes one reason to decide to leave.

Leaving an abusive relationship can’t be rushed or forced.  The person being abused has to hit a breaking point and decide that “enough is enough” and that point is different for each individual survivor.

This happened three years ago, but anniversaries are always difficult for me.  I feel it all again.  I have more nightmares, more anxiety and lower self esteem.  I don’t believe in myself.  I have difficulty trusting. I hate my body so intensely that I struggle to look in mirrors or wear certain clothes. I don’t feel safe or relaxed anywhere.  I return to the automatic living, zombie like state.  I have trouble remembering things and difficulty concentrating.  I sometimes wonder if it has been worth the fight.  The suicidal thoughts creep in suddenly, ambushing me in my day to day life.

But at the end of the day, I have to remember that there were only 2 options left for me:

  1. Leaving
  2. Suicide

As difficult as my life is, and as much pain as I’m in, I believe I made the right choice.

I’m still alive.

 

Gaslighting

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Gaslighting: a form of mental abuse in which a victim is manipulated into doubting his or her own memory, perception and sanity”  -Wikipedia

Gaslighting.  Gaslighting. Gaslighting.

It’s all I can think about these days.  It’s been 967 days since I moved out of the house I shared with my ex-husband.  2 years and almost 8 months.  I was naive back then, I actually thought that moving houses could end the gaslighting but I was wrong.  The incredible thing about gaslighting as a form of abuse is that its impacts last long after the abuse ends.  The manipulation gets inside the victim’s head.  The self doubt, which sometimes extends to an level which almost resembles paranoia, can be paralyzing.  “Maybe I am really crazy,  maybe I’m the one who is abusive,  maybe I’m the one responsible for the abuse, maybe he was right about me, maybe nobody will believe me…maybe, maybe, maybe…”

If you have ever found yourself thinking these types of thoughts within a relationship or after escaping, you may have been a victim of gaslighting.  It can happen within families of origin as well as dating relationships.  I also believe that (at least in my experience) the psychiatric, legal, police and child protection systems collude in gaslighting survivors of violence, especially woman, and especially marginalized women.  In a victim blaming, rape culture, our entire society is complicit in gaslighting survivors of violence.

My first abuser X was a gaslighter.  He manipulated me into believing that he could not live without me, that I was essential in his life and that he loved me deeply.  The thing about gaslighters is they know their victims, they know them in a way that is designed to search out weak spots, and gather information that can be used in a tailored and effective manipulation.  I am an empath, a caretaker, a caregiver, someone who thinks deeply about the well being of those around me and about the society we live in.  Empaths are particularly vulnerable to gaslighting, as the perpetrators are often narcissists. There are lots of interesting articles circulating about toxic relationships between empaths and narcissists.

I believe that X knew these things about me, things that in a healthy relationship are considered strengths, and he turned them against me as weapons.  He knew that threatening me directly would probably have little impact, so he talked about suicide in ways that strongly implied he would literally die without me.  I was 15-16 years old and I believed him completely.  I thought that I was helping him, I felt important and useful and even loved.  He would turn on the love and shower me with attention, notes, gifts and phone calls.  But when we were together he ignored my boundaries.  He didn’t seem to understand no or hesitation of any kind.  He just did what he wanted.  I began to feel like a sexual object, irrelevant and I learned skills like disassociation and distraction to minimize the impact of the sexual abuse.

Part of the gaslighting was making me believe I was helping him, and as long as I felt I was doing good I stuck around.   Part of the gaslighting was the intense shame I felt which prevented me from telling a single person I was being abused. I truly believed that if anyone knew I was sexually active I would be in trouble, I’d be labelled as a slut, my parents would be angry, his parents would judge me etc…  Looking back I realize that this intense shame was a side effect of being sexually abused and having my needs ignored and pushed past.  Instead of realizing that what was happening to me made me uncomfortable and thus, was bad, I began to think that I was inherently bad.   I believe this was also related to the messages I was getting during the sexual abuse, the mental abuse and gaslighting.

The first step is leaving the abusive situation.  But for readers who have not been abused, it’s important to realize that the survivor often takes the mental abuse with them because it has been deeply internalized.

If I need to hear over and over and over “You are not crazy,” please say it to me.

If I tell you that I feel crazy, bad, damaged and unworthy, please reassure me.

If it seems like I don’t believe your reassurance, I probably don’t, but I still need to hear it.

I don’t need you to fix me.  I need you to validate and believe me.  I need to hear consistent and safe messages and I need your patience.  I survived years of gaslighting and it may take years to undo the damage.

I’m not giving up when I say “I feel crazy.”  I’m terrified.  Truly scared that it might be true.  Even though you see me as a functioning adult individual, working, parenting, taking care of my life, a few small triggers can bring up all the feelings of the mental abuse.

I’m not saying these things to be dramatic or to get attention.  I’m looking for evidence to contradict the self doubt that years of gaslighting created in me.

The biggest gaslighting related trigger for me is not being believed or feeling like I am not believed, or even might not be believed.  Because gaslighting is designed to create self doubt and feelings of being crazy, when I feel others don’t believe my real experiences I can begin to question myself all over again.  What if I really am crazy?

Systemic and institutional abuse can be a form of gaslighting as well.  When a woman comes forward to tell her story and she is not believed, she may begin to doubt herself.  Systems are full of contradictions, double binds and no win situations.  In this way, they also create an atmosphere that is retraumatizing and crazy making.   The very systems an abused person may need to turn to in order to escape the abuse are likely to perpetuate more confusion, frustration and contradiction.

I’ve had gaslighting experiences within the psychiatric system, the health care system, the legal system, while working with the police and interacting with child protection services.  That’s a long list.

Break the cycle of abuse.  It’s just as easy as these few words:

I believe you.  It’s not your fault.  I’m so sorry this happened to you. You are not alone and you are not crazy, you are having normal coping reactions to surviving abuse

Repeat as often as possible, whenever self doubt arises.

It’s cheaper than psychiatric meds and has only positive side effects.

 

 

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.